Diet during cancer treatment

Nutritional status and diet play an essential role from the preventive stage to the final stage of cancer, influencing its evolution, prognosis, treatment results and the patient's quality of life.

From the moment of cancer diagnosis, diet should be one more tool for its treatment, adapting periodically to the evolution of the disease, contributing to the maintenance of the patient's weight, strength and mood, essential elements for the success of the therapies.

The most frequent problems that require modifications of the diet are:

• General effects caused by the disease. Examples: alterations in the perception of taste, loss of appetite and decay.

• The effects caused by certain tumors due to their location in the digestive tract, head or neck. Examples: obstructions and swallowing difficulties.

• Side effects caused by surgeries or different therapies. Examples: nausea, vomiting, diarrhea and mucositis.

Objectives of the diet during cancer treatment

• Prevent or correct nutritional deficit.

• To improve tolerance to antitumor therapy.

• To improve the patient's immune status.

• To decrease the risks of surgical complications.

• To better combat possible complications.

• Improve the patient's quality of life.

General recommendations for the planning of the diet of patients with cancer

• Avoid having the patient prepare his/her own food.

• To carry out physical activities according to their condition that stimulate appetite.

• Distribute food throughout the day between 6 and 7 meals a day with schedules appropriate to the medication and the patient's general condition.

• Plan diets that include a wide variety of foods, with high energy and protein density, to ensure additional nutrient requirements, in order to maintain body weight and muscle tissue.

• Take advantage of the hours of greater appetite and better emotional condition of the patient (generally the morning) to provide the most copious meals, which include a greater number of important foods.

• It is recommended to prepare small snacks to be taken between meals. Examples: milk or yogurt with cereals, poultry, cheese and vegetable sandwiches, a bowl of hearty soup and bread or crackers, etc. Before going to bed solid foods are not recommended, a glass of milk or yogurt is better tolerated.

• It is not recommended to drink liquids during meals to avoid the sensation of premature satiety.

• Food should be steamed, boiled, boiled, cooked, microwaved, adding little fat.

• A pleasant atmosphere should be sought during meals, preferably in the company of family and friends.

• No meal should be omitted.

• Food should be served at room temperature, slightly warm or cool; it should not be eaten hot or cold.

Dietary modifications to mitigate nutritional complications caused by cancer or its treatment.

Lack of appetite:

• Plan 6 to 7 moderate meals a day.

• Adjust meal times to the patient's mood and physical condition. Most of the patients in the first hours of the day, tolerate better the most copious meals, with several important foods.

• Vary frequently the food, as well as the way of preparation and presentation of the dishes, taking into account the patient's preferences.

• Food should be served soft, easy to chew. If necessary, purees, croquettes or meatballs should be prepared.

To increase the caloric and protein content of the various meals throughout the day, it is recommended:

• Add cream, milk, soy powder, margarine, cream or cheese to pasta, potatoes and rice; use peanut butter on toast and crackers.

• Include desserts such as flan, rice pudding, ice cream and custard in any meal.

Provide fluids to hydrate outside meal times. During meals, drinking a lot of liquids or infusions increases the feeling of satiety, limiting the intake of more nutritious foods such as pasta, rice, legumes, fish, meat or eggs.Fruits should preferably be given in blended form or in natural juices. Taste and smell alterations (dysgeusia):

• Identify the foods that produce the most metallic taste or repugnance because they seem bitter or very sweet and try to vary the way of preparation and presentation.

• Use aromatic herbs in the preparation of food to transform its smell. Examples: oregano, laurel, mint, thyme, parsley and basil.

• Adding simple sauces such as mayonnaise, cream or bechamel sauce to foods to mask unappetizing foods.

• Consume food at room temperature or cold so that it gives off less odor and does not diminish the taste.

• Keep the patient out of the environment where food is prepared.

• Provide fruit smoothies or juices during meals.

• No new foods or flavors should be introduced on treatment days.

• Wash or rinse your mouth before meals.

• Use plastic cutlery to reduce the metallic taste of food.

If the consumption of meats causes them aversion you can try:

• Prepare stewed meat with peas, carrots, celery, spinach or potatoes.

• To macerate the meat previously and to introduce it in lemon juice, wine or soft vinegar.

• Replace red meats with cooked ham, york ham, chicken, turkey or rabbit.

Dry mouth:

• Prepare foods in the form of broths, purees, creams, ice creams, custards, yogurt or sorbets.

• Avoid dry foods such as crackers, nuts or chips.

• Citrus juices, such as lemon and orange, facilitate saliva production.

• Take sour candies or chewing gum, lemon or orange.

• Avoid very hot and very cold foods.

• Increase the consumption of liquids, preferably outside meal times.

Swallowing difficulties (dysphagia):

• Maintain the correct position when eating: sitting, with the back straight, shoulders forward and feet flat on the floor.

• Prepare food in the form of purees, creams, jellies or custard.

• Drink water in the form of jellies.

• Do not eat rough foods such as toast and crackers.

• Avoid acidic, spicy and salty flavors.

• Eat without distractions, slowly and relaxed.

• Do not mix foods with two or more consistencies. For example: jelly, or yogurt with fruits; rice pudding and fruits in syrup.

Inflammation of the mucous membranes of the gastrointestinal tract lining (mucositis):

• Always take medication prescribed by your doctor for pain.

• Plan diets that include soft, juicy, easy-to-treat foods such as purees, broths, creams. Serve them at room temperature or slightly warm.

• It is recommended to rinse the mouth with water with bicarbonate before and after meals.

• Take foods rich in energy and protein nutrients, more frequently and in small quantities. For example: custard, ice cream, rice pudding, flan and yogurt.

• Avoid consumption of acidic, rough, bitter, very sweet, spicy, salty or sticky foods such as toast, crackers, and boiled potatoes.

Nausea and vomiting:

• Always take the medication indicated by the physician to treat them well in advance.

• You should wait about two hours after having eaten, to carry out the chemotherapy treatment; and wait an equal amount of time after the treatment to eat some food.

• Keep the body hydrated by drinking small amounts of liquids frequently.

• Meals are better tolerated when they are frequent and in small quantities. Avoid prolonged periods of fasting.

• Eat slowly and chew properly.

• Food preparations containing a lot of liquid should be avoided so as not to overfill the stomach.

• Liquids should be ingested in small portions (about half a glass at a time), away from meals at least half an hour before or half an hour after.

• Reduce the content of fats, spices and dietary fibers.

• Always eat meals sitting down or sitting up, and remain in that position for at least one hour afterwards.

• The patient should not stay in closed spaces where he/she should inhale cooking or food preparation odors.

• The dining room should be well ventilated to avoid intense food odors.

• Room temperature and cold foods are better tolerated.

To start feeding in case of vomiting, the following recommendations should be taken into account:

• Start feeding with infusions and light broths.

• Continue with skimmed milk and sorbets.

• Introduce thicker and thicker soups and purees.

• The first solid foods to be introduced are: rice, potatoes and pasta.

• Increase the amount of food in each feeding little by little.

• If vomiting persists consult a doctor.

Diarrhea:

• Eat very moderate and frequent meals.

• Drink about half a glass of water frequently.

• If the diarrhea is very abundant and liquid, it is recommended to take alkaline lemonade or oral serum to avoid dehydration.

• Avoid consumption of foods rich in dietary fiber such as whole grains, legumes and vegetables.

• Mashed potatoes and carrots are recommended as well as boiled or souped rice.
• Yogurt should be consumed instead of milk.

• Chicken meat or white fish should be prepared without using much fat.

• Avoid consumption of fatty products such as avocados, fatty meats and fish.

• Avoid consumption of stimulants such as coffee, tea, chocolate and alcoholic beverages.

• Reduce the content of spices in food, especially spicy and acidic juices.

• Provide peeled or blended fruits. Baked apples and rice or rice water are recommended for their astringent properties.

• Increase hygiene (washing and drying) after each bowel movement.

Constipation:

• Drink plenty of fluids.

• It is recommended to drink a glass of warm water on an empty stomach.

• Use olive oil as culinary fat.

• Increase intakes of fiber-rich foods such as unpeeled fruits, vegetables, whole grain cereals and breakfast cereals.

• Maintain bowel habits on an approximately fixed schedule every day.

• Consult your doctor about the use of a laxative as a preventive method.

• Walk or do some light physical exercise.

Nutritional supplements

Nutritional supplements are formulas designed to supplement the diet when the diet alone is not sufficient to meet the patient's needs. Their consumption should always be individualized and monitored by a health professional. The effect of supplements is not curative and can never replace a healthy diet.

Objectives of nutritional supplementation:

• Increase total nutrient intake in t