For About and By Caregivers

Cancer and Nutrition
What Every Caregiver Should Know


“If he would only eat more, I know he’d gain the weight and strength he needs to get better,” says a concerned wife speaking with her husband’s doctor. The husband tells his doctor, “I force myself to eat at times, just to make my wife less worried. But I have no appetite and after only a bite or two, I’m so full that I can’t continue.” This scenario is typical of a condition known as “cancer-related weight loss.”

Many factors can influence the outcome of a person’s chances of surviving cancer, but in recent years, the role of maintaining optimal nutritional health has become increasingly important in successfully managing this disease. Nutrition is one area of cancer care where caregivers can play an important role. It’s crucial for both the caregiver and the one being cared for to know what to expect about every aspect of the disease, especially the impact of cancer-related weight loss and the 
nutritional challenges and needs that may arise. 

A caregiver may try to tempt a person living with cancer into eating by preparing favorite foods and desserts. On the other hand, this well intentioned effort may cause a loved one to feel nagged by demands to eat. 

“Forcing a person with cancer to eat can have a negative impact. It places additional stress on the situation and eating becomes less enjoyable. Ultimately, the caregiver’s attempt to help can backfire,” suggests Denae Garrett, M.S., R.D., Chao Family Comprehensive Cancer Center, Irvine, California. “However, most people with cancer can identify times of the day or night when they feel best and may have a better appetite. It’s a good idea to use those times to prioritize eating. Remember to keep meal times flexible — it’s ok to eat breakfast foods at 4pm or have a midnight snack.”

It’s true that people with cancer may feel better after eating something, so it helps to focus on what they were able to eat, rather than what was left uneaten. 

By better understanding cancer-related weight loss, a caregiver can help improve the quality of life of someone with cancer through increased strength and activity resulting from a good, solid nutritional program designed by the caregiving team.

When Weight Loss Isn’t Desirable

Caregivers have an opportunity to influence the diet of people with cancer, and recognizing cancer-related weight loss is often the first step. Many times the initial symptom of cancer is weight loss, so it’s important to have a person with cancer assessed by a medical professional in order to specifically identify the causes for the unexplained weight loss. 

Weight loss when living with cancer is different than weight loss from dieting. Many people go through life trying to lose weight and stay fit, but with cancer, weight loss isn’t desirable. People with cancer need to maintain weight and muscle to prevent complications that can impact the effectiveness of therapy and ultimately survival. In fact, losing as little as five percent of body weight can adversely affect a person’s response to cancer therapy. Slowing or stopping weight loss and rebuilding muscle allows for more energy, strength and independence to perform everyday functions and favorite activities.

Simply eating more food or using conventional nutritional beverages may not be enough to prevent or reverse the weight and muscle loss, but there are nutritional options available. In fact, certain fatty acids have been found to play a role in cancer-related weight loss. One such fatty acid is EPA (or eicosapentaenoic acid), an omega-3 fatty acid that has been effective in stabilizing weight loss in people with cancer. A therapeutic nutritional beverage with 2 grams of EPA has been shown to help restore normal metabolism and build muscle so that people with cancer have increased strength to respond to cancer therapies.

It is important to address the metabolic problems associated with cancer-related weight loss early on, because excessive weight and muscle loss can adversely affect a person’s response to cancer therapy. The earlier a person with cancer begins taking a therapeutic nutritional beverage specifically designed to help normalize metabolism and promote weight gain, the easier it may be to manage or even hold off cancer-related weight loss.

As with any illness or injury, a person produces and releases different substances into the bloodstream that promote healing. This type of reaction from the immune system tends to speed-up the regular metabolic rate, causing more calories than usual to be burned. Once well, a person’s metabolism then returns to normal, but during the time it ran at a higher rate, some inches and pounds most likely were shed. 

When a person with cancer fights a tumor, however, this response can continue indefinitely. The tumor produces substances that alter the metabolism of macronutrients — protein, carbohydrates and fat — and causes the body to burn calories faster than they ordinarily can be replaced. The result is catabolism, the breakdown of muscle and other tissue.

In addition to cancer-related weight loss, there are many other reasons people with cancer lose weight. Causes include depression, fatigue, pain, altered taste perception, side effects of treatment, or obstruction of the gastrointestinal tract. In these cases as well, consumption of a high calorie, high protein, EPA-containing beverage may help reverse weight loss.

Psychological distress also can play a major role in weight loss. The anxiety that comes with receiving a diagnosis of cancer, the intensified feelings of anxiety and depression, and the possibility of pain, all can cause weight loss. Once a particular psychological issue is addressed, some of the weight loss may be reversed.

The Search for Treatment

Promising new science shows that it may be possible to prevent or reverse cancer-related weight loss by providing a specific combination of nutrients that can help restore the body’s metabolism. One key nutrient is the omega-3 fatty acid EPA, which helps to counteract the metabolic changes that lead to weight loss. Research shows consuming 2 grams of EPA daily may help stabilize weight loss by reducing production of tumor factors that cause weight loss. Researchers who examined the effect of EPA in clinical studies found two important results. According to a study published in Nutrition and Cancer, EPA supplementation stabilized weight in patients with cancer-related weight loss, and increasing the dose of EPA from 2 to 6 grams per day did not lead to weight gain. 

In a study published in the British Journal of Cancer, researchers hypothesized that providing EPA in combination with calories, protein, vitamins and minerals may result in weight gain rather than just weight stabilization. Study participants drank a high protein, high calorie, therapeutic nutritional beverage with EPA. After only three weeks of drinking two cans of the therapeutic nutritional beverage per day, in addition to a usual diet, patients increased muscle and were able to eat more food. In addition, a sub-group of the patients also participated in a smaller study to test their physical activity level. Published in Clinical Nutrition, the study found that some patients, who once had been too weak to be active, were able to get out of bed and resume normal activity after eight weeks.

By including a high-protein, high-calorie therapeutic nutritional beverage with EPA, along with a nutritional assessment and management by medical professionals, the nutritional status and quality of life for people with cancer experiencing cancer-related weight loss can improve. 

Tips to Promote Good Nutrition

In addition to utilizing an existing therapeutic nutritional beverage with EPA, caregivers must still try to help the ones being cared for eat a variety of foods, since lots of nutrients from many different sources are required to meet physical and nutritional needs. Caregivers can help people with cancer create a flexible, personalized nutritional plan that will be easy to adapt to their ever-changing needs. Following are guidelines to help create the basis for a sound, nutritional program.

Adding Calories

There are many ways to add calories, and eating high calorie foods is a good place to start. Caregivers and people with cancer can enjoy adding the following to increase calorie intake:

  • Melt margarine onto hot foods such as toast, soups, vegetables, cooked cereals, rice and soft-boiled eggs. 

  • Choose mayonnaise instead of salad dressing for use in meat salads, in deviled eggs and on lettuce.

  • Serve peanut butter - also high in protein - with an apple, banana, or pear, or spread it on a sandwich with mayonnaise. 

  • Top puddings, pies, hot chocolate, fruit, gelatin and other desserts with whipped cream. Cook with heavy cream instead of milk. 

  • Sprinkle nuts or seeds on vegetables, salads, and pasta, or sprinkle on desserts such as fruits, ice cream, pudding and custard.

Adding Protein

It can be extremely beneficial for a person with cancer to receive extra protein, especially if they are healing after surgery. The following suggestions will help provide more healing proteins and extra calories to the diet: 

  • Add nonfat dry milk or powdered protein supplements, like Soy Protein Shakes, to regular milk. Also, they can be added to sauces and gravies or used for breading meat, fish or poultry. 

  • Cook cereals with milk instead of water.

  • Use milk, half-and-half and evaporated milk when making instant cocoa, canned soups, mashed potatoes, and puddings. 

  • Add extra ice cream to milkshakes. 

  • Add small pieces of meat, fish or poultry to soups and to vegetable, noodle and rice casseroles. 

  • Add grated cheese to cream sauces, casseroles, or vegetables. 

  • Melt sliced cheese over hot apple pie.

  • Combine cottage cheese and cream cheese with fruit.

  • Use cream cheese and margarine on hot bread or rolls. 

  • Blend finely chopped hard-boiled eggs into sauces, gravies, chopped meats, or salad dressings or sprinkle over salads. 


Loss of Appetite

Sometimes medical treatments and therapies can cause a decrease in appetite. Here are some ways that caregivers can help make favorite dishes appealing again:

  • Try seasonings such as lemon juice, mint, basil and other herbs and spices to perk up the taste and smell of food.

  • Add sugar and salt to foods, if intake is not restricted.

  • Serve food attractively and in a pleasing atmosphere.

  • Vary the colors of foods on the plate and use garnishes such as lemon or lime wedges.

  • Colorful place settings and soft background music can help make mealtimes more enjoyable, too.

  • Use a therapeutic nutritional beverage such as ProSure to help reverse the metabolic changes that can affect appetite.

  • Walk the dog or take an early-evening stroll before eating.

  • Light exercise may help stimulate the appetite.

  • Plan the biggest meal of the day when a person with cancer is most hungry, even if that’s early in the day.

  • Serve foods a loved one enjoys whenever they feel like eating, even if it’s not a usual meal time:

Overcoming Vomiting and Nausea

If a person with cancer is suffering from vomiting, nausea, or feels too full to eat, try these tips:

  • Drink liquids an hour before or after eating to keep from filling up quickly during meals.

  • Eat high-carbohydrate foods such as crackers and toast if troubled by nausea. They move through the stomach quickly and may be particularly helpful if eaten first thing in the morning.

  • Eat slowly and chew food thoroughly.

  • Rest after eating. Activity can slow digestion and may cause discomfort.

  • If food smells cause nausea, keep a person with cancer out of the kitchen while meals are prepared - even have them leave the house, if possible. Cold foods tend to have fewer odors, so try serving more dairy products, chicken or tuna salad sandwiches, cold soups and cool desserts with fruit.

Change of Taste and Smell

Some therapies and treatments can change the way food tastes and smells. Here are some tips that may help alleviate these symptoms:

  • Serve food cold or at room temperature to decrease its smell and taste.

  • Choose foods that provide texture and crunch to help give a real sense of eating that is not provided by soft, bland foods.

  • Use seasonings and condiments such as salt, lemon juice, catsup, pickles and olives that don’t rely on smell to enhance food.

  • Avoid the area where food is being prepared, as odors may increase the chance for nausea.

  • Eat several small meals during the day rather than three large ones.


Soothing Mouths and Throats

Some treatments can make mouths and throats uncomfortable, dry and sore. Here are some tips that may help to eliminate some of these problems:

  • Try moist and liquid foods such as soups and stews. They may be easier to chew and swallow.

  • Try soft, cold foods such as ice cream, frozen fruit-juice bars, watermelon and grapes. They may feel and taste better than other foods.

  • Drink through a straw to make swallowing easier.

  • Avoid using spices.

  • Avoid carbonated beverages and highly acidic foods, like citrus juices and tomatoes.

  • Try fruit juices such as apple and nectar instead.

Decreasing Diarrhea

If diarrhea is a problem, these suggestions may help to prevent, or at the very least, lessen the severity:

  • Try eating small meals frequently rather than two or three large meals each day and don’t skip meals.

  • Avoid greasy, fatty and fried foods.

  • If dairy products cause problems, try decreasing the amount that a person with cancer eats or drinks at one time.

  • Possibly eliminate items from the diet temporarily if they are causing too many problems.

  • Drink plenty of liquids to counter fluid loss.

  • It is a good idea to keep an oral electrolyte solution on hand at home to help replace water and minerals lost during diarrhea.

  • Talk with a doctor if diarrhea occurs more than twice daily.

  • If blood is noticed in the stool, be sure to tell the doctor immediately.

Preventing Gas

Gas may cause cramping, bloating and pain. To help prevent it, try these tips:

  • Avoid carbonated beverages, chewing gum, highly spiced foods and too many sweets.

  • Don’t talk and chew at the same time. This can cause air to be swallowed, which then causes gas.

  • Eat only peeled, cooked fruits and vegetables that don’t have seeds. Strain the seeds out of tomatoes.

  • Avoid beans, corn (including popcorn) and nuts.

  • Vegetables in the cabbage and onion families - including broccoli and garlic - also may cause problems.

Improving Regularity

Keeping regular can be a problem for anyone, but in particular for people who have been receiving different medicines, treatments, therapies, as well as experiencing extreme metabolic changes. Here are some ideas that caregivers can use in helping to keep regular:

  • Eat high-fiber foods such as raw fruits and vegetables, or whole-grain, high-fiber cereals.

  • If a person with cancer has trouble swallowing, try grating or cooking the fruits and vegetables.

  • Don’t forget to add prune juice to their diet.

  • Drink plenty of liquids and exercise as much as possible.

  • If a person with cancer still suffers from irregularity and continued discomfort, be sure to speak to a doctor.

Caregivers have an opportunity to play an active role in helping people with cancer. By understanding the importance of nutrition in the treatment of cancer, and applying useful strategies and tips, caregivers can help people with cancer regain weight and reclaim quality of life.  


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