This post is aimed at a very specific audience and, frankly, I hope you never become part of that group. It you do, I pray this post may help you in a very difficult time. Of course each person undergoing treatment will experience different issues and varied severity of the issues. I will be happy to research anything that may help you and your loved one during this most difficult time. Please feel free to ask!
There are so many forms of cancer and each has its individual difficulties. Radiation and chemotherapy are, in some ways, worse than the cancer because of the many side effects. Some of these side effects can last years or may never fully resolve. My husband was treated for oropharyngeal cancer and had 35 radiation treatments and 3 rounds of chemotherapy. The radiation was directed at his head and neck and left him without saliva, without the ability to taste food, and with difficulties swallowing. Feeding a cancer patient is a truly challenging dilemma. Here are some of the things I’ve learned.
There are many forms of cancer and the side effects of treatment vary widely. Everyone knows that chemo leaves patients feeling weak and very sick. Patients often don’t want to eat at all but nutrition is crucial during treatment. A high enough caloric intake with the proper amount of protein, vitamins, and minerals is sometimes hard to maintain.
The patient’s cancer team should include a nutritionist who will help guide you through the stages of nutrition during treatment. But as your loved one’s caretaker you will be the one who has to provide the foods and hydration needed. It can be tricky.
In some ways we were “lucky” while my husband was getting chemo because he had a feeding tube. His nutrition and hydration were simply a matter of filling his bags and setting the pump. The removal of the feeding tube caused problems I hadn’t anticipated. In the months since the end of his treatments I’ve learned a great deal about what is and isn’t possible for him to comfortably or safely eat. I hope the things I’ve come to know can help you if you are struggling with maintaining the nutrition for a cancer patient.
No saliva – This is a common problem for anyone who has had radiation treatments to the head. The radiation basically fries the saliva glands and they stop producing. This makes it very difficult for the person to chew and swallow food. Saliva wets the food in our mouths and without it eating can be very, very challenging. Serving foods with gravies, sauces, or those that are naturally wet helps a lot! Breads and other dry items can be eaten as long as there is something that helps alleviate the natural dryness of certain foods. Avoid very spicy foods as the lack of saliva means that these no buffer between the mouth and tongue and the hot spices.
Thick saliva/secretions – My husband had extremely thick mucus at the end of and after his radiation treatments. At that time he still had his feeding tube so we didn’t have to worry about eating but if your loved one is trying to eat with this issue it can be more than challenging. Try having him/her eat pineapple or papaya to thin the secretions but only if the person doesn’t have mouth sores. Keep the mouth clean by using 1 quart of water with 1 teaspoon of salt and 1 teaspoon of baking soda as a swish and spit rinse.
Mouth sores – Radiation can cause mouth sores that make eating downright painful. Your doctor may prescribe a mouthwash (Magic Mouthwash is a common name for it) that will help with the sores. You should also avoid tart, acidic, or salty foods, as well as pickled and vinegary foods, tomato-based foods, and some canned broths. Rough-textured or hard foods, like dry toast, crackers, chips, nuts, granola, and raw fruits and vegetables should also be avoided. They can scratch or cut the mouth where sores occur. Don’t eat very hot foods. Lukewarm or cold foods are soothing. Try freezing fruits, and suck on frozen fruit pops, fruit ices, or ice chips. Stay away from alcohol, caffeine, and tobacco. Avoid irritating spices like chili powder, cloves, curry, hot sauces, nutmeg, and pepper. Season foods with herbs like basil, oregano, and thyme. Creamy foods like cream soups, cheeses, mashed potatoes, yogurt, eggs, custards, puddings, cooked cereals, and canned liquid food supplements like Boost or even Carnation Instant Breakfast are much easier to eat. Use a straw and/or tilt your head back to help food slide to the back of the mouth. Puree foods for easier eating. Eat plenty of high-protein, high-calorie foods to help speed healing. Blend and moisten foods that are dry or solid. Mix them in with soups or sauces, gravies, and casseroles. Avoid using mouthwashes that contain alcohol. This will burn the mouth.
No sense of taste/Altered taste – Just as radiation kills saliva glands, it can also destroy the person’s ability to taste food as can some chemo medicines. Experiment with flavors that stand out. Lemon and other citrus flavors may be something the person can taste. If the person has saliva you may want to try spicing things up. If the person can taste certain flavors you should try to find recipes featuring those ingredients so eating isn’t such a chore. If we can’t taste it’s hard to want to eat.
Nausea – Try grazing. Eat 6 to 8 snacks or small meals a day, instead of 3 large meals. Eat dry foods, like crackers, toast, dry cereals, or bread sticks, when you wake up and every few hours during the day. Strong odors may exacerbate the nausea. Eat foods that don’t have strong odors. Eat cool foods instead of hot or spicy foods. Avoid foods that are overly sweet, greasy, fried, or spicy. For at least an hour after eating sit up or recline with your head raised. Sip clear liquids frequently to prevent dehydration. Clear liquids include broth, sport drinks, water, juice, gelatin, and popsicles. Your doctor can prescribe medicines to prevent or stop nausea. Try bland, soft, easy-to-digest foods on scheduled treatment days. Foods like Cream of Wheat and chicken noodle soup with saltine crackers may settle the stomach better than heavy meals.Eating in a room that’s too warm, or that has cooking odors or other smells may make the person’s nausea worse. Cook outside on the grill or use boiling bags to reduce cooking odors. Hard candy like peppermint or lemon can help alleviate the symptom of a bad taste in the person’s mouth. If the person is vomiting, dehydration can become a problem. As often as possible have the person drink clear liquids. After the person has vomited, have him/her rinse his/her mouth, wait for about 30 minutes, then try to drink sips of a clear liquid like apple juice, cranberry juice, flat soda, or broth, or take bites of frozen flavored ice.
Swallowing problems – This can cause more than just issues with eating. The person can choke and even aspirate (suck food into the lungs). The doctor may refer the person to a speech therapist. Follow the speech therapist’s instructions for any special eating techniques. Call the cancer care team right away if the person cough or chokes while eating, especially if he has developed a fever. Eat small, frequent meals. Use canned liquid nutritional supplements if the person is unable to eat enough food to meet nutritional needs. Chop or puree food in a blender or food processor. Have the person drink 6 to 8 cups of fluid each day, and thicken the fluid to the consistency that’s easiest for the person to swallow. Try these thickening products:
Gelatin: Use to help soften cakes, cookies, crackers, sandwiches, pureed fruits, and other cold food. Mix 1 tablespoon unflavored gelatin in 2 cups hot liquid until dissolved; pour over food. Allow food to sit until saturated.
Tapioca, flour, and cornstarch: Use to thicken liquids. Note that these must be cooked before using.
Commercial thickeners: Follow label instructions, and use to adjust a liquid’s thickness.
Pureed vegetables and instant potatoes: Use in soups. Note that these change the food’s flavor.
Baby rice cereal: Use to make a very thick product. *I made baby rice cereal for my husband when he had his feeding tube removed. I combined it with baby food bananas and other jarred baby food and initially kept it very thin.
- If thin liquids are recommended for you, try these: coffee, tea, soft drinks, liquid nutritional supplements, Italian ice, sherbet, broth, and thin cream-based soups.
- If thick liquids are recommended for you, try these: buttermilk, eggnog, milk shakes, yogurt shakes, and ice cream.
Appetite changes – Fatigue, pain, nausea, constipation; these are just a few of the problems that may cause changes in the person’s appetite. Have the person eat several snacks throughout the day, rather than 3 large meals. Avoid liquids with meals, or take only small sips of liquids to keep from feeling full early (unless liquids are needed to help swallow or for dry mouth). Try to have the person drink most liquids between meals. Make eating more enjoyable by setting the table with pretty dishes, playing favorite music, watching TV, or eating with someone. The person should try to be as physically active as possible. Start off slowly, and increase activity over time as he/she feels stronger. Sometimes a short walk an hour or so before meals can help stimulate appetite. Keep high-calorie, high-protein snacks on hand. Try hard-cooked eggs, peanut butter, cheese, ice cream, granola bars, liquid nutritional supplements, puddings, nuts, canned tuna or chicken or trail mix. Serve the person’s favorite foods any time of the day; for instance, if the person likes breakfast foods, eat them for dinner.