Beyond the Cancer Diagnosis: Interview with Catarina Ribeiro, by Adrian Pogacian

In current episode of ‘Beyond the Cancer Diagnosis’, Adrian Pogacian approaches the subject of Oncology Nutrition for cancer patients. What we know and what we should discover further, along with Catarina Ribeiro, Board-certified medical oncologist with additional certification in Palliative Medicine.

Currently a PhD candidate with a joint scholarship from King’s College London and the University of Coimbra, focused on innovation in supportive cancer care. In 20217, Catarina completed a Master’s degree at King’s College London with distinction, supported by the Calouste Gulbenkian Foundation (DINAMO Project), where she led the first clinical trial on exercise in oncology ever conducted in Portugal. Successfully completed the Clinical Scholars Research Training Program at Harvard Medical School – Portugal, a two-year advanced training in clinical research, and holds an Executive MBA from Quantic Business School, USA.

Catarina is currently a Senior Medical Director in Oncology at Syneos Health, contributing to all phases of clinical development and conduct of global cancer trials with innovative treatments.

Adrian Pogacian, licensed clinical psychologist, with executive education in Psycho-oncology, holding a degree in Global Health Diplomacy from Geneva Graduate Institute and a certificate in Medical Intel Course from NATO School, Oberammergau.  Currently, invited speaker and associate lecturer with focus on Impact of Cancer Diagnosis on Couples and Families, Communication in Cancer Care and managing Fear of Recurrence. His expertise is on Coping with Cancer and Posttraumatic Growth.

Additionally, Founder of INCKA Psycho-oncology Center incka.org, Host of Beyond the Cancer Diagnosis Interview Series at OncoDaily.com, Journalist at CancerWorld.net, co-author of the first Romanian Multimodal Care Guideline in Pediatric Onco-hematology, active contributor to the International Psycho-oncology Society, presently IPOS Fear of Cancer Recurrence (FORwards) Special Interest Group Board Member (2025-2027), IPOS Early Career Professionals in Psycho-Oncology Committee Founding Member (2023-2026) and Multinational Association of Supportive Care in Cancer (MASCC) member.

Oncology Nutrition for cancer patients. What we know and what we should discover

Adrian Pogacian: Catarina, you are a board-certified oncologist with a truly interdisciplinary approach — integrating nutrition, lifestyle medicine, and digital health into cancer care. Could you share with us your main areas of interest within oncology and what drives you to go beyond conventional treatment in supporting people with a cancer diagnosis?

Catarina Ribeiro: My main areas of interest are lifestyle interventions as part of healthcare. These include, exercise, nutrition, metabolic health, circadian rhythms and the psychosocial aspects of cancer care. It still amazes me to this day how these influence quality of life, treatment tolerance, and long-term outcomes. What drives me is the conviction that people with a cancer diagnosis are more than a disease to be treated, they are whole human beings with physical, emotional, social, and existential needs as well as cancer is a systemic disease, not a local group of cells. Conventional treatments save lives, but we often overlook the lived experience of the person receiving them. My mission is to integrate evidence-based strategies from lifestyle medicine, behavioral science, and digital health to offer more personalized, compassionate, and effective care.

Adrian Pogacian: You are also the co-founder of Mentora Health, a digital companion app for people with cancer. What was the vision behind this project, and what values guide your work as a team?

Catarina Ribeiro: Mentora Health was born from a simple yet powerful idea: no one should go through cancer alone or uninformed. We envisioned a digital platform that could act as a companion — not just delivering information, but also offering emotional support, personalized guidance, and practical tools on lifestyle habits across all phases of the cancer journey. Our core values are empathy, scientific integrity, and empowerment, aiming to humanize digital health by blending the best of clinical expertise with the immense potential of technology to bridge hospital care with patient’s daily lives.

Adrian Pogacian: Oncology nutrition is one of your key areas of focus, especially the issue of malnutrition throughout the cancer trajectory. In your view, what are the main causes of malnutrition in cancer patients, and how do psychosocial factors influence this condition?

Catarina Ribeiro: Malnutrition in oncology is often misunderstood and many still equate it with low body weight, but this view is dangerously outdated. In reality, people with cancer can be severely malnourished even with a normal or high BMI. This includes cases of sarcopenic obesity, where excess fat masks a profound loss of muscle mass. It’s one of the reasons we speak today of the obesity paradox in cancer where individuals may appear well-nourished based on body weight alone, but actually have poor functional reserves and worse outcomes.

Malnutrition in cancer is driven by a complex interplay of biological, treatment-related, and psychosocial factors. Chronic inflammation, metabolic dysregulation, reduced appetite, and treatment side effects all contribute, but so do psychological distress, isolation, food aversion, socioeconomic barriers, and lack of culturally sensitive support. Eating is not just a physiological act, it’s tied to identity, autonomy, and emotional safety.

Unfortunately, conventional assessments that rely solely on body weight or BMI miss much of this complexity. They are body composition agnostic, and do not capture muscle mass, strength, or functionality, all critical prognostic indicators. We need more nuanced tools and interdisciplinary collaboration to properly assess and address malnutrition in oncology before it becomes clinically visible or functionally disabling.

Adrian Pogacian: Nutrition is now considered a vital component of integrative cancer care. However, there is still a great deal of confusion — and even misinformation — surrounding this topic. From your perspective, what should we truly understand as “evidence-based oncology nutrition”?

Catarina Ribeiro: Evidence-based oncology nutrition is not about one-size-fits-all dietary advice or eliminating entire food groups, it’s about delivering personalised, clinically relevant care grounded in science, adapted to the individual’s context, and responsive to their changing needs across the cancer continuum.

It starts with accurate assessment, and this is where we often fall short. Many people with cancer are not nutritionally evaluated beyond body weight or BMI. But we now know that malnutrition and muscle loss, including in people who are overweight or obese, are independent predictors of poorer outcomes. This is why we use tools such as the GLIM criteria to diagnose malnutrition based on phenotypic and etiologic factors, and the PG-SGA to capture nutritional status, symptoms, and functionality in a structured, patient-centered way. In some cases, CT scans already done for staging or follow-up can be re-analysed to quantify muscle mass and identify sarcopenia, offering critical prognostic insight.

Beyond assessment, evidence-based oncology nutrition is about intervening early, addressing both macro- and micronutrient needs, managing symptoms, supporting metabolism, and respecting cultural and personal preferences. It’s also about debunking myths and misinformation, like restrictive “anti-cancer diets” that can do more harm than good, while empowering people with practical, safe, and meaningful strategies to nourish themselves through treatment and beyond.

Ultimately, this field demands both rigour and compassion. We must integrate the best available evidence with clinical expertise and the lived experience of each person and that’s what makes it truly effective.

Adrian Pogacian: Psycho-nutrition is an emerging concept in oncology. How do you view the connection between food, emotional well-being, and outcomes in cancer care?

Catarina Ribeiro: The connection is profound and often underestimated. Food is never just about nutrients. It carries emotional, cultural, and symbolic weight. In oncology, this connection becomes even more charged. A cancer diagnosis can transform the act of eating into something fraught with anxiety, fear, or guilt. Many people struggle with changes in appetite, taste, and body image, while simultaneously receiving conflicting dietary advice that leaves them confused or ashamed of their choices.

Psycho-nutrition is about recognising that what and how we eat is deeply intertwined with our emotional state, identity, and coping mechanisms. It acknowledges that nutrition care in oncology isn’t only about meal plans but it is also about restoring a sense of control, pleasure, and dignity around food. When we approach nutrition through a psychosocial lens, we’re better able to support motivation, adherence, and emotional recovery.

There’s also a physiological dimension. Chronic stress, depression, and trauma can alter appetite-regulating hormones, gut-brain signalling, and even the microbiome, all of which influence nutritional status, inflammation, and immune function. In other words, emotional well-being isn’t separate from physical recovery, it’s part of it.

To improve outcomes, we need to stop viewing nutrition and mental health as separate silos. Psychology and nutritional care, combining symptom management, therapeutic education, and psychological support, should be part of the standard model in oncology. It’s not just about preventing malnutrition. It’s about helping people feel safe, seen, and supported in their bodies during one of the most vulnerable times of their lives.

Adrian Pogacian: Finally, many experts suggest that the cancers of the future will be increasingly linked to immune system dysfunction. Do you agree with this view? And how do you see the role of nutrition and lifestyle in immune modulation and cancer prevention?

Catarina Ribeiro: Yes, I strongly agree. We are witnessing a major shift in how we understand cancer moving beyond the idea of it being solely a genetic disease, and recognising the critical role of immune system dysfunction, chronic inflammation, and systemic imbalance. Many cancers emerge from genetic mutations that allow the cancer cells to evade the immune system, which otherwise would detect and eliminate malignant cells early.

What we eat, how we sleep, move, connect with others, manage stress, and even how we breathe, all these factors modulate immune function. Lifestyle is not “complementary” to immune health, it is foundational. For instance, poor nutrition can impair the gut barrier and microbiome diversity, both of which are essential for immune regulation. Sedentary behaviour, circadian disruption, and chronic stress can all create environments conducive to tumour growth, while suppressing immune vigilance.

Nutrition and lifestyle are part of a dynamic network of inputs that shape the immune landscape throughout life. This has profound implications for prevention and also, after a cancer diagnosis, on how people respond to treatments in terms of efficacy and toxicities, including immunotherapies. A nourished, metabolically balanced, and resilient body is more likely to benefit from these cutting-edge interventions.

If we want to reduce cancer incidence, improve outcomes, and make healthcare systems more sustainable, we must stop treating lifestyle as an afterthought. It needs to be integrated into the very core of cancer care: before, during, and after diagnosis and recognised as a legitimate, evidence-based lever of immune modulation and health equity.

For those of you who embrace this vision and mission, let me invite you to follow the European School of Lifestyle Oncology here on Instagram as they are launching a disruptive public health campaign to convey this message globally.

Read Other Episodes of Beyond the Cancer Diagnosis on OncoDaily.