Nutrition for people living with cancer

The link between food and cancer is complex. There are many different types of cancer and many different causes of cancer, only some of which are understood.

Cancer starts when cells begin to grow out of control. The reason for this change is not always known. Poor eating habits combined with smoking, too little exercise, drinking too much alcohol, being overweight and too much sunlight exposure may, over a long period of time, increase the risk of developing some cancers.

Drinking alcohol increases the risk of developing some cancers, particularly cancers of the mouth, throat, oesophagus, stomach, bowel, liver and breast. Mouth cancers are six times more common in people who drink alcohol than non-drinkers. The type of alcohol you drink – wine, beer, spirits – doesn’t make a difference.

But drinking alcohol doesn’t mean that you’ll definitely get cancer. Your risk will depend on other factors, including your age and genetics.

Cancer Council recommends drinking less alcohol to reduce your risk of cancer. Drinking less alcohol has lots of other benefits too. It can help reduce your risk of accidents, high blood pressure and liver disease.

See NHMRC guidelines for their current health advice.

The World Health Organization (WHO) classifies processed meats such as bacon, ham and salami as Group 1 carcinogens because there is strong evidence that processed meats cause cancer. WHO puts processed meats in the same category as other proven causes of cancer such as tobacco, alcohol and ultraviolet (UV) radiation.

WHO classifies red meat as a Group 2A carcinogen because there is growing evidence that eating too much red meat increases the risk of bowel cancer but the evidence isn’t as conclusive as it is for processed meats.

These classifications do not indicate the risk of getting cancer from these foods; they describe the strength of the evidence that these foods are linked to cancer.

To reduce cancer risk, Cancer Council and the Australian Dietary Guidelines recommend that you:

• eat little, if any, processed meat such as bacon, ham and salami
• aim for no more than 455 g of cooked lean red meat (e.g. beef, lamb, pork, kangaroo, goat) per week. This could be one serve a day (65 g cooked) or 2 small serves at 3–4 meals a week.

You can swap a serve of red meat for fish, chicken, eggs or legumes (e.g. chickpeas or lentils) and get adequate amounts of the nutrients you need. If you are losing weight or finding it hard to eat enough during cancer treatment, ask your doctor or dietitian what foods to eat to help you get enough energy and protein.

Organic farmers and food producers grow and produce food without using synthetic pesticides or fertilisers. They also don’t expose food to radiation to extend shelf life, or use seeds, plants or animals that have had their genetic make-up altered in a laboratory.

Some people believe it’s better to eat organic foods because they don’t have extra chemicals. However, there is no strong evidence that organic food is better for you, or that it will help you recover faster or reduce the risk of cancer coming back.

Organic fruits and vegetables contain the same vitamins and minerals as those grown in the usual way and can be more expensive to buy. Wash all fruit and vegetables thoroughly before you eat them. Focus on eating a wide variety of fruits and vegetables, rather than whether or not they’re organic.

After a cancer diagnosis, you may think about changing what you eat. Improving your diet can help your body cope with the effects of cancer and its treatment, and speed up recovery. It can also give you a sense of control. Or you may need to adjust your diet to make sure you continue to eat the right balance of foods during or after treatment.

Some people claim that a particular diet or way of life can cure or control cancer on its own. Often these diets are promoted on social media or in the traditional media. There are no special foods, diets or vitamin and mineral supplements that have been scientifically proven to cure cancer. There’s also no research that shows any particular foods can lower the chance of the cancer coming back.

Many unproven diets encourage people to:

• cut one or more food groups (e.g. all dairy or all grains)
• eat large amounts of specific fruits and vegetables or their juices
• take special or high-dose supplements.

Following an unproven diet may mean you don’t get enough energy (kilojoules/calories), protein, fat, carbohydrates, vitamins and minerals. This may affect your energy levels, cause unwanted weight loss and fatigue, and weaken your immune system. This may make it harder for you to cope with treatment and lead to malnutrition. Buying large amounts of fruits and vegetables, or supplements can be expensive. Cutting out specific foods can also make it harder to eat meals with your family, at restaurants or other people’s homes.

See ‘Understanding Complementary Therapies’ for more information.

Vitamins and minerals are an essential part of a healthy diet and play an important role in the body’s immune system. It’s best to get your vitamins and minerals from eating whole foods, as these are easier for the body to absorb. If you are able to eat a wide variety of foods, you may not need to take vitamin and mineral supplements.

Some people may need to take vitamin and/or mineral supplements during and after treatment. For example, osteoporosis can be a side effect of treatment for prostate cancer and breast cancer, so you may need to take a calcium or vitamin D supplement. If you have had surgery to any part of your digestive system (e.g. gastrectomy), you will probably need to take nutritional supplements. A dietitian can give you more information.

Some people believe that taking high doses of certain vitamins will boost the body’s immune system during cancer treatment. However, there is little evidence to support this claim. In fact, some vitamin and mineral compounds can be toxic at high levels, and may affect how radiation therapy, chemotherapy and other medicines work.

If your appetite is poor or if you’re concerned you’re not getting enough vitamins or minerals, check with your doctor or dietitian before taking any vitamin or mineral supplements.

Sugar is a type of carbohydrate found naturally in fruit and dairy products. It is also added to soft drinks and many processed foods. Our body uses  sugar for energy.

You may hear that because cancer cells use sugar to grow, cutting out all sugar and carbohydrates from your diet will stop the cancer growing. This is a myth and can be harmful. Cancer cells will get the energy they need to grow from other body tissues even if there are no carbohydrates available. The healthy cells in your body also use sugar to grow, so changing your diet in this way would mean missing out on the sugar that helps your vital organs work.

It’s a good idea to limit drinks with high amounts of added sugar such as soft drinks, cordials, fruit drinks, vitamin waters, and energy and sports drinks. Foods and drinks high in sugar may cause you to put on weight. If you are losing weight or struggling to eat enough, having foods with sugar in them may help to keep your energy levels up. Talk to a dietitian about what to eat after a cancer diagnosis.

Some people think that eating very little or no food for a specific period of time (fasting) helps treat cancer, but there is not enough evidence to support this idea, and it can be harmful. Not eating enough can leave you feeling tired, cause you to lose muscle and weight, weaken your immune system and affect your ability to cope with treatment. These outcomes may lead to treatment delays or a shorter course of treatment.

It is important to try to eat enough of a wide variety of foods to meet your body’s needs, so you maintain strength during treatment. Speak to your dietitian and treatment team before trying any fasting techniques.

Along with eating well, physical activity is important for general health and wellbeing. Any activity that gets your body moving and speeds up your breathing and heart rate can help you achieve or maintain a healthy body weight, improve your mood, and reduce the risk of several conditions, such as heart disease, type 2 diabetes and some types of cancer.

Australia’s Physical Activity and Sedentary Behaviour Guidelines for Adults encourage everyone to move more and sit less. Adults should aim to be active on most, preferably all, days of the week. Any physical activity is better than none. You don’t have to go to the gym or run; going for a walk or doing housework can also help. The aim is to be as physically active as your abilities and condition allow. For details on how active to be, visit health.gov.au/health-topics/physical-activity-and-exercise.

The advice used to be to rest during cancer treatment. But now exercise is recommended for most people during and after treatment. Research shows that regular physical activity can:

• help manage fatigue and other common side effects of treatment
• increase appetite
• speed up recovery
• strengthen muscles and bones, and improve circulation
• reduce the risk of the cancer coming back (for some cancer types) and of developing other health problems
• improve quality of life by reducing stress and improving mood.

According to the Clinical Oncology Society of Australia (COSA) position statement on exercise in cancer care, exercise should be prescribed to all cancer patients as a standard part of their cancer care to help manage the effects of cancer and its treatment. Talk to your treatment team or GP before starting an exercise program, and see a physiotherapist or exercise physiologist to develop an exercise plan that suits your situation. A  physiotherapist or exercise physiologist may be part of the team at your hospital or treatment centre, or your GP can refer you to one in private practice.

See our ‘Exercise for People Living with Cancer’ booklet for more information.

Cancer treatment often causes side effects that affect your mouth and teeth, such as dry mouth, mouth ulcers, tooth decay and mouth infections. These problems can make it hard to eat, and poor oral health can make them worse. This is why it is important to have a check-up with your dentist before treatment starts, especially if your treatment includes radiation therapy to the head or neck, some types of chemotherapy, or the drugs known as bisphosphonates (used to treat bone disease).

Your dentist can check the health of your teeth and find any problems early. You can also ask your dentist or your cancer treatment team for advice about caring for your teeth and mouth before, during and after treatment.

See our ‘Mouth Health and Cancer Treatment’ fact sheet for more information.

After cancer treatment, you might think about changing what you eat to reduce the risk of cancer coming back. There’s no research that shows any particular foods or eating plan can lower the chance of the cancer coming back.

To reduce your risk of cancer, follow the Australian Dietary Guidelines and Australia’s Physical Activity and Sedentary Behaviour Guidelines for Adults. These are similar to the World Cancer Research Fund International’s cancer prevention recommendations. For more information, visit wcrf.org/diet-activity-and-cancer/cancer-prevention-recommendations.

A common side effect of treatment is feeling extreme and constant tiredness. This is known as fatigue. It is different to normal tiredness because it usually doesn’t improve with rest. Fatigue can be caused by treatment side effects that reduce the number of red blood cells (anaemia) or that affect your appetite.

How to manage fatigue

• Eat a wide variety of foods. See a dietitian for advice tailored to you.
• Plan ahead for when you feel too tired to cook. Buy frozen meals from the supermarket or prepare food in advance and store it in the freezer.
• Cook in the morning when you are less likely to be tired.
• Buy groceries online instead of going to the shops.
• Ask for and accept offers of help with shopping and cooking from others.
• Use apps such as CanDo to coordinate offers of help.
• Keep snacks such as wholefood muesli bars, dried fruit, nuts and wholegrain crackers in handy locations, e.g. in your bag or car. This will allow you to keep your energy levels up if you have unexpected delays.
• Use home delivery meal companies or services that bring pre-prepared food to you. Or try companies that deliver ingredients with recipes that you can cook at home yourself.
• Do regular exercise to help improve fatigue and appetite.
• Eat with others to make meals as enjoyable as possible, particularly if you are feeling too tired to eat.

For more information, listen to our podcast episode on cancer fatigue and download our ‘Fatigue and Cancer’ fact sheet.

Cancer and some treatments (such as chemotherapy and stem cell transplants) can reduce your white blood cell level, making it harder for your body to fight infections. If this happens, you will need to take care preparing and storing food because you are more likely to get foodborne illnesses.

General precautions

• Wash your hands and knives, cutting boards and food preparation areas thoroughly with hot soapy water before and after cooking.
• Take extra care when eating out. Where possible, ask for meals to be made fresh and avoid pre-prepared foods that have been sitting for unknown periods of time.

Making safer food choices

Chicken 

• cook thoroughly
• thaw in refrigerator or microwave and cook immediately

Precautions to take

• refrigerate leftover cooked chicken immediately – don’t let it cool on the benchtop
• eat within 24 hours; reheat until steaming hot
• don’t refreeze raw chicken after defrosting
• don’t buy ready-to-eat chicken

Meat

• cook thoroughly
• thaw in refrigerator or microwave

Precautions to take

• refrigerate leftover cooked meat immediately – don’t let it cool on the benchtop
• eat within 24 hours; reheat until steaming hot
• don’t refreeze raw meat after defrosting

Seafood

• cook thoroughly
• buy fresh seafood

Precautions to take

• refrigerate leftover seafood immediately, and eat within 24 hours
• avoid raw seafood (e.g. oysters, sushi) and ready-to-eat peeled prawns
• don’t buy ready-to-eat smoked seafood

Cold meats

• store home-cooked cold meats in fridge

Precautions to take

• avoid ready-to-eat cold meats from the deli counter and packaged, sliced ready-to-eat cold meats

Sandwiches

• eat freshly made

Precautions to take

• avoid pre-made sandwiches

Salad, fruit and vegetables

• wash thoroughly before preparing

Precautions to take

• refrigerate leftovers immediately, and eat within 24 hours
• avoid ready-to-eat or pre-packaged deli salads (including pre-cut fruit salads and roast vegetables)
• pick unblemished fruit and vegetables

Eggs

• keep uncracked, clean eggs in fridge
• cook until yolks and whites are solid

Precautions to take

• avoid cracked, dirty and raw eggs
• avoid food containing raw eggs (e.g. homemade mayonnaise, raw cake mix and biscuit dough)

Cheese and other dairy products

• eat hard or processed cheese
• store cheese and pasteurised dairy products in fridge

Precautions to take

• avoid soft, semisoft and surface ripened cheeses (e.g. camembert, brie, ricotta, feta, blue)
• avoid unpasteurised dairy products

Packaged food

• eat within use-by dates

Precautions to take

• store unused perishable food in fridge in clean, sealed containers, and use within 24 hours of opening

Ice-cream

• keep frozen

Precautions to take

• avoid soft serve ice-cream

Not feeling like eating is known as loss of appetite. This may happen because of the side effects of cancer itself or the treatment, such as feeling sick, not enjoying the smell of food, or worrying about the diagnosis and treatment. Loss of appetite can contribute to weight loss and malnutrition. It is important to keep trying to eat so you can maintain your weight and meet your nutrition needs.

How to manage loss of appetite

• Eat small meals every 2–3 hours during the day, and keep to a regular eating pattern rather than waiting until you’re hungry.
• Follow your appetite. It’s okay to eat what you feel like, when you feel like it, e.g. have cereal for dinner or a main meal at lunchtime. Putting on or maintaining your weight is the main focus at the moment.
• Exercise before a meal. Gentle physical activity can make you feel hungry, e.g. take a short walk around the block.
• Use a smaller plate. A big plate of food may put you off eating.
• Add extra energy to your food with butter, cream, cheese and sour cream.
• Choose fluids that are high in kilojoules and protein, such as milk, milkshakes, smoothies or creamy soup. These may be easier to manage than a meal.
• Make mealtimes more enjoyable by setting the table, playing music or eating with someone.
• Manage side effects that may be affecting your appetite.

Some cancers, treatments and medicines can cause stomach contents to come back up into the oesophagus (food pipe). This is known as reflux, and  it can irritate the lining of the oesophagus. Reflux can lead to a burning feeling in the upper chest, oesophagus and/or throat. This sensation is called indigestion or heartburn. Eating certain foods or lying down after eating can make heartburn worse.

Heartburn may make you feel too uncomfortable to eat much, which could lead to weight loss. Keeping a diary of the foods you eat and your  symptoms can help you identify which foods trigger the heartburn. If the tips below don’t relieve heartburn, let your doctor know. They may be able to prescribe medicines to help.

How to manage reflux

• Avoid large meals; try to eat three small meals and three snacks throughout the day.
• Eat slowly and enjoy your meal. Avoid wearing tight clothing (especially belts) while eating.
• Sip fluids between meals, rather than drinking large amounts at mealtimes.
• Limit or avoid foods that may make heartburn worse – very spicy foods, high-fat foods (e.g. fried food, pastries, cream), acidic foods including tomato and tomato products, citrus fruits, vinegar, chocolate, coffee (including decaf), strong tea, soft drinks and alcohol.
• After eating, sit upright for at least 30 minutes and avoid lying down or activities that involve bending over (e.g. gardening).
• Sleep with the head of the bed lifted by 15–20 cm. Put blocks under the front bed legs or use a wedge under the mattress.

Some treatments can affect the taste and smell of foods. Chemotherapy and targeted therapy drugs can change the taste receptors in the mouth. Radiation therapy or surgery to the head, neck and mouth area can damage the salivary glands and tastebuds on the tongue. Food may taste bitter  or metallic, or may not have as much flavour as before.

It’s common to have changes in taste during treatment and for a short time afterwards. People with cancer often say, “All food tastes the same”,  “Food tastes like cardboard”, “Food tastes metallic”, or “I no longer like the taste of my favourite food”. It may take several months for your sense of taste to return to normal. In some cases, taste changes may be permanent.

Some people find that even the taste of water is a problem. This can make it challenging to get through the recommended amount of water each day and to swallow medicines with water. Adding lemon, lime, fruit juice, cordial or fresh mint to water may make it easier to drink.

A sore mouth, sore throat or swallowing difficulties can make it hard to eat. Talk to your doctor, speech pathologist, dentist or dietitian – some of the suggestions listed below may not be suitable.

How to manage changes in taste or smell

Taste changes

• Add extra flavour to meals (e.g. fresh herbs, spices, lemon, lime, ginger, garlic, soy sauce, honey, chilli, pepper, Worcestershire sauce or pickles).
• Keep trying different foods, as your tastes may change. You may not like bitter drinks (e.g. tea, coffee, beer, wine) or sweet foods (e.g. chocolate), even if you liked them before treatment. It is common to prefer savoury foods after treatment.
• If meat tastes unpleasant during treatment, replace it with other protein sources (e.g. cheese, eggs, nuts, dairy foods, seafood, baked beans, lentils, chickpeas).
• Add a little sugar to food if it tastes bitter or salty.
• Serve food hot or warm.
• Use bamboo cutlery if metal spoons, forks and knives taste metallic.
• Drink through a paper or silicone straw so the taste isn’t as strong. Metal straws may add a metallic taste.

Smell changes

• Eat cold food or food at room temperature – hot food smells stronger.
• Consider not eating your favourite foods when having chemotherapy. Some people find afterwards that they cannot tolerate the smell of foods associated with their treatment.
• Avoid using large amounts of strong-smelling ingredients (e.g. garlic, onion, spices).
• If cooking smells bother you, ask others to cook, then stay out of the kitchen when food is being prepared.
• Turn on the exhaust fan, open a window and cover pots with lids to help reduce cooking smells, or cook outside on the barbecue.
• Avoid eating in stuffy or overly warm rooms. Have meals outside.
• Take good care of your mouth, as a bad or bitter taste in the mouth can make things smell unpleasant.

For more information download our ‘Understanding Taste and Smell Changes’ fact sheet.

Radiation therapy to the head or neck area and surgery that affects the salivary glands can reduce the amount of saliva in your mouth, make your mouth dry or make your saliva thick and sticky. This is known as xerostomia. Without enough saliva, bacteria can grow too quickly and may cause oral thrush, which will make eating and swallowing more difficult. A dry mouth can also make it harder to keep your teeth and mouth clean, which can increase the risk of tooth decay.

How to relieve a dry mouth

• Rinse your mouth often. Ask your doctor or nurse what type of alcohol-free mouthwash to use and how often to use it. They may give you an easy recipe for a homemade mouthwash.
• Brush your teeth with a soft toothbrush.
• Ask your dentist or health care team what oral (mouth) lubricants or saliva substitutes to use.
• Avoid foods that may sting your mouth, such as crunchy or dry foods (e.g. chips, nuts, toast, dry biscuits), and salty or spicy foods.
• Soften food by dipping it into milk, soup, tea or coffee, or moisten it with sauce, gravy, cream, custard, etc.
• Sip fluids during meals and throughout the day.
• Avoid smoking and limit alcohol and coffee as they remove fluids from the body.
• Chew sugar-free gum to stimulate the flow of saliva.
• Suck on ice cubes or frozen grapes or rub the inside of your mouth with a small amount of grapeseed oil, coconut oil or olive oil to moisten your mouth.
• Use a moisturising lip balm to keep your lips moist.

For more information download our ‘Mouth Health and Cancer Treatment’ fact sheet.

Chewing and swallowing involve your lips, teeth, tongue and the muscles in your mouth, jaw and throat working together. Surgery to the jaw, mouth or throat areas can cause swallowing difficulties. Radiation therapy can also make chewing and swallowing hard. These changes are usually temporary, but can sometimes be permanent.

Problems chewing – People with dentures who lose weight may find their teeth become loose. Treatment for head and neck cancer sometimes involves removing teeth. Both of these things can make it hard to chew.

Difficulty swallowing – If you’re having difficulty swallowing (dysphagia), you may need to change the consistency of food by chopping, mincing, pureeing or thickening it. Signs that the texture of food is causing problems include taking longer to chew and swallow; coughing or choking while eating or drinking; feeling like food or drink is going down the wrong way; food sticking in your mouth or throat like a ball; or throat clearing after meals. A speech pathologist can assess how your swallowing is working, and a dietitian can suggest ways to make sure you are getting enough nutritious food.

Feeding tubes – Severe swallowing problems can make it hard to eat and drink. You may need a feeding tube until swallowing gets easier. This will help you meet your nutrition needs. A feeding tube is rare for most people with cancer, but is more of a possibility with cancers affecting the head and neck, stomach, oesophagus or lung. If a feeding tube is required, your treatment team will discuss this with you.

For more information download our ‘Understanding Head and Neck Cancers’ or ‘Understanding Stomach and Oesophageal Cancers’ booklets.

Ways to change the texture of foods

If you need to adjust the texture of your food, this sample menu provides some ideas. See a speech pathologist and dietitian for other options. Check with your dietitian if you have another health condition, such as diabetes, or if you have been told you need thickened fluids, as you may not be able to have all of the foods suggested here or you may need to modify them. For more information on food textures, see iddsi.org.

Food textures

Soft and bite-sized – Food can be chewed but not necessarily bitten. It should be easily broken up with a fork and need little cutting. Sauce or gravy can be added to make it softer.

Minced and moist – Food should be soft and moist and easily form into a ball in the mouth. Small lumps can be mashed up with the tongue rather  than by biting or chewing.

Pureed – The texture of pureed food means it can be moulded, layered or piped to make it look more appealing. You can add sauce or extra liquid if you prefer.

Breakfast

• Soft and bite-sized – scrambled or poached eggs; soft chopped fruit and yoghurt; oats or cereal softened with milk or yoghurt
• Minced and moist – oatmeal porridge or wheat biscuits with lots of milk and little texture; well-cooked rice pudding; congee (rice porridge) with
  little texture
• Pureed – strained or pureed porridge (made with milk); strained or pureed congee

Lunch

• Soft and bite-sized – boiled and mashed egg mixed with tinned tuna and store-bought mayonnaise (avoid homemade mayonnaise); baked beans
• Minced and moist – soup with well-cooked vegetables or meat pieces (no bigger than 4 mm); well-cooked lentil dhal with very soft rice
• Pureed – well-cooked pasta that has been pureed in a blender with added sauce; pureed tinned tuna with store-bought mayonnaise; pureed mashed potato; pureed soup strained to remove lumps

Dinner

• Soft and bite-sized – casserole with small pieces of tender meat and well-cooked vegetables; well-cooked rice or wheat noodles (not fried) with boiled vegetables and crumbled soft tofu or tender meat
• Minced and moist – moist macaroni cheese; mashed or scrambled tofu with small, soft vegetable pieces (no bigger than 4 mm); moist risotto
• Pureed – pureed chicken blended with extra gravy or sauce and pureed noodles; pureed lentil dhal or curry and pureed rice

Snacks, dessert and drinks

• Soft and bite-sized – mango; stewed fruit pieces; yoghurt with soft fruit pieces; soft cake with lots of custard; fruit smoothie
• Minced and moist – mashed banana; steamed egg pudding; soft cheesecake without the crust; semolina pudding; creamed rice; milkshake; milk or soy milk
• Pureed – pureed pear or apple pushed through a sieve; yoghurt with no fruit pieces or lumps; ice-cream; mousse; milk or soy milk

Avoid

• Soft and bite-sized – nuts; dried fruit; dry or gristly meat; raw vegetables; muesli; hard cheeses (unless melted); hard crackers, crisps; bread, sandwiches
• Minced and moist – nuts; hard vegetables; all bread and crackers; dried food; lollies (jubes, marshmallows)
• Pureed – meat; eggs; cereals or vegetables that have not been pureed in a blender; peanut butter

Chemotherapy and radiation therapy can damage the cells lining the mouth and digestive tract, leading to ulcers and infections. This is known as oral mucositis. A sore can form on any soft tissue in your mouth, and make it painful to eat and swallow.

Your doctor can give you medicines to reduce pain and discomfort when you eat or drink. Some medicines can be applied directly to the mouth sores to numb them.

To reduce discomfort, eat softer foods. You may need to avoid hot, cold, salty, spicy or acidic foods and drinks. Mucositis usually gets better a few weeks or months after treatment ends.

Nausea is feeling sick and vomiting is throwing up. It’s common to have them together. Radiation therapy, chemotherapy, other medicines and the cancer itself can cause nausea and vomiting. If you have chemotherapy, you will be given anti-nausea medicine with your treatment and to take at home afterwards. In many cases, this will prevent severe nausea and vomiting, but some people do still feel sick and may vomit. It’s important to take anti-nausea medicine as directed to help prevent nausea from occurring – don’t wait until you feel sick.

Nausea and vomiting can also be triggered by stress, food smells, gas in the stomach or bowel, motion sickness or even the thought of having
treatment. After a person has had a few treatment sessions, they may link certain sights, sounds or smells with treatment and feel nauseated when they experience them. This is known as anticipatory nausea or vomiting, and it is more common in people having chemotherapy.

How to cope with nausea and vomiting

Nausea

• Have a light snack before chemotherapy, and don’t eat for a few hours after.
• Eat small meals every 2–3 hours. Going without food for long periods can make nausea worse.
• Choose dry or bland snacks, e.g. crackers, toast, dry cereals, bread sticks or pretzels.
• Have cold foods or foods at room temperature as they have less aroma.
• Drink fluids all day to avoid becoming dehydrated.
• Try drinks and foods with ginger, e.g. ginger tea, non-alcoholic ginger beer, ginger biscuits.
• Avoid foods that are too sweet, fatty, fried or spicy, or that have strong smells.
• Brush teeth regularly to help reduce tastes that may make you feel nauseated.
• Don’t eat your favourite food when feeling nauseated as you may develop a permanent dislike.

Vomiting

• Take sips of fluids as often as possible, e.g. flat dry ginger ale, cold flat lemonade, weak cordial, or cold apple juice. Oral rehydration solutions, such
  as Hydralyte or Gastrolyte, can help keep you hydrated.
• See your doctor if vomiting lasts for more than a day or if you can’t keep fluids down, as you may become dehydrated.
• Slowly introduce more nourishing fluids once you stop vomiting, e.g. cold or iced drinks; milk or fruit drinks with added water so they are not too strong; clear broth; weak tea.
• Have small amounts of solid foods once vomiting is under control, e.g. plain dry biscuits; toast or bread; stewed fruits and yoghurt.
• Increase how much you eat until you’re eating what is normal for you.
• Listen to our .

Constipation is when your bowel movements (faeces, stools or poo) are hard and difficult to pass. It can be caused by different factors including: some chemotherapy and anti-nausea drugs; strong pain medicines (opioids); eating less fibre; not moving around as much; not drinking enough (dehydration); or not eating enough.

If you have severe constipation with symptoms such as abdominal (tummy) pain and swelling, nausea and vomiting, this may be sign of a blockage in the bowel (bowel obstruction). This needs urgent medical attention.

How to manage constipation

• Drink 8–10 glasses of fluid a day (e.g. water, herbal tea, milk-based drinks, soup, prune juice) to soften faeces.
• Eat foods high in insoluble fibre (e.g. wholegrain breads, cereals or pasta; raw and unpeeled fruits and vegetables; nuts and seeds; legumes and pulses).
• If you add foods with more insoluble fibre to your diet, drink more fluids to avoid the extra fibre making constipation worse.
• Ask your doctor about using a laxative, stool softener and/or fibre supplement.
• Plan to do some physical activity every day. Ask your doctor, exercise physiologist or physiotherapist about the amount and type of exercise that is right for you.
• Visit your doctor if you see blood in your faeces. They’ll check for haemorrhoids or any other issues.
• If you have had surgery for bowel cancer and have a stoma, ask your health care team for specific dietary advice. They may suggest eating more low-fibre foods to avoid constipation.

Diarrhoea is when you have loose, watery bowel movements several times a day. You may also get cramping and pain, and have an urgent need to go to the toilet. Chemotherapy, radiation therapy to the abdomen (belly) or pelvis, some types of surgery (e.g. bowel), medicines, infections, reactions to certain foods, and anxiety can all cause diarrhoea. If the tips below don’t help improve diarrhoea, ask your doctor about anti-diarrhoea medicines and rest until you feel better.

For support managing constipation and diarrhoea, visit the Continence Foundation of Australia or call their helpline on 1800 33 00 66.

How to manage diarrhoea

• Drink plenty of water and other fluids such as diluted cordials and oral rehydration solutions (e.g. Gastrolyte) to prevent dehydration. Avoid high-sugar drinks, alcohol, strong caffeine or very hot fluids.
• Watch for signs of dehydration such as dark yellow urine (pee) or urinating less than usual.
• Choose foods that are low in insoluble fibre (e.g. bananas, mashed potato, white rice, white pasta, white bread, steamed chicken without skin, white fish). It may also help to eat foods that are high in soluble fibre (e.g. oats, barley, rye, legumes, peeled fruits and vegetables, avocado, soy products).
• Avoid foods that are high in insoluble fibre (e.g. wholegrain breads, bran cereals, nuts and seeds, raw fruit, vegetable skins) and foods that increase bowel activity (e.g. spicy, fatty or oily foods, caffeine, alcohol or artificial sweeteners).
• Switch to soy milk or lactose-free milk for a period of time. Having diarrhoea may affect your ability to digest the natural sugar in milk (lactose).

This is a group of symptoms that develops when food moves too quickly from the stomach into the small bowel. You may have cramps, nausea, racing heart, sweating, bloating, diarrhoea or dizziness.

Dumping syndrome can develop after surgery to remove part or all of the stomach (for example, gastrectomy).

The symptoms can vary depending on what you eat. Foods and drinks high in sugar such as soft drinks, juices and cordial can make dumping syndrome worse. Symptoms may begin 15–30 minutes after eating, or sometimes after several hours. They often improve over time. Your treatment team can suggest changes to what you eat and medicines to help manage dumping syndrome.

For more information download our ‘Understanding Stomach and Oesophageal Cancers’ booklet

Some chemotherapy drugs, stem cell transplants and radiation therapy to the pelvic area can make the bowel swollen and sore. This is called colitis when it affects the colon (the large bowel), and proctitis when it affects only the rectum (the last part of the bowel before the anus). You may feel the need to empty your bowels often, perhaps without much result. Straining can cause discomfort, and there may be blood or mucus in your bowel movements. Diarrhoea, nausea and vomiting are also common, but can be managed with medicines.

The small bowel may become irritated after chemotherapy or radiation therapy to the abdomen or pelvic area. This is known as enteritis and it can cause discomfort in the abdomen (like cramps or wind pain), pale and runny bowel movements, and more wind than usual.

How to manage bowel irritation

• Eat and drink slowly, take small mouthfuls and chew your food well to avoid swallowing air.
• Have foods low in insoluble fibre to reduce bowel irritation in the short term. Include foods high in soluble fibre to “soak up” additional liquid in your bowel.
• Avoid fatty, spicy or fried foods, and rich gravies and sauces.
• Reduce foods such as corn, beans, cabbage, onions, pickles and fizzy drinks, which can produce wind.
• Drink plenty of water, and eat soft or cooked peeled fruit, fine wholemeal bread and bran to provide soft bulk. You may be encouraged to take an oral rehydration solution, such as Hydralyte or Gastrolyte, to keep hydrated.
• Do some gentle exercise, such as walking, to encourage more regular bowel movements.
• Tell your doctor if symptoms don’t improve. Bowel irritation is usually temporary, with colitis and proctitis lasting up to 8 weeks and enteritis lasting 1–2 weeks after treatment ends.

It’s common for people diagnosed with cancer to lose weight. This is because the process of cancer cells dividing uses up a lot of energy, and  treatment side effects can change your desire to eat, or make eating difficult or painful.

Weight loss may depend on the type of cancer you have. Losing weight without trying is a sign of malnutrition. Advanced cancer may mean the way the body absorbs food changes. This is known as cachexia. With the support of your cancer care team you can prevent or slow down weight loss.

Maintaining your weight, particularly your muscle stores, will help you stay strong and recover faster. If the tips below don’t help, talk to your dietitian about nutritional supplement drinks or having a feeding tube.

You and your family and friends may be concerned that the suggestions below are high in energy and protein. During treatment when you don’t feel well enough to eat, just eating something is more important than making healthy food choices. Keep in mind that these changes are often temporary – you can return to the usual guidelines for healthy eating once you have recovered from treatment.

Nutritional supplements

If you cannot eat a balanced diet, or are losing weight without trying, your doctor or dietitian may suggest nutritional supplements such as Sustagen, Ensure, Fortisip or Resource. These are high in energy and protein, and provide nutrients that can help maintain your strength.

Nutritional supplements are available as:

• powders to mix with milk or water, or sprinkle on food
• ready-made drinks, puddings, custards and jellies.

They can be used as snacks between meals, or some can be added to drinks or meals.

A dietitian can recommend the right nutritional supplement for you. If you are having difficulty swallowing, talk to a speech pathologist for directions
on thickening the supplements.

Many pharmacies and supermarkets sell nutritional supplements. While you don’t need a prescription for many supplements, a prescription may make them cheaper to buy.

How to manage weight loss

• Treat food like medicine: something your body needs regularly to feel better.
• Set times for meals and snacks rather than waiting until you’re hungry.
• Have your biggest meal when you’re hungriest and not too tired.
• Eat your favourite foods at any time of day.
• Carry snacks so you can eat any time you feel like it. Try hard-boiled eggs, muesli bars, dried fruit and nuts, crackers and fruit buns.
• Choose drinks and snacks that are higher in protein and energy (kilojoules), e.g. drink full-cream milk rather than water and choose cheese and  biscuits over lollies.
• Add high-protein foods, e.g. poultry, fish, meat, eggs, tofu, dairy, nuts, seeds and legumes, to every meal or snack.
• Add fats and oils (kilojoules) to what you are already eating, e.g. use extra butter, avocado, nut butters, cheese, extra virgin olive oil and cream. Avoid food and drinks labelled low-fat or no fat.
• Have dessert after meals.
• Do some gentle exercise, e.g. a walk before meals to increase your appetite.
• Make enriched milk to use in tea and coffee, cereal, soups, sauces, scrambled eggs, milkshakes and smoothies. Add 4 or more heaped tablespoons of milk protein to 1 litre of full-cream milk and mix thoroughly. Use straightaway, or keep refrigerated and use within 24 hours (stir before use).
• Stock up on ready-to-use nutritional supplement drinks when you are travelling or on other occasions when it is difficult to prepare a meal.

Ways to add energy and protein

Add these ingredients – full-cream cow’s milk, cream, coconut milk or soy milk (liquid or powdered versions)
to these meals and snacks – porridge, sauces, desserts, mashed vegetables, egg dishes, cream soups, scrambled eggs, congee, milkshakes, flavoured milk drinks (e.g. Milo, Akta-Vite)

Add these ingredients – yoghurt or sour cream
to these meals and snacks – dips, salad dressings, fruit, potatoes, roast vegetables, soups, rice dishes, lentil dhal

Add these ingredients – butter, margarine or olive oil
to these meals and snacks – bread, toast, mashed potato, cooked vegetables, rice and pasta dishes, soup

Add these ingredients – cheese (e.g. cheddar, cream cheese, feta, haloumi)
to these meals and snacks – scrambled eggs, sauces, soups, baked potatoes, vegetables, casseroles, salads, toast, sandwich fillings, pasta, crackers,
tacos, sauces

Add these ingredients – mayonnaise (store bought, avoid homemade)
to these meals and snacks – egg or chicken sandwiches, potato salad, coleslaw, salad dressing, tinned tuna

Add these ingredients – peanut butter, other nut butters
to these meals and snacks – bread, toast, porridge, crackers, pancakes, scones, fruit, smoothies

Add these ingredients – avocado
to these meals and snacks – toast, sandwich fillings, dips, salads, crackers, smoothies

Add these ingredients – nuts and seeds, e.g. LSA (linseed, sunflower seeds and almonds), almond meal, hemp seeds, chia seeds
to these meals and snacks – porridge, muesli, yoghurt, salads, baked goods, stir-fries, desserts

Add these ingredients – beans or legumes
to these meals and snacks – rice dishes, toast toppings, salads, pasta dishes, soups, casseroles, mince dishes

Add these ingredients – egg or tofu
to these meals and snacks – toast, sandwich fillings, stir-fries, mashed potato, soups, pasta sauce, salads

Although it is more common to lose weight during treatment, some people put on weight. This is more likely to happen with certain types of cancer such as breast cancer.

Weight gain can happen as a side effect of treatment and/or medicines:

• Some chemotherapy drugs can cause your body to retain extra fluid in cells and tissues. This is called oedema, and it can cause weight gain and make you feel and look puffy. If chemotherapy makes you feel nauseated, you may find snacking helps but means you eat more.
• Hormone therapy lowers the amount of hormones in the body, which slows your metabolism.
• Steroid therapy (corticosteroids) can cause a larger abdomen, fluid retention (oedema), and a rounded, puffy face. Steroids can also increase your appetite, which may mean you eat more and put on weight.

Feeling stressed or depressed can also make some people eat differently, and being tired because of the treatment may make it harder to exercise.

If you put on weight during treatment and are concerned, speak to your doctor or dietitian about how to best manage it. It is important that your body gets enough nutrition, so do not try a weight loss diet without guidance from a health professional.

When you eat foods with less energy and protein than your body needs over a period of time or you lose weight without trying, you may become malnourished. This can occur before, during or after treatment.

Factors that increase the risk of malnutrition include:

• surgery for head and neck, lung and gastrointestinal cancers, which may make it hard to swallow and digest food
• increased nutritional needs caused by cancer and treatments such as chemotherapy, radiation therapy and surgery
• symptoms or side effects of treatment such as loss of appetite, nausea, vomiting, dry mouth and mouth sores
• loss of nutrients through diarrhoea or vomiting
• some medicines
• anxiety, stress and fatigue.

Many of the difficulties with eating, swallowing and digestion can contribute to, or be symptoms of, malnutrition. Other signs of malnutrition include muscle weakness; significant weight loss; dry and brittle hair and nails; and pale or pigmented skin.

Having malnutrition can increase your risk of infection and reduce your strength, ability to function and quality of life. It can also affect how your  body responds to cancer treatment and make your recovery longer. You can become malnourished regardless of how much you weigh – it is possible to be malnourished even if you are overweight or obese. Talk to your doctor or dietitian if you think malnutrition may be an issue. It is important to do this early so you receive the right advice. They may ask you questions such as have you lost weight without trying or have you been eating poorly because of a decreased appetite.

Insulin is a hormone that controls the amount of sugar in the blood. A person with diabetes does not create or produce enough insulin or has a resistance to the effects of insulin. This means they need medicines to help control their blood sugar levels.

Side effects and diabetes – Some treatment side effects may make controlling blood sugar levels difficult. These include loss of appetite, nausea, fatigue, constipation and diarrhoea. If you are unable to eat enough, your blood sugar levels may drop too low.

You may need to check your blood sugar levels more often and have snacks that include a variety of carbohydrates. Choose carbohydrate foods that produce a slower rise in blood glucose levels – these are described as having a low glycaemic index (GI). You can also talk to your doctor about changing your dose of insulin or tablets.

Steroids and diabetes – Some medicines, such as steroids, can also cause high or unstable blood sugar levels in people with diabetes. How long the steroids affect your blood sugar levels will depend on the dose and type of steroid you are taking. Steroids given as creams or nasal sprays are unlikely to affect blood sugar levels.

Blood sugar levels should go back to a healthy range once you have finished your course of steroids. Talk to your doctor about how to monitor your blood sugar levels if you have diabetes and are prescribed steroids. Strategies may include taking medicines, eating well and moving more.

Pancreatic cancer and diabetes – Some people with pancreatic cancer develop diabetes before the cancer is diagnosed or after surgery to remove the pancreas. The way diabetes is managed varies from person to person, but it usually includes making changes to your diet and taking medicines including insulin.

Enzyme replacement therapy

The pancreas produces digestive enzymes to help break down food. If you have had surgery for pancreatic cancer, your body may not be able to make enough of these enzymes. This will affect your ability to digest food and is often referred to as pancreatic exocrine insufficiency.

Signs include diarrhoea, pain in the abdomen, bloating and pale, floating faeces. To help prevent these symptoms, ask your doctor or a dietitian for information on enzyme supplements.

For more information, download our ‘Understanding Pancreatic Cancer’ booklet.

In some cases, after surgery for bowel cancer you may need a stoma. This may be temporary or permanent. A stoma is a surgically created opening in the abdomen that allows bowel movements (faeces, stools or poo) to leave the body. The end of the bowel is brought out through the opening and stitched onto the skin. A bag is attached to collect the faeces.

If you have a stoma, you may need to change what you eat in the first few weeks to help the stoma settle. The amount of matter coming out of the stoma (output) will vary depending on how much you eat and when you eat.

What to eat when you have a stoma

Work with your dietitian to explore which foods cause problems for you. Different foods can affect people differently.

Keep a diary of what you eat and how it affects you. Make a note of the foods that cause constipation or diarrhoea, gas, pain or bloating. It is better to limit – not eliminate – these foods in your diet, as you may find that what you can handle improves over time.

When returning to your usual diet, introduce one food at a time. If something causes a problem, try it again in a few weeks to see if your response has improved.

Share this information with your dietitian or the health care team because it can help them figure out how to manage any issues.

Sometimes foods such as nuts, seeds and very fibrous foods can build up and block the stoma. A stoma blockage can be uncomfortable and cause a
bloated feeling or nausea. If you experience symptoms of a blockage for more than two hours or you start vomiting, contact your nurse or hospital.

If your stoma output is higher than recommended, drinking oral rehydration solutions can help replace the lost fluid. You can also ask your dietitian for information.

For more information, download our ‘Understanding Bowel Cancer’ booklet. The Australian Government’s ‘Improving Bowel Function After Bowel Surgery’ booklet may also be helpful.

Light meals

• baked beans on toast with grated cheese
• crumpets or muffins toasted with cheese, and a piece of fruit
• scrambled or poached egg on toast and a glass of orange juice
• tuna or sardines on buttered toast with fresh tomato
• omelette with cheese or mushrooms and buttered bread
• toast with cheese, avocado or peanut butter, followed by sliced banana and yoghurt
• cereal or toasted muesli with full-cream milk and yoghurt
• porridge or rice pudding made with milk and cream
• congee
• pancakes or French toast with fruit and maple syrup

Nourishing drinks

These drinks are high in protein, energy, vitamins and minerals:

• enriched milk mixed with Akta-Vite, Milo or Horlicks
• milkshake
• banana smoothie
• mango lassi (see recipe below)
• hot chocolate
• flavoured milk
• apricot lemon crush (see recipe below)

Apricot lemon crush recipe

• 410 g can apricot halves in natural juice
• 1 cup natural yoghurt
• juice of 1 lemon
• 1 tbsp honey
• 2 tbsp wheatgerm
• crushed ice

Place all ingredients in a blender and blend until smooth.

Mango lassi recipe

• 1 cup canned mango in natural juice
• 1 heaped tbsp milk powder or powdered nutritional supplement
• 1 tsp honey
• ½ cup natural yoghurt
• 3 ice cubes

Place all ingredients in a blender and blend until smooth.

• fresh or frozen fish with chips and salad
• grilled lamb cutlets, mashed potato with margarine or butter, and peas and carrots
• pasta with a ready-made sauce, e.g. pesto or bolognaise, and cheese
• cheesy vegetable bake (see recipe below)
• lentil dhal with chapatis or rice
• green or red chicken or vegetable curry with basmati rice
• salmon, tuna or egg with store bought mayonnaise, salad and buttered bread roll
• frozen or fresh lasagne or moussaka
• frittata or quiche
• salmon or tofu with soba noodles
• occasional takeaway such as noodles, stir-fry, curry and rice, hamburgers or pizza (ensure the food is freshly cooked)
• refrigerated leftover food from the previous day – reheat till steaming
• microwave potato with baked beans and cheese
• egg, tempeh and cooked vegetables with gado gado (peanut) dressing
• wrap with falafel, hummus and salad

Cheesy vegetable bake

• oil, for greasing dish
• 400 g sweet potato or pumpkin*, peeled and thinly sliced
• 1 parsnip and 1 carrot, peeled and thinly sliced
• 4 potatoes, peeled and thinly sliced
• ½ cup thickened cream
• ½ cup cheddar cheese, grated

Preheat oven to 180°C. Brush a medium ovenproof dish with oil. Layer the vegetables in the prepared dish. Drizzle each layer with a small amount of cream. Top with the remaining cream and sprinkle with cheese. Bake for 1 hour or until vegetables are tender and top is golden brown.

* Use whatever vegetables you have

• crackers with cheese
• pita bread with hummus
• buttered pikelets, scones, muffins, fruit buns, crumpets, finger buns or raisin toast
• celery with cream cheese or peanut butter
• hard-boiled eggs
• dried fruit and nuts
• jaffles, sandwiches and toast – try egg and store-bought mayonnaise, cheese, peanut butter, avocado, tinned salmon or tuna
• milk puddings, such as creamed rice, rice pudding, custard, mousse and instant puddings
• fruit (fresh, frozen or tinned) with custard, yoghurt, jelly, ice-cream, cream or condensed milk
• stewed fruit with custard or cream
• creamy soup with added cream, and buttered toast (see recipe below)
• hot chips, chicken nuggets or fish fingers
• instant noodles with frozen vegetables
• potato crisps, pretzels or corn chips with dips, salsa or guacamole
• yoghurt or ice-cream frozen sausage rolls, meat pies, samosas or spring rolls

Potato and leek soup

• 1–2 tsp olive or vegetable oil
• 2 leeks, cleaned and sliced
• 1 tsp cumin seeds
• 1 kg potatoes, peeled and finely chopped
• 5 cups vegetable or chicken stock
• ½ cup cream

Heat oil in a large saucepan and cook leeks until soft. Add cumin seeds and cook for 2 minutes. Add potatoes and stock to saucepan and bring to the boil. Reduce heat and simmer for 25–30 minutes or until potatoes are tender. Add soup to a blender or food processor and puree until smooth. Stir in cream.