Nutrition and Oncology Treatment: Managing Side Effects and Supporting Recovery

Cancer treatment is a physically and emotionally challenging journey, not only for the individual diagnosed but also for their families. As registered dietitians (RD), we work with cancer patients to optimize their nutrition, improve their quality of life, and help manage treatment side effects. Nutrition plays a crucial role during and after cancer treatment, providing the body with the nutrients it needs for energy, healing, and immune support.

Oncology Treatments Available and Common Side Effects Experienced

Cancer treatment typically involves a combination of surgery, chemotherapy, radiation therapy, and immunotherapy. Each of these treatments is designed to target cancer cells, but they can also have a wide range of effects on a patient’s health and nutrition status.

Let’s break down how these treatments work and what side effects they commonly cause.

1. Chemotherapy: This treatment uses medication to destroy or slow the growth of cancer cells, but it can also impact healthy cells, leading to side effects like nausea, vomiting, fatigue, and appetite loss.

2. Radiation Therapy: While it’s focused to target cancer cells, radiation can also damage surrounding tissues, particularly those in the gastrointestinal (GI) tract, leading to symptoms such as dry mouth, difficulty swallowing, and diarrhoea.

3. Immunotherapy: Helps to stimulate the body’s immune system to recognize and fight cancer cells. However, it may cause gastrointestinal issues, fatigue, skin changes, and appetite changes.

4. Surgery: The removal of tumours or organs may affect the body’s ability to digest food properly, especially if parts of the digestive tract are removed or altered.

5. Hormone therapy: This treatment is designed to block hormones that promote cancer growth, this can cause nausea, fatigue, weight gain & muscle loss.

Managing Oncology Related Side Effects with Nutrition

While cancer treatments vary, they often share some common side effects. Managing these side effects effectively is crucial to a patient’s ability to continue with treatment and to maintain optimal nutrition.

Nutrition can play a key role in managing and alleviating some of the side effects of cancer treatment, here is a list of the common side effects and how to nutritionally manage these difficulties:

1. Loss of appetite 

2. Focus on consuming small, frequent meals throughout the day

3. Make use of high-calorie, nutrient dense food items. Always make sure to use the full cream or full fat option and try incorporating protein into most meals. Examples include full fat dairy products with fruit, smoothies made with nut butter & protein powder, oats with nut butter, fruit & protein powder and soup containing vegetables, legumes and protein.

4. Make sure to drink enough fluids during the course of the day. It might help to sip on water, herbal tea, fruit juice or nutrient rich beverages

5. Avoid greasy, spicy or very sweet foods

6. Nausea & vomiting

7. Consume small, frequent meals.

8. Focus on bland, low fat or less greasy food. Make use of dry crackers, plain rice cakes, toast, banana or applesauce.

9. Ginger or peppermint tea & chews can be included.

10. Stay hydrated with clear fruit juice, electrolyte containing drinks or broth.

11. Mouth sores (Mucositis) or a dry mouth (Xerostomia)

12. Focus on soft, moist foods such as mashed potato & gravy, scrambled eggs, smoothies, etc.

13. Include cold foods more often like ice cream, cold smoothies, drinking yogurt as this can help soothe the mouth and reduce discomfort.

14. Limit acidic food intake such as pineapple, oranges, tomatoes, etc.

15. Diarrhoea

16. Reduce the amount of fibre in your diet and focus on easily digestible foods like white rice, toast, banana, applesauce. Limit the intake of dairy products, caffeine, and fatty foods.

17. Constipation

18. Make sure to stay well hydrated by dinking enough water, herbal tea or homemade iced teas. A general fluid recommendation is calculated based on weight (30-40 ml per kilogram of body weight, per day)

19. Make sure to include adequate fibre (fruit, vegetables, oats and whole grain starches)

20. Movement can also help to improve constipation

21. Fatigue

22. Fatigue can be a side effect of oncology treatment but also of poor nutritional intake, therefore it is essential to follow a balanced diet which includes all your macronutrients (carbohydrates, protein & healthy fats)

23. Stay well hydrated

24. Taste changes (Dysgeusia)

25. Include colder, or room temperature foods.

26. Experiment with different herbs & spices to enhance the flavour of food

Nutrition Recommendations for Oncology Patients

Nutrient deficiencies can often cause symptoms such as fatigue, poor wound healing, weakness, hair loss & brittle nails. If you experience any of these symptoms, it is important to inform your healthcare provider.

Key areas to focus on to prevent nutritional deficiencies include:

• Ensure to consume adequate protein. Aim for 1.2 - 2.0 grams of protein per kilogram of body weight, daily.

• Make use of calorie rich foods.

• If you are struggling to meet your requirements, make use of nutritional supplements, meal replacement shakes or protein powders (This should only be used under the supervision of your healthcare team)

Common deficiencies in oncology patients, may include:

• Vitamin D: Important for immune function and bone health.

• Iron: A lack of iron can exacerbate fatigue.

• Calcium: Necessary for bone health, especially during long-term treatment.

• Vitamin B12: Often depleted in patients undergoing chemotherapy.

• Folate: Can be low, particularly after chemotherapy.

(These deficiencies can only be diagnosed and treated by your healthcare provider and should not be treated on your own as certain nutrients can interfere with oncology treatment outcomes).

Conclusion

Managing oncology treatment from a dietary perspective requires a comprehensive approach that involves addressing treatment side effects, preventing nutritional deficiencies, and promoting healing and recovery. Nutrition is a powerful tool in improving the quality of life, reducing the severity of side effects, and ultimately enhancing treatment outcomes to work towards a healthier future.

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References

1. Garutti, M.; Noto, C.; Pastò, B.; Cucciniello, L.; Alajmo, M.; Casirati, A.; Pedrazzoli, P.; Caccialanza, R.; Puglisi, F. Nutritional Management of Oncological Symptoms: A Comprehensive Review. Nutrients 2023, 15, 5068. https://doi.org/10.3390/nu15245068

2. Ravasco, P. Nutrition in Cancer Patients. J. Clin. Med. 2019, 8, 1211. https://doi.org/10.3390/jcm8081211