Key Points for This Section

Anorexia Taste Changes Dry Mouth Mouth Sores and Infections Nausea Diarrhea Low White Blood Cell Counts and Infections Dehydration (Lack of Fluid) Constipation

When side effects of cancer or cancer treatment affect normal eating, changes can be made to help the patient get the nutrients needed. Medicines may be given to increase appetite. Eating foods that are high in calories, protein, vitamins, and minerals is usually best. Meals should be planned to meet the patient's nutrition needs and tastes in food. The following are some of the more common symptoms caused by cancer and cancer treatment and ways to treat or control them.

Anorexia

Anorexia (the loss of appetite or desire to eat) is one of the most common problems for cancer patients. Eating in a calm, comfortable place and getting regular exercise may improve appetite. The following may help cancer patients who have a loss of appetite:

• Eat small high-protein and high-calorie meals every 1-2 hours instead of three large meals. The following are high-calorie, high-protein food choices:
  • 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, deviled ham on crackers, or cream cheese or peanut butter on crackers or celery.
  • Chocolate.

• Add extra calories and protein to food by using butter, skim milk powder, honey, or brown sugar.

• Drink liquid supplements (special drinks that have nutrients), soups, milk, juices, shakes, and smoothies, if eating solid food is a problem.

• Eat breakfasts that have one third of the calories and protein needed for the day.

• Eat snacks that have plenty of calories and protein.

• Eat foods that smell good. Strong odors can be avoided in the following ways:
  • Use boiling bags or microwave steaming bags.
  • Cook outdoors on the grill.
  • Use a kitchen fan when cooking.
  • Serve cold food instead of hot (since odors are in the rising steam).
  • Take off any food covers to release the odors before going into a patient's room.
  • Use a small fan to blow food odors away from patients.
  • Order take-out food.

• Try new foods and new recipes, flavorings, spices, and foods with a different texture or thickness. Food likes and dislikes may change from day to day.

• Plan menus ahead of time and get help preparing meals.

• Make and store small amounts of favorite foods so they are ready to eat when hungry.

See the NCI Web site ¹ for Eating Hints: Before, During, and After Cancer Treatment ², which has recipes such as Lactose-Free Double Chocolate Pudding ³, Banana Milkshake ⁴, and Fruit and Cream ⁵. For a free copy of this booklet, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

Taste Changes

Changes in how foods taste may be caused by radiation treatment, dental problems, mouth sores and infections, or some medicines. Many cancer patients who receive chemotherapy notice a bitter taste or other changes in their sense of taste. A sudden dislike for certain foods may occur. This can cause a loss of appetite, weight loss, and a decreased quality of life. Some or all of a normal sense of taste may return, but it may take up to a year after treatment ends. The following may help cancer patients who have taste changes:

• Eat small meals and healthy snacks several times a day.

• Eat meals when hungry rather than at set mealtimes.

• Eat favorite foods and try new foods when feeling best.

• Eat poultry, fish, eggs, and cheese instead of red meat.

• Eat citrus fruits (oranges, tangerines, lemons, grapefruit) unless mouth sores are present.

• Add spices and sauces to foods.

• Eat meat with something sweet, such as cranberry sauce, jelly, or applesauce.

• 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.

• Rinse mouth with water before eating.

• Eat with family and friends.

• Have others prepare the meal.

• Use plastic utensils if foods have a metal taste.

Taking zinc sulfate tablets during radiation therapy to the head and neck may help a normal sense of taste come back faster after treatment.

Dry Mouth

Dry mouth is often caused by radiation therapy to the head and neck and by certain medicines. Dry mouth may affect speech, taste, and the ability to swallow or to use dentures or braces. There is also an increased risk of cavities and gum disease because less saliva is made to wash the teeth and gums.

The main treatment for dry mouth is drinking plenty of liquids. Other ways to help relieve dry mouth include the following:

• Keep water handy at all times to moisten the mouth.

• Eat moist foods with extra sauces, gravies, butter, or margarine.

• Eat foods and drinks that are very sweet or tart (to increase saliva).

• Eat ice chips or frozen desserts (such as frozen grapes and ice pops).

• Drink fruit nectar instead of juice.

• Suck on hard candy or chew gum.

• Use a straw to drink liquids.

• Clean teeth (including dentures) and rinse mouth at least four times a day (after eating and at bedtime). Don't use mouth rinses that contain alcohol.

See the Dry Mouth ⁶ section of the PDQ summary on Oral Complications of Chemotherapy and Head/Neck Radiation ⁷ for more information.

Mouth Sores and Infections

Mouth sores can be caused by chemotherapy and radiation therapy. These treatments affect fast-growing cells, such as cancer cells. Normal cells inside the mouth also grow quickly and may be damaged by these cancer treatments. Mouth sores can be painful and become infected or bleed and make it hard to eat. By choosing certain foods and taking good care of their mouths, patients can usually make eating easier. The following can help patients who have mouth sores and infections:

• 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 and puddings.
  • Gelatin.
  • Milkshakes.
  • Scrambled eggs.
  • Oatmeal or other cooked cereals.

• Stay away from the following:
  • Citrus fruits and juices, (such as oranges, tangerines, lemons, and grapefruit).
  • Spicy or salty foods.
  • Rough, coarse, or dry foods, including raw vegetables, granola, toast, and crackers.

• Use a blender to make vegetables (such as potatoes, peas, and carrots) and meats smooth.

• Add gravy, broth, or sauces to food.

• Drink high-calorie, high-protein drinks in addition to meals.

• Cook foods until soft and tender.

• Eat foods cold or at room temperature. Hot and warm foods can irritate a tender mouth.

• Cut foods into small pieces.

• Use a straw to drink liquids.

• Numb the mouth with ice chips or flavored ice pops before eating.

• Clean teeth (including dentures) and rinse mouth at least four times a day (after eating and at bedtime).

See the Oral Mucositis ⁸ and Infection ⁹ sections of the PDQ summary on Oral Complications of Chemotherapy and Head/Neck Radiation ⁷ for more information on mouth sores and infections.

Nausea

Nausea caused by cancer treatment can affect the amount and kinds of food eaten. The following may help cancer patients control nausea:

• Eat before cancer treatments.

• Rinse out the mouth before and after eating.

• Eat foods that are bland, soft, and easy-to-digest, rather than heavy meals. Eat small meals several times a day.

• Eat dry foods such as crackers, bread sticks, or toast throughout the day.

• Slowly sip fluids throughout the day.

• Suck on hard candies such as peppermints or lemon drops if the mouth has a bad taste.

• Stay away from foods that are likely to cause nausea. For some patients, this includes spicy foods, greasy foods, and foods that have strong odors.

• Sit up or lie with the upper body raised for one hour after eating.

• Don't eat in a room that has cooking odors or that is very warm. Keep the living space at a comfortable temperature with plenty of fresh air.

See the PDQ summary on Nausea and Vomiting ¹⁰ for more information.

Diarrhea

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) or low levels of salt and potassium, which are important minerals needed by the body.

The following may help cancer patients control diarrhea:

• Eat broth, soups, bananas, and canned fruits to help replace salt and potassium lost by diarrhea. Sports drinks can also help.

• Drink plenty of fluids during the day. Liquids at room temperature may cause fewer problems than hot or cold liquids.

• Drink at least one cup of liquid after each loose bowel movement.

• Stay away from the following:
  • Greasy foods, hot or cold liquids, or caffeine.
  • High-fiber foods—especially dried beans and cruciferous vegetables (such as broccoli, cauliflower, and cabbage).
  • Milk and milk products, until the cause of the diarrhea is known.
  • Foods and beverages that cause gas (such as peas, lentils, cruciferous vegetables, chewing gum, and soda).
  • Sugar-free candies or gum made with sorbitol (sugar alcohol).

See the Dehydration (Lack of Fluid) ¹¹ section for more information.

Low White Blood Cell Counts and Infections

A low white blood cell count may be caused by radiation therapy, chemotherapy, or the cancer itself. Patients who have a low white blood cell count have an increased risk of infection. The following may help cancer patients prevent infections when white blood cell counts are low:

• Stay away from:
  • Raw eggs or raw fish.
  • Old, moldy, or damaged fruits and vegetables.
  • Food sold in open bins or containers.
  • Salad bars and buffets when eating out.

• Wash hands often to prevent the spread of bacteria.

• Thaw foods in the refrigerator or microwave. Never thaw foods at room temperature. Cook foods immediately after thawing.

• Keep hot foods hot and cold foods cold.

• Cook all meat, poultry, and fish until well done.

• Refrigerate all leftovers within 2 hours of cooking and eat them within 24 hours.

• Buy foods packed as single servings, to avoid leftovers.

• Do not buy or eat food that is out of date.

• Do not buy or eat food in cans that are swollen, dented, or damaged.

Dehydration (Lack of Fluid)

The body needs plenty of water to replace the fluids lost every day. Nausea, vomiting, and pain may keep the patient from drinking and eating enough to get the amount of water the body needs. Long-term diarrhea causes a loss of fluid from the body. One of the first signs of dehydration (lack of water in the body) is feeling very tired. The following may help cancer patients prevent dehydration:

• Drink 8 to 12 cups of liquids a day. This can be water, juice, milk, or foods that have a lot of liquid in them, such as ice pops, flavored ices, and gelatins.

• Stay away from drinks that have caffeine in them, such as sodas, coffee, and tea (both hot and cold).

• Take a water bottle whenever leaving home. It is important to drink even if not thirsty.

• Drink most liquids between meals.

• Use medicines that help prevent and treat nausea and vomiting.

Constipation

It is very common for cancer patients to have constipation (fewer than three bowel movements a week). Constipation may be caused by the following:

• Too little water or fiber in the diet.
• Not being active.
• Cancer treatment, such as chemotherapy.
• Certain medicines used to treat the side effects of chemotherapy, such as nausea and pain.

Preventing and treating constipation is a part of cancer care.

To prevent constipation:

• Eat more fiber-containing foods. Twenty-five to 35 grams of fiber a day is best. Food labels show the amount of fiber in a serving. (Some sources of fiber are listed below.) Add a little more fiber each day and drink plenty of fluids at the same time to keep the fiber moving through the intestines.

• Drink 8 to 12 cups of fluid each day. Water, prune juice, warm juices, lemonade, and teas without caffeine can be very helpful.

• Take walks and exercise regularly. Wear shoes made for exercise.

To treat constipation:

• 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 take more than 6 tablespoons a day.

• Stay physically active.

• Use over-the-counter constipation treatments, if needed. These include:
  • Bulk-forming products (such as Citrucel, Metamucil, Fiberall, and Fiber-Lax).
  • Stimulants (such as Dulcolax and Senokot).
  • Stool softeners (such as Colace and Surfak).
  • Osmotics (such as milk of magnesia).

• Cottonseed and aerosol enemas can also help. Do not use lubricants such as mineral oil because they may keep the body from using important nutrients the way it should.

Good food sources of fiber include the following:

• Legumes (beans and lentils).
• Vegetables.
• Cold cereals (whole grain or bran).
• Hot cereals.
• Fruit.
• Whole-grain breads.

See the Constipation ¹² section of the PDQ summary on Gastrointestinal Complications ¹³ for more information.