How to Manage Chemotherapy Side Effects

Good nutrition for chemotherapy patients can be affected by side effects that can occur during and after chemotherapy treatments. The goal is to know how to combat these symptoms and maintain an adequate diet throughout your treatments.

Listed below are common nutrition-related treatment side effects as well as tips for managing each side effect while still meeting nutrient needs.

• Anorexia (loss of appetite)
• Constipation
• Dehydration
• Diarrhea
• Dysphagia (difficulty swallowing)
• Nausea/Vomiting
• Neutropenia (low white blood cells)
• Stomatitis/mucositis (mouth and throat sores)
• Taste and smell changes
• Xerostomia (dry mouth)

Anorexia (Loss of Appetite)

• Plan a daily menu in advance.
• Eat small, frequent, high-calorie meals and snacks with a goal frequency of every 2-3 hours.
• Arrange for help in preparing meals.
• Add extra protein and calories to food.
• Keep convenience foods on hand.
• Consider the time of day when you feel your best (morning, afternoon, evening) and attempt to consume a good portion of your calories during this time.
• Seek foods that appeal to the sense of smell.
• Experiment with different foods as your taste may have changed.
• Perform frequent mouth care to relieve symptoms and decrease after-tastes.
• Eat in a calm, comfortable environment.
• Add low intensity regular exercise (such as daily walking).

What types of foods are usually recommended during anorexia?

• Cheese and crackers
• Peanut butter and crackers
• Muffins
• Puddings and custards
• Oral Nutrition supplement (for example; Ensure and Boost)
• Milkshakes and smoothies
• Greek yogurt
• Cottage cheese
• Ice cream
• Powdered milk added to foods
• Finger foods
• Chocolate
• Eggs
• Soup
• Rice
• Mashed potatoes

Constipation

• Drink at least 80 ounces of fluid per day.
• Add low intensity exercise (such as daily walking) to promote motility.
• Increase the amount of fiber (fruits, vegetables, and whole grains).
• Ask your medical team if over the counter medications are appropriate for you. These include bulk-forming products, stimulants, stool softeners, and osmotics.

What types of foods are recommended during constipation?

• Foods containing fiber (fruits, vegetables, beans, lentils, whole grains).
• Fluids

Dehydration

• Drink 8 to 12 cups of liquid a day, mostly caffeine free. Urine should be pale or clear in color.
• Keep a water bottle with you so you can sip throughout the day.
• Include high liquid foods like soups, popsicles, and Jell-O.
• Drink most liquids after and between meals to leave room for solids at meal time.
• Communicate with your medical team if you are vomiting or having diarrhea. Both can result in fluid loss and dehydration. Dietary changes and medications can help you avoid hospitalization or treatment delays resulting from dehydration.

Diarrhea

• Limit insoluble fiber (roughage) and increase soluble fiber sources (those that absorb water such as rice, bananas, white bread, oatmeal, mashed potatoes, and applesauce).
• Increase the amount of sodium (salt) and potassium in your diet. Ask your medical team if an oral rehydration solution is necessary.
• Drink plenty of caffeine-free, low sugar fluids throughout the day. Urine should be pale or clear in color.
• Limit milk to 2 cups or eliminate milk and milk products until the source of the problem is determined. Dairy can make diarrhea worse for some people with lactose intolerance.
• Limit gas-forming foods and beverages such as soda, cruciferous vegetables, beans and lentils, and chewing gum.
• Limit the use of sugar-free candies or gum made with sugar alcohol (sorbitol).
• Drink at least 1 cup of liquid after each loose bowel movement.

What types of foods are recommended during diarrhea?

Eat more foods containing soluable fiber:

• Rice
• Bananas
• Breads
• Cereals
• Oats
• Potatoes
• Applesauce

Avoid concentrated sources of sugars like:

• Fruit juices
• Jams
• Jellies
• Syrups

Avoid spicy foods, fried foods and heavy meals.

Dysphagia (Difficulty Swallowing

• Keep a blender on hand to modify consistency of foods.
• Add liquids like sauces and gravies to increase moisture in foods.
• Shred meats and poultry for easy-to-swallow protein.
• Consider high protein, high calorie milkshakes.
• Eat slowly and chew foods well.
• Sip on liquids to help clear out mouth and throat after swallowing.

Nausea/Vomiting

• Eat small meals throughout the day.
• Include refrigerated or room temperature entrees.
• Rinse mouth with lemon water after eating.
• Suck on ice cubes, mints, or hard candies.
• Include distracting activities such as TV, music, or reading, which may be helpful while eating.
• Sit up or recline with a raised head for 1 hour after eating.
• Eat bland, soft, easy-to-digest foods rather than heavy meals.
• Avoid eating in a room that has cooking odors, keep air circulating and living areas well ventilated.
• Rinse out the mouth before and after eating.

What types of foods are usually recommended during nausea and vomiting?

• Bland starchy, dry foods like crackers, toast, and cereal
• Clear sodas
• Hard candies

Neutropenia (Low White Blood Cell Count)

• Check expiration dates on food and do not buy or use if expired.
• Do not buy or use food in cans that are swollen, dented, or damaged.
• Thaw foods in the refrigerator or microwave and cook foods immediately after thawing.
• Refrigerate all leftovers promptly (within 2 hours of cooking) and eat them within 24 hours.
• Keep hot foods hot and cold foods cold.
• Avoid old, moldy, or damaged fruits and vegetables.
• Cook all meat, poultry, and fish thoroughly.
• Avoid raw eggs or raw fish.
• Use caution when dining out at restaurants and residences other than your own. Avoid buffets and pay attention to food safety practices if food prep area is visible.
• Wash hands frequently to prevent the spread of bacteria.
• Use caution when preparing items to be eaten fresh (fruits and vegetables) with items that need to be cooked (meat, poultry, eggs). Use separate utensils and preparation areas.
• Wash fresh fruits and vegetables well.

Stomatitis/Mucositis (Mouth and Throat Sores)

• Eat soft foods that are easy to chew and swallow.
• Cook foods until soft and tender.
• Puree foods to decrease chewing.
• Cut foods into small pieces.
• Use a straw to drink liquids.
• Eat foods cold or at room temperature; hot and warm foods can irritate a tender mouth.
• Avoid foods that irritate the mouth such as citrus or highly acidic foods, spicy or salty foods, rough, course and dry foods.
• Increase the fluid content of foods by adding gravy, broth, or sauces.
• Supplement meals with high-calorie, high-protein drinks.
• Numb the mouth with ice chips or flavored ice pops.

What types of foods are recommended during stomatitis and mucositis?

• Soft, tender, moist foods
• High calorie, high protein liquids
• Frozen fruits and desserts

Taste/Smell Changes

• Eat small, frequent meals and snacks.
• Eat meals when hungry rather than at set mealtimes.
• Use plastic utensils if foods taste metallic.
• Have others prepare the meal.
• Maintain good air circulation while cooking and eating. Consider cooking outdoors.
• Try new foods when feeling best.
• Substitute poultry, fish, eggs, and cheese for red meats.
• Use a vegetarian cookbook to help create high protein meals without meat.
• Use lemon drops, gum, or mints when experiencing a metallic or bitter taste in the mouth.
• Add spices and sauces to foods.
• Eat meat with something sweet, such as cranberry sauce, jelly, or applesauce.

Xerostomia (Dry Mouth)

• Try a salt and soda rinse, mix 1/2-1 teaspoon of salt or baking soda with a glass of water. Swish and spit the solution 4-5 times daily or more often.
• Avoid oral care products that dry the mouth (i.e. products containing alcohol or peroxide).
• Try lubricating your mouth with artificial saliva.
• Perform oral hygiene after each meal and before bedtime.
• Keep water handy at all times to moisten the mouth.
• Try sweet or tart foods and beverages, which may simulate saliva.
• Use a straw to drink liquids.

What types of foods are recommended during xerostomia?

• Moist foods including those with gravies and sauces
• Soups and stews
• Frozen fruits and desserts
• Pudding, yogurt, cottage cheese and kefir

Key Points:

• You may experience a variety of possible nutrition-related side effects and symptoms during your treatment.
• Talk to a dietitian to determine what dietary changes will help if you are experiencing side effects.

Due to variation in specific illness and treatment plans, eating practices of individuals diagnosed with cancer should be assessed throughout the continuum of care. Request an appointment with a registered dietitian at your treatment facility for a comprehensive nutrition assessment and tailored nutrition therapy plan to reflect your personal treatment goals.

If you are a patient at Taussig Cancer Institute at Cleveland Clinic, you can call (216) 444-6833 to schedule an appointment with the dietitian.

If you are a patient at Radiation Oncology at Cleveland Clinic, you can call (216) 444-5571 to schedule an appointment with a dietitian.

If you are not a Cleveland Clinic patient, you can call 216.444.3046 to schedule an appointment with a Cleveland Clinic dietitian.

If you are interested in corresponding with a Cleveland Clinic dietitian, but are unable to have an in-person appointment, we have two options for online, distance nutrition consultation services.

• To schedule a MyConsult with a Cleveland Clinic dietitian, please to go http://www.eclevelandclinic.org/nutrition
• To schedule a virtual nutrition consultation via the online platform ExpressCare Online, please call 216.444.3046.