Information Prescriptions Information Prescriptions are a quick and easy way to provide information about your condition and local services. www.nhs.uk/ips Acknowledgement With many thanks to the Queensland Cancer Fund for the use of their information on nutrition Oncology Dietitian, Northampton General Hospital Oxford Oncology Dietitian How can I help reduce healthcare associated infections? Infection control is important to the well-being of our patients and for that reason we have infection control procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections. We ask that you, and anyone visiting you, use the hand rub (special gel) available at the main entrance of the hospital and at the entrance to every ward before coming in to and after leaving the ward or hospital. In some situations hands may need to be washed at the sink using soap and water rather than using the hand rub. Staff will let you know if this is the case. www.buckshealthcare.nhs.uk If you require an interpreter or need a document in another language, large print, Braille or audio version please ask for assistance. Issued by: Date: Common nutritional problems and cancer Resource 3 Information for Patients A guide to helping with common nutritional problems and side effects associated with cancer Author: Jessica Phillips Issue date: May 2010 Reviewed: July 2014 Review date: July 2016 Leaflet code: CISS - 24 Version: 3
Introduction This booklet is designed to give you information on ways to help overcome common nutritional problems often encountered with cancer. These problems may be related to the disease itself, while others may be temporary side effects of treatment. This booklet offers suggestions to assist you in overcoming any problems that may arise but remember, trial and error is also a very good way to find solutions to individual difficulties in eating. Some people may require specific dietary advice, in which case your nurse or doctor may refer you to a dietitian for specialist advice. Good nutrition can help you to: maintain well being and improve your body s ability to fight infection, helps you to cope better with some of the side effects of treatments, maintain your weight at a suitable level, or regain lost weight, The common forms of treatment for cancer are surgery, chemotherapy and radiotherapy. Some of the nutritional problems/side effects that you may experience with cancer treatment are listed. These will vary according to the type of treatment you are having. Not all people will suffer these side effects. Drink plenty of fluids as your body may lose a lot of fluid while you have diarrhoea. Avoid very hot or cold drinks. Limit alcohol, strong tea and coffee. Sometimes diarrhoea can cause a temporary lactose intolerance, where ordinary milk may make the diarrhoea worse. You may find it helpful to change to soya milk or low lactose milk until diarrhoea ceases. Constipation Constipation may be due to a number of causes. These may include reduced food and fluid intake, inadequate exercise, medication or reluctance to use bowels because of discomfort. Sometimes medication is required but it may help to increase the amount of fibre and fluid in your diet. This can be done by including: Bread: Try wholemeal, high fibre white bread or granary. Cereals: Try wholegrain varieties e.g. porridge, Shredded Wheat, Weetabix. Liquids: Aim to drink at least 2 litres (8-10 glasses/mugs) of fluids a day. Further Information For further information on building up your food intake, please ask for a copy of the Diet and Cancer booklet by Macmillan Cancer Support. See the section on The building up diet or the Buckinghamshire NHS Trust diet leaflet on Eating well with a small appetite. If you have ongoing problems with a poor appetite and weight loss, you can ask to be referred to a dietitian. 1 10
If your mouth is sore Common side effects of cancer treatment are listed below: Avoid dry, rough or hard foods such as toast, biscuits or crisps. Avoid highly spiced foods. Surgery - altered food intake may be as a result of: fasting for the operation decreased intake after the operation Drink plenty of nourishing fluids. Add extra sauce, gravy or butter to your meals to soften the food. Eat little and often. Avoid fruit juice and alcohol which may irritate a sore mouth. Avoid very hot drinks, try warm or cold drinks instead. Ensure you maintain good mouth hygiene and if your mouth is very sore, speak to your doctor who may suggest a mouth wash or painkiller is taken before a meal. Diarrhoea Diarrhoea can be due to a number of different factors including treatment, medications or anxiety. Whatever the cause of diarrhoea a temporary change in diet may help. While you have diarrhoea, cut down your fibre intake by replacing wholemeal bread and cereals with white varieties, avoid raw fruit and vegetables with skins, seeds, nuts and peas/beans. Choose plain, bland foods. Avoid spiced and fatty foods. Avoid very hot or cold foods. 9 Chemotherapy Radiotherapy Common problems include: - side effects vary with individuals. Common problems include: Nausea and vomiting Ulceration of the mouth Diarrhoea and/or constipation Altered taste Loss of appetite poor appetite loss of weight nausea and vomiting chewing and swallowing problems dry or coated mouth loss or alteration of taste diarrhoea and constipation - Problems are specifically related to the area being treated. For example, - head and neck region: Sore throat or mouth Dry or coated mouth Altered taste - abdomen or pelvis: nausea change of bowel habit 2
Poor appetite This is a frequent side effect of cancer or the treatment of cancer. Try to keep a regular meal pattern. You may not feel hungry but your body still needs nourishment. Small frequent meals may be more acceptable than the traditional three meals a day. Try to have something to eat every two hours during the day. Avoid drinks with meals as these can fill you up quickly. Try having nourishing drinks between meals, instead of drinking water, squash, tea or coffee. Try full cream milk. For recipes please refer to leaflet CISS-25 Eating well with a small appetite. If you do not feel like preparing a meal, have a range of ready prepared foods and snacks on hand. Cook in advance to reduce tiredness at meal times. There may be times of the day when you feel more like eating. Take advantage of this by eating well at these times. Keep snacks handy e.g. cheese and crackers, yoghurts, cereal bars, scones, nuts. Loss of weight To help overcome the altered taste sensitivity the following may be useful: If you have lost your taste, try sharp and strong flavours ie bitter jams, strong cheese - extra mature varieties. Fresh fruit, fruit juices and boiled sweets can be refreshing. Try adding meat extracts such as Oxo, Bovril or Marmite to meat dishes for extra taste. Drinking more fluids e.g. lemon tea, lemonade, fruit juice, ginger ale can remove unpleasant tastes in the mouth. These are often more acceptable than tea and coffee. Try using a straw and position it at the back of the mouth to bypass the taste buds. Seasoning and spices can often disguise unpleasant tastes (be careful if your mouth is sore). Cold foods often taste better than hot. Trial and error may be the answer, keep trying. Go along with your food cravings and enjoy the foods you can take. If meat does not taste right, try eating fish, eggs, cheese or beans/pulses instead. Use plastic cutlery if you have a metallic taste in your mouth. If underweight or losing weight you need to include more protein and calories in your diet. Weigh yourself weekly to check whether you are maintaining your weight. 3 8
Try changing the consistency and texture of foods making them easier to manage. A liquidiser may be useful. Use extra sauces and gravies. An additional booklet is available which offers specific information for soft/pureed or liquid diets. Dry or coated mouth A dry or coated mouth can result from radiotherapy or chemotherapy as saliva may be reduced or become thicker. Ensure regular alcohol-free mouthwashes. Moisten your foods with gravy or sauces. Suck ice or ice lollies, sugar free boiled sweets, soft drinks. Be sure to drink fluids with meals or snacks. Pineapple chunks can often be refreshing and can increase saliva production. Your doctor maybe able to prescribe mouthwashes, lozenges, artificial saliva sprays or gels to help. Loss or alteration of taste This may result from the disease itself, or from the side effects of treatment. Smell and taste may be affected. Some common complaints are that all food tastes the same, food is like cardboard, food has a metallic taste, I no longer like the taste of my favourite food. 7 Good sources of protein and calories include: Meat, fish, poultry, milk and dairy products, eggs, legumes, pulses (eg baked beans, chick peas, lentils) and nuts. Use milk and dairy foods wherever possible: Add skimmed milk powder to full cream milk; use this instead of ordinary milk in coffee, packet soups, sauces or on breakfast cereals Use evaporated/condensed milk or cream on breakfast cereal, in puddings, milk-based sauces Add grated cheese, evaporated milk, or dried milk powder to soup Use cheese in cooking sprinkled over a meal, on vegetables and in sauces. Add full cream yoghurt and honey to breakfast cereal. Use eggs frequently: In egg dishes e.g. scrambled eggs. Other sources of protein: Use peanut butter freely (on sandwiches, crackers). Use baked beans as a snack. Try adding beans or peas to soups, salads and casseroles. 4
For extra calories, incorporate foods high in fat and sugar into your meal plan. Add butter, oil, cream, sour cream and mayonnaise freely when preparing meals. Drink high sugar drinks eg lemonade, lucozade. Add sugar, glucose, honey as desired. Nausea and vomiting Sometimes chemotherapy and radiotherapy treatment can make you feel sick. This may be made worse if you are anxious or emotionally upset. This is usually temporary but it will obviously make eating difficult. A variety of medications are available to help combat nausea and vomiting ask your doctor to find one suitable for your needs. Avoid eating directly before treatment, if this makes the nausea worse. Ginger flavoured food or drinks may help to reduce feelings of sickness (e.g. ginger ale, ginger biscuits, ginger tea). Try small, frequent meals. Sickness is often worse if you have long periods without food. Try to avoid the smell of food cooking, try cold foods (eg sandwiches, yoghurts, fruit salad) or where possible get someone else to do the cooking. Try getting some fresh air before eating or sit by an open window whilst eating. Eat dry foods such as plain biscuits, or toast, bland foods such as chicken, salty foods such as crisps and crackers. Take cold fluids e.g. squash, lemonade, ginger ale, jelly. Avoid fatty, rich and spicy foods. Avoid wearing tight fitting clothes Eat slowly and relax after a meal. Nausea can become worse when the stomach is empty, so try to eat regularly. Swallowing difficulties This may occur if you are having radiotherapy to the mouth and throat area. Ensure good oral hygiene with a soft toothbrush. Keep your mouth clean with regular alcohol-free mouthwashes. Avoid extreme temperatures i.e. very hot or cold. Avoid highly spiced foods. Drink plenty of nourishing fluids. If you are finding thicker fluids easier to swallow than thin liquids, a thickening powder may be useful. Your doctor may give you a prescription for some. 5 6