What eating problems do cancer treatments cause?

Treatments for cancer may cause a range of eating problems such as nausea, poor appetite, dry mouth, swallowing difficulties, or bowel problems such as constipation or diarrhoea. This topic looks at difficulties that may be encountered and offers practical tips for dealing with these.

Eat well when you can

If you are having or recovering from cancer surgery or other treatment, it is important to eat well. Between your treatments, symptoms should improve, so take advantage of this and eat a variety of foods that you enjoy. Tell your nurse, doctor, or radiation therapist if you have not eaten well over the last few days.

Loss of appetite

Some tips for improving your appetite:

• Eat six small, frequent meals and snacks rather than three big meals.
• Use a smaller plate.
• Present meals attractively.
• Serve your favourite foods often.
• If possible, eat with family or friends rather than by yourself, or try eating while watching TV or reading a magazine or newspaper to take your mind off the food.
• Choose fluids that provide calories rather than water, coffee, tea, or broth.
• Relaxing before meals can reduce anxiety, as sometimes worrying may decrease your appetite.
• Try foods that are easy to eat, eg. eggs, milk puddings, crackers, soups, spaghetti, macaroni cheese, chicken, fish, mashed vegetables, and fruit.
• Garnishing food with chopped herbs, watercress, onion rings, orange slices, nuts, or tomato wedges can make food more appealing.
• Chop food up into bite-sized portions to make eating less of an effort.

Nausea (feeling sick)

Ways to deal with nausea:

• Not eating for an extended period of time can prolong nausea; therefore, try to eat small amounts regularly.
• Keep up your fluid intake – sip drinks slowly. Try gingerale or lemonade, fruit juice, weak tea, yeast spreads made into broths, clear broths, fruit or vegetable juices, nectars, ice blocks, and ice chips.
• Eat your main meal at the time of day when you feel the best.
• Choose foods that do not have a strong smell.
• Try a short walk in the fresh air before eating.
• Avoid fried, fatty foods, because they make you feel worse.
• Rest after eating.
• Keep away from the kitchen if cooking smells put you off eating, or ask someone else to prepare your food.
• Generally, foods at room temperature have a mild smell compared with hot foods.
• Eat and drink slowly.

Taste and smell changes

Your treatment may cause your sense of taste or smell to change temporarily. You may not like foods which you once enjoyed, or find that you enjoy food which you previously disliked. Some ideas that may help:

• Experiment with flavourings, such as lemon juice, herbs, chutneys and pickles, spices, pepper, celery salt, chocolate, fruit, or cheese.
• Add salt to foods that taste too sweet, and sugar to foods that are acidic (sour) or too salty.
• If you have lost your taste for meat, try marinating meats using soy sauce, honey, ginger, fruit juice, or wine before cooking. Or try canned or fresh fish, eggs, beans, nuts, lentils, or cheese instead. If your taste for salt is increased, eat meats, such as corned beef, sausages, luncheon meat, bacon, ham, salty savouries, olives, anchovies, tinned or smoked fish, smoked chicken, tasty or feta cheese. Try gravy and sauces (either homemade or bought) with meals.
• Use fruit or fruit puree in ice cream or desserts, junket, milkshakes, or puddings to add extra flavour.

Mouth or swallowing difficulties

There may be times when eating is physically difficult. You may have difficulty chewing or moving food around your mouth, difficulties swallowing, or pain in your mouth or throat. Some tips to help:

• Avoid foods that may sting your mouth, such as acidic or highly spiced foods, eg. pineapple, kiwi fruit, citrus fruits, tomatoes, spicy and salty foods, very hot or icy cold foods and drinks.
• Avoid rough and crunchy foods, such as nuts, chips, and hard toast.
• Try drinking liquids through a straw.
• Cook meat until very tender so you do not have to chew so much.
• It is important to keep your mouth clean to prevent infection and dental decay. It will help to clean your teeth with a soft toothbrush, and use a mouthwash after each meal. Check dentures are well-fitting.

If your mouth is too sore to eat adequately, pain relievers may help. Ask your doctor or nurse for their advice.

Dry mouth

• Serve drinks with meals. Sip when eating.
• Suck on ice blocks to provide moisture. Ice blocks will also stimulate the flow of saliva.
• Try pineapple juice or lemon juice in ice blocks for a refreshing mouthwash. NB – lemon juice is highly acidic and long-term use can lead to tooth decay.
• Add gravy, sauce, custard, cream, milk, melted butter, oil, or dressing to make food moist.

Altering the texture of foods

Changing the texture of foods can make it easier to chew and swallow.

Soft foods

These are foods that are soft enough so they can be cut with the side of a fork. Vegetables may need to be cooked for longer, and meat or chicken cooked longer on a lower heat with liquid to make them soft and tender.
Here are some soft food suggestions:

Soups

• Smooth with no hard lumps.

Eggs

• Scrambled, poached, boiled or made into an omelette.
• Quiche.
• Cooked sliced egg in a cheese sauce, or mild curry sauce with rice.

Milk and milk products

• Dairy food, yoghurt, ice cream, milk puddings, soft cheeses, and cheese sauce.
• Avoid hard cheeses or those with dried fruit or nuts in them.
• Avoid grilled cheese that has gone hard.

Fish

• Fish in white sauce/cheese sauce/parsley sauce.
• Convenience foods – boil in the bag, fish fingers, fish nuggets, canned tuna/smoked fish/salmon.

Chicken

• Boiled/steamed/microwaved/roasted, or rotisserie, and diced with gravy, white sauce, mushroom sauce, cheese sauce, or any other sauces.

Meat

• Boiled, stewed, roasted, grilled, and diced or sliced, served with gravy, mint sauce, redcurrant jelly, mustard sauce, or any other sauce.
• Cold meats – ham, pork and apple sauce, ham and chicken.
• Mince with spaghetti, meat balls, potato top pie, and hamburger patties.

Breads and cereals

• Soft breads without crusts with soft fillings, eg. ham/egg/grated cheese and pineapple/minced chicken and mayonnaise, canned fish, and smooth
  peanut butter.

Fruit and vegetables

• Fresh, stewed, or canned fruit and vegetables.
• Soften by chopping, mashing, or grating.

Snacks

• Baking – biscuits or cakes, eg. shortbread, sponge or Madeira cake, fruit loaf, muffins, pikelets, scones and crackers.

Puree foods
Use a blender, stick blender, or food processor to puree foods so they have a smooth texture with no lumps.

Tips – pureed foods

• Some fibrous fruit and vegetables, eg. peas, corn, celery, onions, and pip fruits may not puree very easily. Try straining after pureeing and they may be soft enough.
• Individual flavours and colours of a meal can be preserved better when vegetables and meat are pureed separately.
• Pureed meat often loses its colour and flavour – try adding tomato, soya or Worcestershire sauce, herbs, mushrooms, or tomatoes. Serve meats with gravies, sauces, or jellies, eg. mint sauce or redcurrant jelly with lamb.
• Pureed meals can be frozen. Thaw in the fridge and heat thoroughly, add a little more liquid if necessary. If stored in the refrigerator, pureed meals will keep for only 12 hours.
• Green vegetables can look unappealing when pureed. Try mixing with a little mashed potato or instant potato flakes. Tasty pureed vegetable combinations include swede/carrot, carrot/parsnip, and beans/parsnip.

BOWEL PROBLEMS
Treatment can alter your normal bowel habit causing constipation or diarrhoea. Consult your doctor if symptoms persist.

Constipation

If you are constipated, increasing the fibre content of your diet can help:

• Eat regular meals.
• Drink at least eight glasses (1500ml) of fluid each day.
• Ensure you are having 5+ servings of fruit and vegetables a day. Eat raw or cooked.
• If excessive wind is a problem, try avoiding vegetables that may cause wind or discomfort, such as cabbage, onions, cucumber, peas, and baked beans.
• Choose wholemeal or wholegrain breads and cereals, eg. porridge, Weetbix, All Bran, muesli, wholemeal bread, wheatgerm, bran biscuits, or muffins. Use wholemeal flour for baking or in sauces.
• Add extra fibre to your food, eg. one or two teaspoons of wheat bran flakes or oat bran daily. This can be gradually increased to an amount that will give you a regular bowel habit. The bran can be added to cereals or used in cooking. When you use bran to increase your fibre it is important to increase your fluids as well.

• Commercial products, such as Kiwicrush, Benefiber, Metamucil, or Stimulance may be useful.
• Kiwifruit, prunes and their juices are helpful in preventing constipation.

Diarrhoea

• Drink between meals to replace lost fluids. Choose from diluted fruit juice, flat soft drink, vegetable juice, vegetable broth, weak tea, and nutritional supplements. Aim for at least eight glasses (1500ml) of fluid daily.
• Eat small, frequent meals.

Low fibre diet
Foods that may need to be restricted or avoided:

• Breads and cereals: Breads that contain whole grains, nuts, seeds, and kibbled wheat; cereals, such as muesli, which contain nuts, seeds, or dried fruit; and brown rice or pasta.
• Fruit: Fruits with seeds, pips, pith, or hard skins, eg. kiwifruit, berries, apples, citrus fruits, and dried fruit.
• Vegetables: Vegetables with hard skins, seeds, or stalks, eg. corn, celery, vegetables from cabbage family, onions, cucumbers, garlic, peas, and broad beans.
• Nuts and seeds: Crunchy peanut butter, nuts, and seeds – whole or chopped.
• Meat, fish, poultry, eggs, and pulses: Tough, gristly meat, fried meat, fish or poultry, fatty or highly seasoned meats, such as sausages, curry, prepared dried meals, fried eggs, baked beans, and pulses.

Other foods or drink that may make diarrhoea worse:

• Beverages: Alcoholic drinks, strong tea, or coffee.
• Fat: Rich sauces, highly seasoned dressings, rich pastry, batter, and fried foods. Any new foods should be introduced cautiously, one at a time, so that you can check their effect. You can gradually return to a normal diet.

Low residue diet
This is the same as a low-fibre diet plus the points below:

• If you experience cramping pains, bloating, and diarrhoea (these can result if lactose (milk sugar) is not digested), you could try limiting the amount of cows’ milk you drink to 300ml daily. Hard cheeses are usually well-tolerated. Cows’ milk should be substituted with soy or rice milk, or nutritional supplement drinks. You will be able to tolerate lactose again after the diarrhoea has settled. Cows’ milk may then be re-introduced. Many people do tolerate milk products, and they should only be avoided if not tolerated on a consistent basis.
• It is advisable to limit fruit and vegetables to three servings a day. All fruit and vegetables should be peeled and cooked without pips or seeds. Fruit and vegetable juices are not restricted.
• Use white bread for toast and sandwiches. Use cream crackers and water crackers for snacks. Only use baked or cereal products made from white flour, eg. white rice, noodles, spaghetti, cornflakes, and rice bubbles.
• Avoid pepper, curries, foods containing spices, alcohol, and fatty foods.
• Re-introduce foods one at a time so that you can judge their effect.

Intolerance to some foods

If you have had bowel surgery, you may find for a time that your body can no longer tolerate some foods that were previously a part of your diet. It will take time for your body to adjust to the changes made by the surgery but, usually, it will gradually return to a normal or near-normal state. After a time (it may take some weeks or months), gradually introduce a new food into your diet.

Try one new food at a meal, and start with a teaspoonful. Once you find that your body accepts the new food, you can increase the quantity. You will then be able to use the same process for another new food.

Easy food preparation

• Prepare and freeze extra meals when you are feeling better to save time and effort when you are not feeling so well.
• Keep stocks of convenience foods – ‘ready to prepare’ noodle or rice dishes, spaghetti, baked beans, canned fish, packet or canned soups, instant gravy or sauce sachets, eggs, cheese, milk, canned or packet dessert foods.
• Use the freezer to store bread, pizza, pies, fish, meat and chicken portions, frozen vegetables, and individual meals.
• Use the microwave oven to cook vegetables quickly, and to reheat leftovers and frozen convenience foods.
• Keep stocks of nutritious fluids, eg. nutritional supplement drinks, fruit juice, and milk.

Related topics

Also see Eating well when you have cancer and Radiation treatment side effects and Chemotherapy side effects

Original material provided by the Cancer Society of New Zealand, 2007. Reviewed by everybody, August 2008.