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by J. Clifford, C. Didinger ^* (12/19)

Quick Facts…

• A largely plant-based diet with limited consumption of alcohol, red meat, and processed meat is recommended for those at risk for or with cancer.
• Side effects from cancer treatment may include reduced appetite, taste alterations, diarrhea, constipation, and difficulty swallowing, which may result in weight loss.
• It is important to maintain a healthy weight during cancer treatment, which may reduce the risk for complications.  Attention to the types and amounts of foods eaten and other coping strategies can help limit weight loss.
• During treatment, immune system function may be compromised, so it is important to always practice safe food handling techniques.

A Plant-Based Eating Pattern

Emphasis on whole foods of plant origin can promote health, provide key nutrients, and support maintenance of a healthy weight. Institutions like the World Cancer Research Fund recommend limiting red meat intake (i.e. beef, lamb, and pork) and avoiding processed meat (e.g. bacon, ham, and hot dogs). See fact sheet 9.313 Diet and Cancer Prevention for more details about healthy eating tips.

Cancer and Nutrition: The Importance of Healthy Weight Maintenance

Weight loss and malnutrition are common problems for cancer patients, although some cancer treatments may result in weight gain. Even a small loss in body weight can predict a reduced response to treatment, thus those undergoing treatment for cancer should try to maintain a healthy weight and avoid losses or gains in weight. Research shows that cancer patients who retain a healthy weight and maintain a good nutritional status have fewer complications, regardless of the form of treatment. Fewer complications result in improved response and tolerance of treatment, reduced illness, fewer infections, shorter hospital stays, and an overall higher quality of life. A healthy weight is important for increased energy levels, strength, and coping with the side effects of cancer treatment.

Dietary Tips for Healthy Weight Maintenance

The following tips are useful for all cancer patients. However, for those experiencing weight loss, maintaining a healthy weight by consuming protein and calorie-rich foods should be a primary goal.

Eat a variety of whole foods — An eating pattern that emphasizes whole, plant-based foods is important for a nutritionally complete diet. Incorporate whole grains, legumes, and lean protein sources, like non-fat or low-fat dairy. Although it is important to eat fruits and vegetables, it may be advisable to choose higher calorie options to avoid weight loss, such as sweet potatoes, squashes, bananas, avocados, and dried fruit.

Limit caffeine, sugar, sodium (salt), and alcohol — Exceptions for this guideline include those experiencing weight loss, as fat is a good source of calories that will aid in weight gain.

Hydration — Drink as many fluids as possible throughout the day, as dehydration may be a problem with nausea, constipation, or diarrhea. Eat foods with high water content, such as vegetables, fruits, soups, smoothies, and popsicles.If weight loss is a problem, try high-calorie fruit smoothies or natural juices. Refer to a medical professional for advice on specific dietary recommendations.

Coping with Cancer’s Effect on the Diet

Cancer’s effect on the diet falls into two categories:

1. Dietary side effects of the disease itself
2. Dietary side effects of cancer treatment

1. Diet and Cancer — Side Effects of the Disease

Loss of Appetite and Weight Loss — Early signs and symptoms of cancer include a decreased ability to eat, digest, or absorb food and nutrients. Cancer cells may use the body’s energy reserves, or release chemicals that alter the way that the body makes energy from food. With a cancer diagnosis, a lack of appetite may also be a result of emotional distress or depression.

Change in bowel habits or bladder function — Constipation, diarrhea, or pain when urinating may result from colon, bladder, and prostate cancer. This may interfere with proper nutrient absorption and result in loss of fluids and electrolytes.

Trouble swallowing — Difficulty chewing or swallowing may result from head and neck cancer, or esophageal cancer. These symptoms may cause vomiting, early satiety, and fluid and electrolyte imbalances.

2. Diet and Cancer — Side Effects of Treatment

Surgery — The effects of surgery on the diet vary greatly depending on the location of the tumor and the surgical procedure used. If surgery is scheduled, talk to the doctor about what side effects might develop. When a side effect does develop, a doctor or registered dietitian can assist with the diet. Fatigue and weight loss are common symptoms.

Chemotherapy — Chemotherapy works by destroying rapidly dividing cells, such as cancer cells. It also destroys normal body cells that divide rapidly, such as those in bone marrow and those that line the small intestine. Side effects can include nausea, vomiting, diarrhea, or constipation, all of which may adversely affect dietary intake. Alterations in taste are also common with patients undergoing chemotherapy. In addition, dry mouth is a frequent symptom, with decreased saliva production impacting the amount of chemicals released from food, contributing to alterations in taste.

Radiation Therapy — The dietary side effects of radiation therapy depend on the location of the tumor. For instance, therapy for a head or neck tumor often causes nausea, fatigue, loss of appetite, swallowing pain, and dry mouth. Also, radiation can damage taste cells and inhibit proliferations of new cells. Thus, a frequent side effect of patients undergoing radiation therapy is taste alteration.

Changes in Food’s Flavor and Odor

Cancer and treatment often result in taste alterations. For example, chemotherapy can result in the reduced ability to taste sweetness and a higher sensitivity to bitterness. This changes the flavor of foods like sweets, desserts, fruits, and vegetables. Some individuals may experience an unusual dislike for certain foods, flavors, or odors; this may develop when unpleasant symptoms are tied to a food recently eaten. Some studies indicate that zinc supplementation may protect against taste disorders.

Overall, these side effects can result in decreased calorie intake and not meeting daily energy and nutrient requirements, causing weight loss. In addition to effects on appetite and body weight, psychological well-being can also be affected. The pleasure associated with eating can be negatively impacted, resulting in social and emotional impacts. Taking steps to improve nutrition and the eating experience can thus help improve physical and emotional well-being. Everyone is different, but Table 1 presents potential side effects and coping strategies:

Table 1. Diet and Cancer — Potential Side Effects and Coping Strategies

Cancer and Nutrition: Guidance Before, During, and After Treatment

Before Cancer Treatment

• Make sure your body is well-nourished before treatment begins.
• Plan ahead and stock your kitchen with foods you can easily prepare.
• Cook in advance, freezing meal-sized portions.
• Stock nutritious snacks in case you do not feel like preparing a meal, including snacks you can eat even when not feeling well.
• Have a support group ready to help with preparing meals and grocery shopping.
• Look into a grocery delivery service for your home.

During Cancer Treatment

• Eat a healthy diet rich in nutritious foods to help your body function at its best.
• Between treatments, nourish your body well when an appetite is present.
• Incorporate lots of whole, plant-based foods, such as legumes, whole grains, vegetables, and fruits.
• Maintain a healthy weight and remain physically active.
• Be patient when coping with side effects such as changes in taste preference and the loss of taste and smell.

After Cancer Treatment

• Cancer survivors are at an increased risk for developing other cancers; therefore it is important to minimize one’s risk through a nutrient-dense diet, healthy weight maintenance, and living a physically active lifestyle. For more information, see fact sheet 9.313 Diet and Cancer Prevention.
• Following the USDA Dietary Guidelines is recommended for proper nourishment, which can help rebuild strength after treatment.

Additional Resources

Keep the doctor informed of diet problems, treatment difficulties, and changes in condition. Hospital registered dietitians and those in private practice can help with dietary problems. They help patients better understand the effects of cancer and its treatment may have on diet.

The American Cancer Society can provide names of support groups or other services, such as Meals on Wheels, available to cancer patients in the community. Contact the American Cancer Society at: 1-800-227-2345, or visit their website at:  www.cancer.org.

The National Cancer Institute offers a helpful booklet called Eating Hints for Cancer Patients: Before, During, and After Treatment. This document can be accessed online at: www.cancer.gov/cancertopics/coping/eatinghints.  Free copies can be obtained by calling 1-800-638-6694.

The Oncology Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics: www.oncologynutrition.org

For additional help and information, call the Cancer Hotline at 1-800-4-Cancer.

For additional help and information, call the Cancer Hotline at 1-800-4-Cancer.

References

American Cancer Society. (2017). ACS guidelines for nutrition and physical activity. Retrieved from https://www.cancer.org/healthy/eat-healthy-get-active/acs-guidelines-nutrition-physical-activity-cancer-prevention/guidelines.html

American Cancer Society. (2015). Nutrition for the person with cancer during treatment. Retrieved from https://www.cancer.org/treatment/survivorship-during-and-after-treatment/staying-active/nutrition/nutrition-during-treatment.html

Amézaga, J., Alfaro, B., Ríos, Y., Larraioz, A., Ugartemendia, G., Urruticoechea, A., & Tueros, I. (2018). Assessing taste and smell alterations in cancer patients undergoing chemotherapy according to treatment. Supportive Care in Cancer, 26(12), 4077-4086. doi: 10.1007/s00520-018-4277-z

Bressan, V., Bagnasco, A., Aleo, G., Catania, G., Zanini, M. P., Timmins, F., & Sasso, L. (2017). The life experience of nutrition impact symptoms during treatment for head and neck cancer patients: A systematic review and meta-synthesis. Supportive Care in Cancer, 25(5), 1699-1712. doi: 10.1007/s00520-017-3618-7

Ganzer, H., Touger-Decker, R., Byham-Gray, L., Murphy, B. A., & Epstein, J. B. (2015). The eating experience after treatment for head and neck cancer: a review of the literature. Oral Oncology, 51(7), 634-642. doi: j.oraloncology.2015.04.014

Hager, K. K. (2016). Management of weight loss in people with cancer. Journal of the Advanced Practitioner in Oncology, 7(3), 336-338.

Kapoor, V., Basur, S., & Pandey, A. (2015). Chemotherapy and oral complications -The most neglected side of cancer. Journal of Advanced Medical and Dental Sciences Research, 3(1), 71-80.

Mourouti, N., Panagiotakos, D. B., Kotteas, E. A., & Syrigos, K. N. (2017). Optimizing diet and nutrition for cancer survivors: A review. Maturitas, 105, 33-36. doi: 10.1016/j.maturitas.2017.05.012

Murtaza, B., Hichami, A., Khan, A. S., Ghiringhelli, F., & Khan, N. A. (2017). Alteration in taste perception in cancer: causes and strategies of treatment. Frontiers in Physiology, 8, 134. doi: 10.3389/fphys.2017.00134

Sánchez-Lara, K., Sosa-Sánchez, R., Green-Renner, D., Rodríguez, C., Laviano, A., Motola-Kuba, D., & Arrieta, O. (2010). Influence of taste disorders on dietary behaviors in cancer patients under chemotherapy. Nutrition Journal, 9(1), 15. doi: 10.1186/1475-2891-9-15

Wilkes, P. A., & Allen, D. H. (2018). Nutrition care: Managing symptoms from cancer. The Journal for Nurse Practitioners, 14(4), 267-275. doi: 10.1016/j.nurpra.2018.01.011

*J. Clifford, Extension Nutrition Specialist, Department of Food Science Human Nutrition; C. Didinger, Graduate Student, Department of Food Science Human Nutrition. Previously updated by: Bellows and R. Moore. 3/02. Revised 12/19.

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