Nutrition During Cancer Care

By Dr. Adil Akhtar

Under most circumstances, sitting down to a nice meal is an enjoyable activity— but for patients undergoing cancer treatment, mealtime can be a minefield. Unpleasant treatment side effects such as extreme fatigue, nausea, digestive upset, and warped taste buds, can make even favorite foods far from appetizing.

When diagnosed with cancer however, proper nutrition can make a world of difference— and during treatment it’s more important than ever to maintain and sustain strength, energy, and immune function.

As the Director of Inpatient Clinical Operations at Karmanos-McLaren Oakland Cancer Center in Michigan, I oversee cancer care for his patients—including helping them optimize their eating and nutrition during treatment.

Patients may have different side effects depending on what type of treatment they are receiving (whether chemotherapy, targeted therapy, immunotherapy, or a combination of treatments), and knowing what, when, and how much to eat can go a long way.

Although eating may not always seem appealing during treatment, it’s important not to skip meals, as that can exacerbate unpleasant side effects. No matter what treatment plan a patient is on, patients should make sure they are taking in enough energy— ideally from healthy, whole foods.

On the other hand, it’s also important that patients know what not to eat. I would especially recommend steering clear of processed foods and supplements that claim ‘immune support’ on the label. Not only are these marketing gimmicks unlikely to actually improve health— they could also adversely affect your treatment. It’s also important to note that a registered dietician should also be a part of the treatment team, and patients and their families should begin working with them before starting treatment.

Many cancer treatments, including chemotherapy, can disrupt the digestive system, leading to decreased appetite, diarrhea, constipation, nausea and vomiting, weight gain or loss, and changes in taste or smell. Eating the right foods at regular intervals can help mitigate some of these side effects— though it may require some additional planning.

On an infusion day, and in the days to follow, chemotherapy patients should try to eat lightly every few hours, sticking to small portions of simple, easy-to-digest foods. Since spicy, acidic or overly fatty foods can upset the digestive tract, it’s advised that patients avoid them on treatment days. Fresh fruit, yogurt, eggs and toast, cereal with milk, or chicken soup with crackers would all be ideal options.

Many patients feel better if they also eat a small snack during their infusion. Juices and supplement drinks like Ensure or Boost are also typically available at infusion centers, and, of course, patients can bring along their own snacks as well.

Immunotherapy is becoming an increasingly popular treatment option for cancer patients. The side effects can be less severe than chemotherapy, though patients may still have changes in taste, diarrhea and weight loss, in addition to muscle aches, fever, and a dry or sore mouth.

Immunotherapy drugs stimulate the body’s immune system to fight cancer cells, and as such, immunotherapy patients will want to make sure they are nourishing and supporting their immune system with a variety of healthy, anti-oxidant-rich foods. Patients should focus on fresh fruits and vegetables along with lean proteins to ensure their immune has the nutrients it needs.

With side effects ranging from loss of appetite to nausea to changes in smell and taste, patients may find it difficult to eat during cancer treatment. Here are five tips for making food more palatable. Here are some additional tips for managing nutrition and easing unpleasant side effects during cancer treatment:

Stay Cool:

Cold foods may be a more appealing option for patients struggling with nausea. Hot food can have a more intense aroma than foods that are room temperature or cooler, which won’t have as strong of a smell. Cold foods will also be more appealing for patients with a sore mouth or throat.

Blander May Be Better:

If you’re dealing with digestive upset, queasiness, and loss of appetite, bland, simple, low-fat foods may be the way to go. Not only will these foods be easier to keep down, they also require less energy to digest.

Fluids Are Your Friend:

Drink fluids frequently—this is important not only for staying hydrated, it can also help remove some of the byproducts of the chemotherapy. As always, water is the best, but for added variety, patients can also try a low-acid fruit juice (like apple or grape), clear soups and low-sodium broth, herbal teas, sports drinks, and even popsicles.

Pick Plastic:

If you have a bitter or metallic taste in your mouth when eating, you can try using plastic utensils instead of metal ones; this may help mitigate the metallic aftertaste.

Meatless Meals:

Meat may taste “off” during treatment. First and foremost, make sure any and all meat you eat during treatment is thoroughly cooked. If it still doesn’t taste quite right, embrace vegetarian protein options at mealtimes such as eggs, yogurt, beans and lentils, tofu, and nuts.

Dr. Adil Akhtar is currently Chief, Division of Palliative & End of Life Care, Michigan Health Professionals, and Director, Impatient Clinical Services, Karmanos-McLaren Oakland Cancer Center in Michigan. In addition, he is Associate Professor, Department of Medical Oncology & Hematology, Oakland University-William Beaumont School of Medicine. He is President and CEO of Advance Care Now, LLC. He is also the Medical Director of Premier Hospice and Palliative care.  Dr. Akhtar’s medical specializations are oncology, palliative care and end of life/hospice care.

Dr. Adil Akhtar believes that everyone has a right to decide what kind of medical care they want. He is very passionate about the healthcare living will and advance care planning. He has founded Advance Care Now to help people understand and make decisions about advance care planning.

Dr. Akhtar received his M.B., B.S. at Dow Medical College, University of Karachi, Pakistan.  His training includes a Research Fellowship in Experimental Hematopoiesis, Department of Oncology, Johns Hopkins University in Baltimore; a Clinical Fellowship in the Division of Oncology, Department of Medicine, Wayne State University in Detroit; and his Residency was at Wayne State University School of Medicine, Internal Medicine, Division of Hematology and Oncology in Detroit. 

Dr. Akhtar also specializes in palliative care, the holistic multidisciplinary medical care for people with serious illness. This type of care is focused on providing relief from the physical symptoms and emotional stress of a serious illness. The goal is to improve quality of life for both the patient and the family. From pain management, emotional support to proper diet and nutrition. Palliative care can be implemented in conjunction with the cancer treatment such as radiation therapy and chemotherapy. Dr. Akhtar’s program is a pioneer in home based palliative care.