Dietary advice during chemotherapy

This leaflet aims to answer some of the questions you may have about your diet while receiving chemotherapy. If you have any questions or concerns, please ask your oncology dietitian or nurse. If you have any further questions or concerns, please contact the oncology dietitians (details are at the end of this leaflet. Do you need a special diet during chemotherapy? You do not need a special diet while on chemotherapy. It is more important to have a nutritious and well-balanced diet to help you cope with the side effects of treatment, prevent weight loss, prevent nutritional deficiencies, reduce the risk of infections and help with recovery from treatment. There are many advertised dietary supplements, herbal preparations and anti-cancer diets that claim to cure cancer or help slow its growth, however, there is no reliable scientific evidence to support this. If you decide to take dietary supplements of any kind, please discuss this with your oncology dietitian or doctor. Your oncology dietitian can ensure you receive the correct information and make an informed decision. Eating well with chemotherapy Eating well means eating a varied and balanced diet that will provide your body with all the nutrients it needs to function well. These nutrients include protein, carbohydrates, fat, vitamins, and minerals. The following information will give you ideas on how to maintain a balanced diet that provides adequate calories and the nutrients your body needs. Try to:  eat at least three meals every day and include a variety of foods that you enjoy.  have starchy carbohydrate foods such as bread, potatoes, rice, pasta, yam, plantain, chapattis and cereals at each meal. These are energy-rich foods.  include meat, poultry, fish, eggs, cheese, and yoghurt, beans, Quorn, tofu or lentils at least twice per day. These are protein-rich foods.  include fruits and vegetables in your meals every day. These provide vitamins and minerals.  drink at least six to eight cups of fluids each day. In addition to water, try tea, coffee (in moderation), fruit juice, fruit squash, soups, milky drinks and smoothies. 2 of 6 Making meals easy Nutritious meals do not have to be hot meals and can be quick to prepare. Sandwiches, flans and quiches, tinned fish and meats can all go towards making a nutritious meal. If you are finding cooking difficult or tiring, try using convenience foods which can be as nutritious as home cooked meals. Many supermarkets have a wide range of frozen, chilled, packet and tinned foods and meals. Weight changes with chemotherapy Weight changes may occur as a result of chemotherapy. A slight change in your weight during chemotherapy is not a concern. Weight loss Significant weight loss may affect your ability to tolerate chemotherapy. Rapid and significant weight loss can lead to loss of muscle resulting in decreased strength, weakness, fatigue (tiredness) and a reduced ability to perform day to day activities. Chemotherapy-related weight loss may occur as a result of side effects such as:  loss of appetite  taste and smell changes  dry and/or sore mouth  nausea (feeling sick) and vomiting (being sick)  bowel changes (constipation or diarrhoea)  fatigue Your oncology doctor can prescribe medication to help with some of these side effects including anti-sickness, pain relief, laxatives, anti-diarrhoeal drugs and mouth washes. If you have lost your appetite, or food intake is affected by any of the above, these are some simple steps that may help. Try to:  eat little and often.  enrich your foods with butter, cheese, cream, honey and syrup. This will provide you with more energy.  choose high-energy snacks such as cheese and biscuits, cakes and full fat yoghurts.  if you are having difficulty with eating solid foods, have more nutritious fluids such as milkshakes. An oncology dietitian will be able to provide you with further practical advice on how to better manage some of these chemotherapy side effects and how to enrich your meals to help maintain or regain weight. Additional information leaflets can be provided by the oncology dietitians on how to manage the side effects of treatment. 3 of 6 Weight gain Unwanted excess weight gain may occur during chemotherapy for some people. This may be due to decreased physical activity and increased eating possibly as a result of boredom, stress or steroid-related increased appetite. In the short term, a slight increase in weight is not a concern, although in the longer term it can affect your health. Your oncology dietitian will be able to provide dietary advice on how to better manage this. Food safety and chemotherapy Chemotherapy can interfere with the body’s natural defence against infections including breakdown of skin and reducing the number of neutrophils (white blood cells) in your blood. Ensuring food safety while on chemotherapy is important to reduce the risk of food poisoning. The best way to ensure food safety includes cooking food properly to reduce the numbers of germs to a safe level, storing food at correct temperatures to limit growth of germs, avoiding contamination of food after cooking other foods, kitchen utensils and people. Here are some practical ways in which you can ensure food safety and limit risk. Shopping  Check expiry and ‘use by date’ on food labels.  Avoid mouldy, bruised or damaged fruits and vegetables.  Avoid foods with damaged or broken packaging.  Make sure you get chilled and frozen foods home as soon as possible. Storage  Keep your fridge between 0ºC and 5ºC. Keep your freezer below -18ºC.  Chill foods properly – especially foods with a ‘use by’ date, cooked dishes and ready-to-eat foods such as prepared salads, cut fruits and desserts.  Cool cooked food within two hours and cover before storing in the fridge or freezer.  Store raw and cooked foods in separate areas or shelves – cooked and ready-to-eat foods at the top of the fridge and raw meats at the bottom of the fridge in a covered container.  Throw mouldy food away and any food past its ‘use by’ date.  Don’t re-freeze raw food once defrosted unless you have cooked it first.  Leftover food should not be kept in the refrigerator for more than two to three days. Food preparation  Wash hands thoroughly before preparing food and after touching raw foods such as meat, poultry, fish, eggs and unwashed fruit and vegetables.  Ensure that all preparation surfaces are clean before you start preparing food.  Cooked food should not come into contact with raw meat, unwashed vegetables or salads, or with utensils, cloths or surfaces contaminated by contact with raw food.  Use separate chopping boards for raw food and ready-to-eat food.  Wash salads, fruit and vegetables thoroughly before eating. 4 of 6 Cooking  Thaw frozen foods in the refrigerator and cook immediately once thawed.  Ensure food is cooked properly, thoroughly and piping hot throughout.  When cooking with a microwave oven, turn and stir foods halfway through cooking time to prevent uneven heating.  Serve hot food as soon as possible after cooking.  Do not reheat cooked food more than once and make sure it is piping hot throughout. Eating out  Always ask for your food to be freshly prepared.  Ensure hot foods are served piping hot and cooked all the way through.  Avoid buying food from salad bars, buffets, street vendors and ice cream vans. Foods requiring additional care to avoid food poisoning Some foods have a higher risk of carrying germs and it is important to be careful in their preparation, cooking and storage to limit risk of food poisoning. Eggs  Store eggs safely in a cool dry place such as a fridge.  Observe ‘best before’ dates.  Eating lightly-cooked eggs is safe as long as they are produced under the British Lion Code of Practice (and have the British Lion symbol stamped on them). If you choose lightly-cooked eggs when eating out, check that these eggs are British Lion eggs.  Avoid food products containing raw eggs such as home-made Caesar salad dressing and hollandaise sauce. Poultry, red meat and products  Cook thoroughly and do not serve pink or rare. Rice  Serve as soon as rice is cooked.  If storing cooked rice, cool quickly within one hour of cooking and store in the fridge.  Store cooked rice in the fridge for no more than one day.  When reheating cooked rice, ensure that it is steaming hot all the way through. 5 of 6 Milk, cheese and yoghurts  Pasteurised milk and cheese products are safe to eat but avoid unpasteurised products.  Avoid mould-ripened and blue veined cheeses such as Brie, Camembert, Gorgonzola and Roquefort.  Cheeses safe to eat include the following – o hard cheeses such as Cheddar, Cheshire, Derby, double Gloucester, Edam, Emmental, Gouda, Gruyère, Parmesan and red Leicester. o Soft cheeses such as cottage cheese, mozzarella, feta, cream cheese, paneer, ricotta, halloumi, goats’ cheese, Quark and processed cheeses including cheese segments.  Avoid supplements, food and drinks containing probiotics such as bio-yoghurts, Actimel, Yakult and supermarket own brands. These products contain live bacteria and although are generally considered safe, need to be used with caution during chemotherapy when your immune function may be weakened. Fish, oysters, and other seafood  Do not eat raw seafood such as oysters or shellfish.  Sushi made from frozen raw fish and cooked shellfish are safer to eat as freezing and cooking will reduce the risk of food poisoning.  Ensure smoked salmon is stored in the fridge and eaten before its ‘use by’ date. Oncology dietitians The oncology dietitians can provide information, dietary advice and support throughout your treatment, especially if you:  are losing weight (more than 2kg since last appointment)  are underweight  are struggling with eating and drinking due to o poor appetite o taste changes o swallowing difficulties o feeling full o dry mouth o sore mouth o changes in bowel habit.  have questions about alternative diets  You can request to be referred to an oncology dietitian for support with any of the above, by your doctor or nurse.