Issue 126 face to face

F2F

FACE TO FACE Ursula meets:

Ursula meets amazing people who influence nutrition policies and practices in the UK.

Ursula Arens Writer; Nutrition & Dietetics Ursula has a degree in dietetics, and currently works as a freelance nutrition writer. She has been a columnist on nutrition for more than 30 years.

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CLARE SHAW Consultant dietitian: The Royal Marsden Hospital Author: Royal Marsden Cancer Cookery Book

If you do not come across cancer personally or professionally, it will enter your life regardless. It could be a degree removed via friends and family, or several degrees removed via tales of famous celebrities or tragic heroes.

It might even be further removed via fictional description: Breaking Bad and The Fault in our Stars both engaged millions of people with the themes of battling cancer.

“Working in the field of oncology is not for everyone,” concedes Dr Clare Shaw. But having worked as an oncology dietitian at Britain’s most specialist oncology hospital for more than 30 years, it seems to be just the job for her.

Clare presented the British Dietetic Association annual Elsie Widdowson memorial lecture in 2016. This is viewable via www.bda.uk.com/ events, and is a moving description of her career in oncology. The unexpected and delightful insert in the lecture is a photo of supreme Elsie next to the young schoolgirl Clare: a picture that captured two great passions for nutrition: past and future.

As a 14-year-old, she had been lucky enough to spend a day observing the dietetic work practices of our own NHD Final Helpings columnist, Neil Donnelly. This allowed the move from a ‘perhaps’ to a ‘definite’, about a career in Dietetics. During later school days,

www.NHDmag.com July 2017 - Issue 126

her teachers were not familiar with the A-Level combinations of chemistry and home economics, but Clare was fated by her name: she was sure. She entered a food and nutrition competition funded

by Kraft Foods, and winning allowed her the meet-Elsie moment. “I didn’t really know much about Elsie, as this was a pre-Google time, but I was so impressed that she was so enthusiastic about nutrition research,” says Clare.

She completed her dietetic degree at Queen Elizabeth College (now Kings College, London) and graduated in 1984. She started her career as a basic grade dietitian at Barts hospital and became involved in her first oncology cases. After 18 months, she moved on to take a one-year post at The Royal Marsden (and has never left). Her boss was concerned that she was becoming too specialist too quickly: it would be harder to move into other dietetic specialities later, but again Clare was sure.

Of course, a 30-year career at the Royal Marsden means that you will have witnessed every kind of cancer and every kind of therapy.

Clare enjoyed being part of research teams and first contributed to a trial examining possible effects of very low fat diets on hormone levels associated with breast cancer risk (= no benefit).

Bitten by the research bug, she signedup to do a PhD at Kings College under

Of course, a 30-year career at the Royal Marsden means that you will have witnessed every kind of cancer and every kind of therapy.

Professor Pat Judd. This was in addition to a full-time job! “It was harder and took longer than planned,” she confessed. But by 2003, she had a doctorate and could claim expertise in the beneficial effects of weight loss in the treatment of lymphedema. Clare has come to value critical questioning of practice and thinks all dietitians should self-audit their effectiveness.

Importantly, the ‘so what’ hurdle should be put against any research proposals.

“I think that the role of nutrition has become more and more important over the last 30 years. This is because many aspects of treatment, other than the cancer itself, affect nutrition status. Treatments have become better and more targeted and survival periods are now much longer. But it can also mean longer periods where feeding is affected and may need to be modified or supported,” says Clare. Her areas of specialism are late effects gastro function, particularly related to bile acid malabsorption, and she leads the parenteral nutrition team. She continues to attend outpatient clinics. And guides several candidates undertaking MSc and PhD projects. And guides future leaders undertaking the Darzi fellowships on clinical leadership at the Marsden.

“Oncology did not used to be a dietetic specialism,” says Clare. “The oncology group of the BDA started with seven members; now there are 360. Longer survivorship means longer periods of time where dietetic care can make a big difference to health, and more dietitians are really needed to support community-based

oncology care.”

Clare corrects my use of the word ‘patients’: it is ‘person with cancer’. And we laugh that a few years back the term ‘invalid’ was the common term (it so shrieks in-valid: how could this not be offensive?). In any case, I wonder how Clare deals with the constant challenging nutrition therapies and treatments being offered to people with a cancer diagnosis? Some cures are extreme and bizarre; others more moderate, advising single food elimination, but still advocating changes to normal meal patterns and food choices.

Clare advocates always being open to dialogue and discussion on such topics.

Elimination of dairy products is sometimes chosen after the diagnosis of breast cancer; although there is no evidence of benefit, this is easier today when various calcium-fortified milk-alternative products are widely available.

Currently popular are ‘sugar free’ diets, but even here there is confusion: for some people this means no refined sugar added to tea or cereal; for others it means very low intakes of all carbohydrate foods – sometimes ketogenic diets. There is no evidence to support extreme diets as beneficial after cancer diagnosis, and dietetic advice means supporting food choices that offer best possible nutrition status while allowing for beliefs and preferences.

Motivational interviewing (rather than just issuing food lists which may have been former practice) is now an essential part of dietetic practice.

If you would like to suggest a F2F date

(someone who is a ‘shaker and mover’ in UK nutrition) for Ursula, please contact:

info@networkhealthgroup.co.uk www.NHDmag.com July 2017 - Issue 126

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1. Data on file. Abbott Laboratories Ltd., 2007 (PaediaSure Plus & PaediaSure Plus Fibre taste testing).

2. Data on file. Abbott Laboratories Ltd., 2013 (PaediaSure Fibre taste testing).

3. Data on file. Abbott Laboratories Ltd., 2013 (PaediaSure & PaediaSure Peptide vs. Peptamen Junior Powder). *Independent, head-to-head taste testing for PaediaSure, PaediaSure Plus, PaediaSure Fibre, PaediaSure Plus Fibre, and PaediaSure Peptide vs. Fortini or Frebini Energy or Peptamen Junior Powder Date of preparation: March 2017 ANUKANI170057

OUR NEXT PAEDIATRIC ONS, WILL BE OUR SMALLEST PAEDIATRIC ONS. The PaediaSure range includes some of the best-tasting, most-loved paediatric ONS on the market.1–3* But sometimes kids need all that nutrition, flavour, and goodness to come in a smaller volume.

So our next addition will be our smallest addition, providing everything they love about PaediaSure, in a size they will too.