Side Effect Management – Diet and Exercise

Good nutrition and physical activity are important for cancer patients. Not only can they improve your quality of life and long-term survival, but these cancer treatment tips can also help you reduce your chance of cancer recurrence and better manage side effects that are associated with certain cancer treatments.

Nutrition & Side Effect Management During Cancer Treatment

Getting enough calories and protein, as well as making wise food choices, are both important aspects of nutrition during cancer treatment. However, because everyone is different, there is no way to know if you will have difficulty eating, and if so, how bad it will be.

Changes in nutritional needs vary among patients. Sometimes, it’s due to the cancer itself. Other times, it’s because of side effects (e.g. nausea, loss of appetite) from treatment. Regardless, changes like these can make it both challenging to eat and to eat enough.

Consuming a healthy and well-balanced diet during cancer treatment can help you feel better and stay stronger. A healthy diet includes eating and drinking enough to maintain the nutrients the body needs including vitamins, minerals, protein, carbohydrates, and fat. Plus it’s important to stay hydrated. For most people, this includes a diet that consists of:

• Lots of fruits, vegetables, and whole-grain bread and cereals
• Modest amounts of meat and milk products
• Small amounts of fat, sugar, alcohol, and salt

People with cancer, however, often need that and more. This is because the illness and the treatment can affect your appetite as well as your body's ability to tolerate certain foods and use nutrients. When you have cancer, you may need to increase your calorie and protein intake. This means you will need to choose high-calorie, high-protein foods as often as possible in order to compensate for any nutritional loss.

Keep in mind that calorie needs during cancer are not the same for everyone. Factors such as your weight, height, the presence of side effects, and type(s) of cancer treatment must be taken into consideration when deciding what and when to eat.

Nutrition therapy is often used to help cancer patients keep a healthy body weight, maintain strength, keep body tissue healthy, and decrease side effects both during and after treatment. A registered dietitian (or nutritionist) is an important part of the health care team and can work with patients, their families, and the rest of the cancer care team to help the patient manage their nutritional needs during and after cancer treatment. If you start to have eating problems such as loss of appetite, dry or sore mouth, nausea, vomiting, difficulty swallowing, weight loss or weight gain, constipation, or diarrhea, tell your cancer care team right away so.

Some ways cancer patients can get the most nutrients out of your foods and drinks, as recommended by the National Cancer Institute, might include:

• Eating several small meals and snacks throughout the day, rather than three large meals, focusing on items that are high-calorie and high-protein.
• Eating your biggest meal when you are the most hungry.
• Focus on eating foods that sound good until you are able to eat a bigger variety, even if it’s the same thing again and again. You might also drink a liquid meal replacement for extra nutrition.
• Drink plenty of liquids. Aim to drink 8 to 12 cups of liquid a day. Liquids may include drinks such as water, clear apple juice, clear carbonated beverages, or weak, caffeine-free tea.

In addition to paying attention to what to eat and how much to eat, cancer patients must also pay attention to how food is handled and prepared. Cancer patients are at a greater risk of suffering a foodborne illness because of their weakened immune systems. Because of the higher risk, it is important that additional food safety practices are used at all times.

Be careful to:

• Wash your hands and surfaces before handling food.
• Keep foods at their required temperatures (hot foods hot, cold foods cold).
• Refrigerate leftovers immediately after eating.
• Separate raw meat and poultry from ready-to-eat foods.
• Cook food to safe temperatures.
• Scrub all raw fruits and vegetables with a brush and water before eating. Unwashed fresh vegetables, including lettuce (salads), can put you at a higher risk for infection, as they are more likely to contain harmful bacteria or viruses.
• Foods that are not easily scrubbed (e.g. berries) should be soaked in water, then rinsed.
• Foods with rough outer surfaces and peels should be scrubbed with a brush and water prior to cutting them.
• Avoid raw honey, milk, and fruit juice, and choose pasteurized versions instead.
• When eating out, avoid salad bars; sushi; and raw or undercooked meat, fish (including shellfish), poultry, and eggs—these foods are more likely to contain harmful bacteria.

Be sure to consult with your oncologist or dietary advisor if you have any questions about the safety of particular foods. When uncertain, the U.S. Food & Drug Administration (FDA) recommends to “throw it out when in doubt.”

For additional information regarding common food problems triggered by cancer treatment, how to deal with them, and recipes that can help you meet your nutritional needs, download the National Cancer Institute’s booklet Eating Hints: Before, During, and After Cancer Treatment.

Exercise Management of Treatment-Related Side Effects

In the past, cancer patients were often told by their doctors to rest and reduce their physical activity. New research, however, indicates that physical activity may have beneficial effects for several aspects of cancer for patients and survivors--specifically, weight gain, quality of life, cancer recurrence or progression, and prognosis (likelihood of survival). It can also help with side effects, such as fatigue, anxiety, and stress, which are often experienced during treatment.

Lack of physical activity can lead to loss of body function, muscle weakness, and reduced range of motion. Because of this, many cancer care teams are urging their patients to be as physically active as possible both during and after cancer treatment.

Regular exercise during cancer treatment can help in various ways, which can include:

• Controlling your weight
• Maintaining or improving your physical abilities
• Improving balance
• Lessening the risk of osteoporosis
• Maintaining muscle strength
• Reducing fatigue (tiredness)
• Lessening nausea
• Improving blood flow; reduced risk of blood clots
• Boosting your self-esteem
• Lowering the risk of feelings such as anxiousness and depression

Because every patient is different, fitness regimens are not one-size-fits-all. Each patient’s exercise program should be based on what is safe for them and what they can handle. The type and stage of cancer you have, the treatment you are receiving, and your ability to perform (e.g. stamina, strength, fitness level) are some factors that can affect how much you are able to exercise.

In regards to physical activity, The American Cancer Society recommends that cancer patients:

• Avoid inactivity and return to normal daily activities as soon as possible after diagnosis
• Try to exercise for at least 150 minutes per week
• Incorporate strength training exercises at least 2 days per week

Always check with your doctor before starting any exercise program. While some people can safely begin or maintain a low-to-moderate exercise program on their own, others may need to seek help from a professional, such as a physical therapist or exercise specialist. Your oncologist or hematologist will be able to help you understand what you can and can’t do.

Remember, even a little bit of physical activity can be beneficial. It’s okay to start slowly and then gradually work your way up. Exercise as you are able and don’t push yourself while in treatment. As you exercise, be sure to listen to your body.