Download Common nutritional problems and cancer

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Acknowledgement
With many thanks to the Queensland Cancer Fund for the use of their
information on nutrition
Oncology Dietitian, Northampton General Hospital
Oxford Oncology Dietitian
How can I help reduce healthcare associated
infections?
Infection control is important to the well-being of our patients
and for that reason we have infection control procedures in
place. Keeping your hands clean is an effective way of
preventing the spread of infections. We ask that you, and
anyone visiting you, use the hand rub (special gel) available
at the main entrance of the hospital and at the entrance to
every ward before coming in to and after leaving the ward or
hospital. In some situations hands may need to be washed
at the sink using soap and water rather than using the hand
rub. Staff will let you know if this is the case.
Common
nutritional
problems and
cancer
Resource 3
Information for Patients
A guide to helping with common
nutritional problems and side
effects associated with cancer
www.buckshealthcare.nhs.uk
If you require an interpreter or need a document in another
language, large print, Braille or audio version please ask for
assistance.
Author: Jessica Phillips
Issue date: May 2010
Reviewed: July 2014
Review date: July 2016
Leaflet code: CISS - 24
Version: 3
Issued by:
Date:
Introduction
This booklet is designed to give you information on ways to help
overcome common nutritional problems often encountered with
cancer.
These problems may be related to the disease itself, while others
may be temporary side effects of treatment.
This booklet offers suggestions to assist you in overcoming any
problems that may arise but remember, trial and error is also a very
good way to find solutions to individual difficulties in eating.
Some people may require specific dietary advice, in which case
your nurse or doctor may refer you to a dietitian for specialist
advice.
Good nutrition can help you to:
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maintain well being and improve your body’s ability to fight
infection,
helps you to cope better with some of the side effects of
treatments,
maintain your weight at a suitable level, or regain lost weight,
The common forms of treatment for cancer are surgery,
chemotherapy and radiotherapy. Some of the nutritional
problems/side effects that you may experience with cancer
treatment are listed. These will vary according to the type of
treatment you are having. Not all people will suffer these side
effects.
Drink plenty of fluids as your body may lose a lot of fluid while
you have diarrhoea. Avoid very hot or cold drinks. Limit
alcohol, strong tea and coffee.
Sometimes diarrhoea can cause a temporary lactose
intolerance, where ordinary milk may make the diarrhoea
worse. You may find it helpful to change to soya milk or low
lactose milk until diarrhoea ceases.
• Constipation
Constipation may be due to a number of causes. These may
include reduced food and fluid intake, inadequate exercise,
medication or reluctance to use bowels because of discomfort.
Sometimes medication is required but it may help to
increase the amount of fibre and fluid in your diet. This
can be done by including:
Bread: Try wholemeal, high fibre white bread or granary.
Cereals: Try wholegrain varieties e.g. porridge, Shredded
Wheat, Weetabix.
Liquids: Aim to drink at least 2 litres (8-10 glasses/mugs)
of fluids a day.
Further Information
For further information on building up your food intake, please
ask for a copy of the Diet and Cancer booklet by Macmillan
Cancer Support. See the section on “The building up diet” or the
Buckinghamshire NHS Trust diet leaflet on “Eating well with a
small appetite”.
If you have ongoing problems with a poor appetite and weight
loss, you can ask to be referred to a dietitian.
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If your mouth is sore
Common side effects of cancer treatment are listed below:
• Avoid dry, rough or hard foods such as toast, biscuits or
crisps.
Surgery
- altered food intake may be as a result
of:
• fasting for the operation
• decreased intake after the operation
Chemotherapy
- side effects vary with individuals.
Common problems include:
• Nausea and vomiting
• Ulceration of the mouth
• Diarrhoea and/or constipation
• Altered taste
• Loss of appetite
Radiotherapy
- Problems are specifically related to the
area being treated. For example,
• Avoid highly spiced foods.
• Drink plenty of nourishing fluids.
• Add extra sauce, gravy or butter to your meals to soften the
food.
• Eat little and often.
• Avoid fruit juice and alcohol which may irritate a sore mouth.
• Avoid very hot drinks, try warm or cold drinks instead.
- head and neck region:
• Sore throat or mouth
• Dry or coated mouth
• Altered taste
• Ensure you maintain good mouth hygiene and if your mouth is
very sore, speak to your doctor who may suggest a mouth wash
or painkiller is taken before a meal.
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Diarrhoea
Diarrhoea can be due to a number of different factors
including treatment, medications or anxiety. Whatever the
cause of diarrhoea a temporary change in diet may help.
While you have diarrhoea, cut down your fibre intake by
replacing wholemeal bread and cereals with white varieties,
avoid raw fruit and vegetables with skins, seeds, nuts and
peas/beans.
Choose plain, bland foods. Avoid spiced and fatty foods.
Avoid very hot or cold foods.
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- abdomen or pelvis:
• nausea
• change of bowel habit
Common problems include:
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poor appetite
loss of weight
nausea and vomiting
chewing and swallowing problems
dry or coated mouth
loss or alteration of taste
diarrhoea and constipation
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Poor appetite
To help overcome the altered taste sensitivity the following
may be useful:
This is a frequent side effect of cancer or the treatment of
cancer. Try to keep a regular meal pattern. You may not
feel hungry but your body still needs nourishment.
Small frequent meals may be more acceptable than the
traditional three meals a day. Try to have something to eat
every two hours during the day.
If you have lost your taste, try sharp and strong flavours
ie bitter jams, strong cheese - extra mature varieties. Fresh
fruit, fruit juices and boiled sweets can be refreshing. Try
adding meat extracts such as Oxo, Bovril or Marmite to meat
dishes for extra taste.
Avoid drinks with meals as these can fill you up quickly.
Drinking more fluids e.g. lemon tea, lemonade, fruit juice, ginger
ale can remove unpleasant tastes in the mouth. These are
often more acceptable than tea and coffee.
Try having nourishing drinks between meals, instead of
drinking water, squash, tea or coffee. Try full cream milk.
For recipes please refer to leaflet CISS-25 Eating well with a
small appetite.
Try using a straw and position it at the back of the mouth to
bypass the taste buds.
If you do not feel like preparing a meal, have a range of ready
prepared foods and snacks on hand. Cook in advance to
reduce tiredness at meal times.
There may be times of the day when you feel more like eating.
Take advantage of this by eating well at these times.
Keep snacks handy e.g. cheese and crackers, yoghurts, cereal
bars, scones, nuts.
Seasoning and spices can often disguise unpleasant tastes
(be careful if your mouth is sore).
Cold foods often taste better than hot.
Trial and error may be the answer, keep trying. Go along with
your food cravings and enjoy the foods you can take.
If meat does not taste right, try eating fish, eggs, cheese or
beans/pulses instead.
Use plastic cutlery if you have a metallic taste in your mouth.
• Loss of weight
If underweight or losing weight you need to include more
protein and calories in your diet.
Weigh yourself weekly to check whether you are maintaining
your weight.
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Try changing the consistency and texture of foods making them
easier to manage. A liquidiser may be useful. Use extra sauces
and gravies.
An additional booklet is available which offers specific
information for soft/pureed or liquid diets.
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Dry or coated mouth
A dry or coated mouth can result from radiotherapy or
chemotherapy as saliva may be reduced or become
thicker.
Ensure regular alcohol-free mouthwashes.
Moisten your foods with gravy or sauces.
Suck ice or ice lollies, sugar free boiled sweets, soft drinks.
Be sure to drink fluids with meals or snacks.
Pineapple chunks can often be refreshing and can increase
saliva production.
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Good sources of protein and calories include:
Meat, fish, poultry, milk and dairy products, eggs, legumes,
pulses (eg baked beans, chick peas, lentils) and nuts.
Use milk and dairy foods wherever possible:
• Add skimmed milk powder to full cream milk; use this
instead of ordinary milk in coffee, packet soups, sauces
or on breakfast cereals
• Use evaporated/condensed milk or cream on breakfast
cereal, in puddings, milk-based sauces
• Add grated cheese, evaporated milk, or dried milk
powder to soup
• Use cheese in cooking sprinkled over a meal, on
vegetables and in sauces.
• Add full cream yoghurt and honey to breakfast cereal.
Use eggs frequently:
Your doctor maybe able to prescribe mouthwashes, lozenges,
artificial saliva sprays or gels to help.
• In egg dishes e.g. scrambled eggs.
Loss or alteration of taste
Other sources of protein:
This may result from the disease itself, or from the side
effects of treatment.
Smell and taste may be affected. Some common complaints
are that – ‘all food tastes the same’, ‘food is like cardboard’,
‘food has a metallic taste’, ‘I no longer like the taste of my
favourite food’.
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• Use peanut butter freely (on sandwiches, crackers).
• Use baked beans as a snack. Try adding beans or peas to
soups, salads and casseroles.
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Try getting some fresh air before eating or sit by an open
window whilst eating.
For extra calories, incorporate foods high in fat and sugar
into your meal plan.
• Add butter, oil, cream, sour cream and mayonnaise
freely when preparing meals.
Eat dry foods such as plain biscuits, or toast, bland foods
such as chicken, salty foods such as crisps and crackers.
• Drink high sugar drinks eg lemonade, lucozade. Add
sugar, glucose, honey as desired.
Take cold fluids e.g. squash, lemonade, ginger ale, jelly.
Avoid fatty, rich and spicy foods.
• Nausea and vomiting
Avoid wearing tight fitting clothes
Sometimes chemotherapy and radiotherapy treatment can
make you feel sick. This may be made worse if you are
anxious or emotionally upset. This is usually temporary but it
will obviously make eating difficult.
Eat slowly and relax after a meal. Nausea can become worse
when the stomach is empty, so try to eat regularly.
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Swallowing difficulties
A variety of medications are available to help combat nausea
and vomiting – ask your doctor to find one suitable for your
needs.
This may occur if you are having radiotherapy to the mouth
and throat area.
Avoid eating directly before treatment, if this makes the nausea
worse.
Ensure good oral hygiene with a soft toothbrush. Keep your
mouth clean with regular alcohol-free mouthwashes.
Ginger flavoured food or drinks may help to reduce feelings of
sickness (e.g. ginger ale, ginger biscuits, ginger tea).
Avoid extreme temperatures i.e. very hot or cold.
Avoid highly spiced foods.
Try small, frequent meals.
Drink plenty of nourishing fluids.
Sickness is often worse if you have long periods without food.
Try to avoid the smell of food cooking, try cold foods
(eg sandwiches, yoghurts, fruit salad) or where possible get
someone else to do the cooking.
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If you are finding thicker fluids easier to swallow than thin
liquids, a thickening powder may be useful. Your doctor may
give you a prescription for some.
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