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Get Relief from Gastrointestinal Side Effects

by Marie Morande, RD, CSO, LD

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Preventing and treating oral mucositis starts with good mouth care.

While cancer treatments affect everyone differently, radiation, chemotherapy, and surgery all pose potential side effects. Cancer treatment can affect your body’s ability to absorb food, reduce how much you enjoy food, and cause disruptive gastrointestinal issues. Common gastrointestinal side effects include nausea, vomiting, diarrhea, constipation, and sore mouth or throat.

Nausea and vomiting greatly affect nutritional intake during treatment. Proper antinausea medications are important for managing nausea, so you should consult your doctor for specific recommendations. Dietary changes can also be helpful. Eat small, frequent meals and easily digestible foods. Try crackers, pudding, yogurt, sherbet, popsicles, fruits, rice, baked chicken, oatmeal, and broth-based soups. Avoid cooking foods that produce strong aromas, and avoid eating spicy or greasy foods.

Other possibly effective management strategies include acupressure bands, music therapy, progressive muscle relaxation, and psychosocial support. Ginger, lemon, peppermint, and chamomile may be beneficial in managing nausea and vomiting, but their effectiveness lacks strong research.

Your doctor can help you develop a plan to minimize these effects on your body while maximizing food and fluid intake and increasing your quality of life.

Diarrhea is defined as a change in the consistency or frequency of your stools. Diarrhea may force you to stay home and limit your activity, decreasing your quality of life. The standard treatment for diarrhea is loperamide, but other medication options are available. Your doctor can recommend a medication that he or she thinks will work for you.

Your diet also plays a role in managing diarrhea, and there is some evidence that probiotics may help with radiationinduced diarrhea. If you are experiencing diarrhea, eat a low-fiber diet by avoiding raw vegetables (like broccoli and cauliflower), salad, bran, skins of fruit, and high-fiber cereals, and limit dairy products containing lactose. Eat small, frequent meals to ease digestion, avoid spicy and greasy foods, and consume foods high in salt and potassium to replenish electrolytes.

Constipation is a common side effect of cancer treatment and of antinausea and opioid pain medications. To prevent constipation, it’s important to initiate a daily bowel care program when you begin treatment and if you begin taking opioids. Although the exact regimen will vary by person, experts recommend starting with a stimulant laxative and stool softener, and then adjusting as needed. Your doctor can offer more specific recommendations.

Additionally, a high-fiber diet is recommended for managing constipation. Whole wheat bread, raw fruits and vegetables, cauliflower, carrots, potatoes with skin, bananas, prunes, oranges, and berries are good foods to include in your diet. It’s also important to increase fluid intake; drinking warm beverages may help. Physical activity is also beneficial.

Mucositis is inflammation of the lining of the gastrointestinal tract, usually caused by chemotherapy or radiation therapy. Mucositis can occur anywhere along the gastrointestinal tract, but oral mucositis refers to inflammation and ulceration that occurs in the mouth. Preventing and treating oral mucositis starts with good mouth care: brushing with a soft toothbrush, rinsing your mouth four times daily with a bland mouthwash, and avoiding drinking alcohol and smoking.

No single rinse has been found more effective than another in preventing oral mucositis; however, a baking soda or salt rinse is a common and economical option. Mix one teaspoon of baking soda or salt with one pint of water. Rinse your mouth with one tablespoon for thirty seconds, and then spit out the mixture. Repeat four times per day.

If you’re starting fluorouracil or melphalan infusions, sucking on ice chips for five minutes before, during, and after infusion has been shown effective in reducing oral mucositis. However, avoid ice if you’re taking drugs that increase cold sensitivity, such as capecitabine or oxaliplatin.

If you have mucositis, eat bland, soft, and moist foods. Avoid spicy foods, citrus, and dry or coarse foods that may increase discomfort until your mucositis heals. Talk with your doctor to find out which side effects you should expect from your course of treatment. Your doctor can help you develop a plan to minimize these effects on your body while maximizing food and fluid intake and increasing your quality of life.

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Marie Morande is a certified specialist in oncology nutrition at Lynn Cancer Institute in Boca Raton, FL, and a member of Oncology Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics. She has 15 years of experience as a clinical dietitian.

This article was published in Coping® with Cancer magazine, March/April 2013.

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