Before Treatment Begins

Nutrition Recommendations Can Be Different for Cancer Patients Preparing Yourself for Cancer Treatment

Managing Eating Problems During Treatment

Coping with Side Effects Loss of Appetite Weight Loss Weight Gain Sore Mouth or Throat Dry Mouth Dental and Gum Problems Changed Sense of Taste or Smell Nausea Vomiting Diarrhea Lactose Intolerance Constipation Fatigue and Depression Preventing Food-Borne Illness Extra Vitamins and Minerals - Will They Help? What About Alternative Therapies?

Special Notes for Caregivers

After Treatment Ends

Ways to Get Back Into Eating

Recipes

Banana Milkshake Fortified Milk High-Protein Milkshake Peanut Butter Snack Spread Fruit and Cream Lactose-Free Double Chocolate Pudding Apple/Prune Sauce

Figure and Tables

Table 1. How Cancer Treatments Can Affect Eating Table 2. Examples of Clear Liquids Table 3. Examples of Full-Liquid Foods Table 4. Quick & Easy Snacks Table 5. How to Increase Calories Table 6. How to Increase Protein Keeping Track of Side Effects

Resources

Your Diet Is an Important Part of Your Treatment

Your diet is an important part of your treatment for cancer. Eating the right kinds of foods before, during, and after your treatment can help you feel better and stay stronger.

The National Cancer Institute (NCI) has prepared this information to help you learn about your diet needs during treatment and to help you cope with side effects that may affect eating. It is designed for cancer patients and their families and other caregivers. The information here has been gathered from many sources and reflects the tried-and-true experience of cancer patients and the doctors, nurses, and dietitians who work with them.

Back to Top Before Treatment Begins

When your cancer was first diagnosed, your doctor talked to you about a treatment plan. This may have involved surgery, radiation therapy, chemotherapy, hormone therapy, and biologic immunotherapy or some combination of those treatments.

All of these methods of treating cancer kill cells. In the process of killing the cancer cells, some healthy cells are also damaged. That is what causes the side effects of cancer treatment. Side effects that can affect your ability to eat include:

• loss of appetite
• changes in weight (either losing or gaining weight)
• sore mouth or throat
• dry mouth
• dental and gum problems
• changes in sense of taste or smell
• nausea/vomiting
• diarrhea
• lactose intolerance
• constipation
• fatigue and/or depression

You may or may not have any of these side effects. Many factors determine whether you will have any and how severe they will be. These factors include the type of cancer you have, the part of your body being treated, the type and length of treatment, and the dose of treatment. The good news is that if you do have side effects they can often be well-controlled. Most side effects also go away after treatment ends. Your doctor or nurse can tell you more about your chances of having side effects and what they might be like.

Nutrition Recommendations Can Be Different for Cancer Patients

Preparing Yourself for Cancer Treatment

Think Positively

• Many people have few or no eating-related side effects. Even if you do, they may be mild, and most go away after cancer treatment ends. Also, there are new drugs now that can work well to control side effects.
  
• Having a positive attitude, talking out your feelings, becoming well-informed about your cancer and treatment, and planning ways to cope can all help reduce worry and anxiety, make you feel more in control, and help you keep your appetite.
  
• Give food a chance. Even if you do have eating problems, you'll have days when eating is a pleasure.

Eat a Healthy Diet

• A healthy diet is vital for a person's body to work its best. This is even more important for cancer patients.
  
• If you've been eating a healthy diet, you'll go into treatment with reserves to help keep up your strength, prevent body tissue from breaking down, rebuild tissue, and maintain your defenses against infection.
  
• People who eat well are better able to cope with side effects. You may even be able to handle higher doses of certain treatments. For example, we know that some cancer treatments are actually much more effective if the patient is well-nourished and getting enough calories and protein in his or her diet.
  
• Don't be afraid to try new foods. Some things you may never have liked before may taste good to you during treatment.

Plan Ahead

• Stock the pantry and freezer with favorite foods so that you won't need to shop as often. Include foods you know you can eat even when you are sick.
  
• Keep foods handy that need little or no preparation, for example, pudding, peanut butter, tuna fish, cheese, and eggs.
  
• Do some cooking in advance and freeze in meal-sized portions.
  
• Talk to friends or family members about helping with shopping and cooking. Or, ask a friend or family member to manage that job for you.
  
• Talk to a registered dietitian about your concerns and what you might expect. She or he can give you ideas and help you plan meals. Ask for help in developing a grocery list with foods that might help with potential side effects, such as constipation or nausea. Ask about what has worked for other patients.

Back to Top Managing Eating Problems During Treatment

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

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

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

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

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

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

• When you can eat, try to eat meals and snacks with sufficient protein and calories; they will help you keep up your strength, prevent body tissues from breaking down, and rebuild tissues that cancer treatment may harm.
• Many people find their appetite is better in the morning. Take advantage of this and eat more then. Consider having your main meal of the day early, and have liquid meal replacements later on if you don't feel so interested in eating (see the information on liquid meal replacements).
• If you don't feel well and can eat only one or two things, stick with them until you are able to eat other foods. Try a liquid meal replacement for extra calories and protein.
• On those days when you can't eat at all, don't worry about it. Do what you can to make yourself feel better. Come back to eating as soon as you can, and let your doctor know if this problem doesn't get better within a couple of days.
• Try to drink plenty of fluids, especially on those days when you don't feel like eating. Water is essential to your body's proper functioning, so getting enough fluids will ensure that your body has the water it needs. For most adults, 6-8 cups of fluid a day are a good target. Try carrying a water bottle with you during the day. That may help you get into the habit of drinking plenty of fluids. Tables 2 and 3 include many examples of fluids you can try.

Coping with Side Effects

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

Let them know that you appreciate their support. Tell them about Special Notes for Caregivers.

At the end of Eating Hints, you will find two items that may be especially useful as you go through treatment and use this booklet. The first, "Keeping Track of Side Effects," is a chart that you copy and use to monitor how you feel as you go through treatment. Use the second, "Notes," to jot down questions or concerns that you want to discuss with your health care team.

Loss of Appetite

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

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

• Try liquid or powdered meal replacements, such as "instant breakfast," during times when it is hard for you to eat food.
• Try frequent small meals throughout the day, rather than fewer big ones. It may be easier to eat more that way, and you won't get so full.
• Keep snacks within easy reach so you can have something whenever you feel like it. Cheese and crackers, muffins, ice cream, peanut butter, fruit, and pudding are good possibilities. Take a portable snack with you when you go out, such as peanut butter crackers or small boxes of raisins. You can find more snack ideas in Table 4.
• Even if you don't feel like eating solid foods, try to drink beverages during the day. Juice, soup, and other fluids like them can give you important calories and nutrients. Milk-based drinks also provide protein. Tables 2 and 3 give lots of examples of fluids.
• If possible, try having something at bedtime. It won't affect your appetite for the next meal.
• Sometimes, changing the form of a food will make it more appetizing and help you eat better. For example, if eating whole, fresh fruit is a problem, try mixing fruit into a milkshake. (Banana Milkshake Recipe)
• Try softer, cool, or frozen foods, such as yogurt, milkshakes, or popsicles.
• Take advantage of times when you do feel well, and have a larger meal then. Many people have a better appetite first thing in the morning, when they are well rested.
• During meals, sip only small amounts because drinking may make you feel full. If you want to have more than just a small amount to drink, have it 30-60 minutes before or after a meal.
• Make mealtimes as relaxed and pleasant as possible. Presenting food or meals in an attractive way may also help.
• If your doctor allows, have a small glass of wine or beer during a meal. It may help to stimulate your appetite.
• Regular exercise may help your appetite. Check with your doctor to see what options are open to you.

Weight Loss

Many cancer patients lose weight during their cancer treatment. This is partly due to the effects of the cancer itself on the body. Also, if you've lost your appetite and are eating less than usual because of your treatment or emotional worries, you may lose weight. Table 5: How to Increase Calories and Table 6: How to Increase Protein will give you some ideas for slowing weight loss or even gaining a few pounds. The tips under Loss of Appetite may help, too.

Here are three simple recipes that show you how to increase the calories and protein of familiar foods:
Fortified Milk
High-Protein Milkshake
Peanut Butter Snack Spread

Instant Dry Milk as a Protein Powder

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

Weight Gain

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

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

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

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

• Emphasize fruits, vegetables, and breads and cereals.
• Choose lean meats (lean beef or pork trimmed of fat, chicken without skin) and low-fat dairy products (skim or 1% milk, light yogurt).
• Cut back on added butter, mayonnaise, sweets, and other extras.
• Choose low-fat and low-calorie cooking methods (broiling, steaming).
• Avoid eating high-calorie snacks between meals.
• If you feel up to it, increase the amount of exercise you get.

Sore Mouth or Throat

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

• milkshakes
• bananas, applesauce, and other soft fruits
• peach, pear, and apricot nectars
• watermelon
• cottage cheese, yogurt
• mashed potatoes, noodles
• macaroni and cheese
• custards, puddings, and gelatin
• scrambled eggs
• oatmeal or other cooked cereals
• pureed or mashed vegetables, such as peas and carrots
• pureed meats
  

Here's a simple blender recipe that's easy on a sore mouth: Fruit and Cream

• Avoid foods or liquids that can irritate your mouth. These include:
  • oranges, grapefruits, lemons, or other citrus fruit or juice
  • tomato sauces or juice
  • spicy or salty foods
  • raw vegetables, granola, toast, crackers, or other rough, coarse, or dry foods
  • commercial mouthwashes that contain alcohol
• Cook foods until they are soft and tender.
• Cut foods into small pieces.
• Use a blender or food processor to puree your food.
• Mix food with butter, margarine, thin gravy, or sauce to make it easier to swallow.
• Use a straw to drink liquids.
• Use a smaller-than-usual spoon, such as a baby spoon.
• Try foods cold or at room temperature. Hot foods can irritate a tender mouth and throat.
• Try drinking warm bouillon or salty broth; it can soothe throat pain.
• Try sucking on ice chips.
• If swallowing is hard, tilting your head back or moving it forward may help.
• If your teeth and gums are sore, your dentist may be able to recommend a special product for cleaning your teeth.
• Rinse your mouth often with water to remove food and bacteria and to promote healing.
• Ask your doctor about anesthetic lozenges and sprays that can numb your mouth and throat long enough for you to eat meals.

Dry Mouth

Chemotherapy and radiation therapy in the head or neck area can reduce the flow of saliva and cause dry mouth. When this happens, foods are harder to chew and swallow. Dry mouth also can change the way foods taste. Some of the ideas for sore mouth and throat may help. The suggestions below also may help you deal with dry mouth.

• Have a sip of water every few minutes to help you swallow and talk more easily. Consider carrying a water bottle with you so you always have some handy.
• Try very sweet or tart foods and beverages, such as lemonade; these foods may help your mouth make more saliva. (Do not try this if you also have a tender mouth or sore throat and the sweet or tart foods make it worse.)
• Suck on hard candy or popsicles or chew gum. These can help make more saliva.
• Eat soft and pureed foods, which may be easier to swallow.
• Keep your lips moist with lip salves.
• Moisten food with sauces, gravies, and salad dressings to make it easier to swallow.
• If your dry mouth problem is severe, ask your doctor or dentist about products that coat, protect, and moisten your mouth and throat. These are sometimes called "artificial saliva."

Dental and Gum Problems

Cancer and cancer treatment can cause tooth decay and other problems for your teeth and gums. For example, radiation to the mouth can affect your salivary glands, making your mouth dry and increasing your risk of cavities. Changes in eating habits also may add to the problem. Your doctor and dentist should work closely together to fix any problems with your teeth before you start treatment. If you eat often or eat a lot of sweets, you may need to brush your teeth more often. Brushing after each meal or snack is a good idea. Here are some other ideas for preventing dental problems:

• Be sure to let your doctor know about any dental problems you are having.
• Be sure to see your dentist regularly. Patients who are receiving treatment that affects the mouth - for example, radiation to the head and neck - may need to see the dentist more often than usual.
• Use a soft toothbrush. Ask your doctor, nurse, or dentist to suggest a special kind of toothbrush and/or toothpaste if your gums are very sensitive.
• Rinse your mouth with warm water when your gums and mouth are sore.
• If you are eating foods high in sugar or foods that stick to your teeth, be sure to brush or rinse your mouth afterward so that the sugar won't damage your teeth, or use sugar-free varieties. (Sorbitol, a sugar substitute that is contained in many sugar-free foods, can cause diarrhea in many people. If diarrhea is a problem for you, check the labels of sugar-free foods before you buy them and limit your use of them.)

Changed Sense of Taste or Smell

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

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

• Choose and prepare foods that look and smell good to you.
• If red meat, such as beef, tastes or smells strange, try chicken, turkey, eggs, dairy products, or mild-tasting fish instead.
• Help the flavor of meat, chicken, or fish by marinating it in sweet fruit juices, sweet wine, Italian dressing, or sweet-and-sour sauce.
• Try using small amounts of flavorful seasonings, such as basil, oregano, or rosemary.
• Try tart foods, such as oranges or lemonade, that may have more taste. A tart lemon custard might taste good and will also provide needed protein and calories. (If you have a sore mouth or throat, tart or citrus foods might cause pain or discomfort.)
• If smells bother you, try serving foods at room temperature, turning on a kitchen fan, covering foods when cooking, and cooking outdoors in good weather.
• Try using bacon, ham, or onion to add flavor to vegetables.
• Visit your dentist to rule out dental problems that may affect the taste or smell of food.
• Ask your dentist or doctor about special mouthwashes and good mouth care.

Nausea

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

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

• Ask your doctor about antiemetics that might help you control nausea and vomiting.
• Try foods that are easy on your stomach, such as:
  • toast, crackers, and pretzels
  • yogurt
  • sherbet
  • angel food cake
  • cream of wheat, rice, or oatmeal
  • boiled potatoes, rice, or noodles
  • skinned chicken that is baked or broiled, not fried
  • canned peaches or other soft, bland fruits and vegetables
  • clear liquids
  • ice chips
  • carbonated drinks
• Avoid foods that:
  • are fatty, greasy, or fried
  • are very sweet, such as candy, cookies, or cake
  • are spicy or hot
  • have strong odors
• Eat small amounts, often and slowly. Eat before you get hungry, because hunger can make feelings of nausea stronger.
• If nausea makes certain foods unappealing, then eat more of the foods you find easier to handle.
• Avoid eating in a room that's stuffy, too warm, or has cooking odors that might disagree with you.
• Drink fewer liquids with meals. Drinking liquids can cause a full, bloated feeling.
• Slowly drink or sip liquids throughout the day. A straw may help.
• Have foods and drinks at room temperature or cooler; hot foods may add to nausea.
• Don't force yourself to eat favorite foods when you feel nauseated. This may cause a permanent dislike for those foods.
• Rest after meals, because activity may slow digestion. It's best to rest sitting up for about an hour after meals.
• If nausea is a problem in the morning, try eating dry toast or crackers before getting up.
• Wear loose-fitting clothes.
• If nausea occurs during radiation therapy or chemotherapy, avoid eating for 1 to 2 hours before treatment.
• Try to keep track of when your nausea occurs and what causes it (specific foods, events, surroundings). (see chart) If possible and if it helps, change your diet or schedule. Share the information with your doctor or nurse.

Vomiting

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

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

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

• Do not eat or drink anything until you have the vomiting under control.
• Once the vomiting is under control, try small amounts of clear liquids, such as water or bouillon. Table 2 gives you more examples of clear liquids. Begin with 1 teaspoonful every 10 minutes, gradually increasing the amount to 1 tablespoon every 20 minutes. Finally, try 2 tablespoons every 30 minutes.
• When you are able to keep down clear liquids, try a full-liquid diet or a soft diet. Table 3 gives examples of full-liquid foods. Continue taking small amounts as often as you can keep them down. If you feel okay, gradually work up to your regular diet. If you have a hard time digesting milk, you may want to try a soft diet instead of a full-liquid diet, because a full-liquid diet includes a lot of milk products. Ask a registered dietitian for information about a soft diet.

Diarrhea

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

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

• Drink plenty of fluids to replenish what you lose with the diarrhea. Tables 2 and 3 give examples of fluids to try.
• Eat small amounts of food throughout the day instead of three large meals.
• Eat plenty of foods and liquids that contain sodium and potassium, two important minerals that help your body work properly. These minerals are often lost during diarrhea. Good high-sodium liquids include bouillon or fat-free broth. Foods high in potassium that don't cause diarrhea include bananas, peach and apricot nectar, and boiled or mashed potatoes. Sports drinks contain both sodium and potassium and have easily absorbable forms of carbohydrates.
• Try these foods:
  • yogurt, cottage cheese
  • rice, noodles, or potatoes
  • farina or cream of wheat
  • eggs (cooked until the whites are solid; not fried)
  • smooth peanut butter
  • white bread
  • canned, peeled fruits and well-cooked vegetables
  • skinned chicken or turkey, lean beef, or fish (broiled or baked, not fried)
• Avoid:
  • greasy, fatty, or fried foods if they make your diarrhea worse
  • raw vegetables and the skins, seeds, and stringy fibers of unpeeled fruits
  • high-fiber vegetables, such as broccoli, corn, dried beans, cabbage, peas, and cauliflower
• Avoid very hot or cold food or beverages. Drink liquids that are at room temperature.
• Limit foods and drinks that contain caffeine, such as coffee, some sodas, and chocolate.
• If you have a sudden, short-term attack of diarrhea, try having nothing but clear liquids for the next 12 to 14 hours. (see chart) This lets your bowel rest and replaces the important fluids lost during the diarrhea. Make sure your doctor or nurse knows about this problem.
• Be careful when using milk and milk products. The lactose they contain can make diarrhea worse. Most people, though, can handle small amounts (about 1-1/2 cups) of milk or milk products.

Lactose Intolerance

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

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

If you have this problem, your doctor may advise you to follow a diet that is low in foods that contain lactose. Talk to a registered dietitian to get advice and specific tips about how to follow a low-lactose diet. Your supermarket should carry milk and other products that have been modified to reduce or eliminate the lactose. You can also make your own low-lactose or lactose free foods. Here's a simple recipe for a lactose-free pudding: Lactose-Free Double Chocolate Pudding).

Constipation

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

• Drink plenty of liquids - at least eight 8-ounce glasses every day. This will help to keep your stools soft. Another way to think about fluids is to try to drink at least 1/2 oz. per pound of your body weight.
• Have a hot drink about one-half hour before your usual time for a bowel movement.
• Check with your doctor to see if you can increase the fiber in your diet (there are certain types of cancer for which a high-fiber diet is not recommended). If you can, try foods such as whole-grain breads and cereals, dried fruits, wheat bran, wheat germ; fresh fruits and vegetables; dried beans and peas. Eat the skin on potatoes. Make sure you also drink plenty of fluids to help the fiber work. Here's is an easy recipe that might help relieve constipation: Apple/Prune Sauce.
• Get some exercise every day. Talk to your doctors or a physical therapist about the amount and type of exercise that's right for you.

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

Fatigue and Depression

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

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

• Talk about your feelings and your fears. Being open about your emotions can make them seem more manageable. Consider talking with your nurse or social worker, who can help you find ways to lessen your worries and fears.
• Become familiar with your treatment, possible side effects, and ways of coping. Being knowledgeable and acting on that knowledge will help you feel more in control. Don't be afraid to talk with your doctor and ask questions.
• Make sure you get enough rest:
  • take several naps or rest breaks during the day, rather than one long rest
  • plan your day to include rest breaks
  • make rest time special with a good book in a comfortable chair or a favorite video with a friend
• try easier or shorter versions of your usual activities; don't push yourself to do more than you can manage.
• Save your favorite foods for times that aren't associated with treatment sessions. That way, they won't be linked to an uncomfortable or distressing event.
• Take short walks or get regular exercise, if possible. Some people find this helps to lessen their fatigue and raise their spirits.

Preventing Food-Borne Illness

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

• Wash all raw fruits and vegetables well. If it can't be well washed (as with raspberries), avoid it. Scrub rough surfaces, like the skin of melons, prior to cutting.
• Carefully wash your hands and food preparation surfaces (knives, cutting boards) before and after preparing food, especially after handling raw meat.
• Thaw meat in the refrigerator, not on the kitchen counter.
• Be sure to cook meat and eggs thoroughly.
• Avoid raw shellfish and use only pasteurized or processed ciders and juices and pasteurized milk and cheese.

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

Extra Vitamins and Minerals - Will They Help?

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

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

What About Alternative Therapies?

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

Back to Top Special Notes for Caregivers

There is much that you can do to help your friend or loved one through the period of cancer treatment. Read over the tips and suggestions in Managing Eating Problems During Cancer Treatment. Many may be useful to you as you prepare food or meals for the patient.

In addition, here are some other things to remember that will help you cope:

• Be prepared for the patient's tastes to change from day to day. Some days he or she won't want favorite foods because they don't taste good. Other times, he or she will be able to eat a dish that couldn't be tolerated just the day before.
• Have food within easy reach at home. For example:
  • a snack-pack of applesauce or pudding and a spoon on the bedside table if the patient isn't feeling well that day
  • a bag of cut-up carrots on the top shelf of the refrigerator
• Have meals and snacks ready so the patient can have something to eat when he or she is ready.
• Be prepared for times when the patient is able to eat only one or two foods for a few days in a row, until side effects diminish. Even if he or she can't eat at all, still encourage plenty of fluids. Tables 2 and 3 contain a variety of examples of fluids, and the section on "Coping with Side Effects" has lots of ideas for getting enough fluids.
• Talk to the patient about needs and concerns, and about ideas that might work best. A willingness to be flexible and supportive no matter what will help the patient feel in control of the situation.
• Try not to push the patient into eating and drinking. Encourage and support without being overwhelming.

Back to Top After Treatment Ends

Most eating-related side effects associated with radiation, chemotherapy, or other treatments go away after cancer treatment ends. If you have had side effects, you should gradually begin to feel better, and your interest in food and mealtimes will come back. Sometimes, though, side effects persist, especially weight loss. If this happens to you, talk to your doctor and work out a plan together for how to address the problem.

After cancer treatment ends and you're feeling better, you may want to think again about the traditional guidelines for healthy eating. Just as you wanted to go into treatment with all the reserves that such a diet could give you, you'll want to do the best for yourself at this important time. There's no current research that suggests that the foods you eat will prevent your cancer from recurring. But, we do know that eating right will help you regain your strength, rebuild tissue, and help you feel well. Here are the fundamentals:

• Focus on eating a variety of foods every day. No one food contains all the nutrients you need.
• Emphasize fruits and vegetables. Raw or cooked vegetables, fruits, and fruit juices provide the vitamins, minerals, and fiber you need.
• Emphasize breads and cereals, especially the whole grain varieties, such as whole wheat bread, oats, and brown rice. These foods are good sources of complex carbohydrates, vitamins and minerals, and fiber.
• Go easy on fat, salt, sugar, alcohol, and smoked or pickled foods. Choose low-fat milk products, and small portions (no more than 6-7 oz. a day) of lean meat and poultry without skin. Try lower-fat cooking methods, such as broiling, steaming, and poaching.

The U.S. Department of Agriculture and U.S. Department of Health and Human Services have published materials to help Americans learn how to choose a healthy diet. The Resources section at the end of this booklet gives you information on how to get these materials. If you have any questions about guidelines for healthy eating, or whether such guidelines are right for you at this time, talk to a registered dietitian.

Some patients need to have treatments that last a long time. Others may have surgery to remove part of their stomach or intestines. These patients may have ongoing eating-related concerns. If this is your situation, talk to your doctor and a registered dietitian. He or she can give you more information about the long-term issues that you will deal with and can help you develop an individual diet plan.

Ways to Get Back Into Eating

Even if your treatment is over and you're feeling much better, you still may not feel completely back to your old self. Here are some ways to help you ease back to regular meals and mealtimes, without overdoing it:

• Make simple meals using familiar, easy-to-prepare recipes.
• Cook enough for two or three meals, then freeze the remainder for a later meal.
• Take advantage of the supermarket's salad bar and prepared foods to make cooking easier.
• Think about ways you used to make mealtime special and try them again.
• Don't be afraid to ask a friend or family member for help with cooking or shopping.

Back to Top Recipes

Banana Milkshake

Place all ingredients into a blender.
Blend at high speed until smooth.

Yield: 1 serving
Serving size: Approximately 2 cups

If made with whole milk:
Calories per serving: 255 calories
Protein per serving: 9 grams

If made with 2% milk:
Calories per serving: 226 calories
Protein per serving: 9 grams

If made with skim milk:
Calories per serving: 190 calories
Protein per serving: 9 grams

Fortified Milk

1 quart whole milk
1 cup nonfat instant dry milk

Pour liquid milk into a deep bowl.
Add dry milk and beat slowly with beater until dry milk is dissolved (usually less than five minutes).
Refrigerate and serve cold.
Note: If it tastes too strong, start with 1/2 cup of dry milk powder and gradually work up to 1 cup.

Yield: 1 quart
Serving size: 1 cup
Calories per serving: 211 calories
Protein per serving: 14 grams

Use fortified milk when making:

• macaroni and cheese
• puddings and custards
• cream sauces for vegetables
• mashed potatoes
• cocoa
• French toast or pancake batter
• soup

High-Protein Milkshake

Put all ingredients in a blender.
Blend at low speed for 10 seconds.

Yield: 1 serving
Serving size: Approximately 1-1/2 cups
Calories per serving: 425 calories
Protein per serving: 17 grams

Peanut Butter Snack Spread

Combine dry milk, water, and vanilla, stirring to moisten.
Add honey and peanut butter, stirring slowly until liquid blends with peanut butter.

Spread on crackers.

Mixture also can be formed into balls, chilled, and eaten as candy.

Keeps well in refrigerator but is difficult to spread when cold.

Yield: 6 tbsp
Serving size: 3 tbsp
Calories per serving: 279 calories
Protein per serving: 11 grams

Fruit and Cream

Yield: 2 servings
Serving size: 1-1/2 cups

If made with ice cream:
Calories per serving: 302 calories
Protein per serving: 7 grams

If made with frozen yogurt:
Calories per serving: 268 calories
Protein per serving: 9 grams

Lactose-Free Double Chocolate Pudding

Melt chocolate in small pan or on foil.
Measure cornstarch and sugar into saucepan.
Add part of the liquid and stir until cornstarch dissolves.
Add the remainder of the liquid.
Cook over medium heat until warm.
Stir in chocolate until mixture is thick and comes to a boil.
Remove from heat.
Blend in vanilla and cool.

Yield: 2 servings
Serving size: 3/4 cup
Calories per serving: 382 calories
Protein per serving: 1 gram

Apple/Prune Sauce

Blend all ingredients and store in refrigerator.
Take 1-2 tablespoons of this mixture before bedtime, then drink 8 oz. of water.
Note: Make sure you drink the water, or else it will not work to relieve constipation.

Yield: 16 servings
Serving size: 1 tbsp
Calories per serving: 10 calories

Back to Top Figure and Tables

Table 1. How Cancer Treatments Can Affect Eating

Table 2. Examples of Clear Liquids

Table 3. Examples of Full-Liquid Foods

Table 4. Quick & Easy Snacks

Table 5. How to Increase Calories

Table 6. How to Increase Protein

Keeping Track of Side Effects

Here's a form to help you keep track of eating-related side effects you may experience while you are undergoing cancer treatment. Feel free to copy this form and keep your own record. You can also share it with the health professional who is keeping track of side effects with you during this time. Your Name: Week of: Write the type and date of your last treatments(s): Type of Treatment: Date: Type of Treatment: Date: Your Weight:lbs. (measure once a week) Below you will find a list of some eating-related side effects that cancer patients may experience. Check the box next to any side effect listed below that you experience in the week you have listed above. Next to each one you have checked, write a number from 1 to 3 indicating how severe you think each side effect was for you, where: 1= mild; 2= moderate; and 3= severe.
Side Effect	M	T	W	Th	F	S	Sun
Sore/Dry Mouth	o	o	o	o	o	o	o
Nausea	o	o	o	o	o	o	o
Vomiting	o	o	o	o	o	o	o
Constipation	o	o	o	o	o	o	o
Diarrhea	o	o	o	o	o	o	o
Fatigue	o	o	o	o	o	o	o
Other: _______	o	o	o	o	o	o	o
Other Questions or Concerns (Use this space to write down questions or concerns you may want to talk about with your health care provider.)

Back to Top Resources

You may want more information for yourself, your family, and your doctor. The following National Cancer Institute (NCI) services are available to help you.

Telephone

Cancer Information Service (CIS)

Provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information specialists translate the latest scientific information into understandable language and respond in English, Spanish, or on TTY equipment.

Toll-free: 1-800-4-CANCER (1-800-422-6237)
TTY: 1-800-332-8615

Internet

Cancer.gov

NCI's Web site provides comprehensive information about cancer causes and prevention, screening and diagnosis, treatment and survivorship; clinical trials; statistics; funding and training; and the Institute's programs and research activities.

American Dietetic Association (ADA)

The ADA is a professional society of registered dietitians and other professionals working in food- and nutrition-related fields. For a referral to a registered dietitian in your area and to listen to recorded food and nutrition messages, call the ADA's consumer nutrition hotline at 1-800-366-1655. Or, visit the ADA's home page on the World Wide Web at http://www.eatright.org.

PUBLICATIONS

Cancer patients, their families and friends, and others may find the following National Cancer Institute books useful. They are available free of charge by calling 1-800-4-CANCER.

• "Chemotherapy and You: A Guide to Self-Help During Treatment" (Order Spanish Version)
• "Eating Hints for Cancer Patients Before, During, and After Treatment" (Order Spanish Version)
• "Get Relief From Cancer Pain"
• "Helping Yourself During Chemotherapy: 4 Steps for Patients"
• "Pain Control: A Guide for People with Cancer and Their Families" (Order Spanish Version)
• "Taking Time: Support for People With Cancer and the People Who Care About Them"
• "Taking Part in Clinical Trials: What Cancer Patients Need to Know" (Order Spanish Version)
• "If You Have Cancer: What You Should Know About Clinical Trials" (Order Spanish Version)

The National Cancer Institute and the U.S. Department of Agriculture and U.S. Department of Health and Human Services have published several materials on healthy eating. You may find them helpful after your treatment is over. They include:

• Nutrition and Your Health: Dietary Guidelines for Americans"
  U.S. Department of Agriculture and U.S. Department of Health and Human Services
• The Food Guide Pyramid_U.S. Department of Agriculture"
  To get a copy of either publication or other USDA nutrition publications, write to:
  U.S. Department of Agriculture
  Human Nutrition Information Service
  6505 Belcrest Road_Hyattsville, MD 20782

The Food and Drug Administration (FDA) has published a booklet called "The Unwelcome Dinner Guest: Preventing Food-Borne Illness," which contains useful information and tips on symptoms of food-borne illness, safe food storage, safe cooking and storing temperatures, safe food handling, and other topics related to preventing food-borne illness. Cancer patients and others with weakened immune systems need to be careful about food-borne illness, so this booklet may be especially helpful. To get up to 10 free copies write the FDA Office of Consumer Affairs:

Food and Drug Administration
Office of Consumer Affairs
5600 Fishers Lane
Room 1685, HFE 88
Rockville, MD 20857

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