Coping with Effects of Cancer Treatment

Cancer treatment can cause tooth decay and other problems for your teeth and gums. Changes in eating habits may add to the problem. If you eat often or eat a lot of sweets, you may need to brush your teeth more often.

Here are some ideas for preventing dental problems:

• See your dentist before starting treatment, especially if you have a history of tooth or gum problems. This may help prevent infection or other problems later on.
• Use a soft toothbrush. If your gums are very sensitive, clean your teeth with cotton swabs or mouth swabs made especially for teeth cleaning.
• Rinse your mouth with warm water when your mouth and gums are sore. Also rinse your mouth if you have been vomiting to get rid of any acid remaining on your teeth.
• If you are not having trouble with poor appetite or weight loss, limit the amount of sugar in your diet. Also, cut down on foods that stick to the teeth such as caramels, dried fruits, seeds and chewy candy bars.
• Try to brush or rinse your mouth after each meal or snack.
• See your dentist regularly. Patients who are receiving treatment that affects the mouth (e.g., radiation to the head and neck) may need to see the dentist more often than usual.

Nausea, with or without vomiting, may occur as a side effect of cancer surgery, chemotherapy, radiation therapy, biological therapy, and with some medications used for pain. The cancer itself, or other conditions unrelated to your cancer or treatment, may also cause nausea. Nausea can keep you from getting enough food and needed nutrients.

Try foods such as:

• Toast and crackers
• Yogurt
• Sherbet
• Popsicles
• Pretzels
• Angel food cake
• Canned peaches, pears, fruit cocktail, melons
• Skinned chicken (baked, boiled)
• Hot cereal, such as oatmeal
• Clear liquids, broth
• Ice chips

Helpful suggestions:

• Avoid foods that are fatty, greasy, fried or spicy.
• Avoid foods that have strong odors.
• Eat small amounts often and slowly.
• Avoid eating in a room that's stuffy or too warm, or has cooking odors or smells that might disagree with you.
• Drink fewer liquids with meals; drinking liquids can cause you to feel full and bloated.
• Sip liquids throughout the day, except at mealtimes. Using a straw may help.
• Drink beverages cool or chilled. Try freezing favorite beverages in ice cube trays.
• Eat foods at room temperature or cooler; hot foods may add to nausea.
• Don't force yourself to eat favorite foods when you are nauseated; it may cause you to develop a permanent dislike of those foods.
• Always sit upright when eating.
• Rest after meals since activity may slow digestion. Rest sitting up, for about an hour after meals.
• If you feel nauseated in the morning, try dry toast or crackers before getting up.
• Wear comfortable, loose-fitting clothes.
• Avoid eating for one or two hours before radiation therapy or chemotherapy, if nausea occurs during treatment.
• Many people undergoing cancer treatment feel best in the mornings. There is nothing wrong with having your major meal at that time.
• Ask your doctor about anti-nausea medications.

Vomiting may follow nausea and may be brought on by treatment, food odors, gas in the stomach or bowel or motion. In some people, certain surroundings (such as the hospital) may initiate vomiting.

Here are some helpful ideas:

• Do not drink or eat until you have the vomiting under control.
• Sit upright for a period of time after vomiting.
• Once you have controlled the vomiting, try small amounts of clear liquids, such as cranberry juice, flat ginger ale or cool broth. Begin with one teaspoon every 10 minutes, gradually increase to one tablespoon every 20 minutes, then try 2 tablespoons every 30 minutes.
• When you are able to keep down clear liquids, try a 'full-liquid' diet that may include cream of wheat, pudding, ice cream or frozen yogurt, broth, gelatin and milk. Continue to take small amounts as often as you can keep them down. If you feel okay on a full-liquid diet, gradually work your way up to your regular diet. Carbonated beverages are fine for some people, but others find the beverages make them feel full or bloated, or cause burping, which can stimulate vomiting.

If you experience nausea and/or vomiting from your treatment, avoid eating your favorite foods prior to the time you are likely to feel sick. It is not uncommon for individuals to associate a particular food with the onset of unpleasant symptoms. This is called an 'acquired food aversion.’ Save your favorites for a time when you feel well.

Diarrhea may be caused by chemotherapy, radiation therapy to the abdomen, infection, food sensitivity and emotional upset. Long-term or severe diarrhea may cause dehydration and other health problems, since needed water and nutrients are lost. Contact your doctor if the diarrhea is persistent.

Low-residue, low-fiber foods can sometimes offer relief. These might include:

• Rice or noodles
• Farina or cream of wheat
• Eggs (cooked until the whites are solid, not fried)
• Bananas
• Puréed vegetables, or cooked soft
• Canned or cooked fruit without skins, such as applesauce
• White bread
• Skinned turkey or chicken
• Tender or ground beef
• Fish
• Mashed potatoes

Helpful tips are:

• Avoid foods that make it worse. These might include: beans, onions or strong spices; greasy, fatty or fried foods; raw vegetables, raw fruits or nuts; high fiber vegetables such as broccoli, corn, beans, cabbage, cauliflower or peas.
• Avoid alcoholic beverages
• Avoid dairy products if they increase indigestion and diarrhea. (Many liquid nutritional supplements are milk free and are available in a variety of flavors.)
• Eat small amounts of food and liquids throughout the day.
• Drink liquids that are at room temperature. Avoid very hot or very cold foods.
• Eat plenty of foods and liquids that contain sodium and potassium. These minerals are often lost during diarrhea. Foods high in potassium that don't cause diarrhea include bananas, peach and apricot nectar and boiled or mashed potatoes. Good liquid choices include bouillon or fat-free broth.
• Try a clear liquid diet during the first 12 to 24 hours of onset.

Some anticancer drugs and other drugs, such as pain medications, may cause constipation. This problem may also occur if your diet lacks enough fluid or bulk, or if you are not physically active. Here are some suggestions to prevent and treat constipation:

• Drink plenty of liquids (at least eight glasses per day) to help keep your stools soft. A daily four-ounce serving of prune juice may also be helpful.
• Take a hot drink about one half hour before your usual time for a bowel movement.
• Try high-fiber foods, including whole grains, fresh vegetables and fruits. For example, choose whole wheat bread, cauliflower, carrots, potatoes with skin, prunes, oranges and berries.
• Add unprocessed wheat bran to foods such as casseroles and hot cereals.
• Get some exercise, such as walking, every day. Speak with to your doctor or physical therapist about the amount and type of exercise that is right for you.
• If none of these suggestions works, ask your doctor about fiber supplements, like Metamucil, or medicine to ease constipation. Drink plenty of fluids, as indicated in the directions for use. Be sure to check with your doctor before adding fiber or taking any laxatives or stool softeners.

Damage to the mouth, gums and throat may result from cancer treatment. If you have a sore mouth, see your doctor to be sure the soreness is not due to a correctable dental or medical problem. Certain foods will irritate an already sore mouth. To make eating easier, carefully choose the foods you eat and take good care of your mouth.

Try soft foods that are easy to chew and swallow, such as:

• Bananas, applesauce, watermelon, canned fruits
• Peach, pear and apricot nectars
• Cottage cheese, yogurt, milkshakes
• Mashed potatoes, macaroni and cheese
• Custards, puddings, gelatin
• Scrambled eggs
• Oatmeal and other cooked cereals
• Puréed or mashed vegetables
• Puréed meats

Here are some suggestions:

• Avoid citrus fruit or juice.
• Avoid spicy or salty foods.
• Avoid rough, coarse or dry foods.
• Avoid hot spices, such as chili powder, nutmeg and cloves.
• Cook foods until they are soft and tender.
• Cut foods into small pieces, grind or purée. Try stews and casseroles.
• Mix food with butter, thin gravies and sauces to make it easier to swallow.
• Use a straw to drink liquids.
• Try food cold or at room temperature, since hot and warm foods can irritate a tender mouth and throat.
• If your teeth and gums are sore, your dentist may suggest a special product for cleaning your teeth.
• Rinse your mouth with water often to remove food and bacteria and promote healing.
• Ask your doctor about anesthetic lozenges and sprays (such as Tisol and Mouthkote) that can numb the mouth and throat long enough for you to eat meals.
• Keep dentures clean and remove them, except when eating, until your mouth heals.
• Do not smoke, and keep alcohol to a minimum.

Chemotherapy and radiation therapy in the head or neck area - which can reduce the flow of saliva - often cause dry mouth. When this happens, it is hard to chew and swallow. Dry mouth can also change the way foods taste. To reduce problems caused by dry mouth, try the suggestions below, as well as the ideas given for a sore mouth or throat.

• Avoid salty foods.
• Try tart foods and beverages, such as lemonade. These foods may help your mouth produce more saliva. Melon may also help.
• Suck on hard candy such as lemon drops, eat popsicles, or chew sugar-free gum.
• Keep your lips moist with lip salves.
• Use sauces, gravies and salad dressings to make food moist and easier to swallow.
• Try thick drinks, such as fruit nectars, at room temperature or cold.
• Have a sip of water every few minutes, to help you swallow and talk more easily.
• Maintain good oral hygiene.
• If your dry mouth problem is severe, ask your doctor or dentist about products that coat and protect your mouth. Synthetic saliva products, such as Glandosane, Optimoist, Moistin or Mouthkote, may help.

Problems with swallowing can be the result of cancer or its treatment. The use of feeding tubes, at least right after surgery, will allow healing to take place. If a tube is not required, there are several things you can do to make eating easier:

• Take deep breaths before attempting to swallow, and exhale or cough after swallowing.
• Thick liquids may be easier to swallow than thin liquids. Gelatin may be easier to swallow than thick or thin liquids.
• Mashed foods should not be too thick.
• Drink your fluids between, rather than during, meals since they may reduce your appetite. Liquids at room temperature may be easier to swallow.

If part or all of the tongue or jawbone has been removed, then chewing and tongue movement may be limited. Food will move down your digestive tract once it gets to the throat. Speech therapists, dietitians or nurses can teach effective swallowing techniques. Also, try these suggestions:

• Use a straw. It makes swallowing beverages easier.
• Use a spoon. It is easier to control and less hazardous than a fork.
• Ask your therapist to demonstrate the best way for you to place food in your mouth.
• Avoid very hot or very cold foods.
• Choose the right liquid diet for your needs, to help avoid constipation or diarrhea.
• Try puréed foods. They may be easier to tolerate than foods of regular consistency.
• Exercise your tongue and jaw. Try to move them through the usual range of motion - stick your tongue out and back, yawn and move your jawbone from side to side.

Chemotherapy, radiation therapy, or the cancer itself may cause your sense of taste to change. Some patients complain of a bitter, metallic taste, especially when eating foods high in protein. Each person's sense of taste may be affected differently. You will need to learn which foods, if any, taste differently to you.

Depending on how your taste has been affected, some of the following ideas for improving flavor may work better than others. In addition, visit your dentist to check for dental problems that may affect your food's taste.

• Choose and prepare foods that look and smell good to you.
• If red meat tastes different, use chicken, turkey, eggs, dairy products, tofu or fish that doesn't have a strong smell.
• Make meat, chicken or fish more flavorful by marinating it in sweet fruit juices, sweet wine or Italian dressing.
• Try using small amounts of flavorful seasonings such as basil, rosemary or oregano.
• Try tart foods that may have more taste, such as oranges or lemonade. A tart lemon custard might be tasty and will also provide needed protein and calories.
• Serve foods at room temperature.
• Try using onion, garlic and other seasonings to add flavor to vegetables.
• Maintain good oral hygiene.
• Drink liquids throughout the day.

Weight loss can occur during cancer treatment due to the effects of cancer on the body and its interference with eating, digestion or the absorption of food. Weight loss can also be caused by loss of appetite from cancer therapy or feelings of depression or anxiety.

The following suggestions may help make mealtimes more relaxed and eating more appealing.

• Involve yourself in as many normal activities as possible.
• Stay calm, especially at mealtimes. Don't hurry your meals.
• Try changing the time, place and surroundings of meals. A candlelight dinner can make mealtime more appealing. Eat with others, or listen to your favorite music.
• If you are losing weight, eat food often during the day, even at bedtime. Have nutritious snacks available, but store them out of sight.
• Add variety to your menu by using new recipes, spices and food products. Eat out in restaurants occasionally.
• Ask your dietitian to help you with meal planning for adequate nutrient intake.
• Include your favorite foods in your daily menus.

Weight gain may be an unexpected occurrence during cancer treatment. Sometimes this is due to hormonal changes. Excessive portion sizes or eating too many foods high in calories and fat can also increase weight. Sometimes patients feel less nauseated or anxious when they have food in their mouths. Discuss your weight gain with your physician or registered dietitian to determine the best way to achieve a healthy weight. This is important because excess weight gain may worsen prognosis for certain cancers, such as breast cancer.

Sometimes patients gain excess weight during treatment without eating extra calories. For example, certain drugs (such as prednisone) can cause the body to retain fluid. The extra weight is from water and does not mean you are eating too much. DO NOT go on a diet if you notice weight gain. Instead, tell your doctor so you can find out what may be causing this change. If anticancer drugs are causing the weight gain, your doctor may recommend limiting the salt you eat, since salt causes your body to hold onto water. To get rid of the extra fluid, drugs called diuretics may be prescribed.

To alleviate water retention:

• Eat less salt.
• Drink when you are thirsty, and be sure to have three to four glasses of water each day.
• Stay as physically active as possible. For example, take walks.
• Elevate your legs when resting.

If you were able to digest milk and milk products easily before you began your radiation or chemotherapy treatment, but now develop cramps and diarrhea after you drink milk or eat certain dairy foods, then you may be suffering from lactose intolerance. The cancer therapy may have temporarily inactivated the enzymes in your intestinal tract that digest the milk sugar called lactose.

For most people, the condition will reverse itself in time. Meanwhile, the following measures may be helpful:

• Avoid milk or dairy products that give you problems. Yogurt and small amounts of aged cheeses may be easier to tolerate.
• If you are concerned about not getting enough calcium in your diet, try calcium-fortified orange or apple juice, and calcium-fortified cereals and breads. Ask your doctor or dietitian about taking calcium supplements.
• Try one of the enzyme products, such as LactAid or Lactinex, which helps break down the lactose. Some products can be taken in pill form, while others are added directly to milk. Or try reduced-lactose milk, such as LactAid milk.