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Appetite Changes

It's not unusual for cancer patients to experience a loss of appetite. Causes include:

Treatments, such as surgery, chemotherapy and radiation
Pain
Constipation
Medical conditions, such as fever, pneumonia or shortness of breath
Side effects of certain medications
Sadness or depression
Anxiety

Below are some things you could try to be sure to avoid malnutrition.

Eat small, more frequent meals. Use an alarm clock or TV commercial break to remind yourself to eat.
Take advantage of times when you’re naturally hungriest, such as first thing in the morning.
Do light exercises to stimulate your appetite.
Keep ready-to-eat foods on hand at home and with you on the go.
Drink nutritional shakes, such as Ensure or Carnation Instant Breakfast.
Limit fried and greasy foods. They can be difficult to digest and make you feel full quickly.
If you aren’t able to stimulate your appetite, talk to your physician. You may be prescribed an appetite stimulant.

Taste and smell changes

Patients who are receiving chemotherapy or radiation therapy may experience changes in taste and smell, which can make eating difficult. Below are some tips to help make food more appetizing.

Drink plenty of liquids. Use fruits or herbs to flavor water. Consider trying decaffeinated herbal teas or ginger ale.
Take care of your mouth. Brush your teeth and tongue after every meal. Rinse with a solution of ¼ teaspoon baking soda in 4 ounces of water before eating.
Sorbet (lemon or lime) or frozen fresh fruits (grapes, melons or oranges) can help cleanse your palate before eating.
Try sugar-free gum, peppermints or lemon drops.
If you have a metallic taste in your mouth, use plastic utensils and avoid canned foods.
Marinade and cook meat in sweet juices, sauces, fruits, acidic dressings or wines.
Include other protein sources in your diet, such as fish, eggs, beans, nuts, milk, cheese, yogurt, tofu, peanut butter and protein powders.
If foods taste salty or bitter, increase sweet tastes by adding honey, agave, maple syrup and jam to foods.
If foods taste too sweet, increase salty or tart flavors by adding citrus fruits, vinegar or pickled foods.
Try seasonings you don’t normally eat.
To decrease food smells, eat foods cold or at room temperature. Try soups in a covered container and sipping it with a straw. Avoid rooms where food is being cooked.

Meeting with a dietitian during cancer treatment: What to expect

While there are no foods that can kill cancer cells, the foods you eat during cancer treatment can have a big impact. Changes to your diet can ease side effects or help your body stay strong and healthy during treatment.

“Your nutrition is an important part of your cancer treatment and overall well-being,” says Erma Levy, a clinical dietitian at MD Anderson. “True, it’s just one part of the puzzle when it comes to your treatment. But it’s an important part.”

For this reason, each clinic at MD Anderson has an assigned dietitian who is available to help patients at all stages of their cancer treatment. Patients can ask their care team to connect them with a dietitian.

For many patients, meeting with a dietitian is a new experience. We asked Levy what you can expect. Here’s what she had to say.

Prepare before your appointment with a dietitian

It’s important to prepare for your first appointment with a dietitian to make sure you get the most out of it. Levy recommends bringing the following to your appointment:

Any supplements or vitamins you’ve been taking. If you can’t bring the actual supplement with you, take a picture of the package, including any ingredients or directions, so your dietitian can consider how this may be affecting you or interacting with your diet.
A list of any side effects you’ve been experiencing. Include when you experience the side effects. Your dietitian may be able to make changes to your diet that could ease side effects like nausea, upset stomach, headaches or fatigue.
A food log. Keep track of what you’ve been eating. “If you can do it for a week, that’s great. If you only keep track for a day, that’s fine, too,” Levy says. “Letting your dietitian know what you’re eating can help them better understand your diet.”
Any questions you may have. “We’re here to help you,” Levy says. “Don’t be afraid to ask us anything.”

Your nutrition and physical assessments

During the appointment, your dietitian may perform a nutrition assessment and a physical assessment. During each one, your dietitian may ask you a lot of questions about your eating habits and how you’ve been feeling. The questions vary from patient to patient.

If you’ve lost a significant amount of weight, the dietitian will perform a physical assessment. During the physical assessment, your dietitian will look for signs of malnutrition. Studies show that up to 85% of cancer patients suffer from malnutrition at some point during their treatment, depending on the type of cancer. Signs of malnutrition may include fat loss or muscle loss. Your dietitian will also check your skin, nails, eyes and mouth for signs of malnutrition.

Follow up after your appointment

Don’t be afraid to reach out to your dietitian with questions that may come up after your initial appointment. Be sure to pay attention to how the foods you eat affect how you feel.

Your nutrition goals may change depending upon where you’re at in your cancer treatment. During your treatment, you may be focused on limiting side effects. After your cancer treatment, you may be focused on how your diet can reduce your chance of recurrence.

Don’t hesitate to follow up with your dietitian after your first appointment. You can always send your dietitian a message through myMDAnderson, or schedule a follow-up appointment by calling our Clinical Nutrition department at 713-563-5167.

“Remember, as your cancer treatment changes and progresses, your nutritional needs may change as well,” Levy says. “Your dietitian can help you adjust to that.”

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Caregiver/dietitian: Helping my husband gain weight after chemo

As a registered dietitian at MD Anderson, I know that nausea and other side effects of cancer and treatment make eating difficult, if not impossible. Even though our doctors, nurses and mid-level providers do a great job of educating our patients and caregivers about these possibilities, it is hard to prepare for them.

I didn’t realize just how hard it can be, though, until I became my husband’s caregiver during his B-cell lymphoma treatment, which included chemotherapy and a stem cell transplant.

Diet challenges after chemo
My husband Bob is a fighter and a very compliant patient. But the chemo leading up to his stem cell transplant caused nausea, vomiting, diarrhea and mouth and throat sores. Together, they made it almost impossible for him to eat and drink enough for over a month. He lost about 25 pounds -- mostly muscle.

The medical team did their best to manage Bob’s nausea, vomiting, diarrhea, and mouth and throat sores with medications. But his sense of taste diminished greatly, and there are no pills to fix that. He was hydrated 24/7 in the hospital. For a few weeks after Bob was discharged, he received IV fluids almost daily. His care team monitored his electrolytes closely and gave him magnesium and potassium through an IV until he could keep pill supplements down.

Helplessness in the face of Bob’s weight loss
I watched helplessly as Bob lost weight simply because he could not eat. I knew he was trying. But no matter how much I did or how many different food and liquid options I gave him, I couldn’t make him keep food down and gain weight.

Bob he felt so awful from the drugs he was on that I don’t think he cared whether he ate. He was so fatigued and weak that all he wanted to do was sleep. “I could see the stress in your face,” he told me.

From the beginning, Bob’s doctors had said he’d lose about 10 percent of his body weight. Some patients feel that is a positive thing, but I know this is loss of muscle, not fat. To a dietitian, this equals severe malnutrition. It also prolongs the healing process.

Bob didn’t have 10 percent excess weight prior to his stem cell transplant. I was worried to tears on many occasions about his ability to recover. I’m sure many caregivers know that feeling. It feels like you have failed your loved one or that he or she is simply not trying hard enough.

We tried supplements of all calorie and protein levels in a variety of flavors. He tolerated some, but couldn’t tolerate most. Those that he did tolerate weren’t tolerated for long.

More than anything, I wanted to make sure he kept receiving food through his GI tract. He needed at least small amounts of food to keep it functioning and avoid the need for enteral or parenteral nutrition. I knew that enteral or parenteral feeding would pose the risk of life-threatening infection for Bob, whose immune system was already severely compromised after his stem cell transplant.

Yet we forged ahead, hour by hour, day by day. After three or four weeks, Bob was finally able to keep food down in small amounts, and he progressed from there. About 100 days after his stem cell transplant, Bob started eating some of his normal favorite foods like my homemade lasagna and his mother’s split pea soup. It seemed like he’d turned a major corner.

The long road back to eating
Even now, six months after his transplant, Bob still struggles with regaining weight. But he is enjoying food again. He’s also exercising to rebuild strength and muscle mass. We still have days where we feel like we’re making progress, then take a step back.

This road back to eating and weight gain has taken longer and has been more challenging than I could’ve imagined. Yet as I’ve learned from Bob and my patients, we will get there with patience and perseverance. So will you.