Cancer Treatment Side Effects and Diet            Return to the Beginning

Dietary interventions for cancer are designed to maintain adequate oral nutrition intake while attempting to treat or alleviate the symptoms caused by cancer or the cancer treatment. For the purpose of this learning experience, the focus will be on nutrition for cancer treatment side effects versus on nutrition for cancer prevention. It is important to note that diet recommendations vary between patients depending on their symptoms and side effects.

The type of cancer, location, and treatment precede the side effects and nutrition intervention needed. The object of most cancer treatment is simple: destroy the cancer cells. Unfortunately, healthy cells often get damaged along the way and this is the source of the side effects.

Diet intervention is used to treat a multitude of symptoms. These include: 

• Weight loss
• Lack of appetite
• Early satiety
• Painful or dry mouth and throat
• Changes in taste and smell
• Nausea and vomiting
• Diarrhea
• Constipation

The object of diet intervention is to minimize these symptoms to provide adequate nutrition to keep the patient strong during and after cancer treatment. A healthcare professional’s responsibility is to encourage patients and make suggestions for achieving adequate nutrition intake. Unfortunately, dealing with these symptoms can be tiring for the patient, both physically and emotionally. This only contributes to his or her inability to consume appropriate nutrition. Encouraging a patient to enlist the help of family and friends or mental healthcare professionals is appropriate if needed.

The following information provides guidelines and suggestions/survival skills for dietary treatment of the symptoms listed earlier.

 

Weight Loss

If weight loss alone is the problem without concurrent nausea, vomiting, diarrhea, or other problems, a high calorie, high protein diet may be recommended. Keep in mind that to increase calories and protein during this time, suggestions may seem contradictory to conventional nutritional or healthy eating advice. That is because this is treating a problem: weight loss. This is a temporary diet until weight and medical condition is satisfactory.

 

Weight Loss Survival Skills

• Eat small meals often, especially if early satiety is a problem.
• If appetite is better during certain times of the day (often in the morning), try eating during this time regardless of whether or not it is a conventional mealtime.
• Try milkshakes or commercial liquid supplements. They are a great source of nutrition in a liquid form that may be easier to consume.
• Do not skimp on the margarine or fats, and forgo the diet products.
• Add cheese (a high calorie item with protein) to soup, stews, potatoes, vegetables, etc.
• Nuts and seeds are a great high calorie, low volume option if tolerated. They also are a good source of protein.
• Stress that no foods are off limits if they are tolerable. This means that items such as desserts are a great high calorie source.

 

Lack of Appetite/Early Satiety

Often a diet of six small meals is ordered to provide limited volumes often with the goal of increasing intake total for the whole day. It is also important to keep in mind that the patient’s emotional status plays a significant role in appetite, or in this case, lack of appetite. Recognizing this and providing the patient with emotional support or referring him/her to the appropriate discipline may assist with appetite problems.

 

Lack of Appetite/Early Satiety Survival Skills

• Eat small amounts, often. Encourage snacking, eating every 2 to 3 hours.
• Try liquid forms of nutrition (commercial or homemade). Sometimes appetite for solids may be diminished in a patient who readily accepts fluids.
• Eat when hungry; do not wait for meal times.
• Try to make meal time relaxed and a social event versus a forced event. Pressure to eat often only makes appetite worse.

 

Painful or Dry Mouth and Throat

Mouth pain or dryness is often a result of treatment. While there are medications and oral treatments to ease pain and encourage healing, eating may exacerbate the pain and symptoms. Often a soft, bland diet is the diet order of choice.

 

Painful or Dry Mouth and Throat Survival Skills

• Choose easy to chew foods such as mashed potatoes, ground meats, eggs, canned (non-acidic) fruits, oatmeal, etc.
• Limit/avoid spicy foods or acidic foods such as tomato and citrus fruits.
• Encourage good oral hygiene.
• Take small bites and cut food into small pieces.
• Use bland gravies or sauces to ease swallowing.
• Avoid hot foods.
• Other ideas for dry mouth include: drink fluids throughout the day; use hard candy and gum to stimulate saliva production; discuss “artificial saliva” products with your health practitioner.

 

Taste and Smell Changes

Taste and smell are strongly linked and affect appetite. Even foods that have a favorable odor normally may not be appealing to a patient’s appetite. There is no specific diet order for this; however, there are some suggestions that may help.

 

Taste and Smell Changes Survival Skills

• Steer clear of restaurants where many food odors mix; eat at home as much as possible.
• Have someone else prepare food when possible; avoid the kitchen area.
• Avoid foods that have a strong odor in general such as cabbage, tomato products, and stir-fry/Chinese food.
• Do not open foods yourself. Strong odors get trapped under lids and plastic wrap and can be overwhelming.
• Sweet foods often taste better than meats. Encourage these as calorie sources or try to sweeten your protein dish by cooking in orange juice or using a sweet sauce.

 

Nausea and Vomiting

Many of the preceding suggestions may also help when nausea and vomiting are an issue. There is no specific diet order, except when a patient has an acute bout of intractable nausea and vomiting. In that case, the diet order is a progression from clear liquids (water, juice, broth, popsicles) through thicker liquids, soft foods, and then regular foods if they can be tolerated.

 

Nausea and Vomiting Survival Skills

• Separate liquids from solid meals by at least thirty minutes.
• Avoid large meals or eating past initial feeling of fullness.
• Limit fatty foods such as fried foods, high fat meats, and whole dairy products.
• Try to keep something in your stomach and avoid that empty feeling. Crackers, toast, or anything “dry” usually works well.
• Avoid carbonated fluids.
• If a food sounds unappealing, don’t force it.
• Try not to push foods that are normally your favorites at this time. This can make them seem unappealing later even when nausea and vomiting are not current problems.
• Do not lay down flat right after eating.
• Avoid clothing that constricts around the stomach.

 

Diarrhea

When a patient has diarrhea, re-hydration with water and sodium and potassium-containing beverages (sports drinks, fruit juices, broths) is important. The diet recommended might be low fiber, low residue, increase oral fluids. This type of diet limits the amount of material that is not easily digested, such as fiber in fruits and vegetables and the lactose (milk sugar) in milk in an effort to decrease the volume going through the colon.

 

Diarrhea Survival Skills

• Avoid high fiber fruits and vegetables, especially broccoli, cabbage, cauliflower, and corn. Instead, eat cooked/canned vegetables, peeled fruits and vegetables.
• Switch to white versus whole-wheat grains and cereals
• Avoid milk, specifically to drink. After the diarrhea subsides, slowly add milk back to your diet, stopping if the diarrhea returns. Temporary lactose intolerance could be to blame.
• Avoid large meals.
• Avoid caffeine.

 

Constipation

Pain medications in particular may cause or exacerbate constipation. The diet ordered is usually high fiber with adequate fluid. The goal of this is to increase stool size and softness for easier passage.

 

Constipation Survival Skills

• Drink plenty of liquids, including at least eight 8 ounce glasses (64 ounces) per day.
• Caffeine-containing or hot drinks may stimulate a bowel movement.
• High fiber foods include raw vegetables, whole grains, beans, and peas. Foods with at least 3 grams of dietary fiber per serving according to the food label are considered high in fiber.
• Light exercise or increased movement may help “get things moving.”
• Check with your physician regarding medications to treat constipation, but be sure to continue to consume adequate fluids.

 

These survival skills address basic ideas to assist cancer patients in coping with side effects. Sometimes it comes down to whatever works for the patient and is not necessarily anything conventional. Keep in mind that encouragement and trying different things is the only way to see what works.