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Diet andCancerA guide for patients with cancer

Diet and Cancer

This booklet has been written to help you understand more about dietand cancer. It has been prepared and checked by dietitians, nurses andpatients. The information in this booklet is an agreed view on diet andcancer.

If you are a patient, your doctor, dietitian or nurse may like to gothrough the booklet with you. They can mark sections that areimportant for you. You can also make a note below of the contactnames and information you may need quickly.

>>> Dietitian Tel:

Specialist nurse Tel:

Family doctor (GP) Tel:

Surgeon Tel:

Medical oncologist Tel:

Radiation oncologist Tel:

Radiation therapist Tel:

Medical social worker Tel:

Speech and language therapist Tel:

Emergency number Tel:

Treatments Review dates

If you like, you can also add:

Your name

Address

This booklet has been produced by Nursing Services of the Irish Cancer Society to meet theneed for improved communication, information and support for cancer patients and theirfamilies throughout diagnosis and treatment. We would like to thank all those patients,families and professionals whose support and advice made this publication possible.

DIET AND CANCER ADVISERS

Claire Browne, Dietitian ManagerClaire Molloy, Senior DietitianHaematology Oncology Interest Group of the Irish Nutrition and Dietetic InstituteNiamh O’Sullivan, Dietitian ManagerDr Janice P Richmond, Advanced Nurse PractitionerMargaret Houston, Clinical Nurse Specialist (Oncology)Nora Walshe, Senior Speech and Language Therapist

CONTRIBUTORS

Olive Gallagher, Cancer Information Service NursePauline Forrester, Cancer Information Service Nurse

EDITOR

Tara Droog

SERIES EDITOR

Joan Kelly, Nursing Services Manager

The following sources were used in the publication of this booklet:■ Your Guide to Healthy Eating Using the Food Pyramid. Dept of Health/Health ServiceExecutive, 2012.

■ Nutrition and physical activity guidelines for cancer survivors. CL Rock et al. CA: A Cancer Journal for Clinicians. American Cancer Society, April 2012.

■ Nutrition and Breast Cancer: Making Healthy Diet Decisions. C Anselmo, J Gilman, L Russo, R Zinaman. Memorial Sloan-Kettering Cancer Center, 2011.

■ Reduce Your Risk of Cancer by Taking Three Positive Steps. Irish Cancer Society, 2009.■ Diet and Cancer. Irish Nutrition and Dietetic Institute, 2008.■ Recommendations for Cancer Prevention. World Cancer Research Fund, 2007.■ Preventing Cancer: Food, Nutrition and Physical Activity. Irish Nutrition and DieteticInstitute, 2007.

■ Eating Hints for Cancer Patients. National Cancer Institute (US), 2003.■ Integrative Nutritional Therapies for Cancer: A Scientific Guide to Natural Products Used

to Treat and Prevent Cancer. NB Kumar, K Allen & D Riccardi. Facts & Comparisons (US),2002.

Published in Ireland by the Irish Cancer Society.© Irish Cancer Society, 2008, revised 2011, 2012, 2014Next revision: 2016

Product or brand names that appear in this book are for example only. The Irish CancerSociety does not endorse any specific product or brand.

All rights reserved. No part of this publication may be reproduced or transmitted, in anyform or by any means, electronic or mechanical, including photocopying, recording or anyinformation storage and retrieval system, without permission in writing from the IrishCancer Society.

ISBN 0-95323-690-1

Contents5 Introduction

Healthy eating

7 What is healthy eating?

11 What is a healthy weight?

12 How can I prevent cancer or its recurrence?

Nutrition and treatment

15 What eating problems can I expect from treatment?

20 How can I build myself up?

25 What if I cannot eat?

25 Who can give me advice about my diet?

Eating problems during treatment

27 Poor appetite

28 Taste and smell changes

29 Sore mouth, gums or throat

30 Dry mouth

31 Difficulty swallowing

31 Indigestion

32 Feeling full

32 Nausea (feeling sick)

33 Vomiting

34 Cramping

34 Bloating

34 Diarrhoea

35 Constipation

35 Fatigue (too tired to cook or eat)

36 Weight loss

41 Too much weight gain

42 Other problems

Diet and cancer

IntroductionEating well when you have cancer can help you feel better. It canmake you feel strong and help you to maintain a healthy weight. Itcan also help you tolerate the side-effects of treatment, reduce the riskof infection, and help your recovery. This booklet has been written tohelp you learn more about diet and cancer. It is aimed at people withcancer at any stage. This includes newly diagnosed, during and aftertreatment, or when active cancer treatment has stopped.

You can read about healthy eating, the eating problems to expect fromcancer treatment, and how to cope with them. There is a section onbuilding yourself up if you have lost weight unintentionally or if youare having eating problems. There are also some tips for carers abouteating and preparing food. Some advice is given about special dietsand supplements as well.

It is common to have questions about which foods to eat during andafter treatment. You may wonder what the best diet is for you,especially if you find it hard to eat. Will what you eat affect yourcancer and your recovery?

We hope this booklet will answer some of your questions. If not, at theend of the booklet you will find a list of useful organisations andbooks. There is also a list of websites and special groups to help andsupport you at this time. You can also call the freefone NationalCancer Helpline on 1800 200 700 or visit a Daffodil Centre to discussany queries or concerns you might have. Remember your hospitaldietitian can also give you support and advice.

5

Nutrition after treatment

43 Getting back to healthy eating

Nutrition and advanced cancer

45 Support for eating problems

46 Tips for carers

Other diets and supplements

49 Low bacteria diets

50 Other diets

51 Taking supplements

53 Taking soy products

54 Complementary and alternative diets

Support resources

59 Irish Cancer Society services

63 Useful organisations

69 Helpful books

70 What does that word mean?

73 Questions to ask your doctor

74 Your own questions

National Cancer Helpline Freefone 1800 200 700

Healthy eatingWhat is healthy eating?Healthy eating is something we hear about a lot today. Not only can ithelp your body to grow and work well but also help prevent illness.But sometimes it is hard to know what exactly is a healthy diet.

A healthy diet involves eating a variety of foods that provide thenutrients your body needs in the right amounts. These includeprotein, carbohydrates, fats, vitamins and minerals. They are used byyour body to give you energy, repair and build essential tissues, andhelp with lots of body functions.

If you have cancer, healthy eating is even more important duringtreatment. It can help you to:

■ Feel better

■ Keep up your energy and strength

■ Keep a healthy weight

■ Tolerate the dose of drugs given

■ Cope better with side-effects of treatment

■ Reduce your risk of infection

■ Heal and recover faster

A balanced dietA balanced diet means taking in all the essential nutrients in the rightamounts. That way your body can grow and work well. Thesenutrients fall into five groups. Some you need in large amounts andothers in small amounts. For your diet to be well balanced, you musteat fruit and vegetables. In fact, you should include all the foodgroups in the food pyramid in the right amounts. See page 8 for moredetails about the food pyramid.

For some people with cancer, a balanced diet may not be suitable. For example, if you are losing weight. In this case, you may getdifferent advice from your dietitian.

Diet and cancer 7

Diet and cancer 9Diet and cancer8

Top shelf foods are high in fat, sugar andsalt, are not essential for health and taken inexcess can be harmful.

Fats and oils are essential, but only in small amounts.

The foods and drinks on the bottom4 shelves of the Food Pyramid areessential for good health.

Maximum 1Choose any 2Choose any 2Choose any 3Choose any 5+Choose any 6+

A Guide to Measures

1 small glass = 100 ml

1 large glass = 200 ml

1 cup = 200 ml

A disposable cup is a good guide

1 teaspoon = 5g/ml

1 heaped teaspoon = 7g/ml

1 dessertspoon = 10g/ml

Source: Your Guide to Healthy Eating Using the Food Pyramid. Dept of Health/Health Service Executive, 2012


What is a healthy weight?A healthy weight is when your weight is right for your height, yourbody mass index (BMI) is normal and you are neither overweight nor underweight. The way to achieve and maintain a healthy bodyweight is to balance the food and drink you eat with physicalactivity. If you are unsure about your weight, ask your dietitian foradvice. One way to check it is by finding your body mass index. BMImeasures if your weight is right for your height.

BMI is graded so it can tell if you are underweight, a healthy weight,overweight or obese (fat). If your BMI is between 18.5 and 24.9, youare within a healthy weight range. If it is less than 18.5, you areunderweight. If it is more than 25, you are overweight. If more than30, you are obese.

Your dietitian can measure your BMI for you. Sometimes there arescales in shopping centres or pharmacies that will measure it for you.BMI is a guide only. If you are worried about your score, do talk toyour dietitian. Most people are advised to keep their current bodyweight during cancer treatment. If you are losing or gaining weight,do discuss it with your nurse, doctor or dietitian.

>>> If you have cancer and are losing weight, a balanced dietmay not be suitable. Your dietitian may give you differentadvice instead.

Group Food type Amount to take every day

1 Fats and oils Very little*Sugars, confectionery, cakes, biscuits, high-fat snack foodsAlcohol

2 Meat, fish, eggs, beans, peas, nuts 2 servings*3 Milk, cheese and yoghurt 3 servings*4 Fruit and vegetables 5 servings*5 Bread, cereals and potatoes 6 or more servings*

* This amount may change in special diets.

>>> Some healthy eating guidelines■ Limit foods and drinks from the top shelf of the food pyramid, as theseare high in fat, sugar and salt.

■ Prepare and cook your meals using fresh ingredients. Avoid ready mealsand takeaways in general.

■ Always read the nutrition label: check for high levels of fat, sugar and salt.

■ Eat a variety of 5 or more of different coloured fruit and vegetables everyday.

■ Eat wholegrain breads, high fibre cereals, potatoes, wholewheat pastaand brown rice to satisfy hunger and fuel your body.

■ Choose healthier cooking methods, like steaming, grilling, baking,roasting and stir-frying instead of frying foods.

■ Eat more fish, especially oily fish such as mackerel, sardines and salmon,at least once a week.

■ Choose lower-fat milks, low fat or no added sugar yoghurts and yoghurtdrinks and reduced fat cheese.

■ Choose vegetable oils high in monounsaturated fats such as rapeseed orolive oil.

■ Drink about 8‒10 cups or glasses of fluid every day. Water is best.

■ Enjoy 3 meals a day sitting at a table, away from the TV, phone orcomputer screen. Eat slowly and chew your food properly.

■ Make time for breakfast – you are more likely to be a healthy weight.

■ Drink alcohol sensibly within recommended limits and preferably withmeals.

■ If you eat a healthy balanced diet, there is no need to take foodsupplements, unless advised by your doctor.

Adapted from Your Guide to Healthy Eating Using the Food Pyramid. Dept of Health/Health Service Executive, 2012.


§ To sum up■ Healthy eating during cancer treatment can help you to feel better andrecover faster.

■ A balanced diet is when you take in all the essential nutrients in the rightamounts so your body can grow, work and repair itself.

■ For a diet to be well balanced, you must eat fruit and vegetables. Youshould include all the food groups in the food pyramid in the rightamounts.

■ A healthy weight is when you are neither overweight nor underweight.

■ To help prevent cancer coming back, follow the guidelines for cancerprevention.

Measuring BMI yourselfYou can also calculate your BMI yourself. But first you will need toknow your weight in kilograms (kg) and your height in metres (m).Divide your weight by your height and then divide the result againby your height. There are also many websites that can help youcalculate it.

Waistline measurement Measuring your waistline is a way of checking if you are at risk ofcancer, especially bowel cancer. Extra weight around your middle can also lead to health problems such as diabetes and heart disease.

To measure your waistline:■ Find the top of your hipbone.■ At this point, measure around your waist. Make sure the tapemeasure is snug but not marking your skin.

■ Take the measurement at the end of a normal breath.

Your risk of cancer is higher if your waistline is more than 94 cm or37 inches for men and more than 80 cm or 32 inches for women.Talk to your dietitian if you are worried about your waistline.

How can I prevent cancer or itsrecurrence?A simple guide to preventing cancer or its recurrence is:■ Eat a healthy diet.■ Be physically active.■ Be a healthy weight.

The World Cancer Research Fund believes that at least one-third ofcancers can be prevented. This can be done by eating the right food,taking regular exercise and avoiding obesity. They suggest 10 ways todo this.

>>> Preventing cancer or its recurrence1 Be as lean as possible without becoming underweight.

2 Be physically active for at least 30 minutes every day.

3 Avoid sugary drinks. Limit processed foods that are high in added sugar orlow in fibre or high in fat.

4 Eat a variety of fruit and vegetables, wholegrains and pulses (beans, peas).

5 Limit the amount of red meat (beef, pork, lamb) you eat. Eat no more than500g of cooked meat per week. Avoid processed meats (some sausages,black and white pudding, bacon, ham, cornbeef, salami).

6 Drink less alcohol. Limit it to 2 drinks for men and 1 drink for women a day.Have a few days free of alcohol each week.

7 Eat less salty foods, especially those processed with salt.

8 Avoid dietary supplements if you have a balanced diet. Some people mayneed supplements as advised by their doctor or dietitian.

9 Mothers should breastfeed fully for up to 6 months and then add otherliquids and foods.

10 Cancer survivors should follow the guidelines for cancer prevention. Also, get advice about your diet from a professional dietitian.

Remember do not chew or smoke tobacco.

Diet and cancer 15

Nutrition and treatmentWhat eating problems can I expect fromtreatment?Some cancer treatments can affect your appetite or how you eat. For example, how you chew, swallow and absorb food. Before anytreatment, your doctor and nurse will explain any likely side-effects.Sometimes it can be hard to know what kind of eating problems toexpect. It can depend on several things, for example: ■ Location of your cancer and if it has spread

■ Type of treatment given■ Area being treated■ Number of treatments■ Dose of treatment given

■ Length of treatment■ Symptoms caused by thecancer

■ Side-effects of treatment■ Your own general health

Referral to a dietitianCancer or the side-effects of treatment can reduce your appetite orcause weight loss. This can make you weak and tired, more prone toinfections or less able to tolerate treatment. Ask to be referred to adietitian if you are underweight or losing weight or have any concernsduring your treatment.

SurgeryIt is common to have some eating problems after surgery. Usuallymost people can start eating again a day or two after surgery.

If you have surgery to your digestive system, the eating problems maytake longer to clear up. This includes surgery to your mouth, tongue,throat, gullet (oesophagus), stomach, small intestine, bowel, rectum,pancreas, liver, and gallbladder.

>>> For support and advice on diet, talk to your dietitian.


Eating tips before chemotherapy■ Bring a light meal or snack with you. Some hospitals may offerfood and drink to you.

■ Eat something before treatment. Most people find a light meal orsnack goes down well.

See page 27 for more details about specific eating problems.

Probiotic foodsProbiotic foods should be avoided if you are having chemotherapy.For example, ‘live’ or ‘bio’ yoghurts and drinks. These foods containlive bacteria and could make you sick, especially if your white cellcount is low. Do ask your nurse and dietitian for more advice.

RadiotherapyRadiotherapy does not cause eating problems in general. But likechemotherapy, it can affect normal cells as well. Usually the affectedcells are only those in the area of the body being treated. How severethe eating problems are depends on the area being treated and forhow long.

Treatment of head and neck may cause:

■ Dry mouth■ Sore mouth■ Sore throat

■ Difficulty swallowing■ Taste and smell changes■ Dental problems

Treatment of lung, oesophagus or breast may cause:

■ Loss of appetite■ Nausea and vomiting■ Difficulty swallowing

■ Indigestion■ Increased phlegm (spit)

Treatment of stomach or pelvis may cause:

■ Loss of appetite■ Nausea and vomiting■ Diarrhoea

■ Cramping■ Bloating

■ Taste and smell changes ■ Loss of appetite ■ Sore mouth or throat ■ Nausea and vomiting

■ Diarrhoea ■ Constipation ■ Weight gain or loss

These problems can vary and depend on the drug, dosage and yourown response to it. Usually these problems clear up once treatmentends or soon after.

■ Feeling full■ Swallowing problems■ Loss of appetite ■ Nausea■ Vomiting

■ Cramping■ Diarrhoea ■ Constipation ■ Weight gain or loss

Some common eating problems include:

Because surgery may slow your digestion or affect your mouth, throatand stomach, you will need good nutrition. Good nutrition will helpyour wound to heal well and speed up your recovery. In some cases,you might need tube feeding after your surgery. See page 25 for moredetails about tube feeding.

Eating tips before surgery■ Your doctor, dietitian and nurse will decide if you need building up.This may be needed if you are malnourished through weight loss.

■ Follow the advice of your nurse about clearing your bowels andfasting.


ChemotherapyChemotherapy can affect normal cells as well as cancer cells. Normalcells that grow quickly are usually affected. These cells are found inyour gut and bowel. So at times you may lose your desire for food orbe less able to eat. Eating problems due to chemotherapy can include:


Are there any foods that can affect treatment?Some foods and drink might affect chemotherapy, hormone therapy or biological therapies. For example, alcohol, grapefruit or soy.

Alcohol: It is best to avoid alcohol, or at least reduce your intake,during chemotherapy or biological therapy. This is because somedrugs may affect treatment or else dehydrate you. Do ask your doctorfor advice. Alcohol may also irritate your mouth if you are receivingradiotherapy to your head, neck or chest region. Even small amountsfound in mouthwashes can hurt if your mouth is inflamed.

Grapefruit: It is uncertain if grapefruit interferes with some hormonedrugs used in the treatment of breast cancer. There is a link in theorythat it can affect the absorption rate of these drugs. For example,tamoxifen, Femara® and Aromasin®. In the absence of clear evidence,you might prefer to avoid grapefruit or grapefruit juice.

For most people, fruit juices are safe to drink and are a good source ofvitamin C. Some fruit juices like grapefruit, however, can also affectcertain antibiotics, cyclosporine used after transplants, and somedrugs used to treat heart disease. Do ask your doctor for advice. It isbest to take most medications with water, unless your doctor or nursetells you otherwise.

Soy products: In general, soy is a good source of protein and low insaturated fat. But it may affect certain hormone drugs, like tamoxifen,used in the treatment of breast cancer. Soy contains isoflavones,which are compounds very like the hormone oestrogen. Research is ongoing to find out if soy can affect oestrogen levels in the body.Soy should not be taken if you have hormone-sensitive breast cancerand are taking tamoxifen. Soy may also interfere with aromataseinhibitors used in breast cancer treatment. Do talk to your doctor andnurse about it.

Herbal products may also affect chemotherapy. See page 56 for moredetails.

Fatigue and appetite changes may also affect you during treatment. Youmay feel too tired to shop, prepare or eat food. After treatment, some ofthese problems may take longer to clear up. For your individual needs,do talk to your dietitian.

Eating tips before radiotherapy■ Eat something at least 1 hour before treatment.■ Bring foods or snacks to eat or drink on the way home.■ Eat small frequent meals with fluids if you are having eating problems.


Biological therapy (immunotherapy)Biological therapies use your immune system to fight cancer cells.Because your immune system is working harder, it can affect yourdesire or ability to eat.

Common eating problems are:■ Loss of appetite■ Dry mouth ■ Sore mouth ■ Taste and smell changes

■ Nausea and vomiting ■ Diarrhoea ■ Weight loss ■ Too tired to eat due to feverand aching muscles

Some of these eating problems go away after the first few doses of thedrug or once treatment is over. If your blood count is low due toimmunotherapy, see page 49 for more about low bacteria diets.


Hormone therapySome types of hormone therapy can affect your appetite and changehow your body deals with fluids. It can cause:■ Increased appetite■ Excess fluids in your body (fluid retention)

These problems usually go away once treatment is over. See page 27 for more details about specific eating problems.



Severe weight loss Sometimes severe weight loss (cancer cachexia) can happen due tocancer itself or its treatment. This is where there is severe loss ofappetite, weight loss, loss of strength and muscle mass. If thishappens, there are ways to improve it. Your dietitian and nurse willdiscuss these with you. See page 36 for more details.

What foods contain energy and protein?■ Carbohydrates – a good source of energy■ Fats – high in energy■ Proteins – help your body to repair itself after illness or treatmentand fight infection

■ Vitamins and minerals – help your body to use the foods you eat

Talk to your doctor or dietitian before taking any vitamin or mineralsupplement, as it may interfere with your treatment.

How can I build myself up?During diagnosis, your nurse will talk to you about your eating habits.He or she can discuss any recent weight loss as well. This will includechecking your weight and height. You can also talk about any eatingproblems you have or have had, or any situations where you find ithard to eat. If you live alone or need someone to prepare food, it canbe arranged before you go home.

Building yourself upIf you are underweight, have lost weight unintentionally and have apoor appetite, you may need to build yourself up. Information is givenhere on how to increase the amount of energy and protein in yourdiet. If you have illnesses other than cancer, do talk to your doctor,nurse or dietitian for specific advice.

To deal with poor appetite and weight loss, your doctor, nurse ordietitian may advise you to follow a diet high in protein and energy.This may be confusing as it might seem unhealthy, but you need tofocus on building up your strength. This will help you to deal withthe effects of cancer and treatment. You will also be less prone toinfection.

>>> A diet high in protein and energy may sound unhealthy butyou will need it to build up your strength.

Carbohydrates Fats Proteins Vitamins and minerals

BreadCerealsPotatoesRicePastaSconesCrackersCakesBuns and biscuits

ButterMargarineOilFull-fat milkFull-fat yoghurtFull-fat cheeseCreamEggsFromage fraisNutsSalad dressingMayonnaise

MeatChickenFishEggsMilkCheeseYoghurtNutsPulses (peas,beans, lentils) Many nourishingdrinks

Dried, tinned orfrozen fruit andvegetablesSmoothies madewith fruit andyoghurt or fruitand ice creamMeatChickenFishEggsCheeseMilk and yoghurt

§ To sum up■ Eating problems can depend on many things like the type of cancer andtreatment, and the number and dose of treatments.

■ Common eating problems are loss of appetite, dry or sore mouth, taste andsmell changes, difficulty swallowing, nausea and vomiting, diarrhoea andconstipation.


There are many types of drinks available, for example, Fortisip®, EnsurePlus®, Complan®, Build-Up® and Fresubin® Energy. There are alsodrinks for cancer patients like ProSure®, FortiCare® and Supportan® thathave fish oils to improve severe weight loss (cachexia). If you haveproblems swallowing, there are also puddings and powders to thickenfood or drinks. Your dietitian will tell you which ones are suitable foryou. Some build-up drinks are not suitable if you have diabetes, kidneyfailure or other medical disorders. You can buy build-up drinks inpharmacies and some supermarkets, or your doctor may prescribe themfor you.

Over time the protein and calories in these drinks can help you put onweight. Also, your energy levels may improve and make you feel better.

Increasing energy and proteinHere are some ways to increase your levels of energy and protein.

1 Eat more nutritious snacks and meals during the day. For example,eat six times a day.

2 For extra energy and protein, add the following to your food:■ Butter or margarine■ Milk■ Cream■ Cheese

■ Dressings, sauces andgravies

■ Honey, jam and sugar■ Fry your food

3 Talk to your doctor, nurse or dietitian about nutritionalsupplements. For example, build-up drinks.

Build-up drinks and productsThere are other ways to help you if you are not getting enoughcalories and protein from your diet. You can get special drinks to giveyou nourishment. These are known as nutritional supplements. Mostare high in protein and have extra vitamins and minerals. Some drinkscan be added to food. Others are ready-to-drink and come in a varietyof flavours. They may be based on juices, yoghurts or milk. Thesedrinks should not replace your food but supplement your diet if youcannot eat well.

■ Baked potatoes with beans,cheese, tuna, crème fraiche

■ Breakfast cereal – hot or cold■ Beans■ Cheese■ Crackers■ Creamy soups or broth■ Custards■ Dips made with cheese or yoghurt■ Hot chocolate■ Ice cream■ Milk puddings

■ Milkshakes■ Mousse■ Muffins or scones■ Nuts■ Omelette ■ Quiche■ Sandwiches■ Sausages■ Scrambled eggs ■ Smoothies made with yoghurt■ Creamy soups or broth■ Yoghurt or fromage frais

Milky type Milky type Juicy type Yoghurt stylewith fibre

FortisipEnsure PlusFresubin Energy

Ensure Plus FibreFortisip MultifibreFresubin Energy Fibre

Fresubin JucyFortijuceEnsure Plus Juce

Fortisip Yoghurt StyleEnsure Plus Yoghurt Style

Liquid shot Milkshake style supplements supplements

Procal ShotCalogen

CalshakeScandishakeEnshakeComplanBuild Up Shakes

Swallowing Wound healing Supplements difficulties with fish oils

Ensure Plus CrèmeFresubin CrèmeForticreme Complete

CubitanEnsure Plus HP

ProsureFortiCareSupportan

Ready-to-drink complete supplements

Most of the companies that make supplement drinks have helpfulrecipe suggestions on their websites. For example, you can add build-up drinks to a scone recipe or jelly.

Nutritious snacks high in calories and protein


>>>

What if I cannot eat?Most cancer patients can get all their nutrients from their diet, or fromtheir diet and nutritional supplements. But if this is not possible ortoo difficult, your doctor and dietitian can decide to give you nutrientsanother way. They can be given through a feeding tube or straightinto a vein.

Tube feedingThe need for tube feeding will depend on your type of cancer orsurgery and your general health. After major surgery to the digestivesystem, you may not be able to eat normally at first. You may receivenutrients through a tube passed into your nose, stomach or smallbowel for a short while. Nutrients can also be given directly into yourstomach using a PEG tube.

Tube feeding can also be done if there is serious weight loss,swallowing difficulties, or when not enough nutrients are taken.

Feeding into a veinIn some cases, feeding may need to be given directly into a vein. Thisis called total parenteral nutrition (TPN). TPN is used if your gut isnot working properly or cannot be used for feeding. For example, ifthere is a blockage in your bowel or a large amount of bowel has beenremoved during surgery.

Your dietitian will talk to you about special feeding if it is needed.

Who can give me advice about my diet?There are many experts on the medical team who can give you andyour family advice about diet throughout your treatment andafterwards. Your surgeon can let you know what kind of problems toexpect from surgery and when it is safe to start eating again. Othermembers of the medical team, like dietitians, can give you plenty ofadvice on the type of foods to eat or avoid.

Sample meal plansHere are some sample meal plans that are high in protein and energy.They may give you ideas on how to plan your meals for the day.Remember to eat often if you have eating difficulties. Set aside a littletime every 3 hours to eat something. For snack ideas, see the centrepages of this booklet.

Breakfast

Fresh pineapple

Boiled egg on toast with butter – add lots of full-fat butter to toast

Lunch

Cream of mushroomsoup – add a dollop ofcream and herbs to thetop

Bread roll with butter –add full-fat butter to roll

Fromage frais – choosefull-fat variety

Dinner

Roast chicken

Jacket potato – add full-fat butter

Peas

Fresh fruit salad – addcream or ice cream

Breakfast

Fresh/tinned prunes

Bacon and egg – fry theegg

Bread – fry the bread oradd lots of full-fat butter

Lunch

Beans on toast – addcheese to the beans andfull-fat butter to toast

Banana – add cream

Dinner

Lamb chop

Roast potatoes – coatthe potatoes in oil beforecooking

Carrots and parsnips –mash with butter andcream

Apple pie and custard

Breakfast

Fresh fruit juice

Porridge – made withfull-fat milk, add somecream to porridge

Toast – add extra full-fatbutter to toast when hot

Lunch

Egg and cress sandwich– mix egg filling with full-fat mayonnaise

Yoghurt – choose thickand creamy or full-fatversions

Dinner

Mashed potatoes – addgrated cheese or full-fatbutter

Grilled/baked fillet ofcod – add fresh herbsand olive oil

Green beans

Sherry trifle – adddouble cream


Eating problems duringtreatmentSome of the common eating problems are listed here. Some advice on how to ease and cope with them is given. Do ask your dietitian,doctor and nurse for more advice, if you need it. Most of theseproblems go away once treatment has ended or soon afterwards.Others like dry mouth from radiotherapy may be permanent.Depending on the type of surgery you have, it may take some time for other eating problems to clear up.

See the centre of this booklet for useful foods high in protein andcalories. If you are a diabetic, vegetarian or vegan, talk to your dietitianabout how to get extra proteins and calories in your diet.

>>> Hints & Tips – shopping and cooking ■ When you are having treatment or recovering from it, get someone tohelp you with cooking and shopping or to take it over.

■ Accept all offers of help, even if you prefer to do things yourself.■ Find out if your local shops can deliver your shopping if you order it overthe phone.

■ If you or someone you know has internet access, order your shopping online from a supermarket.

■ Plan and prepare meals in advance.

Poor appetite■ Make the most of your appetite when it’s good. Eat when and whatyou want.

■ Take small meals and snacks about every 2–3 hours.■ Take snacks high in calories and protein.■ Keep snacks handy. Try cheese and crackers, sandwiches, muffinsor scones.

>>> Getting advice about my dietYour doctors may be able to give you some advice on diet. Some of the peoplelisted here can give you more specific help.

Dietitian This is an expert on food and nutrition mainly basedin hospitals. They are trained to give advice on dietduring illness and use diet to help symptoms. Theycan also give you advice as an outpatient. Yourdietitian may put you in touch with special servicesin the community too.

Speech and language This is an expert on eating, drinking and swallowing therapist difficulties. They are based in hospitals and in the

community and are trained to assess swallowingproblems. They can advise you on how to managedry or sore mouth and on the safest drinks and foodsfor you to swallow.

Clinical nurse specialist/ These are specially trained nurses who work in a oncology liaison nurse special cancer care unit. They can give you and your

family advice and support about cancer fromdiagnosis and throughout treatment, but also aboutyour diet and any eating problems. They can put youin touch with a dietitian too.

Helpline nurses These nurses are cancer information nurses at theIrish Cancer Society who can give you advice oneating problems and suggestions on suitable menus.Call them on freefone 1800 200 700.

Daffodil Centres Cancer information nurses are also found in DaffodilCentres in a number of Irish hospitals. They can alsogive advice on diet and cancer.

Medical social worker This is an expert at giving emotional support tocancer patients. They can help with benefits andentitlements too. If you live alone, they can organisea home-help to shop and prepare your meals.

Support groups Someone with a similar cancer and treatment asyours can give you practical advice about living withcancer. They may have useful tips about eatingproblems too.


■ Eat fresh fruit and vegetables rather than canned ones, if possible. ■ Try chewing fresh or tinned pineapple before meals to get rid ofbad tastes.

■ Use plastic utensils if you have a metallic taste while eating.

Sore mouth, gums or throat■ Take sips of fluids like water often. Drink through a straw if yourmouth is painful.

■ Eat soft, moist food like omelettes, scrambled eggs, mashedpotatoes, cream soups, natural yoghurt, milkshakes, stews,puddings.

■ Moisten dry or solid foods with sauces or gravies.■ Purée or liquidise foods, for example, fruit and vegetables, in ablender to make them easier to swallow.

■ Take cold foods and drinks like ice cream to soothe your mouth.■ Take care with the following as they can make a sore mouth orthroat worse:

— pickled, salty or spicy foods

— rough food, like crispy bread, dry toast or raw vegetables

— alcohol and tobacco

— citrus juices, like orange, lemon, lime, grapefruit or pineapple

— mouthwashes that contain alcohol or acidic ones.■ Take nutritious fluids like Complan®, Nesquik® or Build-Up®, anddesserts like yoghurt, ice cream, custard. Eating foods high inprotein and calories will quicken healing.

■ Keep your mouth fresh and clean. Try sucking on mango orpineapple chunks, but avoid them if they sting.

■ Rinse your mouth often with a salt and baking soda mouthwash.Add 1 teaspoon of baking soda and 1 teaspoon of salt to 1 pint ofwarm water.

■ Use special mouthwashes and gels often. Ask your nurse anddoctor about safe ones to use.

■ Use a soft toothbrush. Put it into a container of warm water tosoften the bristles.

■ Use a smaller plate for your meals. Large portions can be offputtingif your appetite is small.

■ Eat slowly and chew your food well.■ Take plenty of drinks like milk, juices and soups.■ Try nutritional supplements, like Complan®, Ensure Plus® orFortisip® or Fresubin® Energy, when it’s hard for you to eat food.Special high-calorie drinks can help to keep your strength up. Talkto your dietitian about suitable ones for you. Your doctor can alsogive you a prescription for these drinks.

■ Take only small sips while eating, as drinking might make you full.■ Encourage your family to eat together and make mealtimes relaxingand enjoyable.

■ Take regular exercise, if you can, as it may help your appetite. Freshair can help too.

■ Talk to your doctor about medications to help other problems, likeconstipation, nausea, pain or other side-effects of treatment, if theyaffect your appetite.

Taste and smell changes■ Eat foods that appeal to your taste buds and smell good.■ Keep your mouth clean by rinsing and brushing – it may improvethe taste of foods.

■ Eat food cold or at room temperature, if smells bother you.■ Hold off eating foods that no longer appeal to you. Try them againsome days or weeks later as you might enjoy them again.

■ Flavour foods with onion, garlic or herbs like mint and basil, if youfind food tasteless.

■ Marinate meat, chicken or fish to help the flavour.■ Try small-sized tasty sandwiches.■ Rinse your mouth with tea, saltwater or baking soda to help clearyour taste buds before eating.

■ Drink plenty of fluids.■ If liquids leave an unpleasant taste in your mouth, try drinkingdecaffeinated tea or coffee.


Difficulty swallowing■ Eat your favourite foods but soften them with sauces and gravies,where possible.

■ Try eating soft, liquid foods like soups, broths, milkshakes,custards, natural yoghurt. But vary them so you don’t get bored.Make sure soups and broths have potato, meat or fish in them forextra nourishment.

■ Thickened liquids can be easier to swallow. Your speech andlanguage therapist can advise you on how to alter your foods.

■ Chop up meat and vegetables finely for stews or casseroles.■ Blend or liquidise cooked foods.■ Eat small, frequent meals.■ Sit up as straight as possible for all your meals. Try to remainseated upright for 20–30 minutes after eating.

■ Take drinks high in calories and protein like Fortisip, Ensure,ProSure, Complan, Build-Up. Your dietitian can advise you aboutthese and your doctor may prescribe them.

■ Drink at least 6 to 8 cups of fluid each day.■ Ask your doctor to refer you to a speech and language therapist forspecial eating techniques.

Indigestion ■ Try to eat small frequent meals instead of large ones.■ Sipping some drops of peppermint oil in hot water may help torelieve any discomfort.

■ Herbal teas like mint or liquorice may help.■ Avoid fizzy drinks, alcohol, spicy foods, pickles and citrus fruits.■ Your doctor may prescribe an antacid like Gaviscon, Aludrox orMaalox to help.

■ If indigestion is worse at night, avoid eating or drinking for 3 to 4hours before bedtime.

■ Sit up after eating.

■ Ask your doctor and nurse for painkillers if your mouth is painful.They may prescribe some antiseptic or local anaesthetic gels orlozenges.

■ Visit your dentist regularly. He or she can give you advice aboutcaring for your mouth and special mouthwashes.

Dry mouth■ Take sips of fluids like water often. Sucking ice cubes or ice popsmay help too.

■ Drinking milk can help to protect your teeth. It is also a goodsource of protein and calories.

■ Eat soft moist food. Moisten your food with sauces or gravy.■ Rinse your mouth regularly, especially before and after meals.■ Avoid the following as they can dry out your mouth:

— salty and spicy foods

— alcohol and caffeine

— mouthwashes that contain alcohol or acidic ones.■ Take care with chocolate, pastry and freshly baked bread as theymay stick to the roof of your mouth.

■ Use special mouthwashes, gels and moisturisers often. For example,Biotène Oralbalance or BioXtra products. These contain salivaenzymes.

■ If you have thick saliva, rinse your mouth often with a baking sodamouthwash. Add 1 teaspoon of baking soda to 12 pints of water.

■ If your mouth has a bad taste due to dryness, rinse it before mealsor suck on pineapple chunks.

■ Brush your teeth after every meal or snack. Use a soft toothbrush.Put it into a container of warm water to soften the bristles.

■ Stimulate the flow of saliva with sugarless gum, boiled sweets orpastilles.

■ Keep your lips moist with Vaseline or a lip balm.


■ Try foods containing ginger, such as ginger ale or tea, ginger nutbiscuits, ginger cake or fresh ginger in hot water.

■ If you have severe nausea, avoid your favourite foods. You may endup hating them after severe bouts of nausea.

■ Ask a friend or family member to cook your meals if odours affect you.■ Ask your doctor and nurse about any anti-sickness medication youcould take. Take them as advised.

■ Relaxation exercises, acupuncture or meditation can sometimes helpto prevent nausea.

Vomiting■ Do not eat anything until the vomiting has stopped and is undercontrol.

■ When the vomiting is under control, try small amounts of clearliquids like water.

■ Carry on taking small amounts of liquid as often as you can keepthem down.

■ When you can keep down clear liquids, try a full liquid diet or a softdiet.

■ Ask your doctor and nurse about any anti-sickness medication youcould take. Take them as advised.

■ If you get sick shortly after radiotherapy or chemotherapy, avoideating for 1–2 hours before and after treatment.

■ A rest after meals may help prevent vomiting.■ Relaxation exercises or acupuncture can sometimes help to preventvomiting.

Cramping■ Eat and drink slowly. Small mouthfuls and chewing well can help. ■ Avoid food and drink that can cause wind or cramps like beer, beans,cabbage, garlic, spicy foods and sugar-free gum and sweets made withsorbitol.

■ Let fizzy drinks go flat before drinking them.

Feeling full■ Eat smaller meals often.■ As you begin to feel less full, gradually increase the amounts of foodand the time between meals.

■ Avoid foods high in fibre to prevent you feeling full very quickly. Forexample, large portions of fruit and vegetables, wholegrain rice andpasta and wholemeal bread.

■ Do not drink large amounts of liquids, especially fizzy drinks, justbefore mealtimes.

Nausea (feeling sick)■ If you have nausea during radiotherapy or chemotherapy, avoid eatingfor 1–2 hours before treatment.

■ Drink clear liquids to prevent getting dehydrated. ■ Take plenty of nourishing fluids if you miss a meal or two.■ Take fluids in between meals, as they may fill you up when eating.■ Eating little and often may help. Eat slowly and chew food well.■ Rest after your meals.■ Eat before you get hungry, as hunger can make nausea worse.■ If you are sensitive to the smell of hot food, try bland, cold foods. ■ Try the following foods and drink as they might help:

— fizzy drinks like mineral water, ginger ale, 7-Up or Sprite

—cold foods like yoghurt, dessert, boiled potatoes, rice, noodles,breakfast cereal or cheese

—dry food like toast, scones, crackers or breakfast cereals. This canhelp in the morning before you get up

—bland foods like breakfast cereal, bread or toast, soup and crackers,yoghurt, milk puddings, scones or sandwiches

—herbal teas like mint■ Avoid the following foods, as they may make nausea worse:

— fatty, greasy or fried foods

—spicy foods

—very sugary foods

—foods with a strong odour.

Diet and cancer 35

■ Take care with the following foods as they can make diarrhoea worse:

— fatty, greasy and fried foods

—gassy or fizzy drinks

—drinks with caffeine like coffee, tea, coke and hot chocolate

—citrus fruits, like orange and grapefruit, and tomato juices

—very hot or very cold fluids

—alcohol and tobacco

—foods containing sorbitol, the artificial sweetener. ■ Take live yoghurt or probiotic yoghurt drinks to replace any healthybacteria lost from your bowel. Avoid these if your white blood cellcount is low or if you have had a recent stem cell transplant. Checkwith your doctor and dietitian if you are unsure.

■ Call your doctor if the diarrhoea continues or gets worse, or if thestools are red or dark in colour.

Constipation■ Drink plenty of fluids. For example, 2 litres of water every day.■ Eat regular meals and at the same time each day.■ Eat foods high in fibre. For example, wholegrain cereals (All-Bran,Bran Flakes or Weetabix), wholegrain breads, brown rice, wholewheat pasta, pulse vegetables (peas, beans and lentils), beetroot, fruit,prune juice and other fruit juices.

■ Drink fig syrup or prune juice as they can help. ■ Drink hot or cold drinks.■ Aim to have a bowel motion at the same time each day.■ Get some gentle exercise.■ Ask your doctor for a suitable laxative, especially if you are takingpainkillers that cause constipation.

Fatigue (too tired to cook or eat)■ Prepare meals in advance when you have the energy. Freeze them forwhen you feel too tired to cook.

■ Take nourishing drinks for the times you do not feel like eating.

Diet and cancer34

■ Herbal teas like mint or liquorice may help.■ Gentle exercise like walking can ease cramps.

Bloating ■ Avoid gassy foods like beans, brussels sprouts, onions, celery, carrots,raisins, bananas, prune juice, apricots and wheatgerm.

■ Avoid gassy or fizzy drinks and beer.■ Eat and drink slowly and chew your food well.■ Don’t skip meals. ■ Eat 4 to 6 small meals spread out over the day. Avoid large meals.■ Add fibre to your diet slowly. For example, small amounts ofvegetables, fresh and dried fruits, and wholegrains. Fibre may makebloating worse for some people.

■ Try not to talk while eating. ■ Avoid chewing gum and sucking on hard sweets. ■ Do not smoke.■ Talk to your doctor and nurse to see if your medication or lactoseintolerance is causing the bloating.

■ Ask your doctor or nurse if any over-the-counter preparations can help.■ If you wear dentures, check with your dentist that they fit properly. ■ Exercise regularly if you can. Get at least 30 minutes of exercise eachday.

Diarrhoea■ Drink plenty of fluids to replace what you lose with diarrhoea. Takeliquids 30 minutes to 1 hour after your meal and/or between meals.

■ Eat small amounts of food during the day instead of three largemeals.

■ Avoid high-fibre foods temporarily. These include bran, wholegraincereals, nuts and seeds, beans and peas, dried fruits, raw fruits andvegetables.

■ Your doctor may prescribe something to control the diarrhoea. Takethis as advised.

Diet and cancer36

■ Buy ready-made meals like frozen meals, takeaways, tinned foods.■ Stock up on convenience foods.■ Ask family and friends to help you shop, prepare and cook food.■ Get enough rest. Nap during the day.■ Get some regular exercise, if possible, like walking.

Weight loss■ Make the most of your appetite when it is good.■ Take nourishing snacks high in calories and full of protein. ■ Take snacks about every 2–3 hours. Do not skip meals.■ Add calories to food. See the centre pages of this booklet forsuggestions.

■ Avoid drinking liquids before meals.■ Take only small sips at mealtimes, as fluids may make you full.■ Do not put too much food on your plate. It can be offputting if yourappetite is small.

■ Try nutritional supplements when you find it hard to eat food.■ Keep snacks handy. Try cheese and crackers, sandwiches, muffinsor scones.

■ Take special high-calorie drinks to help keep your strength up. Yourdoctor can give you a prescription for these drinks.

■ Encourage your family to eat together and make mealtimes relaxingand enjoyable.

Severe weight loss (cancer cachexia)■ Your dietitian will advise you on any special food and drinks totake.

■ Eat more protein and calories in your diet. ■ Eat smaller meals and often. ■ Do not skip meals and remember to take snacks frequently.■ Add cream or butter to food to increase calories and protein. ■ Take drinks like juices, milk or sweetened drinks. ■ Add diced meat or cheese to sauces, vegetables, soups andcasseroles.

Z Cereals – hot or cold

Z Beans on toast

Z Cheese and crackers

Z Custards

Z Hot chocolate(make with milk)

Z Milk puddings

Z Milkshakes

Z Creamy soups

Z Yoghurt or fromage frais

Z Smoothies

Z Mousses

Z Sandwiches

Z Nuts

Z Omelettes

Z Quiche

Z Muffins or scones

Z Sausages

Z Scrambled eggs

Z Baked potatoes withbeans, cheese, tuna

Z Dips made with cheese or yoghurt

NutritiousSnacks

[ Pull-out menu suggestions

Z Water

Z Fruit juiceswithout fruitpieces

Z Clear broth

Z Consommé

Z Ice pops

Z Honey

Z Clear fizzy drinkslike flat 7-Up orSprite

Z Lucozade

Z Sports drinks

Z Strainedvegetable broth

Z Milk

Z Fruit juices

Z Fruit nectars

Z Fruit purée

Z Fresh or frozenyoghurt

Z Milkshakes

Z Smooth ice cream

Z Liquidised soup

Z Tomato juice

Z Vegetable juice

Z Build-up drinks

Z Soft custard

Z Drinking chocolate

LiquidsClear liquids

Full liquids


Z Omelette or scrambledegg

Z Baked egg custard

Z Egg mayonnaise

Z Creamed soups

Z French toast

Z Baked beans with grated cheese

Z Tinned spaghetti withgrated cheese

Z Macaroni cheese

Z Cauliflower with cheese

Z Casseroles or stews

Z Shepherd's pie or cottage pie

Z Bolognaise sauce

Z Lasagne

Z Savoury mince

Z Pasta with creamy tomato sauce

Z Soft poached or flaked fish in sauce

Z Salmon mousse

Z Fish and potato in acreamy sauce

Z Mashed carrots with honey and cream

Z Vegetables mashed with butter and melted cheese

Z Chicken in cream sauce

Z Quiche

Z Jacket potato withbutter, grated cheese or cream cheese

Z Dips like hummus,pesto, guacamole, cream cheese

Nutritious Meals

Diet and cancer 41

■ Choose nourishing snacks like yoghurts, milk puddings, cereal withmilk, or crackers and cheese. Or take snacks high in calories like nuts,sweets and dried fruits during the day.

■ Take nutrition supplements like milkshakes and build-up drinks. ■ Eat more fats. Add cream, butter or margarine to breads andvegetables. Add lots of gravies and sauces to your foods.

■ If you cannot digest fat, talk to your dietitian about other sources offat. They may advise you on suitable supplements to take.

Too much weight gainCaused by medicationSome weight gain during treatment may be caused by medications likesteroids. Once the steroids are stopped, you will have less of an appetiteand lose any weight gained.■ Eat lots of fruit and vegetables. Juice your vegetables if you prefer.■ Eat wholegrain starchy foods like brown bread, pasta, potatoes (withskins), high-fibre breakfast cereals and brown rice, so you feel full.Try to choose the high-fibre varieties.

■ Choose lean meat (beef or pork without the fat, skinless chicken).■ Take low-fat diary products like low-fat milk or diet yoghurt.■ Avoid sweets, biscuits and cakes, and snacks between meals.■ Avoid fried foods. Grill or steam your food instead.■ Get more exercise, if possible.■ Talk to your dietitian if you are worried about the amount of weightgained.

■ Don’t diet without getting the advice of your doctor and dietitian first.

Caused by extra fluids Some weight gain during hormone therapy or chemotherapy may becaused by extra fluid in your body. This holding on to extra water isknown as fluid retention or oedema.■ Limit the amount of salt you take, if advised by your doctor or dietitian.■ Only take water pills (diuretics) prescribed by your doctor.

Z Add butter or margarineto soups, mashed andbaked potatoes, sauces,cooked vegetables, rice.

Z Add whipped cream todesserts, puddings andfruit. Add it unsweetenedto mashed potatoes and puréed vegetables.

Z Add milk or cream tosoups, sauces, puddings,custards, cereals. Usecream instead of milk in recipes.

Z Add cheese to casseroles,potatoes, vegetables,omelettes, sandwiches. Melt where possible.

Z Add chopped hard-boiledeggs to salads,vegetables, casseroles.

Z Sauté or fry foods if you can tolerate them.

Z Add sauces or gravies to your food.

How to increase

calories

How to increase

proteinZ Eat more hard and softcheeses. Add them to foodwhere possible.

Z Use milk instead of wateras a drink and in cookingwhenever possible. Usefull-fat milk.

Z Take build-up drinks.

Z Add ice cream or yoghurtto drinks, fruit and cereals.

Z Add eggs to your foodwhenever possible. Avoidraw eggs.

Z Add nuts, seeds and wheatgerm to your food. Add tocasseroles, salads, breads,biscuits.

Z Add chopped meat or fishto vegetables, salads,casseroles, soups, bakedpotatoes.

Z Eat more beans and peas.Add to soups andcasseroles.

Diet and cancer 43

Nutrition after treatmentGetting back to healthy eating Once your treatment is over, ask your doctor if there is any food youshould avoid in future. Your dietitian can help you plan somebalanced diets.

It may take some time before you feel back to normal. Don’t feel youshould prepare home-cooked meals straightaway.

Staying healthy and preventing cancer returning■ Be as lean as possible without becoming underweight.■ Be physically active for at least 30 minutes every day. This isespecially important if you have or had breast or colon cancer. Ifyou are overweight, take more exercise and eat less fat. Check withyour doctor or dietitian before you start any exercise programme.

■ Avoid sugary drinks. Limit processed foods that are high in addedsugar or low in fibre or high in fat.

■ Eat a variety of fruit and vegetables, wholegrains and pulses(beans, peas).

>>> Preparing meals■ Make simple meals using easy-to-prepare recipes.■ Buy some prepared foods to make cooking easier.■ Stock up on your favourite foods so you can shop less often. ■ Buy foods you are able to eat even when ill.■ Cook enough for two or three meals. ■ Freeze foods in meal-sized portions.■ Think about ways you used to make mealtimes special and try themagain.

■ Don’t be afraid to ask a friend or family member for help with cookingor shopping.

■ Ask the medical social worker in your hospital to arrange a home helpfor you if you live alone.

Diet and cancer42

Other problemsThere are a number of other problems that can happen due to cancertreatments, especially surgery. These include:■ Problems digesting nutrients, especially fat■ Rapid passage of food through your gut or dumping syndrome■ Losing too much fluid from your ileostomy■ Enteritis (inflammation of your small bowel)

If you have any eating problems that are not covered in this booklet,speak to your doctor, nurse or dietitian for individual advice. You canalso call the National Cancer Helpline on 1800 200 700 or visit aDaffodil Centre and speak to a specialist nurse. For problems relatingto stomach cancer surgery, ask for a copy of the bookletUnderstanding Cancer of the Stomach. For bowel surgery problems, thebooklet Understanding Cancer of the Bowel might be useful for you.

>>> Hints & Tips – general guide to eating and drinking■ Eat a balanced and varied diet.■ Eat smaller meals and often.■ Eat food that you enjoy and can eat with family and friends.■ Check with your doctor and nurse if you can drink alcohol.■ Be careful about avoiding certain foods because you think they areharmful. For example, red meat. If you avoid dairy products such as milk,yoghurt and cheese, you will exclude the main sources of calcium inyour diet. Avoid them only if advised by your dietitian.

■ If you eat too many high-fibre foods, like fruit and vegetables, it cancause bloating and diarrhoea.

■ There is no proof that organic foods are better than non-organic foods.In general, organic foods are more expensive.

■ If you have specific eating problems related to another medicalcondition, discuss them with your dietitian.


Nutrition and advanced cancerSupport for eating problemsIf you have advanced cancer, you will have different needs. The aim willbe to treat your symptoms and make you comfortable rather than curethe cancer. This type of care is called palliative care. Many people withadvanced cancer find that they lose weight and that their appetitebecomes smaller. This can be due to side-effects of treatment, symptomsof cancer or due to the cancer itself. You may find for example that theamount of food you eat or the type of food that you like changes fromday to day or from hour to hour for no reason. So it is important to eatthe foods that you most enjoy and aim to have small meals when you feelable to eat. Do discuss changes in appetite and weight with your doctor,nurse or dietitian. A dietitian can help improve your comfort at mealtimes.

>>> Hints & Tips – good nutrition for advanced cancer■ Choose food and drinks you enjoy and that you can tolerate.

■ If you feel unable to manage large meals, aim to have a smallmeal or snack every 2‒3 hours. Snack on foods like cereal, soup,milk, yoghurt, milky puddings, trifle, mousse, desserts, soft cake,cream crackers, scrambled eggs, ice cream, bread or toast, chocolate orbiscuits.

■ If you find large meals offputting, try having smaller meals on a small plate.

■ If you cannot manage dinner or a main meal, aim to have a smaller meal orsnack instead. For example, a small sandwich or dessert, or bread withbutter or soup, or cheese on crackers or biscuits and tea.

■ If you find eating is hard work, try soft food so you do not need to chew. For example, porridge, soup, stew or casserole, poached fish, ice cream,stewed fruits, bananas, custard or milk puddings, jelly, mousse, trifle orscrambled eggs.

■ If you cannot eat food, try taking yoghurt drinks, milkshakes, smoothies orbuild-up drinks. Talk to your dietitian, doctor or nurse about these drinks.

■ If you find preparing food makes you tired, try to use ready-made meals ortinned or frozen foods. Ask your nurse about Meals on Wheels. Accept helpfrom family members and friends as well.

■ Limit the amount of red meat (beef, pork, lamb) you eat. Eat nomore than 500g of cooked meat per week. Avoid processed meats(some sausages, black and white pudding, bacon, ham, cornbeef,salami).

■ Drink less alcohol. Limit it to 2 drinks for men and 1 drink forwomen a day. Have a few days free of alcohol each week.

■ Eat less salty foods, especially those processed with salt.■ Avoid dietary supplements if you have a balanced diet. But takethem if advised by your doctor or dietitian.

■ If you are breastfeeding, do it completely for up to 6 months andthen add other liquids and foods.

■ Follow the above guidelines for cancer prevention. Also, get adviceabout your diet from your dietitian.


Talking about the importance of food can be upsetting for those whohave advanced cancer. Try not to get upset if they do not eat yourcarefully prepared meals. Instead talk about what type of foods theywould prefer and offer these in small amounts. Focus on theirenjoyment of food rather than the amount of food they are eating. If they have lost a lot of weight, it can help to get clothes in a smallersize. Do check that their dentures still fit as well.

Pressure to eatSometimes family members and carers can put pressure on you to eator they might watch what you do eat. You might find this upsetting. Itmight even put you off your food. Remember your family or careronly does this out of love and concern for you. Do tell them that youappreciate their efforts.

Do not worry that you are upsetting your family and friends if you donot eat. But it can help to talk to them about how you are feeling. Forexample, let them know if your appetite is poor and ask them to bringyou the foods you enjoy but in small amounts.

>>> Tips for carersWhen your friend or loved one is ill, it is natural to want to feed them as wellas possible. Sometimes this is not so easy. Difficulty in eating is a problemfaced by many people with advanced cancer. Here are some things toconsider at this time:

■ Ask what foods they would prefer to eat.

■ Don’t force them into eating and drinking. Encourage without beingpushy.

■ Expect that their food tastes will change from day to day. They may go offtheir favourite food or else try something that was not tolerated the daybefore.

■ Have a variety of snacks in the house so that if a meal is refused you canoffer something else. Discuss what type of snacks they would prefer.

■ Put small amounts of food on a small plate so the amount is notoverwhelming.

■ Offer small, frequent meals and snacks every 2 hours.

■ Offer soft or liquid foods if they are having problems swallowing.

■ Present food in an attractive way.

■ If they cannot eat, encourage plenty of fluids.

■ Avoid liquids with meals to prevent them feeling full, unless needed tohelp with dry mouth and swallowing.

■ Ask the dietitian for advice on suitable foods, build-up drinks andproducts.

Diet and cancer 49

Other diets and supplementsLow bacteria dietsMost cancer patients do not have to worry about low bacteria diets.Usually, basic food hygiene is enough to prevent you getting any bugs.But some patients may have a low white cell count due to their canceror treatment. As a result, you may be at risk of getting infections likefood poisoning. It is best to avoid the following foods:

■ Raw or lightly cooked eggs

■ Coleslaw■ Unpasteurised cheeses like Brie, Camembert, Feta, Stilton, Blue,Roquefort

■ Pâté

■ Shellfish

■ Homemade mayonnaise

Probiotics contain live bacteria so it is best to avoid these until yourwhite cell count is normal. Probiotics are found in live or bio yoghurtsand drinks. Your doctor, nurse and dietitian can give you more adviceon precautions if your blood count is low.

Ways to prevent food poisoning■ Wash your hands before and after you handle any food.

■ Avoid unpasteurised milk and dairy products. For example, anycheese, milk, yoghurt that has not been pasteurised.

■ Never eat any vegetable, fruit or bread that has signs of mould.

■ Take special care when handling raw meats, fish, poultry and eggs.

■ Avoid probiotic, live or bio dairy products.

■ Cook meat and eggs fully. Avoid raw and undercooked meat,poultry, fish, shellfish or eggs.

■ Wash all raw fruits and vegetables well. Avoid them if they cannotbe washed well.

■ Avoid tinned food if there are any bulges on the tin.

■ Store raw meats and ready-to-eat foods separately.


Low-sugar dietThere are many myths about cancer and one of them is that ‘sugarfeeds cancer’. Sugar in your diet does not directly increase your risk ofcancer, or help it to grow. But sugar contains no nutrients needed by thebody, apart from energy, and we can get all the energy we need fromhealthier sources. So it is best to limit the amount of sugar in your dietand eat a well-balanced diet as outlined in the food pyramid on page 8.

If you are taking steroids while on chemotherapy or have diabetes, yourblood sugars will be checked often. Again, you should eat a well-balanced diet, as advised by your dietitian. If there are any changes toyour blood sugars, your dietitian and nurse will advise you on your diet.

Taking supplementsMost people get all the nutrients they need from a balanced and varieddiet. Unless you are having problems after treatment, supplements likeiron or multivitamins are usually not needed.

Some people with cancer take large amounts of supplements to boosttheir immune system. Or they may take them in the hope of killingcancer cells. There is no proof that this will happen. Some of thesesubstances can be harmful. In fact, large doses of some vitamins andminerals may make chemotherapy and radiotherapy work less well.

■ Thaw meat in the fridge and not on the kitchen counter.

■ Do not eat food left out at room temperature for longer than 90minutes.

■ Check use-by dates on all foods and drinks. Do not eat foods ordrinks that are out of date.

■ Keep kitchen surfaces and utensils clean and wash chopping boardsin warm soapy water after use.

■ Clean your fridge and cupboards often. Get help from a familymember or friend if you have no energy for cleaning.

■ If you are feeling unwell, do not prepare foods for others.

Other dietsIf you have cancer, you may feel that you should be following aspecial diet. But there is no one 'superfood' or special diet that hasbeen proven to control cancer or reduce your risk of it coming back.Cutting out important parts of a normal diet is not advised. Too muchof any one food is not helpful either and may even be harmful. Whilefruit and vegetables are good for you, large amounts can cause bowelproblems. They can make you too full to eat other foods that areneeded to provide energy and protein.

Be careful about following diets that claim to ‘fight’ cancer. Many ofthese diets are restrictive. This means that certain food items must beavoided and will cause unwanted weight loss.

After a cancer diagnosis, some people may decide to stop eating dairyproducts or take less calcium. While it may be good to eat a low-fatdiet in general, it is not good to cut out all sources of fat and proteinin your diet. Ask your dietitian for advice first. You can also call theNational Cancer Helpline on 1800 200 700 for more information. Askfor a copy of Understanding Cancer and Complementary Therapies: A Guide for Cancer Patients.

Should I change my diet?Each person will have their own special nutrition needs. For thatreason, it is best to talk to your doctor or dietitian about the foodsyou should be eating or avoiding. If your appetite is normal and you havenot lost any weight, the best advice is to eat a balanced and varied diet. It isalso not wise to experiment with diets during chemotherapy or radiotherapy.During chemotherapy, you may feel fatigued, lose your appetite and energy.You will need plenty of nutrition and calories to keep your strength up. Somecancer treatments may cause you to put on weight. It is best not to try tolose this extra weight until all your treatments are finished.

>>> Avoid special diets because you are likely to lose weight.

i


Mineral therapyMinerals are nutrients needed by your body in small amounts to helpit work properly and stay strong. Examples include iron, calcium,potassium and sodium. Some Ayurvedic and Traditional ChineseMedicine remedies may contain lead, mercury or arsenic at levels thatcould be harmful. These minerals might interact with medication youare taking as well. For that reason, tell your doctor about any herbalremedies you are taking. For those who have advanced breast cancerit may be best to avoid calcium supplements. Talk to your nurse ordietitian for more advice.

Taking soy productsSoybeans are native to Southeast Asia and can be taken in manyforms. This includes milk, tofu or texturised protein. It is believed thatsoy products can help to protect against some types of cancer becauseof the isoflavones found in them. Remember these substances are notsuitable on their own as a cancer treatment. But choosing foodscontaining soy can form part of a healthy diet because it is a goodsource of protein and low in saturated fat. Concentrated soy powdersor large quantities of soy products are not recommended.

Do talk to your dietitian if you have any questions about soy andcancer. Soy should not be taken if you have hormone-sensitive breastcancer and are taking tamoxifen. Soy may also interfere witharomatase inhibitors used in breast cancer treatment. See page 19 formore about soy products.

Let your doctor or nurse know if you are taking any dietarysupplements, no matter how safe you think they are. Be careful whatyou read in the newspapers or on the internet. Adverts may say thatsomething has been used for many years, but that does not prove it issafe or helpful. You do not need a prescription to buy dietarysupplements, but be careful and use common sense. Keep in mindthat just because a treatment is natural, it does not mean it isharmless.

Vitamin therapyVitamins are nutrients needed in small amounts for the normalgrowth and health of your body. Because the body does not makethem, they must be taken in in food. Multivitamin supplements canbe used safely as part of healthy eating, but may not be necessary. Itis best to take them at the recommended daily allowance (RDA).

Some people believe that large doses of vitamins can prevent or curecancer. But too much of any vitamin is not safe. This is true for thosewho are healthy too. High doses of vitamins can be toxic to the body.Vitamins are also known to have strong actions in the body. Forexample, high doses of vitamins may affect how chemotherapy andradiotherapy work.

Types of vitaminsVitamins are divided into two groups. There are four fat-solublevitamins (A, D, E and K) and nine water-soluble vitamins (eight Bvitamins and vitamin C). The fat-soluble ones are stored in your bodyand can be toxic when too much is taken. In general, the water-soluble ones are not stored in your body and so cause fewerproblems. Avoid all supplements if you are pregnant, unless advisedby your doctor. Discuss with your dietitian the dosage of vitamins youshould take.

Some vitamins may also affect chemotherapy drugs. For example,vitamin B9 supplements. These may interfere with some cancer drugs,such as methotrexate. It may also affect your white cell count afterchemotherapy. Too much vitamin C in particular can makeradiotherapy or chemotherapy work less well.

Staying healthyThere are many ideas today for staying healthy coming fromTV, the internet, magazines and by word of mouth. Naturally,things can get confusing, especially if you have a seriousillness. Before you make any changes to your diet, do discuss it with yourdoctor, nurse or dietitian.


Complementary and alternative dietsToday many patients are interested in complementary and alternativetherapies. A therapy is complementary when it is given along withconventional or standard medical treatments. Alternative is when thetreatment is given instead of conventional treatments. These therapiesinclude diet therapy, megavitamin therapy and herbalism. Most doctorsand health professionals do not believe that alternative diets can cure orcontrol cancer.

There are many types of cancer diets. Some believe they can improveyour well-being and also cure you. But be careful because there is noevidence that they do.

Many of these diets focus on eating fruit and vegetables and avoiding redmeat, sugar, caffeine, alcohol and dairy products. Most are low-caloriediets that cut out many important sources of protein and carbohydrates.And they may not be very tasty as well. You are likely to lose weight onthese diets. Too many high-fibre foods, like fruit and vegetables, can alsolead to bloating and diarrhoea. They can be expensive and harmful andthey are not advised if you are receiving cancer treatment.

Complementary or alternative diets may leave out some of thefollowing:■ Dairy foods

■ Red meat, poultry and eggs

■ Sugar

Complementary or alternative diets may include some of thefollowing:

■ High-fibre foods, fruit and vegetables

■ Organic foods

■ Vegetarian diets

■ Soya

Juicing: Juicing involves extracting juices from fresh fruit and uncookedvegetables. Juicing can add variety to the diet and can be a good way toconsume vegetables and fruit, especially if chewing or swallowing is aproblem. But juices may be less filling than whole vegetables and fruitsand can often have less fibre. Adding fresh fruit and vegetable juice to ahealthy, balanced diet can be useful but you should not replace mealswith juices. There is no evidence to show that extracted juices arehealthier than whole fruits and vegetables.

Ketogenic diet: The ketogenic diet is high in fat and low in carbohydrates,with moderate amounts of protein. The purpose of the diet is to producehigher levels of ketones in the blood, a state known as a ketosis. Thismeans that the body has to break down body fat for energy. There is noevidence to show that this diet can help cancer patients.

Alkaline diet: The alkaline diet is based on the belief that certain foodscan affect the pH of bodily fluids, and can therefore be used to preventor treat illness. It is not recommended for cancer patients because of alack of scientific evidence.

Before you try any diets, you should talk to your doctor, dietitian ornurse. For more information about diets, read Understanding Cancer andComplementary Therapies: A Guide for Cancer Patients. Call the NationalCancer Helpline on 1800 200 700 for a free copy, or visit a DaffodilCentre.

Examples of complementary and alternative diets Dairy-free diet: Many research studies have looked for a link betweendiets that are high in dairy products and cancer, especially breast andprostate cancer. But these studies have not shown a clear link. Becauseof this, cancer experts do not recommend following a dairy-free diet toreduce the risk of cancer. Dairy products are an important source ofprotein, calcium and some vitamins.

A note on genetically modified foods and organicfoodsGenetically modified (GM) foods are made from organisms whose geneticmaterial (DNA) has been changed in a way that does not occur naturally. Forexample, GM foods may have been changed to be more resistant to pests,slower to spoil or have better flavour. There is no evidence at this time thatGM foods are harmful or that eating them can increase or decrease yourcancer risk. Because GM foods have been available for a relatively short time,some people are concerned about their possible long-term effects.

Organic foods are produced using methods of organic farming. Somestudies claim that organic fruit and vegetables have better flavour and stay

Diet and cancer

■ Herbs may cure animals of cancer when tested in a laboratory. Butwhen tested on humans they do not have the same effects.

■ Some herbs may contain dangerous materials like lead and mercuryor hormones like phytoestrogens.

■ Some herbs may interact with your cancer or treatment in unknownways.

■ Taking some supplements may be good for you but finding accurateinformation about them may be hard.

57Diet and cancer56

>>> If you decide to use complementary oralternative therapies…Before you decide to change your diet and take supplements,be sure to talk to your doctor, dietitian or nurse. Some methodscan be safely used along with standard medical treatment. But others caninterfere with standard treatment or cause serious side-effects. For thatreason, it is important to talk openly with your GP or cancer specialist ifyou are thinking of having treatment with either a complementary oralternative practitioner. Don’t be afraid that your doctor will be offendedby your wish for other treatments. In fact, he or she may be able to advisea safe and useful therapy for you.

Be cautious in selecting a practitioner. Don’t be misled by promises ofcures. At present in Ireland, this area is not fully regulated. Ensure that thepractitioners you plan to visit are properly qualified and have a goodreputation. Check to see if they belong to a professional body or not. Ifyou are unsure but would like to know what other patients have foundhelpful, contact your doctor or a patient support group. Also, it isimportant to make sure that the practitioner is charging a fair price foryour treatment.

More information is available in a free booklet from the Irish CancerSociety called Understanding Cancer and Complementary Therapies: A Guidefor Cancer Patients. If you would like a copy or more advice, call theNational Cancer Helpline on 1800 200 700 or visit a Daffodil Centre if oneis located at your hospital.

Detox therapies Some people are a little uneasy about taking chemotherapy drugs. You may worry that toxins due to treatment will build up in yourbody. You may feel that your body needs to be ‘detoxed’ as a result. Be careful about deciding to have any therapies that claim to clean outyour bowel. These include colonic irrigation and metabolic therapyusing coffee enemas.

These treatments may be harmful if you have had surgery or have anybowel conditions. They can lead to dehydration, chemical imbalances,and infections. Ask your doctor, nurse or dietitian for advice beforetrying any detox therapy.

HerbsHerbs found in nature have been used to treat illness for centuries.Many of them are safe to use but others can have strong effects. Justbecause something grows naturally does not mean it is safe.Remember herbal remedies are also drugs. They can affect your bodyin many ways – known and unknown. Do ask your doctor, dietitian orpharmacist for advice before taking any herb.

Some people take herbs to boost their immune system or cure cancer.But these can interact with medicines you are taking, includingchemotherapy. They can sometimes cause severe allergic reactions.More research is needed to see if they have any positive effects.

Remember…■ Herbs that can help to prevent a disease may not have any benefitsonce you have the disease.

fresher for longer. But no research has been done to find out if an organicdiet can prevent cancer or stop it coming back, compared to a non-organic diet. Some people worry that pesticides used in non-organicfarming may cause cancer. In the EU, there are regulations on the use ofpesticides and laws to ensure that agricultural pesticides are used within asafe level.

Diet and cancer 59

Support resourcesIrish Cancer Society servicesThe Irish Cancer Society funds a range of cancer support services thatprovide care and support for people with cancer at home and in hospital.

■ Cancer Information Service (CIS)■ Daffodil Centres ■ Cancer support services■ Survivors Supporting Survivors■ Counselling

■ Night nursing■ Oncology liaison nurses■ Cancer information booklets■ Financial support■ Care to Drive transport project

Cancer Information Service (CIS)The Society provides a Cancer Information Service with a wide range ofservices. The National Cancer Helpline 1800 200 700 is a freefoneservice that gives confidential information, support and guidance topeople concerned about cancer. It is staffed by specialist cancer nurseswho have access to the most up-to-date facts on cancer-related issues.

These include prevention of cancer, risk factors, screening, dealing witha cancer diagnosis, different treatments, counselling and other supportservices. The helpline can also put you in contact with the varioussupport groups that are available. The helpline is open Monday toThursday from 9am to 7pm, and every Friday from 9am to 5pm.

■ The website www.cancer.ie provides information on all aspects ofcancer.

■ All queries or concerns about cancer can be emailed to the CIS [email protected]

■ Message Board is a discussion space on our website (www.cancer.ie)to share your stories, ideas and advice with others.

■ The CancerChat service is a live chatroom with a link to a CancerInformation Service nurse.

■ The walk-in caller service allows anyone with concerns about cancerto freely visit the Society to discuss them in private.

■ Find us on Facebook and follow us on Twitter (@IrishCancerSoc).


support in a safe and confidential environment. Call the helpline1800 200 700 to find out about counselling services provided by theIrish Cancer Society and services available in your area.

Night nursingThe Society can provide a night nurse, free of charge, for up to 10nights if you need end-of life care at home. The night nurse can alsogive practical support and reassurance to your family. You can findout more about this service from your GP, local public health nurse,a member of the homecare team or the palliative care services at thehospital. Homecare nurses can offer advice on pain control andmanaging other symptoms.

Oncology liaison nursesThe Society funds some oncology liaison nurses who can give youand your family information as well as emotional and practicalsupport. Oncology liaison nurses work as part of the hospital team inspecialist cancer centres.

Cancer information booklets and factsheetsOur booklets provide information on all aspectsof cancer and its treatment, while ourfactsheets deal with very specific topics.The booklets also offer practical adviceon learning how to cope with yourillness. The booklets and factsheets areavailable free of charge from the Irish CancerSociety by calling 1800 200 700. They can also be downloadedfrom www.cancer.ie or picked up at a Daffodil Centre.

Financial supportA diagnosis of cancer can bring with it the added burden of financialworries. In certain circumstances the Irish Cancer Society may beable to provide limited financial help to patients in need throughschemes such as Travel2Care and Financial Aid.

Daffodil Centres Daffodil Centres are located in a number of Irish hospitals. These havebeen set up by the Irish Cancer Society in partnership with eachhospital and are an extension of the Cancer Information Service. Theyare generally found near the main entrance of the hospital and areopen during the day. Staffed by a specialist nurse and trainedvolunteers, they provide a range of information, advice, help andsupport on all aspects of cancer, free of charge.

Daffodil Centres give you a chance to talk in confidence and belistened to and heard. If you are concerned about cancer, diagnosedwith cancer or caring for someone with cancer, you are welcome tovisit the centre. Do check to see if there is a Daffodil Centre in yourhospital.

Cancer support servicesThe Irish Cancer Society funds a range of services set up to supportyou and your family at time of diagnosis, throughout treatment andafterwards. See page 64 for more details.

Survivors Supporting SurvivorsBeing diagnosed with cancer can be one of the hardest situations toface in your lifetime. Survivors Supporting Survivors is a one-to-onesupport programme run by the Irish Cancer Society. It provides peersupport to people who have been diagnosed with cancer. All of thevolunteers have had a cancer diagnosis and have been carefullyselected and trained to give you support, practical information andreassurance when you need it most. You can speak to someone whoreally knows what you are going through. If you would like to makecontact with a volunteer, please call the National Cancer Helpline on1800 200 700.

CounsellingCoping with a diagnosis of cancer can be very stressful at times.Sometimes it can be hard for you and your family to come to termswith your illness. You might also find it difficult to talk to a closefriend or relative. In this case, counselling can give you emotional

>>>


Irish Cancer Society43/45 Northumberland RoadDublin 4Tel: 01 231 0500National Cancer Helpline: 1800 200 700Email: [email protected]: www.cancer.ie

The Carers AssociationMarket SquareTullamoreCo OffalyFreefone: 1800 240 724Email: [email protected]

Citizens Information Tel: 0761 07 4000Email: [email protected]: www.citizensinformation.ie

Get Ireland Active: Promoting PhysicalActivity in IrelandWebsite: www.getirelandactive.ie

HARI: The National Fertility CentreRotunda HospitalParnell SquareDublin 1Tel: 01 807 2732Email: [email protected]: www.hari.ie

Health Promotion HSEWebsite: www.healthpromotion.ie

All Ireland Co-operative OncologyResearch GroupWebsite: www.icorg.ie

Irish Nutrition & Dietetic InstituteAshgrove HouseKill AvenueDún LaoghaireCo DublinTel: 01 280 4839Email: [email protected]: www.indi.ie

Travel2Care: Travel2Care can help with your travel costs if you havegenuine financial hardship due to travelling over 50 kilometres to arapid access diagnostic clinic for tests or to a designated cancer centreor approved satellite centre for cancer treatment. The scheme isfunded by the National Cancer Control Programme (NCCP) andmanaged by the Irish Cancer Society. Travel2Care can help with someof the costs of public transport, such as trains or buses, privatetransport costs, or petrol expenses.

If this applies to you, contact the medical social work department inyour hospital or speak to your cancer care nurse. You can also contactthe Irish Cancer Society on (01) 231 6643 / 231 6619 or email:[email protected]

Financial Aid: A special fund has been created to help familiesexperiencing financial difficulty as a result of cancer. If this applies toyou, contact the medical social work department in your hospital. Youcan also speak to your cancer care nurse or contact the Irish CancerSociety at (01) 231 6619.

Care to Drive transport projectCare to Drive is a scheme operated by the Irish Cancer Society. Itprovides free transport for patients to and from their treatments usingvolunteer drivers. All of the volunteers are carefully selected, vettedand trained. You are collected from your home, driven to yourappointment and brought back home again. Call (01) 231 0522 to findout if Care to Drive is available in your hospital.

Useful organisations Irish Oncology and HaematologySocial Workers GroupWebsite:http://socialworkandcancer.com

Money Advice and Budgeting Service(MABS)Commercial HouseWestend Commercial VillageBlanchardstownDublin 15Tel: 01 812 9350Helpline 0761 07 2000Email: [email protected]: www.mabs.ie

Health insurersAVIVA HealthPO Box 764TogherCorkTel: 1850 717 717Email: [email protected]: www.avivahealth.ie

GloHealthPO Box 12218Dublin 18Tel: 1890 781 781Email: [email protected]: www.glohealth.ie

Laya Healthcare Eastgate RoadEastgate Business ParkLittle IslandCo CorkTel: 021 202 2000LoCall: 1890 700 890Email: [email protected]: www.layahealthcare.ie

If you would like more information on any of theabove services, call the National Cancer Helpline on1800 200 700.


Roscommon Cancer Support GroupVita House Family CentreAbbey StreetRoscommonTel: 090 662 5898Email: [email protected]

Sligo Cancer Support Centre44 Wine StreetSligoTel: 071 917 0399Email: [email protected]: www.sligocancersupportcentre.ie

Tuam Cancer Care CentreCricket CourtDunmore Road TuamCo GalwayTel: 093 28522Email: [email protected]: www.tuamcancercare.ie

Leinster support servicesAoibheann’s Pink Tie[Supporting children with cancer]Unit 22Docklands Innovation Centre128–130 East Wall RoadDublin 3Tel: 01 240 1300 Email: [email protected] Website: www.aoibheannspinktie.ie

ARC Cancer Support CentreARC House65 Eccles StreetDublin 7Tel: 01 830 7333Email: [email protected]: www.arccancersupport.ie

ARC Cancer Support CentreARC House559 South Circular RoadDublin 8Tel: 01 707 8880Email: [email protected]: www.arccancersupport.ie

Voluntary Health Insurance (VHI)IDA Business ParkPurcellsinchDublin RoadKilkennyCallSave: 1850 44 44 44Email: [email protected]: www.vhi.ie

National support servicesSurvivors Supporting SurvivorsIrish Cancer Society43/45 Northumberland RoadDublin 4National Cancer Helpline: 1800 200 700Email: [email protected]: www.cancer.ie

ARC Cancer Support Centres Dublin[See page 65]

Canteen Ireland [Teenage cancer support]Carmichael CentreNorth Brunswick StreetDublin 7Tel: 01 872 2012Email: [email protected]: www.canteen.ie

Cancer Support Sanctuary LARCC[See page 66]

Connaught supportservices Athenry Cancer CareSocial Service CentreNew LineAthenryCo GalwayTel: 091 844 319 / 087 412 8080Email: [email protected]: www.athenrycancercare.com

Ballinasloe Cancer Support CentreMain StreetBallinasloeCo GalwayTel: 090 964 5574Email: [email protected]

Cara Iorrais Cancer Support Centre2 Church StreetBelmulletCo MayoTel: 097 20590 / 087 391 8573Email: [email protected]

East Galway & Midlands Cancer Support Cluain MhuireBrackernaghBallinasloeCo GalwayTel: 090 964 2088 / 087 984 0304Email: [email protected] Website: www.eastgalwaycancersupport.com

Gort Cancer Support GroupGarrabegGortCo GalwayTel: 091 648 606 / 086 172 4500Email: [email protected]: www.gortcancersupport.ie

Hand in Hand[Childhood cancer in west and northwest] Oranmore Business ParkOranmoreCo Galway Tel: 091 799 759Email: [email protected]: www.handinhand.ie

Mayo Cancer Support AssociationRock Rose House32 St Patrick’s AvenueCastlebarCo MayoTel: 094 903 8407Email: [email protected]: www.mayocancer.ie

Arklow Cancer Support Group25 Kings HillArklowCo WicklowTel: 0402 23590 / 085 110 0066Email: [email protected]: www.arklowcancersupport.com

Balbriggan Cancer Support GroupUnit 23, Balbriggan Business ParkHarry Reynold’s RoadBalbrigganCo DublinTel: 087 353 2872 / 086 164 2234

The Bella Rose FoundationMerry Maid HouseWest Park CampusGarter’s LaneCitywestDublin 24Tel: 087 320 3201Email: [email protected]: www.bellarose.ie

Bray Cancer Support & InformationCentreAubrey CourtParnell RoadBrayCo WicklowTel: 01 286 6966Email: [email protected]: www.braycancersupport.ie

Cara Cancer Support Centre7 Williamson’s PlaceDundalkCo LouthTel: 042 937 4905Mobile: 087 395 5335Email: [email protected]: ccscdundalk.ie

Cois Nore Cancer Support Centre 8 Walkin StreetKilkenny Tel: 056 775 2222Email: [email protected]: www.kilkennycancersupport.ieFor other support services in your area, call 1800 200 700.


Cork ARC Cancer Support HouseCliffdale5 O’Donovan Rossa RoadCorkTel: 021 427 6688Email: [email protected]: www.corkcancersupport.ie

Kerry Cancer Support Group124 Tralee Townhouse ApartmentsMaine StreetTraleeCo KerryTel: 066 719 5560 / 087 230 8734Email: [email protected] Website: www.kerrycancersupport.com

Recovery Haven5 Haig’s TerraceTraleeCo KerryTel: 066 719 2122Email: [email protected]: www.recoveryhavenkerry.com

Sláinte an Chláir: Clare Cancer SupportTír MhuireKilnamonaEnnisCo ClareTel: 1850 211 630 Email: [email protected]: www.clarecancersupport.com

South Eastern Cancer FoundationSolas CentreWilliamstownWaterfordTel: 051 304 604 Email: [email protected]: www.solascentre.ie

Suaimhneas Cancer Support Centre2 ClonasleeGortland RoeNenaghCo TipperaryTel: 067 37403 Email:[email protected]

Cuisle Cancer Support CentreBlock RoadPortlaoiseCo LaoisTel: 057 868 1492Email: [email protected]: www.cuislecentre.com

Dóchas: Offaly Cancer Support GroupTeach DóchasOffaly StreetTullamore Co OffalyTel: 057 932 8268Email: [email protected]: www.dochasoffaly.ie

Éist Carlow Cancer Support Centre The WaterfrontMill LaneCarlowTel: 059 913 9684Mobile: 085 144 0510Email: [email protected]: www.eistcarlowcancersupport.ie

Gary Kelly Cancer Support CentreGeorge’s StreetDroghedaCo LouthTel: 041 980 5100Email: [email protected]: www.gkcancersupport.com

Greystones Cancer SupportLa Touche PlaceGreystonesCo WicklowTel: 01 287 1601Email: [email protected] Website: www.greystonescancersupport.com

Hope Cancer Support Centre22 Weafer StreetEnniscorthyCo WexfordTel: 053 923 8555Email: [email protected]: www.hopesupportcentre.ie

Cancer Support Sanctuary LARCCCoole RoadMultyfarnhamMullingarCo WestmeathTel: 044 937 1971CallSave: 1850 719 719Email: [email protected]: www.cancersupport.ie

Rathdrum Cancer Support CentreSt Anne’sLower StreetRathdrumCo WicklowTel: 087 292 8660Email: [email protected]

Tallaght Cancer Support GroupTrustus House1‒2 Main StreetTallaghtDublin 24Tel: 086 400 2736Email: [email protected]: tallaghtcancersupport.com

Wicklow Cancer Support CentreRear of Butler's Medical HallAbbey StreetWicklowTel: 0404 32696Email: [email protected]

Munster support servicesCancer Information & Support CentreUniversity Hospital LimerickDooradoyleCo LimerickTel: 061 485 163Website: www.midwesterncancercentre.ie

CARE Cancer Support Centre14 Wellington StreetClonmelCo TipperaryTel: 052 618 2667Email: [email protected]: www.cancercare.ie

Suir Haven Cancer Support CentreClongour RoadThurlesCo TipperaryTel: 0504 21197Email: [email protected]

Youghal Cancer Support Group161 North Main StreetYoughalCo CorkTel: 024 92353Email:[email protected]

Ulster support servicesCoiste Scaoil Saor ó AilseC/O Ionad Niomh PadraigUpper Dore BunbegLetterkennyCo DonegalTel: 074 953 2949 Email: [email protected] Website: www.scaoilsaor.ie

Crocus: Monaghan Cancer Support CentreThe Wellness Centre19 The GrangePlantation WalkMonaghanTel: 087 368 0965 / 047 62565 Email: [email protected]

Cuan Cancer Social Support and Wellness Group2nd Floor, Cootehill Credit Union22‒24 Market StreetCootehill Co CavanTel: 086 455 6632

The Forge Cancer Support Service The Forge Family Resource CentrePettigoCo DonegalTel: 071 986 1924Email: [email protected]


Helpful books Living Beyond CancerOncology Day Services Letterkenny General HospitalLetterkennyCo DonegalTel: 074 912 5888 (Bleep 674/734) / 074910 4477Email: [email protected]

Other support servicesCancer Care West72 Seamus Quirke RoadGalwayTel: 091 545 000Email: [email protected]: www.cancercarewest.ie

Cúnamh: Bons Secours Cancer SupportGroupBon Secours HospitalCollege RoadCorkTel: 021 480 1676Website: www.cunamh.ie

Dundalk Cancer Support GroupPhilipstownHackballscrossDundalkCo LouthTel: 086 107 4257

Killybegs Cancer Support GroupKilleKilcarCo DonegalTel: 074 973 1292Email: [email protected]

Newbridge Cancer Support GroupTel: 083 360 9898Email:[email protected]

Solace: Donegal Cancer Support CentreSt Joseph’s AvenueDonegal TownTel: 074 974 0837Email: [email protected]

Useful contacts outsideRepublic of IrelandAction Cancer Action Cancer House1 Marlborough ParkBelfast BT9 6XSTel: 028 9080 3344Email: [email protected]: www.actioncancer.org

American Cancer SocietyWebsite: www.cancer.org

Cancer Focus Northern Ireland40‒44 Eglantine AvenueBelfast BT9 6DXTel: 048 9066 3281Email: [email protected]: www.cancerfocusni.org

Cancer Network BuddiesWebsite: www.cancerbuddiesnetwork.org

Cancer Research UKTel: 0044 20 7242 0200Website: www.cancerhelp.org.uk

HealthtalkonlineWebsite: www.healthtalkonline.org

Macmillan Cancer Support (UK)Tel: 0044 20 7840 7840Email: [email protected]: www.macmillan.org.uk

Macmillan Support & Information CentreBelfast City Hospital Trust77–81 Lisburn RoadBelfast BT9 7ABTel: 028 9069 9202Email: [email protected]: www.cancerni.net

National Cancer Institute (US)Website: www.nci.nih.gov

American Cancer Society Complete Guideto Nutrition for Cancer Survivors(2nd edn)B Grant, AS Bloch, KK Hamilton, CAThomson (eds)American Cancer Society, 2010ISBN 9780944235782

The Daily Telegraph Encyclopaedia ofVitamins, Minerals & Herbal Supplements Dr Sarah BrewerRobinson, 2002ISBN 1841191841

Good Nutrition for People with CancerHaematology Oncology Interest Group ofthe Irish Nutrition & Dietetics Institute,2010 [Ask your dietitian for a copy.]

Healthy Eating for Life to Prevent andTreat CancerPhysicians Committee for ResponsibleMedicineWiley, 2002 ISBN 9780471435976

>>> Free booklets and DVDs from the Irish Cancer Society:■ Understanding Chemotherapy■ A Guide to Chemotherapy (DVD)■ Understanding Radiotherapy■ Radiation Therapy: A Patient Pathway (DVD)■ Coping with Fatigue■ Understanding Cancer and Complementary Therapies■ Journey Journal: Keeping Track of Your Cancer Treatment■ Managing the Financial Impact of Cancer: A Guide for Patients

and Their Families■ Understanding the Emotional Effects of Cancer■ Lost for Words: How to Talk to Someone with Cancer■ Who Can Ever Understand? Talking about Your Cancer■ Talking to Children about Cancer: A Guide for Parents

Nutrition of the Cancer PatientAmerican Institute for Cancer Research, 2010[Download from www.aicr.org]

Nutrition and the Cancer SurvivorAmerican Institute for Cancer Research, 2010[Download from www.aicr.org]

The Power of Food – Cancer: Food Facts & Recipes Clare ShawHamlyn, 2005 ISBN 9780600611103

Turning It Around: Cancer and Nutrition(DVD)Rarer Cancers Foundation, 2007[Contact www.rarercancers.org.uk for details]

101+ Square Meals [Budget and nutrition]Norah Bourke et alMABS/HSE West/Paul Partnership/LimerickVEC/Safefood, 1998ISBN 187407514X[For more details, see www.mabs.ie]

Diet and cancer

Dehydration When your body loses too much water and affectshow it works.

Digestive tract The parts of your body involved with eating,digesting, and getting rid of food. This includesthe mouth, gullet (oesophagus), stomach andintestines.

Diet The foods you eat and drink. This includes liquidsand solids.

Dietitian An expert on food and nutrition. They can giveadvice on the most suitable type of diet to followwhen you have cancer.

Fibre The part of plant foods that your body cannotdigest. It helps to move waste out of your bowelsquickly.

Fluids Things to drink, like water. Also called liquids.

Free radicals Chemicals that are highly reactive and oftencontain oxygen or nitrogen. They are formednaturally in your body during chemical reactions.Because they can cause cell damage, they arelinked to cancer.

Herbalism A form of alternative medicine that uses plantsand simple extracts of plants to heal the wholebody.

Hormone therapy A treatment that changes the amount of hormonesin your body to cure or prevent cancer comingback.

Malnourished When you do not take in enough energy, proteinand other nutrients, you will lose weight and yourbody may not work as well as it should. This canhappen if you do not eat a balanced diet.Undereating or overeating can lead to a lack of abalanced diet.

71

What does that word mean? Alternative therapy A way of promoting health and well-being that

has a different philosophy and viewpoint fromconventional medicine. In this case, the therapiesare used instead of conventional medicine. Forexample herbalism, metabolic therapy,megavitamin therapy.

Anorexia Loss of appetite, lack of desire or interest infood.

Antioxidants Chemicals that protect your body from otherchemicals called free radicals that cause celldamage. Antioxidants are vitamins, enzymes andminerals. They are found in berries, broccoli,tomatoes, red grapes, garlic, spinach, tea andcarrots. Some well-known antioxidants arevitamin A, vitamin C and vitamin E. See alsofree radicals.

Biological therapy A treatment to help your immune system fightdisease and infection. It uses proteins from yourbody to destroy cancer cells.

Calorie This measures the energy your body gets fromfood. You need calories so your body has theenergy to work, grow and repair itself.

Cachexia When there is severe loss of appetite, weightloss, loss of strength and muscle mass due tocancer and/or its treatment.

Complementary Therapies that can be given with conventionaltherapy medicine. For example, massage, acupuncture.

Chemotherapy A treatment that uses drugs to cure or controlcancer.

70 Diet and cancer

Diet and cancer

Questions to ask your doctorHere is a list of questions that you may like to ask. There is also somespace for you to write down your own questions if you prefer.

■ What eating problems can I expect from treatment?

■ Do I have to change my diet?

■ How can my diet prevent cancer coming back?

■ How can I increase calories?

■ How can I increase protein in my diet?

■ I’m overweight, can I lose some weight?

73Diet and cancer

Minerals Nutrients needed by your body to help it workwell. These include iron, calcium, potassium andsodium.

Natural products Products that occur in nature. This does not meanthat they are safe but that they are naturallyoccurring medicines.

Nutrients Chemicals that make up foods. These includeprotein, fat, carbohydrate, vitamins and minerals.They are used by your body to work properly andgrow. Essential nutrients are those that your bodydoes not make itself and must get from foodeaten.

Nutrition The taking in and use of food by your body. Afterfood is eaten, the body breaks it down intonutrients, which then travel through thebloodstream to cells in your body to help it growand work.

Obesity Having a high amount of body fat. A person issaid to obese if they have a body mass index(BMI) greater than 30.

Radiotherapy A treatment that uses high-energy X-rays to cureor control cancer and other diseases.

Soft diet Food that is softened by cooking, mashing,blending or puréeing.

Tube feeding A small tube that is placed in your nose anddown into your stomach or directly into yourstomach or bowel. It can give you liquidnutrients.

Vitamins Nutrients which your body needs to grow and staystrong. For example, vitamins A, B, C, D, E, K.

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Diet and cancer 75Diet and cancer

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Diet and cancer

AcknowledgementsWe would like to extend a special word of thanks to the following for theirinvaluable contributions to this booklet and/or previous editions:

Anne-Marie McGrath, Cancer Information Service NursePauline Forrester, Cancer Information Service NurseRosemary Scott, Health Promotion OfficerSonya Bowen, Cancer Information Service ManagerAoife McNamara, Cancer Information Service NurseAntoinette Walker, Patient Education EditorReach to RecoveryPatient Reviewers

Would you like more information?We hope this booklet has been of help to you. At any time in the future, ifyou feel you would like more information or someone to talk to, please callthe National Cancer Helpline on 1800 200 700.

Would you like to help us?The Irish Cancer Society relies entirely on voluntary contributions from thepublic to fund its programmes of patient care, education and research. Thisincludes patient education booklets. If you would like to support our work inany way – perhaps by making a donation or by organising a local fundraisingevent – please contact us at CallSave 1850 60 60 60 or [email protected]

Irish Cancer Society, 43/45 Northumberland Road, Dublin 4 Tel: 01 231 0500 Email: [email protected] Website: www.cancer.ie

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Would you like to be a patient reviewer?If you have any suggestions as to how this booklet could beimproved, we would be delighted to hear from you. The views of patients, relatives, carers and friends are all welcome.

Your comments would help us greatly in the preparation of futureinformation booklets for people with cancer and their carers. If you wish to email your comments, have an idea for a new booklet or would like toreview any of our booklets, please contact us at [email protected]

If you would prefer to phone or write to us, see contact details below.

Irish Cancer Society43/45 Northumberland Road, Dublin 4

T: 01 231 0500E: [email protected]: www.cancer.ie

National Cancer Helpline Freefone 1800 200 700Open Monday to Thursday 9am to 7pm Friday 9am to 5pm

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Diet and Cancer - Irish Cancer Society · Diet and Cancer This booklet has ... For some people with...

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