Advanced Cancer
Drug-Nutrient Interactions
Guidelines for Healthy Eating
        The Food Guide Pyramid
        Cancer Prevention
Surviving Cancer and Preventing Second Cancers
        Lung Cancer
        Prostate Cancer
        Breast Cancer
        Colon Cancer
        Esophageal and Gastric Cancer

Advanced Cancer

Nutrition-related side effects may occur or become worse as cancer becomes more advanced.

The following are the most common nutrition -related symptoms in patients who have advanced cancer:

• Cachexia (a wasting syndrome that causes weakness and a loss of weight, fat, and muscle).
• Weight loss of more than 10% of normal body weight.
• Feeling too full to eat enough food.
• Bloating.
• Anorexia (the loss of appetite or desire to eat).
• Constipation.
• Dry mouth.
• Taste changes.
• Nausea.
• Vomiting.
• Inability to swallow.

The usual treatment for these problems in patients with advanced cancer is palliative care to reduce the symptoms and improve the quality of life.

Palliative care includes nutrition therapy (see the Nutrition Suggestions for Symptom Relief section) and/or drug therapy (see the Drug-Nutrient Interactions section).

Eating less solid food is common in advanced cancer. Patients usually prefer soft foods and clear liquids. Those who have problems swallowing may do better with thick liquids than with thin liquids. Terminally ill patients often do not feel much hunger at all and may be satisfied with very little food.

When cancer is advanced, food should be viewed as a source of enjoyment. Eating should not just be about calories, protein, and other nutrient needs.

Dietary restriction is not usually necessary, as intake of “prohibited foods” (such as sweets for a patient with diabetes) is not enough to be of concern. Some patients, however, may need certain diet restrictions. For example, patients who have pancreatic cancer, uterine cancer, ovarian cancer, or another cancer affecting the abdominal area may need a soft diet (no raw fruits and vegetables, no nuts, no skins, no seeds) to prevent a blockage in the bowel. Diet restrictions should be considered in terms of quality of life and the patient’s wishes.

The benefits and risks of nutrition support vary for each patient.

Decisions about using nutrition support should be made with the following considerations:

• Will quality of life be improved?



• Do the possible benefits outweigh the risks and costs?



• Is there an advanced directive? An advanced directive is a written instruction about the provision of health care or power of attorney in the event an individual can no longer make his or her wishes known.



• What are the wishes and needs of the family?

Cancer patients and their caregivers have the right to make informed decisions. The healthcare team, with guidance from a registered dietitian, should inform patients and their caregivers about the benefits and risks of using nutrition support in advanced disease. In most cases, the risks outweigh the benefits. However, for someone who still has good quality of life but also physical barriers to achieving adequate food and water by mouth, enteral feedings may be appropriate. Parenteral support is not usually appropriate. Advantages and disadvantages of enteral nutrition include the following:

Benefits

• May improve alertness.
• May provide comfort to the family.
• May decrease nausea.
• May decrease hopelessness and fears of abandonment.

Risks

• May cause diarrhea or constipation.



• May increase nausea.



• Requires surgery for the placement of a tube through the abdomen.



• Increases risk of choking or pneumonia.



• Increases risk of infection.



• Creates a greater burden on the caregiver.

Some foods do not mix safely with certain drugs.

Cancer patients may be treated with a number of drugs throughout their care. Some foods or nutritional supplements do not mix safely with certain drugs. The combination of these foods and drugs may reduce or change the effectiveness of anticancer therapy or cause life-threatening side effects. The following table provides information on some of the drug-nutrient interactions that may occur with certain anticancer drugs:

Some herbs do not mix safely with certain drugs or foods.

The combination of some herbs with certain foods and drugs may reduce or change the effectiveness of anticancer therapy or cause life-threatening side effects. The following table provides information about herbs commonly taken by cancer patients. The information provided covers known interactions only; additional side effects are possible for these herbs. A pharmacist or updated herbal supplement references may provide more information.

The United States Department of Agriculture (USDA) developed Nutrition and Your Health: Dietary Guidelines for Americans that offers diet and fitness recommendations that support good overall health. The USDA Food Guide Pyramid shows five food groups and the number of servings to be eaten each day to provide the nutrients and calories needed. The food groups shown are grains, vegetables, fruits, dairy, and meat and nonmeat protein. Small amounts of fats, oils, and sweets are advised.

Current guidelines for promoting general health and well-being include the following:

• Eat nutrient-rich foods within calorie limits.



• Maintain a healthy body weight.



• Exercise regularly.



• Eat a variety of fruits, vegetables, whole grains, and low-fat dairy products each day.



• Eat less fat and avoid trans fatty acid (trans fats).



• Choose fiber -rich fruits, vegetables, and whole grains often.



• Eat fewer foods high in salt. Choose more foods high in potassium (like bananas, spinach and potatoes).



• Those who choose to drink alcoholic beverages should do so in moderation. Certain individuals should avoid alcohol entirely.



• Keep food safety in mind when preparing, storing, and serving foods.

Healthy food choices and physical activity may help reduce the risk of cancer. The American Cancer Society and the American Institute for Cancer Research have both developed cancer prevention guidelines that are similar.

The following diet and fitness guidelines may help reduce the risk of cancer:

• Eat a plant-based diet. Eat at least 5 servings of fruit and vegetables daily. Include beans in the diet and eat grain products (such as cereals, breads, and pasta) several times daily.



• Choose foods low in fat.



• Choose foods low in salt.



• Get to and stay at a healthy weight.



• Be at least moderately active for 30 minutes on most days of the week.



• Limit alcoholic drinks.



• Prepare and store food safely.



• Do not use tobacco in any form.

Nutrition guidelines for cancer prevention may also help cancer survivors prevent the development of a second cancer. The relationship between diet and cancer continues to be studied.

Study findings have shown the following associations between diet and lung cancer:

• Eating more than 5 servings per day of fruits and vegetables may reduce the risk of lung cancer.



• Taking beta-carotene supplements may increase the risk of lung cancer in male smokers.

Study findings have shown the following associations between diet and prostate cancer:

• Diets high in saturated fat and meat or animal fat may increase the risk of advanced prostate cancer.



• Taking daily vitamin E supplements may reduce the risk of death from prostate cancer.



• Taking daily beta-carotene supplements may reduce the chance of dying from prostate cancer. Taking beta-carotene supplements is not advised for smokers, however, as it may increase their risk of developing prostate cancer.

Study findings have shown the following associations between diet and breast cancer:

• High- calorie, high-fat diets may increase the risk of recurrence.



• Drinking beer may increase the risk of recurrence and death.



• Obesity (having too much body fat) may increase the risk of recurrence.



• Lack of physical activity may increase the risk of recurrence.



• Taking vitamin C above the RDA may reduce the risk of recurrence.



• A diet high in vegetables and fruits may reduce the risk of recurrence.



• A diet rich in foods that contain beta-carotene (such as dark orange vegetables and fruits) may reduce the risk of death from breast cancer.

The effect of soy on breast cancer or breast cancer recurrence is unknown. Studies are under way.

Study findings have shown that a long-term diet rich in whole grains may reduce the risk of colon cancer.

Study findings have shown the following associations between diet and esophageal or gastric (stomach) cancer:

• A diet rich in cereal fiber may reduce the risk of gastric cancer.



• Taking daily supplements of vitamins C and E and beta-carotene may reduce the risk of esophageal cancer.

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