NACES - Nutrition
Nutrition During Cancer Treatment

Cancer treatment usually involves chemotherapy or radiation and sometimes both. The side effects of these treatments have some similarities. The effects vary with the amount of treatment, where in the body the cancer is, how often the treatment occurs and how many weeks or months the treatment lasts. Both forms of treatment can cause some similar symptoms:

  • fatigue
  • loss of appetite
  • loss of taste
  • mouth sores
  • nausea and vomiting
  • diarrhea

The challenge is to find foods that meet your personal needs during this difficult time.

Depending on your treatment schedule, you will likely have periods of 'good days,' usually between treatments, and then you'll have those days when you're experiencing side effects, usually during and immediately after treatments.

Other medical conditions: if you have other medical problems that require watching your diet (such as diabetes or high cholesterol) you will need to take special care to balance your lack of appetite, your food choices, your medication(s) and your blood sugar or cholesterol level. You must talk to your health care provider and create a plan for coping with these important issues.

If you have diabetes, please see our module on Diabetes and Cancer.

If you have long periods of loss of appetite with weight loss, you may need to lower your medications. As your weight decreases you may require less medication, for example, for high cholesterol, diabetes and high blood pressure. This should be monitored by your regular health care provider.

This is one reason it is so important for your regular health care provider to be involved in your care and not just the cancer specialists.

Good Days
Relish the good days! Use them to maximize your nutrition. On the days when food sounds good to you and tastes good enjoy the foods that will strengthen your body. Fresh fruits and vegetables, lean protein and whole grains are the healthiest choices. Sweets and desserts are okay, but on your good days, don't let them displace the healthy foods. If they are one of the few things you can eat on side effects days, you may want to save them for that time.

Talk with your health care provider to get specific recommendations for your nutrition. Ask to see a dietitian or nutritionist to get suggestions. You can also get a personalized calorie and food recommendation at www.MyPyramid.gov where you can click on 'my pyramid' on the right and fill in your age, sex, height, weight and activity level. You will get an estimate of your daily calorie need and examples and amounts of the foods in each food group that you should be eating each day.

You should also talk to your health care provider about multiple vitamins - and any supplements you may be taking. You want to make sure that you're getting enough (but not too much) of vitamins, and that nothing is going to interact with your treatment medications.

Side Effects Days

Fatigue
If you are so tired that you don't want to get off the couch, you're not likely to cook. But you need to eat!

    Some ways of coping with this situation are:
    • Letting family members prepare foods for you
    • Letting friends bring food for you
    • Preparing and freezing foods during the times you feel good
    • Keeping foods handy that are - easy to open (open and eat)
      • easy to prepare
      • easy to digest

Loss of appetite
This is the hardest. How can you eat when you don't feel like it? Making yourself eat when you have no appetite has been described as trying to eat a ball of cotton which just keeps getting bigger. But your body needs the nourishment. So think of your favorite foods. This is one time that you can throw nutritional balance out the window. The important goal is to get some calories in to keep your body strong. Ice cream, mashed potatoes, cookies, potato chips, custard, whatever you are willing and able to get down is important and allowable.

An item you want to keep on hand is a liquid nutritional or diet supplement. Examples are Boost and Ensure. Most people like them chilled. They come in different flavors. You can add calories to them by adding something like ice cream. (If you can't digest milk products, you can try frozen yogurt or soy ice cream or sherbet). It may be a lot easier to slip a chilled Boost through a straw than to try to chew a more solid food.

Because liquids are easier, especially through a straw, when you have no appetite, you may want to use a blender, juicer or food processor to puree healthy and/or favorite foods. Fresh fruit juices, smoothies made with fruits, yogurt, ice cream, milk or soy milk maybe more appealing. If creating a creamier texture makes the difference for you, then you could puree your favorite cooked vegetables (potaoes, carrots, yams, etc.). Creamed soups (already prepared, you just need to heat them) can also be very helpful.

Remember, for energy you need some carbohydrates and fat. To keep your body strong and able to maintain all your tissues, you need a variety of nutrients - so the supplements are perfect for giving you the nutrition of the basic food groups, vitamins and minerals, plus extra calories.

Also remember that small amounts are better than nothing. So if you only feel like sips or small bites, then feel good about doing that. But try to do it more often than regular meals.

If at any time you cannot eat anything at all and especially if you are unable to drink liquids, at least one quart a day, you need to let your doctor know. You may need help to prevent dehydration which could bring on other serious complications.

Loss of taste
For some people this means they simply can't taste things the way they could before they started treatment. For others it means that things which used to taste good now taste awful or at least have no appeal. It can be very disappointing, because you try to prepare your favorite foods to get some good nutrition in and you take one bite - and it doesn't even taste good.

It may be loss of appreciation for the actual taste, but it also can mean the inability to tolerate certain food textures: crisp, creamy, lumpy, dry, crumbly, meaty.

The same two techniques which help those who have no appetite can help those who have lost their ability to appreciate (and perceive) the taste of foods: (1) concentrate on favorite foods and (2) keep diet supplements on hand (preferably chilled).

If because of taste problems, you're not able to eat a balanced diet, focus on your favorite foods - the one or two that you can get down. The most important thing is to get some energy, some calories into your body. If the first two days after chemo or radiation, nothing but lemon meringue pie sounds good, then eat it as often as you can.

The second approach to depend on, if you can, are the supplements, like Boost or Ensure. Most people prefer them chilled. Remember you can add things to them, directly, like ice cream or in the blender, like a banana or other fruit. You can make them more liquid by adding milk or soy milk. Or if you're preferring thicker liquids, then add ice cream for more calories and taste.

For many people their taste returns gradually, the longer it's been since they had a treatment.

Mouth sores
Mouth sores can be a big problem. They can be like small fever blisters or they can be like big canker sores. They can be a nuisance or they can be so painful when you try to eat or even drink, that it becomes a real challenge to get nourishment on the days when they're bad.

If you have mouth sores, call your doctor to get a prescription for local anesthetic that will help with the pain. Sometimes it's referred to as "magic mouthwash." It usually will give you an hour or two of relief, enough to drink some liquids and eat some soft foods.

Drinking nutritious drinks or soups through a straw is another way of getting nutrition while your mouth is sore.

Like several other side effects the mouth sores tend to be worst a few days after each treatment, then get better the longer the time since the last treatment.

Nausea and vomiting
Nausea can be a very frustrating and even depressing symptom. In addition to not being able to eat or enjoy food, you actually feed bad. Nausea can also be a persistent problem, lasting longer than some of the other symptoms which wax and wane with the treatment schedule.

There are many medicines available now to help treat both nausea and vomiting, so if you find yourself coping with these symptoms, don't just suffer them. Ask for help.

If your nausea or vomiting is mild or occasional and you're trying to manage without additional medicine, there are some things to try.

First, it sometimes helps to try sucking, either a piece of hard candy, a sucker, ice, a Popsicle or a juice bar. Likewise sipping cold drinks through a straw is more likely to be tolerated than trying to swallow - whether a drink or a bite. Just take small sips. Trying to drink even a half cup may make your symptoms worse. Frequent small sips usually work better.

You should only try to eat small amounts, not a whole meal. You may find it easier to eat small amounts more frequently throughout the day. Putting too much in your stomach, whether food or drink, can cause nausea and vomiting.

Choose foods that are easy on your stomach. Starches (bread, potatoes, pasta/noodles), Jell-o, puddings, applesauce are usually good. Avoid acidic items (citrus juices, coffee), spicy foods, and fatty foods.

Frequent or persistent vomiting can lead to serious medical problems, especially if you're undernourished to begin with. If you are vomiting several times a day, notify your doctor to see if there is medication they can give you - or if you need to be evaluated.

Diarrhea
Diarrhea is a very frustrating problem. It's uncomfortable, a nuisance, sometimes it hurts, and sometimes you feel like all your hard work to nourish yourself is literally going down the drain.

For starters you should check with your health care provider about the diarrhea: is it expected with your treatment? How long will it likely last? What can you take for it? What foods may help? What foods may make it worse? Don't just assume it's a treatment side effect, unless you've discussed it with your caregivers.

Once you know that you should expect it, use the medicine, if any, they've given you to try to control it. Then you need to experiment to see if there are foods which seem to make the diarrhea worse. Suspect foods might be: milk products, acidic foods, spicy foods, high carbohydrate foods (such as pancakes with syrup) and foods with high fiber (bran cereal, whole kernel corn, etc.). Your morning coffee might cause diarrhea, too. Caffeine is a stimulant which can cause diarrhea.

On the other hand there are some foods which seem to help slow diarrhea. Examples of those foods include: bananas, applesauce (especially homemade, stewed apples), plain pasta (noodles) and yogurt (the milk sugar is digested by the bacteria in the yogurt), and toast. High starch vegetables, such as potatoes, sweet potatoes and carrots can be cooked till soft and eaten. They seem to help with slowing diarrhea, too.

Be sure to let your doctor know, if your diarrhea is getting worse. Keep up with your fluids. If you are having diarrhea, but have no appetite or taste for food, try sipping ice water through a straw. Diarrhea can be dangerous if it leads to dehydration. So don't hesitate to check in with your doctor.

Everyone's response to chemotherapy and radiation are different. There seems to be no predicting, even with the same medications. Symptoms may even change for one individual over the course of treatment. You may be one of the fortunate ones who has no vomiting or diarrhea. You should also remember that if you are having intolerable or disabling side effects, talk to your doctor! It may be possible to continue your treatments, but at a lower dose or with longer intervals between treatments. That gives you a bit of a rest, something to look forward to and an opportunity to improve your nutrition and strengthen yourself during the breaks.

Looking to the future, know that the treatments will end. And anticipating that time, browse the section on Nutrition for Healthy Survivorship.




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