Nutritional problems of cancer therapy
Surgery, chemotherapy and radiotherapy cause nausea, mouth sores, taste changes, diarrhoea and weight loss. Each problem has simple food fixes that keep the patient eating.
Nutritional problems by type of treatment
| Treatment | Nutrition problems |
|---|---|
| Surgery: head and neck | Difficulty chewing and swallowing; may need tube feeding |
| Surgery: stomach or oesophagus | Early fullness, dumping syndrome, poor absorption of iron, calcium and vitamin B12 |
| Surgery: intestine or pancreas | Diarrhoea, fat malabsorption, short bowel syndrome; diabetes after pancreas removal |
| Chemotherapy | Poor appetite, nausea and vomiting, mouth ulcers, metallic or bitter taste, diarrhoea or constipation, low blood counts and infection risk, tiredness |
| Radiotherapy: head and neck | Dry mouth, thick saliva, sore mouth and throat, loss of taste, painful swallowing, tooth decay |
| Radiotherapy: chest | Painful swallowing from inflamed oesophagus |
| Radiotherapy: abdomen and pelvis | Nausea, diarrhoea, inflamed intestine (radiation enteritis), temporary lactose intolerance |
| Steroids and hormone therapy | High blood sugar, increased appetite, weight gain, bone loss |
Problem and food fix
| Problem | What to do |
|---|---|
| Poor appetite | 6-8 small meals; energy-dense foods; eat by the clock, not by hunger; biggest meal when appetite is best |
| Nausea and vomiting | Dry foods (toast, marie biscuits) on waking; cold or room-temperature foods; ginger or lemon; avoid greasy, fried and strong-smelling foods; sip fluids between meals |
| Taste changes | Use lemon, mint, tamarind and spices if no mouth sores; plastic spoons for metallic taste; marinate meat; try egg, paneer or dal if meat tastes bitter |
| Mouth ulcers | Soft, bland, cool foods (curd rice, idli, custard, kheer); avoid chilli, sour, salty and rough foods; use a straw; rinse the mouth often |
| Dry mouth | Moist foods with gravy, rasam or curd; sip water often; sour sweets or lemon to boost saliva; avoid dry biscuits and bread alone |
| Difficulty swallowing | Thick, smooth, moist foods (khichdi, mashed dal, porridge); thicken liquids if they cause coughing; tube feeding if intake stays low |
| Diarrhoea | ORS and fluids; low residue; limit milk and fatty foods; banana, curd rice, rice kanji |
| Constipation | More fluids, fibre and gentle activity, as allowed |
Dumping syndrome after stomach surgery
- What it is: food rushes into the small intestine too fast. Early dumping (15-30 minutes after a meal): cramps, diarrhoea, dizziness, fast heartbeat. Late dumping (1-3 hours after): low blood sugar, sweating, shakiness.
- Eat 6 small, dry meals; drink fluids 30-60 minutes before or after meals, not with them.
- Avoid sugar, sweets, sweet drinks and juices; choose complex carbohydrates.
- Include protein and some fat in every meal to slow emptying.
- Lie down for 15-30 minutes after meals if it helps.
Food safety when blood counts are low
- Wash hands before preparing and eating food.
- Eat freshly cooked, piping hot food; avoid leftovers kept outside the fridge.
- Drink boiled or filtered water; avoid street food and cut fruit from stalls.
- Avoid raw sprouts, raw eggs, undercooked meat and unpasteurised milk.
- Choose thick-skinned fruits you can wash and peel (banana, orange, papaya).
Sample one-day menu (mouth ulcers during chemoradiation)
| Meal | Menu |
|---|---|
| Early morning | Cool milk with ragi malt |
| Breakfast | Soft idli soaked in mild dal; mashed banana |
| Mid-morning | Oral nutrition supplement or milkshake (through a straw) |
| Lunch | Curd rice, mashed moong dal, soft bottle gourd kootu |
| Evening | Custard or rice kheer; tender coconut water |
| Dinner | Soft khichdi with ghee; steamed egg or soft paneer; curd |
| Bedtime | Cool milk or a supplement drink |
In the chemotherapy day-care unit, the dietitian asks every patient what is stopping them from eating today and fixes that problem first: a cold curd rice for ulcers, ginger lemonade for nausea, or a straw and supplement for a sore throat.
2 marks: “What is xerostomia?” Dryness of the mouth from reduced saliva, common after head and neck radiotherapy.
5 marks: “Write a note on dumping syndrome and its dietary management.” Rapid emptying after gastric surgery; early and late dumping; small dry meals, fluids between meals, no simple sugars, protein and fat with meals.
10 marks: “Discuss the nutritional problems of cancer therapy and their dietary management.” Problems by surgery, chemotherapy, radiotherapy and steroids; a problem-food-fix table; dumping syndrome; food safety in neutropenia; a soft menu.
Fix the symptom on the plate: cold for nausea and ulcers, moist for dry mouth, dry and sugar-free for dumping, cooked and hot for low counts.