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  • Body

  • Loss of appetite

    Why it happens: 

    Losing your appetite is one of the most common problems caused by cancer and its treatment. There are many reasons why someone may have a loss of appetite either during or after cancer treatment. The side effects of treatment itself can put a person off their food. Emotions such as stress and depression can also play a part and contribute to appetite loss.

    Helpful tips:

    • Try to eat small, frequent meals and snacks every 2 - 3 hours, instead of having 3 meals a day.
    • Have starchy, ‘energy providing’ foods at each meal, such as breads, potatoes, rice, pasta, cereals, rice flour, cornmeal, couscous, maize, taro or sweet potato.
    • Include protein-rich foods in your meals at least twice a day. This includes meat, chicken, turkey or fish. Vegetarian options include eggs, lentils, beans, Quorn, tofu, soya mince, cheese or yogurt.
    • Be flexible with mealtimes. Make the most of the times when you do feel well and have a larger meal.
    • Soft foods are easier to manage when the appetite is poor, for example shepherd’s pie, curry, well-stewed meat, mashed potato, fish in sauce and scrambled eggs.
    • Have a pudding twice a day. Try fruit with cream/custard or Greek yogurt, cheesecake, ice cream, crème caramel, trifle, full fat fromage frais/yogurt or plain sponge cake.
    • Avoid drinking too much fluid with meals as this may reduce how much is eaten as it can make you feel full.
    • Keep high-calorie snacks within easy reach. Cheese and crackers, biscuits, cakes, nuts, dried fruit and peanut butter on toast are a good way to get extra calories and protein throughout the day.
    • Add cream, butter, whole milk or honey to food to increase calorie and protein intake.
    • Think outside of the box. The foods you eat at meals do no have to be the same as what you used to eat previously. For example you could have a cooked breakfast as a lunch or evening meal if you preferred to eat something like this or a small bowl of cereal as a light snack.
    • If you find eating solid foods difficult, try over the counter nourishing drinks during the day e.g. milky drinks such as Complan®. If you are struggling to eat enough, talk to your Healthcare Professional or ask to see a Dietitian about your concerns. They may suggest you try oral nutritional supplements which can be prescribed. There are low volume, high calorie and high protein options available which can make it easier to get the calories and protein you need even if you have a small appetite.

    Nausea and vomiting

    Why it happens: 

    Nausea and vomiting is a common side effect of cancer treatments, in particular chemotherapy. For some people, it can occur right after treatment, whilst others may experience it two or three days later and others may never experience it at all. For most people, the nausea goes away once the treatment is completed. Nausea can also stop you from getting the calories and protein you need as it reduces appetite and may lead to weight loss if it is not properly controlled.

    Helpful tips: 

    Here are some ideas that can help you deal with nausea and vomiting.

    • Make sure you talk to your Healthcare Professional about the symptoms you are experiencing so that they can prescribe anti-sickness medication if it is needed. You may find it helps to take your anti-sickness medications about half an hour before you try to eat a meal.
    • Aim for small, frequent meals during the day as tolerated. Plain and/or salty foods, such as toast, bread, crisps, rice, potatoes and savoury biscuits may be preferable. You may also find that carbonated drinks help.
    • Foods and drinks containing ginger may help with symptoms of nausea, such as ginger biscuits, ginger cakes, crystallised ginger, ginger tea or ginger beer.
    • Try to avoid foods that have strong tastes or smells. For example, limit the amount of fried, very sweet or spicy food that you eat.
    • It can help to have someone prepare meals for you.  Alternatively you could use ready made meals to help you avoid the smell of cooking.
    • Have foods and drinks at room temperature or cooler as they may be easier to tolerate as they have less of a smell.
    • Rinse out the mouth before and after eating, or suck on hard sweets if the mouth has a bad taste.
    • If you are vomiting, it is important to make sure you are drinking as much as possible to avoid getting dehydrated. Make sure that you seek medical advice to help control your vomiting and avoid dehydration.
    • If you are struggling to eat enough and/or are losing weight, talk to your Healthcare Professional about whether oral nutritional supplements may be of help to you.

    Diarrhoea

    Why it happens: 

    Diarrhoea refers to passing loose or watery stools more than four times a day. It could be caused by the treatment you have had or are having such as chemotherapy, radiotherapy to the prostate, bowel or gynaecological areas and surgery to the stomach, pancreas or bowel. Other causes of diarrhoea include infections, and sometimes medicines including some antibiotics. With diarrhoea, foods and liquids pass through the bowel too quickly so your body cannot absorb all the nutrients and water from them, which can lead to dehydration, a reduced appetite and weight loss.

    Helpful tips:

    • Make sure you talk to your Healthcare Professional about the symptoms you are experiencing so that they can check for any infection or prescribe anti-diarrhoea medication if needed.
    • It is important to drink plenty of fluids to replace what you lose with diarrhoea.
    • Eat small amounts of food throughout the day instead of three large meals.
    • Try drinking sports drinks which contain fluid, sodium, potassium and carbohydrates that are easily absorbed; they are often called 'iso-tonic' drinks and are better at rehydrating you than plain water.
    • Avoid spicy, greasy, fatty or fried foods, as well as high fibre foods such as raw vegetables, fruit with seeds, pips or skins, peas, lentils and beans.
    • Avoid very hot or cold beverages, caffeinated drinks such as coffee, hot chocolate and coca cola.
    • In some cases, if the treatment you have had is likely to cause long term problems with diarrhoea, you should speak to your Healthcare Professional. There may be specific advice on how you can manage your diarrhoea in the longer term.
    • Talk to your Healthcare Professional about whether oral nutritional supplements may be of help to you.

    Constipation

    Why it happens: 

    Constipation may be a side effect of chemotherapy and certain medicines such as morphine-containing drugs. It may also be caused by not drinking enough fluids or eating enough fibre in the diet or being less mobile. Being constipated may make you feel full and you may not have much of an appetite. It is therefore important to avoid going for long periods without opening our bowels.

    Helpful tips:

    • Increasing the amount of fibre in your diet may be helpful. Foods that are high in fibre include:
      • Wholemeal bread, whole wheat crackers, digestive biscuits and oatcakes.
      • High fibre breakfast cereals e.g. bran flakes, muesli or porridge oats.
      • All fruits and vegetables including dried, frozen, tinned or fresh.
      • Brown rice, wild rice, wholegrain pasta.
       
    • Drink enough fluid (at least 6-8 glasses a day). This is particularly important if you increase the amount of fibre in your diet.
    • Make sure you talk to your Healthcare Professional about the symptoms you are experiencing so that they can prescribe medication to help with constipation if it is needed.
    • Talk to your Healthcare Professional about oral nutritional supplements. There are fibre containing options available which may help with constipation.

    The content of this page was reviewed by Saira Chowdhury
    Specialist Upper GI Oncology Dietitian
    Guys & St Thomas' NHS Foundation Trust
    January 2015