Managing side effects

What if eating becomes difficult?

The ' Eating well when eating becomes difficult' resource has been written by dietitians at University Hospitals Bristol and Weston NHS Foundation Trust, North Bristol NHS Trust, Macmillan, and Nutritionists at Penny Brohn, it is available to download.

Where possible, try to eat as healthily as you can, however there may be times when supporting your health and coping with cancer or treatment-related side-effects means that you need to adjust the way that you eat. Dealing with some of the side effects of treatment requires patience and a willingness to experiment with different meal patterns, flavours and foods.

For information specific to some of the common symptoms and side effects of cancer and cancer treatments, see below.

Coping with a small appetite

Loss of appetite during cancer treatment is very common and can be related to the physical and emotional effects of cancers, or the side-effects of your surgery or treatment. Often a loss of appetite can make it difficult to eat as much as normal and can result in weight loss.

When your appetite is low or you have lost weight without trying you may need to make different food choices to what you are used to. When you are eating less, it is important to make sure what you do eat is as high in nutrients, calories (energy), and protein as possible. This can help to avoid weight loss and help you feel as well as you can.

For ideas of how to make your diet more nourishing click on the following links:

Coping with a small appetite

Coping with a small appetite when you have diabetes

Webinar: Eating when you have a poor appetite

Sore mouth and throat

If eating and drinking is painful speak with your healthcare team as they may be able to advise/ prescribe mouthwashes or medications to help ease the discomfort. Some of these may be best taken 20-30 minutes before eating but always follow the advice of your healthcare professional.

For dietary tips on coping with a sore mouth and throat download our resources or watch our webinar: Eating with a sore mouth and throat.

Dry mouth

Often people find that regularly sipping drinks and choosing moist foods help them cope with a dry mouth, however, some find that special lozenges and chewing gums can also be helpful and are available to buy from a pharmacy. Artificial saliva in the form of sprays, pastilles or gels are also available on prescription. Put the gel on your tongue and around the inside of your mouth for longer lasting relief at night. Talk to your doctor or nurse about these.

For dietary tips on coping with a dry mouth download our leaflet or watch our webinar: Eating with a dry mouth.

Taste changes

Sometimes as a result of cancer or cancer treatments and medications, the taste of your food changes. Some people may find foods taste too salty, too sweet or they may not taste of anything at all. Some people report a metallic taste, and others will report that everything tastes like 'cardboard'. For others some things just might taste 'off'.

Dealing with taste changes requires patience and willingness to experiment with different flavours and combinations of food and drinks. Download some tips to help you eat when you have taste changes or watch our webinar: Taste changes

Nausea

If nausea and vomiting is caused by medical treatment, your doctor may need to prescribe anti-sickness medication. These medicines work in different ways so it may take time to find the right one for you. If they are not working for you, speak with your healthcare team.

Dietary tips to help you eat when you are nauseous.

Diarrhoea

Diarrhoea is a common side effect of cancer treatments and medications as well as after bowel surgery. Chemotherapy and pelvic radiotherapy can affect the lining of the bowel, causing looser bowel movements. This is usually temporary.

Infections and certain medications such as antibiotics can also give you diarrhoea. It's important to discover the cause of your diarrhoea to ensure that it's correctly treated or managed. If you are having diarrhoea please talk to your healthcare team about it.

Drink plenty to replace the liquid you have lost and avoid dehydration. If the diarrhoea is very frequent consider adding salt to foods or eating salty foods and drinks e.g. savoury drinks and crisps.
Limit or avoid caffeinated and alcoholic drinks as they can act as stimulants to the bowel and may make diarrhoea worse.
Limit fatty, greasy and oily foods as these can also make diarrhoea worse for some people.
For some, reducing the amount of fibre (roughage) in the diet in the short term can be helpful. Fibre can be found in the skins, pips and seeds of fruits vegetables and grains so peeling fruit and vegetables and choosing white or low fibre cereals and bread e.g. white bread, corn or rice based cereals will help reduce the fibre in your diet. You can reintroduce these higher fibre foods once the diarrhoea has settled as this is an important part of a healthy diet.

People who have had bowel surgery may have an altered bowel habit after surgery which differs to before surgery. The advice above may still be helpful but you can talk to your healthcare team about what is to be expected after surgery.

Constipation

Constipation can be caused by medications for example some chemotherapies, painkillers and antisickness medications. Changes in diet and reduced activity during cancer treatment can also affect your bowel habits. Sometimes laxatives are needed; you can speak to your healthcare team about this.

Some of the following tips can also help:

Caffeine, for example in tea, coffee and some fizzy drinks can sometimes have a mild laxative effect. However, be aware that caffeine is a stimulant and can affect your sleep pattern.
Increasing the amount of fibre that you eat can also help with constipation. Foods which are naturally high in fibre are fruits, vegetables, whole grains and beans and pulses. For packaged foods a good source of fibre would contain more than 3g of fibre per 100g. You can find this out by looking at the nutritional information on food packaging.
Be mindful that increasing fibre intake can cause abdominal symptoms of bloating and gas but this should settle
Be sure to drink plenty of fluids when increasing your fibre intake and increase fibre gradually to minimise symptoms

Inform your healthcare team if you remain constipated after trying these measures.

If you are having treatment that involves the bowel, you should always seek specialist advice from your healthcare team before increasing your fibre intake.

Fatigue and tiredness

Fatigue can make food shopping, meal preparation and eating more difficult. Eating a nutritious diet can be an important step towards improving your energy levels. Watch our webinar: Eating when you have fatigue

Practical tips:

Make the most of times when you have more energy to plan meals, or batch cook. Freeze individual portions for the days you have less energy or time.
Take friends or family up on any offers to help with food shopping or preparation. People often want to know how to help. They can help you prepare meals to eat or keep in the fridge or freezer for another time.
Using items which can be kept in the kitchen store cupboard or freezer can help simplify meal and snack preparation. Some foods are available pre-portioned for ease of preparation.
Eat when you feel like it, even if this differs from your normal eating pattern.
Soft, moist foods require less chewing and therefore can be easier to eat.
Most supermarkets offer an online home delivery service.
Ready-prepared/frozen meals can be delivered by a supermarket or a specialist company. There are wide ranges available, and many include healthier options to suit all budgets.
Some companies offer recipe boxes with all the ingredients needed to prepare a meal.
Some people find it helpful to set alarms or write daily checklists to prompt them to eat, this can be useful when you have lost interest in food
Local voluntary organisations may also be available in your area (ask your Cancer Support Worker or the Cancer Information and Support Centre at level 4 Bristol Haematology and Oncology Centre)