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Acknowledgement
Cancer and Nutrition

What is the right form of nutrition for cancer patients? Depending on the patient's choice of treatment, the diet varies. For example, if one opts for a macrobiotic diet, obviously it will be totally different from the commonly defined balanced diet. Traditional Chinese Medicine includes dietary therapy which is unique as well.

Generally, most people will opt for mainstream treatment. The following eating guidelines are extracted and summarized from booklets that are printed by Singapore General Hospital Pte Ltd and Singapore Cancer Society. If you have eating problems, please ask your doctor to refer you to a dietitian. Alternatively, if you believe in Traditional Chinese Medicine, please consult a Chinese physician. Some Chinese herbs can help to improve one's appetite and body immune system.


Importance of Proper Nutrition

Nutrition plays an important role in your total care and treatment. With proper nutrition, you can :

  • Prevent weight loss
  • Tolerate your therapy with lesser side effects
  • Keep fit to fight infection
  • Enhance the repair of normal tissues damaged by chemotherapy
  • Feel better and recover quickly

Your doctor may have told you to eat well so that you will not lose weight during your chemotherapy. However, you may encounter difficulties finding suitable food to eat due to side effects from your therapy, such as nausea, vomiting or a sore mouth. There may be times when eating is limited and your diet is not well-balanced. Do not worry about meeting all your nutritional needs if these times are brief. If prolonged, you must look for new food choices that may be better tolerated.


General Eating Guideline

There is no particular food that you should avoid. It is important to have a well balanced diet, one that is high in protein, mineral and iron. Proteins are needed for cell building. This is important because chemotherapy retards the process of normal cell division. Proteins also accelerate cell growth. Examples of food that are high in protein are meat, poultry, fish, eggs, milk, cheese, peanut butter and nuts, yoghurt and seafood. Food supplements such as Complan, Ensure, Sustagen or Sustain are useful if you are unable to eat a balanced meal. It is also helpful to eat frequent small meals and light snacks.

Frequent small meals
  • Eat small, frequent snacks (six per day) instead of three main meals that include foods you best tolerate, even if you are not hungry.
  • Make sure that you eat in a comfortable position.
  • Serve foods attractively. Socializing increases your appetite, so eat with someone whenever possible.

Light Snacks

These may include :
  • Agar agar, jelly
  • Toast with jam or suitable spreads
  • Low fat or skimmed milk
  • Sponge cake
  • Low fat yoghurt
  • Nonya cakes, "huat kuey"
  • Puddings (corn, sago)
  • Cheese and crackers
  • "Putu mayam", "apam"
  • Light sandwiches
  • Plain tosei
  • Broth based soups
  • Ice-cream
  • Fruits and fruit juices
  • Cereals (hot or cold)
Low fat foods are digested easier and quicker than high fat foods and you may be more likely to be hungry again by meal time.


More Eating Tips

If you wish to know more eating hints for cancer patients, please visit the web site hosted by National Cancer Institute.

To suit local needs, the following sections on nutritional strategies and general eating problems are adapted from seminar handouts written by Mrs Tan Siok Eng, a retired dietitian.


Nutritional Strategies

  • Seek early treatment and prevent weight loss
  • Supplement in between meals with high calorie and high protein foods
  • Exercise to increase appetite
  • Do not allow patient to be depressed

General Eating Problems


Taste Changes
It may be due to infection, medication, mouth sores or after radiotherapy or chemotherapy treatment. Familiar and previously favourite foods may taste different as taste buds may exaggerate sweetness or sourness. Usually taste changes are temporary.

Eating tips :
  • Choose a variety of flavours each day, eg. sour, sweet and spicy
  • Eat your favourite foods and re-try them in a few weeks as taste may change
  • Select foods that smell good to increase desire to eat
  • Allow foods to cool. Very cold foods may not be tolerated by some. Therefore, let foods reach the temperature which you can tolerate best.
  • Try sharp tasting foods and drinks that are refreshing eg, fruit juices, fresh fruits, lemonade or citrus fruits. Sucking sweets or mints may refresh mouth.
  • Add spices to foods, eg. marinade meats, fish, etc.

Loss of Appetite
Common complaint can be due to treatments such as chemotherapy, radiotherapy, anxiety or depression.

Eating tips :
  • Use texture, appearance, colour and odours to stimulate the appetite. Simple garnishes such as orange slices, lemon wedges, sliced chilly, sprigs of parsley, can help to enhance the appearance of a meal served. For children, food may be served in shapes, eg. cookies in shapes of animals, potatoes in shapes of alphabets or numbers to stimulate appetite
  • Avoid bland food, use different seasonings for flavour enhancement
  • Avoid certain foods that may taste temporarily unpleasant
  • Serve foods in small portion
  • Be flexible with eating time. Eat when you feel like eating
  • Keep drinks and biscuits at hand so that you can eat them when you feel like eating
  • Socializing increases your appetite, so eat with someone whenever possible
  • Eat slowly and chew food thoroughly so that your stomach will not be filled too quickly

Night Sweats
Sweating at night may lose fluid and salt. Therefore, it is important to replace them. Otherwise, dehydration may occur and feeling weak, lightheaded, headache or muscle cramps may result.

Tips for replacing fluid and salt :
Normal intake of fluid is about 6-8 cups per day. This intake should be doubled if you have heavy sweating.
  • Use larger cup or glass
  • Try drinks that provide energy/calories, eg. frizzy drinks, soups, fruit juices, hot beverages with milk and sugar
  • Have a drink before bedtime
  • Keep a thermos flask of water by your bed at night and have a drink when you wake up
  • Try salty foods like cheese, crisps, biscuits

Diarrhoea
It occurs in patients with cancer of the bowel or after chemotherapy or radiotherapy. It can rapidly cause electrolyte imbalance and dehydration if not treated. For severe cases, patients must see a doctor immediately.

Eating tips:
  • Drink plenty of water, 8-10 glasses per day
  • Avoid drinking liquids with your meals
  • Reduce intake of concentrated sugar drinks
  • Avoid milk (lactose), beverages with caffeine and alcohol. Try soya bean milk as a substitute
  • Avoid fruit juice
  • Avoid high fibre foods, eg. bran, whole grain cereals, skins and seeds, beans and legumes, dried fruits, nuts, fresh fruits and vegetables
  • Drink natural yoghurt as it may help to re-establish normal bacterial colonization of the bowel
  • Try bovril, marmite, lucozade, barley water
  • Try foods that are soft and easy to digest, eg. white fish, chicken, mashed potato, ice-cream
  • Eat low fibre foods, eg. white bread, white flour products, cream crackers, rich tea biscuits and rice

Constipation
Sometimes chemotherapy treatment may slow down bowel. Therefore increase intake of fibre and roughage will help to improve bowel activity.

Eating tips:
  • Eat more vegetables, eg. mustard leaves, Chinese cabbage, broccoli, brussels sprouts, carrots, corn, potato with skin, spinach, etc.
    Increase intake of vegetables preferably at both meals. Instead of only one serving, add another extra serving
  • Eat more baked beans, kidney beans, lima beans and nuts
  • Eat fresh fruits whole, with skin intact, eg. apples, pears and fresh oranges instead of juice
  • Increase your intake of dried fruits, eg. raisins, prunes and dates. If it is difficult to eat raw and coarse foods, try prune juice and grated raw fruits and vegetables
  • Eat more high fibre bread, eg. wholemeal bread, high fibre loaf, raisin bread, wholewheat croissant
  • Eat unpolished rice instead of white rice
  • Eat more wholegrain cereals
  • Drink plenty of water or fluids, 8-10 glasses per day
  • Exercise regularly

Sore Mouth
You may experience sore mouth during chemotherapy treatment. Your mouth may become sore if the drugs affect its lining. This can be relieved with extra attention to mouth care. Thus it is important to have regular mouthwashes and clean your teeth after eating in order to prevent infection. This also applies to dentures. If you have a sore in your mouth, use a soft toothbrush and avoid spicy food and very hot or cold drinks.

Eating tips :
  • Food should be soft, non acidic and not salty
  • Avoid dry foods, eg. toast, biscuits, salads
  • Avoid alcoholic drinks
  • Add sauces and gravies on meat and vegetables to make them moist
  • Serve food at room temperature
  • Drink from a straw
  • Taking milky drinks between meals can be soothing to the mouth and improves nutritional intake

Dry Mouth
Many drugs such as those used for nausea cause dry mouth. A sore mouth and throat and a lack of saliva also make dry food difficult to swallow.
Eating tips :
  • Keep plenty of fluid at hand for sipping
  • Moisten foods with soup or gravy
  • Dip bread or biscuits in hot drinks
  • Take jelly or ice-cream that can be refreshing
  • Suck shaved ice or ice cubes
  • Suck hard candy can stimulate salivary gland
  • Avoid very hot, spicy, acidic, highly salted foods
  • Herbal candies, sweets or peppermints, etc. may be used throughout the day to keep the mouth moist
  • If you find solid food too difficult to swallow, you should try a blenderized diet or a full liquid diet

Difficulty in Swallowing
It may be due to chewing difficulty or tumour blocking the oesophagus.
Eating tips :
  • Food should be soft and moist, eg. a blenderized diet or a full liquid diet
  • If condition is severe, consider nasogastric tube feeding
  • Use a straw to make drinking easier
  • Avoid sticky, dry foods, eg. peanut butter
  • Avoid coarse food, eg. nuts, corn and rice

Weight Loss
It should be tackled as soon as possible. Weight loss can be due to poor appetite, tiredness, diarrhoea or constipation, nausea, sore mouth and swallowing difficulty. Weight gain can only be achieved by increasing the energy content of daily food intake.
Eating tips :
  • Eat 3 meals and 3 snacks per day
  • If you do not feel like eating, replace meals with high protein drinks, eg. Complan, Ensure, Enercal
  • Eat fish, meat, eggs, cheese and beans
  • Add glucose, sugar or honey to your drinks
  • Use oil or fats in cooking
  • Take snacks, eg. sweets, chocolate, nuts

Nausea and Vomiting
Some drugs may cause nausea and vomiting because they affect the stomach lining and the part of the brain that controls vomiting. Do not eat a heavy meal, immediately before or after your treatment.
Eating tips :
  • Taking a walk may increase appetite
  • Eat in a well-ventilated room and relaxed atmosphere
  • Avoid drinking fluids with meals
  • Eat frequent small meals or snacks
  • Avoid cooking smells if possible
  • Eat slowly and chew food thoroughly
  • Eat as much variety as possible but not too rich
  • Try dry biscuits or dry toast in the morning
  • Ginger and ginger flavoured drink and food may help, eg. ginger ale, ginger beer, ginger biscuits
  • Avoid hot foods - their odours sometimes aggravate nausea. Try cold meat and fruit, small sandwiches and bland food
  • Avoid fried onions, garlic, celery, parsley, salted egg and fish, durian, jackfruit and dried cuttlefish which have strong odours


Early Satiety
Patients who have lost their appetite or undergone stomach surgery, often feel full after eating a few mouthful of food.
Eating tips :
  • Eat small but frequent meals
  • Avoid drinking with and before meals
  • Avoid gas forming food that may cause excessive flatulence. This in turn will cause a sense of fullness (bloated feeling).
    The following foods may cause flatulence :
    • Cauliflower, broccoli, onions, parsnips, brussel sprouts, asparagus, radishes, turnip, kangkong and cucumber
    • Dried beans, peas, baked beans, soya beans, lima beans and lentils
    • Prunes, raisins, bananas
    • High fibre products such as wholemeal bread, bran, cereals, bran muffins
    • High lactose foods, eg. milk, ice-cream, whipped cream
    • High fat foods such as fried kway teow/mee and fatty meats, pork luncheon meat and sausages

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