Loss of Appetite

Loss of appetite and changes in taste are common side effects of cancer treatment. Increased sensitivity to bitterness, decreased sensitivity to sweetness, decreased salt recognition, a general sense that food doesn’t taste right, and a metallic taste in food are a few changes that can affect the desire to eat.

Radiation to the head and neck region can cause taste buds to stop working, meaning you cannot taste food. Additionally, fatigue, nausea, sore mouth, depression and stress can decrease your appetite during treatment.

It’s important to keep your protein and calorie intake adequate and to drink plenty of fluids. Healthy protein and calorie levels repair tissues damaged by treatment. If you’re not hungry, nutritional supplements such as milkshakes and other high-calorie fluids can help maintain hydration levels and provide needed calories and protein.

Improve Your Appetite

Patients who eat well can better handle both their disease and the side effects of treatment. Try these suggestions to improve appetite:

• Eat foods at room temperature.
• Eat when you’re hungry, even if it’s not mealtime.
• Eat several small meals during the day rather than three large ones.
• Vary your diet and try new recipes.
• Add high-calorie supplements in liquid and powder form to regular meals.
• Keep healthy snacks cheese, peanut butter or nuts on hand.
• Resist eating your favorite foods when you don’t feel well because they will no longer be your favorite.
• Substitute chicken or fish, cheese products or peanut for red meat if meat tastes bitter.
• Suck on hard candy or mints to decrease the metallic taste sometimes caused by chemotherapy.
• Try tart flavors, which are often preferred by people with altered taste.
• Think about a food’s texture and how it looks instead of how it tastes.
• Reduce nausea, sore mouth and pain by eating meals after taking medications.
• Explore the American Cancer Society’s website for diet advice and recipes.
• Ask a dietitian or nurse for further information.

Nutrition

The body needs protein and plenty of calories and fluids to repair tissues damaged by treatment. Weight loss can add to fatigue and reduce the body’s ability to repair and rebuild. It can also prolong the recovery period.

Nutrition Tips

Cancer and its side effects are more manageable with proper nutrition.

• Stay hydrated. This is the most important thing you can do. Drink 8-10 glasses of non-caffeinated fluid during the day to prevent hydration and clean the body of toxic substances released from dying cancer cells.
• Avoid caffeine before bedtime.
• Eat eggs, cheese, meat, fish and protein supplements to boost energy.
• Eat mashed potatoes with gravy, casseroles, macaroni and cheese, and other moist foods if you experience dry mouth or mouth sores.
• Eat some starchy comfort foods like pasta, potatoes, breads and cereals to send feel-good messages to the brain.
• Maintain a constant energy level by eating a variety of foods from different food groups in small amounts throughout the day. 
• Rely on foods other than sugar and caffeine for energy.
• Rehydrate after diarrhea or vomiting with beverages that have high levels of electrolytes.
• Eat starchy comfort foods like pasta, potatoes, breads and cereals.

Feeding Tubes

If you are unable to meet nutritional needs by mouth either because of the cancer’s location or side effects from treatment, your doctor may order a feeding tube. With tube feeding, a nutritional liquid either supplements or replaces food. A dietitian helps determine daily tube feeding and water requirements.

Types of Feeding Tubes

• Percutaneous endoscopic gastrostomy tube (PEG or G tube). A PEG is inserted through the abdominal wall into the stomach.
• Jejunostomy feeding tube (J-tube). A J-tube is inserted through the abdominal wall into the small bowel (jejunum). J-tubes are not as common as PEGs. Medications are not typically given through a J-tube because it clogs more easily.

 Tube feeding is delivered by:

• Gravity through a bag hung above the stomach
• A pump that regulates the liquid delivery rate
• Syringe (also known as bolus feeding)

 Feeding Tube Care

• Wash hands with soap and warm water before starting the feeding.
• During the feeding and for one hour after, sit up in a chair or bed.
• Check the amount of residual before each feeding. Don’t begin the feeding if more than 100 mL remains from the previous feeding.
• Clean the area around the tube daily with mild soap and water. Clean it more often if there is drainage.
• Replace the drainage sponge daily.
• Do not allow the shower head to spray directly on tube, and do not soak in a bathtub. Pat the insertion site dry after showering.
• Keep the disc (flange) a few millimeters off the skin, leaving just enough room for a gauze sponge. Pulling the flange too tightly can damage the skin. Leaving it too loose can result in leaking.
• Do not dangle or tug on the tube. Tape it to the belly or pin it to the inside of your shirt.
• Call the doctor if the tube comes out or if it is blocked, clogged, cracked or breaking down.

 Feeding Tubes and Medication

• Crush medicines into a powder and dissolve them completely in 1 Tbsp. of warm water.
• Do not crush or dissolve extended-release or coated medicines.
• To prevent clogs, flush the tube before, after and in between giving medicines.
• Use liquid medicines whenever possible.

When to Call the Doctor

Call the doctor about:

• A fever 100.5° F or higher
• Abdominal pain, bloating or tightness
• Diarrhea that lasts more than two days
• Drainage from the tube site
• Persistent vomiting, diarrhea or constipation
• Signs of infection (redness, swelling, foul odor, or warmth) at the tube site