This booklet is for patients with a cancer diagnosis, and offers advice on ways to alter your diet (normal eating pattern) at a time when you may be concerned about changes in your weight, loss of appetite, or eating difficulties. These changes could be due to your illness or the side effects of treatment.

You may find that the balance of your diet changes and you may be advised to eat foods that are high in fat and sugar, which is different from the advice normally given. You should follow the advice in this booklet while you are having difficulties or concerns about weight loss. When these issues are resolved you can gradually return to a healthier balanced diet.

It is important to eat well to ensure that your body has the energy and nutrients (goodness from food) needed to fight infection, cope with treatment side effects, rebuild damaged tissue and recover after your treatment. Additionally, there is some evidence that good nutrition helps you respond better to your treatment. Changes to your diet can slow weight loss or help put weight back on.

This booklet contains advice for nutritional problems that may occur during radiotherapy and/or chemotherapy and should be used as a guide only. Some of the information will not apply to you. If you experience any other problems with eating or drinking during your treatment that are not included in this booklet, tell your doctor, nurse or radiographer.

The advice in this leaflet includes food containing high levels of sugar and fat. Some of the foods when eaten may cause your blood sugar to rise. However, if you have a poor appetite and are losing weight it is important not to restrict your food intake.

If you have diabetes it is advisable to consult your doctor or diabetes specialist nurse for individual advice, as some of the foods recommended may not be suitable for you. Another booklet is available that includes the best types of foods to eat when you have diabetes.

Your diabetes team can increase your medications if needed.

If you are following a special diet for a medical condition some of the information in this booklet may not be suitable for you. You can ask for a referral to a dietitian for individual advice.

Food hygiene is essential in reducing and preventing the risk of infection and food poisoning. This is especially important during treatment when your immune system may be weaker. Hygienic food preparation should be practiced by everybody.

Some simple rules to remember are:

  • Always wash your hands before handling different foods.
  • Always prepare food on a clean surface.
  • Store food at the correct temperature in the correct location.
  • Always check ‘best before’ and ‘use by’ dates on food items.
  • Wash fruit and vegetables before preparing them.
  • Make sure that any utensils you use are clean.

We should all try to eat a wide variety of different foods to make sure we get the nutrition our bodies need.

Table explaining why different types of food are important
Foods Function
Meat, fish, eggs, tofu, soya products, pulses (beans and lentils), Quorn®, nuts These are a good source of protein, which is needed for the growth of body tissue, muscle strength and wound healing. They also contain vitamins and minerals.
 
Dairy products (cheese, milk, yogurt and non-dairy alternatives (soya milk, soya yogurt) These contain protein, fat, vitamins and minerals - if you are losing weight choose full fat varieties. If eating non-dairy alternatives, choose varieties fortified with vitamins and minerals.
Bread(s), cereals, pasta, rice, potatoes, noodles, couscous, biscuits, crackers  These starchy foods contain energy. Some may also contain vitamins, minerals and fibre.
Fruits and vegetables These are good sources of vitamins and minerals, but usually not protein and energy. If you have a reduced appetite, you may need to reduce normal quantities in order to eat higher calorie foods.
Sugar, honey, syrup, treacle and sugary foods like chocolate, cakes and sweets These are high in energy and useful if you are losing weight.
Butter, margarine, oil, cream These are high in energy and useful if you are losing weight.
Drinks Aim for about 6 to 8 glasses of fluids daily. If you are losing weight try to choose nourishing drinks instead of just tea, coffee and water.


 

Ways to fortify food and drink:

  • Try to use full fat products - especially milk and yogurts instead of low fat types
  • Add grated cheese to soups, sauces, sandwiches, potatoes and pasta
  • Serve evaporated milk, cream or crème fraiche with puddings, pies or stir into soups
  • Use butter or margarine instead of low fat varieties
  • Stir olive, rapeseed, sunflower or vegetable oil into savoury foods and soups
  • Use full fat mayonnaise, oils, salad dressings and cream cheese
  • Add nuts to cereals and pasta dishes
  • If you can eat sugary foods, add honey, syrup, jam, marmalade, white and brown sugar to cereals, drinks or puddings

Ideas for drinks:

Recipe: Fortified milk
Add 3-4 tablespoons of dried milk powder to a pint of full cream milk (around 600ml)

  • Aim to drink at least 6-8 glasses of fluid every day
  • Full fat milk is a good source of nutrients. Use fortified milk whenever you would use ordinary milk
  • Make coffee, cocoa, drinking chocolate or malted drinks such as Horlicks® and Ovaltine® with fortified hot milk
  • Make milk shakes with fortified milk and add ice cream
  • If you use soya milk choose one with added calcium
  • Smoothies can be made with fruit and yogurt (plain, Greek or flavoured)
  • Enriched powdered drinks such as Complan® or Build-up® can be bought from chemists and larger supermarkets. These drinks can supplement your food intake and are best made up with full fat milk or fortified milk. They come in both sweet (milk shakes) and savoury (soups)
  • Try taking drinks after meals rather than before or with meals to prevent feeling full
  • Avoid ‘diet’, low calorie or sugar free drinks
  • Try fruit or vegetable smoothies or juice (or make your own)

Try these snack ideas:

  • Crackers or digestive biscuits with butter and cheese, cream cheese or peanut butter
  • Soup with added cheese or cream
  • Small bowl of cereal with fortified milk
  • Cereal bar / flapjack
  • Dried fruits and nuts
  • Small sausage roll or pork pie
  • Hard boiled eggs
  • Crumpet or breakfast muffin with butter or margarine and jam
  • Cheese toasties with butter on the bread
  • Tinned, fresh or frozen fruit, serve with custard, ice-cream or cream 
  • Ready-made desserts in individual size portions such as yogurt, mousse, cheesecake, crème caramel, trifle
  • Ice cream or ice lolly
  • Sweets and mints
  • Yogurt with fruit
  • Small packet of crisps or nuts
  • Small croissant (plain or chocolate)

Meal ideas:

  • You could try the following on buttered toast: bacon and egg with tomatoes, scrambled egg with grated cheese, omelette with cheese, baked beans, or tinned spaghetti
  • You could try the following on a baked potato with butter: baked beans, tuna mayonnaise, cheese, coronation chicken, chilli con carne, coleslaw or egg mayonnaise
  • Macaroni cheese
  • Corned beef hash
  • Ready-made stew or casserole
  • Fish cakes with buttered bread
  • Slice of pizza or quiche

Puddings / desserts:

  • Yogurt – full fat, thick and creamy, Greek yogurt
  • Tinned, fresh or frozen fruit, serve with custard, cream, ice-cream or crème fraiche
  • Egg custard or milk puddings
  • Sponge puddings with custard
  • Fruit pie with ice cream, double cream or custard
  • Jelly fluff (jelly made with evaporated milk)
  • Angel Delight® or instant whip (made with full fat or fortified milk)

Soups:

  • Instant soups can be made with full fat milk or fortified milk instead of water
  • Tinned or fresh soups can have extra nourishment added by stirring in olive oil, grated cheese, double cream, soured cream, crème fraiche or dried milk powder
  • Buttered bread or toast, croutons or cheese on toast can be added on top
  • Homemade soups can be very nourishing. Try adding red lentils for extra protein and fibre

If you are too tired to cook or eat

Your illness and treatment can make you feel very tired, but it is vital to keep your nutritional intake at its best.

You may find the following tips helpful:

  • If you are finding shopping and cooking tiring think about using convenience foods. Frozen meals, tinned foods, boil in the bag meals and takeaways are good options at this time
  • Others may offer to help – let them do your shopping and food preparation
  • Shop online and have food delivered
  • There are companies who deliver frozen ready meals and puddings
  • Instant mashed potatoes or frozen mashed potatoes are available in most supermarkets and can be used when making meals like shepherd’s or cottage pie
  • If you know in advance the times you are likely to feel tired, then you could try to plan ahead to help you through these times. If you have a freezer, you could prepare food while you are feeling active and freeze it for when you are more tired
  • You could stock up on some convenience foods. Keep foods such as rice puddings, custards, instant whip, tinned soups, tinned spaghetti, corned beef, baked beans, jelly and cereal bars in your cupboards
  • If you really cannot face eating, have a nourishing drink, such as warm milk with cocoa
  • If you feel you need more help coping at home with your cooking and eating, tell your doctor, nurse or radiographer.

Tips to make cooking and food prep easier:

  • Batch cooking
  • Using a slow cooker
  • Microwaveable options
  • Meal planning
  • Grocery delivery from supermarket
  • Pre-cooked or pre-chopped food
  • One pot meals

Eating when you have a poor appetite

Your appetite may vary throughout and following treatment, but it is still important to keep eating as much as you can.

Try some of the following tips:

Eat your meals slowly, chew the food well and try to relax and enjoy what you eat

  • Try to eat when you do feel hungry and make the most of the good days by eating well and treating yourself to your favourite foods
  • Eat little amounts as often as possible if you cannot face big meals. Try to have a small portion of food every two hours during the day
  • Try to eat a variety of different foods. You may enjoy foods you wouldn’t usually eat
  • Tempt your taste buds by making your food look as attractive as possible
  • Put small portions on your plate and garnish the food with lemon, tomato or parsley. Try using a smaller plate
  • Keep snacks handy to nibble whenever you can. Bags of nuts, crisps, dried fruit or a bowl of grated cheese are quite light, tasty and nutritious
  • Sweet or savoury nourishing drinks can be used between meals and can be sipped slowly over the course of the day
  • Try to have a nourishing drink instead of a cup of tea or coffee
  • If you are allowed alcohol a glass of sherry, brandy or glass of wine half an hour before a meal is a good way of stimulating your appetite – check with your doctor, nurse or radiographer

Coping with dry mouth

Radiotherapy to the head or neck, some chemotherapy treatments and painkillers can all lead to a dry mouth which can make eating difficult.

Try the following tips:

  • Sip cool drinks frequently, especially with meals. Even taking just a few sips at a time, can help keep your mouth moist. You may find fizzy drinks the most refreshing
  • Keep your mouth fresh and clean
  • Try sucking ice cubes or ice lollies
  • Eat soft, moist foods. Moisten your food with lots of gravy or sauce
  • Avoid sticky, chewy and dry foods like bread, cold meat, chocolate and pastry
  • Try sucking on strongly flavoured pastilles or mints to keep your mouth moist
  • Boiled sweets or chewing gum can help stimulate saliva production
  • Sharp flavours such as lemonade may help your mouth produce more saliva – but don’t use them if your mouth is sore
  • You may find fruit chunks or juice refreshing
  • Try dipping bread, crackers and biscuits in tea, coffee, milk or soup to make eating easier

Coping with a sore mouth

Radiotherapy and chemotherapy can cause a sore mouth or throat. If you have these problems contact your doctor, nurse or radiographer who can prescribe medication to help. Avoid things that will hurt or irritate.

The following foods may need to be avoided:

  • Salty or spicy foods
  • Curry, chillies, pepper, vinegar
  • Acid fruits and juices such as oranges, grapefruit and tomato
  • Coarse or dry foods such as crisps, toast and dry biscuits
  • Alcohol especially wines and spirits
  • Food that is very hot or very cold

Coping with thick saliva

Radiotherapy that includes the mouth area can cause thick saliva or mucous, which may contribute to difficulty swallowing, nausea, vomiting and/or poor oral intake/

  • Try warm liquids like soups, hot chocolate, Ovaltine®, Horlicks®, broth, tea or warm water to help clear mouth of thick saliva and wash foods down

Difficulty swallowing

Radiotherapy to the head and neck, lungs or oesophagus can cause difficulty swallowing. You may find the following suggestions helpful.

  • Try soft, moist foods
  • Make what you eat as nourishing as possible
  • Aim for 5 to 6 small meals or snacks daily
  • Have nourishing drinks between meals
  • Add sauces, gravy, olive oil, melted butter or margarine to make food moister

If you are only able to swallow fluids, ask your nurse or radiographer to refer you to the dietitian.

Feeling sick

Some types of chemotherapy and radiotherapy can make you feel sick (nausea). This is usually only temporary, but it can disrupt your eating.

There are medications that can be prescribed for sickness. Discuss how you are feeling with your doctor, nurse or radiographer.

Remember to take your medication regularly, as recommended, to prevent sickness from developing.

If you are feeling sick:

  • Eat little and often, rather than just at mealtimes
  • Eat and drink slowly
  • If the smell of cooking makes you feel sick, try eating cold meals or convenience foods
  • Open windows when cooking or use an extraction fan to remove cooking smells. If possible ask someone else to do the cooking
  • Try eating dry foods, such as toast, crackers, crisps, plain bagels, toasted breakfast muffins, or dry cereal
  • Foods or drinks containing ginger can help to reduce feelings of sickness. You can use crystallized ginger, ginger tea, ginger biscuits or ginger beer
  • Sipping a fizzy drink is a popular remedy for feeling sick. Try mineral water, lemonade or soda water and sip it slowly through a straw 
  • Try having drinks between meals rather than with your food

Taste changes

Your illness or the treatment can affect your sense of taste so that food loses its flavour or tastes differently.

The following advice may be helpful:

  • Eat foods that you like the taste of and ignore those that do not appeal to you. However, do try them again as your taste may have returned
  • Try marinating meat in fruit juice or wine, or serve meat with sauces. Cranberry sauce or red currant jelly can be added to meat dishes to add flavour
  • Sharp tasting foods like fresh fruit, fruit juice and boiled sweets e.g. lemon barley and strong mints may be refreshing
  • Choose foods that are highly flavoured. Try combining different temperature foods, i.e. hot fruit pie with cold ice cream
  • Try lemon, green or herbal tea
  • Try herbs and seasonings like thyme, oregano, rosemary, basil and mint to add flavour to your cooking
  • Cured meats such as ham may taste better
  • Flavour your food with chutneys, relishes or ketchup
  • If you have metallic taste – gargle with lemon juice in water before eating
  • Avoid canned food or food in metal containers
  • Take good care of your teeth
  • If excess sweetness is a problem, try adding lemon juice or diluting drinks with soda or mineral water. Adding spices such as ginger, nutmeg or cinnamon to desserts and puddings may also reduce the sweetness; try sharper fruit flavours – grapefruit, rhubarb
  • If you can sip drinks through a straw, you will avoid some of the taste buds – this may cut down the unpleasant taste
  • To ensure you get some protein and if red meat tastes unpleasant replace it with fish, chicken, turkey, eggs or dairy produce such as milk, cheese and yogurt. Pulses such as peas, beans and lentils or soya products may also be useful

Gas, bloating or cramping

Certain treatments may cause gas, bloating or cramping. There are a number of medications that can help these symptoms, so talk with your nurse or doctor. Here are some ideas that may help.

  • Eat and drink slowly. Take small mouthfuls and chew your food well
  • Avoid food that you think gives you wind; for example, beans, pickles and fizzy drinks
  • Avoid drinking through a straw
  • Try peppermint tea
  • Gentle exercise, especially walking can bring some relief
  • If the pain becomes severe or continues, tell your doctor, nurse or radiographer

Heartburn and reflux

This causes a burning feeling in your throat and upper stomach and can make your mouth taste sour. It is very common in cancer treatments. There are medications that can help. Ask your nurse, doctor or radiographer. The following tips may also help:

  • Acidic citrus fruits and spicy foods may make the problem worse
  • Some people find that avoiding foods high in fat may help
  • Don’t drink immediately before eating and wait 30 minutes after eating before you have a drink
  • Try not to lie down immediately after eating
  • Limit your intake of alcohol, fizzy drinks coffee and tea
  • Sit up to eat, ideally at a table to let gravity help

Constipation

Eating very little or not drinking enough fluids can make you become constipated. This can be made worse by some treatments and medicines. It may be that you will need to be prescribed medicine for constipation.

  • Gentle exercise can help to keep your bowels in working order such as walking, especially in the morning
  • Drink plenty of fluids, aim to drink enough water that your urine is a pale straw colour
  • Try to eat regular meals, trying to keep your routine as consistent as you can day to day
  • Aim to increase soluble fibre, try adding 1-2 tbsp. flaxseeds to your porridge or try eating 2-4 prunes. Aim for wholegrain cereals and breads or try to add extra servings of fresh / cooked fruit and veg into your meals
  • Try drinking warm beverages and sometimes this can get things moving

Diarrhoea

Diarrhoea may be due to illness, treatment or medication. Talk to your doctor, nurse or radiographer who will try to determine the reason for your diarrhoea and give you any necessary advice and/ or medication. The following suggestions may help:

  • Drink plenty of fluids, when you have diarrhoea you lose a lot of fluids so it is important that they are replaced
  • Look out for symptoms of dehydration, such as passing urine less often and passing small amounts of dark coloured urine
  • Try eating plain, starchy foods in small amounts and more frequently. Avoid eating too much fibre (e.g. raw fruit and vegetables, beans and nuts)
  • Avoid rich and greasy meals such as takeaways and spicy foods until diarrhoea resolves

If you are experiencing severe diarrhoea (e.g. up to 6 times per day) then it’s important to get in touch with your medical team or go to A&E as this may be an effect of treatment. It is important to get checked out and have your fluids.

If you are eating well and eating a variety of foods you are unlikely to need a vitamin and mineral supplement.

If your appetite is poor you may need a standard complete multivitamin preparation to meet your daily needs. High doses of vitamins and minerals can be harmful and may interfere with your treatment.

Please speak to your doctor, dietitian or pharmacist about the most suitable ones for you.

If you need further information ask your doctor, nurse or radiographer or GP to refer you to a dietitian.

Additional information

British Dietetic Association
British Dietetic Association, 3rd Floor Interchange Place, 151-165 Edmund Street, Birmingham, B3 2TA
United Kingdom
Tel: 0121 200 8080
www.bda.uk.com

Nutrition Support in Adults: understanding NICE guidance
Information for people who need nutrition support, their families and carers and the public
Tel: 0300 323 0140
www.nice.org/uk

Macmillan Cancer Support
0808 808 00 00 or www.macmillan.org.uk

Cancer Information and Support Centres - The Clatterbridge Cancer Centre

Clatterbridge Cancer Centre - Liverpool and Clatterbridge Cancer Centre - Wirral
0151 556 5570 /  0151 556 5000

Clatterbridge Cancer Centre - Aintree
0151 556 5959

Clatterbridge Dietitians 
0151 556 5117
Email The Clatterbridge Cancer Centre dietitians 

We know there is a lot of information out there and understand it can sometimes be overwhelming, so if you need more information, here are some resources for honest, helpful advice and guidance.

Dr Carla Prado, a PhD registered dietitian at The University of Alberta has put together a video on the relevance of low muscle mass to our health

British Dietetic Association (BDA): Sustainable Diet Tips
Read the BDA sustainable diet tips

Maggie’s Centres also run a number of classes on nutritional support
Read Maggie's Centre information about cancer and nutrition

Life Kitchen: providing free cookery classes and recipes for patients living with taste and smell changes due to cancer treatment
Life Kitchen website

BDA: Challenging Cancer Diet Myths
Read the BDA guidance challenging cancer diet myths