Strategies for Common Nutrition-Related Symptoms
Cancer treatment regimens have expected adverse effects that vary by drug, chemotherapy combination, and radiation treatment area. Patients may experience nausea, vomiting, changes in bowel habits, dysgeusia, xerostomia, dehydration, loss of appetite, weight loss, mucositis, pain, and/or fatigue. Because nurses are typically one of the first points of contact during a patient’s visit, your awareness of nutrition strategies that can help manage these common symptoms is essential. The following are common evidence-based suggestions for the more frequently reported symptoms managed by oncology-credentialed dietitians1:
- Encourage patients to use an antiemetic medication 30 to 60 minutes before consuming a meal for optimal benefit.
- Advise patients to avoid having an empty stomach for an extended period of time, especially if they are taking oral medications.
- Advise patients to avoid consuming large meals and greasy, spicy, or very high-fat foods when nauseated.
- Recommend that patients avoid drinking large amounts of water at the same time as eating, but to hydrate well if fluids are lost during emesis.
- Advise patients to eat at regular mealtimes or create an eating schedule to avoid skipping meals. Ideally, patients should eat 5 to 6 small meals throughout the day, or at least every 3 to 4 hours.
- Suggest eating easily digestible carbohydrates such as crackers, toast, or dry cereal, to help settle nausea.
- Ginger has antinausea properties, but advise patients to use products containing real ginger root (eg, sliced ginger root, pickled ginger, ginger tea, ginger cookies, or ginger sucking candies). Ginger can also easily be added to soups and stir fry.
- Recommend that patients avoid greasy, fatty, or fried foods; alcohol; and large meals until diarrhea resolves. Patients who are sensitive to lactose may also need to limit or avoid dairy foods.
- Suggest patients increase their intake of soluble fiber when experiencing diarrhea. Soluble fiber acts like a sponge to absorb water in the gastrointestinal tract. Sources of soluble fiber are ripe bananas, quick cook oatmeal, mashed potatoes without skins, and unsweetened applesauce.
- Conversely, also recommend limiting intake of insoluble fiber because it adds bulk to the stool and encourages a bowel movement. Insoluble fibers include vegetables such as cabbage, Brussels sprouts, broccoli, spinach, and cauliflower; fruits; nuts; and whole grain foods.
- Fluids may be lost with excessive watery diarrhea. To replenish depleted electrolytes, advise patients to consume at least 8 to 10 8-oz cups of fluids per day. These fluids can be water, mild juices, unsweetened coconut water, and sports drinks or hydration powders (available in the pharmacy). Good dietary sources for improving potassium levels include avocado, ripe bananas, skinless white or orange potatoes, cantaloupe, cooked carrots, and asparagus tips.
- Advise patients to consume more high fiber foods to help resolve constipation. However, you need to emphasize that patients should increase their fluid intake when increasing fiber consumption to avoid further worsening constipation. High-fiber foods are fruits, vegetables, whole wheat and whole grain breads, rice, cereals, pasta, nuts, and legumes.
- Recommend starting the day with a high-fiber breakfast (eg, bran cereal with slivered almonds and mixed berries), hydration, and a warm beverage to encourage a bowel movement.
- Recommend avoiding gas-producing foods such as beans, corn, peas, and cruciferous vegetables (eg, broccoli, cauliflower) to prevent uncomfortable bloating.
- Encourage patients to engage in physical activity as tolerated. This can help promote regularity.
Lack of Appetite/Anorexia
- Patients should be told to make the most of “mealtimes.” Eating meals at the same times every day can help patients avoid skipping meals, avoid frustration from concerned caregivers, and can encourage trying to eat at routine times each day.
- They can maximize each bite by eating nutrient-dense meals such as a high calorie smoothie (eg, Peaches and Cream Oat Smoothie), scrambled eggs with added cheese, tuna melt sandwich, creamy soups, steel cut oatmeal made with whole milk, and snacks such as cheese and crackers, trail mix, nut granola bars, or yogurt and fruit.
- If regular meals are overwhelming, suggest eating smaller meals 5 or 6 times per day.
- Assess the patient for the root cause of their appetite loss. Perhaps they are experiencing a treatment-related effect such as constipation, nausea, or mouth sores, which can be treated both medically and nutritionally. Treating these issues may help improve the patient’s appetite.
Mouth Sores/Dry Mouth
- Advise patients to eat soft, moist foods such as creamed soups, casseroles, scrambled eggs, mashed potatoes, and tuna or egg salad.
- Advise patients to avoid foods that are overly acidic or spicy, such as tomato or citrus-based dishes and foods with spicy ingredients, because these foods can irritate their mouth.
- Suggest adding extra gravy, sauce, broth, or butter to moisten foods.
- Encourage patients to follow routine good oral care.
- Suggest using oral nutritional supplements as needed.
Changes in Taste
- Recommend food substitutions to manage changes in taste, such as substituting poultry, fish, eggs, beans, tofu, or soymilk for red meats.
- Suggest eating foods chilled or at room temperature to limit offensive tastes.
- Advise patients experiencing metallic taste to use plastic utensils.
- Strategies for removing an unpleasant taste in the mouth include sip ginger ale, suck on hard candy, or add lemon juice.
- Routine good oral care can also help manage this effect.