Eating Hints For Cancer Patients provides information and recipes to help patients meet their needs for good nutrition before, during and after treatment. NIH Publication #98-2079. Revised July 1997

Table of Contents

Eating Hints for Cancer Patients: Before, During, and After Treatment

Introduction

The National Cancer Institute (NCI) has prepared this booklet to help you learn about your diet needs during treatment and to help you cope with side effects that may affect eating. It is designed for cancer patients and their families and other caregivers. The information here has been gathered from many sources and reflects the tried-and-true experience of cancer patients and the doctors, nurses, and dietitians who work with them.

How Eating Hints for Cancer Patients Is Organized

People also find that their need for information changes over time. Many of the patients we talked to said that in the beginning, general information about cancer and cancer treatment was the most helpful, or was all they could handle. Later, during their treatment, they found that they wanted more detailed information about their treatment and how it was going to affect them. 

As a result, Eating Hints for Cancer Patients is organized in separate sections that relate to specific stages of cancer treatment. Each section can stand alone, so read as much or as little of the book as you need. 

Before Treatment Begins
This section briefly describes eating-related side effects that may occur with different types of cancer treatments. It also gives some tips to help you prepare physically and mentally for your treatment. 

Managing Eating Problems During Treatment
This section provides more detailed information on specific eating-related side effects that people experience with their treatment. While many side effects are described, they may or may not happen to you. There is a wide variation in what patients experience. This section includes lots of suggestions for coping, as well as some recipes that patients and caregivers have found to be especially helpful. 

After Treatment Ends
This section deals with the time period after your treatment ends. It gives you suggestions for getting back to a normal eating routine and provides tips for healthy eating. 

Eating Hints for Cancer Patients also includes two other sections:

Resources, which includes information on other NCI publications about cancer, its treatment, and coping with the illness. We have also listed NCI's Cancer Information Service (CIS) at 1-800-4-CANCER. The CIS provides information about cancer, cancer treatment, research studies, and living with cancer to patients, their families, health professionals, and the public. In addition, this section includes information about nutrition publications published by NCI and the U.S. Departments of Agriculture and of Health and Human Services.

How to Use This Booklet

 A registered dietitian is your best source of information about your diet. The information here will add to what the dietitian can tell you. Feel free to ask for help or advice when you need it. Writing down your questions in advance will help you make sure you get the information you need. Ask the dietitian to repeat or explain anything that is not clear. She or he can also explain anything in this book if you have a question and can give you more detailed information. Your doctor or nurse can also give you helpful advice and can refer you to a registered dietitian. If you cannot get a referral, call the American Dietetic Association's (ADA) toll-free nutrition hotline. The information specialist you talk to can help you find a registered dietitian in your area. The Resources section at the end of Eating Hints provides the telephone number and other contact information for the ADA.
 

Before Treatment Begins

All of these methods of treating cancer kill cells. In the process of killing the cancer cells, some healthy cells are also damaged. That is what causes the side effects of cancer treatment. Side effects that can affect your ability to eat include:

• loss of appetite
• changes in weight (either losing or gaining weight)
• sore mouth or throat
• dry mouth
• dental and gum problems
• changes in sense of taste or smell
• nausea/vomiting
• diarrhea
• lactose intolerance
• constipation
• fatigue and/or depression

Preparing Yourself for Cancer Treatment

Think Positively

• Many people have few or no eating-related side effects. Even if you do, they may be mild, and most go away after cancer treatment ends. Also, there are new drugs now that can work well to control side effects.
• Having a positive attitude, talking out your feelings, becoming well-informed about your cancer and treatment, and planning ways to cope can all help reduce worry and anxiety, make you feel more in control, and help you keep your appetite.
• Give food a chance. Even if you do have eating problems, you'll have days when eating is a pleasure.

Eat a Healthy Diet

• A healthy diet is vital for a person's body to work its best. This is even more important for cancer patients.
• If you've been eating a healthy diet, you'll go into treatment with reserves to help keep up your strength, prevent body tissue from breaking down, rebuild tissue, and maintain your defenses against infection.
• People who eat well are better able to cope with side effects. You may even be able to handle higher doses of certain treatments. For example, we know that some cancer treatments are actually much more effective if the patient is well-nourished and getting enough calories and protein in his or her diet. 
• Don't be afraid to try new foods. Some things you may never have liked before may taste good to you during treatment.

Plan Ahead

• Stock the pantry and freezer with favorite foods so that you won't need to shop as often. Include foods you know you can eat even when you are sick.
• Keep foods handy that need little or no preparation, for example, pudding, peanut butter, tuna fish, cheese, and eggs.
• Do some cooking in advance and freeze in meal-sized portions.
• Talk to friends or family members about helping with shopping and cooking. Or, ask a friend or family member to manage that job for you.
• Talk to a registered dietitian about your concerns and what you might expect. She or he can give you ideas and help you plan meals. Ask for help in developing a grocery list with foods that might help with potential side effects, such as constipation or nausea. Ask about what has worked for other patients.

Managing Eating Problems During Treatment

Side effects of cancer treatment vary from patient to patient. The part of the body being treated, the type and length of treatment, and the dose of treatment determine whether side effects will occur. 

The good news is that not everyone has side effects during treatment, and most side effects go away when treatment ends. Side effects can also be well-controlled with new drugs. Talk to your doctor about possible side effects from your treatment and what can be done about them. 

Some eating problems are caused by the treatment itself. Other times, patients may have trouble eating because they are upset, worried, or afraid. Losing your appetite and nausea are two normal responses to feeling nervous or fearful. Once you get into your treatment period and have a better sense of what to expect and how you will react, these anxiety-related eating problems should get better. 

While you are in the hospital or undergoing treatment, talk to your doctor, nurse, or a registered dietitian. They can answer your questions and give you suggestions for specific meals, snacks, and foods, and for dealing with any eating problems you may have. They can also help with dietary preferences that reflect various cultural and ethnic backgrounds. Feel free to talk to them if problems arise during your recovery as well. Ask them what has worked for other patients. 

Remember, there aren't any hard and fast nutrition rules during cancer treatment. Some patients may continue to enjoy eating and have a normal appetite throughout most of their cancer treatment. Others may have days when they don't feel like eating at all; even the thought of food may make them feel sick. Here are some things to keep in mind:

• When you can eat, try to eat meals and snacks with sufficient protein and calories; they will help you keep up your strength, prevent body tissues from breaking down, and rebuild tissues that cancer treatment may harm. 
• Many people find their appetite is better in the morning. Take advantage of this and eat more then. Consider having your main meal of the day early, and have liquid meal replacements later on if you don't feel so interested in eating (see page 11 for more information on liquid meal replacements). 
• If you don't feel well and can eat only one or two things, stick with them until you are able to eat other foods. Try a liquid meal replacement for extra calories and protein. 
• On those days when you can't eat at all, don't worry about it. Do what you can to make yourself feel better. Come back to eating as soon as you can, and let your doctor know if this problem doesn't get better within a couple of days. 
• Try to drink plenty of fluids, especially on those days when you don't feel like eating. Water is essential to your body's proper functioning, so getting enough fluids will ensure that your body has the water it needs. For most adults, 6-8 cups of fluid a day are a good target. Try carrying a water bottle with you during the day. That may help you get into the habit of drinking plenty of fluids. Tables 2 and 3 include many examples of fluids you can try. 

Coping with Side Effects

Let them know that you appreciate their support. Tell them about Special Notes for Caregivers.

At the end of Eating Hints, you will find two items that may be especially useful as you go through treatment and use this booklet. The first, "Keeping Track of Side Effects," is a chart that you copy and use to monitor how you feel as you go through treatment. Use the second, "Notes," to jot down questions or concerns that you want to discuss with your health care team. 

Loss of Appetite

For some people, loss of appetite happens for just a day or two; for others, it's an ongoing concern. Whatever the reason, here are some suggestions that might help:

• Try liquid or powdered meal replacements, such as "instant breakfast," during times when it is hard for you to eat food. 
• Try frequent small meals throughout the day, rather than fewer big ones. It may be easier to eat more that way, and you won't get so full. 
• Keep snacks within easy reach so you can have something whenever you feel like it. Cheese and crackers, muffins, ice cream, peanut butter, fruit, and pudding are good possibilities. Take a portable snack with you when you go out, such as peanut butter crackers or small boxes of raisins. You can find more snack ideas in Table 4. 
• Even if you don't feel like eating solid foods, try to drink beverages during the day. Juice, soup, and other fluids like them can give you important calories and nutrients. Milk-based drinks also provide protein. Tables 2 and 3 give lots of examples of fluids. 
• If possible, try having something at bedtime. It won't affect your appetite for the next meal. 
• Sometimes, changing the form of a food will make it more appetizing and help you eat better. For example, if eating whole, fresh fruit is a problem, try mixing fruit into a milkshake. (Banana Milkshake Recipe) 
• Try softer, cool, or frozen foods, such as yogurt, milkshakes, or popsicles. 
• Take advantage of times when you do feel well, and have a larger meal then. Many people have a better appetite first thing in the morning, when they are well rested. 
• During meals, sip only small amounts because drinking may make you feel full. If you want to have more than just a small amount to drink, have it 30-60 minutes before or after a meal. 
• Make mealtimes as relaxed and pleasant as possible. Presenting food or meals in an attractive way may also help. 
• If your doctor allows, have a small glass of wine or beer during a meal. It may help to stimulate your appetite. 
• Regular exercise may help your appetite. Check with your doctor to see what options are open to you.

Weight Loss

Here are three simple recipes that show you how to increase the calories and protein of familiar foods:
Fortified Milk
High-Protein Milkshake
Peanut Butter Snack Spread

Instant Dry Milk as a Protein Powder

Weight Gain

It is important not to go on a diet right away if you notice weight gain. Instead, tell your doctor so you can find out what may be causing this change. Sometimes, weight gain happens because certain anticancer drugs can cause your body to hold on to excess fluid. This condition is called edema. The weight comes from the extra water. If this is the case, your doctor may ask you to talk with a registered dietitian for guidelines on limiting the amount of salt you eat. This is important because salt causes your body to hold extra water. Your doctor may also want to prescribe a diuretic. This is a medication that causes your body to get rid of excess fluid.

Breast cancer patients with a primary diagnosis of cancer may be different. Over half of them may actually gain weight rather than lose during treatment. Because of this, many of the recommendations for breast cancer patients do emphasize a lower fat, reduced calorie diet similar to those provided to patients after cancer treatment has been completed (see page 37).

Weight gain may also be the result of increased appetite and eating extra food and calories. If this is the case and you want to stop gaining weight, here are some tips that can help. Talk to a registered dietitian for more guidance:

• Emphasize fruits, vegetables, and breads and cereals. 
• Choose lean meats (lean beef or pork trimmed of fat, chicken without skin) and low-fat dairy products (skim or 1% milk, light yogurt). 
• Cut back on added butter, mayonnaise, sweets, and other extras. 
• Choose low-fat and low-calorie cooking methods (broiling, steaming). 
• Avoid eating high-calorie snacks between meals. 
• If you feel up to it, increase the amount of exercise you get.

Sore Mouth or Throat

• milkshakes 
• bananas, applesauce, and other soft fruits 
• peach, pear, and apricot nectars 
• watermelon 
• cottage cheese, yogurt 
• mashed potatoes, noodles 
• macaroni and cheese 
• custards, puddings, and gelatin 
• scrambled eggs 
• oatmeal or other cooked cereals 
• pureed or mashed vegetables, such as peas and carrots 
• pureed meats

• Avoid foods or liquids that can irritate your mouth. These include: 
• oranges, grapefruits, lemons, or other citrus fruit or juice 
• tomato sauces or juice 
• spicy or salty foods 
• raw vegetables, granola, toast, crackers, or other rough, coarse, or dry foods 
• commercial mouthwashes that contain alcohol 
• Cook foods until they are soft and tender. 
• Cut foods into small pieces. 
• Use a blender or food processor to puree your food. 
• Mix food with butter, margarine, thin gravy, or sauce to make it easier to swallow. 
• Use a straw to drink liquids. 
• Use a smaller-than-usual spoon, such as a baby spoon. 
• Try foods cold or at room temperature. Hot foods can irritate a tender mouth and throat. 
• Try drinking warm bouillon or salty broth; it can soothe throat pain. 
• Try sucking on ice chips. 
• If swallowing is hard, tilting your head back or moving it forward may help. 
• If your teeth and gums are sore, your dentist may be able to recommend a special product for cleaning your teeth. 
• Rinse your mouth often with water to remove food and bacteria and to promote healing. 
• Ask your doctor about anesthetic lozenges and sprays that can numb your mouth and throat long enough for you to eat meals.

Dry Mouth

• Have a sip of water every few minutes to help you swallow and talk more easily. Consider carrying a water bottle with you so you always have some handy. 
• Try very sweet or tart foods and beverages, such as lemonade; these foods may help your mouth make more saliva. (Do not try this if you also have a tender mouth or sore throat and the sweet or tart foods make it worse.) 
• Suck on hard candy or popsicles or chew gum. These can help make more saliva. 
• Eat soft and pureed foods, which may be easier to swallow. 
• Keep your lips moist with lip salves. 
• Moisten food with sauces, gravies, and salad dressings to make it easier to swallow. 
• If your dry mouth problem is severe, ask your doctor or dentist about products that coat, protect, and moisten your mouth and throat. These are sometimes called "artificial saliva."

Dental and Gum Problems

• Be sure to let your doctor know about any dental problems you are having. 
• Be sure to see your dentist regularly. Patients who are receiving treatment that affects the mouth - for example, radiation to the head and neck - may need to see the dentist more often than usual. 
• Use a soft toothbrush. Ask your doctor, nurse, or dentist to suggest a special kind of toothbrush and/or toothpaste if your gums are very sensitive. 
• Rinse your mouth with warm water when your gums and mouth are sore. 
• If you are eating foods high in sugar or foods that stick to your teeth, be sure to brush or rinse your mouth afterward so that the sugar won't damage your teeth, or use sugar-free varieties. (Sorbitol, a sugar substitute that is contained in many sugar-free foods, can cause diarrhea in many people. If diarrhea is a problem for you, check the labels of sugar-free foods before you buy them and limit your use of them.) 

Changed Sense of Taste or Smell

There is no foolproof way to prevent changes to your sense of taste or smell because each person is affected differently by illness and treatments. However, the tips below should help if you have this problem. (If you also have a sore mouth, sore gums, or a sore throat, talk to your doctor, nurse, or registered dietitian. They can suggest ways to help you without hurting the sore areas.) 

• Choose and prepare foods that look and smell good to you. 
• If red meat, such as beef, tastes or smells strange, try chicken, turkey, eggs, dairy products, or mild-tasting fish instead. 
• Help the flavor of meat, chicken, or fish by marinating it in sweet fruit juices, sweet wine, Italian dressing, or sweet-and-sour sauce. 
• Try using small amounts of flavorful seasonings, such as basil, oregano, or rosemary. 
• Try tart foods, such as oranges or lemonade, that may have more taste. A tart lemon custard might taste good and will also provide needed protein and calories. (If you have a sore mouth or throat, tart or citrus foods might cause pain or discomfort.) 
• If smells bother you, try serving foods at room temperature, turning on a kitchen fan, covering foods when cooking, and cooking outdoors in good weather. 
• Try using bacon, ham, or onion to add flavor to vegetables. 
• Visit your dentist to rule out dental problems that may affect the taste or smell of food. 
• Ask your dentist or doctor about special mouthwashes and good mouth care.

Nausea

Whatever the cause, nausea can keep you from getting enough food and needed nutrients. Here are some ideas that can help:

• Ask your doctor about antiemetics that might help you control nausea and vomiting. 
• Try foods that are easy on your stomach, such as: 
• toast, crackers, and pretzels 
• yogurt 
• sherbet 
• angel food cake 
• cream of wheat, rice, or oatmeal 
• boiled potatoes, rice, or noodles 
• skinned chicken that is baked or broiled, not fried 
• canned peaches or other soft, bland fruits and vegetables 
• clear liquids 
• ice chips 
• carbonated drinks 
• Avoid foods that: 
• are fatty, greasy, or fried 
• are very sweet, such as candy, cookies, or cake 
• are spicy or hot 
• have strong odors 
• Eat small amounts, often and slowly. Eat before you get hungry, because hunger can make feelings of nausea stronger. 
• If nausea makes certain foods unappealing, then eat more of the foods you find easier to handle. 
• Avoid eating in a room that's stuffy, too warm, or has cooking odors that might disagree with you. 
• Drink fewer liquids with meals. Drinking liquids can cause a full, bloated feeling. 
• Slowly drink or sip liquids throughout the day. A straw may help. 
• Have foods and drinks at room temperature or cooler; hot foods may add to nausea. 
• Don't force yourself to eat favorite foods when you feel nauseated. This may cause a permanent dislike for those foods. 
• Rest after meals, because activity may slow digestion. It's best to rest sitting up for about an hour after meals. 
• If nausea is a problem in the morning, try eating dry toast or crackers before getting up. 
• Wear loose-fitting clothes. 
• If nausea occurs during radiation therapy or chemotherapy, avoid eating for 1 to 2 hours before treatment. 
• Try to keep track of when your nausea occurs and what causes it (specific foods, events, surroundings). (see chart) If possible and if it helps, change your diet or schedule. Share the information with your doctor or nurse.

Vomiting

If vomiting is severe or lasts for more than a day or two, contact your doctor. He or she may give you an antiemetic medication to control nausea and vomiting.

Very often, if you can control nausea, you can prevent vomiting. At times, though, you may not be able to prevent either. Relaxation exercises or meditation may help you. These usually involve deep rhythmic breathing and quiet concentration, and can be done almost anywhere. If vomiting does occur, try these suggestions to help prevent further episodes:

• Do not eat or drink anything until you have the vomiting under control. 
• Once the vomiting is under control, try small amounts of clear liquids, such as water or bouillon. Table 2 gives you more examples of clear liquids. Begin with 1 teaspoonful every 10 minutes, gradually increasing the amount to 1 tablespoon every 20 minutes. Finally, try 2 tablespoons every 30 minutes. 
• When you are able to keep down clear liquids, try a full-liquid diet or a soft diet. Table 3 gives examples of full-liquid foods. Continue taking small amounts as often as you can keep them down. If you feel okay, gradually work up to your regular diet. If you have a hard time digesting milk, you may want to try a soft diet instead of a full-liquid diet, because a full-liquid diet includes a lot of milk products. Ask a registered dietitian for information about a soft diet. 

Diarrhea

Diarrhea may have several causes, including chemotherapy, radiation therapy to the abdomen, infection, food sensitivities, and emotional upset. Work with your doctor to identify the cause of your diarrhea so that it can be successfully treated.

During diarrhea, food passes quickly through the bowel before your body has a chance to absorb enough vitamins, minerals, and water. This may cause dehydration, which means that your body does not have enough water to work well. Long-term or severe diarrhea may cause problems, so contact your doctor if the diarrhea is severe or lasts for more than a couple of days. Here are some ideas for coping with diarrhea:

• Drink plenty of fluids to replenish what you lose with the diarrhea. Tables 2 and 3 give examples of fluids to try. 
• Eat small amounts of food throughout the day instead of three large meals. 
• Eat plenty of foods and liquids that contain sodium and potassium, two important minerals that help your body work properly. These minerals are often lost during diarrhea. Good high-sodium liquids include bouillon or fat-free broth. Foods high in potassium that don't cause diarrhea include bananas, peach and apricot nectar, and boiled or mashed potatoes. Sports drinks contain both sodium and potassium and have easily absorbable forms of carbohydrates. 
• Try these foods: 
• yogurt, cottage cheese 
• rice, noodles, or potatoes 
• farina or cream of wheat 
• eggs (cooked until the whites are solid; not fried) 
• smooth peanut butter 
• white bread 
• canned, peeled fruits and well-cooked vegetables 
• skinned chicken or turkey, lean beef, or fish (broiled or baked, not fried) 
• Avoid: 
• greasy, fatty, or fried foods if they make your diarrhea worse 
• raw vegetables and the skins, seeds, and stringy fibers of unpeeled fruits 
• high-fiber vegetables, such as broccoli, corn, dried beans, cabbage, peas, and cauliflower 
• Avoid very hot or cold food or beverages. Drink liquids that are at room temperature. 
• Limit foods and drinks that contain caffeine, such as coffee, some sodas, and chocolate. 
• If you have a sudden, short-term attack of diarrhea, try having nothing but clear liquids for the next 12 to 14 hours. (see chart) This lets your bowel rest and replaces the important fluids lost during the diarrhea. Make sure your doctor or nurse knows about this problem. 
• Be careful when using milk and milk products. The lactose they contain can make diarrhea worse. Most people, though, can handle small amounts (about 1-1/2 cups) of milk or milk products. 

Lactose Intolerance

Lactose intolerance may occur after treatment with some antibiotics, with radiation to the stomach or with any treatment that affects the digestive tract. The part of your intestines that digests lactose may not work properly during treatment. For some people, the symptoms of lactose intolerance (gas, cramps, diarrhea) disappear a few weeks or months after the treatments end or when the intestine heals. For others, a permanent change in eating habits may be needed.

If you have this problem, your doctor may advise you to follow a diet that is low in foods that contain lactose. Talk to a registered dietitian to get advice and specific tips about how to follow a low-lactose diet. Your supermarket should carry milk and other products that have been modified to reduce or eliminate the lactose. You can also make your own low-lactose or lactose free foods. Here's a simple recipe for a lactose-free pudding: Lactose-Free Double Chocolate Pudding). 

Constipation

• Drink plenty of liquids - at least eight 8-ounce glasses every day. This will help to keep your stools soft. Another way to think about fluids is to try to drink at least 1/2 oz. per pound of your body weight. 
• Have a hot drink about one-half hour before your usual time for a bowel movement. 
• Check with your doctor to see if you can increase the fiber in your diet (there are certain types of cancer for which a high-fiber diet is not recommended). If you can, try foods such as whole-grain breads and cereals, dried fruits, wheat bran, wheat germ; fresh fruits and vegetables; dried beans and peas. Eat the skin on potatoes. Make sure you also drink plenty of fluids to help the fiber work. Here's is an easy recipe that might help relieve constipation: Apple/Prune Sauce. 
• Get some exercise every day. Talk to your doctors or a physical therapist about the amount and type of exercise that's right for you.

Fatigue and Depression

Fatigue and depression aren't eating problems in and of themselves, but they can affect your interest in food and your ability to shop and prepare healthy meals. Here are some suggestions that may help:

• Talk about your feelings and your fears. Being open about your emotions can make them seem more manageable. Consider talking with your nurse or social worker, who can help you find ways to lessen your worries and fears. 
• Become familiar with your treatment, possible side effects, and ways of coping. Being knowledgeable and acting on that knowledge will help you feel more in control. Don't be afraid to talk with your doctor and ask questions. 
• Make sure you get enough rest: 
• take several naps or rest breaks during the day, rather than one long rest 
• plan your day to include rest breaks 
• make rest time special with a good book in a comfortable chair or a favorite video with a friend 
• try easier or shorter versions of your usual activities; don't push yourself to do more than you can manage. 
• Save your favorite foods for times that aren't associated with treatment sessions. That way, they won't be linked to an uncomfortable or distressing event. 
• Take short walks or get regular exercise, if possible. Some people find this helps to lessen their fatigue and raise their spirits.

Preventing Food-Borne Illness

• Wash all raw fruits and vegetables well. If it can't be well washed (as with raspberries), avoid it. Scrub rough surfaces, like the skin of melons, prior to cutting. 
• Carefully wash your hands and food preparation surfaces (knives, cutting boards) before and after preparing food, especially after handling raw meat. 
• Thaw meat in the refrigerator, not on the kitchen counter. 
• Be sure to cook meat and eggs thoroughly. 
• Avoid raw shellfish and use only pasteurized or processed ciders and juices and pasteurized milk and cheese.

Extra Vitamins and Minerals - Will They Help?

The NCI strongly urges you to depend on traditional, healthy foods for vitamins, minerals, and other nutrients. Talk to your doctor, nurse, registered dietitian, or a pharmacist before taking any vitamin or mineral supplements. Too much of some vitamins or minerals can be just as dangerous as too little. Large doses of some vitamins may even stop your cancer treatment from working the way it should. To avoid problems, don't take these products on your own. Follow your doctor's guidance.
 

What About Alternative Therapies? 

Special Notes for Caregivers

There is much that you can do to help your friend or loved one through the period of cancer treatment. Read over the tips and suggestions in "Managing Eating Problems During Cancer Treatment." Many may be useful to you as you prepare food or meals for the patient. 

In addition, here are some other things to remember that will help you cope:

• Be prepared for the patient's tastes to change from day to day. Some days he or she won't want favorite foods because they don't taste good. Other times, he or she will be able to eat a dish that couldn't be tolerated just the day before. 
• Have food within easy reach at home. For example: 
• a snack-pack of applesauce or pudding and a spoon on the bedside table if the patient isn't feeling well that day 
• a bag of cut-up carrots on the top shelf of the refrigerator
• Have meals and snacks ready so the patient can have something to eat when he or she is ready. 
• Be prepared for times when the patient is able to eat only one or two foods for a few days in a row, until side effects diminish. Even if he or she can't eat at all, still encourage plenty of fluids. Tables 2 and 3 contain a variety of examples of fluids, and the section on "Coping with Side Effects" has lots of ideas for getting enough fluids. 
• Talk to the patient about needs and concerns, and about ideas that might work best. A willingness to be flexible and supportive no matter what will help the patient feel in control of the situation. 
• Try not to push the patient into eating and drinking. Encourage and support without being overwhelming.

After Treatment Ends

Most eating-related side effects associated with radiation, chemotherapy, or other treatments go away after cancer treatment ends. If you have had side effects, you should gradually begin to feel better, and your interest in food and mealtimes will come back. Sometimes, though, side effects persist, especially weight loss. If this happens to you, talk to your doctor and work out a plan together for how to address the problem. 

After cancer treatment ends and you're feeling better, you may want to think again about the traditional guidelines for healthy eating. Just as you wanted to go into treatment with all the reserves that such a diet could give you, you'll want to do the best for yourself at this important time. There's no current research that suggests that the foods you eat will prevent your cancer from recurring. But, we do know that eating right will help you regain your strength, rebuild tissue, and help you feel well. Here are the fundamentals:

• Focus on eating a variety of foods every day. No one food contains all the nutrients you need. 
• Emphasize fruits and vegetables. Raw or cooked vegetables, fruits, and fruit juices provide the vitamins, minerals, and fiber you need. 
• Emphasize breads and cereals, especially the whole grain varieties, such as whole wheat bread, oats, and brown rice. These foods are good sources of complex carbohydrates, vitamins and minerals, and fiber. 
• Go easy on fat, salt, sugar, alcohol, and smoked or pickled foods. Choose low-fat milk products, and small portions (no more than 6-7 oz. a day) of lean meat and poultry without skin. Try lower-fat cooking methods, such as broiling, steaming, and poaching.

Some patients need to have treatments that last a long time. Others may have surgery to remove part of their stomach or intestines. These patients may have ongoing eating-related concerns. If this is your situation, talk to your doctor and a registered dietitian. He or she can give you more information about the long-term issues that you will deal with and can help you develop an individual diet plan.

Ways to Get Back Into Eating

• Make simple meals using familiar, easy-to-prepare recipes. 
• Cook enough for two or three meals, then freeze the remainder for a later meal. 
• Take advantage of the supermarket's salad bar and prepared foods to make cooking easier. 
• Think about ways you used to make mealtime special and try them again. 
• Don't be afraid to ask a friend or family member for help with cooking or shopping.

Recipes

Banana Milkshake

Place all ingredients into a blender.
Blend at high speed until smooth. 

Fortified Milk

Pour liquid milk into a deep bowl.
Add dry milk and beat slowly with beater until dry milk is dissolved (usually less than five minutes).
Refrigerate and serve cold.
Note: If it tastes too strong, start with 1/2 cup of dry milk powder and gradually work up to 1 cup.

• macaroni and cheese
• puddings and custards
• cream sauces for vegetables
• mashed potatoes
• cocoa
• French toast or pancake batter
• soup

High-Protein Milkshake

Put all ingredients in a blender.
Blend at low speed for 10 seconds.

Peanut Butter Snack Spread

Combine dry milk, water, and vanilla, stirring to moisten.
Add honey and peanut butter, stirring slowly until liquid blends with peanut butter.

Spread on crackers.

Mixture also can be formed into balls, chilled, and eaten as candy.

Keeps well in refrigerator but is difficult to spread when cold.

Fruit and Cream

Lactose-Free Double Chocolate Pudding

Melt chocolate in small pan or on foil.
Measure cornstarch and sugar into saucepan.
Add part of the liquid and stir until cornstarch dissolves.
Add the remainder of the liquid.
Cook over medium heat until warm.
Stir in chocolate until mixture is thick and comes to a boil.
Remove from heat.
Blend in vanilla and cool.

Apple/Prune Sauce

Blend all ingredients and store in refrigerator.
Take 1-2 tablespoons of this mixture before bedtime, then drink 8 oz. of water.
Note: Make sure you drink the water, or else it will not work to relieve constipation.

Figure and Tables

Table 1. How Cancer Treatments Can Affect Eating

Table 2. Examples of Clear Liquids

Table 3. Examples of Full-Liquid Foods

Table 4. Quick & Easy Snacks

Table 5. How to Increase Calories

Table 6. How to Increase Protein

Keeping Track of Side Effects

Here's a form to help you keep track of eating-related side effects you may experience while you are undergoing cancer treatment. Feel free to copy this form and keep your own record. You can also share it with the health professional who is keeping track of side effects with you during this time. Your Name: Week of: Write the type and date of your last treatments(s): Type of Treatment: Date: Type of Treatment: Date: Your Weight:lbs. (measure once a week)  Below you will find a list of some eating-related side effects that cancer patients may experience. Check the box next to any side effect listed below that you experience in the week you have listed above. Next to each one you have checked, write a number from 1 to 3 indicating how severe you think each side effect was for you, where: 1= mild; 2= moderate; and 3= severe.
Side Effect	M	T	W	Th	F	S	Sun
Sore/Dry Mouth	o	o	o	o	o	o	o
Nausea	o	o	o	o	o	o	o
Vomiting	o	o	o	o	o	o	o
Constipation	o	o	o	o	o	o	o
Diarrhea	o	o	o	o	o	o	o
Fatigue	o	o	o	o	o	o	o
Other: _______	o	o	o	o	o	o	o
Other Questions or Concerns (Use this space to write down questions or concerns you may want to talk about with your health care provider.)

Resources

Telephone

Provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information specialists translate the latest scientific information into understandable language and respond in English, Spanish, or on TTY equipment.

Toll-free: 1–800–4–CANCER (1–800–422–6237)
TTY: 1–800–332–8615

Internet

NCI’s Web site provides comprehensive information about cancer causes and prevention, screening and diagnosis, treatment and survivorship; clinical trials; statistics; funding and training; and the Institute’s programs and research activities. 

Fax

Includes NCI information about cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care. To obtain a contents list, dial 1–800–624–2511 or 301–402–5874 from your touch-tone phone or fax machine hand set and follow the recorded instructions.

American Dietetic Association (ADA)

PUBLICATIONS

• "Chemotherapy and You: A Guide to Self-Help During Treatment" ² </