Eating Problems During Cancer Treatment

Eating problems during cancer treatment are a common experience. About 20 to 70% of people treated for cancer have some trouble eating. (1)  While this is distressing, it is not your fault, and you don’t have to feel guilty, frustrated, or anxious about it. Cancer and its treatments (chemotherapy, radiation, and immunotherapy) can make it significantly harder to eat well. If eating problems continue over time, they can lead to unintentional weight loss, loss of muscle mass and strength, and an increased risk of malnutrition. Early support can help prevent these problems from becoming more severe. Cancer itself can dampen your mood, suppress your appetite, and make it harder to chew and swallow. Its treatments can have side effects causing problems that can affect your eating and diet. (2,3) Your health care team can help create a personalised plan that addresses your concerns. This article provides more information about what to expect, how to manage the situation, and how to recognise signs that you may need urgent care. 

Cancer can affect eating because both cancer and its treatment can change your emotions, appetite, anatomy, gut functions, and metabolism. These changes can manifest as: (4)

• Change in smell and taste, which makes food unpleasant.
• Nausea and vomiting.
• Constipation, diarrhoea, bloating, reflux.
• Pain in your stomach, mouth, or throat.
• Mouth sores, dry mouth, difficulty chewing or swallowing.
• Getting full quickly.
• Fatigue and weakness making it harder to prepare meals or even chew.
• Emotional stress, anxiety, or depression, which can reduce  appetite.
• Reduced appetite due to inflammation and hormonal changes.
• Side effects of medication, such as steroids, painkillers, or anti-sickness drugs. 

You may experience unintentional weight and muscle loss if your eating problems persist for a long time. 

Eating problems are not always obvious. They can go unnoticed until weight changes start to show up. But weight loss is not the only warning sign. Other signs include: 

• Feeling tired most of the time 
• Unexplained weakness 
• Dizziness 
• Signs of dehydration 
• Loss of your muscle mass or strength
• Your clothes or jewellery become loose 
• You struggle to finish your meals 
• You show signs of nutritional deficiencies 

Let your healthcare team know if you experience any of these symptoms.   

Although appetite loss is common during cancer treatment, small changes can make a big difference. The goal isn’t to eat too much; it’s to eat well. You need to eat enough to maintain energy, meet your daily nutrient needs, and support recovery. If your symptoms persist, speak with a registered dietitian or your medical team. 

Eating problems make it difficult to get the nutrients you need for recovery. Here are practical strategies to help you eat enough food each day: 

• Eat small food portions more often throughout the day.
• Focus on eating high-calorie, high-protein meals.
• Make food taste better by adding sauces, gravy, herbs and spices, and healthy oils.
• Drink nourishing fluids between meals, e.g. milk, fruit juices, smoothies.
• Rinse your mouth with water.
• Eat as much as you can when your appetite is at its best.
• If you are sensitive to smells, try to choose (eat) cold food which produces less odours or ask someone to help with food preparation.
• Snack on high-calorie foods like nuts, eggs, cheese and avocados.

Certain foods and recipes made just for you can help you maintain adequate nutrition. Consider making small nutrient-rich meals that contain good amounts of energy, are high in protein and may include healthy fats and easily digested carbohydrates. 

Remember to choose meals that don’t make your symptoms worse and prepare them in ways that address your taste changes, nausea, or swallowing problems. For instance, blending, mashing, freezing, or roasting your food.

If you are unable to get enough nutrients from your normal diet and drinks alone, your medical team can recommend oral nutritional supplements to help fill the nutritional gap.

Oral Nutritional Supplements are food for special medical purposes and must be used under medical supervision. Oral nutritional supplements can supply energy, protein and other nutrients. They can help you meet your nutritional requirements, especially when you are struggling with low appetite, fatigue, or treatment side effects. Speak to your doctor or medical team about oral nutritional supplements before taking them. 

You may require tube feeding to meet your nutritional needs. This type of nutrition support is usually recommended and monitored by the multidisciplinary healthcare team. Common feeding tubes include:

• Nasogastric tube: this is a fine tube passed from your nose into your stomach.
• Nasoduodenal tube: this is a tube passed from your nose into your small intestine. It is used to bypass your stomach if you have reflux, or food cannot stay in your stomach. 
• Gastrostomy tube: (also called a G-tube) this is a tube used for longer-term feeding placed in your stomach through your abdomen. It may be used when you have a functioning digestive system but can’t swallow. 

Enteral tube feed products are food for special medical purposes and must be used under medical supervision.

Eating problems can affect you emotionally and impact how you act/interact with people around you. You don’t have to feel guilty about not being able to eat, whether this happens when you are alone or when you are with friends or family. 

You can socialise without eating. If anyone asks, let them know you’ll eat when you feel like it. 

If you are caring for someone with cancer-related eating problems, offer them support. You can:

• Remind and encourage them gently to eat.
• Prepare foods they like.
• Adjust recipes. For instance, you can mash, blend, toast, or roast their food.
• Make food and snacks readily available.
• Join them for dietitian visits and help them follow their meal plan. Ask about additional nutrition support and suggestions from the dietitian to help them meet their nutritional needs. 
• Create a pleasant mealtime experience. Don't force them to eat or blame them for their eating problems.
• Note any struggles they have with weight, appetite, or keeping food down and discuss them with their healthcare team.

While managing eating problems, speak to your medical team if you experience any of the following:

• Prolonged, severe loss of appetite.
• Rapid unintended weight loss.
• Noticeable loss of muscle mass or decline in strength.
• Vomiting after food.
• Signs of dehydration, such as dark urine, lightheadedness, or a dry mouth.
• Vomiting that doesn’t go away despite prescribed medication.
• A profound weakness that keeps you in bed.
• Severe emotional distress.

Seek care early to avoid malnutrition, prevent complications, and support your recovery.

Eating problems during cancer treatment are common and can arise because of the cancer, its treatments, and how you are feeling. Choosing the right meals and eating habits can help you get the right nutrients. Sometimes in spite of these changes your nutritional needs cannot be met by normal food alone, this is when your medical team can recommend oral nutritional supplements. With this holistic approach, you can get the right nutrients, regain appetite, and support your recovery.