Monica Crawford featured in Philadelphia Inquirer: Achieving good nutrition during cancer treatments



When it comes to nutrition and cancer, most information is directed toward preventing the disease. But what  if you already have cancer and are being treated for it, whether with surgery, chemotherapy, radiation therapy, or perhaps all three?

Although there have been improvements in managing side effects with medications, there are still those which remain that make it difficult to eat well during and following treatments. Poor nutrition can leave patients too weak to tolerate treatment. As many as 20 percent of cancer patients actually die from the effects of malnutrition, rather than from the cancer itself.

While many cancers can lead to malnutrition some of the highest risk patients I see are those with cancers of the head and neck or gastrointestinal tract.

One of the biggest barriers to eating is a change in sense of taste, also called dysgeusia. With this condition, various patients have told me that food tastes like cardboard, fish tank water, rusty nails, or overly sweet or salty.

One example of such a patient was Stuart* who had cancer at the base of his tongue. He was treated with 6 weeks of radiation therapy to the tongue, combined with concurrent weekly chemotherapy. Chemotherapy, as well as radiation therapy to the head and neck, can both affect taste buds.

At a follow up visit after completing treatment, he complained of severe dry mouth, known as xerostomia, as well as the complete absence of a sense of taste, which was very discouraging to him. Although Stuart was declared cancer-free, his inability to taste foods was affecting his desire to eat and his quality of life. Unfortunately, the sense of taste following radiation to the tongue can take months to years to return, and in some cases never returns completely.

Other conditions can also hinder good nutrition. Without adequate saliva, taste can be altered. Patients can also experience mouth ulcers or thrush, a fungal infection of the mouth that can impact taste.

I met with Stuart several times to offer suggestions and encouragement. We discussed various strategies to help him stay well-nourished and stop his weight loss, while awaiting his sense of taste to improve as he healed from his treatment. Some of my recommendations included:

•                As long as there are no mouth sores, use tart or sour foods (lemon, lime, vinegar, tomato sauce), which can often be tasted even with dysgeusia.

•                Season foods with herbs/spices, marinades, such as basil, oregano, or barbecue sauce.

•                Try eating with plastic utensils to decrease any metallic taste.

•                Experiment with different foods that you do not normally eat, and save the ones you do love for when you’re feeling better, so that you don’t get turned off to them forever because they taste “wrong” during  treatment.

•                Drink liquids with a straw to bypass taste buds.

•                Practice good oral hygiene. Choose only mouthwashes that are alcohol-free. Rinse frequently with 1 quart of warm water + 1 teaspoon baking soda + 1 tablespoon salt.

  • Suck on a sugar-free hard candy prior to meals to help stimulate saliva and taste buds.

Another patient, Wendy*, who was being treated for metastatic pancreatic cancer, suffered from loss of appetite and weight loss. There are many reasons for loss of appetite, also called anorexia, in cancer patients. The cancer itself can sometimes rob a person of a desire to eat, or cause them to feel full much faster, which we call “early satiety.” Anti-cancer treatments and fatigue can take away a patient’s appetite as well. Wendy’s loss of appetite was triggered by early satiety, fatigue, as well as a side effect from chemotherapy.  At less than 5 feet tall, over the course of a year of treatment, she struggled to take in enough nutrition, and her weight dropped from 80 lbs down to a dangerous 60 lbs.

Among the strategies I recommended: 

•                Eat small, frequent, high-calorie, high-protein meals on a schedule, at least 6 times a day. Eat when it is time to eat, rather than waiting until you feel hungry. Look at nutrition as part of continued treatment, similar to taking a prescribed medication. Eat for fuel, remembering that our bodies need nutrition to function.

•                Plan moderate physical activity like walking to stimulate appetite.

.                 Graze on ready-to-eat, healthy, high-calorie, high-protein snacks at hand.  These could include such items as protein shakes or bars, yogurt, trail mix, peanut butter crackers, cheese stick, hard-boiled eggs, hummus, and custards.

  • Supplement with high-calorie, high-protein shakes or smoothies between meals if unable to eat enough to maintain weight. Often it is easier to drink liquids than eat solids when appetite is decreased.

Side effects are common during anti-cancer therapies. Dysgeusia and anorexia are two conditions that can lead to decreased intake and weight loss if not addressed. Adequate nutritional status can improve strength, immune function, and treatment tolerance. Nutritional strategies can help manage many side effects, and improve quality of life.

*Names have been changed.

Source: “Eating Hints: Before, During, and After Cancer Treatment,” from the National Cancer Institute.

Monica H. Crawford in an outpatient oncology dietician at the, Sidney Kimmel Cancer Center at Thomas Jefferson University.

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