UVM Cancer Center: Innovations (Spring 2024)

INNOVATIONS

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NUTRITION AND CANCER Pilot course gets future doctors cooking

DIRECTOR’S MESSAGE

Dear UVM Cancer Center community,

An important priority identified by the UVM Cancer Center Community Advisory Board, both from patient support and research perspectives, is to address nutrition for patients and families affected by cancer. As a theme, nutrition has roots in all four pillars of the UVM Cancer Center: research, education, community outreach, and clinical care.

In this issue of Innovations, you’ll find an exciting initiative driven by first-year medical students to learn about nutritional science and cancer prevention that has led to a formal elective and brings culinary medicine to the initial stages of medical training. You’ll meet new UVM Cancer Center associate member, Trishnee Bhurosy, Ph.D., whose research focuses on food security for cancer patients, an area of growing interest since it can impact cancerrelated outcomes. In the clinical space, a philanthropy-supported pilot project led by registered dietitian Alison Jones and Conor O’Neill, M.D., shows the positive impact of early nutritional intervention for cancer patients undergoing surgery. These projects, along with the amazing work of UVM Medical Center executive chef, Leah Pryor, to provide nutritional support for cancer patients in our community, are just a sampling of efforts to push the boundaries of nutritional science research at the UVM Cancer Center.

These stories also highlight expertise of Cancer Center members and partners across the University of Vermont, University of Vermont Health Network, College of Nursing and Health Sciences, Larner College of Medicine, and Osher Center for Integrative Health. With input from our community stakeholders, the UVM Cancer Center will continue to priorotize a holistic approach to patient care and patientcentered research.

Randall F. Holcombe, M.D., M.B.A.

J. Walter Juckett Chair in Cancer Research

Director, University of Vermont Cancer Center Associate Dean for Cancer Programs, Larner College of Medicine Chief, Division of Hematology & Oncology

University of Vermont Cancer Center 149 Beaumont Avenue Burlington, VT 05405

CONTRIBUTORS

Kate Strotmeyer Managing Editor

Jeff Wakefield, Janet Franz, Katie Queen, Ph.D. Contributing Writers

Ann Howard Designer CONTACT INFORMATION UVM Cancer Center cancer@uvmcc.med.uvm.edu 802-656-3099

@UVMCancerCenter www.vermontcancer.org

INSIDE

1 / Clinical Care

2 / Education

3 / Community Outreach

4 / Research ON THE COVER:

(PAGE 2)

INNOVATIVE PROGRAM INCORPORATES A DIETICIAN INTO EVERY STEP OF A CANCER PATIENT’S JOURNEY

Thomas Whalen was devastated to be battling cancer for the second time, but a nutritional intervention would change his life. The new program, made possible through philanthropic support by the Victoria Buffum Endowment, was envisioned by UVM Cancer Center member Conor O’Neill, M.D.

Dr. O’Neill, a surgical oncologist at the University of Vermont Medical Center, saw too many of his patients experiencing nutritional challenges which interfered with their course of treatment and quality of life. With new funding, O’Neill set out to test his theory that incorporating a dietician into every aspect of patient care could reduce these challenges.

With the one-year grant, Alison Jones, RD, joined the team as a full-time dietician. This meant that when Whalen first saw Dr. O’Neill, Jones was there to support him from the beginning. Jones provided more than just one-time nutritional support; she served as an integral part of Whalen’s care team, connecting his nutritional needs with his medical care during both his course of treatment and his recovery. Reflecting on having Jones on his team, Whalen said, “I would not be here if I didn’t

have a dietician that worked with my team of doctors. Through her expertise, Ali played several critical roles in my journey, and her impact was astounding”.

Nutrition support may improve patient outcomes

Whalen is just one of nearly 70 patients Jones has worked with at over 600 established patient visits. While Dr. O’Neill intends to share full findings at the conclusion of the program, early evidence points to numerous success stories, with patients experiencing decreased hospital stay lengths, improved time to surgery, and earlier detection of recurrence. “It is really joyful to see patients implementing changes, working hard, and feeling proud of the changes they are able to make,” reflected Jones.

Nutrition support highlights the need for transdisciplinary teams

From a patient’s perspective, having Jones on his care team resulted in a more caring and positive experience, Whalen said. With additional funding, Jones and O’Neill intend to build on this vision. “Our next goals go beyond nutrition,” O’Neill said. “We are working hard to develop care teams that include physical therapy and strength training, social support, and rehabilitation programs, incorporating entire teams into patient care from the time of diagnosis.” Whalen whole-heartedly agrees that every patient deserves access to this nutrition program: “It is through Ali’s knowledge and care that I am here today. More than the medicine, more than anything else, it was her.”

A one-year innovative program has provided cancer center patients with integrated nutritional support. Funded by the Victoria Buffum Endowment, the program incorporates a dietician into every step of a patient’s journey. Learn more at: go.uvm.edu/prehab @UVMLarnerMed

CONOR O’NEILL, M.D., AND ALISON JONES, RD

FOOD AS MEDICINE

Ginger, garlic, and curry aromas waft through the first-floor hallway in the medical education center, where sounds of light conversation blend with scraping, clinking, and chopping. Inside the Larner Classroom, medical students peel carrots, dice onions, and de-stem kale.

This is not a potluck social, it’s an academic class

This semester, 28 first-year medical students are learning about culinary medicine, which pairs nutritional science with preventative health care. This evening’s session is one of five in a semester-long extracurricular program that teaches about lifestyle interventions for chronic disease. The program was developed by medical class of 2026 students Sarah Krumholz, a registered dietician before med school, and Molly Hurd, who has an MS in pharmacology and saw the benefits of integrative health strategies while studying abroad. Tonight, as the students learn about the role of vegetables and fruits in preventing disease, they prepare and eat their dinner.

On the menu: golden lentil soup, sweet potato stuffed with black beans, and cancer prevention

Co-leaders of the Lifestyle Medicine Student Interest Group at UVM, Hurd and Krumholz recognized the value of including nutrition in medical education. Working with faculty advisor Whitney Calkins, M.D., assistant professor of family medicine, they developed the pilot class with an aim to educate future doctors on the science of culinary medicine and increase their confidence engaging with patients about nutrition, because nutrition counseling can save lives.

Each class focuses on a medical aspect of diet, including controlling obesity, cardiovascular disease, and diabetes,

cancer survivorship, and nutrition through the lifecycle. Following a didactic segment, the students cook together as a group. To pay for recipe ingredients, Hurd and Krumholz applied for and received a Taste of Medicine micro-grant through the American Academy of Lifestyle Medicine.

On this evening, guest speaker Kim Dittus, M.D., Ph.D., associate professor of medicine, presents the didactic portion of the class. An oncologist and UVM Cancer Center member, Dittus’ research focuses on the impact of nutrition and exercise on improving cancer outcomes. She shows the students the scientific evidence linking food and health: Cancer prevalence is higher among people who eat fewer vegetables; individuals who are food insecure tend to eat fewer fruits and vegetables and are more likely to experience chronic conditions; phytonutrients (chemical compounds produced by plants) play a role in cell signaling pathways; insoluble fiber cleanses the digestive track and improves mucous thickness, important aspects of the immune system.

“In the Cancer Center, we work with patients to improve their fruit and vegetable intake because it’s so important,” Dittus said. Her advice for good health: Eat vegetables and fruits at every meal and snack, consume a variety of produce for a more diverse microbiome, and eat a “rainbow” of colors for essential phytonutrients.

Recipes prepared in class typically involve using a hot plate or microwave and nonperishable foods that are low-cost and nutrient-dense, because “not everyone has access to a full kitchen,” Krumholz said. “We have an opportunity to improve patient outcomes if we figure out the keys to lifestyle medicine, and so much of that is about social determinants of heath.

BENJAMIN SEBUUFU ’27 SCOOPS SOUP FOR DR. DITTUS AND JAKE AYISI ’27

ACCOUNTING FOR TASTE

Leah Pryor, the UVM Medical Center’s executive chef manager and founding chef educator, has a devious strategy for coaxing recovering patients back to health: waking up their taste buds.

A case in point is a Pryor favorite, the watermelon demo, which she has regularly conducted at the UVM Cancer Center’s annual Women’s Health and Cancer Conference.

After handing plates of three watermelon slices, a lime wedge, and a mound of sea salt to the cancer survivors in her audience, she asks them first to savor the taste of the watermelon, then to spritz the second slice with lime juice and mull how the acid brightens the flavor, then to juice and salt the third slice and reflect on how the salt focuses the flavor.

“Just having that experience sort of brings things back,” she says. “These are people who aren’t having much luck in the kitchen; they can’t make anything taste good.”

Pryor is an ardent proponent of culinary medicine, an evidence-based field that blends the art of cooking with the science of medicine. It reminds patients that food can taste good, then shows them how to build flavor with simple, nourishing—and delicious—recipes.

“A big part of healing is nourishing your body,” Pryor says. “Part of what we do is getting people excited about food again.”

Pryor has brought her magic to a dizzying array of settings since arriving at the UVM Medical Center in 2011. As a key member of the UVMMC’s Culinary Medicine department, she has done everything from teaching cooking classes to patients, community members, and staff to training nursing and medical students to developing curriculum for the university’s Osher Institute for Integrative Health.

While Pryor brims with the brio of a natural performer (she is a classically trained violist), she knows her role in culinary medicine isn’t a solo performance. All her cooking instruction is done as a pas de deux with a registered dietician, who brings the science of nutrition to culinary medicine.

“The RD has the knowledge,” she says. “I just bring it to life.”

After graduating from the Culinary Institute of America, Pryor worked as head chef at restaurants on Nantucket and in Brooklyn before coleading the kitchen at Mary’s in Bristol.

But working in a restaurant wasn’t conducive to raising her new daughter. Taking the advice of a fellow chef, Pryor explored a job opening for line chef at UVMMC— with trepidation. Instead of the dreary institutional food operation she expected, she discovered an enlightened leadership team eager to move in new directions.

Sensing opportunity, she wrote a grant that funded a new position as a chef educator. She had such success, another grant followed funding a second chef educator position. In 2020, she was named the medical center’s executive chef manager, overseeing a staff of 220.

One of her earliest champions was Jon Porter, director of UVM’s Comprehensive Pain Program, where nutrition is a pillar of the program. Pryor has participated in monthly cooking class with the Pain Program’s dietician, Emily Stone, since the program’s inception in 2017.

“Leah is just an incredibly effective communicator,” Porter says. “She’s an expert in the preparation of food, but she’s also very humorous and very accessible. People fall into conversation with her easily. She is a bright light.”

LEAH PRYOR IN THE TEACHING KITCHEN

NEW MEMBER FOCUSES ON THE INTERPLAY BETWEEN NUTRITION AND CANCER

Trishnee Bhurosy, Ph.D., started experimenting in the kitchen at the age of eight, paving the way for a successful career in nutrition. Born and raised in Mauritius, an island located southeast of Madagascar in the Indian Ocean, Bhurosy was inspired by nutrition research and completed her undergraduate and master’s education in Nutritional Sciences at the University of Mauritius. As an undergraduate student, she led a study looking at the association between food habits, body mass index, and socioeconomic status among pre- and post-menopausal women. Later, as a graduate student in Mauritius, she developed and evaluated a nutrition education program to improve local sources of calcium

among older adults. During those formative years, she became interested in the motivations for dietary practices and ways to improve the nutrition behaviors of different communities, leading her to pursue a Ph.D. Bhurosy completed her Ph.D. in Health Behavior, with a focus on nutrition, at Indiana University Bloomington, where she led research projects and partnered with several community stakeholders to improve nutrition security among socially vulnerable populations. Motivated by her understanding of the high rates of cancer in her home country and its association with decreased nutrition and sedentary lifestyle changes, Bhurosy completed a post-doctoral position at the

A STUDY THAT BHUROSY LED AT THE RUTGERS CANCER INSTITUTE OF NEW JERSEY, DEMONSTRATED THAT LESS THAN 20% OF CANCER PATIENTS RECEIVED ANY FORM OF NUTRITIONAL SUPPORT DURING THEIR TREATMENT.

TRISHNEE BHUROSY, P h.D.

Rutgers Cancer Institute of New Jersey. Before joining the University of Vermont, she worked as a tenure-track assistant professor of public health at Hofstra University where she led the creation and implementation of the Dome Pride Pantry, a satellite food pantry that serves free food to any students, faculty, and staff in need.

Bhurosy joins the UVM Cancer Center with a focus on nutrition security for cancer patients Drawn to the quality of research, collegiality, and resources of the UVM Cancer Center, Bhurosy began her position as an assistant professor of nutrition in August of 2023 and joined the Cancer Population Science research program. “The UVM Cancer Center’s opportunities for start-up funds, grant-writing support, and collaborations are a big part of why I am excited to be here,” Bhurosy said.

An expert in nutrition security and health equity, Bhurosy is actively building her research program here in Vermont. Currently, she is investigating provider-level strategies and systemic approaches to improve access to medical nutrition therapy among cancer patients. Recent evidence shows that nutritional status is an important prognostic factor for response to treatment, survival, and quality of life among cancer patients. However, a study that Bhurosy led at the Rutgers Cancer Institute of New Jersey demonstrated that less than 20% of cancer patients received any form of nutritional support during their treatment. Bhurosy says the reasons for this lack of nutritional support are multifactorial, but she hopes by focusing on the provider side of care,

nutritional support may be effectively embedded into treatment conversations.

Inspiring a future generation of cancer and public health scientists

Bhurosy is a first-generation high school and college graduate who is actively working to diversify the cancer, nutrition, and public health workforces. This includes the implementation of a support group for Black, Indigenous, People of Color (BIPOC) and international students of color in the Department of Nutrition and Food Sciences and advising the first South Asian Student Association at UVM. Her goal is to support the next generation of researchers who might not have access to diverse mentors and resources to thrive in academia. “Representation is critically important. To be a professor— which is so far removed from the kind of professions people in my family have had the opportunities to be able to accomplish—is a big reason I am in this field,” reflects Bhurosy. “From my childhood until now, nutrition has been a very integral part of how I communicate and show my care for other people.”

New member Trishnee Bhurosy (@UnderDogPhD) is working to improve access to medical nutrition therapy among cancer patients. Learn more about her incredible work and additional efforts to inspire future scientists at go.uvm.edu/bhurosy @UVMresearch @UVMLarnerMed

AN AERIAL VIEW OF MAURITIUS (CNN)

BHUROSY AT THE SOCIETY OF BEHAVIORAL MEDICINE CONFERENCE

BHUROSY MENTEE AT THE DOME PRIDE FOOD PANTRY

University of Vermont Cancer Center

89 Beaumont Ave.

Burlington, VT 05405

www.vermontcancer.org

THREE QUESTIONS FOR MEREDITH NILES, PH.D.

Meredith Niles, Ph.D., is an associate professor and new affiliate cancer member whose research focuses on food insecurity. Dr. Niles is particularly interested in developing relationships and collaborations to study food security and nutrition impacts onset by a cancer diagnosis, especially, but not exclusively, through financial toxicity.

How big a problem is food insecurity in Vermont?

Anyone suffering from food insecurity or hunger is a problem, but the number of people in Vermont who are food insecure has increased significantly during and since the COVID-19 pandemic, as a result of job loss and disruption as well as food inflation. The most recent government data suggests more than 57,000 people in Vermont live with food insecurity.

Does food insecurity affect people who live in rural areas?

Food insecurity is actually more common in rural areas than urban areas for a variety of reasons, including lower incomes, a lack of food stores, lack of public transportation, and other factors. This is true also in Vermont, where the ‘Northeast Kingdom’ has among the highest rates of food insecurity in Vermont.

What has prompted your interest in looking at food insecurity in cancer patients?

My research in food insecurity has always focused on crises, first disasters and climate change, then the COVID-19 pandemic. More recently I’ve become interested in individual and family crises, including how opioid use disorder and cancer may impact the home food environment and trigger food insecurity. For cancer patients, many face new financial burdens that can impact their food security, as well as other home and nutrition changes. No one should go hungry in this country because of a medical diagnosis, and I hope to learn more about the extent of this problem and solutions to help alleviate it.

MEREDITH NILES, P h.D.