Dietitian Charlotte Graydon has help for people going through one of life’s biggest challenges.
There are few families who haven’t been affected by cancer in some way. Dealing with cancer treatment and surgery is a common health challenge. Eating well during this time can become a lot more challenging.
While you’re having treatment for cancer, your body is under a lot of stress. You will have greater energy (kilojoule) and protein needs and it is very important to get optimal energy from the food you eat. This can be difficult to do. The cancer itself can cause problems such as taste changes, fatigue, anxiety, depression and the sensation of feeling full quickly (early satiety). In fact, weight-loss is often the first symptom people notice and occurs in up to 80 per cent of people with cancer. Treatments can also affect your ability to eat well. Radiotherapy and chemotherapy can cause nausea, pain, diarrhoea, and mucositis (inflammation and ulceration of the lining of the digestive tract). And surgery may interfere with the absorption of nutrients from your food.
One of the key things to remember is that this is not a time to deliberately lose weight or try to diet, regardless of your weight prior to being diagnosed. Your aim should be to remain the same weight throughout your treatment. You may think it won’t hurt to lose a few kilos but when you’re unwell this weight-loss tends to be from your muscle rather than fat. By maintaining your weight at this time your body will be better able to cope with the treatments and your recovery will be faster.
Common eating problems during cancer treatment
One of the most common symptoms, a reduced appetite can be a combination of the treatment making you feel unwell, feeling fatigued and sometimes feeling a bit low.
Eat little and often. Become a ‘grazer’. Large meals will only reduce your appetite more. Choose liquids that provide energy (kilojoules) such as milkshakes, smoothies and juices, and drink these after or in between meals rather than just before. Try to have food on hand that’s easy to eat such as soups, macaroni cheese and canned spaghetti.
Taste and smell changes
These are quite common when undergoing treatment. They are usually temporary but can linger for a few weeks after treatment finishes. A common complaint is not being able to stomach meat or meat products.
Try marinating meat to alter the taste. Remember: your protein requirements are higher at this time so if this doesn’t do the trick make sure you’re having other protein-rich food such as cheese, tofu, kidney beans, eggs or fish. Experiment a bit with spices, herbs, lemon juice and marinades. Cleaning your teeth regularly and keeping mints nearby can also help.
This is not a pleasant sensation and can occur with or without vomiting.
Firstly, make sure you are taking your anti-nausea medications as directed by your doctor. Secondly, remember an empty stomach makes nausea worse so eat small amounts regularly and keep snacks such as nuts, muesli bars and crackers handy if you are going out.
If you can, avoid cooking smells — a great excuse to delegate the cooking to a family member or friend! Lay off the fried and fatty foods as these will often make you feel worse. Foods that are at room temperature or chilled tend to have less aroma so can be less likely to cause nausea. Don’t worry about eating at traditional mealtimes: eat your main meal at the time of day you’re feeling best.
Maintaining an adequate fluid intake is often difficult during your cancer treatment.
It is very important to keep up your fluid intake whether from water, broths, ice-blocks, lemonade or ginger ale. Just as with food, try sipping smaller amounts in-between and with meals as this will not affect your appetite as much.
Some chemotherapy drugs can cause quite nasty bouts of diarrhoea. It can also be a side-effect of radiotherapy to the pelvic area.
Make sure you contact your nurse or doctor about this as there are a number of treatments that can help. Diarrhoea can rapidly affect the amounts of important salts in your bloodstream which may need monitoring or replacing. When you are experiencing diarrhoea it is vital to keep your fluid intake up. In fact, you need more than usual to replace all the fluid you are losing. Aim for at least eight glasses each day of diluted juices, flat soft drink, weak tea, nutritional supplements, vegetable juices or broths. When you are recovering from a bout of diarrhoea start off with bland foods such as banana, rice, toast and apples — these tend to be better tolerated.
Constipation can be a problem in some cancer patients. If this is you, it is important to maintain a good intake of fibre and fluid.
A sore mouth caused by mucositis is also problematic. In this situation it may be necessary to alter the texture of your food to make it softer. Supplement drinks might be needed to ensure you get enough energy (kilojoules) and protein.
When you have cancer, the treatments can weaken your immune system making you more susceptible to bugs including foodborne illness. There is some very good information for food safety when you have low immunity at www.mpi.govt.nz/food-safety (search ‘low immunity’).
How to get maximum nutrition during cancer treatment
Energy (kilojoules) and protein needs are increased with cancer and surgery. How can you make sure you are getting what you need?
High-energy foods can be added to the food you are already eating. This means you are getting in more energy but without increasing the amount of food you are eating. For example:
- Butter, margarine, mayonnaise, oil, dressings, avocado and coconut cream. A liberal spread of margarine on your toast, a good dollop of oil in the cooking. This may seem to go against all the healthy eating advice you have heard but remember that the most important thing at this time is keeping your weight steady.
- Milk, milk powder, ice cream, yoghurts and cheeses can be added to soups, casseroles and puddings. Double-strength milk can be made by adding three tablespoons of skim milk powder to 600ml milk. Again, this is not a time to worry about using low-fat products.
- Get as much energy as you can from your fluids: use milky drinks such as Milo, Horlicks, soups, juices and non-diet drinks.
There are specifically designed supplement drinks available that can be used in addition to what you are already eating. They are not meal replacements. They are high in energy and protein but do not have all the nutrients you need so it is important to eat well, too.
- Complan and Vitaplan are powders that can be purchased from the supermarket. Mixed with milk or water these are high in energy and protein.
- There are also supplement drinks available on prescription (Sustagen, Ensure and Fortisip powders). Talk to your dietitian, doctor or nurse to see if these would be appropriate for you.
Note on alternative therapies
Studies indicate that between one-quarter to half the number of people with cancer use some sort of alternative or complementary therapy. Some of these are specific diets — for example, cutting out dairy or red meat — and some involve taking various vitamin and mineral supplements. There is no evidence to show that a particular food or food group can cure cancer and during treatment is not an ideal time to be cutting out vital food groups. If you have questions regarding a particular therapy you may have heard about, discuss this with your doctor and/or dietitian. There is also a good fact sheet at www.cancernz.org.nz.