Proper nutrition is crucial for the patient with cancer in fighting off the many effects of the disease. But, unfortunately, loss of appetite, or anorexia, is common among people with cancer. This should not be confused with anorexia nervosa, which is a loss of appetite due to psychological problems. While anorexia in patients with cancer can have some origin in the psychological, social, and cultural impact of the diagnosis of cancer, it is also due to the cancer itself and its treatment.
Loss of appetite and taste alterations are two of the major causes of malnutrition, particularly inadequate intake of protein and calories, among people with cancer. Protein-calorie malnutrition is the most life-threatening form of malnutrition because it involves depletion of the body’s stores of fat and of the protein stored in the muscles and organs. It is also characterized by a weight loss of 10 percent or more within several months.
A balanced diet with adequate calories and protein improves the well-being of the person with cancer by providing the nutrients needed to repair normal cells and thus reduce the side effects of cancer therapy and keep the immune system functioning at an optimal level. The well-nourished person also has more energy.
To maintain an adequate protein and total calorie intake, persons with cancer should eat:
- A minimum of three servings daily of a variety of protein-rich foods such as meat, fish, poultry, eggs, milk, and milk products.
- A minimum of six servings daily of fruits and vegetables high in vitamins A and C. These include cantaloupe, watermelon, apricots, mango, papaya, strawberries, citrus fruits, tomatoes, green peppers, cabbage, broccoli, spinach, kale, escarole, white potatoes, yams, carrots, and acorn squash.
- A minimum of five servings daily (if diarrhea is not present) of whole-grain bread and cereal. For example, whole-wheat bread, brown rice, wheat germ, barley, oatmeal, and bran.
- To minimize weight loss and increase energy, patients should incorporate high-calorie foods into the daily diet. Unless a high-fat diet is contra-indicated, strategies include:
- Mayonnaise on sandwiches and in casseroles and desserts.
- Margarine on sandwiches and toast and in all cooked foods when feasible.
- Peanut butter on crackers, toast, bananas, and chocolate bars.
- Sour cream in potatoes, cakes, cookies, sauces, and gravies.
- Whipped cream in coffee and tea and on puddings, gelatins, and desserts.
- Cream cheese in casseroles and cheesecake and on meat sandwiches and bagels.
- Milk or fruit juice instead of water in cooking. If an incompatibility does not exist, medications should be given with a high-calorie beverage rather than water.
Adequate protein is essential to the repair and regeneration of cells. Patients can increase their protein intake by:
- Using double-strength milk—mixing dry skim milk with liquid milk instead of water.
- Mixing breakfast drinks or snacks (such as Carnation Instant Breakfast) with double-strength milk.
- Using evaporated, condensed, or double-strength milk to make casseroles, hot cereals, sauces, puddings, milkshakes, and soups.
- Eating cheese and crackers as a snack between meals; adding cheese to casseroles, baked potatoes, vegetables, sauces, and sandwiches; sprinkling shredded cheese on salads; layering cheese between vegetables and noodles in lasagna; serving cheesecake as a dessert or a snack between meals or at bedtime.
- Drinking eggnog made with instant breakfast drink, one cup of milk, and custard or a parboiled egg. (For patients with cancer, the egg should be parboiled for one minute to reduce the risk of salmonella infection.)
- Adding eggs to salads, casseroles, and sauces; making omelets with double-strength milk, cheese, butter, mayonnaise, and thinly sliced meats; using desserts containing eggs, such as angel food cake, sponge cake, custard, and cheesecake.
- Adding meat, poultry, and fish to salads, casseroles, and sandwiches; strained and junior baby meats to soups and casseroles.
- Snacking on cocktail wieners, deviled eggs, deviled ham and crackers, cream cheese on crackers topped with caviar.
- Adding beans and peas to casseroles; wheat germ to casseroles, cereals, yogurt, and meat loaf.
- When their appetites are poor, some people find they are able to eat better if they:
- Exercise before meals. A five-to-ten-minute walk, or even range-of-motion exercises in bed (the physical therapist has specifics), can perk up the appetite.
- Make mealtime an event; wash the hands and face, rinse the mouth with half-strength mouthwash to freshen it before eating.
- Serve all foods attractively and in a pleasant environment. Company, soft music, and a glass of wine (if allowed) may stimulate the appetite.
- Eat smaller, more frequent meals—six or eight small meals rather than three full meals a day. Many hors d’oeuvres provide high-protein food in small amounts.
- Avoid foods that are filling or gas-forming, such as salads, the gas-forming vegetables (e.g., cabbage or broccoli), fruits, and beer.
- Enhance the food with bacon bits, toasted almonds, lemon slices, slivers of ham; or by using marinades, herbs, spices, wine sauces, or butter in cooking.
- Avoid liquids with meals or in the hour before, since they can be filling enough to spoil the appetite. In any case, liquids should be nutritious— milk, juice, or soup rather than soft drinks or water.
- Make sure there is a varied selection of food on hand.
- Experiment with herbs, spices, and sauces. Try adding fresh or dried gingerroot to soups, sauces, and gravies for a pleasant flavor.
- Take advantage of the fact that breakfast is usually the meal when the appetite is at the highest level and make it one of the day’s larger meals.
- If pain is present, take an analgesic thirty to sixty minutes prior to mealtime.
- Eat more slowly to allow the stomach to empty while eating, thereby reducing nausea and vomiting. Chew everything thoroughly.
- Counteract a strange taste in the mouth with fresh fruit, juice, or sour hard candy.
Even with all of these suggestions, the patient may not receive enough protein to keep the body functioning properly and to maintain adequate Weight. If adequate nutrition cannot be accomplished with ordinary foods, a nutrient supplement may be necessary. There are a number of brands and flavors on the market and the person should check with his or her doctor or dietitian to see what might be most appropriate. The supplement also may be added to other foods, such as fruit to make a milkshake; substituted for milk in various dishes such as cereals, soups, puddings and other desserts; or frozen to eat like a Popsicle.
A major barrier to adequate nutrition is the task of cooking itself. Many people with cancer simply feel too tired at the end of the day to cook a complete meal. If they have enough energy in the morning, they may want to do the day’s cooking then, and reheat as necessary. If not, they should not be shy about accepting friends’ invitations to dinner or offers of help with cooking. They should learn to rely on convenience foods nutritious frozen dinners or take-out food from a delicatessen or local restaurant. They can also cook double batches on good days to freeze and eat on bad days. Finally, they may want to investigate a Meals on Wheels program through their hospital social worker or local American Cancer Society.