Nutrition and the Cancer Patient

A recent article by Dr. Sanjay Gupta on MedPage Today calls for more efforts to be made on behalf of cancer patients to clarify and broaden nutritional recommendations found online. Dr. Gupta shares information compiled by Dr. Colin Champ of Thomas Jefferson University in Philadelphia, which showed not only that information is lacking, but that much of what is available is contradictory. From the article:

"A review of the websites of 21 National Comprehensive Cancer Network (NCCN) institutions revealed that only four (19%) provided nutritional guidelines. Another seven (33%) linked to external oncology sites -- but only 44% of these sites offered nutritional guidelines for cancer patients.

The real clincher, said senior author Colin Champ, MD, of Thomas Jefferson University in Philadelphia, was that many of the recommendations contradicted one another. Given that data suggest two-thirds of cancer patients go online for guidance, "it's imperative to fund randomized studies on diet and develop consistent, evidence-based nutritional guidelines for patients," Colin said."

We recently attended a video workshop with Michelle Morgan, MS RD CSO LD, a Clinical Dietician at University of Arkansas for Medical Sciences in Little Rock, Arkansas. She shared her professional recommendations for cancer patients who are battling side-effects of their treatment, but these tips can be helpful for cancer patients past treatment as well. As the National Cancer Institute states: "Nutrition in cancer care embodies prevention of disease, treatment, cure, or supportive palliation."

Here are some common (non-diagnosis-specific) side effects of treatment and tips on managing those effects:

Appetite Changes: 

• Increase intake to six small meals per day instead of three
• Delay drinking liquids until after your meals when you have eaten all you can
• Set an attractive table and make a meal an "event"
• Be as physically active as possible to keep your appetite up
• Eat high calorie, high protein snacks

Sore Mouth and Throat:

• Avoid tart, acidic, spicy or salty foods
• Choose soft, creamy foods over rough-textured or hard foods
• Choose lukewarm or cold foods
• Avoid alcohol, caffeine and tobacco which can dehydrate your body

Dry Mouth: 

• Drink 8-10 cups of liquid each day
• Take small bites and chew well
• Eat soft, most foods that are cool or room temperature
• Moisten foods with broth, soup, gravy or creams
• Suck on sugarless candy or chew sugarless gum
• Keep your mouth clean between meals
• Avoid commercial mouthwashes which contain alcohol
• Avoid alcoholic and acidic drinks and tobacco products
• Limit caffeine intake
• Use a cool mist humidifier
• Snack on fresh pineapple (unless you are also dealing with sore mouth)
• Ask your doctor about saliva substitutes

Taste and Smell Changes: 

• Use plastic flatware to reduce metallic taste
• Use fresh or frozen fruits and vegetables rather than canned
• Cook with tart foods and seasonings (unless you are also dealing with a sore mouth)
• Counter a salty taste with sweeteners
• Rinse mouth with baking soda and salt mouthwash before eating to neutralize it
• Keep your mouth clean and brush teeth regularly to reduce bad taste
• Serve food cold or at room temperature

Nausea: 

• Eat 6-8 small meals each day instead of three big meals
• Consume some dry foods upon waking and every few hours
• Avoid foods with strong odors
• Eat cold foods instead of hot or spicy foods
• Avoid foods that are overly sweet, greasy, fried or spicy
• Sit or recline for at least an hour after eating
• Sip clear (decaffeinated) liquids frequently to avoid dehydration

Diarrhea: 

• Drink mild, clear non-carbonated liquids through the day at room temperature
• Eat small, frequent meals
• Avoid greasy, spicy, fried or very sweet foods
• Limit milk or milk products
• Avoid drinks and foods that cause gas
• Drink and eat high-sodium, high-potassium foods
• Increase soluble fiber (click here for a definition and examples of soluble fiber)
• Drink at least 1 cup of liquid after each loose bowel movement
• Avoid sugar-free products

Fatigue: 

• Prioritize daily activities, and enlist friends who want to help
• Take short walks or get regular exercise
• Drink plenty of fluids
• Schedule some rest time during your day
• Avoid high-carbohydrate foods to reduce blood sugar fluctuation
• Increase protein in your diet
• Monitor daily caloric intake (ask your doctor for their recommendation based on your current physical situation, height and activity level)
• Avoid large doses of vitamins and minerals
• Manage stress, and seek out assistance to reduce the items on your "to-do" list

As you can see, many of these suggestions can be beneficial for more than one side-effect. For diagnosis-specific advice, seek out support groups either in your community or online to help you with your particular challenges, or talk to your doctor about your concerns.

Here's another blog post from last year that offers more suggestions on foods to keep on hand for a diet intended to help cancer patients remain healthy through treatment.