Eating Hints: Before, During, and After Cancer Treatment by National Cancer Institute. - HTML preview

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Support for People With Cancer

Eating Hints

Before, During, and After Cancer Treatment

National Cancer Institute

U.S. Department

of HealtH anD

HUman ServiceS

national institutes

of Health

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About this Book

Eating Hints is written for you—someone who is about to get, or is now getting, cancer treatment. Your family, friends, and others close to you may also want to read this book.

You can use this book before, during, and after cancer treatment. It has hints about common types of eating problems, along with ways to manage them.

This book covers:

u What you should know about cancer treatment, eating well, and eating problems

u How feelings can affect appetite

u Hints to manage eating problems

u How to eat well after cancer treatment ends

u Foods and drinks to help with certain eating problems

u Ways to learn more

Talk with your doctor, nurse, or dietitian about any eating problems that might affect you during cancer treatment. He or she may suggest that you read certain sections or follow some of the tips.

Rather than read this book from beginning to end,

look at just those sections you need now.

Later, you can always read more.

Table of Contents

What You Should Know About Cancer Treatment,

Eating Well, and Eating Problems .........................................................................1

Feelings Can Affect Your Appetite During

Cancer Treatment .....................................................................................................8

Eating Problems At-A-Glance ............................................................................. 11

Eating Problems and Ways To Manage Them

Appetite Loss ..........................................................................................12

Changes in Sense of Taste or Smell ........................................................15

Constipation ..........................................................................................17

Diarrhea .................................................................................................20

Dry Mouth .............................................................................................23

Lactose Intolerance ................................................................................25

Nausea ...................................................................................................27

Sore Mouth ............................................................................................30

Sore Throat and Trouble Swallowing .....................................................34

Vomiting ................................................................................................37

Weight Gain ..........................................................................................39

Weight Loss ............................................................................................41

After Cancer Treatment ....................................................................................... 44

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Table of Contents continued

Eating Problems That May Be Caused by

Certain Cancer Treatments ................................................................................. 46

Lists of Foods and Drinks ..................................................................................... 49

Clear Liquids ..........................................................................................49

Full-Liquid Foods ...................................................................................50

Foods and Drinks That Are Easy on the Stomach..................................52

Low-Fiber Foods .....................................................................................54

High-Fiber Foods ....................................................................................55

Foods and Drinks That Are Easy To Chew and Swallow ........................56

Quick and Easy Snacks ..........................................................................57

Ways To Add Protein ..............................................................................59

Ways To Add Calories ............................................................................63

Ways To Learn More .............................................................................................. 65

Recipes

Banana Milkshake .................................................................................14

Apple-Prune Sauce .................................................................................19

Lactose-Free Double Chocolate Pudding ...............................................26

Fruit and Cream .....................................................................................33

Protein-Fortified Milk ............................................................................42

High-Protein Milkshake .........................................................................43

Peanut Butter Snack Spread ...................................................................43

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What You Should Know About

Cancer Treatment, Eating Well,

and Eating Problems

People with cancer have different diet needs

People with cancer often need to follow diets that are different from what they think of as healthy. For most people, a healthy diet includes: u Lots of fruits and vegetables, and whole grain

breads and cereals

u Modest amounts of meat and milk products

u Small amounts of fat, sugar, alcohol, and salt

When you have cancer, though, you need to eat to

keep up your strength to deal with the side effects

of treatment. When you are healthy, eating enough food is often not a problem.

But when you are dealing with cancer and treatment, this can be a real challenge.

When you have cancer, you may need extra protein and calories.

At times, your diet may need to include extra milk, cheese, and eggs. If you have trouble chewing and swallowing, you may

need to add sauces and gravies. Sometimes, you may need to

eat low-fiber foods instead of those with high fiber. Your dietitian can help you with any diet changes you may need to make.

Cancer treatment can cause side effects that lead to

eating problems

Cancer treatments are designed to kill cancer cells. But these treatments can also damage healthy cells. Damage to healthy cells can cause side effects. Some of these side effects can lead to eating problems. See the list on page 11 to see the types of eating problems that cancer treatment may cause.

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Common eating problems during cancer treatment include:

u Appetite loss

u Changes in sense of taste or smell

u Constipation

u Diarrhea

u Dry mouth

u Lactose intolerance

u Nausea

u Sore mouth

u Sore throat and trouble swallowing

u Vomiting

u Weight gain

u Weight loss

Some people have appetite loss or nausea because they are stressed about cancer and treatment. People who react this way almost always feel better once treatment starts and they know what to expect.

Things to do and think about before you start

cancer treatment

u Until treatment starts you will not know what, if any, side effects or eating problems you may have. If you do have problems, they may be mild. Many side effects can be controlled. Many problems go away when cancer treatment ends.

u Think of your cancer treatment as a time to get well and focus just on yourself.

u Eat a healthy diet before treatment starts. This helps

you stay strong during treatment and lowers your risk

of infection.

u Go to the dentist. It is important to have a healthy

mouth before you start cancer treatment.

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u Ask your doctor, nurse, or dietitian about medicine that

can help with eating problems.

u Discuss your fears and worries with your doctor, nurse, or social worker. He or she can discuss ways to manage and

cope with these feelings.

u Learn about your cancer and its treatment. Many people

feel better when they know what to expect. See the list of helpful resources in

“Ways to Learn More” starting on page 65.

Ways you can get ready to eat well

u Fill the refrigerator, cupboard, and freezer with

healthy foods. Make sure to include items you

can eat even when you feel sick.

u Stock up on foods that need little or no cooking,

such as frozen dinners and ready-to-eat cooked foods.

u Cook some foods ahead of time and freeze in meal-

sized portions.

u Ask friends or family to help you shop and cook during

treatment. Maybe a friend can set up a schedule of the tasks that need to be done and the people who will do them.

u Talk with your doctor, nurse, or dietitian about what to

expect. You can find lists of foods and drinks to help with many types of eating problems on pages 49 to 64.

Not everyone has eating problems during cancer treatment

There is no way to know if you will have eating problems and, if so, how bad they will be. You may have just a few problems or none at all. In part, this depends on the type of cancer you have, where it is in your body, what kind of treatment you have, how long treatment lasts, and the doses of treatment you receive.

During treatment, there are many helpful medicines and other ways to manage eating problems. Once treatment ends, many eating problems go away. Your doctor, nurse, or dietitian can tell you more about the types of eating problems you might expect and ways to manage them. If you start to have eating problems, tell your doctor or nurse right away.

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If you start to have eating problems,

tell your doctor or nurse right away.

Talk with your doctor, nurse, or dietitian about foods to eat Talk with your doctor or nurse if you are not sure what to eat during cancer treatment. Ask him or her to refer you to a dietitian. A dietitian is the best person to talk with about your diet. He or she can help choose foods and drinks that are best for you during treatment and after.

Make a list of questions for your meeting with the

dietitian. Ask about your favorite foods and recipes and

if you can eat them during cancer treatment. You might

want to find out how other patients manage their eating

problems. You can also bring this book and ask the

dietitian to mark sections that are right for you.

If you are already on a special diet for diabetes, kidney or heart disease, or other health problem, it is even more important to speak with a doctor and dietitian.

Your doctor and dietitian can advise you about how to follow your special diet while coping with eating problems caused by cancer treatment.

For more information on how to find a dietitian, contact the American Dietetic Association. See “Ways to Learn More” on page 65 for ways to reach them.

Ways to get the most from foods and drinks

During treatment, you may have good days and bad days when it comes to food.

Here are some ways to manage:

u Eat plenty of protein and calories when you can. This helps you keep up your strength and helps rebuild tissues harmed by cancer treatment.

u Eat when you have the biggest appetite. For many

people, this is in the morning. You might want to

eat a bigger meal early in the day and drink liquid

meal replacements later on.

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u Eat those foods that you can, even if it is only one or two items.

Stick with these foods until you are able to eat more. You might also drink liquid meal replacements for extra calories and protein.

u Do not worry if you cannot eat at all some days. Spend this time finding other ways to feel better, and start eating when you can.

Tell your doctor if you cannot eat for more than 2 days.

u Drink plenty of liquids. It is even more important to get plenty to drink on days when you cannot eat. Drinking a lot helps your body get the liquid it needs.

Most adults should drink 8 to 12 cups of liquid a day. You may find this easier to do if you keep a water bottle nearby. Also, try some of the clear liquids listed on page 49.

u If others are making meals for you, be sure to tell them your needs and concerns.

Taking special care with food to avoid infections

Some cancer treatments can make you more likely to get infections. When this happens, you need to take special care in the way you handle and prepare food.

Here are some ways:

u Keep hot foods hot and cold foods cold. Put leftovers in

the refrigerator as soon as you are done eating.

u Scrub all raw fruits and vegetables before you eat them.

Do not eat foods (like raspberries) that cannot be washed

well. You should scrub fruits and vegetable that have rough

surfaces, such as melons, before you cut them.

u Wash your hands, knives, and counter

tops before and after you prepare food.

This is most important when preparing

raw meat, chicken, turkey, and fish.

u Use one cutting board for meat and one

for fruits and vegetables.

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u Thaw meat, chicken, turkey, and fish in the refrigerator or defrost them in the microwave. Do not leave them sitting out.

u Cook meat, chicken, turkey, and eggs thoroughly. Meats should not have any pink inside. Eggs should be hard, not runny.

u Do not eat raw fish or shellfish, such as sushi and uncooked oysters.

u Make sure that all of your juices, milk products, and honey are pasteurized.

u Do not use foods or drinks that are past their freshness date.

u Do not buy foods from bulk bins.

u Do not eat at buffets, salad bars, or self-service restaurants.

u Do not eat foods that show signs of mold. This includes moldy cheeses such as bleu cheese and Roquefort.

For more information about infection and cancer treatment, see Chemotherapy and You: Support for People With Cancer, a book from the National Cancer Institute. You can get it free by calling 1-800-4-CANCER (1-800-422-6237) or online at www.cancer.gov/publications.

Using food, vitamins, and other supplements

to fight cancer

Many people want to know how they can help their body fight cancer by eating certain foods or taking vitamins or supplements. But, there are no studies that prove that any special diet, food, vitamin, mineral, dietary supplement, herb, or combination of these can slow cancer, cure it, or keep it from coming back. In fact, some of these products can cause other problems by changing how your cancer treatment works.

Talk with your doctor, nurse, or dietitian before

going on a special diet or taking any supplements.

To avoid problems, be sure to follow their advice.

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For more information about complementary and alternative therapies, see Thinking About Complementary & Alternative Medicine: A Guide for People With Cancer. You can get this book free from the National Cancer Institute. Call 1-800-4-CANCER (1-800-422-6237) or order online at www.cancer.gov/publications.

Talk with your doctor before going on a special diet or

taking any supplements. Some vitamins and supplements

can change how your cancer treatment works.

A special note for caregivers

u Do not be surprised or upset if your loved one’s tastes change from day to day. There may be days when he or she does not want a favorite food or says it tastes bad now.

u Keep food within easy reach. This way, your loved one can have a snack when he or she is ready to eat. You might put a snack-pack of applesauce or pudding (along with a spoon) on the bedside table. Or try keeping a bag of cut-up carrots on the refrigerator shelf.

u Offer gentle support. This is much more helpful than pushing your loved one to eat. Suggest that he or she

drinks plenty of clear and full liquids when he or she

has no appetite. For ideas on clear liquids, see page 49,

and for full liquids, see page 50.

u Talk with your loved one about ways to manage

eating problems. Doing this together can help you

both feel more in control.

For more information about being a caregiver, see W hen Someone You Love Is Being Treated for Cancer. You can get this book free from the National Cancer Institute. Call 1-800-4-CANCER (1-800-422-6237) or order online at www.cancer.gov/publications.

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Feelings Can Affect Your Appetite

During Cancer Treatment

During cancer treatment, you may feel:

u Depressed

u Anxious

u Afraid

u Angry

u Helpless

u Alone

It is normal to have these feelings. Although these are not eating problems themselves, strong feelings like these can affect your interest in food, shopping, and cooking. Fatigue can also make it harder to cope.

Coping with your feelings during cancer treatment

There are many things you can do to cope with your feelings during treatment so they do not ruin your appetite. Here are some ideas that have worked for other people.

u Eat your favorite foods on days you do not have treatment. This way, you can enjoy the foods, but they won’t remind you of something upsetting.

u Relax, meditate, or pray. Activities like these help many people feel calm and less stressed.

u Talk with someone you trust about your feelings.

You may want to talk with a close friend, family

member, religious or spiritual leader, nurse, social

worker, counselor, or psychologist. You may also

find it helpful to talk with someone who has gone

through cancer treatment.

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u Join a cancer support group. This can be a way to meet others dealing with problems like yours. In support group meetings, you can talk about your feelings and listen to other people talk about theirs. You can also learn how others cope with cancer, treatment side effects, and eating problems. Ask your doctor, nurse, or social worker about support group meetings near you. You may also want to know about support groups that meet over the Internet. These can be very helpful if you cannot travel or there is no group that meets close by.

u Learn about eating problems and other side effects before treatment starts.

Many people feel more in control when they know what to expect and how to manage problems that may occur.

u Get enough rest. Make sure you get at least 7 to 8 hours of sleep each night.

During the day, spend time doing quiet activities such as reading or watching a movie.

u Do not push yourself to do too much or more than you can manage. Look for easier ways to do your daily tasks. Many people feel better when they ask for or accept help from

others.

u Be active each day. Studies show that many people feel better when they take short walks or do light exercise each day. Being active like this can also help improve your appetite.

u Talk with your doctor or nurse about medicine if you

find it very hard to cope with your feelings.

Ways to learn more

The following groups provide support for people with

cancer and their families and friends.

The Cancer Support Community

Dedicated to providing support, education, and hope to people affected by cancer.

Call:

1-888-793-9355 or 202-659-9709

Visit:

www.cancersupportcommunity.org

E-mail:

help@cancersupportcommunity.org

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CancerCare, Inc.

Offers free support, information, financial assistance, and practical help to people with cancer and their loved ones.

Call:

1-800-813-HOPE (1-800-813-4673)

Visit:

www.cancercare.org

E-mail:

info@cancercare.org

To read more about ways to cope with your feelings, see Taking Time: Support for People With Cancer. To learn more about coping with fatigue caused by cancer treatment, see Chemotherapy and You and Radiation Therapy and You.

These books are from the National Cancer Institute. You can get free copies at www.cancer.gov/publications or 1-800-4-CANCER (1-800-422-6237).

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Eating Problems At-A-Glance

Below is a list of eating problems that cancer treatment may cause. Not everyone gets every eating problem. Some people don’t have any problems. Which ones you might have will depend on the type and doses of treatment you receive and whether you have other health problems, such as diabetes or kidney or heart disease.

Talk with your doctor, nurse or dietitian about the eating problems on this list.

Ask which ones might affect you. Put a check mark next to the ones you may get or are having now and go to the pages listed to learn more.

Eating Problems

4 Eating problems that

Pages to

you might have

learn more

Appetite Loss

12

Changes in Sense of Taste or Smell

15

Constipation

17

Diarrhea

20

Dry Mouth

23

Lactose Intolerance

25

Nausea

27

Sore Mouth

30

Sore Throat and Trouble Swallowing

34

Vomiting

37

Weight Gain

39

Weight Loss

41

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Appetite Loss

What it is

Appetite loss is when you do not want to eat or do not feel like eating very much.

It is a common problem that occurs with cancer and its treatment. You may have appetite loss for just 1 or 2 days, or throughout your course of treatment.

Why it happens

No one knows just what causes appetite loss. Reasons may include: u The cancer itself

u Fatigue

u Pain

u Feelings such as stress, fear, depression, and anxiety

u Cancer treatment side effects such as nausea, vomiting, or changes in how foods taste or smell

Ways to manage with food

u When it is hard to eat, drink a liquid or powdered meal replacement (such as “instant breakfast”).

u Eat 5 or 6 small meals each day instead of 3 large meals.

You may find it helps to eat smaller amounts at one time.

This can also keep you from feeling too full.

u Keep snacks nearby for when you feel like eating. Take easy-to-carry snacks such as peanut butter crackers, nuts,

granola bars, or dried fruit when you go out. You can find

more quick and easy snack ideas on page 57.

u Add extra protein and calories to your diet. You can find ways to add protein on page 59 and calories on page 63.

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u Drink liquids throughout the day—even when you do not want to eat.

Choose liquids that add calories and other nutrients. These include juice, soup, and milk and soy-based drinks with protein. You can find lists of clear liquids on page 49 and full-liquid foods on page 50.

u Eat a bedtime snack. This will give extra calories but won’t affect your appetite for the next meal.

u Change the form of a food. For instance, you might make a fruit milkshake instead of eating a piece of fruit. There is a recipe on the next page.

u Eat soft, cool, or frozen foods. These include yogurt, milkshakes, and popsicles. There is a recipe for banana

milkshake on the next page.

u Eat larger meals when you feel well and are rested. For many people, this is in the morning after a good night’s sleep.

u Sip only small amounts of liquids during meals. Many people feel too full if they eat and drink at the same time. If you want more than just small sips, have a larger drink at least 30 minutes before or after meals.

Other ways to manage

u Talk with a dietitian. He or she can discuss ways to get enough calories and protein even when you do

not feel like eating.

u Try to have relaxed and pleasant meals. This

includes being with people you enjoy as well as

having foods that look good to eat.

u Exercise. Being active can help improve your appetite. Studies show that many people with cancer feel better when they get

some exercise each day.

u Talk with your nurse or social worker if fear, depression, or other feelings affect your appetite or interest in food. He or she can suggest ways to help.

u Tell your doctor if you are having nausea, vomiting, or changes in how foods taste or smell. Your doctor can help control these problems so that you feel more like eating.

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Reci pe

To help with appetite loss

Banana Milkshake

1 whole ripe banana, sliced

Vanilla extract (a few drops)