Nutrition

During Cancer Treatment

Even as you begin treatment, be sure you continue to focus on good nutrition. Several factors may contribute to nutritional changes during treatment – including side effects from the treatment itself, the emotional impact of your diagnosis and even the influence of friends and family – making a healthy diet all the more important.

Some patients experience weight loss during treatment, often due to an inability to eat or from other side effects, such as nausea and vomiting. Others may gain weight during treatment, sometimes as a symptom of certain types of chemotherapy or from overeating due to stress. In addition, loved ones may encourage you to eat more food and more often, and friends and family delivering food may opt for fattening casseroles and comfort foods, which can also lead to unhealthy weight gain. While this may be a time for “cheating” on your diet, especially if you’re having trouble keeping weight on, it isn’t a time to abandon good nutrition and risk unhealthy weight gain.

Instead, dietitians recommend maintaining your weight during treatment, so adjusting your nutrition plan to effectively manage any of these changes will be important. A dietitian can help you develop a nutrition plan specifically for your needs as well as help you manage any side effects you may experience that could impact your eating habits.

Managing side effects that may impact nutrition

Eight out of 10 cancer patients will experience some form of malnutrition during their cancer journey. You can help reduce your risk by talking to your doctor or dietitian about any eating problems you are likely to experience and ways to prevent and manage them.

The following are recommendations for eating problems most commonly associated with cancer treatment:

Constipation

Fluid is important to digestion, so drink plenty of fluids, including water, juices or broths, to help meet your daily needs. Although your fluid needs may vary, a good starting goal is about 10 cups of water per day for men and about 8 cups for women. It’s a good idea to talk to your doctor about how much fluid you should drink daily to ensure you are getting enough. It’s also important to get 25 to 35 grams of fiber daily, which can be found in fruits, vegetables, legumes, whole-grain cereals, breads and oatmeal. Include more beans, lentils and peas in your diet by adding them to soups and casseroles. Fiber supplements may be useful as well, so ask your health care team.

Diarrhea

Like vomiting, diarrhea also causes you to lose fluids, so you may need to consume more fluid than normal during treatment to help maintain digestive regularity. Often, plain water is not absorbed adequately during bouts of diarrhea, so electrolytes (sodium and potassium) may also be needed. Sports drinks (that are lower in sugar), broth, noncaloric sodas and other clear, low-sugar fluids help replace what is lost. Drinking clear liquids after diarrhea will help your bowels rest and replace lost fluids. Let carbonated drinks such as ginger ale lose their fizz before drinking. You can also make a good homemade electrolyte replacement drink using ¼ teaspoon salt, 8 teaspoons sugar, 3 tablespoons orange juice concentrate and 4 cups of water.

Also, help manage diarrhea with low-fiber grains, cereals, crackers, rice and white breads; low-fat proteins such as chicken, lean beef, fish, eggs and smooth peanut butter; soft fruits without the skin, such as bananas, applesauce and canned fruits; low-fat or lactose-free dairy products; and caffeine-free beverages. An anti-diarrheal medicine taken before meals may also be suggested. Call your doctor immediately if diarrhea persists for more than 24 hours or if you experience pain, cramping or blood in your stool.

Dry mouth

Chewing gum or sucking on ice chips, hard candy, popsicles, frozen fruit or melon balls may help alleviate symptoms of a dry mouth. Choose fruits that carry moisture such as watermelon, grapes, pears and peaches. Eat soft foods like scrambled eggs, pudding and ice cream, and choose canned fruits or apple sauces instead of raw fruits. Soups and stews with soft, tender meats are also a good option. Try eating mashed potatoes and rice, and remember that adding gravy, broth or sauce may also make some foods easier to chew and swallow. Some over-the-counter medicines may also help increase moisture.

Loss of appetite (weight loss)

Cancer patients may experience a loss of appetite for a number of reasons. It’s important to eat when your appetite is best. Eat higher-calorie meats and side dishes first, and save low-calorie items such as salads and beverages for the end of the meal when you may feel full. Include snack foods in your diet that have a high number of calories in a small serving, such as granola bars, trail mix, peanut butter, nuts, nutritional beverages and dried fruit. If an early feeling of fullness is a problem, try to avoid drinking fluids for at least 30 minutes before a meal and try to drink a minimal amount of fluid during the meal or wait until after you have finished eating to drink. Finally, try eating five or six small meals throughout the day instead of two to three large ones.

Nausea and vomiting

Food odors are a common cause of nausea in cancer patients. Cool and room-temperature foods usually have fewer odors than hot food, so let hot foods cool to lukewarm before eating. This may not be the best time to enjoy some of your favorite foods, as your altered taste and smell may make these less appealing. It’s also a good idea to keep bland, odorless snacks on hand. Sandwiches, fruit and crackers, cottage cheese with sliced veggies and smoothies are all typically low-aroma options. Ginger has been known to help some people with nausea, so try ginger snaps, ginger ale, ginger mints or ginger tea. Call your doctor immediately if vomiting persists for more than 24 hours.

Sore mouth, mouth sores and dental complications

Choose soft, bland foods that are easy to chew and swallow. Try breakfast foods like instant oatmeal, grits, pancakes, waffles and cold cereal softened in milk. Soups and stews with soft, tender meat are also a good option. Pick side dishes such as cottage cheese, macaroni and cheese, mashed white or sweet potatoes, and rice or risotto. And try desserts such as custard, tapioca pudding, ice cream, milkshakes and sherbet.

Choose snacks such as applesauce, gelatin, smoothies, yogurt and nutritional supplemental beverages. Drink low-acid beverages such as small amounts of (or diluted) apple and grape juices, pear nectar, decaffeinated coffee and tea, and avoid alcoholic beverages. See your dentist prior to cancer treatments and frequently through your cancer journey, and talk about your mouth and dental symptoms. Ask about mouthwashes that can help with dryness and mouth sores.

Trouble swallowing

Keep all bites small, moist and tender. Cook foods until they are soft and tender, and moisten and soften foods with gravy, sauces, broth or yogurt. It may be easier to eat a smaller amount of food at one time, so try eating five or six small meals each day instead of three large meals. Drink liquids with meals, and sip drinks through a straw, which may make them easier to swallow.

Main and side dishes that are easy to swallow may include:

• chicken or tuna salad
• eggs (soft boiled or scrambled)
• cheeses
• cooked plain cereals
• soft side dishes such as macaroni and cheese, mashed potatoes and rice
• soft cooked fish
• tofu
• meatballs
• meatloaf

Desserts and snacks can include canned fruits, baked apples, sorbet, gelatin, puddings, ice cream, milkshakes, nutritional supplemental beverages, and waffles softened with syrup.

Weight gain

If you find yourself adding extra pounds during cancer treatment, try eating a variety of whole fruits, vegetables, whole grains and beans. All of these foods are low in calories but high in fiber, which helps you feel full longer. Foods high in protein may also help you feel full longer, so try lean proteins such as eggs, fish, skinless chicken, turkey, lean beef, lean pork, beans and soy products. Choose low-fat and fat-free dairy products that include 1-percent or skim milk, such as low-fat yogurt, reduced-fat cheese and cottage cheese. Finally, drink a glass of water or a low-calorie beverage before each meal to help reduce hunger.