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  What to Do Before Treatment Begins  

What to Do Before Treatment Begins ,When you are healthy, eating enough food to get the nutrients you need is usually not a problem. In fact, most nutrition guidelines stress eating lots of fruits, vegetables, and whole-grain products; consuming a moderate amount of low-fat meat and dairy foods; and cutting back on fat, sugar, alcohol, and salt. During cancer treatment, however, this may become a challenge, especially if you experience side effects or simply don鈥檛 feel well. As a result, your diet may need to be changed to help you build up strength and withstand the effects of your cancer and its treatment.

Nutrition suggestions for people with cancer often emphasize eating lots of high-calorie, high-protein foods that increase protein such as milk, cheese, and cooked eggs. If you experience weight loss, you may also be advised to eat more sauces and gravies and to include more butter, margarine, or oil in your foods to boost calories. In addition, you may be encouraged to eat fewer high-fiber foods, because fiber can aggravate problems such as diarrhea.

When your cancer was first diagnosed, your doctor talked with you about a treatment plan. This may have involved surgery, radiation therapy, chemotherapy, hormone therapy, biologic therapy (immunotherapy), or some combination of treatments.

All of these treatments kill cancer cells. But in the process, some healthy cells also become damaged. That is what causes the side effects of cancer treatment. The following side effects can affect your ability to eat:
Loss of appetite (anorexia)
Weight loss or gain
Sore mouth or throat
Dry mouth
Dental and gum problems
Changes in taste or smell
You may or may not have any of these side effects. Many factors determine whether you will have any and how severe they will be. These factors include the type of cancer, the part of the body affected, the type and length of treatment, and the dose of treatment.
Most side effects can be controlled and most go away after treatment ends. Talk to your doctor or nurse about your chances of having side effects and what they might be like.

Ways to Obtain the Nutrients You Need
If you have cancer, you need to obtain enough nutrients to meet the following goals:
Prevent or reverse nutritional deficiencies
Minimize side effects of cancer and its treatment
Maximize your quality of life

By Mouth

If at all possible, try to meet your nutrient needs by eating and drinking nutritious foods and beverages. You may be able to obtain enough nutrients by eating high-calorie, high-protein meals supplemented with snacks, commercial liquid nutrition products, and homemade drinks and shakes. If that proves to be too difficult, or if your calorie and nutrient needs have greatly increased, you may need to use a feeding tube.

By Feeding Tube

For tube feeding, a thin, flexible tube is placed through the nose and into the stomach. Once the tube is in place, liquid nutrition formulas can be given through it. If needed, such formulas can provide 100 % of your needs for calories, protein, vitamins and minerals. People who have feeding tubes can usually continue to eat by mouth. This is because the tubes are so small that they do not interfere with swallowing.
If you need a feeding tube, every effort will be made to enable you to eat by mouth. For example, you may be tube fed at night while you sleep to allow you to eat during the day. Once tube feedings begin you will usually feel better because your nutrition needs are being met. Most people get used to tube feedings within a few days. Some people need longer to adjust. It often helps to talk with someone who has also had a feeding tube.
Tube feedings are most often used to boost weight in people with a poor appetite. They may also be used in people who cannot eat or drink. In these people, the feeding tube can be inserted every night. Most people prefer that it be left in place.
A more permanent type of tube can be surgically placed directly into the stomach (gastrostomy) or the intestines (jejunostomy) through the skin. These procedures can usually be done as an outpatient. Tube feedings can be taken at home, if needed, with the help of family, friends, or caregivers.

By Total Parenteral Nutrition

Tube feedings may provide needed fluids and nutrients in people with serious digestive problems. In these cases, nutrient solutions can be given directly through a vein. This type of therapy is called intravenous hyperalimentation or total parenteral nutrition (TPN). TPN is most often used when someone has had surgery of the digestive system; when there is a complete blockage of the intestine; when severe vomiting or diarrhea occur; or when complications from cancer or treatment prevent eating or using a feeding tube. Like tube feedings, TPN can be given at home.

Preparing Yourself for Cancer Treatment
Until you begin treatment, you won鈥檛 know exactly what, if any, side effects you may have or how they feel. One way to prepare for them is to think of your treatment as a time to concentrate on yourself and on getting well. Here are some ways to get ready:
Think Positively
You can reduce your anxiety about treatment side effects by having a positive attitude, talking about your feelings, and becoming well-informed about your cancer and treatment. In addition, planning ways to cope with possible side effects can make you feel more in control and help you keep your appetite.
Many people have few or no side effects that keep them from eating. Even if you have side effects, they may be mild and most go away after cancer treatment ends. In addition, you may be able to control side effects with new drugs that are available.
For more information on coping, see A Message of Hope: Coping With Cancer in Everyday Life, What is Chemotherapy and How Does it Work?, and What is Radiation Therapy?
A Healthy Diet
A healthy dietis vital for a person鈥檚 body to function at its best. This is even more important for people with cancer.
If you eat a healthy diet you鈥檒l go into treatment with reserves to help keep up your strength, prevent body tissue from breaking down, re-build tissue, and maintain your defenses against infection.
People who eat well are better able to cope with side effects of treatment. And, you may even be able to handle higher doses of certain drugs. In fact, some cancer treatments are more effective in people who are well-nourished and are getting enough calories and protein.
Don鈥檛 be afraid to try new foods. Some things you may never have liked before may taste good to you during treatment.
Plan Ahead
Stock the pantry and freezer with your favorite foods so that you won鈥檛 need to shop as often. Include foods you know you can eat even when you are sick.
Cook in advance and freeze foods in meal-sized portions.
Talk to your friends or family members about helping with shopping and cooking, or ask a friend or family member to take over those jobs for you.
You can also talk to your doctor, nurse, or a registered dietitian about any concerns you have about eating well. She or he can help you plan meals and develop a grocery list in case you have side effects such as constipation or nausea.

Nutritious Snacks
During cancer treatment your body often needs extra calories and protein to help you maintain your weight and recover and heal as quickly as possible. Nutritious snacks can help you meet those needs, maintain your strength and energy level, and enhance your feeling of well-being. To make it easier to add snacks to your daily routine, consider the following:
Try to eat small, nutritious snacks throughout the day.
Try to keep a variety of protein-rich snacks on hand that are easy to prepare and eat. These include yogurt, cereal and milk, half a sandwich, a bowl of hearty soup, and cheese and crackers.
Avoid snacks that may make any treatment-related side effects worse. If you suffer from diarrhea, for example, avoid popcorn and raw fruits and vegetables. If you have a sore throat, avoid dry, coarse snacks and acidic foods.
Examples of Nutritious Snacks
Angel food cake Gelatin Popcorn, pretzels
Bread Granola Puddings, custards
Cereal -- hot or cold Homemade milkshakes and drinks Sandwiches
Cheese Ice cream Sherbet
Cookies Juices Soups -- broth-based or hearty
Crackers Milk Sports drinks
Dips made with cheese, beans, and yogurt Muffins Vegetables -- raw, cooked
Eggnog (pasteurized) Nuts Yogurt -- carton, frozen
Fruit -- fresh, canned, dried Peanut butter

High-Calorie, High-Protein Shake and Drink Recipes
For the following recipes, follow these basic instructions:
Place all ingredients in a blender container or prepare in a large container with a hand-held blender.
Cover and blend on high speed until well blended.
Chill drinks before serving.
Store unused drinks in the refrigerator or freezer.
Add 1 to 2 tablespoons of powdered milk to each recipe to increase protein content.
Note: If you cannot tolerate milk or milk products or if you have diabetes, ask your health care professional for appropriate recipe ideas.
Fortified Milk
Drink or use in cooking to add protein.
1 quart whole milk
1 cup nonfat dry milk
Blend and chill at least 6 hours. Can also be made with buttermilk and dry buttermilk.
(211 calories and 14 grams of protein per cup).
Sherbet Shake
A refreshing shake
1 cup sherbet
1/2 cup whole milk
1/2 teaspoon vanilla extract
(422 calories and 6 grams of protein per serving)
Cottage Cheese Smoothie
A thick, protein-packed drink
1/3 cup cottage cheese
1/2 cup vanilla ice cream
1/4 cup prepared fruit flavored gelatin
(310 calories and 11 grams of protein per serving)
Classic Instant Breakfast Milkshake
A protein-packed favorite
1/2 cup whole milk
1 envelope instant breakfast mix
1 cup vanilla ice cream (add flavorings and different flavor ice creams for variety)
(474 calories and 20 grams of protein per serving)
Peach Yogurt Frost
A frosty, tangy drink
1 envelope vanilla instant breakfast mix
1 cup whole milk
1/2 cup peach yogurt
6 to10 crushed ice cubes
(400 calories and 19 grams of protein per serving)
Chocolate Cocoa Drink
A cool, creamy chocolate drink
1 1/4 cup vanilla ice cream
1/2 cup whole milk
1 package of hot chocolate mix
2 teaspoon Sugar
(600 calories and 24 grams of protein per serving)

Homemade Soup Recipes
Winter Soup
2 tablespoons vegetable oil
1 medium onion, chopped
2 14 1/2-ounce cans fat-free chicken broth, either homemade or canned
3/4 cup tomato sauce
1/2 cup macaroni, uncooked
1 15-ounce can white beans (cannelloni or Great Northern beans), drained
Pepper to taste
Heat oil in a large soup pot over medium low heat. Add onions and cook for 3 minutes. Add broth and tomato sauce, bring to a boil, then stir in macaroni. Reduce heat, cover and simmer for 10 minutes. Add pepper to taste, then stir in white beans. Heat mixture thoroughly. Serve in soup bowls with croutons, cornbread, crackers, or a sprinkle of Parmesan cheese. Makes 4 to 6 servings.
Approximate nutrients per serving: 295 calories, 8 grams of fat
(c)2001 American Cancer Society, The American Cancer Society鈥檚 Healthy Eating Cookbook, Second Edition
Turkey Vegetable Soup
1 teaspoon vegetable oil
1 pound 93%-lean ground turkey
1 cup onion, diced
1 large clove garlic, minced
2 cups water
1 1/2 cups potato, peeled and diced
1/2 cup carrots, peeled and chopped
2 15-ounce cans tomatoes (no salt added)
1 10-ounce package frozen mixed vegetables
1 teaspoon chili powder
1/2 teaspoon each oregano and marjoram In a large pot over low heat, sautee the turkey, onion, and garlic in oil. Drain fat. Add water and potatoes and bring to a boil. Cook 10 minutes. Add carrots and tomatoes and cook 10 minutes more. Add mixed vegetables and spices, cover, and simmer for 15 minutes. Makes 8 1 1/2 cup servings.
Approximate nutrients per serving: 190 calories, 21 grams of protein
2 cans tomato soup
2 cans water
1 tablespoon olive oil
1 teaspoon salt
Dash hot sauce
Dash garlic powder
1 small onion, chopped
1 cucumber, peeled, seeded, and chopped
1 green pepper, seeded, and chopped
1 large can or 2 fresh tomatoes, peeled, seeded, and chopped
Mix together first 6 ingredients, then add remaining 4. Chill and serve with chips or crackers. Can blend in blender to make a pureed soup. Makes 8 1-cup servings.
Approximate nutrients per serving: 90 calories, 2 grams protein, 3 grams fiber.
Cream of Broccoli Soup
3 cups broccoli florets and peeled stems, finely chopped
1 1/2 cups water
1 tablespoon corn oil or margarine
1/2 cup onion, chopped
1 tablespoon all-purpose flour
3 cups 1%-fat milk
1/2 teaspoon salt (optional)
1/2 teaspoon pepper
1/4 teaspoon paprika
1/4 teaspoon celery seed
1/8 teaspoon cayenne pepper
Combine broccoli and water in a 3-quart saucepan and bring to a boil. Lower heat, cover, and simmer for 10 minutes. Drain, saving liquid. Melt corn oil or margarine in a larger saucepan over low heat and add onion and saut‚ until soft. Add flour and continue to cook for several seconds, stirring constantly. Stir in reserved liquid and cook until thickened. Add milk, broccoli, salt, black pepper, paprika, celery seed and cayenne pepper, mixing well. Heat to serving temperature over low heat. Makes 6 servings.
Approximate nutrients per serving: 101 calories, 3 grams of fat
(c)2001 American Cancer Society, The American Cancer Society鈥檚 Healthy Eating Cookbook, Second Edition
Potato Soup
3 medium potatoes, peeled and cubed
2 cups reduced-sodium chicken broth
2 stalks chopped celery
1/2 small onion, peeled
1 tablespoon margarine
1 tablespoon flour
2 cups milk
2 eggs, hard cooked, peeled, and chopped
Salt and pepper to taste
Cook the potatoes in chicken broth with celery and onion until the potatoes are tender. Blend the mixture in a blender or processor. In a heavy saucepan over low heat, melt the margarine and stir in flour to make a paste. Slowly add the milk, stirring or whisking continuously until the mixture is thoroughly blended and heated through. Add the pureed potato mixture. Add chopped eggs that have been pushed through a sieve. Mix well and season with salt and pepper as desired. Serve hot or cold. (This soup thickens when chilled and may need to be thinned with additional chicken broth or milk.) Makes 4 serving.
Approximate nutrients per serving: 240 calories, 12 grams protein when prepared with reduced-fat milk.

Nutrition After Treatment Ends


Most eating-related side effects of cancer treatments go away after the treatment ends. Sometimes, however, side effects such as poor appetite, dry mouth, change in taste or smell, difficulty swallowing, or significant weight loss may persist. If this happens to you, talk to your health care team and work out a plan together to address the problem.
As you begin to feel better, you may have questions about eating a healthful diet. Just as you wanted to go into treatment with the necessary nutrient stores that your diet could give you, you鈥檒l want to do the best for yourself at this important time. There鈥檚 no research that suggests that the foods you eat will prevent your cancer from recurring. But, eating well will help you regain your strength, rebuild tissue, and feel better overall.
Suggestions For Healthy Eating After Cancer:
Check with your doctor for any food or diet restrictions.
Ask your dietitian to help you create a nutritious, balanced eating plan.
Choose a variety of foods from all the food groups. Use the American Cancer Society Guidelines for Nutrition for Cancer Prevention to help choose foods for a well-balanced meal plan.
Try to eat at least five to seven servings a day of fruits and vegetables, including citrus fruits and dark-green and deep-yellow vegetables.
Eat plenty of high-fiber foods, such as whole grain breads and cereals.
Buy a new fruit, vegetable, low-fat food, or wholegrain product each time you shop for groceries.
Decrease the amount of fat in your meals by baking or broiling foods.
Choose low-fat milk and dairy products.
Avoid salt-cured, smoked, and pickled foods.
Drink alcohol only occasionally if you choose to drink.
If you are overweight, consider losing weight by reducing the amount of fat in your diet and increasing your activity. Choose activities that you enjoy. Check with your doctor before starting any exercise program.

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