Staying Well Nourished through Cancer Treatment
by Jeannine B. Mills, MS, RD, CSO, LD
The nutritional well-being of cancer survivors can be significantly challenged by cancer treatment. Nutritional goals for most people facing cancer treatment include maintaining a healthy weight, optimizing calorie needs, minimizing vitamin and mineral deficiencies, and managing treatment-related side effects. Evidence shows that those who are able to maintain a healthy weight and optimize calorie intake during treatment will have an improved response to treatment, enhanced recovery, and a better quality of life.
Just as there are many different cancer-treatment strategies, so are there different recommendations for getting adequate nutrition during cancer. Nutritional goals vary according to cancer type, treatment, weight, age, and preexisting conditions, such as diabetes. Some cancer treatments cause more nutrition-related side effects than others. While some people are at higher risk for losing weight while on treatment, others may be at risk for weight gain. Moreover, cancer-related side effects, such as poor appetite, taste changes, nausea or vomiting, diarrhea or constipation, mouth sores, or discomfort with swallowing, can hinder you from getting the nutrition you need.
If your appetite has decreased, try eating small meals or snacks every two hours and drink calorie-rich liquids.
If you have a poor appetite, getting adequate nutrition can be especially challenging. Poor appetite may be a result of pain, fatigue, nausea, taste changes, alteration in bowels, or depression. Often, the anxiety associated with the cancer diagnosis itself can also affect your appetite. If your appetite has decreased, try eating small meals or snacks every two hours and drink calorie-rich liquids. Focus on condensed calories in smaller servings, such as cheese, dried fruit, nuts, avocados, bananas, full fat or two percent fat dairy products, pasta, dense breads, and pretzels. Try to avoid unnecessary diet restrictions, and cater to your taste preferences.
Taste changes can occur even before cancer treatment begins. Foods may have less taste or no taste at all, or foods may have an unappealing flavor. Texture of foods and liquids may also lose their appeal. This can drive you to not want to eat at all. Cleansing your palate with a non-alcoholic mouth rinse or a baking soda and salt rinse before eating may be helpful.
Bitter and sour flavors may be more appealing when your sense of salt is enhanced or when your sense of sweet is diminished. Try different types of vinegar doused onto vegetables; chutney as a side to meat dishes; marinades for meat or vegetables; salsa added to meals; capers or olives added to salads; cilantro, fresh basil, or arugula added to a mix of salad greens; lemon squeezed onto vegetables or fish; citrus added to seltzer or water; and different fruit juices. Foods that are warm and moist may also be more appealing, as dry mouth may be to blame for your taste changes.
With or without vomiting, nausea can be a significant barrier to eating. Medication to ease your nausea should be the first step in managing this side effect. Some foods may be better tolerated than others when nausea is a problem. For example, foods that are cool or room temperature may be easier to tolerate, as they don’t give off as strong an odor as warm or heated foods. You may also want to avoid overly sweet, fried, or spicy foods when you are experiencing nausea.
Cancer treatment or medications given to manage treatment-related side effects, including pain medications and some anti-nausea medications, can cause constipation. Some medications, like narcotics, can slow the normal action of the stomach. Even if you’re consuming less food than usual, it’s important to continue to try to move your bowels daily or every other day to help avoid constipation.
Staying well hydrated is an important part of managing constipation. A high-fiber diet is often encouraged, and sometimes a daily laxative or stool softener is recommended, but you should first talk with your doctor to determine the best approach for you.
Maintaining a healthy weight, meeting your calorie and protein needs, avoiding micronutrient deficiencies, and managing treatment-related side effects are important components of your cancer care. Meeting these nutritional goals can help you respond and recover more completely from treatment and avoid treatment delays. For further guidance, see a registered dietitian.
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Jeannine Mills is a certified specialist in oncology nutrition and a clinical dietitian at the cancer center at Dartmouth Hitchcock Medical Center in Lebanon, NH. She is also an active member of the Oncology Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics (oncologynutrition.org).
This article was published in Coping® with Cancer magazine, November/December 2012.