Advanced Cancer
Drug-Nutrient Interactions
Guidelines for Healthy Eating
        The Food Guide Pyramid
        Cancer Prevention
Surviving Cancer and Preventing Second Cancers
        Lung Cancer
        Prostate Cancer
        Breast Cancer
        Colon Cancer
        Esophageal and Gastric Cancer

Advanced Cancer

Nutrition-related side effects may occur or become worse as cancer becomes more advanced.

The following are the most common nutrition -related symptoms in patients who have advanced cancer:

• Cachexia (a wasting syndrome that causes weakness and a loss of weight, fat, and muscle).
• Weight loss of more than 10% of normal body weight.
• Feeling too full to eat enough food.
• Bloating.
• Anorexia (the loss of appetite or desire to eat).
• Constipation.
• Dry mouth.
• Taste changes.
• Nausea.
• Vomiting.
• Inability to swallow.

The usual treatment for these problems in patients with advanced cancer is palliative care to reduce the symptoms and improve the quality of life.

Palliative care includes nutrition therapy (see the Nutrition Suggestions for Symptom Relief ¹ section) and/or drug therapy (see the Drug-Nutrient Interactions ² section).

Eating less solid food is common in advanced cancer. Patients usually prefer soft foods and clear liquids. Those who have problems swallowing may do better with thick liquids than with thin liquids. Terminally ill patients often do not feel much hunger at all and may be satisfied with very little food.

When cancer is advanced, food should be viewed as a source of enjoyment. Eating should not just be about calories, protein, and other nutrient needs.

Dietary restriction is not usually necessary, as intake of “prohibited foods” (such as sweets for a patient with diabetes) is not enough to be of concern. Some patients, however, may need certain diet restrictions. For example, patients who have pancreatic cancer, uterine cancer, ovarian cancer, or another cancer affecting the abdominal area may need a soft diet (no raw fruits and vegetables, no nuts, no skins, no seeds) to prevent a blockage in the bowel. Diet restrictions should be considered in terms of quality of life and the patient’s wishes.

The benefits and risks of nutrition support vary for each patient.

Decisions about using nutrition support should be made with the following considerations:

• Will quality of life be improved?



• Do the possible benefits outweigh the risks and costs?



• Is there an advanced directive? An advanced directive is a written instruction about the provision of health care or power of attorney in the event an individual can no longer make his or her wishes known.



• What are the wishes and needs of the family?

Cancer patients and their caregivers have the right to make informed decisions. The healthcare team, with guidance from a registered dietitian, should inform patients and their caregivers about the benefits and risks of using nutrition support in advanced disease. In most cases, the risks outweigh the benefits. However, for someone who still has good quality of life but also physical barriers to achieving adequate food and water by mouth, enteral feedings may be appropriate. Parenteral support is not usually appropriate. Advantages and disadvantages of enteral nutrition include the following:

Benefits

• May improve alertness.
• May provide comfort to the family.
• May decrease nausea.
• May decrease hopelessness and fears of abandonment.

Risks

• May cause diarrhea or constipation.



• May increase nausea.



• Requires surgery for the placement of a tube through the abdomen.



• Increases risk of choking or pneumonia.



• Increases risk of infection.



• Creates a greater burden on the caregiver.

Some foods do not mix safely with certain drugs.

Cancer patients may be treated with a number of drugs throughout their care. Some foods or nutritional supplements do not mix safely with certain drugs. The combination of these foods and drugs may reduce or change the effectiveness of anticancer therapy or cause life-threatening side effects. The following table provides information on some of the drug-nutrient interactions that may occur with certain anticancer drugs:

Some herbs do not mix safely with certain drugs or foods.

The combination of some herbs with certain foods and drugs may reduce or change the effectiveness of anticancer therapy or cause life-threatening side effects. The following table provides information about herbs commonly taken by cancer patients. The information provided covers known interactions only; additional side effects are possible for these herbs. A pharmacist or updated herbal supplement references may provide more information.

The United States Department of Agriculture (USDA) developed Nutrition and Your Health: Dietary Guidelines for Americans ⁵ that offers diet and fitness recommendations that support good overall health. The USDA Food Guide Pyramid ⁶ shows five food groups and the number of servings to be eaten each day to provide the nutrients and calories needed. The food groups shown are grains, vegetables, fruits, dairy, and meat and nonmeat protein. Small amounts of fats, oils, and sweets are advised.

Current guidelines for promoting general health and well-being include the following:

• Eat nutrient-rich foods within calorie limits.



• Maintain a healthy body weight.



• Exercise regularly.



• Eat a variety of fruits, vegetables, whole grains, and low-fat dairy products each day.



• Eat less fat and avoid trans fatty acid (trans fats).



• Choose fiber -rich fruits, vegetables, and whole grains often.



• Eat fewer foods high in salt. Choose more foods high in potassium (like bananas, spinach and potatoes).



• Those who choose to drink alcoholic beverages should do so in moderation. Certain individuals should avoid alcohol entirely.



• Keep food safety in mind when preparing, storing, and serving foods.

For information on healthy food choices for Hispanics/Latinos, see The Road to a Healthy Life ⁷.

Healthy food choices and physical activity may help reduce the risk of cancer. The American Cancer Society and the American Institute for Cancer Research have both developed cancer prevention guidelines that are similar.

The following diet and fitness guidelines may help reduce the risk of cancer:

• Eat a plant-based diet. Eat at least 5 servings of fruit and vegetables daily. Include beans in the diet and eat grain products (such as cereals, breads, and pasta) several times daily.



• Choose foods low in fat.



• Choose foods low in salt.



• Get to and stay at a healthy weight.



• Be at least moderately active for 30 minutes on most days of the week.



• Limit alcoholic drinks.



• Prepare and store food safely.



• Do not use tobacco in any form.

Nutrition guidelines for cancer prevention may also help cancer survivors prevent the development of a second cancer. The relationship between diet and cancer continues to be studied.

Study findings have shown the following associations between diet and lung cancer:

• Eating more than 5 servings per day of fruits and vegetables may reduce the risk of lung cancer.



• Taking beta-carotene supplements may increase the risk of lung cancer in male smokers.

Study findings have shown the following associations between diet and prostate cancer:

• Diets high in saturated fat and meat or animal fat may increase the risk of advanced prostate cancer.



• Taking daily vitamin E supplements may reduce the risk of death from prostate cancer.



• Taking daily beta-carotene supplements may reduce the chance of dying from prostate cancer. Taking beta-carotene supplements is not advised for smokers, however, as it may increase their risk of developing prostate cancer.

Study findings have shown the following associations between diet and breast cancer:

• High- calorie, high-fat diets may increase the risk of recurrence.



• Drinking beer may increase the risk of recurrence and death.



• Obesity (having too much body fat) may increase the risk of recurrence.



• Lack of physical activity may increase the risk of recurrence.



• Taking vitamin C above the RDA may reduce the risk of recurrence.



• A diet high in vegetables and fruits may reduce the risk of recurrence.



• A diet rich in foods that contain beta-carotene (such as dark orange vegetables and fruits) may reduce the risk of death from breast cancer.

The effect of soy on breast cancer or breast cancer recurrence is unknown. Studies are under way.

Study findings have shown that a long-term diet rich in whole grains may reduce the risk of colon cancer.

Study findings have shown the following associations between diet and esophageal or gastric (stomach) cancer:

• A diet rich in cereal fiber may reduce the risk of gastric cancer.



• Taking daily supplements of vitamins C and E and beta-carotene may reduce the risk of esophageal cancer.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

A disease caused by the human immunodeficiency virus (HIV). People with AIDS are at an increased risk for developing certain cancers and for infections that usually occur only in individuals with a weak immune system. Also called acquired immunodeficiency syndrome.

An abnormal loss of the appetite for food. Anorexia can be caused by cancer, AIDS, a mental disorder (i.e., anorexia nervosa), or other diseases.

A drug used to treat depression.

A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention.

A substance found in yellow and orange fruits and vegetables and in dark green, leafy vegetables. The body can make vitamin A from beta carotene. Beta carotene is being studied in the prevention of some types of cancer. It is a type of antioxidant.

A drug used to treat skin problems caused by cutaneous T-cell lymphoma that have not gotten better after other treatment. It is also being studied in the treatment of other types of cancer. Bexarotene is a type of retinoid. Also called LGD1069 and Targretin.

An eastern North American perennial herb. A substance obtained from the root of the plant has been used in some cultures to treat a number of medical problems. It is being studied in the treatment of hot flashes and other symptoms of menopause. The scientific name is Cimicifuga racemosa. Also called black snakeroot, bugbane, bugwort, and rattlesnake root.

A drug that helps prevent blood clots from forming. Also called anticoagulant.

The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel. Also called intestine.

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

Loss of body weight and muscle mass, and weakness that may occur in patients with cancer, AIDS, or other chronic diseases.

A mineral found in teeth, bones, and other body tissues.

A measurement of the energy content of food. The body needs calories as to perform its functions, such as breathing, circulating the blood, and physical activity. When a person is sick, their body may need extra calories to fight fever or other problems.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

Cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).

A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.

A disease in which the body does not properly control the amount of sugar in the blood. As a result, the level of sugar in the blood is too high. This disease occurs when the body does not produce enough insulin or does not use it properly.

Frequent and watery bowel movements.

The things a person eats and drinks.

A product that is added to the diet. A dietary supplement is taken by mouth, and usually contains one or more dietary ingredient (such as vitamin, mineral, herb, amino acid, and enzyme). Also called nutritional supplement.

A health professional with special training in nutrition who can help with dietary choices. Also called nutritionist.

A drug that prevents blood cell clumping and enhances the effectiveness of fluorouracil and other chemotherapeutic agents.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

A drug that increases the production of urine.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

A form of nutrition that is delivered into the digestive system as a liquid. Drinking nutrition beverages or formulas and tubefeeding are forms of enteral nutrition. People who are unable to meet their needs with food and beverages alone, and who do not have vomiting or uncontrollable diarrhea may be given tubefeedings. Tubefeeding can be used to add to what a person is able to eat or can be the only source of nutrition. A small feeding tube may be placed through the nose into the stomach or the small intestine, or it may be surgically placed into the stomach or the intestinal tract through an opening made on the outside of the abdomen, depending on how long it will be used.

Cancer that forms in tissues lining the esophagus (the muscular tube through which food passes from the throat to the stomach). Two types of esophageal cancer are squamous cell carcinoma (cancer that begins in flat cells lining the esophagus) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).

In food, fiber is the part of fruits, vegetables, legumes, and whole grains that cannot be digested. The fiber in food may help prevent cancer. In the body, fiber refers to tissue made of long threadlike cells, such as muscle fiber or nerve fiber.

Cancer that forms in tissues lining the stomach. Also called stomach cancer.

Official nonbrand names by which medicines are known. Generic names usually refer to the chemical name of the drug.

An herb with a root that has been used in some cultures to treat certain medical problems. It may have anticancer effects.

The complex group of organs and cells that defends the body against infections and other diseases.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

A hormone made by the islet cells of the pancreas. Insulin controls the amount of sugar in the blood by moving it into the cells, where it can be used by the body for energy.

One of a pair of organs in the abdomen. Kidneys remove waste from the blood (as urine), produce erythropoietin (a substance that stimulates red blood cell production), and play a role in blood pressure regulation.

A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.

Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.

A drug used to treat some types of cancer, severe skin conditions such as psoriasis, and rheumatoid arthritis. Methotrexate stops cells from making DNA. It is a type of antimetabolite. Also called amethopterin and Rheumatrex.

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

A chemical compound (such as protein, fat, carbohydrate, vitamin, or mineral) contained in foods. These compounds are used by the body to function and grow.

The taking in and use of food and other nourishing material by the body. Nutrition is a 3-part process. First, food or drink is consumed. Second, the body breaks down the food or drink into nutrients. Third, the nutrients travel through the bloodstream to different parts of the body where they are used as "fuel" and for many other purposes. To give the body proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients.

Having an abnormally high, unhealthy amount of body fat.

A part of the body that performs a specific function. For example, the heart is an organ.

Having to do with the ovaries, the female reproductive glands in which the ova (eggs) are formed. The ovaries are located in the pelvis, one on each side of the uterus.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of palliative care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, supportive care, and symptom management.

A disease in which malignant (cancer) cells are found in the tissues of the pancreas. Also called exocrine cancer.

A form of nutrition that is delivered into a vein. Parenteral nutrition does not use the digestive system. It may be given to people who are unable to absorb nutrients through the intestinal tract because of vomiting that won't stop, severe diarrhea, or intestinal disease. It may also be given to those undergoing high-dose chemotherapy or radiation and bone marrow transplantation. It is possible to give all of the protein, calories, vitamins and minerals a person needs using parenteral nutrition. Also called hyperalimentation, total parenteral nutrition, and TPN.

A severe inflammation of the lungs in which the alveoli (tiny air sacs) are filled with fluid. This may cause a decrease in the amount of oxygen that blood can absorb from air breathed into the lung. Pneumonia is usually caused by infection but may also be caused by radiation therapy, allergy, or irritation of lung tissue by inhaled substances. It may involve part or all of the lungs.

A metallic element that is important in body functions such as regulation of blood pressure and of water content in cells, transmission of nerve impulses, digestion, muscle contraction, and heartbeat.

Used to prevent disease.

A drug that is used to treat cancer. It belongs to the family of drugs called alkylating agents.

Cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). Prostate cancer usually occurs in older men.

A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrent cancer.

A drug used to treat some types of cancer, severe skin conditions such as psoriasis, and rheumatoid arthritis. Rheumatrex stops cells from making DNA. It is a type of antimetabolite. Also called amethopterin and methotrexate.

Refers to a new primary cancer in a person with a history of cancer.

A hormone found in the brain, platelets, digestive tract, and pineal gland. It acts both as a neurotransmitter (a substance that nerves use to send messages to one another) and a vasoconstrictor (a substance that causes blood vessels to narrow). A lack of serotonin in the brain is thought to be a cause of depression. Also called 5-hydroxytryptamine.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

A diet consisting of bland foods that are softened by cooking, mashing, pureeing, or blending.

A product from a plant of Asian origin that produces beans used in many food products. Soy contains isoflavones (estrogen-like substances) that are being studied for the prevention of cancer, hot flashes that occur with menopause, and osteoporosis (loss of bone density). Soy in the diet may lower cholesterol levels and reduce the risk of heart disease. Also called Glycine max, soya, and soybean.

An herbal product sold as an over-the-counter treatment for depression. It is being studied for its ability to lessen certain side effects of cancer treatment. Also called Hypericum perforatum.

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

Adding nutrients to the diet.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

One who remains alive and continues to function during and after overcoming a serious hardship or life-threatening disease. In cancer, a person is considered to be a survivor from the time of diagnosis until the end of life.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

A set of symptoms or conditions that occur together and suggest the presence of a certain disease or an increased chance of developing the disease.

A drug used to treat certain types of breast cancer in women and men. It is also used to prevent breast cancer in women who have had ductal carcinoma in situ (abnormal cells in the ducts of the breast) and are at a high risk of developing breast cancer. Tamoxifen is also being studied in the treatment of other types of cancer. It blocks the effects of the hormone estrogen in the breast. Tamoxifen is a type of antiestrogen. Also called Nolvadex and tamoxifen citrate.

A drug that is used to treat certain types of brain tumors in adults and is being studied in the treatment of other types of cancer. It belongs to the family of drugs called alkylating agents. Also called Temodar.

Treatment.

The replacement of tissue with tissue from the person’s own body or from another person.

The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a baby grows. Also called womb.

A nutrient that the body needs in small amounts to function and stay healthy. Sources of vitamins are plant and animal food products and dietary supplements. Some vitamins are made in the human body from food products. Vitamins are either fat-soluble (can dissolve in fats and oils) or water-soluble (can dissolve in water). Excess fat-soluble vitamins are stored in the body’s fatty tissue, but excess water-soluble vitamins are removed in the urine. Examples are vitamin A, vitamin C, and vitamin E.

A nutrient that the body needs in small amounts to function and stay healthy. Vitamin D helps the body use calcium and phosphorus to make strong bones and teeth. It is fat-soluble (can dissolve in fats and oils) and is found in fatty fish, egg yolks, and dairy products. Skin exposed to sunshine can also make vitamin D. Not enough vitamin D can cause a bone disease called rickets. It is being studied in the prevention and treatment of some types of cancer. Also called cholecalciferol.

A nutrient that the body needs in small amounts to function and stay healthy. Vitamin E helps prevent cell damage caused by free radicals (highly reactive chemicals). It is fat-soluble (can dissolve in fats and oils) and is found in seeds, nuts, leafy vegetables, and vegetable oils. Not enough vitamin E can result in infertility (the inability to produce children). It is being studied in the prevention and treatment of some types of cancer. Vitamin E is a type of antioxidant.

To eject some or all of the contents of the stomach through the mouth.

A drug that prevents blood from clotting. It belongs to the family of drugs called anticoagulants (blood thinners).