Alterations in bowel movements are another side effect of medications; treatments; or certain cancers, specifically lower GI-tract cancers. Gastrointestinal resections, pain medications, along with changes in diet may change the consistency of the bowel movement and the transit.2 Either diarrhea or constipation may be the outcome.

Fiber and fluid are two main nutritional components that relieve constipation. Both soluble and insoluble fibers are helpful. Soluble fibers, found in foods such as barley, nuts, beans, and some fruits and vegetables, including broccoli, carrots, apples, and citrus fruits, help to slow digestion. Insoluble fibers add bulk to the stool, and are found in whole grains and vegetables. However, these foods should not be recommended to patients who are prescribed to a low-residue diet.

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A low-residue diet is often recommended to patients when there is a narrowing of the bowel caused by either inflammation or surgical alteration. Radiation to the gastrointestinal tract can also cause damage and require a patient to follow a low-residue diet.2 Low-residue diets, also referred to as low-fiber diets, include foods that are easy for the body to digest and slow down bowel movements (eg, beans, legumes, and many raw fruits and vegetables). Nuts and seeds should be avoided. Furthermore, drinking the recommended 8 to 12 cups of fluid each day helps minimize constipation. Over-the-counter medications and laxatives may also be necessary, but should be used with caution to avoid adverse effects. In addition, as with all with all medications and supplements, patients should be sure to notify their doctor when taking laxatives to be sure there are no negative interactions with the other drugs.

Patients who complain of abdominal gas should limit their intake of carbonated beverages, broccoli, cabbage, cauliflower, cucumbers, dried beans, peas, and onions. OTC products such as Beano, a natural digestive enzyme, or simethicone (Gas-X), can help eliminate gas caused by the sugar in beans and some vegetables, but it will not help gas caused by excessive fiber or lactose. These medications should not be used as a primary method of controlling abdominal gas.6

Diarrhea can lead to weakness, poor appetite, dehydration, and weight loss. Patients who experience diarrhea should drink clear liquids throughout the day. High-sodium foods and sports drinks may help a patient to stay hydrated and will replace lost electrolytes. Other foods that should be encouraged are those high in potassium (eg, baked potatoes, oranges, and bananas) and foods high in pectin (eg, applesauce). Greasy, fried, spicy, or very sweet foods should be avoided. Antidiarrheals can assist with limiting this side effect.

Keeping a detailed food journal is helpful for patients who experience gastrointestinal side effects. Some people can tolerate foods that others cannot. A 62-year-old male with GI cancer presented with difficulty managing his bowels. He was asked to keep a food diary, closely monitoring what he ate by writing down the foods and the amounts he consumed. When an episode of either diarrhea or constipation occurred, the patient was able to trace the cause back to the food he ate and would then eliminate that food from his diet. The patient used over-the-counter medications when necessary, but overall, he was able to control his bowels solely based on what he ate.

Sore mouth or difficulty chewing and swallowing is a common effect experienced by patients with cancer, especially those with head and neck cancers. These patients should be advised to eat soft, bland-tasting foods served at room temperature. Pureeing or liquefying foods will make swallowing easier. Foods moistened with broth, sauces, gravy, or olive oil are also easier to swallow. Choosing fats such as olive oil as opposed to butter will help the patient’s overall health by avoiding unhealthy fats. Adding healthy fats, as well as a protein powder, to drinks and foods can help these patients maintain their weight. In addition, careful attention to food temperatures is helpful (eg, lukewarm, rather than hot, foods are less irritating to the mouth). Encourage patients to rinse often with a baking soda and water mouth rinse to remove food and germs and enhance healing2 (Table 1).

Table 1. Mouth Rinse

1 quart water
¾ teaspoon salt
1 teaspoon baking soda
Combine all ingredients in a container and mix well.

Dry mouth or thick saliva may occur as a result of radiation therapy, some types of chemotherapy, and some medications. Patients with dry mouth may have difficulty eating and have a higher risk of developing dental cavities or mouth infections.7 Smoking, chewing tobacco, alcohol, and caffeine can make the dryness worse, and should be avoided. Eating moist foods and drinking fluids throughout the day helps loosen sticky secretions that can cause the mouth to feel dry.

Changes in taste and smell caused by cancer and its treatment can affect a patient’s appetite. Seasonings and sweeteners, such as honey, can make foods taste more appealing and may increase food intake. Regular mouth rinsing and brushing the teeth may also improve how food tastes. Bitter or metallic taste may be alleviated with sugar-free lemon drops, gum, or mints. Using plastic utensils, rather than stainless flatware, may also help. Appetites can be improved by avoiding hot foods, which tend to have stronger smells and flavors and may turn off the patient’s sense of needing to eat.