Cancer Symptom Management

Poor Appetite

Poor appetite is one of the most common side effects of having cancer and undergoing treatments for your cancer.  It can be frustrating for patients and their family members when a patient has no appetite and their food and beverage intake decreases and they lose weight as a result.  In many cases, appetite does not generally improve during cancer treatments (unless an appetite stimulant is prescribed), though eating well is essential to helping the body tolerate treatment and heal appropriately.  

If you or a loved one has a poor appetite during treatment, consider the following ideas to help:

• Set a schedule and stick with it.  Eat every 2-3 hours according to the clock.
• Pre-plan your meals.  On the weekend or whenever you have some free time, make a list of all of the foods planned for breakfast, lunch, dinner, and snacks for the week.  If mealtime comes around and the patient would prefer something else, be flexible and change to that food.  Otherwise, use this structure to be providing consistent meals.  
• It can often be difficult to think of foods to eat when you have a poor appetite.  The caregiver could consider providing 3 food options and letting the patient choose which of those sounds the most appealing.  
• Just because your body’s internal hunger signals aren’t working properly doesn’t mean you don’t need to eat. Use external cues to remind you to eat, such as trying to eat or drink something during every TV commercial; setting an egg timer, alarm clock on your cell phone, or reminder on the computer to eat every 2 hours.
• Use salad plates instead of dinner plates to serve meals on.  Larger plates can often make food sizes overwhelming, whereas smaller plates can make them seem more manageable.  
• Often high calorie liquids can be a great way to get quick calories down and may be an area to focus on.  Since it requires less effort to consume liquids than solid foods, it may be helpful to push high calorie fluids.  These could be cream soups; black bean, split pea, ham and bean, or broccoli cheddar soups; chili; commercial nutrition supplements like Ensure or Boost; homemade milkshakes or smoothies.  
• Avoid foods or beverages low in calories like diet pop, black coffee, tea without added ingredients, and Jell-o.  Try to get as much “bang for your buck” as you can and consume beverages with calories.
• Take medications with a high calorie beverage.

Nausea and Vomiting

Nausea is the feeling of discomfort in the abdomen, associated with the urge to vomit.  Nausea can be a side effect of certain chemo drugs and receiving radiation to the abdomen and can vary in intensity.  In addition to taking your anti-nausea medications as prescribed, there are some food ‘tricks’ you can try to help alleviate some of the discomfort.  

• Don’t let your stomach get empty…that can make nausea worse!  Sometimes, people don’t want to eat anything when nauseated, in fear of vomiting.  Instead, try to eat small amounts of bland foods every 2-3 hours during the day to help keep the nausea at bay.  This may include foods like saltines, plain or lightly buttered toast, mashed potatoes, dry cereal, white rice, or hard-boiled egg whites.
• It’s important to stay hydrated during your treatments, but it often helps if you have something bland and solid in your stomach prior to eating.  Sometimes liquid hitting an empty, nauseated stomach can make the nausea worse.
• Peppermint and ginger have soothing qualities to nauseated stomachs.  Try sucking on peppermints, drinking peppermint or ginger tea, eating a few ginger snaps, or preparing foods with ginger root.  If you’re interested in taking ginger supplements, discuss it first with your physician.  
• The smell of warm food can trigger nausea for some people.  If this is true for you, let food cool down to room temperature – or choose foods that are naturally cool like sandwiches, salads, yogurt, cottage cheese, crackers and peanut butter – to help eliminate those smells.  
• If smells associated with cooking bother you, try (if possible) to be in a back bedroom when foods are being prepared and have fans running in the kitchen to diffuse the smell.  Utilizing cooking methods that will limit smells such as grilling, using a George Foreman, using a crockpot, and baking.  Using the microwave and stovetop and be more aromatic ways of preparing foods and may want to be avoided.  
• Limit or avoid foods that are very sweet, fatty, greasy, or spicy, as they can all cause nausea to flare up.  
• If you do vomit, it’s important to be even more diligent about fluid intake to prevent dehydration.  Wait about 30 minutes after vomiting and then take sips of clear liquids such as cranberry juice, broth, Gatorade/Powerade/Pedialyte, broth, Sprite or 7Up, or bites of popsicles or Jell-o.

Diarrhea

Diarrhea is defined as frequent passage of loose or watery stools and can be a side effect of some cancer treatments.  Diarrhea can lead to dehydration and weight loss if it is not well-controlled.  

Signs of dehydration are: thirst, dark yellow urine color, urinating less frequently than normal, light-headedness, dizziness, poor skin turgor, or dry skin.

Your physician will discuss medications to help you manage your diarrhea, but there are some dietary tips you can also incorporate to help increase control.

• Your body may tolerate several smaller meals throughout the day better than three larger meals.  
• Foods that tend to increase diarrhea are greasy, fried, fatty, or high sugar foods.  It’s best to limit these.
• Some people don’t tolerate milk products well during treatment.  If you find that you are one of these people, consider trying dairy alternatives like almond milk, soy milk, and/or rice milk products.  
• Soluble fiber works to soak up fluid and form a gel in your bowel, which can slow bowel movements down.  Foods high in soluble fiber are: applesauce, bananas, smooth peanut butter, white rice, barley, the insides of apples and pears (peel them), and oatmeal.  
• Other foods that may be beneficial include: marshmallows or sugar-free gelatin (mix gelatin with liquid and drink before turns into Jell-o consistency) and foods high in pectin such as: bananas, banana chips, plantain chips, citrus fruits, applesauce, apples, and plums.
• Insoluble fiber is considered to be “roughage” and is found in bran, nuts, vegetables, fruit peels.  It is a good idea to limit these types of foods when having diarrhea, as they can hasten motility through the GI tract.

Constipation

Constipation means difficulty passing bowel movements, being unable to move your bowels, or having fewer bowel movements than normal.  It can occur during cancer treatments as a result of medications, taking iron supplements, decreased food or fluid intake, or decreased physical activity.  Constipation can cause a decreased food intake and inability to meet nutrient needs and is important to control.  

Your physician will discuss appropriate medications to take to keep your bowels moving, though there are some dietary tips that may also help you regulate them.  

• Consuming adequate fiber (25-35 grams per day) is beneficial in helping move food contents through the GI tract.  The best sources of fiber can be found in fresh or frozen fruits and vegetables; dried fruits; grains like brown or wild rice, quinoa, steel cut oats; bran; whole grain breads, tortillas, and pastas; nuts and seeds; popcorn; beans; and flaxseed.
• When increasing fiber intake, it’s important to increase fluid intake as well.  Try drinking water, prune juice, warm juices, decaffeinated tea or coffee.  Aim for a minimum of 8 cups (64 oz) of fluids daily.  
• Try the recipe below, taken from Eating Well Through Cancer by Holly Clegg and Gerald Miletello, as a means of relieving your constipation.  

Ingredients: 
1¼ cups unprocessed bran
1 cup prune juice
1 Tbsp molasses or honey
1 cup applesauce

Mix and store in a covered container in the refrigerator for up to 7 days. Stir before taking.  Take 2 Tbsp every night as needed.

Makes 18 (2 Tbsp) servings

Altered Tastes

Altered tastes can be a side effect of some cancer treatments and may be described as foods tasting blander than normal, like cardboard, or metallic.  When foods don’t taste normal, it can discourage people from eating and lead to weight loss.  Here are some helpful hints to help improve the flavor of your foods:

• Some people find bland foods work well since they generally don’t have much taste anyway.  Foods to try would be: potatoes, pastas, oatmeal, pancakes.
• If you don’t have mouth sores, consider using an acid to improve the flavor of your foods.  Lemon juice, lime juice, or vinegar can all help.  Consider marinating meats in lemon or lime juice, putting lemon juice on pastas, eating vinegar-based pasta salads, using vinaigrettes to top salads or vegetables.
• Oftentimes people say fresh fruits taste good when nothing else does.  If you find this is true for you, add your favorite fresh fruit to yogurt, cottage cheese, ice cream, or meats/chicken/fish to improve their flavor.
• If foods are tasting metallic, try using plastic silverware instead of metal silverware.
• Make a homemade mouth rinse of baking soda, salt, and warm water.  Swish and spit several times per day.
• Suck on sugar-free hard candies like lemonheads, peppermints, or root beer barrels if the bad taste lingers in your mouth throughout the day.
• If foods taste too salty, bitter, or sour, try adding a little bit of an artificial sweetener or sugar.  A little sweetness can help improve taste.
• If foods taste too sour, a fruit called miracle fruit can change the flavor from being sour to sweet.  These fruits are expensive and difficult to find, though there are tablets of these fruits available from online retailers.
• Have three or four small servings of different foods on your plate. Take a few bites of one food, and when you get tired of it, try the next one.