Nutritional Considerations

The Benefits of Proper Nutrition During Sarcoma Treatment

By Jessica Iannotta MS, RD, CSO, CDN

When many things seem out of control after a sarcoma diagnosis, you can take control by getting the best nutrition you can. Deciding to eat more healthfully will empower you and your loved ones to enhance your strength during treatment and improve your quality of life.

A healthy diet consists primarily of plant-based food along with lean sources of protein. The proper balance of proteins, carbohydrates and healthy fats helps prevent swings in blood sugar, hormones and energy levels. It also can help you feel less fatigued, with a more positive mood. A well-balanced diet can give you the nutrients needed to fight off infections, and the fuel to repair damage done to healthy cells during treatment. Healthy eating also can reduce the amount and severity of treatment side effects.

Here are some suggestions:

  • Eat small meals and snacks frequently throughout the day.
  • Seek counseling from a registered dietitian (RD) who is a certified specialist in oncology nutrition. Dietitians can recommend foods, beverages, meal plans and supplements to improve your nutrition before, during and after cancer treatment. They can tailor this information to your individual needs,  treatments and side effects.
  • Get information from sources that rely on sound, scientific evidence.
  • Avoid “miracle cures” and unknown dietary supplements, most of which do not have evidence to support their use or benefit during or after cancer treatment. If something sounds too good to be true, chances are it is.

Sarcoma and sarcoma treatment can cause a variety of nutrition-related side effects. Many of these can be managed with changes in diet, food selection, and preparation.

Loss of appetite: You may eat less than usual, not feel hungry at all, or feel full after eating only a small amount. Although you may not feel like eating, getting adequate nutrition and maintaining a healthy weight are important. Take advantage of the times when your appetite is best and try to consume small frequent meals and snacks throughout the day. Eat in enjoyable surroundings, and make meals look less overwhelming by placing them on smaller plates rather than larger plates.

Nausea/vomiting: Chemotherapy, such as doxorubicin, can cause nausea and vomiting. Nausea is sometimes described as an unsettling or queasy feeling in the stomach and can be experienced with or without vomiting. Because an empty stomach may make nausea and vomiting worse, be sure to eat regular meals and snacks. Eat small frequent meals (5-6 times a day) instead of three large meals, and avoid greasy or spicy foods and food with strong odors. Eat foods such as crackers, toast and broth that may be easier on your stomach. Try ginger teas, ginger candies, ginger snaps/cookies or ginger root in soups and stir fries.

Fatigue: This common side effect is usually described as feeling very weak, tired or having a lack of energy. Choose foods high in protein and calories, which provide lots of energy. Try nutritional supplements or liquid-meal replacements if recommended by your physician and health-care team.

Constipation: It can be caused by certain chemotherapies, nausea and pain medications, a change in diet or a decrease in your usual activity level. Be sure to stay hydrated by drinking at least 8-10 8-oz. glasses of fluid each day. Eat foods rich in fiber, such as bran; whole-grain breads, rice, cereal and pastas; fresh fruits and vegetables; and beans and nuts.

Diarrhea: It occurs when you are having frequent, loose, soft or watery bowel movements, and can quickly lead to dehydration. Avoid greasy or fatty food, food high in fiber, raw vegetables and caffeine. Drink a minimum of 8-10 8-oz. glasses of clear fluid a day, such as water, broth, juices, Gatorade or decaffeinated tea. Consume foods rich in potassium, such as fruit juices and nectars, bananas and potatoes (without skin). Also eat foods high in pectin and soluble fiber, such as applesauce, baked apples, bananas and oatmeal to help slow down diarrhea.

Changes in your taste: During sarcoma treatment the foods you usually like may become unappealing. Foods may taste bland, bitter or metallic. Try rinsing with 1-2 oz of baking-soda rinse before and after meals. (Recipe for baking soda rinse: 1 quart water, ¾ teaspoon salt and 1 teaspoon baking soda). If red meats taste strange, try substituting other proteins such as chicken, turkey, fish, eggs, dairy, beans or tofu. Eat foods that smell and look good to you. Avoid using metal utensils; use plastic ones instead. Avoid hot foods to reduce strong odors; serve food at room temperature.

Mouth soreness: Many patients treated with high-dose methotrexate and other chemotherapy drugs develop mucositis and mouth soreness. Avoid acidic and spicy foods along with rough and coarse foods that can irritate the oral cavity. It is helpful to eat nutrient-dense, soft foods such as creamed soups, broth, pudding, scrambled eggs, yogurt, mashed potatoes, cottage cheese, shakes, smoothies and nutritional drinks. Sometimes a straw can divert liquids away from painful areas. Some patients may require prescription numbing rinses before mealtime to reduce pain.

Maintaining adequate fluid intake: Many sarcoma patients are treated with high-dose ifosfamide and are required to drink at least 10 8-oz. glasses of fluid daily and urinate frequently during the first 24 hours after treatment. Some patients at high risk for dehydration may actually be sent home with intravenous hydration. Additional sources of fluids include water, decaffeinated tea, juice, broth, fruit ices, ice pops and gelatin.

Heartburn/reflux: Heartburn can be a side effect of chemotherapy. Avoid acidic foods, like tomatoes and citrus, as well as high-fat and spicy foods. Small frequent meals can minimize acid regurgitation and discomfort. Some patients need over-the-counter or prescription heartburn medications recommended by their health-care team.

New drugs: Pazopanib (Votrient) is an oral chemotherapy in pill form. Some of its  side effects include diarrhea/constipation, acid reflux and weight loss. Special dietary instructions include the avoidance of grapefruit and grapefruit juice while taking this medication.

Jessica Iannotta is responsible for all clinical operations at Meals to Heal, a company that delivers fresh, healthy meals to cancer patients that are tailored to their needs and preferences.  Previously, she spent more than 10 years as both an inpatient and outpatient oncology dietitian, working with a variety of cancer patients. She received a BS in Nutrition, Food and Agriculture from Cornell University and an MS in Clinical Nutrition from the University of Medicine and Dentistry of New Jersey. 

References:

Elliott, Laura, Molseed Laura L., Davis McCallum Paula, Grant Barbara. Oncology Nutrition Dietetic Practice Group.  The Clinical Guide to Oncology Nutrition 2nd Ed.  Academy of Nutrition and Dietetics, 2006.

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Links:

Meals to Heal delivers meals to cancer patients tailored to their needs. The site also has much useful information. http://meals-to-heal.com/

Find an oncology dietitian from the Oncology Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics: http://www.oncologynutrition.org/search/

The National Institutes of Health’s section on dietary supplements: http://ods.od.nih.gov/Research/PubMed_Dietary_Supplement_Subset.aspx