Jan 12, 2022
Each Tuesday in January our Director of Nutrition, Rachel Spencer, RD, will host a class on an aspect of Cancer Nutrition. This week’s session discussed nutritional management of cancer treatment-related symptoms – below is a summary of what she discussed.
Treatment-related symptoms can present in a wide variety of ways. Symptoms severity may change if you are getting chemotherapy, radiation, or immunotherapy – providing cancer support will change depending on the modality. Chemotherapy targets disrupt cell division, targeting rapidly growing cancer cells but also affect other rapidly dividing cells in your body. These include those in your mouth and GI tract, your bone marrow and your hair. Radiation is more targeted, and side effects are typically seen in the tissues and organs close to where radiation is delivered. Immunotherapy and other targeted therapies have similar side effects to chemotherapy and radiation. Your team will discuss possible side effects with you, so you can be prepared for any dietary changes you may need to make.
Loss of appetite and early satiety can be a side effect of treatment, fatigue, depression or physically caused by the cancer itself. Regardless of what the cause is, the recommendations are the same. Sitting down to large meal can be overwhelming when you aren’t hungry, so it is helpful to eat smaller, more frequent meals or snacks, perhaps 6-8 a day. These should be balanced with a carbohydrate, protein, fat and fruit or veggie – for example: a piece of toast with peanut butter and banana slices, cheese and crackers with baby carrots, mac and cheese with broccoli. It can also be helpful to add extra sauces, butter, cheese or gravy to dishes to make sure each bite is as calorically dense as possible.
Fatigue is an extremely common cancer symptom, which we wrote about on our blog here. You should ask your doctor to check for a deficiency in your iron, Vitamin B or Vitamin D levels. If low, they can recommend appropriate supplementation. You can make sure your energy levels stay high by eating consistently with as few skipped meals as possible. Low intake and low blood sugar are main culprits of nutritional-related fatigue. In addition, make sure each time you eat you get a good source of protein, like meat, fish, nuts or beans to ensure your muscles do not become weak. As always, follow an anti-inflammatory diet which includes a variety of brightly colored fruits and vegetables, healthy oils like canola olive or avocado, nuts and seeds, and lean proteins. In some research, low inflammation levels are associated with lower fatigue levels.
Nausea, vomiting and diarrhea are some of the most common side effects of cancer treatment. If suffering from nausea, try choosing bland foods and avoiding any strong scents or flavors when cooking. Mashed potatoes, rice, smoothies, plain chicken or lightly seasoned beans are good choices. Ginger and peppermint teas can be helpful to settle the stomach. Try to avoid eating your favorite foods when feeling nauseous, so you don’t associate something good with that bad feeling.
Diarrhea can be uncomfortable, disruptive to your daily life, and dangerous if not addressed. It is important to replace any fluids lost, choosing a beverage that contains electrolytes if suggested by your doctor. A good rule of thumb is eight cups of liquid + 1 cup for each loose bowel movement. Foods with soluble fiber, such as bananas, oatmeal, beans, pears and flaxseeds will help gel stools. Avoid caffeine, alcohol, and sugar-free products as these can worsen diarrhea. Importantly, you should always communicate changes in bowel habits with your cancer care team. Be sure to take any medications such as Immodium as recommended.
Mucositis or esophagitis are sores that develop in your mouth or throat, a common symptom of cancer treatment. If you are receiving 5-FU or melphalan therapy, eating ice or popsicles for 30 minutes before and during therapy can reduce this side effect. If you already have developed sores, the best solution is to avoid salty, acidic, or spicy foods to reduce irritation. Alcohol and carbonation can also be bothersome, so try to limit this. Foods should be neither very hot nor very cold to improve tolerance. Last, choose moist, soft-textured foods more often than crunchy or sharp foods which could irritate when eaten.
Taste changes can be very disruptive to eating habits and pose a serious risk to nutritional status of cancer patients. If you are experiencing a lack of taste or if things just taste funny, try to use extra seasonings or strongly flavored items like lemon or vinegar or marinates to amp up flavor. Fruity and salty flavors are often best, so try smoothies and mixed dishes to improve flavor. Often foods can develop metallic or bitter taste, so avoid cooking in metal dishes or using metal silverware. Sour or sweet drinks and candies can help improve any lingering bad taste in your mouth. Beef and pork have high iron which can have a metallic taste. Choose poultry, fish, or plant proteins to make sure you are still meeting muscle-preserving targets. Good oral hygiene can also improve taste changes, so make sure you are brushing and flossing daily.
If it is smell that is bothering you, make sure you are cooking in a well-ventilated area or ask a loved one to cook instead. Now may be a time to rely on healthy, ready-made meals or ask friends to drop off meals you can reheat.
All of these symptoms can have a big impact on nutritional intake, and could result in weight loss. All cancer patients should track their weight weekly. For best accuracy, weigh yourself in the morning after using the toilet and before having breakfast. Keeping track of this number and reporting it to your care team can help you catch any trend in weight loss, cueing interventions to prevent malnutrition. Read more about malnutrition in our blog post here.
Patients respond differently to their treatment based on the kind of drug given, the dose, and their own genetic makeup. You may experience all of these symptoms, some or none – but being prepared and informed on how to manage them if they do arise can make a world of difference for your treatment, your nutrition status, and your quality of life.
Do you want personalized advice on how to manage your cancer-related symptoms? Join OncoPower today and reach out to our Registered Dietitians. They are happy to help tailor your diet to help you optimize your nutrition status and provide cancer support services.