Good nutrition is especially important in cancer patients because both cancer treatment and cancer itself can affect the appetite. Cancer and cancer treatment may also affect your body’s ability to tolerate certain foods and to use nutrients. 

• The advantages of good nutrition during cancer and its treatment are many and include:
  • Maintain strength and energy; maintain body weight and body stores of nutrients; toleration of treatment-related side effects; lower risk of infection; improve healing, and recovery; to feel better. 
  • To maintain an overall good nutritional intake means eating a variety of foods that will give you the nutrients you need to protect your health during cancer and cancer treatment. 
• These nutrients include protein, carbohydrates, fat, water, vitamins, and minerals.

Protein - needed for growth, to repair body tissue, and to maintain a healthy immune system. If your body does not get enough protein, it takes longer to heal, and you may have a lower resistance to infection. People with cancer have increased needs for protein. Extra protein may be needed to heal tissues and to prevent infection. Sources of protein include lean meat, poultry, fish, dairy products, nuts, dried beans, peas, lentils, and soy foods.

Carbohydrates - provide fuel for the body for physical activity and for proper organ function. There are good and bad sources of carbohydrates. The good sources of carbohydrates are fruits, vegetables, and whole grains which supply needed vitamins and minerals, fiber, and phytonutrients (certain organic components of plants thought to promote human health. Fruits, vegetables, grains, legumes, nuts, and teas are rich in phytonutrients) to the body’s cells. Other sources of carbohydrates include bread, potatoes, rice,
spaghetti, pasta, cereals, dried beans, corn, peas, and beans. Sweets such as desserts, candy, and sugary drinks can supply carbohydrates but offer very few nutrients.

Fat - plays an important role in nutrition. Fats and oils provide a rich source of energy for the body. They store energy, insulate body tissues, and transport some types of vitamins through the blood. They also play an important role in food preparation by enhancing the flavor of food, making baked products tender, and conducting heat during the cooking process. When considering the effects of fat on your heart and cholesterol level, it would be best to choose unsaturated fats (monounsaturated and polyunsaturated).

Water - plays a vital role in our health. All body cells require water to function. If you do not take in enough fluids or you lose body fluids during vomiting or diarrhea, you may become dehydrated. A healthy average intake of water a person should drink each day is eight to ten 8 oz. glasses. Vitamins and Minerals- are necessary for proper growth and development as well as allowing the body to use the energy (calories) supplied in foods. A person that eats a well-balanced diet with adequate amounts of calories and protein usually gets plenty of vitamins and minerals. However, if you are challenged with a cancer diagnosis and/or cancer treatment, it may be difficult to eat a balanced diet. In those instances, a daily multivitamin and mineral supplement may be helpful. Please be sure to discuss this with your physician first. Large doses of some vitamins and minerals may decrease the cancer-fighting effects of chemotherapy and radiation therapy and therefore should be discussed first with your physician before taking.

Herbs - have been used to treat disease for hundreds of years. Today, herbs are found in many different products, such as pills, liquid extracts, teas, and ointments. While many of these products are harmless and safe to use, others can cause severe and harmful side effects and may even interfere with your proven cancer treatment. If you are interested in taking these products, please discuss it first with your physician.

You won’t know exactly what, if any, side effects you may experience with cancer treatment until your treatment actually starts. One way to prepare for treatment is to tell yourself that this is a time for you to concentrate on yourself and on getting well. The following are ways to get ready:

Positive thinking - Many people have little to no eating-related side effects. Even if you do, the symptoms may be mild and will go away after treatment ends.  Several drugs are available that work well to control side effects. Having a positive attitude, sharing your feelings, becoming informed about your cancer and its treatment, and planning ways to cope are all helpful in decreasing worry, anxiety and making regaining control which will help you keep your appetite. Give food a chance, even if you have an eating problem.

A healthy diet - is necessary for a person’s body to work its best. This becomes more important for a person with cancer. If you were eating healthy before your cancer diagnosis, you will go into treatment with reserves to help keep up your strength, prevent body tissue from breaking down, rebuild tissue, and maintain your defenses against infection.  Another advantage to healthy eating is improved ability to cope with cancer treatment and side effects,

Plan ahead - prepare for the possibility that you may not have the energy to prepare your meals so do the following: stock your pantry and freezer with some of your favorite foods so that you won’t need to shop as often; keep healthy foods on hand that require little or no preparation such as pudding, peanut butter, tuna fish, eggs and cheese; cook some menu items in advance and freeze them; talk with family and friends for assistance with shopping and cooking: discuss your nutrition needs with a dietitian, nurse or doctor. 

Consume nutritious snacks - while undergoing cancer treatment your body needs extra calories and protein to help you maintain your weight and recover and heal as quickly as possible. Nutritious snacks are one way to help you achieve this, as well as maintaining your strength and energy level and enhancing your feeling of well-being. To make it easier to add snacks to your daily routine, try the following:

• Eat small, nutritious snacks throughout the day.
• Have on hand a variety of protein-rich foods (e.g. yogurt, cereal, milk, a sandwich, a bowl of hearty soup, and cheese and crackers) that are easy to prepare and eat.
• Avoid snacks that may worsen treatment-related side effects, such as popcorn and raw fruits and vegetables may worsen diarrhea or coarse and acidic snacks may worsen a sore throat
• Examples of nutritious snacks include angel food cake; bread; cereal; cheese and crackers; cookies; dips made with cheese, beans, and yogurt; fruit; granola; homemade milkshakes and drinks; ice cream; milk; muffins; juice; nuts; peanut butter; popcorn; pretzels; puddings; custards; sandwiches; soups; sports drinks; trail mix: vegetables; and yogurt.

Consume foods higher in calories and protein

• Eat small frequent meals and snacks throughout the day (at least 6 meals).
• Eat favorite foods whenever they sound appealing.
• Eat every few hours and don’t wait until you feel hungry
• Eat your biggest meal when you feel you’re most hungry.
• Eat high-calorie, high-protein foods at each meal and snack.
• Exercise lightly or take a walk before meals to increase your appetite.
• Drink high-protein, high-calorie drinks such as milkshakes or canned liquid supplements.
• Drink the majority of your fluids between meals instead of with meals as drinking fluids with meals may make you feel full.
• Eat nutritious bars and pudding.
• Examples of high-protein foods include milk products, eggs, meats, poultry, fish, beans legumes, nuts, and seeds
• Examples of high-calorie foods include butter, margarine, milk products, salad dressings (the regular not the low-fat dressings), and sweets.

Managing Eating Problems During Cancer treatment
There are five main treatments for cancer:

• Surgery, Radiation therapy
  • Both considered a local treatment
• Chemotherapy, Hormone, and Immunotherapy 
  • All three considered a systemic treatment
• All 5 treatments have the potential for causing side effects. 
  • Some treatments are geared toward targeting the rapidly growing and dividing cells such as cancer cells
  • Normal cells (rapidly dividing) may be affected 
• Hair follicles
• Gastrointestinal tract
• Bone marrow
• Reproductive system. 
• When the normal cells are affected, you may have side effects. 
  • This in turn can affect your ability to eat and may include the following:
• Nausea or vomiting
• Loss of appetite
• Altered taste/smell
• Dry mouth
• Sore mouth/throat
• Thick saliva
• Weight changes (gain or loss)
• Dental problems
• Diarrhea
• Constipation
• Difficulty swallowing
• Fatigue
• Depression

A patient’s response to cancer and its treatment is very individualized. You may or may not have any of the side effects that will be discussed. The goal is to educate you to prevent/recognize/report/treat promptly any side effects that may occur. Talk with your physician or nurse about possible side effects from your treatment and what can be done about them.

Some eating problems are related to the treatment itself while other times it may be related to the fact that you feel worried, upset, or afraid. Losing your appetite and nausea are two normal responses to feeling nervous or afraid. Once you begin your treatments and have a better sense of what to expect and how you will react, these anxiety-related eating problems will get better.

It is important to remember that there are no hard and fast nutrition rules during cancer and cancer treatment. Some patients may continue to enjoy eating and have a normal appetite while others may have days when they don’t feel like eating. The following are some things to keep in mind:

• When you eat, try to eat snacks and meals that contain sufficient protein and calories as this will help you keep your strength up, prevent body tissues from breaking down, and rebuild tissues that cancer treatment may harm.
• Many people have a better appetite in the morning so take advantage of this and eat a larger meal at that time.
• If you don’t feel well and can only eat a few things, stick with them until you are able to eat other foods. Try a liquid meal replacement for extra protein and calories.
• If there are days when you can’t eat at all, do what you can to make yourself feel better and come back to eating as soon as you can. Let your physician know if this problem doesn’t improve in a few days.
• Try to drink plenty of fluids, especially on those days that you don’t feel like eating. Water is vital to your body’s proper functioning, so drinking enough fluids will ensure that your body has the water it needs. A good fluid intake goal is drinking eight to ten 8-oz glasses per day. Carrying a water bottle with you throughout the day is helpful in reaching that goal.

Surgery - is performed to remove cancer cells and surrounding tissue. It is often combined with another form of cancer treatment. The body requires extra protein and calories for wound healing and recovery after surgery. Many patients experience pain and fatigue after a surgical procedure which may affect their ability to eat as well as having an altered diet due to surgery-related side effects. Surgery-related side effects will go away shortly after the operation. There are medications, diet changes, and self-care practices that can lessen the side effects that you have. By eating a nutritious diet while recovering from surgery it will help you to feel better; maintain your energy and strength; maintain your weight and body stores of nutrients; tolerate treatment-related side effects; reduce your risk for infection and overall heal and recover more quickly. The type of side effects that you experience will depend on the type of operation you had and your overall health.

Eating suggestions post-surgery:

• Eat small frequent meals and snacks. Eat as well as you are able to when your appetite is good.
• Ask family and friends for assistance with grocery shopping and meal preparation.
• Foods that are low in fat are easier to digest than high-fat content foods such as fried or greasy foods.
• Set your fluid intake goal at eight to ten 8 oz glasses of fluid every day unless otherwise directed by your physician or nurse, to prevent dehydration. Sip on fluids throughout the day to reach the fluid intake goal.
• The day before your surgery you may be instructed to not eat or drink anything. The day of and after your surgery, you may be started back on liquids only and progress to solid food.
• A clear liquid diet may include water, sports drinks, juices, popsicles, gelatin, tea, clear fat-free broth, bouillon, strained vegetable broth, or clear carbonated drinks.
• Easily digested foods include crackers, instant hot cereal, angel food cake, juices, fruits and vegetables, lean beef, fish, chicken or turkey; milk, soups, white bread, white rice, noodles, and potatoes; custard, puddings, milkshakes, ice cream, yogurt, and eggnog.
• A regular diet includes foods that you normally eat (although some foods may need to be avoided initially). You may wish to avoid high fat, greasy or deep fat fried foods. Eat small frequent meals and snacks.  Cautiously eat the following as they can be gas-producing like beans, melons, and cabbage, broccoli, cauliflower, milk, and milk products.
• Notify your nurse or physician about the side effects you may be having so they may prescribe any additional medications or advice.
• Refer to the specific side effect guidelines on how to manage the following: nausea or vomiting, loss of appetite, sore mouth or throat, altered taste, diarrhea or constipation, and fatigue.

Radiation Therapy
Radiation is like an x-ray beam directed at certain parts of the body with cancer. The side effects experienced with radiation are dependent on what part of the body is irradiated. Radiation is usually delivered daily (Monday thru Friday) for two to nine weeks. Some of the side effects experienced with radiation will occur during the treatment phase while other side effects may not occur until sometime after the treatment is completed.

Radiation side effects usually start around the second or third week of radiation treatment and then peaks around two-thirds of the way through the treatment. If you have side effects, tell your radiation doctor or nurse about them so they may help you manage those side effects.

By eating a nutritious diet while undergoing radiation it will help you to feel better; maintain your energy and strength; maintain your weight and body stores of nutrients; tolerate treatment-related side effects; reduce your risk for infection and overall heal and recover more quickly. The type of side effects that you experience will depend on the area of your body receiving radiation, the size of the body area being treated, and the total dose of radiation delivered as well as your overall health.

Eating suggestions while undergoing radiation therapy:

• Eat something at least 1 hour before treatment.
• Have snacks or nutrition supplements with you for the ride to and from radiation treatment, especially if you have to travel a long distance.
• Eat small frequent meals. If your appetite is better at certain times of the day, eat your largest meal then. You may need extra protein and calories in your diet.
• Liquid nutrition supplements may be helpful. Ask your nurse or physician about nutrition supplements (they may have samples available as well).
• Drink plenty of fluids with a goal of eight to ten 8 oz. glasses per day unless otherwise instructed by your physician.
• Allow family and friends to assist with grocery shopping and meal preparation.
• Notify your nurse or physician about the side effects you may be having so they may prescribe additional medications or advice.
• Refer to the specific side effect guidelines on how to manage the following: nausea or vomiting, loss of appetite, sore mouth or throat, altered taste, diarrhea or constipation, and fatigue.

Chemotherapy
Chemotherapy is a drug that kills cancer cells. The drugs may be taken by mouth or injection into the vein or subcutaneous tissue. Chemotherapy works by targeting and destroying the rapidly growing and dividing cancer cells. There are normal cells in your body that grow and divide rapidly, and they also may be affected by the chemotherapy and when this happens you may experience side effects. One of the reasons that chemotherapy is given in divided dose is to allow your normal cells to recover before another dose of chemotherapy is given. One of the normal cell lines that are affected in the gastrointestinal tract, which includes the mouth through to the rectum.

Side effects will depend on what kind of chemotherapy drugs you receive and how your body responds to the treatment. The following are side effects that may affect your nutrition: loss of appetite, altered taste or smell, mouth sores or tenderness, nausea or vomiting, altered bowel habits (constipation or diarrhea), fatigue, and infection.

You may have some, all, or none of these side effects. Tell your nurse or physician if you do experience side effects as they may have additional advice or prescribe additional medications to control the symptoms. By eating a nutritious diet while undergoing chemotherapy it will help you to feel better; maintain your energy and strength; maintain your weight and body stores of nutrients; tolerate treatment-related side effects; reduce your risk for infection and overall heal and recover more quickly.

Eating suggestions while undergoing chemotherapy:

• If you are getting chemotherapy at an outpatient center/physician's office, it may take a few hours; plan to bring a light meal or snack. There is a refrigerator and a microwave for patient use in the treatment room.
• Make sure you eat something before starting your treatment A light meal or snack is better tolerated.
• Fatigue is a common symptom during chemotherapy, maintaining a well-balanced diet that includes protein, will help boost your energy. Other ideas to reduce fatigue may be found in the fatigue guidelines.
• Avoid heavily fried, fatty, or greasy foods as these are more difficult to digest. On days when you are feeling well and your appetite is good, try to eat regular meals and snacks and on the day when side effects make it difficult to eat, try eating small frequent meals and snacks. Be sure to drink eight to ten 8-oz glasses of fluid every day.
• Allow family and friends to assist with grocery shopping and meal preparation.
• Prompt attention to nutrition-related side effects will help you maintain your weight and energy level and overall sense of feeling good.
• Refer to the specific side effect guidelines on how to manage the following: nausea or vomiting, loss of appetite, sore mouth or throat, altered taste, diarrhea or constipation, and fatigue.

Weakened immune system 
Cancer and cancer treatment can weaken the body’s immune system and as a result, your body cannot fight infection as well as a healthy person’s body can. During cancer treatment, there will be times when your body will not be as able to protect itself as well as it usually can. While your immune system is weakened, you may be instructed to avoid being exposed to possible infection-causing germs.

Eating suggestions for weakened immune systems (the purpose of these suggestions is to help you avoid foods that are more likely to contain germs that could cause infection). You would only be encouraged to follow these suggestions when your bone marrow is suppressed (your nurse or physician would inform you of this).

Foods to Avoid:

• Raw or undercooked meat.
• Pickled fish.
• Meats and cold cuts from a deli.
• Cured hard salami in a natural wrap.
• Unpasteurized milk and milk products.
• Cheeses with molds such as blue, Roquefort, gorgonzola, and Stilton.
• Cheeses containing chili pepper or other uncooked vegetables.
• Fresh salad dressings (those stored in a refrigerated case) that contain aged cheese (such as blue or Roquefort) or raw eggs.
• Unwashed raw vegetables and fruits (if you thoroughly wash raw fruits and vegetables, it is acceptable to eat them).
• Raw vegetable sprouts.
• Unpasteurized commercial fruit and vegetable juices.
• Moldy and outdated food products.
• Unpasteurized beer.
• Raw, uncooked brewer’s yeast.
• Delicatessen salads.
• Commercial salsas stored in the refrigerated case.

Food Handling Suggestions:

• Wash your hands with warm water and soap for 20 seconds before and after food preparation and before eating.
• Keep hot foods (warmer than 140 degrees F) and cold foods (cooler than 40 degrees F).
• Thaw meat, fish, or poultry in the microwave or refrigerator. Do not thaw at room temperature.
• Place perishable foods in the refrigerator within 2 hours of purchasing or preparing them.
• Wash fruits and vegetables thoroughly under running water before peeling or cutting. Do not wash produce with soaps, detergents, or bleach solutions.
• Using a clean vegetable scrubber, scrub produce that has a thick, rough skin or rind (cantaloupe or potatoes) or that has visible dirt on the surface.
• Rinse leaves of leafy vegetables under running water.
• Rinse packaged salads, slaw mixes, and other prepared produce under running water (even when marked as pre-washed).
• Throw away fruits and vegetables that are slimy or moldy.
• Do not buy pre-cut produce at the grocery store (such as melons or cabbage halves).
• Wash the can top with soap and water before opening.
• Use different utensils for stirring foods and tasting them while cooking.
• Cook eggs until the whites are completely hard and the yolks begin to thicken. Throw away eggs with cracked shells.
• Throw away foods with a strange odor, do not taste them.
• Use a clean knife to cut different foods.
• Clean counters and cutting boards with warm soapy water.
• When grilling, always use a clean plate for the cooked meat.
• Use a meat thermometer in the middle of the thickest part of the food to test for doneness.
• Cook meat until it is no longer pink, and the juices run clear. Meats should be cooked to 160 degrees F. and poultry to 180 degrees F.
• Water from your home faucet is considered safe if it is from a city water supply or municipal well.
• If your water is not, use boiled, distilled, or bottled water.
• When grocery shopping: check the sell-buy or use by dates and choose only the freshest products. Do not buy products that are out of date.
• Avoid deli foods or foods from self-serve or bulk containers. Do not eat free food samples.
• When dining out: eat early to avoid crowds; request single-serving condiment packages; avoid high-risk food sources such as salad bars, delicatessens, buffets, and sidewalk vendors.

Most of the eating-related side effects disappear after the treatment ends. However, sometimes the side effects may last for some time and if this happens to it is important to discuss this with your nurse or physician and work out a plan to address the problem.

Healthy eating will help you regain your strength, rebuild tissue, and generally help you feel better. The following are some suggestions for healthy eating after cancer treatment:

• Choose a variety of foods from all of the food groups. Try to eat at least five to seven servings of fruits and vegetables every day.
• Eat plenty of high-fiber foods such as whole-grain cereals and bread.
• Decrease the fat content in your meals by baking or broiling foods.
• Choose low-fat milk products. If you are overweight, consider losing weight by decreasing the amount of fat in your diet and increasing your activity. Check with your physician before starting any exercise program.
• Avoid salt-cured, smoked, and pickled foods.
• If you choose to drink alcohol, do so only occasionally.