Stephanie Buswell RN OCN Staff Nurse St. Mary s Center For Cancer and Blood Disorders

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1 Stephanie Buswell RN OCN Staff Nurse St. Mary s Center For Cancer and Blood Disorders March Campus Avenue, Lewiston, ME

2 Increase knowledge regarding nutritional challenges to patients in treatment Increase knowledge of eating strategies for specific challenges Increase knowledge of food safety practices Learn about available resources

3 Loss of appetite Changes in taste or smell Nausea and vomiting Risk of infection (Neutropenia) Sore mouth or throat Weight gain Weight loss Diarrhea Constipation

4 What it is: You don t feel like eating very much or you do not want to eat. Why it happens: No one is sure why this happens. Reasons may include: The cancer itself Fatigue Pain Feelings such as stress, fear, depression, anxiety Cancer treatment side effects such as nausea and vomiting or changes in taste or smell National Cancer Institute. Eating Hints; 2009; : 12

5 Eat 5-6 small meals a day instead of 3 large meals Drink liquids throughout the day but not at meal time Keep snacks handy for when you feel like eating; peanut butter crackers, nuts, granola bars or dried fruit Have a liquid meal like carnation instant breakfast. This may be more easily tolerated. Talk to your doctor or nurse about your loss of appetite. N ational Cancer Institute. Eating Hints.2009;12-13.

6 Cancer and it s treatments can change your sense of taste and smell. Food may taste bitter or taste like metal. Some patients say everything taste the same or food has no taste" NCI. Eating Hints.2009; 15.

7 Choose foods that look and smell good to you. Try marinades, barbecue sauce or adding spices. Try tart foods or drinks like orange or lemon but not if your mouth is sore. Eat with plastic silverware if you have a metal taste in your mouth. Keep your mouth clean. Try using a straw or travel mug. NCI.Eating Hints.2009;15-16.

8 Nausea occurs when you feel queasy or sick to your stomach. It can keep you from getting the foods and nutrients you need. Nausea can be a side effect to your chemo or radiation to the abdomen, intestines or brain. Nausea can also be caused by certain types of cancer or illnesses. Not everyone gets nausea. Nausea almost always goes away once treatment ends. NCI. Eating Hints. 2009;27.

9 Eat 5-6 small meals or snacks a day Don t skip meals or snacks. This can cause nausea Avoid strong food or drink smells Rest after meals while sitting up Eat or drink foods or fluids that are easy on the stomach : broth, crackers, vanilla yogurt or clear fluids Talk to your doctor or nurse about nausea medicine NCI. Eating Hints.2009;

10 Vomiting is another way to say throwing up Vomiting may follow nausea Vomiting can be caused by cancer treatment, food odors or motion. Some types of chemo and radiation to the abdomen, intestines or brain can cause vomiting by harming normal cells NCI. Eating Hints.2009; 37.

11 Do not eat or drink until you have stopped vomiting Once it stops have small frequent sips of clear fluids and slowly advance to full liquids Talk to your doctor or nurse if vomiting persists. Vomiting can lead to dehydration NCI. Eating Hints. 2009; 37-38

12 Definition: Abnormally low number of white blood cells called neutrophils. Neutrophils normally make up % of white blood cells Neutrophils are the bodies primary defense against infection by destroying bacteria in the blood Degrees of neutropenia Can be caused by certain cancers, cancer meds, radiation or other causes Wikipedia.org/wiki/Neutropenia; March 19, 2011

13 Should be followed by all cancer treatment patients to prevent infection

14 Check expiration dates Good handwashing and dry with a clean towel Wash all surfaces and utensils with hot soapy water or use the dishwasher Use separate cutting boards and knives for meats and fish Thaw frozen foods in the microwave or refrigerator Promptly refrigerate leftovers and use within 24 hours Livestrong.com./article/Neutropenic diet Guidelines;206036;March 18, 2011

15 Avoid raw fruits and vegetables Avoid salad bars and delis No raw or runny eggs ; no raw fish or seafood Nothing unpasteurized as in raw milk or cider No raw honey No uncooked grains No foods containing mold like blue cheese Bottled or city tap water, boil well water for 1 minute Wash foods well Livestrong.com/article/List of foods on a neutropenic diet;317926;march 18, 2011

16 Radiation Therapy to the head or neck, chemotherapy and some biologic therapies can cause sore mouths and throats Why it happens: Cancer treatments can harm the fast growing cells in the lining of your mouth, lips and throat Your risk for a sore mouth or throat increases if you use tobacco or drink alcohol during your treatment NCI. Eating Hints.2009;30-31 and 34.

17 Eating 5-6 small meals may be easier to tolerate than large meals Choose foods that are easy to swallow ie shakes,scrambled eggs Cook foods until soft and tender Moisten foods with sauce, gravy, broth or yogurt Cut foods into small pieces Avoid spicy, crunchy, sharp or high acid foods

18 Diarrhea is when you have frequent bowel movements that may be soft, loose or watery Uncontrolled diarrhea may lead to weight loss, weakness, poor appetite and dehydration Diarrhea can be caused by: 1. Radiation to the abdomen, pelvis or intestines 2. Certain chemotherapies and biotherapies 3. Antibiotics 4. Infections 5. Medicines to treat constipation NCI. Eating Hints. 2009;20 American cancer SocietyNutrition for the person with Cancer during Treatment;

19 Eat frequent small meals instead of large meals Eat low fiber foods like plain vanilla yogurt, white toast and rice Drink plenty of fluids like gatorade, gingerale, water. Let the fizz go out of your gingerale Avoid milk products unless they are lactose free Have salty fluids like broth and foods high in potassium like bananas and potatoes Talk to your doctor or nurse NCI. Eating Hints ACS.Nutrition for the Person with Cancer during Treatment

20 Constipation occurs when stools are less frequent and stools are hard and dry and difficult to pass You may feel bloated, have nausea or have rectal discomfort or pressure Constipation can be caused by inactivity, not enough fluids, certain medicines and not enough fiber NCI. Eating Hints. 2009; 17.

21 Eat high fiber foods like whole grains, beans and dried fruits Drink plenty of fluids Get on a bowel regime Warm or hot liquids may help Be more active Let your doctor or nurse know if you are having constipation NCI. Eating Hints. 2009;

22 Weight loss can be caused by the cancer itself, or by side effects of treatment like nausea and vomiting and loss of appetite Stress and worry can also cause weight loss Many people with cancer lose weight during treatment NCI.Eating Hints. 2009; 41.

23 Extra protein and calories are often needed during cancer treatment to maintain weight Needed to maintain muscle mass, build new immune cells and fight cancer cells Eat when it is time to eat ; don t wait until you are hungry Eat foods high in protein and calories; like icecream, shakes, peanut butter Supplements Protein Fortified milk NCI. Eating Hints. 2009;

24 Many people with cancer think they will lose weight and are surprised and sometimes upset when they gain weight NCI. Eating Hints. 2009; 39.

25 People with certain types of cancer are more likely to gain weight Certain chemo drugs, hormones, medicines or steroids can make you gain weight ( it may be water weight) Some treatments and medications can increase your appetite Cancer and its treatments can cause fatigue that leads to decreased activity NCI. Eating Hints. 2009; 39.

26 Do not go on a diet without talking to your doctor Eat lots of fruit and veggies Eat foods high in fiber such as whole grain breads, cereal and pasta Choose lean meats Choose low fat milk products Eat smaller portions Eat less salt Exercise NCI. Eating Hints. 2009;

27 Talk to your doctor or nurse if you are having issues that are affecting your nutrition Use resources available to you; Eating Hints Book, Resource Room and ask about other resources Nutrition consult may be covered by your insurance

28

29

30 American Cancer Society. Nutrition for the Person with Cancer during Treatment.2006 American Cancer Society, Inc. No Rev. 05/09. National Cancer Institute. Eating Hints.NIH publication No ;September Livestrong.com/article/List of Foods on a Neutropenic Diet; March 18, Livestrong.com/article/Neutropenic Diet Guidelines;206036;March 19, Wikipedia.org/wiki/ Neutropenia; March 19, 2011.

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