(Nutrition) Nutrition Of The Cancer Patient

S p e c i a l P o p u l a t i o n s S e r i e s

Nutrition of the

Cancer Patient

Nut of Can Pat 11-12-03(new) 5/4/04 10:36 AM

Contents

AICR Research Grants (partial listing)Determination of Cranberry Constituents withAntiproliferative Activity Against Human TumorCell LinesPeter Ferguson, Ph.D.London Regional Cancer Center

Increased Efficacy and Amelioration of Side Effectsof RadiotherapyW. Elaine Hardman, Ph.D.University of Texas Health Science Center at San Antonio

A Pilot Study of Silymarin During MaintenanceTherapy in Children with Acute LymphoblasticLeukemia (ALL) and Abnormal Liver Function TestsKara Kelly, M.D.Columbia University

Cancer Anorexia: Peripheral Manifestation ofAbnormal Hypothalamic Neurotransmitter StatusSecondary to CancerMichael Meguid, M.D., Ph.D.SUNY Upstate Medical University

Influence of Caloric Restriction on Brain TumorGrowth and AngiogenesisThomas Seyfried, Ph.D.Boston College

Control of Prostate Carcinogenesis by PC-SPESTze-chen Hsieh, Ph.D.New York Medical College

Antitumor Effects of Dietary Isothiocyanates onProstate CancerTse-Hua Tan, Ph.D.Baylor College of Medicine

Dietary Lipids and Hormones in BreastCarcinogenesisDavid Crowe, D.MSc.University of Southern California

Editorial Review Committee: Ritva Butrum, Ph.D.;Karen Collins, M.S., R.D.; Elaine Feldman, M.D.; DavidHeber, M.D., Ph.D.; Jan Kasofsky, Ph.D., R.D.; LaurenceKolonel, M.D., Ph.D.; Melanie Polk, M.M.Sc., R.D.,FADA; Richard S. Rivlin, M.D.; AICR Executive Staff.

Copyright © 2000 by American Institute for Cancer Research1759 R Street, NWPO Box 97167Washington, DC 20090-7167

S p e c i a l P o p u l a t i o n s S e r i e s

Introduction . . . . . . . . . . . . . . . . . .2

How Cancer Affects Nutritional Needs . . . . . . . . .3

How Treatment May Affect Nutrition . . . . . . . . . . . . . .6

Tips for Handling ProblemsRelated to Nutrition . . . . . .14

Additional Information. . . .36

12345


2Introduction A healthy diet is very important for

someone undergoing treatment for

cancer. This is a time when there is

much demand on the body. There are

three main nutritional goals for some-

one living with cancer. They are: 1) to

maintain a healthy weight; 2) to select

and eat healthy foods that supply the

body with fuel and nutrients for repair

and healing; and 3) to prevent recur-

rence of the cancer and the develop-

ment of a second malignancy.

This booklet discusses eating for good

nutrition throughout cancer therapy.

Nutritional problems associated with

cancer and cancer treatment are pre-

sented, along with tips to help you

minimize these eating difficulties.

How Cancer AffectsNutritional Needs

Not only do eating habits and behaviors

often change in a person with cancer, but

the way the body uses nutrients changes

as well.

Changes in Eating Habitsand Eating Behavior

Eating the same types and the same amountsof foods you enjoyed before your diagnosis ofcancer may sometimes be difficult. Eating less isthe usual response, but eating more is notuncommon either.

Side effects of cancer therapy may affect youreating habits. Some foods may taste less appeal-ing to you and, as a result, you may eat less ofthem. Dietary problems you had before yourdiagnosis may be aggravated by cancer and itstreatment. For example, if you were sensitiveor intolerant to certain foods before yourcancer diagnosis, you may become moresensitive to them.

Coping with changes in your eating habits mayseem overwhelming. You may feel anxious abouteating enough of certain foods. Or you maybecome afraid of eating the “wrong” foods andeat very little at all. These reactions are normal.You can find tips for dealing with nutritionalproblems you may be experiencing in sectionfour of this booklet.

Nutrition of the Cancer Patient 32 Nutrition of the Cancer Patient

1Nut of Can Pat 11-12-03(new) 5/4/04 10:36 AM Page 2


Common Vitamin and Mineral DeficienciesExperienced by Cancer PatientsFolate Vitamin A Vitamin CCopper Iron MagnesiumZinc Calcium Vitamin D

These individuals may benefit from a multi-vita-min/mineral supplement. Such a supplement canhelp people reach the Recommended DietaryAllowance (RDA) of important nutrients. Manyliquid meal replacement beverages can help satisfy protein requirements as well. Protein isimportant to maintain body strength but shouldnot be consumed in excess.

It is important, however, not to take supple-ments in doses that would raise your intake inexcess of the RDA. Excessive amounts of these substances may interfere with the beneficialeffects of certain cancer chemotherapies and/orradiation therapy. If you are concerned aboutyour intake of a specific vitamin or mineral, speakwith your doctor. And always be sure to tell your

Changes in the Way YourBody Uses Nutrients

The way the body uses nutrients is sometimeschanged in people with cancer. These changesmay be caused by the body’s response to thetumor, the side effects of treatment, certainmedications or some combination of these rea-sons.

It is not uncommon to experience changes inthe way your body handles sugar or in yourblood sugar level. You may experience hyper-glycemia (high blood sugar). It is less likely youwill experience hypoglycemia (low blood sugar).If you encounter one of these changes, your doc-tor or registered dietitian can advise you on waysto control your blood sugar through diet.

The Food Guide Pyramid below lists the rec-ommended number of servings from each foodgroup. Some cancer patients, however, may havetrouble consuming enough of a wide variety offoods to satisfy nutritional needs.

Fats, Oils and SweetsUse Sparingly

Milk,Yogurt and Cheese Group2 – 3 Servings

Vegetable Group3 – 5 Servings

Meat, Poultry, Fish, Dry Beans,Eggs and Nuts Group

2 – 3 Servings

Fruit Group2 – 4 Servings

Bread, Cereal, Riceand Pasta Group6 – 11 Servings

Food Guide PyramidA Guide to Daily Food Choices

Information Source: U.S. Department

of Agriculture/U.S. Department of

Health and Human Services


occur. You can find help dealing with theseproblems in section four of this booklet.

Radiation TherapyRadiation therapy uses high energy waves to

damage cancer cells so they are unable to multi-ply. It may be used either alone or in combina-tion with surgery or chemotherapy.

Radiation may be used before surgery toshrink a tumor or after surgery to destroy anycancer cells that may remain in the area.

Radiation treatments can lead to nutritionalproblems just as surgery can. These usuallyoccur when the G.I. tract is in the treatmentarea. Some problems occur early in treatmentand last only a short time, such as irritation ofthe mouth, tongue and throat, milk intolerance,nausea, vomiting or diarrhea. Other problemsmay appear months after therapy and are longerlasting, such as dry mouth, stricture or narrowingof the esophagus, malabsorption of nutrients,abdominal discomfort diarrhea or constipation.You can find help in dealing with these problemsin section four of this booklet.

ChemotherapyChemotherapy is the use of drugs to destroy

cancer cells by disrupting their ability to growand multiply. Chemotherapy may be usedalone or along with radiation and/or surgery.Unlike surgery or radiation, chemotherapy is“systemic.” This means it can affect the entirebody rather than just part of it unless it isinfused to a target area.

The drugs used in chemotherapy interferewith cells as they divide and reproduce. Cancercells are affected most because they divide andreproduce more often than normal cells. Butnormal cells can also be affected, particularly


3doctor which nutrient supplements or herbalpreparations you are taking (if any) and in whatamounts.

How Treatment May Affect Nutrition

There are several different methods of

treating cancer. Each may affect your nutri-

tional needs and your eating habits.

SurgerySurgery is often the preferred treatment for

tumors that have not spread. Through surgery,the tumor and any nearby tissue that may containcancer cells are removed. Sometimes healthy tis-sue may have to be removed from around thetumor to help keep the cancer from spreading.Whether or not surgery is used depends on thetype of cancer, its location and how much it hasspread to other parts of the body.

Surgery can cause temporary or permanentnutritional challenges. The operation itself willincrease your need for calories to do the extrawork of healing. You may be advised to eatslightly more calories and protein to provideenough nutrients for healing. Long-term nutri-tional problems may result when parts of thedigestive system or gastrointestinal (G.I.) tractare removed or altered through surgery.Difficulty with chewing and swallowing andpoor absorption of nutrients in the intestine may

Nut of Can Pat 11-12-03(new) 5/4/04 10:36 AM Page 6

Cancer Surgery and Nutrition

Area of Cancer


Surgical Procedures Possible Nutrition Problems

Head areas,Neck,Tongue

Removal of all or part of theaffected area

Makes chewing and swallowing difficult

Jaw Removal of jaw bone Requires tube feeding

Esophagus Removal (esophagectomy)with reconstruction usingmuscle from the intestine

Food may leak into the lungs or the newesophagus may narrow

Stomach Removal (gastrectomy) orpartial removal

Food may travel to the intestines too quicklyor low blood sugar may develop

Small Intestine Opening created outsidethe body (jejunostomy orileostomy) or removal

Poor absorption of nutrients, vitamin B-12deficiency, salt and water imbalance, blockedbowels

Pancreas Removal Poor absorption of nutrients, diabetes

Large Intestine Removal (colectomy) withor without an openingcreated outside the body(colostomy)

Poor absorption of nutrients and water,leading to diarrhea

cells that normally reproduce very rapidly, suchas in the lining of the gastrointestinal tract.When this happens side effects may occur.

The most common side effects of chemothera-py include nausea, vomiting, hair loss andfatigue. Other common side effects includeinfection, bleeding and anemia. Somechemotherapy drugs can cause constipation or

diarrhea. Others may cause a strange taste inthe mouth, making eating unpleasant. Stillother drugs can cause water retention andbloating. These effects may lead to weight loss,weight gain or other nutritional problems. Youcan find help in dealing with nutritional prob-lems in section four of this booklet.


Radiation and NutritionLocation of Cancer


Area of Treatment Short-term Effects Long-term Effects

Brain, Mouth,Esophagus,Thyroid

Head and Neck Irritation of mouth,tongue, esophagus

Dry mouth, toothdecay, stricture ofesophagus, loss of taste

Stomach, Liver,Pancreas,Gallbladder, Kidney

Abdomen Irritation of stomach, diar-rhea, milk intolerance,nausea and vomiting

Some of these symp-toms may continue insome patients

Breast, Lung Upper torso Irritation of stomach and esophagus


Colon, Rectum Lower torso Diarrhea

Prostate, Uterus,Ovaries, Cervix,Bladder

Pelvis Diarrhea, malabsorption Some of these symp-toms may continue insome patients

Hormone TherapyThis treatment may include the use of drugs

to block the body’s production of hormones, orsurgery to remove hormone-producing organs.Hormone therapy is most commonly used totreat cancers of the breast, prostate, ovary andendometrium.

Hormone therapy can cause a number of sideeffects including nausea, vomiting, swelling,weight gain and hot flashes. Some hormonescause an increase in appetite. In some cases,large doses of hormones are given to advance atherapeutic effect, such as adrenal hormones to

shrink swelling of the brain that occurs with abrain tumor.

Biological TherapyBiological therapy, also called immunotherapy,

is a relatively new form of cancer therapy. In thisform, the body’s immune system is used to helpfight cancer. Interferon and interleukin-2 areused to enhance the ability of white blood cellsto fight cancer. Since these are new forms oftreatment, their effects on nutrition are not yetfully known. However, these agents may produce“flu-like” symptoms, including diarrhea, weak-ness and loss of appetite.



Gene TherapyA very new form of cancer treatment, gene

therapy is still in its investigational stages. Thisapproach to cancer treatment involves replacinga cancer-causing gene, or oncogene, with anormal gene. The effects of gene therapy onnutrition of the patient are currently beinginvestigated.

Complementary/AlternativeMedicine

Complementary/alternative medicine (CAM),now called “integrative” medicine, consists of awide variety of approaches and therapies notincluded in conventional medicine. People mayuse CAM treatments alone or in addition tomainstream treatments. Examples of CAMinclude herbal treatments, homeopathy,acupuncture, macrobiotic diets and spiritualhealing.

Although certain complementary/alternativetherapies for cancer may appear to help in someinstances, scientific evidence proving their effec-tiveness is often lacking. These unproven thera-pies should therefore be approached with greatcaution.

Keep in mind that just because a therapy is“natural” does not guarantee that it is harmless.Unproven treatments could be ineffective, toxic(combining certain herbs with certain drugs, forexample) or could prevent the patient from seek-ing timely conventional and effective treatmentfor cancer. Complementary therapies shouldcomplement, but never replace, traditionalapproaches to cancer treatment.

It is important to tell your doctor if youare using any complementary/alternativetherapies as part of your overall treatmentplan so he or she can take that into accountwhen planning your conventional treatment.

There is now more scientific research on spe-cific CAM therapies, and some may prove to besafe and effective. Much more knowledge isneeded about them, however.


Chemotherapy andNutrition

Chemotherapy-induced Side Effects

Irritation and inflammation of mouth,tongue, throat

DiarrheaConstipationNauseaVomitingTaste changesAppetite changes (increased, decreased)Weight changes (increased, decreased)Milk intoleranceFood aversionsWeaknessAnemia


4Tips for HandlingProblems Related

to NutritionSo far we’ve described what kinds of

challenges you may encounter, depending

on the type of cancer treatment you receive.

Now we’ll discuss what you can do about

them. In this section, you will find tips for

handling nutritional problems.

It’s important to remember that these

suggestions are not meant to replace talking

to your doctor. Speak with him or her about

any changes in your eating patterns and any

problems you may have with appetite, eat-

ing or digestion. Your doctor may refer you

to a registered dietitian specializing in nutri-

tional care of the cancer patient.

Weight Loss and Loss of Appetite

Weight loss is very common in cancer patients.It can be caused by many factors, including lossof appetite, increased demand for energy,changes in the way the body processes andabsorbs food, physical difficulty in eating due tosurgery, side effects of treatment or feelings ofanxiety or depression.

Severe weight loss and undernutrition caninterfere with the work of the heart, liver, kid-neys and other important organs in the body.Also, when a patient is undernourished, the abil-ity to heal and to fight off infections is weakened.

Here are some tips for getting back on theroad to a healthy weight. Your doctor and regis-tered dietitian can help you determine yourhealthy weight goal and your individual calorieand nutrient needs.

If you have lost weight:• Eat several small meals a day instead of three

large meals.

• Keep favorite foods around the house. That way you may find yourself eating more often.

• When eating a meal, eat high-protein foodsfirst, when your appetite is strongest. Someexamples of high-protein foods are beans,peas, tofu, chicken, fish, meat, yogurt, eggsand nuts.

• Eat the most when you feel hungriest. If youare very hungry at breakfast or lunch, makethat your largest meal of the day, even if youwould typically eat a smaller meal at that time.

• Go for a walk before mealtime to stimulateyour appetite.

• Take an interest in food by trying new recipesand products or occasionally eating in afavorite restaurant.



• If the odors of food bother you, try eatingthings cold or at room temperature.

• Experiment with new or different seasonings.

• Make mealtimes more leisurely – take yourtime at the table.

• Drink beverages between meals instead ofwith meals. Drinking a beverage while you eatcan make you feel full faster.

• Sip on higher-calorie beverages during the daysuch as juice, nectar, milk or a fruit and yogurtsmoothie.

• Ask your physician or registered dietitianabout liquid or powdered nutritional supple-ments. They come in a variety of calorie levelsand flavors and are easy to swallow and digest.Some products may taste better than others,so you may want to give several of them a try.

Weight GainWeight gain is not uncommon in cancer

patients. Weight gain may result from taking amedication, such as tamoxifen for breast canceror certain antidepressants. Chemotherapy maycause a false menopause, which is commonlyaccompanied by weight gain. For other patients,a change in eating behavior, due to stress, fear ordepression, may mean an increase in food intakeand subsequent weight gain. Some patients withnausea feel better when they eat more frequent-ly or if they have something in their mouth mostof the time. Fluid retention, which causesswelling (edema), may be another reason yourweight may increase. Tell your doctor about anyexcess weight so he or she can determine thecause, especially if the weight gain occurs rapidlyover a few days.

The following tips can help patients who aregaining weight – for reasons other than fluidretention – to maintain a healthy weight. (If you


Select healthy foods, including a

variety of vegetables, fruits,

whole grains and beans.

have fluid retention, see tips on page 34.) Somepatients are overweight when they begin cancertherapy. The following suggestions will be help-ful for these individuals as well.

If you have gained excessive amountsof weight:

• Select healthy foods, including a variety ofvegetables, fruits, whole grains and beans.These foods are naturally low in calories andare loaded with nutrients and fiber, which canhelp you feel full.

• Pay attention to your portion sizes. Try meas-uring out the serving size listed on the label ofthe foods you eat most often. Remember whatthis portion looks like on a plate the next timeyou serve yourself or eat out. This can helpyou get a handle on how much you’re eating.

• Eat only when you’re hungry. Eating to com-fort feelings of stress, fear or depression willnot alleviate those emotions. Speak to yourdoctor about psychological counseling or med-ication to get to the root of negative feelings.

• Ask your doctor if there is an effective mood-elevating medication that does not promoteweight gain.


DiarrheaDiarrhea can result from many causes, includ-

ing chemotherapy, radiation therapy to theabdomen, certain medications, infection, foodsensitivity, emotional upset or removal of partof the stomach, intestines, pancreas or colon.Severe diarrhea or long-term diarrhea may causedehydration, nutrient loss and other healthproblems. Call your doctor if you have severediarrhea.

If you have diarrhea:• Aim for eight glasses of liquids each day as a

minimum. Drinking enough is especiallyimportant while you have diarrhea to preventdehydration.

• Good choices of fluids include water, dilutedjuices, broth or decaffeinated coffee or tea.Large amounts of coffee and tea do not counttoward your total; the caffeine may cause youto lose fluids.

• Liquids at room temperature are easier to tol-erate than those that are very hot or very cold.

• Eat small amounts of food throughout the dayinstead of three large meals.

• Ask your doctor about medications that maybe helpful for diarrhea.

Some people find relief by eating the following foods:

• low-fiber foods like white rice, noodles, whitebread and mashed potatoes

• soft cooked or puréed vegetables

• soft canned or cooked fruit without skins, suchas bananas and applesauce

• skinned turkey or chicken, lean ground beef,cooked fish and thoroughly cooked eggs

The following foods mayworsen diarrhea:

• foods and beverages that cause gas such as beans, onions, carbonated drinks andchewing gum

• high-fiber foods such as broccoli, corn, beans,cabbage, peas and cauliflower

• some milk and dairy products, except foryogurt, which is generally well-tolerated

• raw vegetables and fruits, nuts

• greasy, fatty, fried, very sweet or very spicy foods

• alcoholic beverages and caffeinated beverages

• sugar-free candies and gums that contain sorbitol (a sugar replacer that has a mild laxative effect)


foods totry

foods toavoid

Stay hydrated with water, diluted juice or

decaffeinated coffee or tea.


ConstipationConstipation can be the result of certain can-

cer drugs, medications, a diet without enoughfluid or fiber, a reliance on tube feedings or alack of physical activity. Constipation should notbe confused with an intestinal obstruction. If youcannot pass stools and are suffering from one ormore of the following: nausea, vomiting, abdomi-nal pain or a swelling of the abdomen, reportthis to your doctor immediately.

If you have constipation:• Drink more liquids, aiming for eight glasses a

day. Drinking enough is especially importantwhile you have constipation to help keepstools soft. Good choices are water, prunejuice, warm juices, decaffeinated teas and hotlemonade.

• Have a hot drink about one half hour beforeyour usual time for a bowel movement.

Eat high-fiber foods including:

• fresh vegetables and fruits such as potatoeswith skins, prunes, carrots, oranges andberries

• legumes including lentils, peas and beans

• whole wheat bread

• wheat bran added to foods such as casserolesand hot cereals

• whole grain cereals

• If you develop gas, limit broccoli, cabbage,cauliflower, cucumbers, onions, carbonateddrinks and beans. Using the anti-gas product“Bean-o” (widely available in pharmacies),may allow you to keep eating high-fiber foodswithout discomfort.

• Eat a large breakfast, including a hot drinkand high-fiber foods like hot or cold cereal,whole wheat toast and fruit.

• Increase your physical activity. Try to get someexercise, such as taking a walk, every day. Talkto your doctor before starting a new exerciseprogram.

• Talk to your doctor about using a fiber supple-ment. Be sure to drink plenty of fluids if youuse a fiber supplement.

• Laxatives may be occasionally necessary. Yourdoctor can make specific suggestions.


Drinkingeight glasses of

liquids a day may

help relieve constipation.

foods totry


NauseaNausea is a common side effect of cancer

surgery, chemotherapy, radiation therapy,immunotherapy and some medications.Vomiting may or may not accompany thequeasy feeling of nausea. Nausea can preventyou from eating enough.

If you experience nausea:• Eat small amounts of food often and slowly.

Eat six or more small meals during the dayrather than three large meals.

• Keep the room well-ventilated, since somepatients find that the odors of some foods mayproduce nausea.

• Drink beverages between meals rather thanwith a meal.

• Drink beverages cool or chilled and sipthrough a straw.

• Eat foods at room temperature or cooler; hotfoods can aggravate nausea.

• Eat sitting up. Also, rest sitting up or reclinedwith your head raised for about an hour aftereating.

• Rinse out your mouth before and after eating.If there is a bad taste in your mouth, suck onhard candy such as peppermint or lemon.

• Don’t force yourself to eat favorite foods whenyou feel nauseated. It may cause you to per-manently dislike them.

• If nausea in the morning is a problem, keepcrackers at your bedside to nibble on beforeyou get up.

• For some nauseated patients, it may be help-ful to keep food out of sight until it is timeto eat.

These foods may help your nausea:

• toast, saltine crackers, dry cereal or breadsticks

• yogurt

• sherbet and popsicles

• canned peaches, pears, fruit cocktail

• skinned chicken (not fried)

• hot cereal such as oatmeal

• clear liquids such as water, broth, cranberryjuice and flat soda

• candied dried ginger

• ice chips

These foods may make your nausea worse:

• fatty, greasy, fried or spicy foods

• candy, cake, rich desserts

• foods with strong odors


foods totry

foods toavoid

Foods like saltinecrackers, yogurt or

canned fruit cocktail may

help relieve nausea.


Food Odors and NauseaIf the smell of food cooking or coolingnauseates you, try:

• opening windows when preparing foods and eating

• preparing meals that don’t need cooking

• heating frozen dinners in the oven ormicrowave

• asking others to cook your meals for you orhave meals delivered from “Meals on Wheels”or another meal delivery service in your area

• when you’re feeling better, cooking yourfavorite foods in large batches and freezingmeal-size portions.You’ll have them availablewhen you don’t feel like cooking

• If nausea occurs during radiation therapy orchemotherapy, avoid eating for one or twohours before treatment. Try eating bland, softfoods on treatment days.

• Try to recognize times, foods, smells or eventsthat trigger your nausea. If possible, try tomake changes in your schedule or diet thathelp you avoid these triggers.

• Talk to your doctor about medication to helprelieve your nausea.

“Anticipatory Nausea”Sometimes nausea can occur even before a

treatment session or other event begins. Yourbrain remembers how you felt after previous ses-sions and anticipates feeling that way again. Thisis called “anticipatory nausea” and there are several things you can do to prevent it from happening or to lessen the discomfort.

• Try to distract yourself during the activitiesyou associate with your treatment.

• Practice relaxation or meditation techniques totake your mind off the treatment.

• Sometimes changing something in the envi-ronment or in the routine can help. For exam-ple, if the smell from the alcohol wipe usedto clean your skin before an injection makesyou feel nauseated, another kind of skincleanser might be substituted.

VomitingVomiting can follow nausea. It can be brought

on by treatment, food odors, gas in the stomachor motion. Contact your doctor if you are vomit-ing for more than 24 hours. If you experience vomiting:

• Do not eat or drink until you have the vomit-ing under control.

• Sit upright after vomiting and bend forward.

• Once vomiting is under control, try drinkingsmall amounts of clear liquids such as cranber-ry juice, cool broth or flat soda (carbonatedbeverages may cause burping which can stim-ulate vomiting in some people).

• When you are able to keep down clear liq-uids, try eating small amounts of soft foodssuch as cream of wheat, pudding, frozenyogurt or gelatin.

• Once you can tolerate soft foods, graduallywork your way back to your regular diet.



Sore Mouth, Tongue and ThroatSoreness of the mouth, tongue and throat canresult from cancer therapy or other reasons. Seeyour doctor if you have a sore mouth to be sureit is not the result of a correctable dental prob-lem. Try to arrange to see your dentist beforeyou begin cancer treatment, or in between treat-ments, to take care of any work that needs to bedone. Soreness usually clears up with time.Preventive dentistry is crucial before you beginchemotherapy or radiation.

Bland, soft foods are easy to chew and swallow.

• bananas, applesauce, watermelon, canned fruits

• peach, pear and apricot nectars

• puréed or mashed vegetables such as mashed potatoes

• oatmeal or other cooked cereal

• cottage cheese, yogurt, milkshakes

• custards, puddings, gelatin

• macaroni and cheese, scrambled eggs, ground meats

Avoid foods that can irritate your mouth.

• citrus fruits or juices such as grapefruit,orange, lemon and lime

• spicy or salty foods

• pickled or vinegary foods

• tomato-based foods such as chili, salsa,spaghetti sauce and pizza

• rough, coarse or dry foods

• hot spices, such as pepper, chili powder, nut-meg, cloves, curry and horseradish

If you have a sore mouth, tongue or throat:

• Cook foods until they are very soft and tender.

• Cut foods into very small pieces or grind orpurée them. Make moist stews and casseroles,or mix foods with thin gravies or sauces tomake them easier to swallow.

• Serve foods cold or at room temperature. Hotand warm foods can irritate a sore mouth andthroat. Cold foods such as sherbet or popsiclesmay soothe soreness.

• Use a straw for drinking fluids.

• Avoid alcohol. It can irritate the delicatemembranes in your mouth.

• Rinse your mouth several times a day withwater or a baking soda mixture (combine onequart water and one tablespoon baking soda)to remove food and promote healing. Avoidcommercial mouthwashes; most are too harshfor a tender mouth.

• Use a toothbrush with soft bristles.

• You should not smoke under any circum-stances.


foods totry

foods toavoid


• Remove your dentures (except during eating)if your gums are sore. Keep your denturesclean.

• Ask your physician about special mouthwashesand anesthetic lozenges and sprays that cannumb the mouth and throat long enough foryou to eat meals.

• If you experience bleeding of the gums duringtreatment, tell your doctor immediately andarrange to see your dentist or a periodontist.

• If you see small, white patches in your mouth,tell your physician or nurse. This may be evi-dence of an infection that may require specialattention.

Dry MouthA dry mouth occurs most often after

chemotherapy and radiation therapy to the heador neck area. The therapy can reduce the flow ofsaliva. This may make it difficult to chew andswallow. It may also change the way foods taste.To relieve a dry mouth, follow the suggestionsfor handling a sore mouth on page 26 and theseideas below.

To relieve a dry mouth:• Sip water or other beverages through a straw

throughout the day to make it easier for you totalk and swallow. Aim for eight cups of liquid aday as a minimum. Limit consumption of caf-feinated coffee, teas and colas.

• Try thick drinks, such as fruit nectars, at roomtemperature or cold.

• Avoid salty foods.

• Try tart foods and beverages, such as lemon-ade, in small amounts, which may help yourmouth produce more saliva.

• Suck on hard candy such as lemon drops,frozen grapes or popsicles, or chew sugarfreegum.

• Eat foods moistened with broth, gravy, saucesand salad dressings. Moist foods are easier to swallow.

• Avoid alcohol.

• Practice good oral hygiene. See the tips onpage 27, in the section for sore mouth. Avoidcommercial mouthwashes.

• Keep your lips moist with lip salves.

• Try using a cool mist humidifier, especially at night.

• If your dry mouth is severe, ask your doctor ordentist about products that coat and protectyour mouth. There are a variety of saliva sub-stitutes available. They include Moistin,Optimoist, MouthKote and Glandosane,among others.

• If you see small, white patches in your mouth,tell your physician or nurse. This may be evi-dence of an infection that may require specialattention.

• Do not smoke under any circumstances.


Suck on frozen grapes or

popsicles to help

relieve dry mouth.


Difficulty SwallowingProblems with swallowing can be the result of

cancer and its treatment, such as surgery to thehead and neck. Or it may be due to other rea-sons. Talk to your doctor if you are experiencingdifficulty swallowing.

To make eating easier:• Take deep breaths before attempting to swal-

low. Exhale or cough after swallowing.

• Aim for eight cups of liquids each day as aminimum. Drink beverages between ratherthan during meals so you don’t feel full tooquickly. Liquids at room temperature may beeasier to swallow.

• Eat small, frequent meals.

• Mashed foods should not be too thick. Thinthem out using broth, gravy, milk or water.

• Report any choking or coughing while eatingto your doctor, especially if accompanied bya fever.

If part or all of your tongue or jawbone hasbeen removed, chewing and tongue movementmay be limited. Food will move down yourdigestive tract once it gets to the throat.Effective swallowing techniques can be taughtby a speech therapist, registered dietitian ornurse. The following suggestions may also behelpful:• Thicken liquids to consistency suggested by

your speech therapist or registered dietitian.

• Avoid very hot or very cold foods.

• Puréed foods may be easier to swallow.

• Gelatin can be used to form a soft gel withcakes, cookies, crackers, sandwiches, puréedfruits and other cold foods to make them easi-er to tolerate. (Mix one tablespoon unflavored

gelatin in two cups liquid until dissolved andpour over food.)

• Eat with a spoon; it is easier to control than afork.

• Ask your therapist to show you how to proper-ly place food in your mouth to avoid choking.

• Exercise your tongue and your jaw. Try tomove them through the usual range ofmotion – stick your tongue out and back, yawnand move your jawbone from side to side.

• Liquid diets can be either high or low in fiber,so you need not suffer constipation or diar-rhea. Speak with a registered dietitian aboutadjusting the fiber in your diet to meet yourneeds.

• Report any choking or coughing while eatingright away to your doctor, especially ifaccompanied by a fever.

StrictureSometimes surgery or radiation therapy can

cause the esophagus to narrow, making it diffi-cult for food to pass through to the stomach.This is called stricture. Your surgeon may beable to widen the opening or insert a feedingtube to bypass the problem until it heals. Trydrinking liquids, which will pass through theesophagus more easily. And keep your head ele-vated both during and after drinking or eating.

Feeling Full QuicklyFeeling full quickly after eating a small

amount of food is not uncommon, especially ifyou’ve had upper abdominal surgery. Not eatingenough can weaken the body and delay healing.

If you feel full quickly when eating:• Eat small meals throughout the day. Keep

healthy snacks on hand to eat between meals.



• Avoid fried or greasy foods. Fat stays in yourstomach longer than carbohydrates or protein.

• Avoid foods that give you gas.

• Drink your beverages between rather thanduring meals. Drinking a beverage during ameal can fill you up more quickly.

• Rest with your head elevated after meals.

• If you eat small meals and are finding it diffi-cult to eat frequently during the day, fortifyyour meals with foods that are rich in caloriesand nutrients. Try adding nonfat dry milk,wheat germ or ground meat to soups, hotcereals, casseroles or other dishes.

• Ask a health professional about drinking aliquid or powdered meal replacement bever-age to provide needed calories and nutrients.

Keep in mind that even though it is importantto eat, it is also important to maintain a healthyweight. Therefore, it is unwise to force yourselfif you’re feeling full or are no longer hungry.

Taste ChangesChanges in how foods taste can be the result

of chemotherapy, radiation therapy or the canceritself. Dental problems may also cause tastechanges. Some patients complain of bitter ormetallic tastes, especially when eating foods highin protein such as meat. Each person’s sense oftaste can be affected differently. Depending onhow your tastes have changed, some of the follow-ing ideas for improving flavor may work for you.

To improve flavor:• Choose and prepare foods that look and smell

good to you. Foods may taste better if servedcold or at room temperature.

• Frozen fruits such as melon balls, grapes ororange wedges that are moist and slightlysweet may be appealing.

• If red meat tastes different, choose chicken,turkey, fish, tofu, beans, eggs or dairy productsthat don’t have a strong smell.

• Marinate meats in juice, soy sauce, barbecuesauce, Italian dressing or other flavorful liquidyou find appetizing.

• Adding sugar to some foods can help decreasesalty, bitter or unpleasant tastes.

• Tart foods and beverages such as oranges,lemon yogurt or lemonade may be appealing.(Do not eat these foods if your mouth is sore.)

• Rinse your mouth and brush your teeth andtongue regularly. (Avoid commercial mouth-washes if your mouth is sore.)

• See your dentist to be certain that you aren’tdeveloping any new infections in your mouth.


Seasonings such as onion,

garlic, herbs and spicesmay make foods more appealing.


If you are retaining fluids:• Drink enough water during the day.• Eat less salt and foods with less sodium.• Stay as physically active as possible.• Elevate your legs when resting.• Your physician can prescribe medication to

help minimize fluid retention.

FatigueFatigue is very common among cancer

patients. Feeling tired can certainly make itharder to prepare and eat nourishing meals.

If you experience fatigue:• Consider asking friends and relatives for help.

• Use frozen dinners. There are dozens ofhealthful varieties now available.

• Meal-making is easier if you use convenienceproducts such as frozen or canned fruits andvegetables, canned beans, prepared pastasauces and instant brown rice. Read labels tolook for products that are low in sodium andhigh in nutrients.

• Have healthy snacks on hand. Keep foods likedried fruit (raisins, dates, apricots), cheeseand whole grain crackers, graham crackersand snack-size puddings in the house.

• Prepare blended fruit and yogurt shakes andkeep them in the refrigerator for between-meal snacks.

• When you’re feeling better, prepare largequantities of your favorite meals and freezethe leftovers in meal-size portions.

• Consider buying prepared foods from yourgrocery store, phoning for carryout or deliveryfood, or having meals delivered from “Mealson Wheels” or another meal delivery service inyour area.

Nutrition of the Cancer Patient 35

Milk or Lactose IntoleranceIf you were able to digest milk and milk prod-

ucts easily before you began radiation orchemotherapy treatment, but now developcramps and diarrhea after you drink milk or eatcertain dairy foods, then you may be sufferingfrom acquired milk or lactose intolerance. Thecancer therapy has probably temporarily inhibit-ed the growth of cells in your intestinal tractthat make the enzymes to digest lactose, whichis the main carbohydrate (sugar) in milk. Inmost patients, the condition eventually reversesitself. The following measures may be helpful inthe meantime.

If you are lactose intolerant: • Avoid the milk or dairy products that give you

problems. Yogurts and aged cheeses may beeasier to tolerate. Look for a reduced lactosemilk or milk that contains “Lactaid,” anenzyme product that helps you digest the lac-tose in milk.

• Lactaid and other enzyme products are avail-able in capsule, pill or liquid drop form. Lookfor them in pharmacies.

• Try calcium-fortified drinks or foods. Readfood labels to find fortified selections. Speakwith your doctor or registered dietitian aboutwhether you could benefit from taking a calci-um supplement.

Fluid RetentionSometimes patients gain extra weight during

treatment without eating extra calories. Thisweight gain may be due to swelling or edema.Certain drugs, such as prednisone, can cause thebody to retain too much fluid as can a nutritionaldeficiency. If you notice rapid weight gain, tellyour doctor so he or she can determine thecause.

34 Nutrition of the Cancer Patient


Nutrition of the Cancer Patient 37

AdditionalInformation

If you would like more information about

your treatment options and how to live well

with cancer, contact the American Institute

for Cancer Research.The Institute provides

referrals on a variety of cancer-related issues

and concerns.

American Institute for Cancer Research

1759 R Street, NW

PO Box 97167

Washington, DC 20090-7167

1-800-843-8114 or 202-328-7744

www.aicr.org

36 Nutrition of the Cancer Patient

How You Can SupportCancer Research andEducation Through Your WillYou can help provide for future cancer research andeducation through a simple bequest in your will.Consult with your attorney when first writing yourwill, or to add a simple paragraph to your existing will.Your bequest to help in the war against cancer can bea cash amount, or can be a gift of the remainder ofyour estate, or a portion of the remainder, after obli-gations to your family and loved ones are met.Your attorney can easily help you make a bequest tothe American Institute for Cancer Research (AICR).To do so, your attorney will need to know:AICR’s official name:American Institute for Cancer ResearchAICR’s mailing address:1759 R Street NW, Washington, DC 20009AICR’s telephone number:202-328-7744AICR’s identification:A not-for-profit organization under Section 501(c)(3)of the Internal Revenue CodeAICR’s tax-exempt IRS number:52-1238026For further information, contact AICR’s EstatePlanning Department at the number below.Prepared by the American Institute for CancerResearch, August 1987Latest Revision, November 2003The American Institute for Cancer Research supportscancer research and provides public education in thearea of diet, nutrition and cancer. For free publica-tions, to reach the Institute’s Nutrition Hotline or tomake a memorial donation, call toll-free or write:American Institute for Cancer Research1759 R Street, NWPO Box 97167Washington, DC 20090-71671-800-843-8114 or 202-328-7744www.aicr.org

5Nut of Can Pat 11-12-03(new) 5/4/04 10:36 AM Page 36

E3B-NP/E31

Nut

rition

of the Cancer Patient

Stopping cancer before it starts


(Nutrition) Nutrition Of The Cancer Patient

Health & Medicine

Transcript of (Nutrition) Nutrition Of The Cancer Patient