Interferon, one of the substances secreted by various virus-infected cells, has been approved by the Food and Drug Administration for the treatment of a rare cancer called hairy-cell leukemia, a disease that until recently had no treatment. Interferon also has been found in clinical tests to fight chronic leukemia, kidney cancer, and Kaposi’s sarcoma, the cancer peculiar to AIDS victims.

Another T-cell substance, interleukin, has been described by the National Cancer Institute as one of the major advances against cancer in a decade. The institute’s Dr. Steven Rosenberg reported in December 1985 that, with interleukin, advanced cancers in one patient had retreated completely, and 11 patients had at least a 50 percent reduction in tumor size. “Here, really for the first time, we can use the immune system to attack a broad array of cancer,” he says.

Besides interferon and interleukin, scientists have identified other powerful immune system chemicals. One, tumor necrosis factor, seems to destroy cancer cells without hurting normal cells.

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The diet history

An adequate diet history tells the counselor about the patient’s food habits and provides the basis for all counseling that follows. The patient’s chart gives much information that is pertinent to the diet, and these items should be identified before the initial counseling session:

Age

Weight, height, changes in weight status; desirable weight

Present illness: symptoms, diagnosis, important laboratory findings

Digestion: appetite, chewing, swallowing, nausea, vomiting, distention, cramping

Elimination: normal, constipation, diarrhea

Physical handicaps: lack of teeth, mouth soreness, need for self-help devices

Social relationships: occupation, family, residence, ethnic background, religion

Income: adequacy, need for financial assistance

The aspects of diet that you will need to question the patient about include:

Meal and snacking patterns: when, where, with whom, when skipped; away from home:

how often, type of facility

Food preparation: by whom, facilities for shopping, cooking

Previous modified diets: self-prescribed or by physician; how long; why; results

Mineral-vitamin supplements: prescribed by whom; kind Food likes and dislikes; food allergies 24-hour recall of food intake

When the diet history has been completed the counselor makes an evaluation with the patient. For example, the good characteristics of the present pattern as well as the deficiencies might be compared with the Four Food Groups.

Motivation and goal setting

Without the patient’s interest, motivation, and decision making, any efforts by the dietetic-nursing team in counseling will be wasted. Fear of ill health is an important motivating factor for some people; for example, the patient recovering from a heart attack is more likely to stick to a low-calorie modified-fat diet than is a person who appears to be healthy. The pregnant woman is motivated to accept a better diet as something she is doing for the well-being of her baby. The adolescent girl is motivated in terms of her figure, and the boy in terms of vigor for athletics, and so on.

Realistic goals are necessary if diet behavior is to be changed. Losing 50 pounds in 8 months might seem like an endless task, but a goal of “six pounds this month” seems easier to achieve. A child who thoroughly dislikes a food cannot be expected immediately to consume a recommended quantity of that food; a better goal might be one or two bites of the food. The diabetic patient who has not been eating breakfast may have goals related to time of getting up in the morning, or development of menus that have appeal at breakfast time, or others.

Instruction

The patient requires information on a diet plan that has been individualized according to his circumstances; food lists that apply to his diet; how to use the food lists; food selection in the market; reading labels; and details concerning food preparation.

At each point in the instruction the patient should be encouraged to ask questions. Following the counseling session the patient will strengthen his understanding of his diet by writing out menus from food lists; keeping a record of what he eats during the day; reading labels to determine whether a food can be used on a given diet. Such activities should be checked by the counselor for any errors or misunderstanding.

Behavior modification is a process now widely used to change the individual’s habits to those that are more desirable. With respect to diet it consists of keeping a detailed record of all behavior related to food and then identifying the changes that must take place. The program requires skilled therapists such as psychologists, dietitians, and nurses; it would not be initiated by dietetic technicians or nurses not trained in these skills.

Follow-up

Successful dietary change almost always requires some follow-up to the initial counseling. Patients should have access by telephone to the dietitian, dietetic technician, or nurse to answer simple questions or to allay fears. Visits to the clinic as necessary help to assure the patient that he is following his diet correctly, to encourage continued adherence to the diet, and to provide opportunity for additional information. Many hospitals provide classes for patients on a given dietary regimen; for example, diabetic patients, or pregnant women, or patients on renal dialysis. Such classes provide a common bond of understanding between patients, as well as furnishing information concerning the dietary regimen.

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