Author: Taylor Salyer

For healthy individuals, proper nutrition is necessary to maintain an appropriate weight, stay healthy, and prevent chronic diseases like diabetes and heart disease.  However, during cancer treatment nutrition plays an even larger role in overall health by maintaining your weight, strength, and energy; and can even help you better respond to cancer treatment. Proper nutrition can speed up recovery and healing time after surgery. It can also help you tolerate chemotherapy side effects better and regain health faster between chemotherapy cycles, and thus have a more optimal response to therapy. All of these things lead to better survival.

The idea behind nutrition for ovarian cancer is different from what most may consider to be a “healthy diet.” It is proven than weight loss is an indicator of poor prognosis. In addition, protein-calorie malnutrition is the most common secondary diagnosis in cancer patients. The focus of nutrition for cancer patients should be maintaining weight and/or preventing weight loss. This is best accomplished by a high-calorie, high-protein diet. To achieve this, you may have to eat more that you are used to or eat food products that you may not perceive as stereotypically “healthy.” This article will focus on tips for consuming a high-calorie, high-protein diet and ways to overcome common side effects of chemotherapy so that this diet can be achieved.

 

Increasing Calorie and Protein Content

  • Eat calorie and protein rich foods when you can.
  • Drink calorie and protein rich nutritional supplements when you can’t eat.
    • Liquid Supplements: Boost, Ensure, Carnation Breakfast Essentials
    • Available in other forms: pudding, nutrition bars
  • Aim to have a meal or snack every 2-3 hours. Eating several small meals a day, rather than 3 larger meals, is easier to digest and helpful in getting more calories in during your day.
  • Take advantage of the times you feel hungry. For a lot of people, their appetite may be best first thing in the morning after hours of not eating. Breakfast may be the best time to have a larger meal and load up on calories.
  • Avoid drinking large amounts of fluids at mealtime. This can fill up valuable stomach space that could be better used for solid foods with more calories and protein. Sip liquids with meals if needed.  If sipping is not satisfactory, try to space out drinks 30-60 minutes before or after meals.
  • Drink high-calorie and/or high-protein fluids between meals, such as smoothies, milkshakes, or liquid supplements.
  • Add fortified foods to your diet. These can easily be added to mac and cheese, sauces, soups, cocoa, pancakes, smoothies, etc.
    • Whey protein, protein-fortified milk, nonfat instant dry milk

 

 

Dealing with Side Effects of Chemotherapy

The most common chemotherapy agents used for ovarian cancer are platinum agents (Carboplatin, Cisplatin) and taxane agents (Paclitaxel, Docetaxel).  The most common gastrointestinal (GI) side effects of these agents are nausea/vomiting firstly, followed by diarrhea. Loss of appetite is a common side effect of any cancer.

 

Loss of Appetite

Loss of appetite can be caused by the cancer itself, the cancer treatment, or the emotions and worry that people can experience.

  • Eat smaller portions of nutrient-rich foods when you cannot eat larger amounts. Eating 5-6 small meals plus snacks every day will help you feel less full.
  • Eat at scheduled times instead of waiting to feel hungry.
  • Eat a bedtime snack. This will not affect your appetite for your next meal.
  • Avoid liquids at meal times, which can make you feel full and prevent you from eating more nutrient-dense foods.
  • Keep your favorite snacks nearby.
  • Try to make meals/snacks more enjoyable. Set the table or dress up your plate to make meals more attractive. Do things you enjoy at mealtime, such as listening to music or eating with friends and family.
  • Exercise regularly or before eating to stimulate your appetite. Light to moderate physical activity, such as a short walk one hour prior to eating can help to stimulate your appetite. Check with your doctor before starting a new or vigorous exercise program.

 

Nausea/Vomiting

The chemotherapy agents used for ovarian cancer are highly emetic (causes nausea/vomiting).  Nausea can occur immediately after your treatment or up to three days later. Nausea can occur with or without vomiting. Vomiting can be caused by cancer treatment, food odors, motion, upset stomach, bowel gas, and even locations that remind you of cancer.  You doctor may prescribe you anti-nausea medications to help with these symptoms, however there are dietary changes you can use adjunctively.

  • Take anti-nausea medications as instructed. It is easier to prevent nausea/vomiting rather than trying to stop the cycle. You can also take medications 30-60 minutes before eating to avoid nausea.
  • Nausea:
  • Eat foods that are easy on stomach. Cool or room temperature foods may be better tolerated.
  • Ginger may be helpful to some people. This is available in a raw root form, supplement/capsule form, powder, candy, chews, etc.
  • Avoid foods that are greasy, fried, high fat, very sweet, spicy/hot, highly seasoned, or foods that have strong odors.
  • Eat smaller meals. Even if tempted, do not skip meals! Having an empty stomach can actually make nausea worse.
  • Save room in your stomach by drinking liquids throughout the day, instead of with meals.
  • Sipping liquids through a straw can help make liquids easier to drink.
  • Rinse your mouth before and after eating.
  • If nauseous in the morning: Eat dry toast or crackers when getting out of bed.
  • If nauseous on chemotherapy treatment days: Avoid eating 1-2 hours before treatment and eat bland/soft foods that day.
  • Keep a journal of the foods you eat, cancer treatment days, and when you feel nauseated to learn what does and does not work for you.
  • Vomiting
    • Do not attempt to eat until vomiting has stopped.
    • Attempt to eat small amounts of clear liquids
    • If a clear liquid diet is tolerated, progress to full liquids and soft foods.
    • Continue to work your way up to regular diet.

 

Diarrhea

Chemotherapy acts by killing rapidly dividing cells, such as cancer cells. Unfortunately, this can also harm other rapidly dividing cells in your body, such as the cells that line your small intestines. This can result in diarrhea or loose bowel movements. Diarrhea can be problematic in that the nutrients from the foods and liquids that you are consuming are moving too quickly to be absorbed. Prolonged diarrhea can also lead to dehydration.

  • Drink plenty of fluids to replace the fluids that your are losing. A good rule of thumb is to drink at least one cup of liquid for every loose bowel movement or episode of diarrhea that you have.
  • Eat smaller, more frequent meals.
  • Replace electrolytes that are important for helping your body function. Eat or drink food/drinks that are high in sodium and potassium.
    • Bouillon, broth, bananas, peach and apricot nectar, boiled/baked/mashed potatoes, Gatorade, Pedialyte
  • Avoid foods that can make diarrhea worse, such as high fiber foods and foods that produce gas.
    • Greasy or fried foods, raw veggies, gas producing vegetables (broccoli, brussels sprouts, cabbage, onion, cauliflower, cucumber, green pepper, corn, turnips, sauerkraut), carbonated beverages, legumes, lentils, chewing gum, hot/cold beverages, caffeinated beverages, milk products, spicy foods, sugar free products containing xylitol or sorbitol (gums and candies)
  • Eat foods that are low fiber and easy on the stomach.

 

When to talk to your doctor:

  • If you have not been able to eat for more than two days
  • If have not had a bowel movement in two or more days
  • If you are experiencing signs of dehydration: dark urine, decreased urine, dry skin or mouth, unquenchable thirst, light-headedness
  • Before starting a special diet or before taking any supplements
    • Certain supplements may interact or interfere with your treatment.
  • Asked to be referred to dietitian if you have any questions.

 

Clear Liquids Bouillon, clear broth, clear fruit juices, clear sodas, water, sports drinks, weak tea without caffeine, gelatin, popsicles, Resource breeze (nutrition supplement), Carnation Instant Breakfast juice, Ensure Clear
Full Liquids Hot cereals, creamed soups, milkshakes, smoothies, tea, tomato/vegetable juice, milk, custard, frozen yogurt, gelatin, ice cream, pudding, sherbert, sorbet, yogurt, Carnation Instant Breakfast, Ensure, Boost, anything in clear liquids
Soft/Bland Foods Milk, mild cheeses, cottage cheese, cooked/canned vegetables (beets, carrots, green beans, wax beans, mushroom, pumpkin, green peas, sweet potato, squash), fruit juice, cooked/canned fruits, avocados, bananas, white bread, bagels, tortillas, cream of wheat, oatmeal, potatoes, pastas, rice, soups, peanut butter, broth, eggs, tender meats
Foods that are Easy on the Stomach Clear broth, clear sodas, cranberry juice, grape juice, milk, sports drinks, tea, water, vegetable juices, avocado, tender beef, hard cheeses, cottage cheese, cream cheese, eggs, fish, noodles, plain pasta, creamy peanut butter, boiled/baked potatoes, pretzels, cold cereals, cream of wheat, saltine crackers, white tortillas, soft/bland vegetables, white bread, white rice, white toast, angel food cake, bananas, canned fruit, applesauce, custard, frozen yogurt, gelatin, ice cream, popsicles, pudding, sherbert, plain or vanilla yogurt, Carnation Instant Breakfast, liquid meal replacement, clear liquid replacements, carbonated beverages, applesauce
Low-Fiber Foods Chicken, turkey, cooked cereals, eggs, fish, noodles, skinned potatoes, white bread, white rice, cooked carrots, canned fruit, fruit juice, mushrooms, cooked string beans, vegetable juice, angel food cake, animal crackers, custard, gelatin, graham crackers, saltine crackers, sherbet, yogurt

 

High-Fiber Foods Bran muffins, bran cereal, peanut butter, peas, beans, whole grain cereals/bread/pasta, apples, berries, broccoli, brussels sprouts, cabbage, corn, dried fruit, green and leafy vegetables (spinach, lettuce, kale, collard greens), potatoes with skins, sweet potatoes, granola, nuts, popcorn, seeds, trail mix

 

High-Protein Foods Hard or semisoft cheese, cottage cheese, ricotta cheese, milk, nonfat instant dry milk (add to milk, milk drinks, or in recipes), instant breakfast powder (in milk, with ice cream, milkshake), ice cream, yogurt, frozen yogurt, eggs, nuts, seeds, wheat germ, peanut butter, nut butters, meat, poultry, fish, beans, legumes, tofu

 

High-Calorie Foods Whole milk, whole milk products (cheese, whipping cream, sour cream), granola, dried fruit, eggs, thick soups, milkshakes, pudding, smoothies, nutritional supplement drinks, chicken, lean red meat, fish, yogurt, frozen yogurt, ice cream, peanut butter, nuts, dried fruit, granola bars, butter, margarine, mayo, regular salad dressing, sweets

 

Loss of Appetite Snacks Chocolate milk, instant breakfast drinks, juices, milk, milkshakes, bread, cereal, cheese, crackers, cream soups, hard-boiled eggs, muffins, nuts, peanut butter, pita bread and hummus, pizza, applesauce, fruit, vegetables, cakes, cookies, granola, custard, dips, frozen yogurt, gelatin, ice cream, popcorn, popsicles, puddings, sherbert, trail mix, yogurt

 

 

 

About the Author:

Taylor Salyer is a fourth year medical student at the University of Arkansas for Medical Sciences (UAMS) in Little Rock, Arkansas. She is originally from Morrow, a very small town in Northwest Arkansas, but has called Little Rock home for the last four years. Her hobbies include reading books (other than medical textbooks), hiking, and spending time with her husband and yorkie. She is interested in pursuing a residency in OB/GYN.