Anorexia
Taste Changes
Dry Mouth
Mouth Sores and Infections
Nausea
Diarrhea
Low White Blood Cell Count
Hot Flashes
Fluid Intake
Constipation

When side effects of cancer or cancer treatment interfere with normal eating, adjustments can be made to ensure the patient continues to get the necessary nutrition. Medications may be given to stimulate the appetite. Eating foods that are high in calories, protein, vitamins and minerals is usually advised. Meal planning, however, should be individualized to meet the patient's nutritional needs and tastes in food.

Anorexia (lack of appetite) is one of the most common problems for cancer patients. The following suggestions may help cancer patients manage anorexia:

• Eat small high- protein and high- calorie meals every 1-2 hours instead of 3 larger meals.



• Have help with preparing meals.



• Add extra calories and protein to food (such as butter, skim milk powder, honey, or brown sugar).



• Take liquid supplements (special drinks containing nutrients), soups, milk, juices, shakes, and smoothies when eating solid food is a problem.



• Eat snacks that contain plenty of calories and protein.



• Prepare and store small portions of favorite foods so they are ready to eat when hungry.



• Eat breakfasts that contain one third of the calories and protein needed for the day.



• Eat foods with odors that are appealing. Strong odors can be avoided by using boiling bags, cooking outdoors on the grill, using a kitchen fan when cooking, serving cold food instead of hot (since odors are in the rising steam), and taking off any food covers to release the odors before entering a patient's room. Small portable fans can be used to blow food odors away from patients. Cooking odors can be avoided by ordering take-out food.



• Try new foods. Be creative with desserts. Experiment with recipes, flavorings, spices, types, and consistencies of food. Food likes and dislikes may change from day to day.

The following high-calorie, high-protein foods are recommended:

• Cheese and crackers.



• Muffins.



• Puddings.



• Nutritional supplements.



• Milkshakes.



• Yogurt.



• Ice cream.



• Powdered milk added to foods such as pudding, milkshakes, or any recipe using milk.



• Finger foods (handy for snacking) such as deviled eggs, cream cheese or peanut butter on crackers or celery, or deviled ham on crackers.

See the NCI Web site'sEating Hints for Cancer Patients: Before, During, and After Treatment for recipes such as Lactose-Free Double Chocolate Pudding, Banana Milkshake, and Fruit and Cream. For a free copy of this booklet, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

Changes in how foods taste may be caused by radiation treatment, dental problems, or medicines. Cancer patients often complain of changes in their sense of taste when undergoing chemotherapy, in particular a bitter taste sensation. A sudden dislike for certain foods may occur. This may result in food avoidance, weight loss, and anorexia, which can greatly reduce the patients' quality of life. Some or all of the sense of taste may return, but it may be a year after treatment ends before the sense of taste is normal again. Drinking plenty of fluids, changing the types of foods eaten and adding spices or flavorings to food may help.

The following suggestions may help cancer patients manage changes in taste:

• Rinse mouth with water before eating.



• Try citrus fruits (oranges, tangerines, lemons, grapefruit) unless mouth sores are present.



• Eat small meals and healthy snacks several times a day.



• Eat meals when hungry rather than at set mealtimes.



• Use plastic utensils if foods taste metallic.



• Try favorite foods.



• Eat with family and friends.



• Have others prepare the meal.



• Try new foods when feeling best.



• Substitute poultry, fish, eggs, and cheese for red meat.



• Find nonmeat, high- protein recipes in a vegetarian or Chinese cookbook.



• Use sugar-free lemon drops, gum, or mints if there is a metallic or bitter taste in the mouth.



• Add spices and sauces to foods.



• Eat meat with something sweet, such as cranberry sauce, jelly, or applesauce.

Taking zinc sulfate tablets during radiation therapy to the head and neck may speed the return of normal taste after treatment.

Dry mouth is often caused by radiation therapy to the head and neck. Some medicines may also cause dry mouth. Dry mouth may affect speech, taste, ability to swallow, and the use of dentures or braces. There is also an increased risk of cavities and gum disease because less saliva is produced to wash the teeth and gums.

The main treatment for dry mouth is drinking plenty of liquids, about ½ ounce per pound of body weight per day. Other suggestions to manage dry mouth include the following:

• Eat moist foods with extra sauces, gravies, butter, or margarine.



• Suck on hard candy or chew gum.



• Eat frozen desserts (such as frozen grapes and ice pops) or ice chips.



• Clean teeth (including dentures) and rinse mouth at least four times per day (after each meal and before bedtime).



• Keep water handy at all times to moisten the mouth.



• Choose foods and drinks that are very sweet or tart, to stimulate saliva.



• Avoid mouth rinses containing alcohol.



• Drink fruit nectar instead of juice.



• Use a straw to drink liquids.

(Refer to the PDQ summary on Oral Complications of Chemotherapy and Head/Neck Radiation for more information on dry mouth.

Mouth sores can result from chemotherapy and radiation therapy. These treatments target rapidly-growing cells because cancer cells grow rapidly. Normal cells inside the mouth may be damaged by these cancer treatments because they also grow rapidly. Mouth sores may become infected and bleed, making eating difficult. By choosing certain foods and taking good care of their mouths, patients can usually make eating easier. Suggestions to help manage mouth sores and infections include the following:

• Eat soft foods that are easy to chew and swallow, such as the following:
  • Soft fruits, including bananas, applesauce, and watermelon.
  • Peach, pear, and apricot nectars.
  • Cottage cheese.
  • Mashed potatoes.
  • Macaroni and cheese.
  • Custards; puddings.
  • Gelatin.
  • Milkshakes.
  • Scrambled eggs.
  • Oatmeal or other cooked cereals.



• Use the blender to process vegetables (such as potatoes, peas, and carrots) and meats until smooth.



• Avoid rough, coarse, or dry foods, including raw vegetables, granola, toast, and crackers.



• Avoid foods that are spicy or salty. Avoid foods that are acidic, such as vinegar, pickles, and olives.



• Avoid citrus fruits and juices, including orange, grapefruit, and tangerine.



• Cook foods until soft and tender.



• Cut foods into small pieces.



• Use a straw to drink liquids.



• Eat foods cold or at room temperature. Hot and warm foods can irritate a tender mouth.



• Clean teeth (including dentures) and rinse mouth at least four times per day (after each meal and before bedtime).



• Add gravy, broth, or sauces to food.



• Drink high- calorie, high- protein drinks in addition to meals.



• Numb the mouth with ice chips or flavored ice pops.

Using a mouth rinse that contains glutamine may reduce the number of mouth sores. Glutamine is a substance found in plant and animal proteins.

(Refer to the PDQ summary on Oral Complications of Chemotherapy and Head/Neck Radiation for more information on mouth sores and infections.)

Nausea caused by cancer treatment can affect the amount and kinds of food eaten. The following suggestions may help cancer patients manage nausea:

• Eat before cancer treatments.



• Avoid foods that are likely to cause nausea. For some patients, this includes spicy foods, greasy foods, and foods that have strong odors.



• Eat small meals several times a day.



• Slowly sip fluids throughout the day.



• Eat dry foods such as crackers, breadsticks, or toast throughout the day.



• Sit up or lie with the upper body raised for one hour after eating.



• Eat bland, soft, easy-to-digest foods rather than heavy meals.



• Avoid eating in a room that has cooking odors or that is overly warm. Keep the living space at a comfortable temperature and with plenty of fresh air.



• Rinse out the mouth before and after eating.



• Suck on hard candies such as peppermints or lemon drops if the mouth has a bad taste.

(Refer to the PDQ summary on Nausea and Vomiting for more information.)

Diarrhea may be caused by cancer treatments, surgery on the stomach or intestines, or by emotional stress. Long-term diarrhea may lead to dehydration (lack of water in the body) and/or low levels of salt and potassium, important minerals needed by the body.

The following suggestions may help cancer patients manage diarrhea:

• Eat broth, soups, sports drinks, bananas, and canned fruits to help replace salt and potassium lost by diarrhea.



• Avoid greasy foods, hot or cold liquids, and caffeine.



• Avoid high- fiber foods--especially dried beans and cruciferous vegetables (such as broccoli, cauliflower, and cabbage).



• Drink plenty of fluids through the day. Room temperature liquids may cause fewer problems than hot or cold liquids.



• Limit milk to 2 cups or eliminate milk and milk products until the source of the problem is found.



• Limit gas-forming foods and beverages such as peas, lentils, cruciferous vegetables, chewing gum, and soda.



• Limit sugar-free candies or gum made with sorbitol (sugar alcohol).



• Drink at least one cup of liquid after each loose bowel movement.

Taking oral glutamine may help keep the intestines healthy when taking the anticancer drug fluorouracil.

(Refer to the PDQ summary on Gastrointestinal Complications for more information.)

Cancer patients may have a low white blood cell count for a variety of reasons, some of which include radiation therapy, chemotherapy, or the cancer itself. Patients who have a low white blood cell count are at an increased risk of infection. The following suggestions may help cancer patients prevent infections when white blood cell counts are low:

• Check dates on food and do not buy or use the food if it is out of date.



• Do not buy or use food in cans that are swollen, dented, or damaged.



• Thaw foods in the refrigerator or microwave. Never thaw foods at room temperature. Cook foods immediately after thawing.



• Refrigerate all leftovers within 2 hours of cooking and eat them within 24 hours.



• Keep hot foods hot and cold foods cold.



• Avoid old, moldy, or damaged fruits and vegetables.



• Avoid unpackaged tofu sold in open bins or containers.



• Cook all meat, poultry, and fish thoroughly. Avoid raw eggs or raw fish.



• Buy foods packed as single servings to avoid leftovers.



• Avoid salad bars and buffets when eating out.



• Avoid large groups of people and people who have infections.



• Wash hands often to prevent the spread of bacteria.

Hot flashes occur in most women with breast cancer and men with prostate cancer. When caused by natural or treatment-related menopause, hot flashes can be relieved with estrogen replacement. Many women, however, (including women with breast cancer), are not able to take estrogen replacement. Eating soy foods, which contain an estrogen -like substance, is sometimes suggested to relieve hot flashes in patients who cannot take estrogen replacement, but no benefit has been proven. (Refer to the PDQ summary on Fever, Sweats, and Hot Flashes for more information.)

The body needs plenty of water to replace the fluids lost every day. Long-term diarrhea, nausea and vomiting, and pain may prevent the patient from drinking and eating enough to get the water needed by the body. One of the first signs of dehydration (lack of water in the body) is extreme tiredness. The following suggestions may help cancer patients prevent dehydration:

• Drink 8 to 12 cups of liquids a day. This can be water, juice, milk, or foods that contain a large amount of liquid such as puddings, ice cream, ice pops, flavored ices, and gelatins.



• Take a water bottle whenever leaving home. It is important to drink even if not thirsty, as thirst is not a good sign of fluid needs.



• Limit drinks that contain caffeine, such as sodas, coffee, and tea (both hot and cold).



• Drink most liquids after and/or between meals.



• Use medicines that help relieve nausea and vomiting.

Constipation is defined as fewer than 3 bowel movements per week. It is a very common problem for cancer patients and may result from lack of water or fiber in the diet; lack of physical activity; anticancer therapies such as chemotherapy; and medications.

Prevention of constipation is a part of cancer care. The following suggestions may help cancer patients prevent constipation:

• Eat more fiber-containing foods on a regular basis. The recommended fiber intake is 25 to 35 grams per day. Increase fiber gradually and drink plenty of fluids at the same time to keep the fiber moving through the intestines.



• Drink 8 to 10 cups of fluid each day. Water, prune juice, warm juices, lemonade, and teas without caffeine can be very helpful.



• Take walks and exercise regularly. Proper footwear is important.

If constipation does occur, the following suggestions for diet, exercise, and medication may help correct it:

• Continue to eat high-fiber foods and drink plenty of fluids. Try adding wheat bran to the diet; begin with 2 heaping tablespoons each day for 3 days, then increase by 1 tablespoon each day until constipation is relieved. Do not exceed 6 tablespoons per day.



• Maintain physical activity.



• Include over-the-counter constipation treatments, if necessary. This refers to bulk-forming products (such as Citrucel, Metamucil, Fiberall, FiberCon, and Fiber-Lax); stimulants (such as Dulcolax tablets or suppositories and Senokot); stool softeners (such as Colace, Surfak, and Dialose); and osmotics (such as milk of magnesia). Cottonseed and aerosol enemas can also help relieve the problem. Lubricants such as mineral oil are not recommended because they may prevent the body's use of important nutrients.

Good food sources of fiber include the following:

4 or more grams of fiber per serving

• Legumes (½ cup, cooked).
  • Kidney beans.
  • Navy beans.
  • Garbanzo beans.
  • Lima beans.
  • Split peas.
  • Pinto beans.
  • Lentils.
• Vegetables and fruit
  • Corn (½ cup).
  • Pears with skin (one medium-sized pear).
  • Popcorn (3 cups popped).
• Cold cereals (1 ounce)
  • Whole-grain cereals.
  • Bran cereals.
• Hot cereals (1/3 cup before cooking).
  • Oatmeal.
  • Oat bran.
  • Grits.

2 or more grams of fiber per serving

• Vegetables (½ cup cooked or 1 cup raw).
  • Asparagus.
  • Green beans.
  • Broccoli.
  • Cabbage.
  • Carrots.
  • Cauliflower.
  • Greens.
  • Onions.
  • Peas.
  • Spinach.
  • Squash.
  • Green peppers.
  • Celery.
  • Canned tomatoes.
• Fruit (½ cup serving or one medium-sized fruit).
  • Apples with the skin.
  • Bananas.
  • Oranges.
  • Strawberries.
  • Peaches.
  • Blueberries.
• Breads.
  • Whole wheat bread (one slice).
  • Whole grain bagel (one half of medium-sized bagel).
  • Whole wheat pita (½ portion).
  • Whole grain crackers (see package for serving size).

Legumes, broccoli, and cabbage may cause gas. Over-the-counter enzyme tablets may be helpful.

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