Navigating Nutrition During Cancer Treatment

Angela Charlton R.D.-N.'s picture
By Angela Charlton... on November 14, 2018

Receiving a cancer diagnosis is an overwhelming experience. Both the symptoms and the treatments can be exhausting, and recovery is sometimes a longer process than anticipated.

In addition to physical effects, the illness and its treatments have profound emotional effects as well—including on relationships. Everyone has well-meaning advice and wants to help, but not everyone knows how to.

That is especially the case for the changing dietary needs and tolerances experienced by cancer patients.

Preparing meals for family and friends is a form of social ritual, a way to nurture and care for those we love. Eating is a source of sensory pleasure, joy and connection.

When physical discomfort, nausea, loss of appetite and taste changes disrupt these pleasures and routines, they can pose unexpected physical and emotional challenges for patients and their caregivers. Relationships to food and the comfort of sharing food-centered rituals become altered. 

For some families, what was once a nurturing act—feeding someone—can even become a point of conflict.

It's not uncommon for caregivers to focus intently on the number of bites their loved one takes at a meal and the weight they gain or lose.

The desire to aid their loved one in their journey can sometimes have the unintended effect of adding to the patient’s distress, as well as their own.

In working with cancer patients and families, I have found that it is important to recognize that nutritional needs are unique from person to person, and from day to day. Factors to consider include the patient’s:

  • Overall medical status
  • Point in treatment, and any side effects or symptoms
  • Social situation and support network
  • Financial situation
  • Emotional factors
  • Cultural, philosophical or religious views and beliefs

The most important nutritional goals for cancer patients are straightforward: hydration, calories, protein and vitamins/minerals.

  • Hydration supports the entire digestive system and protect kidneys, which can take a hit from some chemotherapies
  • Calories support weight maintenance
  • Protein is essential to help retain muscle mass and promote healing and recovery
  • Vitamins and minerals, ideally derived from diet (vitamin D, B vitamins, iron and calcium or a multivitamin may be recommended, but certain supplements may interact with treatment, and may even increase the risk of recurrence with some tumor types; be sure to consult your oncologist before taking supplements)

During cancer treatment, patients may not be able to tolerate physical forms of nutrition in the same way they had before.

Trying to consume their regular diet can be uncomfortable or cause pain or gastrointestinal issues, such that their intake declines.

As a result, what is nourishing is sometimes just what works best in the moment

Simple strategies can remove some of the pressure around eating. With patience and an open mind, patients and their caregivers can discover new joys and new approaches to nutrition during cancer treatment.

Guidance for Patients

One of the most important things a cancer patient can do when undergoing treatment is to pay attention to their body.

When struggling with symptoms, eating what is best tolerated takes precedence over maintaining habits and routines that aren't currently working well. 

A small addition can make foods taste better or even “normal” again. The Cancer-Fighting Kitchen by Rebecca Katz and Mat Edelson offers FASS (fat-acid-salt-sweet) fixes to specific tastes:

  • Metallic taste: Add lemon and maple syrup or agave nectar, or a bit of butter or nut cream
  • Too sweet: Add six drops of lemon or lime juice, taste again and repeat as needed
  • Too salty: Add ¼ teaspoon of lemon juice
  • Too bitter: Add maple syrup or agave nectar
  • Cardboard taste: Add sea salt until the flavor moves toward the front of the mouth; a spritz of lemon also helps

Patients often know their needs and tolerances best and may be able to guide their caregivers in how to help them. Help can be provided in many ways: 

  • Make a grocery list
  • Go grocery shopping with them as you are able
  • Participate in food preparation when you can
  • Spell out what you can tolerate or really want to have

Identifying other non-food ways to comfort or "nourish" can be beneficial too:

  • Providing emotional support
  • Sharing religious or spiritual rituals
  • Simply being present with you
  • Reading to you
  • Playing your favorite music
  • Doing chores such as house cleaning

Helping your loved ones help you empowers both of you to refocus your energies from what you have lost to new rituals you can discover together.

Guidance for Caregivers

The most important thing you can do is listen to the patient. Don’t expect people to eat a whole meal like they used to. Instead, focus on small servings and frequent opportunities for nibbling and sipping.

No matter the issue or problem, there is usually a nourishing option. Some suggestions to consider:

  • Use small plates so the meal does not appear overwhelming
  • Garnish the food with care and beauty
  • Make the setting appealing – in front of a sunny window, using cloth napkins, etc.
  • Focus on liquids – liquids can be a wonderfully simple and pleasurable way of delivering nutrition, and even when a person is struggling with eating, they are generally still thirsty and able to drink

Consuming smoothies, soups and teas can be a shared, social experience or a meditative experience as well as a meal. Eating takes up a lot of energy, so consider serving broth in a mug rather than a bowl with a spoon.

Adding herbs and spices can vary and enrich the flavors while also adding phytonutrients. Nutritional powerhouses include:

  • Garlic
  • Turmeric
  • Ginger
  • Cinnamon
  • Green, leafy herbs such as oregano and parsley; a teaspoon of oregano has more antioxidants than a full cup of broccoli

Other herbs and spices to keep handy include cardamom, cinnamon, cumin, mint and rosemary. Adding them to soups and smoothies ensures that even if a person is not able to eat well, they are getting some nutrients.
 
If you make a full recipe, such as a pan of lasagna, be sure to portion it into individual servings before freezing.

And leave some easy-to-eat foods available to empower your loved ones to help themselves at any time, such as single-serve custards and yogurts, boiled eggs and string cheese.

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Angela Charlton, R.D.-N., specializes in oncology nutrition at Carilion Clinic and is a regular contributor to Carilion Living.