When you're being treated for cancer, food can lose all its appeal. But maintaining good nutrition is more important than ever as you move toward recovery. Dietitians -- and a patient who's been there -- share their advice for how to eat right.
The Nutrition Strategy
Linda Kao of Dallas has gone through a gamut of cancer treatment -- chemotherapy, radiation and surgery. Kao, assistant dean of global programs at Southern Methodist University's Cox School of Business, was traveling in Chile in October 2010 when she says she noticed an "odd mass" in her mouth.
On her return to Dallas, Kao found out she had tonsil cancer, and she began treatment at the Baylor Cancer Center. "From the very first meeting with my oncologist, he introduced me to the nutritionist/dietitian and told me she would be my best friend -- and one of the most important people throughout the treatment," says Kao, who answered questions via email because the cancer treatment significantly weakened her voice.
It's often difficult for patients with head and neck cancers to maintain their weight, so Kao's nutritionist recommended that she put on some pounds early on. Throughout 18 weeks of chemo, antiemetic medications and careful monitoring of her diet staved off nausea and vomiting.
While Kao says she felt "miserable" during the first week, she forced herself to eat. By week three, she felt better and ate as much as she could before facing the next round of chemo. She says she actually gained about 15 pounds. Then came radiation.
Loss of Appetite
When it comes to cancer and nutrition, "everybody wants to do their best, try their hardest to increase their chances of survivorship -- but also feel well in the moment," says Stacy Kennedy, a registered dietitian and senior nutritionist at Dana-Farber/Brigham and Women's Hospital Cancer Center in Boston.
But side effects -- including nausea and vomiting, appetite loss, constipation and diarrhea -- interfere.
Suzanne Dixon, a registered dietitian and former chair of the Academy of Nutrition and Dietetics' Oncology Nutrition Dietetic Practice Group, points out that cancer is not a single disease -- no two cases are identical. Symptoms, treatments and responses vary widely from patient to patient. So it's important to work with a registered dietitian, she says, ideally one who specializes in oncology nutrition.
To combat appetite loss, Dixon suggests doing light physical activity to stimulate appetite, keeping food handy for moments when appetite returns and eating by the clock instead of waiting for hunger cues. Eating small, frequent meals is another way to maintain nutrition as appetite shrinks, Kennedy says.
Smoothies also make great between-meal options. "You can kind of multitask in your glass," she says. "If your goal is to get fruits and vegetables, protein, hydration, fiber, electrolytes -- a smoothie can help you do all that at once."
Keeping nausea at bay is a balancing act -- an empty stomach, a too-full stomach or even hunger can make it worse. Food odors can stimulate nausea, Dixon says. Eating low-odor foods, avoiding food preparation areas and using a lidded cup while drinking smoothies or nutrition supplements can minimize nauseating smells.
Acupuncture also has been shown to help prevent nausea and vomiting in people receiving chemotherapy, according to the National Cancer Institute, Dixon notes.
It's important to replenish lost nutrients, especially when patients experience vomiting, Kennedy says. "With vomiting, you have to really focus on your hydration with electrolyte-rich fluids like broth -- regular broth, not low sodium."
Dixon emphasizes that patients should not endure vomiting as an "expected" chemo side effect to be tolerated: "If you're vomiting profusely, that's a medical problem -- and you really need to talk to your physician or nurse," she says.
Temperature and Taste
Certain types of chemotherapy -- like Oxaliplatin used to treat colon cancer -- may cause sensitivity to cold, including chilly weather and cold beverages. Patients experiencing temperature side effects will be advised to avoid icy or cold drinks.
Tastes can also change during treatment, and once-favorite foods may seem "off." With bitter or metallic tastes, Dixon suggests seasoning food with fresh basil or oregano, using fruit marinades for meat and replacing metal utensils with plastic or bamboo.
Round 2: Radiation
Radiation proved tougher than chemo for Kao. "It burned up my throat -- I lost my voice completely two weeks into treatment," she recalls, adding that the treatment caused swelling inside of her mouth and throat as well as "tremendous pain." Eventually, Kao could no longer keep food down. Her dietitian recommended diet supplements and drinks to keep up with calories and protein.
"Mouth sores can be a really horrific problem with head and neck cancer patients," Dixon says, adding that.medicated mouth rinses can help relieve pain.
With mouths sores, hot foods and liquid should be avoided, and soft, bland foods are preferable to rough, dry foods such as crackers, toast or raw vegetables, Dixon says. Frozen grapes or melon balls are worth a try (if cold sensitivity isn't an issue).
Acidic items, like foods preserved in vinegar, are problematic as well. Kennedy suggests subbing cool avocado for acidic fruit such as oranges, pineapples and lemons.
Some patients who have trouble swallowing after radiation may need a small feeding tube to supplement nutrients with products like Ensure or Glucerna.
Weight Loss or Gain
Cancer and treatment can lead to unwanted weight loss. But for some patients, weight gain is the issue. That can develop from a "perfect storm" of certain treatments, types of cancer, less physical activity and craving high-carb foods, Kennedy says. Surgery can also affect weight and limit what patients eat.
Whatever the issue, Kennedy says, patients and dietitians can work together to develop an individualized plan that might change as patients go in and out of treatment.
Fatigue is an almost across-the-board side effect among cancer patients, Kennedy says. At home, you may be too tired to cook -- much less eat. "Going through cancer treatment itself is a full-time job," she adds.
Dana-Farber's nutrition webpage offers a free nutrition app that helps cancer patients enter food preferences, select recipes and build shopping lists to share with caregivers or others who want to lend a hand in the kitchen.
"Reach out and either ask or accept help people offer," Kennedy says. "So many people in every culture express love and care through food."
Kao still wasn't finished with treatment. The radiation damaged her jawbone, and she had hyperbaric oxygen therapy to repair the bone, followed by complex neck surgery to remove additional tumor found around the carotid artery. Then came the final round of chemo.
Since March 2012, Kao has been cancer-free. Over the past three years, she's learned to enjoy eating again -- but there is a difference.
"I was a foodie," Kao says. "[But] when you have a hard time swallowing from damage to the throat and saliva glands, it pretty much eliminates a whole bunch of food." The challenge, she says, is to eat what you can while taking in enough of the right foods to stay healthy. Avocado, lightly cooked eggs, smoked salmon, sashimi, medium-rare filet mignon, berries and papaya are manageable -- and tasty -- choices for Kao, along with raw fruits and veggies tossed in a blender.
During treatment, people should realize good nutrition "is one of the most important tools to help you fight cancer," Kao says. "You hate the thought of food, but you have to think positively that food is your friend."