Appetite Loss and Nausea
The thing about cancer is that it can really affect your appetite. Between the nausea and mouth ulcers, taste changes and sheer exhaustion, it’s no wonder some people don’t feel like eating.
In this episode of The Thing About Cancer podcast, Julie chats to dietitian Merran Findlay, who has helped many people with cancer work out how to keep eating throughout their treatment.
The classic idea of cancer is that you lose a lot of weight and end up looking quite thin and gaunt. But is this always the case? Merran describes some of the physical impacts of cancer treatment, and how they may play out differently in each unique case.
Why does cancer cause nausea and loss of appetite?
Why do cancer treatments often cause loss of appetite and nausea?
Merran says that a common cause is chemotherapy, which can affect different parts of the brain, such as the part that controls vomiting. When we feel unwell, food we eat at that time or certain smells may trigger that nausea again.
Tips to increase your appetite, and reduce nausea
During this episode you will learn different things you can do to reduce nausea and boost your appetite if your cancer treatment is causing these side effects. Merran says that the key to maintaining your weight is to eat several small meals throughout the day and to make sure they are packed with nutritional value.
This episode also covers important areas like how treatment can affect your taste and smell, and your ability to swallow.
It’s important to talk to your treatment team about managing side effects that affect your appetite. If you are finding it hard to keep eating well or are losing weight, you can ask to see the dietitian at your treatment centre.
Quirky diets probably won’t help, but exercise often does
Merran dispels some myths about quirky diets that claim to cure cancer, saying that there is no evidence to support these miracle cures that are often promoted on the internet.
She does explain, however, that research shows that exercise often helps reduce treatment side effects.
What kind of foods should you eat during treatment?
If you are going through treatment, or you’re caring for someone who is, Merran suggests types of foods that are easy to digest and gentle on the stomach.
She also talks about how carers can encourage someone to eat when they have little appetite.
Quite often his mouth was sore; swallowing was hard – so I blended things, I mixed them with cream. Scrambled eggs became a real staple… I was putting energy in his belly that could make him strong.
— carer Georgie talks about how she prepared meals for her husband during his treatment
Want more information or support?
If you heard something mentioned in the podcast, you’ll find a link for it below. We’ve also added links to other sources of information and support.
From Cancer Council NSW
- Nutrition and cancer – visit this link to understand more about nutrition, and to learn about eating well during and after cancer treatment.
- Easy-to-read information about cancer – cancer types, treatments and issues
- Cancer Council 13 11 20 Information and Support service – call 13 11 20 Mon–Fri, 9am–5pm, to talk confidentially to a health professional about anything to do about cancer
- Cancer Council support for people coping with cancer – information and support online, in person and via phone
- Cancer Council Online Community – a supportive online community for people affected by cancer
- Exercise and cancer – research shows that exercise has many benefits both during and after cancer treatment. Watch these videos to learn more.
- ENRICH – learn more about this free healthy lifestyle program developed by Cancer Council NSW and the University of Newcastle
- Healthy Living After Cancer program – free health coaching over the phone
From other organisations
- Dietitians Association of Australia – find an accredited practising dietitian and learn more about what dietitians do
- American Cancer Society – learn more about poor appetite from US cancer support organisation
- Cancer Research UK – learn more about types of diet problems from UK research-funding organisation
- National Cancer Institute (US) – learn more about nutrition in cancer care from US government cancer control agency
Transcript of Episode 7: Appetite Loss and Nausea
The Thing About Cancer podcast, Cancer Council NSW
[woman] The very essence of all cancers is a change in the way that cells divide.
[man] I remember sitting in there thinking, you know, it’s not happening, it’s not real, it can’t be real.
[woman 2] It’s something that we don’t talk about.
[woman 3] This feeling of being overwhelmed − it will get better once you have a plan and you know what to expect and what’s going to happen. It’s not going to be like this all the time.
[various voices] The Thing About Cancer: A podcast from Cancer Council NSW. Information and insights for people affected by cancer.
Julie McCrossin: Hello, I’m Julie McCrossin and today the thing about cancer is it can really mess with you appetite. Along with the sheer stress of the diagnosis, cancer treatments can cause side effects like nausea, mouth ulcers, and changes to taste, so it’s no wonder that some people don’t feel like eating.
Merran Findlay: I often say to people that your nutrition care is part of your overall care, and oftentimes with a cancer diagnosis there’s so much that you feel is out of your control, but this one thing is actually within your control. We speak to not just the patient who has had the cancer diagnosis, but also the family or the carers because they’re very often involved in supporting the person and particularly with that meal preparation.
Julie: We’re talking to Merran Findlay, an Oncology Specialist Dietitian and Executive Research Lead from Royal Prince Alfred Hospital in Sydney. Merran has helped many people with cancer work out how to keep eating throughout their treatment.
Just to be clear this podcast contains general information only, so we recommend that you talk to appropriate professionals about your individual situation. You could also call Cancer Council 13 11 20 if you have any questions.
We’ll hear more from Merran in a moment but first here’s Georgie talking about preparing food for her husband during his cancer treatment.
Georgie: You think about what he really enjoys eating, what’s soft. So quite often their mouth was sore, swallowing was hard, so I blended things, I mixed things up with cream. Scrambled eggs became a real staple for him because it was soft, it was nurturing. I’d go back to thinking about what would be soft, caring, so I thought I was putting energy in his belly that could grow, maintain and make him strong.
Julie: At the start of this episode dietitian Merran Findlay spoke about nutrition care as part of your overall cancer care, and it’s my pleasure to welcome Merran now to this program. Merran, the classic picture that people have in their mind of someone who’s been diagnosed with cancer is someone who gets very, very thin. Is that an accurate picture of what happens to people?
Merran: That’s actually a really good question Julie, and I think when people have a cancer diagnosis they’re initially very lost, there’s a lot of anxiety around what is going to happen to them and what they should and shouldn’t do, and one of those anxieties is often around diet and nutrition and what I should and shouldn’t eat. And that typical picture that you describe of someone that’s very sort of thin and has lost a lot of weight, that certainly can happen. But it is also important to recognise that for people, no matter whether they are within a healthy weight range or above or below, that anyone can be at risk of malnutrition. And certainly when it’s related to cancer and its treatment, that’s very important part of their carers to look at what they can do in terms of their diet.
Julie: Let’s go to the causes of loss of appetite because that can be common. So could you go through the different treatments and the different factors that can cause – well, can make it harder to keep eating.
Merran: Sure, I mean, there’s a number of factors that can impact on your ability to feel like eating. They can be related to the treatment and related to the disease.
Julie: Can you give me some examples?
Merran: Very common things are like a loss of appetite, nausea and vomiting, changes in the lining of the mouth (in particular, things like mouth ulcers), changes in bowel habits, whether you’ve developed diarrhoea or constipation. And really what we encourage people to do is with those nutrition impacts symptoms is to speak with their care team, particularly the medical and nursing staff, because it may need some medical management to get on top of those things and then the nutrition care and your ability to eat well tends to fall into place once that’s under control.
Julie: Let’s talk through some of those side effects and what you can do about them. Starting with nausea − I know not everyone gets nausea, it depends partly on what type of treatment you have, but it is one of the most common symptoms of cancer treatment. Why does cancer treatment make people nauseous?
Merran: The common cause of nausea is often in relation to chemotherapy, which is used to treat cancer and it can affect different parts different parts of the brain. So there’s a chemotherapy-induced nausea and vomiting centre in the brain that can be triggered through certain drugs. So that does mean that there’s actually a physiological reason for it. And often when we feel unwell, maybe foods that we eat at that time tend to − or certain smells − might trigger that feeling of nausea again. Other physiological reasons can be anxiety and stress. You know, you can be very anxious in attending a chemotherapy appointment. Some people just feel nauseous walking into the treatment centre. But they’re all valid reasons for feeling that way, but there’s a range of treatment options that can help alleviate those symptoms.
Julie: To understand a bit more about what this nausea can be like, we spoke to Sam, who had chemotherapy for non-Hodgkin lymphoma.
Sam: It’s the only thing or it’s the only symptom that you cannot just deal with. Even chronic pain, you can manage that with or without opioids, whatever. But nausea is not something that you can really fight or just say I can keep this in the background, if it gets bad. There is no denying that it is the worst aspect of having treatment.
Sam: However I was fortunate enough in that I didn’t throw up once during my treatment, yet. Right now there’s a suite of drugs that do an incredible job of keeping you from being sick.
Julie: Merran, is there anything you can do to prevent or at least reduce that feeling of nausea?
Merran: The thing with nausea is if it’s uncontrolled it will have a huge impact on your ability to eat well. Very often as part of your treatment, you will have some medications that are prescribed and they can be a preventative being needed to be taken before meals. And trying to keep on top of that nausea is actually really important. Things in terms of nutrition that can help: it’s been shown that ginger can have a role in reducing nausea, so maybe even light sips of ginger ale or sucking on ginger lollies, etc − some people find that they might get some symptom relief with doing that. The other important thing with nausea is particularly if that extends to vomiting as there is a higher risk of dehydration, and so just constantly sipping fluids can actually be helpful, flat lemonade, those sorts of things.
Julie: What are the symptoms of dehydration if you’re not getting enough fluid? How would I know?
Merran: Okay, so very commonly people feel a little bit confused, you might notice that the colour of your urine output is a little bit darker, so the kidneys are working overtime to concentrate − that’s often a sign. A dry mouth is another sign as well, you might notice the texture of your skin is quite dry as well. You know, the effects of dehydration can be quite immediate, so if you’re unable to keep any food and fluids down it’s really important that you get in touch with your care team and they can help maybe troubleshoot, even over the phone, about whether you can do some simple things at home or whether you need to come in and see someone.
Julie: If you are feeling sick, how do you manage to keep eating enough so you don’t become malnourished?
Merran: To do that we try and suggest really nourishing foods that have a lot of nutrition packed into them in a small volume. People with nausea and vomiting or a poor appetite very often don’t feel like eating large meals so we tend to suggest small but frequent meals. And that means, you know, the morning tea, the afternoon tea and the supper are three other really important opportunities in the day to have something that’s nourishing. We would also recommend not filling up on things that don’t really have much nutritional value to them − so those sort of clear broths and those sorts of things really don’t have much substance. Black tea may help with nausea as a small sort of symptom, but if in the long term you need additional nutrition to reduce the unplanned weight loss, then we try and recommend things that are a bit more sort of higher in protein, higher in energy.
Julie: You also mentioned mouth ulcers as a side effect. What treatments can cause them?
Merran: Okay, so with any treatment to the upper gastrointestinal tract where there is radiation to the mouth and throat area, that can cause mucositis and those mouth ulcers that you’ve mentioned.
Julie: What’s mucositis?
Merran: So it’s an inflammation of the mucosal membranes that line the area of the mouth and the upper gastrointestinal tract. So when that gets inflamed it’s obviously very painful, and those two symptoms can cause people to reduce how much they’re eating and drinking. Chemotherapy can also cause mouth ulcers because that is also designed to affect rapidly dividing cells and of course the lining of our mouths are rapidly dividing cells so that can get very sore. The ways that we manage it from a medical point of view is there’s obviously pain relief − that’s important to take that as prescribed. From a nutrition point of view, we might need people to have sort of softer meals and avoid hard and crunchy sorts foods that will irritate a sensitive lining of the mouth, they might need to eat more sort of higher protein and higher energy sorts of foods, and the other sort of thing that’s really important is good mouth care. And so wherever you’re having your treatment, whether it’s chemotherapy or radiotherapy and chemotherapy to the head and neck area, you will be advised on the sorts of regular mouthwashes that you need to do to keep that mouth clean, reduce risk of infection and minimise risk of problems with your teeth as well.
Julie: Taste and smell can be affected by some treatments too, so how do you manage that?
Merran: It’s one of the more challenging things. If people tend to find smell is something that reduces their desire to eat, we often suggest that maybe avoiding the kitchen at the time when those cooking smells are happening. Cold food can be just as nourishing as warm food but it doesn’t necessarily give off the same strong odour. Taste is one of those ones that is harder to do a lot about, but, you know, one of the things that can affect it is a dry mouth, so by keeping the mouth moist, keeping up good mouth care as we mentioned before, that’s actually really important as well.
Julie: Drinking water?
Merran: Drinking water, carrying that water bottle, keeping well hydrated are all really important.
Julie: And trouble swallowing, you’ve already mentioned the head and neck but what can you do to help keep getting that food down and what if you can’t keep getting it down?
Merran: So the other person that a dietitian often works very, very closely with is someone called a speech pathologist and their specialty is looking at the mechanics of swallow and speech and coming up with an individualised plan for people that are having trouble in that area. It’s not just a nutritional issue, it’s also a safety issue because we need to make sure that the food and fluids are going down the right way, so we need to make sure it’s going down the food pipe and not the windpipe. We can do that by adapting the texture of the food that you’re having, so sometimes the softer meals or minced meals, even to puree depending on how well you’re swallowing, and adding moisture can really, really help − so extra sauce and extra gravy just helps that bolus of food form a little bit better and make it easier to swallow.
Julie: I think you mentioned anxiety earlier. Anxiety and depression are common for people going through these difficulties, so can that affect appetite?
Merran: Absolutely it can, and certainly isolation too if people’s social circumstances are that they don’t have social support at home, that can also be a reason that they may not be able to care for their own nutrition needs. Another really important member of the multidisciplinary team are the psycho-oncology team, so there’s a range of psychologists and counsellors available in many cancer centres that can help you with coming up with some strategies to manage that anxiety.
Julie: You know, if you’re listening to this, it sounds so daunting and yet it’s so variable isn’t it?
Merran: This is true.
Julie: Between cancers and even for the same person during the duration of their treatment, so how can we reassure people that they may or may not have only some of these experiences?
Merran: Absolutely and I think it’s important to recognise that the same as we’re all individual, an individual’s cancer diagnosis and their cancer “journey” (for want of a better word) can be very, very different. And you know some people will go through treatment experiencing minimal nutrition impact symptoms, minimal impact on their weight, and they recover and get back to life as normal very, very quickly and very well, but it is important to understand what your unique circumstances are. So speaking with your care team about what the expected side effects might be and then just having a good understanding of who the members are in the care team that can help you if and when you have a problem.
Julie: You’re listening to The Thing About Cancer, a podcast from Cancer Council NSW. I’m Julie McCrossin and I’m talking to Oncology Specialist Dietitian Merran Findlay about dealing with appetite loss during cancer treatment.
If you have any questions about this topic, or just want to talk to someone about your concerns, you can call Cancer Council 13 11 20. They can send you a free copy of Cancer Council’s “Nutrition and Cancer” booklet, which is full of practical tips and recipes. For links to the online version of that booklet or any of the services we mention, or to listen to more podcasts, visit cancercouncil.com.au/podcasts and click through to this “Appetite Loss and Nausea” episode.
We’ll be back to Merran in a moment, but first we’re going to hear from David, who worked out his own way to manage the appetite changes that came with his treatment.
David: Because of the nauseousness and I was selective in what I was eating, I ended up starting cooking − I never cooked − and started cooking because it was like, “Well what do I feel like?” And it was almost I could think of something and it would almost make me feel sick, the thought of serving food and other foods wouldn’t − so I’d just go, “Well, I’ll have that tonight”, sort of a thing. I went through a selection of stuff. I actually got some recipes and started, I went healthy – well, I had a mixed diet, it wasn’t all purely healthy. There was a bit of trying new stuff because I wasn’t a cook and my wife wasn’t cooking and she cooked what she… shall we say, she normally cooked, and so I was trying new things and seeing what was simple for a start and just something that appealed. So there was some vegetarian stuff, there was just some chicken things, there was tuna and fish things with salads because I’ve always loved a salad. And sometimes, I mean, that would work, and sometimes I’d just have a curry. I mean anything worked on different days almost, really I couldn’t say I’d gone off chicken altogether for that period because, you know, see me next week, I was on the chicken and off the fish.
Julie: Merran, I understand a dietitian can often be really helpful if you’re having any trouble eating well during your treatment. Is a dietitian always part of the cancer treatment team?
Merran: In most cancer centres there will be a dietitian that has specific training in looking after people with cancer − it’s certainly a good place to start. If you’re wanting to ask questions about nutrition, speak to your care team about a referral to a dietitian. They may have some screening processes, they can ask you some simple questions about “Have you lost weight recently? Have you been eating poorly due to a poor appetite?” And they’re some simple screening questions that might trigger a referral to a dietitian.
Julie: What are some of the things that might happen to me that mean you should contact the team quick-smart and get a referral to a dietitian? Can you give me some specific things that might be happening to me − “yes, I should ring the dietitian”?
Merran: I think if you had any unplanned weight loss. As a rule of thumb, we tend to say more than 5 per cent weight loss is clinically significant and that’s actually not that much. If you’ve lost more than 3−4 kg it’s probably at that threshold point of being significant. Any symptoms that you’ve had that mean that you’re not eating well can also trigger a referral to a dietitian. Even any concerns that you have about being uncertain about what you need to do in terms of your individual circumstances − “This is the treatment I’m having but I don’t know what that means for me in terms of my diet, in terms of my nutrition.” I think they’re all good reasons to ask to see a dietitian.
Julie: And if there’s a clear, you know, urgent need for you to put on some weight, what are the sort of things a dietitian will be telling me to eat?
Merran: So we focus a lot on weight maintenance versus weight gain − it tends to be more realistic depending on what’s happening with people as they’re going through treatment. We do focus on some of those strategies I mentioned earlier about small and frequent meals, we do focus on foods that are high in protein and also high in energy or another word is calories or kilojoules.
Julie: Yep, so get specific?
Merran: So the foods that are high in protein tend to be foods that are from an animal source, so whether it’s meat and chicken and fish, sometimes adapted texture if you need that for other symptoms; dairy-based foods, so your milks, yoghurts, custards, ice-creams, yoghurts − all those sorts of things can be very nourishing in a small volume; and it might also mean even just changing from a low-fat and a skim-milk version of that product to the full-fat version, even if it’s a temporary measure while you’re eating poorly.
Julie: So suddenly everyone’s telling you to eat −
Merran: − yes
Julie: − fattening things just when you don’t feel like eating.
Merran: Well, the point I’d probably like to make on that is, is really that your nutrition priorities change. It’s different from when prior to when you had a cancer diagnosis, it’s different while you’re going through treatment, and it may change again when you’re recovering. And so it’s just weighing up what’s most important for me at this point in time.
Julie: And there are liquid food supplements that you can get at a cheaper rate if you’re a cancer patient.
Merran: This is true.
Julie: Can you explain them?
Merran: So there’s a range of products that are made that are particularly high in protein and calories to help people meet their elevated requirements during cancer treatment. The dietitian will usually make an assessment to determine which of those products is the most suitable and determine a nutrition prescription of how many of those are required. They’ll then put you in touch with purchasing details and they usually can be at a subsidised rate through tender prices.
Julie: We’ve spoken a lot about how incredibly important it is to avoid malnutrition and to keep eating even if treatment is difficult. And I’m a survivor of head and neck cancer and lost 20 kg in about six weeks and was weighed every day and monitored extremely closely, and so I guess I wanted to alert someone who’s listening who may already have lost a lot of weight and got onto this podcast, that sometimes significant weight loss is part of treatment but it still means you can recover and come back to wellbeing.
Merran: That’s very true and obviously you’ve had that experience from your own cancer journey. I guess what we would prefer to do is avoid people getting into that situation for a number of different reasons. I can imagine that with that severe weight loss in such a short time, you probably felt pretty lousy for a good portion of that, and if we can assist people before they get to that point. And it’s actually, do you know there’s a lot of health care professionals that aren’t necessarily aware of the importance of critical weight loss and malnutrition? So don’t be afraid to speak up, you know, ask for that referral to a nutrition-care expert and, you know, seek advice.
Julie: And I should say this is something that happens more with head and neck cancers than many other cancers, but I just think for someone who might be listening who’s very thin, I have put that weight back on and am feeling well. You know, you can recover.
Merran: Yes, yeah and that’s an important message that you’ve had a really challenging time but in that recovery period you’ve been able to return to eating and drinking through I’m sure a lot of effort and positive reinforcement from your caregivers.
Julie: And dietitians and speech pathologists.
Merran: Fantastic to hear that.
Julie: Some people don’t lose weight, in fact you can even gain weight. Can you explain that?
Merran: It’s actually a really great question and it’s something that it’s probably not as common a problem as cancer-related malnutrition, but it’s important to be sort of aware of what is causing the weight gain, and it may not necessarily be weight gain as we would normally think about it. There can be factors relating to the treatment, for example, certain chemotherapies or drugs might cause fluid accumulation, and one of those common things are steroids. So we can typically see that reflected on the scales but not realise that’s not weight gain as we would usually think about it. Other contributing factors might be changes in eating patterns due to stress, there might also be changes in activity levels because of fatigue. So I think our sort of take-home message would be to speak to your care team about any sort of weight gain that you’ve noticed, see if you can collectively identify a cause for that weight gain, and then come up with a plan that might involve referral to a dietitian, maybe the exercise physiologist or physiotherapist in the centre as well, who can come up with a multidisciplinary care plan for you.
Julie: As I understand it, you’re not meant to try and lose weight while you’re having cancer treatment. Can you explain why that’s important? Because you’re having so many body image issues when you have treatment, you might have hair going out, now you’re putting on weight. For a lot of men and women that’s going to be really hard.
Merran: That’s true, I mean as a general rule, we try and say to maintain your weight, just because we’re not concerned with weight gain as much as we are with weight loss or cancer-related malnutrition. The reason that it’s important is we think about unplanned weight loss versus planned weight loss. And so if you’re well enough to be pursuing healthy diet and activity, that’s not so much the issue, but we often tend to not think about weight loss during cancer treatment as having a negative impact but it can. And often when weight loss is rapid, it comes at the expense of your lean muscle and therefore your feelings of strength, it can increase fatigue, so it’s very important in terms of improving your outcomes by not aiming to lose weight.
Julie: In that recovery period is when can you start losing weight if you’re not happy with how your body is at the end of the treatment process − and who should you talk to about that?
Merran: I think a really good starting point is to speak with your treating medical team and get an understanding of where the disease management is at and, really, I think once you’re feeling well and able to resume your usual activities, starting to think about, you know, lifestyle change if that’s something that you need to incorporate as part of managing a healthy weight. It certainly has a role in reducing cancer recurrence in certain types of cancers and breast cancer is a good example of that, of maintaining a healthy weight. The Cancer Council has a fantastic program called ENRICH and that has an education series around nutrition and exercise, physical activity.
Julie: And the reality for most of us is that we’ll be going back for checks every three months or every six months possibly for two or three years, so you have plenty of opportunities to keep talking to your team about what to do, so just talk to them − I mean, that’s the basic message.
Merran: Sure, yes, great message.
Julie: Let’s come to this issue of exercise, because you mention muscle loss there. Exercise is recommended throughout treatment to some degree. Can you talk about that?
Merran: I think the thinking is or has shifted in that regard. It was very often, you know, to tell people to lie down and rest and don’t do anything, but the evidence and the science is showing us that people who are able to maintain some level of activity throughout treatment, it has a number of positive benefits and, you know, very importantly in terms of quality of life, in mood, in feeling of empowerment, physical strength, preserving your muscle mass. All of those sorts of things are really, really important.
Julie: So we’re really encouraged, to the capacity we can, to keep moving, and again we always talk to our treatment team, and there are also some great exercise resources programs offered by Cancer Council, including that ENRICHing Survivorship exercise and nutrition program. You can find links to all of those on our podcast page at cancercouncil.com.au/podcasts and just click through to this episode.
So Merran can eating well assist recovery?
Merran: Absolutely it can and there’s certainly a lot of good evidence that people that are well nourished will get through treatment and recover more quickly. We do know that people that have lost a lot of weight during treatment or been unable to maintain nutrition will have a more difficult time, they do get more toxicities related to treatment.
Julie: What does that mean?
Merran: So in relation to chemotherapy and radiation therapy, they may have more problems in tolerating the treatments. People who become malnourished may require treatment breaks, they’re not able to proceed through the full course that was originally planned. So we do see nutrition care as a really important adjunct to your standard care.
Julie: You do hear about quirky diets that people will often claim can help you cure cancer and in this series we’re very much encouraging people to stick to the recommended websites that are available on the Cancer Council website and the podcast website and so on. But it’s very hard to avoid these around the internet, there’s so many quirky cancer cure diets. Is there any evidence that any of them work?
Merran: I’m really glad you asked that question, simply because there’s so much information on the internet and equally there is an awful lot of misinformation. And, like anything, we need to still be a discerning consumer of where we’re getting our information from. With regards to diets that claim to cure cancer, unfortunately there isn’t any evidence for such a treatment. I think the checklist of things to run through when you’re weighing up this sort of information that you might find out there, the red flags are: Does it claim to cure cancer? Does it require you to eliminate entire food groups? Because then it will mean that you’re missing out on some important nutrients, whether it’s vitamins or minerals. Does it require you to take really large doses of certain items? A good example of that is sort of the juice therapies that we might have heard about − you know, we think about vitamins and minerals as harmless, but in very high doses they can have toxic effects. Is it costing you a lot of money? Good nutrition and supporting nutrition through cancer care should not cost you a lot of money. And is it socially isolating? Have you found that you’re no longer enjoying meals because you’re following something incredibly restrictive and it’s compromising your quality of life? Those would all be sort of triggers as a warning that this is not a proven diet. I would encourage people to think about, like you want your oncologist and your cancer specialist to be having appropriate qualifications, really check the credentials of the person that you’re seeking nutrition advice from.
Julie: I took the approach that I wouldn’t see anyone unless one of my oncologists referred me or I ran it past them just as a protection.
Merran: It’s really important to recognise that diet is an adjunct to your standard care, it is not a replacement for it.
Julie: And for carers, as family members and partners tend to become after this sort of diagnosis happens to someone they love, what’s our advice to them? Do they need to actively seek information about how they can be helpful, what sort of food to cook, and whether they should, as it were, encourage actively the person to keep eating as a form of medicine?
Merran: It’s a really important role, the role of the carer and, you know, for the people fortunate enough to have someone supporting them through treatment and recovery. Often it’s one of the key roles is that of nurturing and there’s no better way to do that than through food and nutrition. It can become a battleground − I suppose that’s the thing that I would through wanting to nurture someone you love and someone doesn’t want to eat but you’re trying to encourage it, it’s just that delicate balance of maybe thinking about quality versus quantity of nutrition.
Julie: I’m thinking about the 13 11 20 number for Cancer Council and they give information and referral to services and so on − if a carer and family member’s worried, that’s one option, isn’t it?
Merran: Absolutely, yes the Cancer Council resources are something that we often recommend to patients and carers simply because they’re widely accessible, they’re evidence-based, they’ve been peer-reviewed by experts in the field, so they’re a reliable source of information that you can trust.
Julie: There are some cancers that really do make it hard to keep getting good nutrition in. What tips can you offer the carer or friend who’s just wanting to keep actively encouraging the person to keep eating to survive? How can they do it without rubbing the person up the wrong way?
Merran: It’s actually a very challenging position for the carer in that situation. They are definitely the unsung hero of cancer care and they do tend to cop a fair bit − when people are in pain or suffering, you tend to lash out at the person you care about the most. I suppose when it comes to mealtimes versus trying to avoid that battleground situation, I would try and encourage − harness the support of the care team. Allow the dietitians and the nursing staff and the speech pathologists to do a lot of that encouragement, also called nagging, for you, because people tend to respond sometimes better to a health professional than the loved one. But I think resilience, persistence, you know one teaspoon at a time − if that’s all they managed, at least they tried and accept that as a win. And then, you know, the next meal it might be two teaspoonfuls. I think the best thing you can do is keep trying, not give up and remember that supporting the person you care about through such a difficult time is one of the most important jobs that you’ll do.
Julie: We’ve covered a lot of ground in this interview, so just to sum up, what would you say are three key tips for people who are just about to start treatment for cancer?
Merran: I would like to say from a nutrition care point of view to keep an eye on your weight − monitor you weight and if you’ve got any unplanned weight loss or any changes in your weight, I think you should mention those to your care team and they can organise appropriate referrals if needed. I would keep an eye on any symptoms that are impacting your nutrition − whether it’s the things we’ve discussed, the nausea, the vomiting, changes in bowel symptoms − discuss all of those with your care team. And whatever sort of medication they might prescribe to help manage them, please take them because the nutrition and eating will fall into place around that. And lastly, I would like to just emphasise how important nutrition care is in supporting you through your cancer treatment and recovery, I would encourage people to think of it as part of their overall care.
Julie: That’s it for this episode of The Thing About Cancer thanks to Merran, Georgie, Sam and David for sharing their insights.
If you’re looking for more information, you can ring the Cancer Council 13 11 20 Information and Support service from anywhere in Australia, or go to cancercouncil.com.au/podcasts. If you have any feedback on this podcast, we’d love to hear from you, so leave us a review on iTunes or on our website. If you’d like to subscribe to the show, you can do it in Apple Podcasts or your favourite podcasting app.
If you found this episode helpful, you might want to listen to our podcast on coping with fatigue. In that episode, I talk to researcher Haryana Dhillon about what is different about cancer fatigue and how you can get your energy back.
Haryana Dhillon: I think the key thing, really, is to learn about pacing. And pacing is one of those strategies that people can put in place when they are feeling fatigued which helps them to work out essentially how much energy they’ve got in their energy basket and where they’d like to share that around.
Julie: You can find that episode “Managing Cancer Fatigue” on our website at cancercouncil.com.au/podcasts.
Julie: The stories and experiences contained in this podcast represent the views and opinions of the speakers. They do not necessarily represent the views and opinions of Cancer Council NSW. This podcast contains general information only, and Cancer Council NSW recommends you obtain independent advice specific to your circumstances from appropriate professionals. I’m Julie McCrossin and you’ve been listening to The Thing About Cancer – a podcast from Cancer Council NSW, produced by Jenni Bruce and Miles Martignoni.
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