Ask the Cancer Nutritionist

Ask the Cancer Nutritionist

The dietitians at the cancer center see all cancer patients from the time of diagnosis and well into survivorship. We meet patients where they’re at.

Elise B. Cushman, RD

Managing your individual diet and nutritional needs during and after treatment for cancer can be difficult to do on your own. NCCC Oncology Nutrition Services has registered dietitians who are specially trained in cancer care. As part of your care team, they can help you decrease side effects that can make eating difficult, meet your nutritional needs and organize meal planning any time during treatment and into survivorship. Oncology Dietitian Elise B. Cushman, MS, RD, CSO, LD, answers some common questions about diet during and after cancer.

Q: What foods do you suggest always having on hand during cancer treatment?

Cushman: First, fluids are vital. Everyone I see struggles with getting adequate amounts of fluids. For the average person we recommend a minimum of 64 oz or 2 liters of fluids a day; but ideally, you’re looking for about half of your body weight in fluids. By fluids, I mean non-caffeinated fluids such as decaffeinated coffee, seltzer, non-caffeinated sodas, flavored waters, juices that you can dilute down, broths, fruit and herbal teas, sorbet, sherbet, etc. Shakes and smoothies count and can be drank with a straw and/or a lid if tastes and smells are bothersome. Even ice cream and popsicles count. Caffeine and alcohol should be avoided as they are diuretics that make your body release more fluid than you put in. Liquid-based foods such as soups are also easy to sip throughout the day to meet calorie needs.

I also recommend baking soda and salt for mouth rinses. In some chemotherapies, taste and smell can be affected and dry mouth may be an issue. Baking soda and salt rinses help keep the mouth clean and moist. A swish-and-spit before meals can "wipe the slate clean" and after meals can get rid of any lingering odors and tastes that could cause irritation, nausea, mouth sores or mucus build-up.

Fruits are great during reduced sense of taste because of their intense sweet flavor. Fruits also help with hydration. Cold foods such as chicken or bean salad are less aromatic which can be good if you’re sensitive to smells. Custards are easy to swallow and contain eggs for protein.

Lastly, I’d recommend easy-reach grab-and-go types of foods—cheese sticks, yogurt, cottage cheese, applesauce, puddings or peanut butter crackers—things that don’t require a lot of time or preparation.

Q: What do dietitians at the cancer center do? Which cancer patients do you see?

Cushman: The dietitians at the cancer center see all cancer patients from the time of diagnosis and well into survivorship. We meet patients where they’re at in terms of chewing, swallowing and even tasting abilities and physical condition.

We often work with patients to manage lack of taste from chemotherapy. Chemotherapy can also wipe out salivary glands, cells that impact your bowels or cause sensitivity to smells, excess mucus and so on. That’s where we come in to work with people to liberalize their diet and find other options that will help them maintain their weight and stay hydrated so they can continue through treatment.

I personally work with a lot of head, neck and thoracic cancer patients. Tumor size with some neck cancer patients, especially esophageal, may cause difficulty swallowing. In some cases they may need a feeding tube. Also, if a radiation field is near the esophagus it can sometimes cause inflammation of the esophagus which can cause a heartburn-like sensation. Both of these challenges often cause weight loss, so my main goal is to prevent further weight loss or if possible, even help them to gain weight.

Q: What are some common dietary recommendations you make for cancer patients during treatment?

Cushman: I often recommend that patients undergoing treatment, especially chemotherapy, switch to eating every two to three hours. Large plates of food at traditional breakfast, lunch and dinner can be difficult to get through if you have no appetite or aren’t feeling well. That can be frustrating and upsetting for you and for your caregiver. Instead, plan for small meals or bites throughout the day. If all you can eat is a quarter of a sandwich and two bites of pudding, that’s fine. In two hours, come back and try another quarter and two more bites. We’ve seen this "grazing" approach do better than the structured meal approach to help patients both maintain and stabilize their weight and ease emotional pressure.

Another recommendation that isn’t necessarily food-related is to have a good bowel regimen. Sometimes the anti-nausea drugs that are given with chemotherapies slow normal bowel function down. It’s important to have a good regimen in place before it becomes uncomfortable or problematic. Our team of oncology dietitians can help you put a plan in place to keep your bowel function regular and teach you what warning signs to be aware of.

Q: What long-term dietary recommendations do you make for patients well after treatment?

Cushman: For long-term, we lean on resources from the American Heart Association, American Institute for Cancer Research and the American Cancer Society because they’re all evidence-based. The latter two outline steps to reduce your risk of cancer recurrence and overall cancer incidence. Recommendations include maintaining a healthy weight, getting a minimum of 150 minutes of moderate to vigorous exercise and two days of strength training during the week—and we understand that exercise may be less during treatment. By preserving muscle mass you will fare better not only during treatment, but also in recovery.

Evidence-based resources also recommend eating a diet rich in fruits; whole grains; vegetables; healthy fat sources like olive oil, avocados and nuts and lean protein like chicken, turkey, fish and eggs. Limiting alcohol and red meat as well as added sugar intake to no more than 36 grams per day for men and 24 grams for women may also help reduce risk. It’s surprising how many food products contain added sugars. You can tell by looking at the nutrition label. It’s also important to follow surveillance recommendations from your oncologist and medical care team.

Q: What do I tell friends and family who want to cook for me?

Cushman: When friends and family ask what they can do to help, don’t be shy about giving them your favorite recipes and asking if they can make them. Also ask if they can portion the meal into small containers, so you can easily freeze it and microwave as needed, rather than feel overwhelmed with an entire casserole when you only want two bites at a time. Soups, for example, freeze beautifully in small portions. You can thaw a little at a time and sip on them throughout the day. If you’re sensitive to smells you can put a lid on it or drink it out of a travel mug.

Q: What are the three most common questions you get from patients?

Cushman: Does sugar feed cancer?
Sugar feeds every cell in the body. Your body breaks sugar down to glucose in its simplest form to provide energy to cells. All cells have glucose receptors that you can think of like rabbit-ear antenna attracting glucose molecules to feed themselves. A healthy cell has two receptors. A cancer cell can have as many as 60 receptors.

That said, I don’t tell my patients to eliminate sugar from their diet. When treatment starts, taste is impacted and you may crave something you fear you shouldn’t eat. I would rather someone have a few bites of something they want and be satisfied than not eat anything at all. Healthier options for carbohydrates include fruits and whole grains, but if you can’t bring yourself to eat those foods during treatment, that’s understandable. Treatment is temporary. What you eat during that time is not going to set you up for failure later. We can work with you after treatment when your taste buds are returning and you’re ready to turn your diet around. In short, the sugar-and-cancer question is not a black-and-white, yes-or-no answer.

Can or should I take supplements? 
That’s a question to definitely ask your medical or radiation oncologist. If they have no concerns they will defer to us as dietitians. We research the supplement to see if there are any conflicts with your medications and go from there. There are also supplements we often recommend such as vitamin D, which has been shown to be lower in cancer populations and in those who have limited sun exposure or thinner skin due to age.

Do I really have to drink that much fluid? 
Yes. It’s especially important on infusion days, in addition to the bag of saline you may also be given during infusion. Continuing to drink non-caffeinated liquids after you go home from infusion—aim for 64 oz—keeps your kidneys flushing. Dehydration is very common in my patients.

If you’re not feeling well from nausea or constipation, you’re less likely to drink. If your treatment causes diarrhea, you’re losing all your fluids there. If you can’t drink water, there are plenty of options and we can help you to find a system that works for you. You can ask your doctor to schedule an appointment with one of us. We can walk you through options and help you meet your fluid and calorie needs during and after treatment.

If you would like to meet with an oncology dietitian to ask your own questions and discuss your own individual needs, please ask your provider or contact us directly.