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. (For information about the peanut product recall, click here ¹.)



• Chocolate.

See the NCI Web site's ²Eating Hints for Cancer Patients: Before, During, and After Treatment ³ for recipes such as Lactose-Free Double Chocolate Pudding ⁴, Banana Milkshake ⁵, and Fruit and Cream ⁶. 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, mouth sores, thrush (yeast infection), 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.

(See the PDQ summary on Oral Complications of Chemotherapy and Head/Neck Radiation ⁷ 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.

(See the PDQ summary on Oral Complications of Chemotherapy and Head/Neck Radiation ⁷ 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.

(See the PDQ summary on Nausea and Vomiting ⁸ 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.

(See the PDQ summary on Gastrointestinal Complications ⁹ 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. (See the PDQ summary on Fever, Sweats, and Hot Flashes ¹⁰ 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.

Glossary Terms

An abnormal loss of the appetite for food. Anorexia can be caused by cancer, AIDS, a mental disorder (i.e., anorexia nervosa), or other diseases.

A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium.

A test to check the number of red blood cells, white blood cells, and platelets in a sample of blood. Also called CBC and complete blood count.

The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel. Also called intestine.

Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.

A measurement of the energy content of food. The body needs calories as to perform its functions, such as breathing, circulating the blood, and physical activity. When a person is sick, their body may need extra calories to fight fever or other problems.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.

The Cancer Information Service is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER (1-800-422-6237), or by using the LiveHelp instant-messaging service at https://cissecure.nci.nih.gov/livehelp/welcome.asp. Also called CIS.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

Treatment with drugs that kill cancer cells.

A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.

A member of the family of vegetables that includes broccoli, Brussels sprouts, cabbage, cauliflower, collard greens, kale, and turnips. These vegetables contain substances that may protect against cancer. Also called Brassica vegetable.

A condition caused by the loss of too much water from the body. Severe diarrhea or vomiting can cause dehydration.

Frequent and watery bowel movements.

The things a person eats and drinks.

A product that is added to the diet. A dietary supplement is taken by mouth, and usually contains one or more dietary ingredient (such as vitamin, mineral, herb, amino acid, and enzyme). Also called nutritional supplement.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

The injection of a liquid through the anus into the large bowel.

A type of hormone made by the body that helps develop and maintain female sex characteristics and the growth of long bones. Estrogens can also be made in the laboratory. They may be used as a type of birth control and to treat symptoms of menopause, menstrual disorders, osteoporosis, and other conditions.

Hormones (estrogen, progesterone, or both) given to postmenopausal women or to women who have had their ovaries surgically removed. Hormones are given to replace the estrogen no longer produced by the ovaries. Also called ERT.

In food, fiber is the part of fruits, vegetables, legumes, and whole grains that cannot be digested. The fiber in food may help prevent cancer. In the body, fiber refers to tissue made of long threadlike cells, such as muscle fiber or nerve fiber.

A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.

A drug used to treat symptoms of cancer of the colon, breast, stomach, and pancreas. It is also used in a cream to treat certain skin conditions. Fluorouracil stops cells from making DNA and it may kill cancer cells. It is a type of antimetabolite. Also called 5-fluorouracil and 5-FU.

An amino acid used in nutrition therapy. It is also being studied for the treatment of diarrhea caused by radiation therapy to the pelvis.

A sudden, temporary onset of body warmth, flushing, and sweating (often associated with menopause).

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

The long, tube-shaped organ in the abdomen that completes the process of digestion. The intestine has two parts, the small intestine and the large intestine. Also called bowel.

An oily or slippery substance.

The time of life when a woman’s ovaries stop working and menstrual periods stop. Natural menopause usually occurs around age 50. A woman is said to be in menopause when she hasn’t had a period for 12 months in a row. Symptoms of menopause include hot flashes, mood swings, night sweats, vaginal dryness, trouble concentrating, and infertility.

In medicine, a mineral is a nutrient that is needed in small amounts to keep the body healthy. Mineral nutrients include the elements calcium, magnesium, and iron.

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

A chemical compound (such as protein, fat, carbohydrate, vitamin, or mineral) contained in foods. These compounds are used by the body to function and grow.

The taking in and use of food and other nourishing material by the body. Nutrition is a 3-part process. First, food or drink is consumed. Second, the body breaks down the food or drink into nutrients. Third, the nutrients travel through the bloodstream to different parts of the body where they are used as "fuel" and for many other purposes. To give the body proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients.

By or having to do with the mouth.

A measure of weight (one-sixteenth pound) and volume (one-eighth cup).

A medicine that can be bought without a prescription (doctor's order). Examples include analgesics (pain relievers) such as aspirin and acetaminophen. Also called nonprescription and OTC.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

A metallic element that is important in body functions such as regulation of blood pressure and of water content in cells, transmission of nerve impulses, digestion, muscle contraction, and heartbeat.

A gland in the male reproductive system. The prostate surrounds the part of the urethra (the tube that empties the bladder) just below the bladder, and produces a fluid that forms part of the semen.

A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

The watery fluid in the mouth made by the salivary glands. Saliva moistens food to help digestion and it helps protect the mouth against infections.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

A product from a plant of Asian origin that produces beans used in many food products. Soy contains isoflavones (estrogen-like substances) that are being studied for the prevention of cancer, hot flashes that occur with menopause, and osteoporosis (loss of bone density). Soy in the diet may lower cholesterol levels and reduce the risk of heart disease. Also called Glycine max, soya, and soybean.

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

The material in a bowel movement. Stool is made up of food that was not digested, bacteria, mucus, and cells from the intestines. Also called feces.

Adding nutrients to the diet.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

Treatment.

A condition in which Candida albicans, a type of yeast, grows out of control in moist skin areas of the body. It is usually a result of a weakened immune system, but can be a side effect of chemotherapy or treatment with antibiotics. Thrush usually affects the mouth (oral thrush); however, rarely, it spreads throughout the entire body. Also called candidiasis and candidosis.

A nutrient that the body needs in small amounts to function and stay healthy. Sources of vitamins are plant and animal food products and dietary supplements. Some vitamins are made in the human body from food products. Vitamins are either fat-soluble (can dissolve in fats and oils) or water-soluble (can dissolve in water). Excess fat-soluble vitamins are stored in the body’s fatty tissue, but excess water-soluble vitamins are removed in the urine. Examples are vitamin A, vitamin C, and vitamin E.

To eject some or all of the contents of the stomach through the mouth.

A type of immune cell. Most white blood cells are made in the bone marrow and are found in the blood and lymph tissue. White blood cells help the body fight infections and other diseases. Granulocytes, monocytes, and lymphocytes are white blood cells. Also called leukocyte and WBC.

A substance required for cell growth and tissue repair. It is being studied as a way to prevent or decrease mucositis caused by radiation therapy.