It is often observed that cancer patients and survivors do not consider weight management and other medical conditions as important issues. However, this is not true and these problems deserve complete attention from patients, doctors and survivors.
Dr. Ranga Rao answers a few FAQs that will help you to understand better.
1. What can cause me to lose weight or have no appetite?
You can lose weight or have no appetite because of:
- Cancer – Even if you eat a lot, your cancer might keep your body from taking in all the nutrients it needs.
- Treatments – Treatments such as chemotherapy and radiation have side effects that can make it hard to eat. For example, these treatments can cause nausea, vomiting, mouth sores, tiredness, dry mouth, or changes in taste and smell.
- Pain – Having pain from either cancer or treatment (especially surgery) can cause you to lose your appetite.
- Mood – Feeling sad or worried can make people lose their appetite.
2. Why is it important to eat enough?
It’s important to eat enough to healthy and strong as possible, especially during your cancer treatment. You must consume enough fluids to stay energetic and feel good in general.
3. What can I do on my own to eat enough?
To eat properly you need to ensure that your body gets enough nutrients. Try to follow the below-mentioned pattern:
- Eat 5 to 6 small meals a day, instead of 3 large meals
- Eat healthy snacks in between meals whenever you feel hungry
- Add butter, oil, nuts, gravy, powdered milk, protein powder, or cream to your foods to give them extra calories and protein
- Drink fluids in between the meal
- Eat foods that smell good.
- Try to eat food with family or friends rather than having alone
- Ask someone to cook or shop for you
- Take a short walk about an hour before you eat to help you work up an appetite
- Ask your doctor if you should take vitamins or work out a diet plan with a nutrition expert
If you have side effects from your treatments that are keeping you from eating, these tips might help you:
- If you have a dry mouth, drink lots of fluids and avoid foods that are hard or dry (such as toast or crackers). You can eat moist foods, or suck on ice chips or sugar-free hard candy.
- If you have mouth sores, eat soft foods that you can chew and swallow easily. You can also cut up your food into small pieces or mash it in a blender. Try to avoid spicy or salty foods.
- If you have nausea, eat foods that are bland and dry, such as rice, curd and toast. Avoid foods that are spicy and greasy.
- If you have trouble having a bowel movement, try to drink more fluids. You can also eat foods with a lot of fibre, such as vegetables, fruits, beans, nuts, oatmeal, and some breads and cereals.
- If you have diarrhoea, try to drink a lot of fluids so your body doesn’t lose too much water. Try to avoid milk, greasy foods, and foods with a lot of fibre.
4. Are there medicines that can increase my appetite?
Yes. Doctors can prescribe different medicines to help increase a person’s appetite. Medicines that doctors commonly use include:
- Hormone medicines
- Steroids – Doctors usually recommend that people not take these medicines for more than a few weeks.
5. What are the other methods if the disease restricts intake of food (eg. oral cancer-causing difficult swallowing)?
People who can’t eat on their own but whose bodies can digest food might get “tube feedings.” People who get tube feedings get their food and nutrients through a tube that goes into the stomach or small intestine. This is also called Enteral feeding.
6. Weight Loss after completion of treatment? What to expect?
Usually, there is weight gain after completion of treatment but there might be certain malignancies eg Head and Neck malignancies where there might be weight loss, which continues even after treatment completion. It is primarily caused due to “dry Mouth or difficult swallowing. Artificial saliva, good mouth care and dental hygiene are a usual treatment given to the patients. Hence, it is advisable that such patients should drink enough fluids and eat puree based diets.
7. Is there Weight Gain during and after Cancer therapy?
Patients having Hormonal driven cancers –Breast and Prostate do experience weight gain during the course of therapy. The repeated use of steroids in chemotherapy is responsible for weight gain. Also, a check should be kept on hypothyroidism and diabetes, which is at times precipitated post radiotherapy as well as certain targeted therapies. Usually, the end of treatment brings pivotal changes, both mental and physical, for cancer survivors, including a recommended switch back to a diet rich in unsaturated fats to manage weight. Infact, cancer survivors should fill half their plates with fruits and vegetables and other half with grains and proteins.
8. How can regular exercise help me?
Regular exercise which is not strenuous especially during chemotherapy has the following benefits:
- Increases Appetite
- Allays Depression
- Decreases chances of constipation
The important thing is to keep Doing Exercise to a level which does not let fatigue set in and therefore these schedules should not be stringent.
Managing Diabetes during and after treatment
Diabetes mellitus (DM) increases the risk of cardiovascular events and the susceptibility to infections, both relevant for cancer patients. Healing may be impaired in patients with DM, resulting in higher rates of postoperative complications.
Despite higher risks of toxicities, a priori dose adjustments or specific anti-cancer treatment selection are not recommended on the basis of having concomitant diabetes, but close monitoring of side effects is necessary.
Diabetes and cancer are therefore both common diseases that have a great impact on health worldwide. Approximately 8–18% of people with cancer have diabetes as well, and both are diagnosed in the same individual more frequently than would be expected by chance. This increased frequency of concurrent cancer and diabetes has been described in epidemiological studies for many types of cancer such as liver, endometrial, colorectal and breast cancer, and it occurs predominantly in patients with type 2 diabetes.
Practical hints in cancer patients with diabetes
- Hypertension is a common problem. Target blood pressure for patients with DM is <130/80 mmHg
- Monitor dyslipidaemia, especially in patients receiving hormonal treatments
- Chemotherapy-related neuropathy may worsen the pre-existing neuropathy and therefore it is a consideration while choosing chemotherapy
- Risk of renal toxicity when receiving platinum-based therapies is higher for diabetic patients
- Local infections like paronychia, Folliculitis or gingivitis are commonly associated with some anti-cancer agents, and these infections may be more difficult to resolve in diabetic patients, leading to systemic infections
- Use lower doses of steroids throughout the day when possible, instead of a high-dose daily bolus
- Remember to adjust anti-diabetic treatment when starting steroids. Postprandial glycaemia should be monitored in addition to fasting value.