Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Good nutrition for chemotherapy patients can be affected by poor mouth care, fatigue, pain, fever, as well as the many symptoms that can occur during and after cancer chemotherapy treatments. The goal is to know how to overcome these symptoms and maintain an adequate diet after chemotherapy.

Tips for managing symptoms to achieve a good diet after chemotherapy:

Loss of Appetite for Food (Anorexia)

Diet tips to try:

• Eat 6 small and regular meals throughout the day
• Plan ahead – plan daily menu in advance
• Have help with preparing meals
• Make every bite count – choose high protein high energy foods
• Eat breakfasts that contain at least ⅓ of your calorie needs
• Pack snacks to keep on hands at all times
• Eat foods with odors that are appealing
• Cooking odors can be minimised by:
  • Cooking outdoor on the grill
  • Using kitchen fan when cooking
  • Serving cold or room temperature food instead of hot
  • Ordering take-away, meal delivery
• Try new foods as food likes and dislikes may change from day to day

Nausea/Vomiting

Foods to avoid:

• Hot, spicy foods
• Deep fried and greasy foods
• Very sweet and sugary foods
• Large meals and soupy dishes
• Food with strong smells
• Eating or drinking too quickly
• Drinking beverages with meals
• Lying down after meal

Diet tips to try:

• Eat before cancer treatment
• Eat dry foods such as crackers, toasted bread throughout the day
• Eat bland, soft, easy to digest foods rather than heavy meals
• Slowly sip fluids throughout the day
• Sit up or lie with the upper body raised for one hour after eating
• Rinse mouth before and after eating
• Suck on ice cubes, mints, or hard candies to keep mouth fresh
• Distractions such as TV, music, or reading may be helpful while eating

Diarrhea

Foods to avoid:

• Hot, spicy foods
• High fibre foods
• Fatty, greasy or fried foods
• Rich desserts
• Nuts, seeds, or dried fruit

Beverages to avoid:

• Drinks that are very hot or cold
• Drinks containing caffeine (coffee, tea, cola, and chocolate)
• Drinks containing dairy products

Diet tips to try:

• Eat broth, soups, electrolytes drinks, bananas and canned fruits to help replace salt and potassium lost by diarrhea
• Avoid cruciferous vegetables such as broccoli, cauliflower and cabbage
• Drink plenty of fluids through the day, room temperature fluid may be better tolerated
• Limit dairy products until the problem is solved
• Limit sugar-free candies made with sorbitol
• Drink 1 cup of fluid after each loose bowel movement

Constipation

Constipation is defined as fewer than 3 bowel movements per week. It is very common problem for cancer patients and may result from lack of water or fibre in the diet; lack of physical activity; anticancer therapies such as chemotherapy; and medications.

Diet tips to try:

• Increase the amount of fibre e.g. fruits, vegetables, and whole grains
• Drink plenty of fluids at least 8–10 glasses
• In some cases a low fibre diet may be appropriate with increase clear fluids
• Introduce some physical activity if allowed
• Include over the counter constipation treatments

Dry Mouth (Xerostomia)

Mouth care:

• Try a ‘mouth wash’ solution; mix ½-1 teaspoon of salt or baking soda with a glass of water. Do this 4-5 times daily
• Avoid commercial mouth wash that containing alcohol

Diet tips to try:

• Eat moist foods with extra sauces, gravies
• Use chewing gum to stimulate saliva
• Eat frozen desserts or ice chips
• Keep water handy at all times to moisten the mouth
• Avoid drinks and foods that contain lots of sugar
• Use straw to drink

Mouth Sores (Stomatitis)

Mouth sores may become infected and bleed, making eating difficult. By choosing certain foods and taking good care of their mouths, patients can usually make eating easier.

Diet tips to try:

• Eat soft foods, pureed or liquid diet to decrease chewing
• Avoid citrus and tomato based products
• Avoid rough, coarse or dry foods like crackers, toast, raw vegetables, etc
• Avoid foods that are spicy or salty
• Avoid foods that are acidic like vinegar, pickles, etc
• Try to maximise calories and protein with fortified nutrition supplements

Taste Changes

Patients undergoing chemotherapy often complain of changes in their sense of taste, in particular a bitter taste sensation. A sudden dislike for certain foods may occur.

Diet tips to try:

• Rinse mouth with water before eating
• Try citrus fruits such as oranges, tangerines, lemons, grapefruit, unless mouth sores are present
• Eat small meals and healthy snacks several times a day
• Eat meals when hungry rather than at set mealtimes
• Use plastic utensils if foods taste metallic
• Meat often tastes bitter, substitute with chicken, fish, eggs and cheese
• Try vegetarian sources of protein such as gluten, tofu, beans, etc
• Eat meat with something sweet, such as cranberry sauce, jelly or applesauce

Low White Blood Cell Count

Patients who have a low white blood cell count are at an increased risk of infection. The following suggestions may help in preventing infections when white blood cells counts are low:

• Always check on expiry date of foods before purchasing and consuming them
• Thaw foods in the refrigerator, never thaw at room temperature
• Cook foods immediately after thawing
• Refrigerate all leftovers within 2 hours of cooking and eat them within 24 hours
• Keep hot foods hot and cold foods cold
• Avoid moldy and damaged fruits and vegetables
• Avoid unpacked tofu sold in open bins
• Cook all meat, poultry and fish thoroughly. Avoid raw eggs or raw fish
• Buy foods packed in single servings to avoid leftovers
• Avoid salad bars and buffets when eating out
• Avoid crowded place and people who have infections
• Practice personal hygiene

Nutrition Support

Eating by mouth is the preferred method and should be used wherever possible, but some patients may not be able to take any or enough food by mouth due to complications from cancer or cancer treatment. This may include patients with cancer of the head, neck, esophagus or stomach. A patient may be fed using enteral nutrition (tube feeding). Nutritionally complete formula will be administered, and content of formula depends on the needs of patient and feeding method.

Please contact a dietitian if the symptom persist and you are not able to tolerate normal food and fluid or if you require nutrition support.