How to Manage Side Effects of Cancer Treatment Through Nutrition

December 10, 2019

It’s no secret: Cancer treatments are powerful. It’s also no secret that these drugs can also harm healthy cells in the body, which can lead to side effects. It’s not uncommon for patients to feel nauseous or experience a loss of appetite as a result of treatment.

While there are medications you can take to address these symptoms, making dietary adjustments can also help. In this podcast, Dana-Farber nutrition specialist Stacy Kennedy, MPH, RD/LDN, CSO, shares tips for patients.

AUSTIN FONTANELLA: Can you give us a little more information as to why patients experience side effects as a result of treatment?

STACY KENNEDY, MPH, RD/LDN, CSO: The causes really can be a lot of different reasons — whether it’s side effects from chemotherapy, radiation treatment, surgery, or even the cancer itself that can have a side effect that nutrition can help with. For example, with chemo, as you mentioned, sometimes people can feel nauseous. Fatigue is absolutely one of the number one side effects, and that’s very common with radiation treatment as well. Obviously with surgery, there’s a need for healing,

Gastrointestinal symptoms we also see, whether it’s a sore throat from radiation treatment for lung cancer or difficulty with gas and changes in bowel movements from either radiation or chemotherapy. So it’s really important to talk to the patient and find out the details on the symptoms so we can come up with a very targeted suggestion.

FONTANELLA: Now, I know we want to go through a couple of symptoms, but is there a certain treatment that you usually hear a lot about, like I’m experiencing X because I undergo this treatment?

KENNEDY: We can look at the list of chemotherapy or immunotherapy treatments and have a sense of what those side effects will be, but it really is often more than one happening, and then there’s the individual’s experience. So, like with taste changes, they’re really common, but it could be different kinds of taste changes, so we can get into that for sure.

FONTANELLA: Alright, let’s talk about nausea.

KENNEDY: That’s a very common side effect that we hear, and both an empty stomach and a full stomach can trigger nausea. So not everybody is aware of that — when you’re nauseous you don’t feel like eating, but not eating can actually make the nausea worse. So getting on a frequent eating pattern can be really helpful for somebody feeling nauseous. Also, lemon and ginger have natural anti-nausea properties, so those are great flavors to add into water and recipes. Patients report that even smelling a lemon can help them feel a little less nauseous; the same goes for lemon aromatherapy.

Drinking water would probably make it worse, because you’re just adding fluid to this empty stomach. So sometimes for patients, keeping crackers next to your bed or a rice cake and nibbling a little bit before you even get up, or having a lemon candy or a lemon tea that you can sip a little bit, might help — having a bit of something every two or three hours. Many patients find it easy to digest foods like carbohydrates and foods with salt, so crackers, toast, bagels, pretzels, potatoes, things like that. So don’t feel badly if you want to include some of those foods.

And the last thing I’ll talk about is smell and nausea. Chemotherapy can sometimes affect how a person perceives taste and smell, so the smell of a lot of things all at once — like a food court, or of animal protein cooking, like chicken or meat or fish — really shuts off appetite or makes them nauseous. So, having the patient not be the one cooking, or having them out of the house, opening a window, trying to get the smell away — all of that can be helpful too.

FONTANELLA: What if you just aren’t hungry? How do you address that loss of appetite?

KENNEDY: It’s hard, right? There’s the mental focus, I would say, of thinking of food and nutrition as a medicine, as part of your treatment, so it’s really about having a schedule and getting yourself to follow the schedule, but giving yourself permission to have the amount that feels right in the moment. So, eating every two or three hours like it’s your full-time job is helpful, but then you might only want to take one bite, two bites — that’s fine.

It’s kind-of the caregiver’s job to help provide food and encourage the schedule, but only the patient knows the right amount to eat in the moment. Give yourself permission to stick with the schedule, but not have to finish everything.

FONTANELLA: Okay, so, it can be as simple as maybe one or two crackers, just keeping yourself on that schedule.

KENNEDY: Exactly, yes, and that will help wake the appetite up a little bit in terms of just expecting some food.

FONTANELLA: What about undesired weight changes?

KENNEDY: Yes, so for undesired weight loss, that eating-very-often schedule helps, obviously. And then adding in healthy high-calorie foods. So, including things like avocado, nuts, nut butters, a little extra olive oil — really making sure you’re getting those extra healthy calories. If you have dairy, maybe you choose a whole milk variety for yogurt or cottage cheese instead of skim milk. You want to kind of maximize the density of calories.

The opposite is true for unwanted weight gain. Then, you’d want to focus on really making sure there’s a lot of nutrient density, but also less calories, more fiber, and more protein. So looking to have plant-based healthy foods throughout the day and making sure again that you’re losing weight — if you’ve gained weight due to treatment and it’s the amount of weight that you want to lose — you do it in a healthy way. Hydration and exercise are going to be important to you.

FONTANELLA: In terms of the weight changes, does it ever make sense to keep a log of what you’ve been eating just so you can track it for patients?

KENNEDY: Yeah, that can really help. The journal is a targeted tool. If you try to do it every day indefinitely, it’s really tedious and it’s kind-of frustrating, but keeping a log to get some information and discovery can be incredibly helpful for the person trying to gain weight or with a low appetite. Knowing that you have to write it down does sometimes help you stay on that schedule. So, yeah, I think it’s something we definitely recommend at times.

FONTANELLA: Moving on to bowel irregularities. I know that’s probably something you hear about a lot. Are there some general tips you have for patients going through that?

KENNEDY: Yeah, and again it will depend, and those are great things to talk about one-on-one with your nutritionist. For gas and for reflux and bloating, making sure not to have too much roughage or fiber actually is important, so doing more cooked vegetables or fruits that you have to peel (like a melon or a banana) versus a lot of roughage like celery and salads, for example. For people with constipation, you want all the veggies, all the fruits, all of those whole grains. There’s also senna-based tea, like Smooth Move tea, which can be helpful for constipation.

Being hydrated and focusing on movement (like walking) is something really helpful, as is avoiding too much air. Sometimes drinking through a straw and having carbonated beverages can contribute to gas because you’re taking in more air.

FONTANELLA: So you could even be eating or drinking the same thing and maybe get rid of the straw?

KENNEDY: Yeah, and eating slowly and drinking slowly are some of the hardest things for anybody to change, but those can make a really big impact. So we want to take our time, for sure.

FONTANELLA: What about if you’re experiencing fatigue?

KENNEDY: Everything we talked about will help fatigue. Exercise and movement is the number one medicine for fatigue. So when you’re tired, it does not sound like you would want to get up and move, so you don’t need to go do a workout, but being mobile is really going to help. Whether you’re doing a five minute walk around your house or going outside and getting fresh air for ten minutes, getting that movement in your day will really help with fatigue as well as the small frequent meals, the fruits and veggies, protein, and the hydration — all those things we talked about.

FONTANELLA: Is making a schedule for movement also a good idea?

KENNEDY: Yeah, it’s almost like move, eat, rest, repeat. Or it might not be in that order — you can pick your own order — but yes, that kind of an idea would be really helpful.

FONTANELLA: What about mouth sores or if you’re having trouble swallowing foods?

KENNEDY: Having foods that are soft with moisture can really help, and sometimes foods with one texture. So dry foods like bread might be challenging for swallowing difficulties, so someone might want to have the egg salad or chicken salad or tuna salad without the bread, for example. Just the middle. Or having mashed potatoes instead of rice. Even though rice is soft, it’s in pieces. So, sometimes for swallowing difficulty we’ll go through things like that, including things like avocado or a gravy or a sauce that has moisture. Dry foods are harder to swallow.

With the mouth sores, that can be true as well, and it’s really about avoiding things that would aggravate your mouth sores. So, anything really salty, really spicy, really acidic like with citrus — those are gonna be tough for mouth sores. You want cooler, more softer foods, so avocado again would be something that might be helpful.

FONTANELLA: What if you have a combination of all of these issues?

KENNEDY: There’s always an answer, there’s always a way of coming up with a plan. I would say quickly I would see a lot of mashed potatoes in your future if that were your situation.

FONTANELLA: Sometimes when you undergo treatment, taste changes and maybe things don’t taste like they used to, and your favorite food isn’t your favorite anymore. Is there a way to address that and really make it work for you?

KENNEDY: So when you’re under-hydrated, those taste changes can be worse, so again, getting that hydration — you hear it over and over — is super important. Water often doesn’t taste good, so assuming you don’t have mouth sores, adding lemon or orange can really help make the water more palatable. You can also take 100% juice add an ounce or two to your water to flavor your water. Sour and tart flavors can help cut through some of the taste issues, so looking for pomegranate, kiwi, citrus or ginger. Those kind of flavor profiles might be really helpful.

For anyone with a metal taste, which is a common side effect, you’re going to pick up on anything that touches metal that you ingest, like cans, sodas, even silverware. Look to use plastic, chopsticks, or glass silverware; look to avoid aluminum foil; use a different kind of packaging. So avoiding metal can really help.

Sometimes there are certain vitamins that can help, but those are good conversations to have one on one with your dietitian.

FONTANELLA: So if you’re a caregiver or you know somebody who is going to be making meals for you, that’s probably a conversation you should have with them.

KENNEDY: Oh yeah, absolutely — questions like, “Are you having any taste changes?” And you know, foods not tasting like they’re supposed to is common, and so like I said there’s a couple supplements we sometimes suggest, but a lot of times it’s exploring new foods, it’s an opportunity. So, having those conversations is a good starting point.

FONTANELLA: Now, if someone is experiencing a side effect that we haven’t talked about today, how do they go about addressing that and how can they get tips on those changes?

KENNEDY: We have a lot of tips on our website: You can see a lot of tips for managing side effects. We have recipes that are tagged by side effect as well, so you can search through our recipe database. But bring it up, don’t be shy — ask for a consultation with a dietitian at your facility, or go online and look up a dietician that is also an expert in cancer and try to reach out to get an appointment.

This interviewed has been edited and condensed for clarity.