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:
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.
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.
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.
Tip from the dietitian
"Medical nutrition therapy is evidence-based and proven to help your cancer treatment work by focusing on maintaining a good nutritional status and fighting the side effects that may interrupt treatment."- Margaret Martin, RD, MS, LDN, registered dietitian, PearlPoint Nutrition Services
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.
Tip from the dietitian
"What you eat can make a difference in your ability to tolerate anti-cancer therapy and in your recovery. Pay attention to your weight and keep an eye on your intake. Weight loss, eating less than usual? Time to see the dietitian and take action!"
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.
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)
- cooked plain cereals
- soft side dishes such as macaroni and cheese, mashed potatoes and rice
- soft cooked fish
Desserts and snacks can include canned fruits, baked apples, sorbet, gelatin, puddings, ice cream, milkshakes, nutritional supplemental beverages, and waffles softened with syrup.
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.
When you can’t eat enough
Sometimes the effects of your cancer or its treatment may affect your food consumption to the point where you can no longer meet your nutritional needs with food and oral nutrition supplements. In this case, you should consider an alternative means of receiving nutrition to avoid malnutrition.
- Enteral nutrition – Also known as tube feeding, this technique is used when you just cannot eat enough or your food is not able to reach your stomach (due to a head and neck cancer, for example). A tube may be placed directly into your abdomen and into the stomach or intestine. A liquid formula (very similar to commercially available products such as Ensure or Boost) can then be infused (delivered through the tube) directly into your body. The formula can be infused in several “meals” throughout the day, or a specific amount can be delivered over a certain amount of time through the use of a special pump. In the hospital, your health care team will manage this for you. If you need to continue (or begin) this feeding at home, a member of your team will train you on the process. The formula and other supplies are often provided by a durable medical equipment provider, home health agency or home infusion company, and these companies will also be able to provide you with assistance.
- Parenteral nutrition – When your digestive tract is not working, or when a blockage is present, parenteral nutrition may be the best option. In this type, the nutrients you need, including vitamins, minerals, calories and protein, are delivered intravenously (through a vein), usually through a port that is surgically inserted. The goal of either type of nutrition is to help you maintain your nutritional status – or regain your health – and improve your nutrition so you can return to normal eating. These types allow you to receive the nutrients when you would otherwise not be able to.
Find more support online through the Oley Foundation (www.oley.org), which includes educational information and resources for people using enteral or parenteral nutrition.
Tip from the dietitian
“A company that provides home tube feeding or parenteral nutrition should have qualified clinicians – dietitians, nurses and pharmacists – to manage this therapy at home with the patient and physician. Ask about this when selecting your home care provider."- Carol Ireton-Jones, PhD, RDN, nutrition therapy specialist
Recipes and food & drink suggestions
Food and drink suggestions:
- Baked skinless chicken
- Broth or low-sugar sport drink
- Fruit gelatin
- Oatmeal muffins
- Rice balls
Mashed Potato-Chicken Patties
Cooked chicken breast adds lean protein, while the easy-to-digest potatoes may help thicken stool.
- ¼ cup all-purpose flour
- Salt and freshly ground black pepper
- 1 cup cooled mashed potatoes (no skins)
- 1 cup (about 4 ounces) cooked skinless chicken breast, ground or very finely chopped
- 1 tablespoon vegetable oil
- On a plate, combine the flour and a sprinkle of salt and pepper.
- In a bowl, beat the egg and add the mashed potatoes and chicken.
- Form the mixture into 2-inch balls. Lightly dredge the balls in the flour. You may need to wet your hands after every three to four balls.
- In a large, preferably nonstick skillet over medium heat, add the oil.
- Add the balls and flatten into patties with a spatula. (They should be about 2 ½ inches wide.) Cook for 5-8 minutes per side, or until crispy and golden.
Source: What to Eat During Cancer Treatment, by Jeanne Besser, Sheri Knecht, Kristina Ratley and Michele Szafranski
Dry or sore mouth
Food and drink suggestions:
- Baked custard
- Chilled cucumber and yogurt soup
- Coffee shake
- Cream of broccoli soup
- Frozen yogurt popsicles
- Peanut butter and banana shake
- Potato soup
- Roasted root vegetable soup
Fruit and Cream Smoothie
This blended beverage packs in nutrients, yet is easy to swallow and shouldn’t cause any pain.
- 1 cup 2% or whole milk
- 1 cup vanilla ice cream or frozen yogurt
- 1 cup canned fruit (peaches, apricots, pears) in heavy syrup with juice
- Almond or vanilla extract to taste
1. Place all ingredients in a blender. Blend well, and chill before serving.
Source: National Cancer Institute
Food and drink suggestions:
- Baked apples
- Chicken noodle soup
- Chilled fruit salad
- Ginger-mint tea
- Lemon popsicles
- Rice pudding
- Toast with peanut butter (or other nut butter)
- Vegetable-barley soup
Studies have shown that ginger soothes an upset stomach. Try this simple ginger rice recipe to help manage nausea.
- 2 tablespoons grated and peeled fresh ginger
- 1 teaspoon sugar
- 1 teaspoon salt
- 2.5 cups water
- 2 cups uncooked rice
- Stir together ginger, sugar and salt in saucepan.
- Add water and bring to a boil; boil for 2 minutes
- Stir in rice, reduce heat to low. Cover; cook until most of the water is absorbed, 15 - 18 minutes.
- Remove from heat; let stand, covered, for 7 minutes.
- Fluff rice with a fork before serving.
Source: PearlPoint Nutrition Services