Managing Eating Problems During Treatment
All the methods of treating cancer - surgery, radiation therapy, chemotherapy, hormone therapy, and biological therapy (immunotherapy) - are very powerful. Although these treatments target the fast-growing cancer cells in your body, healthy cells can also be damaged. Healthy cells that normally grow and divide rapidly, such as those in the mouth, digestive tract, and hair, are often affected by cancer treatments. The damage to healthy cells is what produces the unpleasant side effects that cause eating problems. Table 1 shows some of the effects that can occur as a result of cancer treatment.

Side effects of cancer treatment vary from patient to patient. The part of the body being treated, the type and length of treatment, and the dose of treatment determine whether side effects will occur.

The good news is that not everyone has side effects during treatment, and most side effects go away when treatment ends. Side effects can also be well-controlled with new drugs. Talk to your doctor about possible side effects from your treatment and what can be done about them.

Some eating problems are caused by the treatment itself. Other times, patients may have trouble eating because they are upset, worried, or afraid. Losing your appetite and nausea are two normal responses to feeling nervous or fearful. Once you get into your treatment period and have a better sense of what to expect and how you will react, these anxiety-related eating problems should get better.

While you are in the hospital or undergoing treatment, talk to your doctor, nurse, or a registered dietitian. They can answer your questions and give you suggestions for specific meals, snacks, and foods, and for dealing with any eating problems you may have. They can also help with dietary preferences that reflect various cultural and ethnic backgrounds. Feel free to talk to them if problems arise during your recovery as well. Ask them what has worked for other patients.

Remember, there aren't any hard and fast nutrition rules during cancer treatment. Some patients may continue to enjoy eating and have a normal appetite throughout most of their cancer treatment. Others may have days when they don't feel like eating at all; even the thought of food may make them feel sick. Here are some things to keep in mind:

When you can eat, try to eat meals and snacks with sufficient protein and calories; they will help you keep up your strength, prevent body tissues from breaking down, and rebuild tissues that cancer treatment may harm.
Many people find their appetite is better in the morning. Take advantage of this and eat more then. Consider having your main meal of the day early, and have liquid meal replacements later on if you don't feel so interested in eating (see page 11 for more information on liquid meal replacements).
If you don't feel well and can eat only one or two things, stick with them until you are able to eat other foods. Try a liquid meal replacement for extra calories and protein.

On those days when you can't eat at all, don't worry about it. Do what you can to make yourself feel better. Come back to eating as soon as you can, and let your doctor know if this problem doesn't get better within a couple of days.

Try to drink plenty of fluids, especially on those days when you don't feel like eating. Water is essential to your body's proper functioning, so getting enough fluids will ensure that your body has the water it needs. For most adults, 6-8 cups of fluid a day are a good target. Try carrying a water bottle with you during the day. That may help you get into the habit of drinking plenty of fluids. Tables 2 and 3 include many examples of fluids you can try.

Coping with Side Effects
This section offers practical hints for coping with treatment side effects that may affect your eating. These suggestions have helped other patients manage the same eating problems that you may have. Try all the ideas to find what works best for you. Share your needs and concerns with your family and friends, particularly those who prepare meals for you.

Loss of Appetite
Loss of appetite or poor appetite is one of the most common problems that occurs with cancer and its treatment. No one knows exactly what causes loss of appetite. It may be caused by the treatments or by the cancer itself. Emotions such as fear or depression can also take away a person's appetite. Ask a nurse or social worker about ways to lessen these emotional difficulties. Sometimes it is the side effects of treatment such as nausea, vomiting, or changes in food's taste or smell that make a person feel like not eating. If this is the cause, work with your doctor or nurse to get the side effects under better control.

For some people, loss of appetite happens for just a day or two; for others, it's an ongoing concern. Whatever the reason, here are some suggestions that might help:

Commercial Products to Improve Nutrition
If you cannot get enough calories and protein from your diet, commercial meal replacements such as drinks, "shakes," and "instant breakfast" powders may help. Other products also can be added to any food or beverage. These supplements are high in protein and calories and have extra vitamins and minerals. They come in liquid, pudding, and powder forms. Most commercial meal replacements contain little or no lactose. However, it is important to check the label if you are sensitive to lactose. Your nurse or a registered dietitian can tell you which products are best for you and which ones are available in your area.

Most of these products need no refrigeration until you open them. That means you can carry them with you and have them whenever you feel hungry or thirsty. They are also good chilled as between-meal or bedtime snacks. You may want to take a can with you when you go for treatments or other times when you may have a long wait.

Many supermarkets and drugstores carry a variety of commercial liquid meal replacements. If you don't see these products on the shelf, ask the store manager if they can be ordered.

Weight Loss
Many cancer patients lose weight during their cancer treatment. This is partly due to the effects of the cancer itself on the body. Also, if you've lost your appetite and are eating less than usual because of your treatment or emotional worries, you may lose weight.

Here are three simple recipes that show you how to increase the calories and protein of familiar foods:

For extra protein in dishes, consider adding a little nonfat instant dry milk to scrambled eggs, soup, cereal, sauces, and gravies.

Weight Gain
Some patients find their weight does not change during treatment. They may even gain weight. This is particularly true for breast, prostate, and ovarian cancer patients taking certain medications or who are on hormone therapy or chemotherapy.

It is important not to go on a diet right away if you notice weight gain. Instead, tell your doctor so you can find out what may be causing this change. Sometimes, weight gain happens because certain anticancer drugs can cause your body to hold on to excess fluid. This condition is called edema. The weight comes from the extra water. If this is the case, your doctor may ask you to talk with a registered dietitian for guidelines on limiting the amount of salt you eat. This is important because salt causes your body to hold extra water. Your doctor may also want to prescribe a diuretic. This is a medication that causes your body to get rid of excess fluid.

Breast cancer patients with a primary diagnosis of cancer may be different. Over half of them may actually gain weight rather than lose during treatment. Because of this, many of the recommendations for breast cancer patients do emphasize a lower fat, reduced calorie diet similar to those provided to patients after cancer treatment has been completed.

Weight gain may also be the result of increased appetite and eating extra food and calories. If this is the case and you want to stop gaining weight, here are some tips that can help. Talk to a registered dietitian for more guidance:

Sore Mouth or Throat
Mouth sores, tender gums, and a sore throat or esophagus often result from radiation therapy, chemotherapy, or infection. If you have a sore mouth or gums, see your doctor to be sure the soreness is a treatment side effect and not an unrelated dental problem. The doctor may be able to give you medicine that will control mouth and throat pain. Your dentist also can give you tips for the care of your mouth. Certain foods will irritate an already tender mouth and make chewing and swallowing difficult. By carefully choosing the foods you eat and by taking good care of your mouth, teeth, and gums, you can usually make eating easier.

Here are some suggestions that may help:

Try soft foods that are easy to chew and swallow, such as:

Avoid foods or liquids that can irritate your mouth. These include:

Changed Sense of Taste or Smell
Your sense of taste or smell may change during your illness or treatment. Foods, especially meat or other high-protein foods, can begin to have a bitter or metallic taste. Many foods will have less taste. Chemotherapy, radiation therapy, or the cancer itself may cause these problems. Dental problems also can change the way foods taste. For most people, changes in taste and smell go away when their treatment is finished.

There is no foolproof way to prevent changes to your sense of taste or smell because each person is affected differently by illness and treatments. However, the tips below should help if you have this problem. (If you also have a sore mouth, sore gums, or a sore throat, talk to your doctor, nurse, or registered dietitian. They can suggest ways to help you without hurting the sore areas.)

Nausea
Nausea, with or without vomiting, is a common side effect of surgery, chemotherapy, radiation therapy, and biological therapy. The disease itself, or other conditions unrelated to your cancer or treatment, may also cause nausea. Some people have nausea or vomiting right after treatment; others don't have it until two or three days after a treatment. Many people never experience nausea. For those who do, nausea often goes away once the treatment is completed. Also, there are now drugs that can effectively control this side effect. These medications, called antiemetics, are often given at the beginning of a chemo-therapy session to prevent nausea.

Whatever the cause, nausea can keep you from getting enough food and needed nutrients. Here are some ideas that can help:

Ask your doctor about antiemetics that might help you control nausea and vomiting.

Try foods that are easy on your stomach, such as:

Avoid foods that:

Try to keep track of when your nausea occurs and what causes it (specific foods, events, surroundings). If possible and if it helps, change your diet or schedule. Share the information with your doctor or nurse.

Vomiting
Vomiting may follow nausea and may be brought on by treatment, food odors, gas in the stomach or bowel, or motion. In some people, certain associations or surroundings, such as the hospital, may cause vomiting. As with nausea, some people have vomiting right after treatment, while others don't have it until a day or more after treatment.

If vomiting is severe or lasts for more than a day or two, contact your doctor. He or she may give you an antiemetic medication to control nausea and vomiting.

Very often, if you can control nausea, you can prevent vomiting. At times, though, you may not be able to prevent either. Relaxation exercises or meditation may help you. These usually involve deep rhythmic breathing and quiet concentration, and can be done almost anywhere. If vomiting does occur, try these suggestions to help prevent further episodes:

Do not eat or drink anything until you have the vomiting under control. Once the vomiting is under control, try small amounts of clear liquids, such as water or bouillon. Table 2 gives you more examples of clear liquids. Begin with 1 teaspoonful every 10 minutes, gradually increasing the amount to 1 tablespoon every 20 minutes. Finally, try 2 tablespoons every 30 minutes.

When you are able to keep down clear liquids, try a full-liquid diet or a soft diet. Table 3 gives examples of full-liquid foods. Continue taking small amounts as often as you can keep them down. If you feel okay, gradually work up to your regular diet. If you have a hard time digesting milk, you may want to try a soft diet instead of a full-liquid diet, because a full-liquid diet includes a lot of milk products. Ask a registered dietitian for information about a soft diet.

Diarrhea
Diarrhea may have several causes, including chemotherapy, radiation therapy to the abdomen, infection, food sensitivities, and emotional upset. Work with your doctor to identify the cause of your diarrhea so that it can be successfully treated.

During diarrhea, food passes quickly through the bowel before your body has a chance to absorb enough vitamins, minerals, and water. This may cause dehydration, which means that your body does not have enough water to work well. Long-term or severe diarrhea may cause problems, so contact your doctor if the diarrhea is severe or lasts for more than a couple of days. Here are some ideas for coping with diarrhea:

Try these foods:

Avoid:

Drink liquids that are at room temperature.

Limit foods and drinks that contain caffeine, such as coffee, some sodas, and chocolate.
If you have a sudden, short-term attack of diarrhea, try having nothing but clear liquids for the next 12 to 14 hours. This lets your bowel rest and replaces the important fluids lost during the diarrhea. Make sure your doctor or nurse knows about this problem.

Be careful when using milk and milk products. The lactose they contain can make diarrhea worse. Most people, though, can handle small amounts (about 1-1/2 cups) of milk or milk products.

Special Diets for Special Needs
When you have special needs because of your cancer or treatment, your doctor or registered dietitian may prescribe a special diet. For example, a soft diet may be best if your mouth, throat, esophagus, or stomach is sore. Or, if your treatment makes it difficult for you to digest dairy products, you may need to follow a low-lactose diet. Other special diets include a clear-liquid diet, a full-liquid diet, and a fiber-restricted diet.

Some special diets are well balanced and can be followed for long periods of time. Others, however, should be followed for only a few days because they may not provide enough nutrients for the long term. If you think you need a special diet, talk with your doctor and a registered dietitian. Together, you can work out a plan. You also should work with your doctor and dietitian if you are already on a special diet for a disease such as diabetes, kidney, or heart disease.

Lactose Intolerance
Lactose intolerance means that your body can't digest or absorb the milk sugar called lactose. Milk, other milk-based dairy products (such as cheese and ice cream), and foods to which milk has been added (such as pudding) may contain lactose.

Lactose intolerance may occur after treatment with some antibiotics, with radiation to the stomach or with any treatment that affects the digestive tract. The part of your intestines that digests lactose may not work properly during treatment. For some people, the symptoms of lactose intolerance (gas, cramps, diarrhea) disappear a few weeks or months after the treatments end or when the intestine heals. For others, a permanent change in eating habits may be needed.

If you have this problem, your doctor may advise you to follow a diet that is low in foods that contain lactose. Talk to a registered dietitian to get advice and specific tips about how to follow a low-lactose diet. Your supermarket should carry milk and other products that have been modified to reduce or eliminate the lactose. You can also make your own low-lactose or lactose free foods.

Constipation
Some anticancer drugs and other drugs, such as pain medications, may cause constipation. This problem also can occur if your diet lacks enough fluid or fiber, or if you've been in bed for a long time. Here are some suggestions for preventing and treating constipation:

If these suggestions don't work, ask your doctor about medicine to ease constipation. Be sure to check with your doctor before taking any laxatives or stool softeners.

Fatigue and Depression
All the methods of treating cancer treatment are powerful. Treatment may go on for weeks or months. It may even cause more illness or discomfort than the initial disease. Many patients say they feel exhausted and depressed, and unable to concentrate. Fatigue during cancer treatment can be related to a number of causes: not eating, inactivity, low blood counts, depression, poor sleep, and side effects of medicine. It is important for you to raise the issue with your health care team if you are having fatigue. Together, you can decide what is causing the problem, since many of the causes can be treated.

Fatigue and depression aren't eating problems in and of themselves, but they can affect your interest in food and your ability to shop and prepare healthy meals. Here are some suggestions that may help:

Talk about your feelings and your fears. Being open about your emotions can make them seem more manageable. Consider talking with your nurse or social worker, who can help you find ways to lessen your worries and fears.
Become familiar with your treatment, possible side effects, and ways of coping. Being knowledgeable and acting on that knowledge will help you feel more in control. Don't be afraid to talk with your doctor and ask questions.

Make sure you get enough rest:

Preventing Food-Borne Illness
Cancer patients undergoing treatment can develop a weakened immune system because most anticancer drugs decrease the body's ability to make white blood cells, the cells that fight infection. That's why cancer patients should be especially careful to avoid infections and food-borne illnesses. Here are some tips to help you prevent food-borne illness:

The Food and Drug Administration has published a booklet that includes these and other tips for preventing food-borne illness.

Extra Vitamins and Minerals - Will They Help?
Many cancer patients want to know whether vitamins, minerals, or other dietary supplements (such as phytochemicals) will help "build them up" or help fight their cancer. We know that patients who eat well during cancer treatment are better able to cope with their disease and any side effects of treatment. However, there is no scientific evidence that dietary supplements or herbal remedies can cure cancer or stop it from coming back.

The Stolfa Foundation strongly urges you to depend on traditional, healthy foods for vitamins, minerals, and other nutrients. Talk to your doctor, nurse, registered dietitian, or a pharmacist before taking any vitamin or mineral supplements. Too much of some vitamins or minerals can be just as dangerous as too little. Large doses of some vitamins may even stop your cancer treatment from working the way it should. To avoid problems, don't take these products on your own. Follow your doctor's guidance.

What About Alternative Therapies?
You may hear or read about many different kinds of treatments people have tried to cure their disease. A therapy is called complementary when it is used in addition to conventional treatments; it is often called alternative when it is used instead of conventional treatment. A number of medical centers are evaluating the scientific aspects of complementary and alternative therapies and developing studies to test them. Many of these treatments have not been thoroughly studied, and there is no proof that they work or that they are safe. Other treatments have been studied, and we know they don't help or are harmful. It is important to talk with your doctor or nurse if you are considering trying any of these treatments, because some therapies may interfere with your standard treatment or may be harmful when used with conventional treatment. He or she can talk to you about any research that has been done and whether or not the treatment is safe or would interfere with your treatment. The Stolfa Foundation strongly urges you to follow a treatment program prescribed by a doctor who uses accepted and proven methods or treatments. People who depend upon unconventional treatments alone may lose valuable treatment time and reduce their chances of controlling their cancer and getting well.