Nutritional Guidance During Treatment

Cancer patients undergoing radiation treatment, chemotherapy, and surgery may experience significant nutritional problems. Some of these difficulties are temporary and will gradually subside after treatment, while others may be long-term. For example, radiation to the head, neck, chest, or esophagus may lead to changes in how you taste food and other problems, such as dry mouth, sore throat, and trouble swallowing. Radiation to the abdomen and pelvis may lead to diarrhea, nausea, and vomiting.

Sometimes radiation to the head and neck area may make it unsafe for you to swallow, or you may not be able to drink/eat enough to maintain a healthy weight. If this is your situation, our healthcare team may suggest that you alter the consistency of your food or that you use a feeding tube. If a feeding tube becomes necessary, we will provide you with support and training.

Symptoms and Tips:

Oral/throat mucositis, mouth sores, or trouble swallowing
These symptoms are common after starting head or neck cancer treatment. To ensure you have a healthy mouth, visit your dentist two weeks before beginning treatment.

• Avoid tart, spicy, or acidic foods such as tomatoes, citrus, pickles, peppers, and hot sauces.
• Avoid rough, coarse foods that can irritate the throat. If you need added moisture, add non-tomato sauces and gravies to your meals.
• If you have trouble chewing or swallowing, try moist and soft foods, such as mashed potatoes, yogurts, cottage cheese, soups, puddings, and smoothies. Use a blender to puree your food.
• Eat cold or lukewarm food.
• Use a straw for drinks or soups.
• Avoid alcohol, caffeine, and tobacco.
• Avoid mouthwashes that contain alcohol, including those meant for dry mouth.

Discuss with your radiation oncologist whether you should use an anesthetic (numbing) throat spray or lozenges before eating.

Dry mouth
According to the National Cancer Institute, “Radiation therapy to the head and neck areas, some types of chemo, and certain other medicines can cause dry mouth or thick saliva. The glands that make saliva can become irritated and make less saliva, or your saliva can become very thick and sticky.”

• Sip liquids frequently during the day and with meals to moisten your mouth.
• Suck on sugar-free hard candy, popsicles, or frozen grapes or chew sugar-free gum.
• Brush your teeth before eating, which can help if your saliva is uncomfortably thick because of radiation therapy.
• Ask your doctor about artificial saliva.
• The American Cancer Society recommends that you “rinse your mouth every 2 hours with a salt and soda solution,” which you can make “by adding one teaspoon of salt and one teaspoon of baking soda to 1 quart of warm water. Shake the solution before each use, then swish it and spit. Do not swallow it.”

Changes in taste or smell

• Eat foods cold or lukewarm.
• Experiment with herbs, spices, onions, garlic, lemon, and pepper.
• Try the Rebecca Katz “FASS method.” FASS^™ stands for: Fat, Acid, Salt, and Sweet.
• If food has a metallic taste, avoid eating from a can or using metallic flatware.
• If meats taste odd, try cooking them in fruit marinades. Also consider protein alternatives, such as tofu, soybeans, eggs, cottage cheese, Greek yogurt, and legumes.

Nausea or vomiting

• Try small, frequent easy-to-digest meals – such as rice, broth, dry crackers, or toast.
• Choose foods, such as sandwiches, that you can eat cold or at room temperature.
• Avoid eating strong-smelling foods and areas where they are prepared.
• Avoid greasy and high-fat foods.
• Add ginger (ginger roots, ginger tea, ginger ale, or ginger candy) to your diet.
• Drink liquids between meals rather than with food.
• If your doctor prescribed anti-nausea medications, take them as prescribed, and eat when they are working best. Consider keeping a log of when you feel nauseous.

Decreased appetite

• Eat frequent, small meals.
• Take advantage of when you are hungriest - often in the morning - to take in more calories.
• Choose nutritionally rich foods. You can also increase your meals’ calories by adding butter, cream, vegetable oils, gravies, and avocadoes.
• Keep ready-to-eat foods on hand at home and on the road.
• You can make high-calorie, high-protein shakes or try ready to drink nutrition shakes, such as Ensure,^® BOOST Plus,^® Orgain,^® and Kate Farms.^®
• Go for a walk or practice light exercise, which can stimulate your appetite.
• Address other issues that can also contribute to decreased appetite, such as constipation and mood changes. If you just can’t bring yourself to eat, ask your doctor about appetite stimulants.

Fatigue

• Batch cook foods during times of high energy and set aside meal-sized portions for the days you experience fatigue.
• Ask your friends/family for help with grocery shopping and preparing meals.
• Try a catering or meal delivery service.
• Keep non-perishable snacks, such as granola bars, nearby.
• Try foods that are easy to chew and swallow, such as applesauce, yogurts, and smoothies.

Diarrhea

• Foods that have soluble fiber can help control diarrhea. Examples include oats, barley, beans, apples, and carrots.
• Choose foods that are low in insoluble fiber (wheat bran, nuts, cauliflower, potatoes).
• Choose lactose-free dairy products.
• Avoid eating foods that contain sugar alcohols (reduced-calorie sweeteners), such as sorbitol, mannitol, and xylitol.
• Drink plenty of fluids to avoid dehydration.
• Replenish your electrolytes, such as sodium and potassium. Try sugar-free sports drinks, coconut water, or electrolyte replenishing supplements.
• Try probiotic supplements.
• Take anti-diarrheal medications as prescribed by your physician.

Constipation

• Slowly increase fiber intake to 25-35g fiber daily.
• Maintain proper hydration by drinking at least 8 cups of fluid daily.
• Drink warm beverages, such as warm prune juice, coffee, or tea.
• Do some light exercise or stretching.
• Take probiotic pills or eat foods that provide probiotics (yogurt, kefir, miso, tempeh).

Note: Eating a lot of fiber is NOT recommended for people with certain cancers, so check with your physician before increasing your fiber intake. Furthermore, constipation is a common pain medication side effect; your physician will help you determine if you may benefit from taking medication to prevent it.

Dietary Supplements
You should fulfill your dietary needs primarily through the foods you eat. Sometimes supplements are necessary, but when you are undergoing chemotherapy or radiation, these supplements may negatively interact with your treatment. Unless your physician or health care team determines otherwise, it is generally recommended that you avoid supplements during treatment. When you visit your physician and dietitian, please remember to bring a list of any supplements that you are taking.

Nutrition Services
Along with following these tips, we encourage our patients to take advantage of the Sylvester Comprehensive Cancer Center’s nutrition services, which include counseling related to:

• Food safety
• Meal planning
• Treatment-related nutritional complications
• Nutritional deficiencies
• Oral-fluid and electrolyte requirements
• Weight management

If you are interested in making an appointment with a registered dietitian who specializes in oncology nutrition, ask your physician to submit a referral, or call Cancer Support Services at 305-243-4129 or 305-243-8204.

Acknowledgments:

We relied on the Oncology Nutrition for Clinical Practice, a reference book by The Oncology Nutrition Dietetic Practice Group, for a lot of the guidance presented here.

• Cancer.org - Treatments and Side Effects
• Cancer.org - Nutrition During Treatment
• Cancer.org - Foods to Try
• The Oncology Nutrition Dietetic Practice Group - Eating Well When Unwell
• Cancer.org - Manage Eating Problems Related to Cancer Treatment

Click HERE for nutrition tips in Spanish (Cancer.gov)