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Table of Contents Overview of Nutrition in Cancer Care
Effect of Cancer on Nutrition
Effect of Cancer Treatment on Nutrition
Nutrition Therapy Overview
Nutrition Suggestions for Symptom Relief
Other Nutrition Issues
Resources
Get More Information From NCI
Changes to This Summary (08/22/2008)
Questions or Comments About This Summary
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Overview of Nutrition in Cancer Care
Cancer and cancer treatments may cause nutrition-related side effects.
The diet is an important part of cancer treatment. Eating the right kinds of foods before, during, and after treatment can help the patient feel better and stay stronger.
To ensure proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients (vitamins, minerals, protein, carbohydrates, fat, and water). For many patients, however, some side effects of cancer and cancer treatments make it difficult to eat well. Symptoms that interfere with eating include anorexia, nausea, vomiting, diarrhea, constipation, mouth sores, trouble with swallowing, and pain. Appetite, taste, smell, and the ability to eat enough food or absorb the nutrients from food may be affected. Malnutrition (lack of key nutrients) can result, causing the patient to be weak, tired, and unable to resist infections or withstand cancer therapies. Eating too little protein and calories is the most common nutrition problem facing many cancer patients. Protein and calories are important for healing, fighting infection, and providing energy.
Anorexia and cachexia are common causes of malnutrition in cancer patients.
Anorexia (the loss of appetite or desire to eat) is a common symptom in people with cancer. Anorexia may occur early in the disease or later, when the tumor grows and spreads. Some patients may have anorexia when they are diagnosed with cancer. Almost all patients who have widespread cancer will develop anorexia. Anorexia is the most common cause of malnutrition in cancer patients.
Cachexia is a wasting syndrome that causes weakness and a loss of weight, fat, and muscle. It commonly occurs in patients with tumors of the lung, pancreas, and upper gastrointestinal tract and less often in patients with breast cancer or lower gastrointestinal cancer. Anorexia and cachexia often occur together. Weight loss can be caused by eating fewer calories, using more calories, or a combination of the two. Cachexia can occur in people who are eating enough, but who cannot absorb the nutrients. Cachexia is not related to the tumor size, type, or extent. Cancer cachexia is not the same as starvation. A healthy person's body can adjust to starvation by slowing down its use of nutrients, but in cancer patients, the body does not make this adjustment.
Good eating habits during cancer care help the patient cope with the effects of the cancer and its treatment.
Nutrition therapy can help cancer patients get the nutrients needed to maintain body weight and strength, prevent body tissue from breaking down, rebuild tissue, and fight infection.
Eating guidelines for cancer patients can be very different from the usual suggestions for healthful eating. Nutrition recommendations for cancer patients are designed to help the patient cope with the effects of the cancer and its treatment. Some cancer treatments are more effective if the patient is well nourished and getting enough calories and protein in the diet. People who eat well during cancer treatment may even be able to handle higher doses of certain treatments. Being well-nourished has been linked to a better prognosis (chance of recovery).
Reference citations in some PDQ Supportive Care information summaries may include links to external Web sites that are operated by individuals or organizations for the purpose of marketing or advocating the use of specific treatments or products. These reference citations are included for informational purposes only. Their inclusion should not be viewed as an endorsement of the content of the Web sites or of any treatment or product by the PDQ Supportive Care Editorial Board or the National Cancer Institute (NCI).
 Back to Top Effect of Cancer on Nutrition
Cancer can change the way the body uses food.
Tumors may produce chemicals that change the way the body uses certain nutrients. The body's use of protein, carbohydrates, and fat may be affected, especially by tumors of the stomach or intestines. A patient may appear to be eating enough, but the body may not be able to absorb all the nutrients from the food. Diets higher in protein and calories can help correct this and prevent the onset of cachexia. Drugs may also be helpful. It is important to monitor nutrition early, as cachexia is difficult to completely reverse.
Drugs may help relieve cancer symptoms and side effects that cause weight loss.
Early treatment of cancer symptoms and side effects that affect eating and cause weight loss is important. Both nutrition therapy and drugs can help the patient maintain a healthy weight. The types of drugs commonly used to relieve these symptoms and side effects include the following:
(Refer to the Nutrition Screening and Assessment section and the Nutrition Suggestions for Symptom Relief section for more information.)
Back to Top Effect of Cancer Treatment on Nutrition
Effect of Surgery on Nutrition
Surgery increases the body's need for nutrients and energy.
The body needs extra energy and nutrients to heal wounds, fight infection, and recover from surgery. If the patient is malnourished before surgery, there may be complications during recovery, such as poor healing or infection. Patients with certain cancers, such as cancers of the head, neck, stomach, and intestines, may be malnourished at diagnosis. Nutrition care may therefore begin before surgery.
Nutrition-related side effects may occur as a result of surgery.
More than half of cancer patients have cancer-related surgery. Surgery may include the removal of all or parts of certain organs, which may affect a patient's ability to eat and digest food. The following are nutrition problems related to specific surgeries:
- Surgery to the head and neck may cause chewing and swallowing problems. Mental stress due to the amount of tissue removed during surgery may affect appetite.
- Surgery involving cancer of organs in the digestive system may lessen the ability of the digestive system to work properly and may slow the digestion of food. Removal of part of the stomach may cause a feeling of fullness before enough food has been eaten. Stomach surgery may also cause dumping syndrome (emptying of the stomach into the intestines before food is digested). Some of the organs in the digestive system normally produce important hormones and chemicals that are necessary for digestion. If surgery affects these organs, the protein, fat, vitamins, and minerals in the diet may not be absorbed normally by the body. Levels of sugar, salt, and fluid in the body may become unbalanced.
Nutrition therapy can treat these problems and help cancer patients get the nutrients they need.
Nutrition therapy can treat the nutrition-related side effects of surgery.
Nutrition therapy may include the following:
Surgery may cause fatigue, pain, and loss of appetite.
It is common for patients to experience pain, tiredness, and/or loss of appetite after surgery. For a short time, some patients may not be able to eat their regular diet because of these symptoms. The following eating tips may help:
- Avoid carbonated drinks (such as sodas) and gas-producing foods (such as beans, peas, broccoli, cabbage, brussel sprouts, green peppers, radishes, and cucumbers).
- If regularity is a problem, increase fiber by small amounts and drink lots of water. Good sources of fiber include whole-grain cereals (such as oatmeal and bran), beans, vegetables, fruit, and whole grain breads.
- Choose high-protein and high- calorie foods to help wounds heal. Good choices include eggs, cheese, whole milk, ice cream, nuts, peanut butter, meat, poultry, and fish. Increase calories by frying foods and using gravies, mayonnaise, and salad dressings. Supplements high in calories and protein are available.
Effect of Chemotherapy on Nutrition
Chemotherapy may affect the whole body.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Because chemotherapy targets rapidly dividing cells, healthy cells that normally grow and divide rapidly may also be affected by the cancer treatments. These include cells in the mouth and digestive tract.
Nutrition-related side effects may occur during chemotherapy.
Side effects that interfere with eating and digestion may occur during chemotherapy. The following side effects are common:
Nutrition therapy can treat the nutrition-related side effects of chemotherapy.
The side effects of chemotherapy may make it difficult for a patient to obtain the nutrients needed to regain healthy blood counts between chemotherapy treatments. Nutrition therapy can treat these side effects and help chemotherapy patients get the nutrients they need to tolerate and recover from treatment, prevent weight loss, and maintain general health. Nutrition therapy may include the following:
Effect of Radiation Therapy on Nutrition
Radiation therapy can affect healthy cells in the treatment area.
Radiation therapy is a cancer treatment that uses high energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
Healthy cells that are near the cancer may be affected by the radiation treatments, and side effects may occur. The side effects depend mostly on the radiation dose and the part of the body that is treated.
Nutrition-related side effects may occur during radiation therapy.
Radiation therapy to any part of the digestive system is likely to cause nutrition -related side effects. The following side effects may occur:
- Radiation therapy to the head and neck may cause anorexia, taste changes, dry mouth, inflammation of the mouth and gums, swallowing problems, jaw spasms, cavities, or infection.
- Radiation therapy to the chest may cause infection in the esophagus, swallowing problems, esophageal reflux (a backwards flow of the stomach contents into the esophagus), nausea, or vomiting.
- Radiation therapy to the abdomen or pelvis may cause diarrhea, nausea and vomiting, inflammation of the intestine or rectum, and fistula (holes) in the stomach or intestines. Long-term effects can include narrowing of the intestine, chronic inflamed intestines, poor absorption, or blockage in the stomach or intestine.
- Radiation therapy may also cause tiredness, which can lead to a decrease in appetite and a reduced desire to eat.
Nutrition therapy can treat the nutrition-related side effects of radiation therapy.
Nutrition therapy during radiation treatment can provide the patient with enough protein and calories to tolerate the treatment, prevent weight loss, and maintain general health. Nutrition therapy may include the following:
Effect of Immunotherapy on Nutrition
Nutrition-related side effects may occur during immunotherapy.
Immunotherapy is treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biologic therapy or biotherapy.
The following nutrition -related side effects are common during immunotherapy:
Nutrition therapy can treat the nutrition-related side effects of immunotherapy.
If the side effects of immunotherapy are not treated, weight loss and malnutrition may occur. These conditions can cause complications during recovery, such as poor healing or infection. Nutrition therapy can treat side effects from immunotherapy and help patients get the nutrients they need to tolerate treatment, prevent weight loss, and maintain general health.
Effect of Bone Marrow and Stem Cell Transplantation on Nutrition
Bone marrow and stem cell transplant patients have special nutritional needs.
Bone marrow and stem cell transplantation are methods of replacing blood -forming cells destroyed by cancer treatment with high doses of chemotherapy or radiation therapy. Stem cells (immature blood cells) are removed from the bone marrow of the patient or a donor and are frozen for storage. After the chemotherapy and radiation therapy are completed, the stored stem cells are thawed and given back to the patient through an infusion. Over a short time, these reinfused stem cells grow into (and restore) the body’s blood cells.
Chemotherapy, radiation therapy, and medications used in the transplant process may cause side effects that prevent a patient from eating and digesting food as usual. These side effects include the following:
Transplant patients also have a very high risk of infection. The high doses of chemotherapy and radiation therapy reduce the number of white blood cells, the cells that fight infection. Cancer patients should be especially careful to avoid infections and food-borne illnesses. Patients are advised to avoid eating certain foods that may carry harmful bacteria.
Nutrition therapy can treat the nutrition-related side effects of bone marrow and stem cell transplantation.
Patients undergoing the transplant process need adequate protein and calories to tolerate and recover from the treatment, prevent weight loss, fight infection, and maintain general health. Nutrition therapy is also designed to avoid possible infection from bacteria in food. Nutrition therapy during the transplant process may include the following:
- A diet of only cooked and processed foods, avoiding raw vegetables and fresh fruit.
- Instruction on safe food handling.
- Specific diet guidelines based on the type of transplant and the cancer site.
- Parenteral nutrition (feeding through the bloodstream) during the first few weeks after the transplant is complete, to ensure the patient gets the calories, protein, vitamins, minerals and fluids needed for good health.
Back to Top Nutrition Therapy Overview
Nutrition Screening and Assessment
Finding and treating nutrition problems early may improve the patient's prognosis (chance of recovery).
Early nutrition screening and assessment can identify problems that affect the success of anticancer therapy. Patients who are underweight or malnourished may not respond well to cancer treatments. Malnutrition may be caused by the cancer or made worse as the cancer progresses. Finding and treating nutrition problems early may help the patient gain or maintain weight, improve the patient's response to therapy, and reduce complications of treatment.
Screening and assessment are done before beginning anticancer therapy, and assessment continues throughout treatment.
Because the ability to tolerate treatment is better for the well-nourished patient, screening and assessment are done before beginning anticancer therapy. Appropriate nutrition management is begun early, and nutritional status is checked often during treatment.
Screening is used to identify patients who may be at nutritional risk. Assessment determines the complete nutritional status of the patient and identifies if nutrition therapy is needed. The patient or caregiver may be asked for the following information:
- Weight changes over the past 6 months.
- Changes in the amount and type of food eaten compared to what is usual for the patient.
- Problems that have affected eating, such as nausea, vomiting, diarrhea, constipation, dry mouth, changes in taste and smell, mouth sores, pain, or loss of appetite.
- Ability to walk and perform the activities of daily living.
A physical exam is part of the assessment. The physical exam will check the body for general health and signs of disease, such as lumps or growths. The physician will look for loss of weight, fat and muscle, and fluid buildup in the body.
Ongoing assessment is completed by a healthcare team with expertise in nutritional management.
A nutrition support team will monitor the patient's nutritional status during cancer treatment and recovery. The team may include the following specialists:
Goals of Nutrition Therapy
The goals of nutrition therapy for cancer patients in active treatment and recovery are designed to restore nutrient shortages, maintain nutritional health, and prevent complications.
The goals of nutrition therapy for patients in active treatment and recovery are to do the following:
- Prevent or correct malnutrition.
- Prevent wasting of muscle, bone, blood, organs, and other lean body mass.
- Help the patient tolerate treatment.
- Reduce nutrition-related side effects and complications.
- Maintain strength and energy.
- Protect ability to fight infection.
- Help recovery and healing.
- Maintain or improve quality of life.
A patient whose religion forbids eating certain foods may consider speaking with a religious leader about waiving the restriction during cancer treatment and recovery.
Good nutrition continues to be important for patients who are in remission or whose cancer has been cured.
The goals of nutrition therapy for patients who have advanced cancer are designed to improve the quality of life.
The goals of nutrition therapy for patients who have advanced cancer are to do the following:
- Reduce side effects.
- Reduce risk of infection.
- Maintain strength and energy.
- Improve quality of life.
Methods of Nutrition Care
Nutrition support provides nutrition to patients who cannot eat normally.
Eating by mouth is the preferred method and should be used whenever possible, but some patients may not be able to take any or enough food by mouth due to complications from cancer or cancer treatment. This may include patients with cancer of the head, neck, esophagus, or stomach. A patient may be fed using enteral nutrition (through a tube inserted into the stomach or intestine) or parenteral nutrition infused into the bloodstream directly). The nutrients are delivered in formulas, liquids that contain water, protein, fats, carbohydrates, vitamins, and/or minerals. The content of the formula depends on the needs of the patient and the method of feeding.
Nutritional support can improve a patient's quality of life during cancer, but there are risks and disadvantages that should be considered before making the decision to use it. The effect of nutritional support on tumor growth is not known. Also, each form of nutrition therapy has its own benefits and disadvantages. For example, enteral nutrition keeps the stomach and intestines working normally and has fewer complications than parenteral nutrition; nutrients are used more easily by the body in enteral feeding. These and other issues should be discussed with the patient's health care providers so that an informed decision can be made. (See the Advanced Cancer section below for more information on deciding whether to use nutritional support.)
Patients with certain conditions are most appropriate for treatment with nutrition support.
Nutrition support may be helpful for patients who have one or more of the following characteristics:
- Low body weight.
- Inability to absorb nutrients.
- Holes or draining abscesses in the esophagus or stomach.
- Inability to eat or drink by mouth for more than 5 days.
- Moderate or high nutritional risk.
- Ability, along with the caregiver, to handle tube feedings at home.
Enteral Nutrition
Enteral nutrition is also called tube feeding.
Enteral nutrition is food (in liquid form) given to the patient through a tube that is inserted into the stomach or the small intestine. The following types of tube feeding may be used:
- A tube inserted through the nose and throat down into the stomach or small intestine. This kind of tube is usually used for short-term use.
- A tube inserted into the stomach or small intestine through a stoma (an opening made on the outside of the abdomen). This kind of tube is usually chosen for long-term use or for patients who cannot tolerate a tube in the nose and throat.
If the tube is placed in the stomach, food may be given through the tube continuously or in batches several times a day. If the tube is placed in the small intestine, the food is delivered continuously. Different formulas are available. Some provide complete nutrition and others provide certain nutrients. Formulas that meet the patient's specific needs are selected. Formulas are available for patients who have other health conditions, such as diabetes.
Enteral nutrition is sometimes used when the patient is able to eat small amounts by mouth but cannot obtain enough food that way. The patient may continue to eat or drink as able, and the tube feeding provides the balance of calories and nutrients that are needed.
Enteral nutrition may be appropriate for patients whose gastrointestinal tract is still working.
Enteral nutrition continues to use the stomach and/or intestines to digest food. Enteral nutrition may be used for patients who have cancer of the head, neck, or digestive system and whose treatment with chemotherapy and radiation therapy causes side effects that limit eating or drinking.
Enteral nutrition is not appropriate for the following patients:
- Patients whose stomach and intestines are not working or have been removed.
- Patients who have a blockage in the bowel.
- Patients who have severe nausea, vomiting, and/or diarrhea.
- Patients whose platelet count is low. Platelets are blood cells that help prevent bleeding by causing blood clots to form.
- Patients who have low levels of all blood cells (white blood cells, red blood cells, and platelets).
Enteral nutrition may continue after a patient leaves the hospital.
If enteral nutrition is to be part of the patient's care after leaving the hospital, the patient and caregiver will be trained in use of the tube and pump, and in care of the patient. The home must be clean and the patient must be monitored often by the nutrition support team.
Parenteral Nutrition
Parenteral nutrition provides the patient with nutrients delivered into the blood stream.
Parenteral nutrition is used when the patient cannot take food by mouth or by enteral feeding. Parenteral feeding bypasses the normal digestive system. Nutrients are delivered to the patient directly into the blood, through a catheter (thin tube) inserted into a vein. Patients with the following problems may benefit from parenteral nutrition:
- Stomach and intestines that are not working or have been removed.
- Severe nausea, diarrhea, or vomiting.
- Severe sores in the mouth or esophagus.
- A fistula (hole) in the stomach or esophagus.
- Loss of body weight and muscle with enteral nutrition.
The catheter may be placed into a vein in the chest or in the arm.
A central venous catheter is placed beneath the skin and into a large vein in the upper chest. Placement of a central venous catheter is done by a surgeon.
A peripheral venous catheter is placed into a vein in the arm. Placement of a peripheral venous catheter is done by trained medical staff. This site may be used for short-term parenteral feeding.
The patient is checked often for infection or bleeding at the site (place) where the catheter enters the body.
Some drugs should not be given with parenteral formulas.
Many drugs and other substances do not mix safely with the formulas used for parenteral feeding. A pharmacist or doctor should be consulted before adding anything to the formula or using the catheter for another substance.
Trained medical staff should manage the use of parenteral nutrition.
The techniques and formulas involved in parenteral nutrition support are precise and require management by trained medical staff or a nutrition support team. Some of the serious complications that may occur with parenteral feeding include the following:
- Placement of the tip of the catheter into the wrong place.
- Blood clots.
- A collapsed lung.
- A high or low sugar level in the blood.
- A low potassium level in the blood.
- Elevated liver enzymes.
Parenteral nutrition support may continue after a patient leaves the hospital.
If parenteral nutrition is to be part of the patient's care after leaving the hospital, the patient and caregiver will be trained in the procedures and in care of the patient. The home must be clean and the patient must be monitored often by the nutrition support team.
Experienced medical staff should manage the patient's removal from parenteral nutrition support.
Going off parenteral nutrition support needs to be done gradually and under medical supervision. The parenteral feedings are reduced by small amounts over time as the patient is changed to enteral or oral feeding.
Back to Top Nutrition Suggestions for Symptom Relief
When side effects of cancer or cancer treatment interfere with normal eating, adjustments can be made to ensure the patient continues to get the necessary nutrition. Medications may be given to stimulate the appetite. Eating foods that are high in calories, protein, vitamins and minerals is usually advised. Meal planning, however, should be individualized to meet the patient's nutritional needs and tastes in food.
Anorexia
Anorexia (lack of appetite) is one of the most common problems for cancer patients. The following suggestions may help cancer patients manage anorexia:
- Eat small high- protein and high- calorie meals every 1-2 hours instead of 3 larger meals.
- Have help with preparing meals.
- Add extra calories and protein to food (such as butter, skim milk powder, honey, or brown sugar).
- Take liquid supplements (special drinks containing nutrients), soups, milk, juices, shakes, and smoothies when eating solid food is a problem.
- Eat snacks that contain plenty of calories and protein.
- Prepare and store small portions of favorite foods so they are ready to eat when hungry.
- Eat breakfasts that contain one third of the calories and protein needed for the day.
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