CancerResource: Treatment and Care

• Working With Your Physician and Health Care Team
• Understanding Treatment Options
• Side Effects of Cancer Treatment
• Nutritional Effects of Cancer Treatment
• Coping With the Side Effects of Cancer Treatment on Your Nutritional Status
• Dealing With Insurance and Home Health Care Concerns
• The Emotional Impact of Cancer Treatment

Working with Your Physician and Health Care Team

"The kindness and patience of my doctor was invaluable to me... My questions were answered, sometimes two or three times when I was too anxious to actually hear what he was saying."

One of the most important considerations in the treatment of your cancer is deciding on a doctor. You can find a board-certified oncologist, or cancer specialist, by asking your primary care physician, managed-care representative, or contacting the oncology department at the hospital. Besides experience, there are other qualities that your doctor should have, which may require a little more research on your part.

You must feel that your oncologist is competent and up-to-date, and that he sees you as a partner in your cancer treatment. Your doctor should be willing to listen to your concerns, offer support, and explain treatment options and side effects in language that you understand.

It is important to include your primary care physician in decisions about your treatment and medical care. Think of your primary care physician as your gatekeeper, the doctor who has good knowledge about your overall health and who can refer you to other health professionals, when needed. Other members of the health care team, such as the nurse, dietitian, physical therapist, radiation therapist, and social worker are also excellent sources of information and explanations for various aspects of your treatment. So be sure to ask questions.

The Office Visit

It is very common to feel anxious when initially visiting an oncologist. One way to remove some of the anxiety of a first visit is to bring a list of questions with you. Paper and pencil or a tape recorder may also help, so you can remember the answers given.

You might want to bring a family member or close friend with you for support, especially if you are feeling overwhelmed or upset. Some individuals, however, feel more comfortable speaking privately with the doctor. A good compromise may be for the friend to accompany you, but remain in the waiting room while you are with the doctor.

Good communication is critical to a doctor-patient relationship. Your initial meeting will help you gauge how comfortable you feel with this particular doctor. If your interaction is not satisfactory, you may want to seek another referral from your primary care physician, or you can call the oncology department of your local hospital for a list of names of local oncologists who treat your type of cancer.

Following is a list of questions you may want to ask about your treatment. Remember, if you do not understand the medical terminology at any time, be sure to ask.

Questions to ask your physician and other health care providers about your treatment.
(Print out these questions to take with you.)

1. What is your experience in treating this type of cancer?
2. What kinds of treatment do you recommend and why?
3. What are the chances that the treatment(s) you suggest will be successful?
4. How long is treatment typically?
5. What are the side effects of the treatment?
6. How do you determine if symptoms I am experiencing are normal or adverse responses to the medications or other treatment?
7. What will my quality of life be during and after treatment?
8. Are clinical trials or investigational agents an option for me?
9. Who is available for medical questions when you are not?
10. Is a nurse or other health care professional available to deal with phone inquiries?
11. What is the schedule for follow-up and post-treatment?
12. When do you generally return phone calls?
13. What is the cost of treatment and is it covered by my health plan?

Getting a Second Opinion

A second opinion can give you confidence in the information and recommendations you have already obtained, or it may offer a different approach to treatment. If the second physician disagrees with the initial consultation, you may even want to seek a third opinion. The important thing is that you receive the best state-of-the-art diagnostic tests and treatment, and that you have confidence in the care you are receiving.

You may ask your primary care physician for a referral for a second opinion, or you can ask the oncologist that you have already seen. You should not be uncomfortable asking for this referral. Many physicians welcome the additional input and reassurance provided by a second opinion. It is your right as a patient to obtain this information. If this request is met with resistance, give some extra thought to whether you wish to continue with this doctor.

Most insurance companies will pay for a second opinion; some require it. Check your insurance policy or ask about second-opinion coverage.

Keep Asking Questions

For many cancer patients, the first few days and weeks following a diagnosis of cancer are filled with a blur of appointments, tests and new information, often in a language that isn't quite clear. No one can be expected to remember everything the first time around. Your nurses and physicians know this and should encourage you to continue asking questions even the same questions two or three times.

There’s no need to feel embarrassed if you don’t understand the medical terminology being used. Ask to have the information explained in simpler language, and paraphrase the answers to make sure they’re clear to you. This information will affect important treatment and care decisions you’ll have to make. Being an involved, active participant in your treatment means asking questions to get the answers you need for those decisions.

Return to top

Understanding Treatment Options

"I know that the treatment of cancer is pretty complicated - I don't feel in control of what's happening unless I feel capable of making some choices."

Methods of Treating Cancer

Modern medicine has developed several methods of treating cancer. The most common are surgery, radiation therapy, and chemotherapy. Other cancer treatments include hormone and investigational therapies. Complementary/alternative medicine (sometimes referred to as "integrative medicine") is becoming more integrated into mainstream medicine.

There is no "best" method of treating cancer. In deciding on a specific type of treatment, the physician must consider a number of factors, including the type, stage, and location of the cancer, as well as the health and age of the patient.

An individualized plan of care will generally fit into one of three categories:

• It is very clear, based on the scientific literature, what should be done to treat your cancer. In many cases, clinical practice guidelines will direct your doctor to use these established practices.
• It is not clear what to do, but there are several promising alternatives (e.g,. radiation vs. surgery). Your doctor will have a balanced discussion with you about the various options. You will be asked your preferences based on your cancer and your lifestyle.
• It may be unclear what treatment to use. In this case you may wish to participate in a clinical trial of a promising new treatment.

A combination of treatments is commonly used to treat a specific cancer. Regardless of the type of treatment, the goal is the same to stop the uncontrolled growth of the cancer cells. Surgery does this by attempting to remove all the cancer cells. Radiation and chemotherapy work by destroying the cancer cells.

Your physician should be willing to discuss each of the treatment options or combination of treatment options under consideration, including the advantages and disadvantages, and complications or side effects of each type of treatment.

Below is a brief description of the various treatment methods and their side effects.

Surgery

Surgery removes the tumor and any nearby tissue that may contain cancer cells. Sometimes, healthy tissue may have to be removed from around the tumor to help keep the cancer from spreading.

Cancer cells can spread by traveling through the bloodstream or the lymphatic system, which carries lymph fluid through the body. Surgeons often remove lymph nodes that are near the tumor to see if they contain cancer cells. This information contributes to treatment decisions. The location and extent of surgery determine the long- and short-term side effects.

Radiation Therapy

In radiation therapy (also called X-ray therapy, radiotherapy, cobalt treatment, or irradiation), high-energy rays are used to damage cancer cells so they are unable to grow and multiply.

Radiation therapy may be used before surgery to shrink the tumor or after surgery to destroy any cancer cells that may remain in the area. Most often, the radiation is delivered as a series of treatments using a machine that directs high-energy rays at the cancer. In some cases, however, radioactive material may be implanted at the tumor site to give continuous treatment over a period of time.

Even though radiation therapy is directed only to the area where treatment is needed, it can cause side effects. Most of the side effects are not permanent. The most common side effects of radiation therapy are fatigue, skin rashes or redness in the area being treated, reduced appetite and gastrointestinal upset. In some cases, radiation therapy may cause a decrease in the type of blood cells that help protect the body against infection, bleeding and anemia.

Chemotherapy

Chemotherapy, or treatment with anti-cancer drugs, is used to destroy cancer cells by disrupting their ability to grow and multiply. The type and stage of cancer determines which drugs are used, and often more than one drug is used during a single course of treatment.

Chemotherapy drugs poison the cancer cells. That action, as well as the toxic effect they may have on some normal, healthy cells can produce a wide range of temporary side effects. The most common side effects of chemotherapy include nausea and vomiting, hair loss, loss of appetite and fatigue. Other side effects include an increased chance of infection, bleeding and anemia.

Hormone Therapy

Some types of cancer depend on hormones for their growth, while other types of cancer may be suppressed by high doses of hormones. For these reasons, doctors may recommend therapy that either prevents cancer cells from getting the hormones they need to grow, or supplies amounts of hormones that limit the growth of cancer cells.

Hormone therapy is most commonly used to treat cancers of the breast, prostate and other hormone-responsive tissues. Drugs may be used to block the body's production of hormones, or surgery is performed to remove hormone-producing organs.

Hormone therapy can cause a number of side effects, depending on the specific drug or surgical procedure. In some cases, the treatment interferes with the body's normal production or use of hormones. For example, women taking tamoxifen may experience some symptoms of menopause, such as hot flashes. Patients may have nausea and vomiting, swelling and weight gain. Since some hormones cause an increase in appetite, they are occasionally prescribed for this purpose.

Investigational Therapies

Investigational therapies are new treatment approaches that are being tested in clinical trials. There is not yet sufficient data to make the therapy a standard method of treatment. Biological therapy and gene therapy are considered investigational therapies.

Biological therapy

Biological therapy (sometimes called immunotherapy or biological response modifier therapy) uses the body’s immune system to fight cancer or to lessen some of the side effects of cancer treatment. This therapy may suppress or alter cancer cell growth, boost the killing power of immune system cells, or enhance the body’s ability to repair or replace normal cells damaged by other cancer treatments. Examples of biological therapy include interferon, interleukin-2, monoclonal antibodies, colony-stimulating factors, and vaccines.

Cancer vaccines are a form of biological therapy with potential to encourage the immune system to recognize cancer cells. They may help the body reject tumors and prevent them from recurring. Unlike other types of vaccines, cancer vaccines are injected after the disease is diagnosed. They are being studied for their possible use with other biological therapies and as a treatment for melanoma and many other types of cancers.

The side effects and severity of biological therapy depend on the type of treatment. It may cause flu-like symptoms, including fever, chills, nausea, vomiting and fatigue. Muscle aches and rashes at the site of injection may occur. Interleukin-2, in high doses, can have more severe side effects and is usually administered in the hospital where the patient is closely monitored.

Gene therapy

Initiated in the 1990's, gene therapy replaces an active cancer-causing gene, or oncogene, with a normal gene. It might also involve removing bone marrow from a cancer patient, inserting a "designer" gene, and then returning bone marrow to the patient.

At present, there are a number of serious obstacles to the complete success of gene therapy. These need to be overcome before this process is routinely available.

Clinical trials

Researchers use clinical trials to find out whether investigational therapies are safe and effective. These carefully controlled studies often compare the new therapy with standard treatment methods. In a clinical trial, some participants are given the best known treatment along with the investigational therapy, and some are given the best known treatment alone. This is at minimal or no cost to patients. The participants are randomized by chance to determine who will receive the investigational therapy and who will not. Sometimes the investigational therapy is not helpful, but other times it can lead to significant improvements in treatment and quality of life.

Patients who participate in clinical trials make an important contribution to the advancement of medical science and cancer care. For more information on clinical trials and how to participate in them, see AICR’s Cancer Information: Where to Find Help brochure, under Investigational Treatment.

Complementary and Alternative Medicine

Complementary/alternative medicine (CAM) can be described as diagnosis, treatment and/or prevention that complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine. CAM is now also referred to as "integrative medicine."

Complementary and alternative therapies include, but are not limited to:

• Acupuncture
• Botanicals/Herbals
• Dietary Supplements and Antioxidants
• Mind/Body Therapies
• Macrobiotic Diets

While certain complementary/alternative therapies for cancer may appear to help some people, scientific evidence proving their effectiveness is often lacking. If you are already using or want to try complementary therapies, it is important to tell your doctor what you are doing. Some of these therapies may be harmful or may interfere with conventional treatments. There is often little information available about how herbal therapies and supplements interact with prescription drugs. In addition, many botanicals and herbals are poorly standardized, so it is not known exactly what is in them and in what amounts.

Always approach unconventional, alternative cancer therapies with caution. Keep in mind that just because a therapy is "natural" does not guarantee that it is harmless. Complementary therapies should complement, but never replace, traditional medical approaches to cancer treatment. For your own well-being, always inform your physician about any complementary therapies you are using.

Return to top

Side Effects of Cancer Treatment

Most methods of treating cancer are associated with side effects. Treatments that destroy or limit the growth of cancer cells may also damage healthy cells and tissues, producing unpleasant side effects.

The range of side effects depends on the type of treatment and how the person reacts to it. Ask your doctor about the side effects you might expect from a specific treatment method. Realize, though, that it is not possible to predict exactly what the type and extent of the side effects might be for you. Indeed, there may be no side effects at all, or only very limited ones.

Doctors try to plan the treatment to keep side effects to a minimum. Keep in mind that:

• Not everyone is affected the same way. The side effects you experience may be very mild. This does not mean that the treatment is not working.
• There are often ways to control and limit the severity of side effects. Speak with your physician about reactions and problems related to your treatment.
• Side effects are usually only temporary--as the treatment ends, so will the side effects.
• Enduring side effects for a short time is worth the potential benefit of effective treatment.

Hair Loss

Hair loss, a side effect of chemotherapy, is a concern for many patients. Some drugs may cause the hair to thin out, while others may cause the loss of all body hair. Deciding how to handle the situation before starting treatment may help. You may want to check the phone book for shops that sell wigs, hair pieces, or turbans, or for hair replacement centers that have experience in servicing people with cancer. Fortunately, the hair loss is only temporary. It usually returns after an interval when treatment has been stopped or completed.

Fatigue

Fatigue occurs in many people with cancer, especially in those actively receiving treatment. Cancer itself may cause fatigue by interfering with normal body processes. Cancer treatment may cause fatigue because extra energy is needed to repair tissues damaged by radiation or chemotherapy. Fatigue during treatment does not mean a person's cancer is getting worse.

Dehydration is a frequent cause of fatigue, so be sure to drink plenty of fluids, especially water. In many instances, the fatigue has no clear cause, but in some cases it may be a symptom of depression.

Here are some ideas that may help you cope with fatigue:

• Eat well. Choose a variety of healthful foods every day. To help keep your energy level up, try to eat several smaller meals and healthful snacks instead of three larger meals throughout the day.
• Get adequate sleep and rest. Short naps may help restore energy during the day, while long naps may make it difficult to sleep at night.
• Conserve your energy. Set priorities, take rest breaks, and arrange your home so items used the most are close by. Sit whenever possible, use proper body positions when lifting or carrying objects, and let other people help you.
• Work wisely. Talk with family, friends, coworkers and your supervisor about your fatigue. Schedule tasks that require the most attention for times of the day when you have the most energy. Trade more fatiguing duties and use energy-saving appliances and services.
• Keep active. Plan some light activity into each day, possibly with other people. A simple exercise program that includes both strength training and cardiovascular exercise can help you feel more energetic during the day and sleep better at night. Speak to your doctor before beginning an exercise program.
• Reduce stress. For example, listen to relaxation tapes or soothing music. Get a massage, meditate, get involved in a hobby, take warm baths. Laugh with family and friends.
• Think positively. Focus on healing and recovery. Set realistic goals for yourself and be patient in reaching them. Participate in social activities. Reward your progress, and keep looking ahead.

Return to top

Nutritional Effects of Cancer Treatment

"I never really felt like eating during treatment, but when I did, I felt better."

Eating healthfully is especially important for people with cancer. Proper nutrition helps your body fight cancer and cope with its treatment.

Eating well can help you feel better and stronger. It helps you better cope with side effects and recuperate faster after treatment. People who are well nourished may even be able to handle higher doses of certain treatments.

Generally, a diet for cancer patients should provide enough calories and protein, as well as vitamins and minerals. This helps to maintain your strength, prevent body tissues from breaking down, and rebuild tissues that cancer and its treatment may harm.

When you are unable to eat enough food or the right kind of food, your body uses stored nutrients as a source of energy. This may weaken your body’s natural defenses and its ability to fight infection or other bodily stresses.

It’s important to drink plenty of fluids, especially if you don’t feel like eating much. Keep a glass of water, fruit juice or vegetable juice within easy reach throughout the day. You can drink carbonated beverages, if you prefer, but remember that they may give you symptoms of gas, make you feel full and reduce your desire for food. Try to limit caffeine-containing beverages, since they may keep you from getting your needed rest.

To help meet calorie and nutrient needs, eating several small meals throughout the day may work better than eating three large meals. A commercial nutritional supplement, like a drink or shake, might be recommended by your doctor or dietitian if poor appetite or side effects of treatment make eating difficult. Supplements are available in cans, as a powder, or as pudding. They are tasty chilled and come in a variety of flavors. Liquid nutritional supplements are found in most pharmacies and supermarkets, or can be special-ordered by your pharmacist. Discuss supplement choices with your physician and registered dietitian.

When the gastrointestinal tract is not working effectively, total parenteral nutrition (TPN) may be used. This process involves feeding nutrients directly into a vein. TPN is costly and may have side effects. Therefore, before resorting to TPN, your doctor will want to explore all the available options of enteral activities, including feeding by mouth or with a tube.

Resource Note: AICR provides a Nutrition Hotline, in which registered dietitians will answer your questions on diet, nutrition and cancer. The dietitians who respond to your calls cannot give medical advice, but can offer suggestions on easing the dietary problems that can occur during cancer treatments. The toll-free number is 1-800-843-8114, 9:00 a.m.-5:00 p.m. EST, Monday-Friday.

Return to top

Coping with the Effects of Cancer Treatment on Your Nutritional Status

Cancer treatment may affect your ability to digest, absorb and use food. If a form of cancer treatment is causing dietary side effects, discuss it with your doctor and health care team. There may be ways to ease the problem, such as changing treatment levels or drugs. A registered dietitian may also have some eating suggestions to help minimize the side effects.

Below are strategies for coping with some of the side effects of treatment. Subjects covered are:

• Tooth Decay
• Nausea
• Vomiting
• Acquired Food Aversion
• Diarrhea
• Constipation
• Sore Mouth or Throat
• Dry Mouth
• Difficulty Swallowing
• Changed Sense of Taste
• Loss of Appetite, Weight Loss and Undernutrition
• Weight Gain
• Fluid Retention
• Lactose Intolerance

Tooth Decay

Cancer treatment can cause tooth decay and other problems for your teeth and gums. Changes in eating habits may add to the problem. If you eat often or eat a lot of sweets, you may need to brush your teeth more often.

Here are some ideas for preventing dental problems:

• See your dentist before starting treatment, especially if you have a history of tooth or gum problems. This may help prevent infection or other problems later on.
• Use a soft toothbrush. If your gums are very sensitive, clean your teeth with cotton swabs or mouth swabs made especially for teeth cleaning.
• Rinse your mouth with warm water when your mouth and gums are sore. Also rinse your mouth if you have been vomiting to get rid of any acid remaining on your teeth.
• If you are not having trouble with poor appetite or weight loss, limit the amount of sugar in your diet. Also, cut down on foods that stick to the teeth such as caramels, dried fruits, seeds and chewy candy bars.
• Try to brush or rinse your mouth after each meal or snack.
• See your dentist regularly. Patients who are receiving treatment that affects the mouth (e.g., radiation to the head and neck) may need to see the dentist more often than usual.

Nausea

Nausea, with or without vomiting, may occur as a side effect of cancer surgery, chemotherapy, radiation therapy, biological therapy, and of some medications used for pain. The cancer itself, or other conditions unrelated to your cancer or treatment, may also cause nausea. Nausea can keep you from getting enough food and needed nutrients. Here are some helpful suggestions.

General Suggestions

• Eat small amounts often and slowly.
• Avoid eating in a room that's stuffy or too warm, or has cooking odors or smells that might disagree with you.
• Drink fewer liquids with meals; drinking liquids can cause you to feel full and bloated.
• Sip liquids throughout the day, except at mealtimes. Using a straw may help.
• Drink beverages cool or chilled. Try freezing favorite beverages in ice cube trays.
• Eat foods at room temperature or cooler; hot foods may add to nausea.
• Don’t force yourself to eat favorite foods when you are nauseated; it may cause you to develop a permanent dislike of those foods.
• Always sit upright when eating.
• Rest after meals since activity may slow digestion. Rest sitting up, for about an hour after meals.
• If you feel nauseated in the morning, try dry toast or crackers before getting up.
• Wear comfortable, loose-fitting clothes.
• Avoid eating for one or two hours before radiation therapy or chemotherapy, if nausea occurs during treatment.
• Try to keep track of when your nausea occurs and what is causing it (specific foods, events, surroundings). A small notebook can serve as a food diary to record the circumstances associated with the nausea. If possible, make appropriate changes in your diet or schedule. Share this information with your doctor, nurse or registered dietitian.
• Many people undergoing cancer treatment feel best in the mornings. There is nothing wrong with having your major meal at that time.
• Ask your doctor about anti-nausea medications.

Vomiting

Vomiting may follow nausea and may be brought on by treatment, food odors, gas in the stomach or bowel or motion. In some people, certain surroundings (such as the hospital) may initiate vomiting. Here are some helpful ideas:

• Do not drink or eat until you have the vomiting under control.
• Sit upright for a period of time after vomiting.
• Once you have controlled the vomiting, try small amounts of clear liquids, such as cranberry juice, flat ginger ale or cool broth. Begin with one teaspoon every 10 minutes, gradually increase to one tablespoon every 20 minutes, then try 2 tablespoons every 30 minutes.
• When you are able to keep down clear liquids, try a "full-liquid" diet that may include cream of wheat, pudding, ice cream or frozen yogurt, broth, gelatin and milk. Continue to take small amounts as often as you can keep them down. If you feel okay on a full-liquid diet, gradually work your way up to your regular diet. Carbonated beverages are fine for some people, but others find the beverages make them feel full or bloated, or cause burping, which can stimulate vomiting.

Acquired Food Aversion

If you experience nausea and/or vomiting from your treatment, avoid eating your favorite foods prior to the time you are likely to feel sick. It is not uncommon for individuals to associate a particular food with the onset of unpleasant symptoms. This is called an "acquired food aversion." Save your favorites for a time when you feel well.

Diarrhea

Diarrhea may be caused by chemotherapy, radiation therapy to the abdomen, infection, food sensitivity and emotional upset. Long-term or severe diarrhea may cause dehydration and other health problems, since needed water and nutrients are lost. Contact your doctor if the diarrhea is persistent.

Low-residue, low-fiber foods can sometimes offer relief. These might include:

• rice or noodles
• farina or cream of wheat
• eggs (cooked until the whites are solid, not fried)
• bananas
• puréed vegetables, or cooked soft
• canned or cooked fruit without skins, such as applesauce
• white bread
• skinned turkey or chicken
• tender or ground beef
• fish
• mashed potatoes

Avoid foods that make it worse. These might include:

• beans, onions and strong spices
• greasy, fatty or fried foods
• raw vegetables and fruits, nuts
• high fiber vegetables such as broccoli, corn, beans, cabbage, cauliflower, and peas
• alcoholic beverages

General Suggestions

• Avoid dairy products if they increase indigestion and diarrhea. (Many liquid nutritional supplements are milk free and are available in a variety of flavors.)
• Eat small amounts of food and liquids throughout the day.
• Drink plenty of liquids, such as water, diluted cranberry juice, broth, decaffeinated coffee or tea. Drinking fluids is important because your body may not get enough water when you have diarrhea.
• Drink liquids that are at room temperature. Avoid very hot or very cold foods.
• Eat plenty of foods and liquids that contain sodium and potassium. These minerals are often lost during diarrhea. Foods high in potassium that don't cause diarrhea include bananas, peach and apricot nectar and boiled or mashed potatoes. Good liquid choices include bouillon or fat-free broth.
• Try a clear liquid diet during the first 12 to 24 hours of onset.

Constipation

Some anticancer drugs and other drugs, such as pain medications, may cause constipation. This problem may also occur if your diet lacks enough fluid or bulk, or if you are not physically active. Here are some suggestions to prevent and treat constipation:

• Drink plenty of liquids (at least eight glasses per day) to help keep your stools soft. A daily four-ounce serving of prune juice may also be helpful.
• Take a hot drink about one half hour before your usual time for a bowel movement.
• Try high-fiber foods, including whole grains, fresh vegetables and fruits. For example, choose whole wheat bread, cauliflower, carrots, potatoes with skin, bananas, prunes, oranges and berries.
• Add unprocessed wheat bran to foods such as casseroles and hot cereals.
• Get some exercise, such as walking, every day. Speak with to your doctor or physical therapist about the amount and type of exercise that is right for you.
• If none of these suggestions works, ask your doctor about fiber supplements, like Metamucil, or medicine to ease constipation. Drink plenty of fluids, as indicated in the directions for use. Be sure to check with your doctor before adding fiber or taking any laxatives or stool softeners.

Sore Mouth or Throat

Damage to the mouth, gums and throat may result from cancer treatment. If you have a sore mouth, see your doctor to be sure the soreness is not due to a correctable dental or medical problem.

Certain foods will irritate an already sore mouth. To make eating easier, carefully choose the foods you eat and take good care of your mouth. Here are some suggestions:

Try soft foods that are easy to chew and swallow, such as:

• bananas, applesauce, watermelon, canned fruits
• peach, pear and apricot nectars
• cottage cheese, yogurt, milkshakes
• mashed potatoes, macaroni and cheese
• custards, puddings, gelatin
• scrambled eggs
• oatmeal and other cooked cereals
• puréed or mashed vegetables
• puréed meats

Avoid foods that can irritate your mouth, such as:

• citrus fruit or juice
• spicy or salty foods
• rough, coarse or dry foods
• hot spices, such as chili powder, nutmeg and cloves

General Suggestions

• Cook foods until they are soft and tender.
• Cut foods into small pieces; grind or purée. Try stews and casseroles.
• Mix food with butter, thin gravies and sauces to make it easier to swallow.
• Use a straw to drink liquids.
• Try food cold or at room temperature, since hot and warm foods can irritate a tender mouth and throat.
• If your teeth and gums are sore, your dentist may suggest a special product for cleaning your teeth.
• Rinse your mouth with water often to remove food and bacteria and promote healing.
• Ask your doctor about anesthetic lozenges and sprays (such as Tisol and Mouthkote) that can numb the mouth and throat long enough for you to eat meals.
• Keep dentures clean and remove them, except when eating, until your mouth heals.
• Do not smoke, and keep alcohol to a minimum.

Dry Mouth

Chemotherapy and radiation therapy in the head or neck area - which can reduce the flow of saliva - often cause dry mouth. When this happens, it is hard to chew and swallow. Dry mouth can also change the way foods taste. To reduce problems caused by dry mouth, try the suggestions below, as well as the ideas given for a sore mouth or throat.

• Avoid salty foods.
• Try tart foods and beverages, such as lemonade. These foods may help your mouth produce more saliva. Melon may also help.
• Suck on hard candy such as lemon drops, eat popsicles, or chew sugar-free gum.
• Keep your lips moist with lip salves.
• Use sauces, gravies and salad dressings to make food moist and easier to swallow.
• Try thick drinks, such as fruit nectars, at room temperature or cold.
• Have a sip of water every few minutes, to help you swallow and talk more easily.
• Maintain good oral hygiene.
• If your dry mouth problem is severe, ask your doctor or dentist about products that coat and protect your mouth. Synthetic saliva products, such as Glandosane, Optimoist, Moistin or Mouthkote, may help.

Difficulty Swallowing

Problems with swallowing can be the result of cancer or its treatment. The use of feeding tubes, at least right after surgery, will allow healing to take place. If a tube is not required, there are several things you can do to make eating easier:

• Take deep breaths before attempting to swallow, and exhale or cough after swallowing.
• Thick liquids may be easier to swallow than thin liquids. Gelatin may be easier to swallow than thick or thin liquids.
• Mashed foods should not be too thick.
• Drink your fluids between, rather than during, meals since they may reduce your appetite. Liquids at room temperature may be easier to swallow.

If part or all of the tongue or jawbone has been removed, then chewing and tongue movement may be limited. Food will move down your digestive tract once it gets to the throat. Effective swallowing techniques can be taught by speech therapists, dietitians, or nurses. Also, try these suggestions:

• Use a straw. It makes swallowing beverages easier.
• Use a spoon. It is easier to control and less hazardous than a fork.
• Ask your therapist to demonstrate the best way for you to place food in your mouth.
• Avoid very hot or very cold foods.
• Choose the right liquid diet for your needs, to help avoid constipation or diarrhea.
• Try puréed foods. They may be easier to tolerate than foods of regular consistency.
• Exercise your tongue and jaw. Try to move them through the usual range of motion - stick your tongue out and back, yawn and move your jawbone from side to side.

Changed Sense of Taste

Chemotherapy, radiation therapy, or the cancer itself may cause your sense of taste to change. Some patients complain of a bitter, metallic taste, especially when eating foods high in protein. Each person's sense of taste may be affected differently. You will need to learn which foods, if any, taste differently to you.

Depending on how your taste has been affected, some of the following ideas for improving flavor may work better than others. In addition, visit your dentist to check for dental problems that may affect your food's taste.

General Suggestions

• Choose and prepare foods that look and smell good to you.
• If red meat tastes different, use chicken, turkey, eggs, dairy products, tofu or fish that doesn't have a strong smell.
• Make meat, chicken or fish more flavorful by marinating it in sweet fruit juices, sweet wine or Italian dressing.
• Try using small amounts of flavorful seasonings such as basil, rosemary or oregano.
• Try tart foods that may have more taste, such as oranges or lemonade. A tart lemon custard might be tasty and will also provide needed protein and calories.
• Serve foods at room temperature.
• Try using onion, garlic and other seasonings to add flavor to vegetables.
• Maintain good oral hygiene.
• Drink liquids throughout the day.

Loss of Appetite, Weight Loss, and Undernutrition

Weight loss can occur during cancer treatment. It is often caused by the effects of cancer on the body and its interference with eating, digestion, or absorption of food. Weight loss can also be caused by loss of appetite from cancer therapy or feelings of depression or anxiety.

The following suggestions may help make mealtimes more relaxed and eating more appealing.

• Involve yourself in as many normal activities as possible.
• Stay calm, especially at mealtimes. Don't hurry your meals.
• Try changing the time, place and surroundings of meals. A candlelight dinner can make mealtime more appealing. Eat with others, or listen to your favorite music.
• Eat whenever you are hungry. You do not need to eat three meals a day; try several smaller meals throughout the day.
• If you are losing weight, eat food often during the day, even at bedtime. Have nutritious snacks available, but store them out of sight.
• Add variety to your menu by using new recipes, spices and food products. Eat out in restaurants occasionally.
• Ask your dietitian to help you with meal planning for adequate nutrient intake.

Include your favorite foods in your daily menus.

Weight Gain

Weight gain may be an unexpected occurrence during cancer treatment. Sometimes this is due to hormonal changes. Excessive portion sizes or eating too many foods high in calories and fat can also increase weight. Sometimes patients feel less nauseated or anxious when they have food in their mouths. Discuss your weight gain with your physician or registered dietitian to determine the best way to achieve a healthy weight. This is important because excess weight gain may worsen prognosis for certain cancers, such as breast cancer.

Fluid Retention

Sometimes patients gain excess weight during treatment without eating extra calories. For example, certain drugs (such as prednisone) can cause the body to retain fluid. The extra weight is from water and does not mean you are eating too much.

DO NOT go on a diet if you notice weight gain. Instead, tell your doctor so you can find out what may be causing this change. If anticancer drugs are causing the weight gain, your doctor may recommend limiting the salt you eat, since salt causes your body to hold onto water. Drugs called diuretics also may be prescribed to get rid of the extra fluid.

To alleviate water retention:

• Eat less salt.
• Check food labels for sodium content. Processed foods can add enormous amounts of soidum, so look for products with no salt added.
• Drink when you are thirsty, and be sure to have three to four glasses of water each day.
• Stay as physically active as possible. For example, take walks.
• Elevate your legs when resting.

Lastose Intolerance

If you were able to digest milk and milk products easily before you began your radiation or chemotherapy treatment, but now develop cramps and diarrhea after you drink milk or eat certain dairy foods, then you may be suffering from lactose intolerance. The cancer therapy may have temporarily inactivated the enzymes in your intestinal tract that digest the milk sugar called lactose.

For most people, the condition will reverse itself in time. Meanwhile, the following measures may be helpful:

• Avoid milk or dairy products that give you problems. Yogurt and small amounts of aged cheeses may be easier to tolerate.
• If you are concerned about not getting enough calcium in your diet, try calcium-fortified orange or apple juice, and calcium-fortified cereals and breads. Ask your doctor or dietitian about taking calcium supplements.
• Try one of the enzyme products, such as LactAid or Lactinex, which helps break down the lactose. Some products can be taken in pill form, others are added directly to milk. Or try reduced- lactose milk, such as LactAid milk.

Questions to ask your dietitian about nutrition during your cancer treatment
(Print out these questions to take with you.)

1. Are there any changes I should make to my current diet?
2. Should I be taking a multivitamin? (If you are taking supplements of any kind, be sure to bring a list of what you are taking and share this with the dietitian.
3. If my treatment is causing me to vomit often, should I be concerned about getting necessary nutrients?
4. Should I try the liquid meal replacements now available if I’m having trouble keeping solid foods down? Do these provide enough of the daily nutrients I need? How much should I drink?

5. What if I just don’t feel like eating much for a couple of days after treatment?

Return to top

Dealing with Insurance and Home Health Care Concerns

The financial impact of cancer is one the most stressful aspects of this illness. Below are some issues that may arise, with ideas on how to deal with them.

Insurance

"Will my insurance cover cancer treatment?"

People who had health and life insurance before treatment generally are able to keep it, although costs and benefits may change. Review your insurance policies to find out exactly what your coverage includes. Talk to your insurance provider to make sure you understand the extent of your coverage and its limitations. Also check your disability insurance or benefits to see if you are eligible to maintain your income during times when you may not be able to work.

It is very important that you keep careful records of all your covered expenses and claims. If a claim is turned down, you do not have to simply accept it. Ask your doctor to explain to the company why the services meet the requirements for coverage under your policy. If you are turned down again, find out if the company has an appeals process.

Cancer patients may find assistance with health care costs or applying for new policies in the following ways:

• Cost and extended payment options may be negotiated with health care providers.
• Medicare offers coverage to people 65 or older and to those who are permanently disabled, after two years of collecting disability payments.
• Medicaid covers people who are in low-income brackets.
• The U.S. Department of Veterans Affairs (VA) may be able to help with health care costs if a cancer patient or spouse is, or has been, a member of the Armed Forces. Any VA health care facility can provide information about these programs.
• The Federal Government's Civilian Health and Medical Programs of the Uniformed Services (CHAMPUS) helps pay for civilian medical care for spouses and children of active duty Uniformed Services personnel, retired Uniformed Services personnel and their spouses and children, and spouses and children of active duty or retired active duty personnel who have died. For further information, contact the Information Office of CHAMPUS, Aurora, CO 80045.
• If you want to apply for a new policy, health maintenance organizations often have open enrollment periods when you may be accepted regardless of your history.
• You may be eligible for group insurance through a professional, fraternal or political organization to which you belong.

You also have the option of seeking medical advice or treatment from physicians or hospitals not affiliated with your health maintenance organization (HMO) or preferred provider organization (PPO). Out-of-pocket costs are higher if you decide on this option.

When Health Insurance Doesn't Cover the Bills

Cancer and cancer treatment require careful financial planning, whether or not there is health insurance to cover some of the costs. The financial burdens of cancer are much more difficult for someone with no health insurance, but a lack of insurance should not mean a lack of competent medical care and treatment.

If you do not have health insurance, you will usually be expected to use as much of your own assets as possible to pay for your care and treatment. There may be other sources of financial assistance available, as your own assets become limited. Discuss this with your social worker.

The federally backed Medicaid program provides health coverage for the elderly and for people with no insurance and limited means. Your local or state office of social services (or welfare office) can supply information on eligibility and coverage. Requirements vary from state to state, so be sure to check the current regulations for your state of residence. In most cases, Medicaid covers direct medical costs, as well as home health care, when needed.

Some hospitals are required to provide treatment for needy patients under special federal aid construction programs. Speak with your physician, your local social services or welfare office, and your hospital's social worker to see what help may be available.

Some pharmaceutical manufacturers have patient assistance programs. To learn if your specific drug might be available at reduced cost or free of charge, ask your doctor to contact the drug manufacturer through such a program.

Home Health Care

"The professionals that came to my home helped so much with my recovery. I don't know what I would have done without them."

At different stages of your cancer treatment, you may want to use the services of a home health care agency. Home health care agencies provide home visits by registered nurses to check on wound healing after surgery, to administer intravenous (IV) antibiotics or chemotherapy, or to monitor your condition between visits to your doctor. Some also can provide physical therapists to help with your recovery, or trained aides who can help with your personal care.

Health insurance coverage varies for these services, so it is important to find out exactly what your health insurance will pay for. Also, be sure to ask the agency a few key questions: the qualifications of its staff and whether they are bonded and insured; whether there is a minimum number of visits; whether they offer discounts for multiple visits; and the amount of notice required to have someone at the home.

If your health insurance is limited or does not cover this type of assistance, check with your local or state social services office to find out if you are eligible for state programs providing such assistance. In addition to medical assistance, there may be special programs in your area, such as Meals on Wheels, to help with the challenges of everyday living during the times when you may need it. Your local social services or welfare office, or your hospital social worker, should be able to provide information about these services and how to apply for them.

If you reside in an assisted living community, you may have access to home health care services. Call the management office to find out what services are available to residents of the community.

For more information on resources offering financial assistance and financial counseling, check the "Cancer Information—Where to Find Help" brochure, in the Financial Aid section.

Return to top

The Emotional Impact of Cancer Treatment

"We travel a road paved with an awesome mingling of hope and despair, courage and fear, humor and anger, and constant uncertainty."

Despite the ups and downs, millions of people today live well with cancer and learn to see themselves as triumphant individuals, not only as cancer patients.

Cancer treatment carries its own emotional effects that may be more subtle than the initial reaction to learning you have cancer, but just as important to your overall well-being and quality of life.

As you or your loved one begins treatment, you may find yourself on an emotional roller coaster. Hope for a cure, joy at each success, and a determination to get life back to normal, alternate with fear that treatment will fail, frustration at physical limitations, and sadness when treatment brings changes in physical appearance. Powerful anticancer drugs, radiation therapy, surgery, biological therapy and hormone therapy sometimes cause unpleasant side effects that may lead to irritability and depression.

Look for signs of depression or other emotional reactions that may occur as you undergo cancer treatment. Keep in mind that depression may have nothing to do with the cancer.

Don't assume that the symptoms of depression, listed below, are side effects of cancer:

• Depressed mood
• Loss of pleasure or interest
• Inability to concentrate
• Feelings of guilt or worthlessness
• Disturbed sleep patterns
• Fatigue or loss of energy
• Change in weight or appetite
• Slowed movements or inability to stay still
• Thoughts of death or suicide

Let your doctor know if you experience some of these symptoms. Counseling and medication may help. Your hospital social worker can direct you and family members to local resources that offer support.

Here are some suggestions to help you and your family and friends cope with the emotional impact of cancer.

• Be gentle with yourself. Be careful not to get angry at yourself for all those emotions. They are natural reactions.
• Talk it out. Sometimes expressing your fears to a trusted family member or friend helps relieve anxiety.
• Learn to tell others what you need. Family, friends and physicians often take their cues from patients. Ask questions about the cancer and its treatment and ask for assistance when you need it.
• Don't be afraid to ask for support. Most cancer patients need emotional support from individuals other than family members and friends. Nurses, social workers and dietitians are among the professionals that are available through support groups, local hospitals, health care agencies and mental health centers.
• Take good care of yourself. Fill your days with activities that are important to you, but don't overextend yourself physically. It's easier to feel hopeful when life is balanced with rest, nutritious meals, recreation and meaningful work.
• Educate yourself. Often what you imagine causes greater fear than the facts. Read the materials in CancerResource and use the additional resources provided.
• Be positive and proactive. Take charge of your health and medical care.

Return to top

Go to Next Secton: After Treatment >