Cancer treatment affects everyone differently. However, common side effects are losing your appetite, feeling nauseous and losing your sense of smell and taste.
Oncology clinical nurse specialist Ruth Van Gerpen explains why your appetite might change with cancer treatments. She shares tips on food suggestions to help ease nausea and a sore throat, and she offers useful ways to encourage eating in cancer patients.
Selected Podcast
Cancer Treatment & Appetite Changes: Tips to Get the Nutrition You Need
Featured Speaker:
Ruth Van Gerpen, RN, Bryan oncology clinical nurse specialist
Ruth Van Gerpen is an oncology clinical nurse specialist at Bryan. Transcription:
Cancer Treatment & Appetite Changes: Tips to Get the Nutrition You Need
Melanie Cole (Host): If you or a loved one is going through cancer treatments, you know that there are so many factors involved, and one of the factors that plights many people is appetite changes relating to the treatments and decrease in appetite. My guest today is Ruth Van Gerpen. She’s an Oncology Clinical Nurse Specialist at Bryan. Ruth, how can going through cancer treatment affect the person’s appetite? What is the cause of it? Because I understand there’s probably many factors.
Ruth Van Gerpen (Guest): There are quite a few of them, and I think the main ones, the treatment itself such as chemotherapy or radiation therapy are probably the biggest factors. They can cause the person to actually lose their appetite because of the drug itself or the effects that it may have, on their taste buds and can cause food to smell or even taste different. One of the main changes some people will talk about with a few of our drugs is some of the foods will actually taste almost metal like or metallic. In addition, appetite can change from day to day. It kind of depends on where a person is in their treatment cycle. Sometimes it’s better, sometimes it’s just not so good because it also maybe due to the fact that other effects of treatment such as your nausea, diarrhea, constipation or mouth sores, even sometimes swallowing problems. All of those effect what we eat as well as how easy it is for us to eat. One of the things that we worry about is we know that it is vital for our patients to make sure that they continue to eat as well as drink fluids to avoid any weight loss or dehydration. We don’t want people losing weight while they’re on treatment. It’s important so that we can continue to make the most of it and really truly to keep them on schedule with their treatment.
Host: So you mentioned things like chemotherapy and we’ve heard that’s pretty bad for appetite. Can the pain and depression and fatigue also lead to a loss of appetite and what can we do about some of this?
Ruth: Actually it can. We know that fatigue and depression are common, especially with treatment, especially as they continue to have more cycles, more episodes of treatment with the chemotherapy or with radiation. If they’re getting it every day, typically five days a week for several weeks in some cases, is the more you have the more tired you are. Along with that, is you don’t have as much energy and that can also effect your appetite in addition to the side effects of the treatment, and sometimes depression is a common aspect of treatment. Sometimes it’s just very difficult to maintain that optimism or for some even that sense of hope, and that can also effect appetite. I think many people, even those that aren’t dealing with cancer find that sometimes when you get overwhelmed, depression sets in, and appetite is one of the things, that is effected.
Host: So what do you want the loved ones, who are helping to care for this person with cancer, and they tell you they’re not hungry and you can’t get them to eat, what should you do and what foods would you like – I mean we obviously don’t want just high calorie, right? We’d like high calorie also that give more bang for the buck. How do you get them to eat and what do you want them to eat?
Ruth: You know, that’s exactly true. We have a lot of wants, don’t we? We want them to make sure that they’re eating foods that have protein in them, is probably one of the most important things. We want them to make the most of every bite, kind of you get the most bang for your buck, but we want foods that have more calories but we also want that nutritional value, and primarily that’s protein. Protein is what helps those cells in our body that have been damaged by treatment to be able for the body to make new ones, and the protein is one of the key things for that. So these are things like peanut butter, cheeses, butter, not skim milk anymore, maybe you go to 1% or 2% milk, but things that have more protein in them or your foods that have more calories to increase calorie intake. Another thing that is often helpful is sometimes when we sit down eating three meals a day, but now a full plate of food is too much at one time. So it helps to do small amounts throughout the day, even five or six times a day. For instance, maybe you can have some eggs or you can have some eggs with some cheese on it or have some oatmeal, and then in the middle of the morning maybe you have a few nuts or you have part of an apple and put some peanut butter on it. In the afternoon after some lunch, you have some crackers with some slices of cheese on it. It doesn’t have to be a lot, but throughout the course of the day you’re going to get the added calories, you’re going to get the added protein into that and you’re going to find as well that it’s easier to do that. Often our dietitians we work with indicate to not let more than three hours go by without eating or drinking something. Sometimes too for people if they’re struggling with nausea is that can be worse if the stomach is empty, so keeping some food in the stomach is important from that aspect as well. Sometimes too we tend to always tend to drink more when we’re eating and sometimes that can fill you up too much. So do your drinking more between your meals. If you’re drinking things that you can add a little protein to if you like some of the protein drinks, don’t do those along with your meal. Drink them in between and use those as a substitute maybe for a snack. One of the things too that I’ve commented to many people, things they’ve never think about is to take their medications with milk or protein supplements and I’ve had many patients go, “Oh, I’ve never even thought of doing that.” They said that would be easy to do because you’re needing to take it with liquids and so you can take your medications in that manner. I think one of the challenges, especially for people who are alone or don’t have somebody to eat with regularly is the fact that it’s easier to skip a meal because you don’t have anybody to visit with or make sure that you’re not alone when you eat. In other words, eat with somebody or have the TV on or turn on a favorite movie or turn on the radio, something to take the focus off of the food, something that you can concentrate on or enjoy. Often if we’re enjoying something we tend to eat better, eat more or at least a few more bites of the food that we’re eating. One of the other things that sometimes can help encourage an appetite is just to stay physically active, be as active as you can. Maybe that means when you’re out trying to get a little bit of walk or walking a little bit more around the house is do that before you eat to try to make you a little bit hungry. Sometimes that can improve appetite. We know it can help digestion, but I think one of the most important points for those that are the caregivers, those that are caring for somebody with cancer, is to try not to take it personally. When you’ve fixed a meal, you fixed spent some time making a soup or maybe you’ve even gone out to get their favorite snack at a fast food place, and you bring it home and you put it in front of them and they take one bite, and they go, “I don’t want anymore,” try not to take it personally. It’s not you. It’s the disease, it’s the treatment. They do appreciate everything that you’ve done but it can be very difficult with the disease and sometimes appetite can change that quickly. So it isn’t a personal complaint. It is just the fact that the disease and the treatment is making it difficult from an appetite standpoint.
Host: One of the things that factors into that loss of appetite is nausea and the taste and smell of the food. Are there medications that can help?
Ruth: Yes there are some excellent medications. We call them antiemetics, or the anti-nausea medicines, and these are medicines that the oncologist, the cancer specialist doctors and nurse practitioners, will make sure that you have a prescription for these medications to take when you’re getting chemotherapy. Sometimes they will have you take them regularly on a schedule, especially if you’re struggling a great deal with the nausea. In many cases it’s ones that you can take when you need to, and if you find that nausea is a significant component and really affecting your meals and your eating, is take a pill about an hour before you’re going to eat and you find that really will make eating much easier. If you don’t have any medicine for nausea and you’re struggling, ask because they will give you something and there are various options that are available for that. A few other quick ideas as far as nausea goes. In the morning, more people tend to struggle with that when you wake up, but do what we call dry foods, things like crackers, toast or dry cereal can help. Those are also things that you can nibble on during the day. Not that they have a tremendous amount of nutritional value, but a lot of times they will help keep the nausea in check so that then you will be able to eat other foods as well. Sometimes foods that have a lot of odor to them or a lot of aroma may be a little bit too overwhelming and can sometimes trigger nausea, so we find often times that foods that are room temperature or are cold can be more helpful. Other types of foods that sometimes can trigger nausea are your greasy, fried, spicy or foods that are overly sweet. From a liquid standpoint, in addition to water, try juices or try popsicles or ginger ale, even ginger tea. Ginger is a spice actually that can help control nausea and I’ve had many individuals talk about how they will steep it and either drink it as a hot tea or add it to ice and have a ginger iced tea. I’ve found that to be very helpful with managing nausea.
Host: Great advice, and before we wrap up I’d like to ask you one more question, some people may get a sore mouth or sore throat during treatment, which can cause pain. Do you have some food suggestions? Does it have to be all soft food?
Ruth: You know soft foods are one of the things that help the most, and sometimes it’s difficult to think of what a soft food is, but your foods that are creamy to a degree such as yogurts or cream soups, eggs, puddings can be helpful. The other things sometimes can be just to make foods more moist like adding a gravy or a sauce to something that you like to eat can make it easier to swallow and that can be helpful as well. Another suggestion is to have honey, take a tablespoon of honey and mix it with warm water, and that can be very soothing to drink or drink using a straw. Sometimes too if you do that you can kind of bypass the mouth sores and that may make it easier to take some of your liquids. Of course one of my favorites types of foods, and I don’t have to deal with mouth sores, but your milkshakes or your smoothies, slushes or frozen yogurt can be very soothing and helpful as well.
Host: Wrap it up with your best advice and what you would like listeners to know if they or a loved one are going through cancer treatments and have some problems with eating, whether it’s a loss of appetite or nausea or sores, what you would like them to know.
Ruth: I think one of the most important things to remember is this is going to be temporary and it is going to come in cycles. It’s going to kind of come and go during the period of time of treatment. It’s important to make sure that your physician, the oncologist is aware of these struggles. Don’t just assume you have to put up with them because they’re there. There are a lot of things that they can do to help minimize those or even in some cases maybe even prevent that for you, so be honest. Don’t assume that you have to buck up and put up with it. You don’t. For the caregiver just continue to do everything you can for the individual you’re helping. Ask and offer options. There are a lot of excellent resources, cookbooks and things that are available that your oncology provider will have available for you that may provide you with some tips. The other thing that I think is important as well is just to continue to try different options. Come up with some ideas and give them a try and I so believe that you will be successful and just give it some patience as well as some time.
Host: Thank you so much Ruth for being on with us today. It’s great information and so important for cancer patients to hear and really thank you again. If you want to hear more Bryan Health podcasts, please go to bryanhealth.org/podcasts, that’s bryanhealth.org/podcasts. This is Melanie Cole, thanks so much for tuning in today.
Cancer Treatment & Appetite Changes: Tips to Get the Nutrition You Need
Melanie Cole (Host): If you or a loved one is going through cancer treatments, you know that there are so many factors involved, and one of the factors that plights many people is appetite changes relating to the treatments and decrease in appetite. My guest today is Ruth Van Gerpen. She’s an Oncology Clinical Nurse Specialist at Bryan. Ruth, how can going through cancer treatment affect the person’s appetite? What is the cause of it? Because I understand there’s probably many factors.
Ruth Van Gerpen (Guest): There are quite a few of them, and I think the main ones, the treatment itself such as chemotherapy or radiation therapy are probably the biggest factors. They can cause the person to actually lose their appetite because of the drug itself or the effects that it may have, on their taste buds and can cause food to smell or even taste different. One of the main changes some people will talk about with a few of our drugs is some of the foods will actually taste almost metal like or metallic. In addition, appetite can change from day to day. It kind of depends on where a person is in their treatment cycle. Sometimes it’s better, sometimes it’s just not so good because it also maybe due to the fact that other effects of treatment such as your nausea, diarrhea, constipation or mouth sores, even sometimes swallowing problems. All of those effect what we eat as well as how easy it is for us to eat. One of the things that we worry about is we know that it is vital for our patients to make sure that they continue to eat as well as drink fluids to avoid any weight loss or dehydration. We don’t want people losing weight while they’re on treatment. It’s important so that we can continue to make the most of it and really truly to keep them on schedule with their treatment.
Host: So you mentioned things like chemotherapy and we’ve heard that’s pretty bad for appetite. Can the pain and depression and fatigue also lead to a loss of appetite and what can we do about some of this?
Ruth: Actually it can. We know that fatigue and depression are common, especially with treatment, especially as they continue to have more cycles, more episodes of treatment with the chemotherapy or with radiation. If they’re getting it every day, typically five days a week for several weeks in some cases, is the more you have the more tired you are. Along with that, is you don’t have as much energy and that can also effect your appetite in addition to the side effects of the treatment, and sometimes depression is a common aspect of treatment. Sometimes it’s just very difficult to maintain that optimism or for some even that sense of hope, and that can also effect appetite. I think many people, even those that aren’t dealing with cancer find that sometimes when you get overwhelmed, depression sets in, and appetite is one of the things, that is effected.
Host: So what do you want the loved ones, who are helping to care for this person with cancer, and they tell you they’re not hungry and you can’t get them to eat, what should you do and what foods would you like – I mean we obviously don’t want just high calorie, right? We’d like high calorie also that give more bang for the buck. How do you get them to eat and what do you want them to eat?
Ruth: You know, that’s exactly true. We have a lot of wants, don’t we? We want them to make sure that they’re eating foods that have protein in them, is probably one of the most important things. We want them to make the most of every bite, kind of you get the most bang for your buck, but we want foods that have more calories but we also want that nutritional value, and primarily that’s protein. Protein is what helps those cells in our body that have been damaged by treatment to be able for the body to make new ones, and the protein is one of the key things for that. So these are things like peanut butter, cheeses, butter, not skim milk anymore, maybe you go to 1% or 2% milk, but things that have more protein in them or your foods that have more calories to increase calorie intake. Another thing that is often helpful is sometimes when we sit down eating three meals a day, but now a full plate of food is too much at one time. So it helps to do small amounts throughout the day, even five or six times a day. For instance, maybe you can have some eggs or you can have some eggs with some cheese on it or have some oatmeal, and then in the middle of the morning maybe you have a few nuts or you have part of an apple and put some peanut butter on it. In the afternoon after some lunch, you have some crackers with some slices of cheese on it. It doesn’t have to be a lot, but throughout the course of the day you’re going to get the added calories, you’re going to get the added protein into that and you’re going to find as well that it’s easier to do that. Often our dietitians we work with indicate to not let more than three hours go by without eating or drinking something. Sometimes too for people if they’re struggling with nausea is that can be worse if the stomach is empty, so keeping some food in the stomach is important from that aspect as well. Sometimes too we tend to always tend to drink more when we’re eating and sometimes that can fill you up too much. So do your drinking more between your meals. If you’re drinking things that you can add a little protein to if you like some of the protein drinks, don’t do those along with your meal. Drink them in between and use those as a substitute maybe for a snack. One of the things too that I’ve commented to many people, things they’ve never think about is to take their medications with milk or protein supplements and I’ve had many patients go, “Oh, I’ve never even thought of doing that.” They said that would be easy to do because you’re needing to take it with liquids and so you can take your medications in that manner. I think one of the challenges, especially for people who are alone or don’t have somebody to eat with regularly is the fact that it’s easier to skip a meal because you don’t have anybody to visit with or make sure that you’re not alone when you eat. In other words, eat with somebody or have the TV on or turn on a favorite movie or turn on the radio, something to take the focus off of the food, something that you can concentrate on or enjoy. Often if we’re enjoying something we tend to eat better, eat more or at least a few more bites of the food that we’re eating. One of the other things that sometimes can help encourage an appetite is just to stay physically active, be as active as you can. Maybe that means when you’re out trying to get a little bit of walk or walking a little bit more around the house is do that before you eat to try to make you a little bit hungry. Sometimes that can improve appetite. We know it can help digestion, but I think one of the most important points for those that are the caregivers, those that are caring for somebody with cancer, is to try not to take it personally. When you’ve fixed a meal, you fixed spent some time making a soup or maybe you’ve even gone out to get their favorite snack at a fast food place, and you bring it home and you put it in front of them and they take one bite, and they go, “I don’t want anymore,” try not to take it personally. It’s not you. It’s the disease, it’s the treatment. They do appreciate everything that you’ve done but it can be very difficult with the disease and sometimes appetite can change that quickly. So it isn’t a personal complaint. It is just the fact that the disease and the treatment is making it difficult from an appetite standpoint.
Host: One of the things that factors into that loss of appetite is nausea and the taste and smell of the food. Are there medications that can help?
Ruth: Yes there are some excellent medications. We call them antiemetics, or the anti-nausea medicines, and these are medicines that the oncologist, the cancer specialist doctors and nurse practitioners, will make sure that you have a prescription for these medications to take when you’re getting chemotherapy. Sometimes they will have you take them regularly on a schedule, especially if you’re struggling a great deal with the nausea. In many cases it’s ones that you can take when you need to, and if you find that nausea is a significant component and really affecting your meals and your eating, is take a pill about an hour before you’re going to eat and you find that really will make eating much easier. If you don’t have any medicine for nausea and you’re struggling, ask because they will give you something and there are various options that are available for that. A few other quick ideas as far as nausea goes. In the morning, more people tend to struggle with that when you wake up, but do what we call dry foods, things like crackers, toast or dry cereal can help. Those are also things that you can nibble on during the day. Not that they have a tremendous amount of nutritional value, but a lot of times they will help keep the nausea in check so that then you will be able to eat other foods as well. Sometimes foods that have a lot of odor to them or a lot of aroma may be a little bit too overwhelming and can sometimes trigger nausea, so we find often times that foods that are room temperature or are cold can be more helpful. Other types of foods that sometimes can trigger nausea are your greasy, fried, spicy or foods that are overly sweet. From a liquid standpoint, in addition to water, try juices or try popsicles or ginger ale, even ginger tea. Ginger is a spice actually that can help control nausea and I’ve had many individuals talk about how they will steep it and either drink it as a hot tea or add it to ice and have a ginger iced tea. I’ve found that to be very helpful with managing nausea.
Host: Great advice, and before we wrap up I’d like to ask you one more question, some people may get a sore mouth or sore throat during treatment, which can cause pain. Do you have some food suggestions? Does it have to be all soft food?
Ruth: You know soft foods are one of the things that help the most, and sometimes it’s difficult to think of what a soft food is, but your foods that are creamy to a degree such as yogurts or cream soups, eggs, puddings can be helpful. The other things sometimes can be just to make foods more moist like adding a gravy or a sauce to something that you like to eat can make it easier to swallow and that can be helpful as well. Another suggestion is to have honey, take a tablespoon of honey and mix it with warm water, and that can be very soothing to drink or drink using a straw. Sometimes too if you do that you can kind of bypass the mouth sores and that may make it easier to take some of your liquids. Of course one of my favorites types of foods, and I don’t have to deal with mouth sores, but your milkshakes or your smoothies, slushes or frozen yogurt can be very soothing and helpful as well.
Host: Wrap it up with your best advice and what you would like listeners to know if they or a loved one are going through cancer treatments and have some problems with eating, whether it’s a loss of appetite or nausea or sores, what you would like them to know.
Ruth: I think one of the most important things to remember is this is going to be temporary and it is going to come in cycles. It’s going to kind of come and go during the period of time of treatment. It’s important to make sure that your physician, the oncologist is aware of these struggles. Don’t just assume you have to put up with them because they’re there. There are a lot of things that they can do to help minimize those or even in some cases maybe even prevent that for you, so be honest. Don’t assume that you have to buck up and put up with it. You don’t. For the caregiver just continue to do everything you can for the individual you’re helping. Ask and offer options. There are a lot of excellent resources, cookbooks and things that are available that your oncology provider will have available for you that may provide you with some tips. The other thing that I think is important as well is just to continue to try different options. Come up with some ideas and give them a try and I so believe that you will be successful and just give it some patience as well as some time.
Host: Thank you so much Ruth for being on with us today. It’s great information and so important for cancer patients to hear and really thank you again. If you want to hear more Bryan Health podcasts, please go to bryanhealth.org/podcasts, that’s bryanhealth.org/podcasts. This is Melanie Cole, thanks so much for tuning in today.