Cooking, Shopping and Planning During Treatment

Individual cancer diagnosis and type of treatment may require changes in the diet. In addition, fatigue, information overload, and the desire of family and friends to provide assistance can create considerable stress for the patient.

This section provides information on modifying your diet, planning meals and snacks and communicating needs to family and friends. These measures, while not always a remedy for stress, can help provide solutions to common problems surrounding nutrition and cancer treatment.

Adding Calories and Protein

Calorie and protein needs frequently increased during cancer and cancer treatment. Boosting these nutrients can be challenging, especially if your taste has changes or you have decreased appetite. Below are hints from the Academy of Nutrition and Dietetics that can help you to increase protein and calories on a daily basis.

• Aim for at least 6 meals and snacks each day. Don't rely on your appetite to tell you when it's time to eat. Try to eat or drink something with calories every 2 hours to meet your nutrient needs. Pay attention to the time you feel your best (morning, afternoon, evening) and try to maximize calories during that time.
• Plan ahead to meet nutrient needs before, after and during treatment. Bring snacks with you when you leave the house should you experience any travel or appointment delays.
• Eat more fat. Fat provides a lot of calories in just a few bites. A tablespoon of oil, butter, or margarine has about 100 calories. Add nut butters, avocados, hummus, butter, salad dressing or oil to grains, fruits, vegetables and meats. Choose full fat milk products like whole milk, yogurt and cheese rather than low fat milk products.
• Choose high-calorie drinks such as whole milk, smoothies, milkshakes, and oral nutrition supplements like Ensure or Boost.
• Fix up fruits and vegetables. Get more calories and protein by adding cheese sauce, butter, margarine, gravy, oil, or salad dressing to your favorite fruits and vegetables.
• Enjoy starchy vegetables such as potatoes, sweet potatoes, peas, winter squash, and corn. These vegetables they have more calories than non-starchy vegetables like green beans and carrots.
• Enjoy chips, crackers, fruits and vegetables with dips like hummus (made from beans), guacamole, Greek yogurt, and cheese.
• Choose high protein foods like milk, eggs, cheese, cottage cheese, Greek yogurt, meat, fish, poultry, and beans. You may also try protein powders and meal replacement shakes and bars.

Modifying Textures, Tastes and Smells

Depending on treatment and side effects, it may be necessary to change the texture and taste of your food or avoid foods that produce an offensive odor. Included below are tips to assist you in this process:

Modifying Textures

• Use blender or food processor to blend or liquefy smoothies, soups, and stews to desired consistency.
• Increase moisture of foods by adding sauces, gravies and other liquids.
• Use slow cooker to create tender one pot meals that include protein vegetables, and whole grains.
• Choose ground and shredded meats over large whole pieces.
• Include soft foods like puddings, soups, stews, cooked cereals, yogurt, cottage cheese, guacamole and hummus.
• Include foods with high water content like melons, tomatoes, and squash.

Modifying Taste

• Use plastic utensils if foods taste metallic.
• Try new foods when feeling best.
• Substitute poultry, fish, eggs, and cheese for red meat.
• 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.

Dealing with Smell Aversions

• Have others prepare the meals.
• Keep air circulating by cracking windows and using fans.
• Move slow cooker to the garage or use other outdoor cooking methods like grilling.
• Identify particularly offensive odors and limit buying and cooking these items.

For additional tips on food preparation and ways to increase calories and protein, take a look at the National Cancer Institute's Eating Hints Booklet

Creating Menus and Shopping Lists

Prior to treatment, think about the expected side effects of your treatment and the types of foods that you will likely tolerate. Using this information, make a list of easy-to-prepare items as well as oral nutrition supplements. Create a shopping list that includes these foods and print several copies. As treatment begins, change the list to include foods that you tolerate and enjoy. It is important to keep this list handy for any family, friends, and caregivers that may be assisting you with your cooking and shopping during treatment.

For additional assistance with creating menus and shopping lists, talk with a registered dietitian or consult some of the below online resources:

Foodonthetable.com - a free online tool to plan meals and create shopping lists based on grocery stores in your area.

USDA Healthier You Food Shopping List - a pre-made grocery list that allows you to check boxes of items you wish to include on your shopping list.

American Institute for Cancer Research, Foods that Fight Cancer - a list of foods that are known to have cancer fighting properties.

The Cancer Fighting Kitchen - a cookbook filled with recipes that include foods that are known to have cancer fighting properties; addresses modifying taste, texture, and consistency for side effects.

Communicating Changes to Family, Friends and Caregivers

Food and nutrition can be a significant source of stress during cancer and treatment. Communicate to your family, friends and caregivers your nutrition goals during this time, as well as what role you want them to play.

Patients and caregivers have the same end goal of health and improved quality of life. This underlying goal can get lost in the everyday push to maintain body weight and nutrient adequacy. The appetite and preferences of someone undergoing cancer treatment is often unreliable at best - while are spending time shopping and preparing foods, patients might find that their appetite has changed. As a result, they are no longer able to enjoy the food that has been painstakingly prepared for them. For this reason, it is recommended that household meals be prepared with input from the patient, but that snacks and convenience food items like canned soup, frozen meals, and oral nutrition supplements be on hand should the patient change their mind about what they are able to eat.

Open communication will help minimize the stress surrounding nutrition and cancer. Rather than hold feelings inside, discuss needs and wants openly. It can also be helpful to seek the assistance of mental health professionals and social workers to navigate the strain of disease on relationships.

For more information on coping and emotional support during chemotherapy, ask for a referral to a mental health professional and/or social worker during your treatment. You can find additional information at the National Cancer Institute's Coping and Support.

Key Points:

• Your tastes and food preferences will likely change during treatment.
• Plan ahead of time to ensure a variety of healthy foods will be available to you during treatment.
• Find ways to increase the calories and protein of your meals and snacks to help you maintain weight.
• Treat your family and friends as part of your team. Work together with them throughout treatment to help you eat healthfully.

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.