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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK66004_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK66004_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK66004_"><span class="title" itemprop="name">Nutrition in Cancer Care (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Supportive and Palliative Care Editorial Board</span>.</p><p class="small">Published online: September 6, 2023.</p><p class="small">Created: <span itemprop="datePublished">March 24, 2003</span>.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000286996__632">This PDQ cancer information summary has current information about nutrition before, during, and after cancer treatment. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000286996__633">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly, and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.</p></div><div id="CDR0000286996__125"><h2 id="_CDR0000286996__125_">Overview of Nutrition in Cancer Care</h2><div id="CDR0000286996__125.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000286996__532">Good nutrition is important for people with cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__575">Nutrition goals are set for each person with cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__703">A registered dietitian is an important part of the healthcare team.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__126">Cancer and cancer treatments may cause side effects that affect nutrition.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__706">Cancer and cancer treatments may cause malnutrition.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__129">Anorexia and cachexia are common causes of malnutrition in people with cancer.</a></div></li></ul></div><div id="CDR0000286996__532"><h3>Good nutrition is important for people with cancer.</h3><p id="CDR0000286996__534"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044698/" class="def">Nutrition</a> is a process in which food is taken in and used by the body for growth, to keep the body healthy, and to replace <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>. Good nutrition is important for good health. A healthy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044660/" class="def">diet</a> includes foods and liquids that have important <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044697/" class="def">nutrients</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044744/" class="def">vitamins</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045787/" class="def">minerals</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">proteins</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000285960/" class="def">carbohydrates</a>, fats, and water) the body needs.</p></div><div id="CDR0000286996__575"><h3>Nutrition goals are set for each person with cancer.</h3><p id="CDR0000286996__577">Nutrition goals during cancer therapy are based on a person’s cancer type, cancer stage, and other medical conditions. Eating the right amount of protein and calories is important for healing, fighting infection, and having enough energy.</p></div><div id="CDR0000286996__703"><h3>A registered dietitian is an important part of the healthcare team.</h3><p id="CDR0000286996__705">A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454994/" class="def">registered dietitian</a> (or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044662/" class="def">nutritionist</a>) is a part of the team of health professionals that help with cancer treatment and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>. A dietitian will work with you, your family, and the rest of the medical team to manage your diet during and after cancer treatment.</p></div><div id="CDR0000286996__126"><h3>Cancer and cancer treatments may cause side effects that affect nutrition.</h3><p id="CDR0000286996__809">Nutrition problems are likely when tumors involve the head, neck, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046408/" class="def">esophagus</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046335/" class="def">intestines</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046254/" class="def">pancreas</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>.</p><p id="CDR0000286996__348">For many people, the effects of cancer treatments make it hard to eat well. Cancer treatments that affect nutrition include:</p><ul id="CDR0000286996__579"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a>.
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045110/" class="def">Hormone therapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a>.
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a>.
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">Immunotherapy</a>.</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">Stem cell transplant</a>.
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</div></li></ul></div><div id="CDR0000286996__706"><h3>Cancer and cancer treatments may cause malnutrition.</h3><p id="CDR0000286996__708">Cancer and cancer treatments may affect taste, smell, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454699/" class="def">appetite</a>, and the ability to eat enough food or absorb the nutrients from food. This can cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046014/" class="def">malnutrition</a>, which is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> caused by a lack of key nutrients. </p><p id="CDR0000286996__751">Malnutrition can cause a person to be weak, tired, and unable to fight <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a> or finish cancer treatment. As a result, malnutrition can decrease the person's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a> and become life-threatening. Malnutrition may get worse if the cancer grows or spreads.</p></div><div id="CDR0000286996__129"><h3>Anorexia and cachexia are common causes of malnutrition in people with cancer.</h3><p id="CDR0000286996__131"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044103/" class="def">Anorexia</a> is the loss of appetite or desire to eat. It is a common <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptom</a> and the most common cause of malnutrition in people with cancer. Anorexia may occur early in the disease or later, if the cancer grows or spreads. Some people already have anorexia when they are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> with cancer. Most people who have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478743/" class="def">advanced cancer</a> will have anorexia. </p><p id="CDR0000286996__351"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044108/" class="def">Cachexia</a> is a condition marked by weakness, weight loss, and fat and muscle loss. It is common in people with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> that affect eating and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463707/" class="def">digestion</a>. It can occur in people with cancer who are eating well, but are not storing fat and muscle because of tumor growth.</p><p id="CDR0000286996__709">Some tumors change the way the body uses certain nutrients. The body's use of protein, carbohydrates, and fat may change when tumors are in the stomach, intestines, or head and neck. A person may seem to be eating enough, but the body may not be able to absorb all the nutrients from the food.</p><p id="CDR0000286996__536"> People with cancer may have anorexia and cachexia at the same time. </p></div></div><div id="CDR0000286996__151"><h2 id="_CDR0000286996__151_">Effects of Cancer Treatment on Nutrition</h2><div id="CDR0000286996__151.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000286996__243">Chemotherapy and Hormone Therapy </a></div><ul><li class="half_rhythm"><div><a href="#CDR0000286996__244">Chemotherapy and hormone therapy affect nutrition in different ways.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__247">Chemotherapy and hormone therapy cause different nutrition problems.</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000286996__253">Radiation Therapy</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000286996__254">Radiation therapy kills cells in the treatment area.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__257">Radiation therapy may affect nutrition.</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000286996__242"> Surgery</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000286996__152">Surgery increases the body's need for nutrients and energy.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__155">Surgery to the head, neck, esophagus, stomach, or intestines may affect nutrition.</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000286996__263">Immunotherapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__270">Stem Cell Transplant</a></div></li></ul></div><div id="CDR0000286996__243"><h3>Chemotherapy and Hormone Therapy </h3><div id="CDR0000286996__244"><h4>Chemotherapy and hormone therapy affect nutrition in different ways.</h4><p id="CDR0000286996__246"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> affects <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> all through the body. Chemotherapy uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> to stop the growth of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> cells, either by killing the cells or by stopping them from dividing. Healthy cells that normally grow and divide quickly may also be killed. These include cells in the mouth and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046447/" class="def">digestive tract</a>.</p><p id="CDR0000286996__710"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045110/" class="def">Hormone therapy</a> adds, blocks, or removes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045713/" class="def">hormones</a>. It may be used to slow or stop the growth of certain cancers. Some types of hormone therapy may cause weight gain.</p></div><div id="CDR0000286996__247"><h4>Chemotherapy and hormone therapy cause different nutrition problems.</h4><p id="CDR0000286996__249">Side effects from chemotherapy may cause problems with eating and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463707/" class="def">digestion</a>. When more than one chemotherapy drug is given, each drug may cause different side effects, or when drugs cause the same side effect, the side effect may be more severe.</p><p id="CDR0000286996__753">The following side effects are common:</p><ul id="CDR0000286996__358"><li class="half_rhythm"><div>Loss of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454699/" class="def">appetite</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390302/" class="def">Nausea</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390324/" class="def">Vomiting</a>.</div></li><li class="half_rhythm"><div>Dry mouth.</div></li><li class="half_rhythm"><div>Sores in the mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439429/" class="def">throat</a>.</div></li><li class="half_rhythm"><div>Changes in the way food tastes.</div></li><li class="half_rhythm"><div>Trouble swallowing.</div></li><li class="half_rhythm"><div>Feeling full after eating a small amount of food.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407757/" class="def">Constipation</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000306496/" class="def">Diarrhea</a>.</div></li></ul><p id="CDR0000286996__754"> People who receive hormone therapy may need changes in their <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044660/" class="def">diet</a> to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439419/" class="def">prevent</a> weight gain.</p></div></div><div id="CDR0000286996__253"><h3>Radiation Therapy</h3><div id="CDR0000286996__254"><h4>Radiation therapy kills cells in the treatment area.</h4><p id="CDR0000286996__256"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> kills cancer cells and healthy cells in the treatment area. How severe the side effects are depends on the following:</p><ul id="CDR0000286996__516"><li class="half_rhythm"><div>The part of the body that is treated.</div></li><li class="half_rhythm"><div>The total <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> and how it is given.</div></li></ul></div><div id="CDR0000286996__257"><h4>Radiation therapy may affect nutrition.</h4><p id="CDR0000286996__259">Radiation therapy to any part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046446/" class="def">digestive system</a> has side effects that cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044698/" class="def">nutrition</a> problems. Most of the side effects begin two to three weeks after radiation therapy begins and go away a few weeks after it is finished. Some side effects can continue for months or years after treatment ends.</p><p id="CDR0000286996__593">The following are some of the more common side effects:</p><ul id="CDR0000286996__361"><li class="half_rhythm"><div>For radiation therapy to the brain or head and neck
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<dl id="CDR0000286996__518" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Loss of appetite.</p></dd><dt>-</dt><dd><p class="no_top_margin">Nausea.</p></dd><dt>-</dt><dd><p class="no_top_margin">Vomiting.</p></dd><dt>-</dt><dd><p class="no_top_margin">Dry mouth or thick <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257526/" class="def">saliva</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463717/" class="def">Medication</a> may be given to treat a dry mouth.</p></dd><dt>-</dt><dd><p class="no_top_margin">Sore mouth and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000481753/" class="def">gums</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Changes in the way food tastes.</p></dd><dt>-</dt><dd><p class="no_top_margin">Trouble swallowing.</p></dd><dt>-</dt><dd><p class="no_top_margin">Pain when swallowing.</p></dd><dt>-</dt><dd><p class="no_top_margin">Being unable to fully open the mouth.</p></dd></dl></div></li><li class="half_rhythm"><div>For radiation therapy to the chest<dl id="CDR0000286996__519" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Loss of appetite.</p></dd><dt>-</dt><dd><p class="no_top_margin">Nausea.</p></dd><dt>-</dt><dd><p class="no_top_margin">Vomiting.</p></dd><dt>-</dt><dd><p class="no_top_margin">Trouble swallowing.</p></dd><dt>-</dt><dd><p class="no_top_margin">Pain when swallowing.</p></dd><dt>-</dt><dd><p class="no_top_margin">Choking or breathing problems caused by changes in the upper <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046408/" class="def">esophagus</a>.</p></dd></dl>
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</div></li><li class="half_rhythm"><div>For radiation therapy to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a><dl id="CDR0000286996__520" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Nausea.</p></dd><dt>-</dt><dd><p class="no_top_margin">Vomiting.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000779580/" class="def">Bowel obstruction</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044318/" class="def">Colitis</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Diarrhea.</p></dd></dl>
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</div></li></ul><p id="CDR0000286996__517">Radiation therapy may also cause tiredness, which can lead to a decrease in appetite.
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</p></div></div><div id="CDR0000286996__242"><h3> Surgery</h3><div id="CDR0000286996__152"><h4>Surgery increases the body's need for nutrients and energy.</h4><p id="CDR0000286996__154">The body needs extra energy and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044697/" class="def">nutrients</a> to heal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000441269/" class="def">wounds</a>, fight <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recover</a> from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>. If someone is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000659993/" class="def">malnourished</a> before surgery, they may have trouble healing. For these people, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463725/" class="def">nutrition care</a> may begin before surgery.</p></div><div id="CDR0000286996__155"><h4>Surgery to the head, neck, esophagus, stomach, or intestines may affect nutrition.</h4><p id="CDR0000286996__157">Most people with cancer are treated with surgery. Surgery that removes all or part of certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> can affect a person's ability to eat and digest food.</p><p id="CDR0000286996__755">The following are nutrition problems caused by surgery:</p><ul id="CDR0000286996__354"><li class="half_rhythm"><div>Loss of appetite.</div></li><li class="half_rhythm"><div>Trouble chewing.</div></li><li class="half_rhythm"><div>Trouble swallowing.</div></li><li class="half_rhythm"><div>Feeling full after eating a small amount of food.</div></li></ul></div></div><div id="CDR0000286996__263"><h3>Immunotherapy</h3><div id="CDR0000286996__264"><h4>Immunotherapy may affect nutrition.</h4><p id="CDR0000286996__363">The side effects of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapy</a> are different for each person and the type of immunotherapy drug given. </p><p id="CDR0000286996__756">The following nutrition problems are common:</p><ul id="CDR0000286996__364"><li class="half_rhythm"><div>Fatigue. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">Fever</a>.</div></li><li class="half_rhythm"><div>Nausea.
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</div></li><li class="half_rhythm"><div>Vomiting.
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</div></li><li class="half_rhythm"><div>Diarrhea.
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</div></li></ul></div></div><div id="CDR0000286996__270"><h3>Stem Cell Transplant</h3><div id="CDR0000286996__271"><h4>People who receive a stem cell transplant have special nutrition needs.</h4><p id="CDR0000286996__365">Chemotherapy, radiation therapy, and other medicines used before or during a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a> may cause side effects that keep a person from eating and digesting food as usual.</p><p id="CDR0000286996__757">Common side effects include the following:</p><ul id="CDR0000286996__366"><li class="half_rhythm"><div>Mouth and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439429/" class="def">throat</a> sores.
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</div></li><li class="half_rhythm"><div>Diarrhea.
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</div></li></ul><p id="CDR0000286996__711">People who receive a stem cell transplant have a high risk of infection. Chemotherapy or radiation therapy given before the transplant decrease the number of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cells</a>, which fight infection. It is important that these people learn about safe food handling and avoid foods that may cause infection.</p><p id="CDR0000286996__758">After a stem cell transplant, people are at risk for acute or chronic <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045703/" class="def">graft-versus-host disease</a> (GVHD). GVHD may affect the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046189/" class="def">gastrointestinal tract</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> and change the person's ability to eat or absorb nutrients from food.</p></div></div></div><div id="CDR0000286996__164"><h2 id="_CDR0000286996__164_">Nutrition Assessment in Cancer Care</h2><div id="CDR0000286996__164.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000286996__278">The healthcare team may ask questions about diet and weight history.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__281">Counseling and diet changes are made to improve the person's nutrition.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__742">The goal of nutrition therapy for people who have advanced cancer depends on the overall plan of care.</a></div></li></ul></div><div id="CDR0000286996__278"><h3>The healthcare team may ask questions about diet and weight history.</h3><p id="CDR0000286996__369"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046171/" class="def">Screening</a> is used to look for health problems that affect the risk of poor <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044698/" class="def">nutrition</a>. This can help find out if you are likely to become <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000659993/" class="def">malnourished</a>, and if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463725/" class="def">nutrition therapy</a> is needed.</p><p id="CDR0000286996__585">The healthcare team may ask questions about the following: </p><ul id="CDR0000286996__370"><li class="half_rhythm"><div>Weight changes over the past year.</div></li><li class="half_rhythm"><div>Changes in the amount and type of food you've eaten.</div></li><li class="half_rhythm"><div>Problems with eating, such as loss of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454699/" class="def">appetite</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390302/" class="def">nausea</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390324/" class="def">vomiting</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000306496/" class="def">diarrhea</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407757/" class="def">constipation</a>, mouth sores, dry mouth, changes in taste and smell, or pain.
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</div></li><li class="half_rhythm"><div>Ability to walk and do other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430401/" class="def">activities of daily living</a> (dressing, getting into or out of a bed or chair, taking a bath or shower, and using the toilet).</div></li></ul><p id="CDR0000286996__523"> A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">physical exam</a> is done. Your doctor will check for signs of weight, fat, and muscle loss, and for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> buildup in your body.</p></div><div id="CDR0000286996__281"><h3>Counseling and diet changes are made to improve the person's nutrition.</h3><p id="CDR0000286996__697">A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454994/" class="def">registered dietitian</a> can counsel you and your family on ways to improve your nutrition. The registered dietitian gives care based on your nutritional and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044660/" class="def">dietary</a> needs during cancer treatment and recovery. Changes to the diet are made to help decrease <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> or cancer treatment. These changes may be in the types and amount of food, how often you eat, and how food is eaten (for example, at a certain temperature or taken with a straw).</p><p id="CDR0000286996__712">In addition to the dietitian, the healthcare team may include the following:</p><ul id="CDR0000286996__373"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390246/" class="def">Physician</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269445/" class="def">Nurse</a>.
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044730/" class="def">Social worker</a>.
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044716/" class="def">Psychologist</a>.
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</div></li></ul></div><div id="CDR0000286996__742"><h3>The goal of nutrition therapy for people who have advanced cancer depends on the overall plan of care.</h3><p id="CDR0000286996__744">The goal of nutrition therapy in people with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478743/" class="def">advanced cancer</a> is to provide the best possible <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a> and control symptoms that cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454701/" class="def">distress</a>.</p><p id="CDR0000286996__745">People with advanced cancer may be treated with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000639945/" class="def">anticancer therapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269448/" class="def">palliative care</a>, palliative care alone, or may be in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044182/" class="def">hospice</a> care. Nutrition goals will be different for each person. Some types of treatment may be stopped.</p><p id="CDR0000286996__746">As the focus of care goes from cancer treatment to hospice or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000774823/" class="def">end-of-life care</a>, nutrition therapy may become less <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046053/" class="def">aggressive</a> to keep the person as comfortable as possible.
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For more information, see the <a href="#CDR0000286996__190">Nutrition Needs at End of Life</a> section.
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</p></div></div><div id="CDR0000286996__177"><h2 id="_CDR0000286996__177_">Treatment of Symptoms</h2><div id="CDR0000286996__177.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000286996__178">Anorexia</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__767">Nausea</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__771">Vomiting</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__775">Dry Mouth</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__779">Mouth Sores</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__784">Taste Changes</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__788">Sore Throat and Trouble Swallowing</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__793">Lactose Intolerance</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__658">Weight Gain</a></div></li></ul></div><p id="CDR0000286996__416">When <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> or cancer treatment affect normal eating, changes can be made to help you get the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044697/" class="def">nutrients</a> you need. Eating foods that are high in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044651/" class="def">calories</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044744/" class="def">vitamins</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045787/" class="def">minerals</a> is important. Meals should be planned to meet your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044698/" class="def">nutritional</a> needs and tastes in food.</p><p id="CDR0000286996__698">The following are common <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> caused by cancer and cancer treatment and ways to treat or control them.</p><div id="CDR0000286996__178"><h3>Anorexia</h3><p id="CDR0000286996__180">The following may help people with cancer who have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044103/" class="def">anorexia</a> (loss of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454699/" class="def">appetite</a> or desire to eat):</p><ul id="CDR0000286996__417"><li class="half_rhythm"><div>Eat foods that are high in protein and calories. The following are high-protein food choices:<ul id="CDR0000286996__699"><li class="half_rhythm"><div>Beans.</div></li><li class="half_rhythm"><div>Chicken.</div></li><li class="half_rhythm"><div>Fish.</div></li><li class="half_rhythm"><div>Meat.</div></li><li class="half_rhythm"><div>Yogurt.</div></li><li class="half_rhythm"><div>Eggs.</div></li></ul></div></li><li class="half_rhythm"><div>Add extra protein and calories to food, such as using protein-fortified milk.
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</div></li><li class="half_rhythm"><div>Eat high-protein foods first in your meal when your appetite is strongest. </div></li><li class="half_rhythm"><div>Sip only small amounts of liquids during meals.</div></li><li class="half_rhythm"><div>Drink milkshakes, smoothies, juices, or soups if you do not feel like eating solid foods.</div></li><li class="half_rhythm"><div>Eat foods that smell good.</div></li><li class="half_rhythm"><div>Try new foods and new recipes.</div></li><li class="half_rhythm"><div>Try blenderized drinks that are high in nutrients (check with your doctor or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454994/" class="def">registered dietitian</a> first).</div></li><li class="half_rhythm"><div>Eat small meals and healthy snacks often throughout the day.</div></li><li class="half_rhythm"><div>Eat larger meals when you feel well and are rested.</div></li><li class="half_rhythm"><div>Eat your largest meal when you feel hungriest, whether at breakfast, lunch, or dinner.</div></li><li class="half_rhythm"><div>Make and store small amounts of favorite foods so they are ready to eat when you are hungry.</div></li><li class="half_rhythm"><div>Be as active as possible so that you will have a good appetite.</div></li><li class="half_rhythm"><div>Brush your teeth and rinse your mouth to relieve symptoms and aftertastes.</div></li><li class="half_rhythm"><div>Talk to your doctor or registered dietitian if you have eating problems such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390302/" class="def">nausea</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390324/" class="def">vomiting</a>, or changes in how foods taste and smell.</div></li></ul><p id="CDR0000286996__766">If these <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044660/" class="def">diet</a> changes do not help with the anorexia, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390298/" class="def">tube feedings</a> may be needed.</p><p id="CDR0000286996__806"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482419/" class="def">Medicines</a> may be given to increase appetite. For more information, see the <a href="#CDR0000286996__799">Medicines to Treat Loss of Appetite and Weight Loss</a> section.</p></div><div id="CDR0000286996__767"><h3>Nausea</h3><p id="CDR0000286996__769">The following may help people with cancer control nausea:
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</p><ul id="CDR0000286996__770"><li class="half_rhythm"><div>Choose foods that appeal to you. Do not force yourself to eat food that makes you feel sick. Do not eat your favorite foods, to avoid linking them to being sick.</div></li><li class="half_rhythm"><div>Eat foods that are bland, soft, and easy-to-<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463707/" class="def">digest</a>, rather than heavy meals.</div></li><li class="half_rhythm"><div>Eat dry foods such as crackers, bread sticks, or toast throughout the day.
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</div></li><li class="half_rhythm"><div>Eat foods that are easy on your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a>, such as white toast, plain yogurt, and clear broth.</div></li><li class="half_rhythm"><div>Eat dry toast or crackers before getting out of bed if you have nausea in the morning.</div></li><li class="half_rhythm"><div>Eat foods and drink liquids at room temperature (not too hot or too cold).</div></li><li class="half_rhythm"><div>Slowly sip liquids throughout the day.</div></li><li class="half_rhythm"><div>Suck on hard candies such as peppermints or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000537557/" class="def">lemon</a> drops if your mouth has a bad taste.</div></li><li class="half_rhythm"><div>Stay away from foods and drinks with strong smells.</div></li><li class="half_rhythm"><div>Eat 5 or 6 small meals every day instead of 3 large meals.</div></li><li class="half_rhythm"><div>Sip on only small amounts of liquid during meals to avoid feeling full or bloated.</div></li><li class="half_rhythm"><div>Do not skip meals and snacks. An empty stomach may make your nausea worse.</div></li><li class="half_rhythm"><div>Rinse your mouth before and after eating.
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</div></li><li class="half_rhythm"><div>Don't eat in a room that has cooking odors or that is very warm. Keep the living space at a comfortable temperature and well-ventilated.</div></li><li class="half_rhythm"><div>Sit up or lie with your head raised for one hour after eating.
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</div></li><li class="half_rhythm"><div>Plan the best times for you to eat and drink.</div></li><li class="half_rhythm"><div>Relax before each cancer treatment.</div></li><li class="half_rhythm"><div>Wear clothes that are loose and comfortable.</div></li><li class="half_rhythm"><div>Keep a record of when you feel nausea and why.</div></li><li class="half_rhythm"><div>Talk with your doctor about using antinausea medicine.</div></li></ul></div><div id="CDR0000286996__771"><h3>Vomiting</h3><p id="CDR0000286996__773">The following may help people with cancer control vomiting:</p><ul id="CDR0000286996__774"><li class="half_rhythm"><div>Do not eat or drink anything until the vomiting stops.</div></li><li class="half_rhythm"><div>Drink small amounts of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000791444/" class="def">clear liquids</a> after vomiting stops.</div></li><li class="half_rhythm"><div>After you are able to drink clear liquids without vomiting, drink liquids such as strained soups, or milkshakes, that are easy on your stomach.</div></li><li class="half_rhythm"><div>Eat 5 or 6 small meals every day instead of 3 large meals.</div></li><li class="half_rhythm"><div>Sit upright and bend forward after vomiting.</div></li><li class="half_rhythm"><div>Ask your doctor to order medicine to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439419/" class="def">prevent</a> or control vomiting.</div></li></ul></div><div id="CDR0000286996__775"><h3>Dry Mouth</h3><p id="CDR0000286996__777">The following may help people with cancer who have dry mouth:</p><ul id="CDR0000286996__778"><li class="half_rhythm"><div>Eat foods that are easy to swallow.</div></li><li class="half_rhythm"><div>Moisten food with sauce, gravy, or salad dressing.
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</div></li><li class="half_rhythm"><div>Eat foods and drinks that are very sweet or tart, such as lemonade, to help make more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257526/" class="def">saliva</a>.</div></li><li class="half_rhythm"><div>Chew gum or suck on hard candy, ice pops, or ice chips.
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</div></li><li class="half_rhythm"><div>Sip water throughout the day.</div></li><li class="half_rhythm"><div>Do not drink any type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463134/" class="def">alcohol</a>, beer, or wine.</div></li><li class="half_rhythm"><div>Do not eat foods that can hurt your mouth (such as spicy, sour, salty, hard, or crunchy foods).</div></li><li class="half_rhythm"><div>Keep your lips moist with lip balm.</div></li><li class="half_rhythm"><div>Rinse your mouth every 1 to 2 hours. Do not use mouthwash that contains alcohol.</div></li><li class="half_rhythm"><div>Do not use <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439432/" class="def">tobacco</a> products and avoid <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538647/" class="def">second hand smoke</a>.</div></li><li class="half_rhythm"><div>Ask your doctor or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000389460/" class="def">dentist</a> about using artificial saliva or similar products to coat, protect, and moisten your mouth and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439429/" class="def">throat</a>.</div></li></ul></div><div id="CDR0000286996__779"><h3>Mouth Sores</h3><p id="CDR0000286996__781">The following can help people with cancer who have mouth sores:</p><ul id="CDR0000286996__782"><li class="half_rhythm"><div>Eat soft foods that are easy to chew, such as milkshakes, scrambled eggs, and custards.</div></li><li class="half_rhythm"><div>Cook foods until soft and tender.
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</div></li><li class="half_rhythm"><div>Cut food into small pieces. Use a blender or food processor to make food smooth.</div></li><li class="half_rhythm"><div>
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Suck on ice chips to numb and soothe your mouth. </div></li><li class="half_rhythm"><div>Eat foods cold or at room temperature. Hot foods can hurt your mouth.
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</div></li><li class="half_rhythm"><div>Drink with a straw to move liquid past the painful parts of your mouth.</div></li><li class="half_rhythm"><div>Use a small spoon to help you take smaller bites, which are easier to chew.</div></li><li class="half_rhythm"><div>Stay away from the following:<ul id="CDR0000286996__783"><li class="half_rhythm"><div>Citrus foods, such as oranges, lemons, and limes.</div></li><li class="half_rhythm"><div>Spicy foods.</div></li><li class="half_rhythm"><div>Tomatoes and ketchup.</div></li><li class="half_rhythm"><div>Salty foods.</div></li><li class="half_rhythm"><div>Raw vegetables.</div></li><li class="half_rhythm"><div>Sharp and crunchy foods.
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</div></li><li class="half_rhythm"><div>Drinks with alcohol.</div></li></ul></div></li><li class="half_rhythm"><div>Do not use tobacco products.</div></li><li class="half_rhythm"><div>Visit a dentist at least 2 weeks before starting <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapy</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the head and neck. </div></li><li class="half_rhythm"><div>Check your mouth each day for sores, white patches, or puffy and red areas.</div></li><li class="half_rhythm"><div>Rinse your mouth 3 to 4 times a day. Mix ¼ teaspoon baking soda, ⅛ teaspoon salt, and 1 cup warm water for a mouth rinse. Do not use mouthwash that contains alcohol.</div></li><li class="half_rhythm"><div>Do not use toothpicks or other sharp objects.</div></li></ul></div><div id="CDR0000286996__784"><h3>Taste Changes</h3><p id="CDR0000286996__786">The following may help people with cancer who have taste changes:</p><ul id="CDR0000286996__787"><li class="half_rhythm"><div>Eat poultry, fish, eggs, and cheese instead of red meat.
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</div></li><li class="half_rhythm"><div>Add spices and sauces to foods (marinate foods).</div></li><li class="half_rhythm"><div>Eat meat with something sweet, such as cranberry sauce, jelly, or applesauce. </div></li><li class="half_rhythm"><div>Try tart foods and drinks.</div></li><li class="half_rhythm"><div>Use sugar-free lemon drops, gum, or mints if there is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463718/" class="def">metallic</a> or bitter taste in your mouth.
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</div></li><li class="half_rhythm"><div>Use plastic utensils and do not drink directly from metal containers if foods have a metal taste.</div></li><li class="half_rhythm"><div>Try to eat your favorite foods, if you are not nauseated. Try new foods when feeling your best.
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</div></li><li class="half_rhythm"><div>Find nonmeat, high-protein recipes in a vegetarian or Chinese cookbook.
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</div></li><li class="half_rhythm"><div>Chew food longer to allow more contact with taste buds, if food tastes dull but not unpleasant.</div></li><li class="half_rhythm"><div>Keep foods and drinks covered, drink through a straw, turn a kitchen fan on when cooking, or cook outdoors if smells bother you.</div></li><li class="half_rhythm"><div>Brush your teeth and take care of your mouth. Visit your dentist for checkups.</div></li></ul></div><div id="CDR0000286996__788"><h3>Sore Throat and Trouble Swallowing</h3><p id="CDR0000286996__790">The following may help people with cancer who have a sore throat or trouble swallowing:</p><ul id="CDR0000286996__791"><li class="half_rhythm"><div>Eat soft foods that are easy to chew and swallow, such as milkshakes, scrambled eggs, oatmeal, or other cooked cereals.</div></li><li class="half_rhythm"><div>Eat foods and drinks that are high in protein and calories.</div></li><li class="half_rhythm"><div>Moisten food with gravy, sauces, broth, or yogurt.</div></li><li class="half_rhythm"><div>Stay away from the following foods and drinks that can burn or scratch your throat:<ul id="CDR0000286996__792"><li class="half_rhythm"><div>Hot foods and drinks.</div></li><li class="half_rhythm"><div>Spicy foods.</div></li><li class="half_rhythm"><div>Foods and juices that are high in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642987/" class="def">acid</a>.</div></li><li class="half_rhythm"><div>Sharp or crunchy foods.</div></li><li class="half_rhythm"><div>Drinks with alcohol.</div></li></ul></div></li><li class="half_rhythm"><div>Cook foods until soft and tender.
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</div></li><li class="half_rhythm"><div>Cut food into small pieces. Use a blender or food processor to make food smooth.
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</div></li><li class="half_rhythm"><div>Drink with a straw.
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</div></li><li class="half_rhythm"><div>Eat 5 or 6 small meals every day instead of 3 large meals.</div></li><li class="half_rhythm"><div>Sit upright and bend your head slightly forward when you eat or drink, and stay upright for at least 30 minutes after eating.
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</div></li><li class="half_rhythm"><div>Do not use tobacco.</div></li><li class="half_rhythm"><div>Talk to your doctor about tube feedings if you cannot eat enough to stay strong.</div></li></ul></div><div id="CDR0000286996__793"><h3>Lactose Intolerance</h3><p id="CDR0000286996__795">The following may help people with cancer who have symptoms of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045745/" class="def">lactose intolerance</a>:</p><ul id="CDR0000286996__796"><li class="half_rhythm"><div>Use <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044686/" class="def">lactose</a>-free or low-lactose milk products. Most grocery stores carry food (such as milk and ice cream) labeled “lactose free” or “low lactose.”</div></li><li class="half_rhythm"><div>Choose milk products that are low in lactose, like hard cheeses (such as cheddar) and yogurt.</div></li><li class="half_rhythm"><div>Try products made with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407766/" class="def">soy</a> or rice (such as soy and rice milk and frozen desserts). These products do not contain lactose.</div></li><li class="half_rhythm"><div>Avoid only the dairy products that give you problems. Eat small portions of dairy products, such as milk, yogurt, or cheese, if you can.</div></li><li class="half_rhythm"><div>Try nondairy drinks and foods with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045632/" class="def">calcium</a> added.</div></li><li class="half_rhythm"><div>Eat calcium-rich vegetables, such as broccoli and greens.</div></li><li class="half_rhythm"><div>Take <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476616/" class="def">lactase</a> tablets when eating or drinking dairy products. Lactase breaks down lactose, so it is easier to digest.</div></li><li class="half_rhythm"><div>Prepare your own low-lactose or lactose-free foods. </div></li></ul></div><div id="CDR0000286996__658"><h3>Weight Gain</h3><p id="CDR0000286996__660">The following may help people with cancer prevent weight gain:</p><ul id="CDR0000286996__661"><li class="half_rhythm"><div>Eat a lot of fruits and vegetables.</div></li><li class="half_rhythm"><div>Eat foods that are high in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046401/" class="def">fiber</a>, such as whole-grain breads, cereals, and pasta.</div></li><li class="half_rhythm"><div>Choose lean meats, such as lean beef, pork trimmed of fat, and poultry (such as chicken or turkey) without skin.</div></li><li class="half_rhythm"><div>Choose low-fat milk products.</div></li><li class="half_rhythm"><div>Eat less fat (eat only small amounts of butter, mayonnaise, desserts, and fried foods).</div></li><li class="half_rhythm"><div>Cook with low-fat methods, such as broiling, steaming, grilling, or roasting.</div></li><li class="half_rhythm"><div>Eat less salt.</div></li><li class="half_rhythm"><div>Eat foods that you enjoy so you feel satisfied.</div></li><li class="half_rhythm"><div>Eat only when hungry. Consider <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450098/" class="def">counseling</a> or medicine if you eat because of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450122/" class="def">stress</a>, fear, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430479/" class="def">depression</a>. If you eat because you are bored, find activities you enjoy.</div></li><li class="half_rhythm"><div>Eat smaller amounts of food at meals.</div></li><li class="half_rhythm"><div>Exercise daily.</div></li><li class="half_rhythm"><div>Talk with your doctor before going on a diet to lose weight.</div></li></ul></div></div><div id="CDR0000286996__312"><h2 id="_CDR0000286996__312_">Types of Nutrition Support</h2><div id="CDR0000286996__312.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000286996__563">Nutrition support helps people who cannot eat or digest food normally.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__587">Nutrition support can be given in different ways.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__320">Enteral Nutrition</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__323">Parenteral Nutrition</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000286996__394">Parenteral nutrition carries nutrients directly into the blood stream.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__398">The catheter may be placed into a vein in the chest or in the arm.</a></div></li></ul></li></ul></div><div id="CDR0000286996__563"><h3>Nutrition support helps people who cannot eat or digest food normally.</h3><p id="CDR0000286996__316">It is best to take in food by mouth whenever possible. Some people may not be able to take in enough food by mouth because of problems from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> or cancer treatment. </p></div><div id="CDR0000286996__587"><h3>Nutrition support can be given in different ways.</h3><p id="CDR0000286996__760">In addition to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450098/" class="def">counseling</a> by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044661/" class="def">dietitian</a> and changes to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044660/" class="def">diet</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463725/" class="def">nutrition therapy</a> includes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463726/" class="def">nutritional supplement</a> drinks and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390275/" class="def">enteral</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390306/" class="def">parenteral nutrition</a> support. Nutritional supplement drinks help people with cancer get the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044697/" class="def">nutrients</a> they need. They provide energy, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a>, fat, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000285960/" class="def">carbohydrates</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046401/" class="def">fiber</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044744/" class="def">vitamins</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045787/" class="def">minerals</a>. They are not meant to be the person's only source of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044698/" class="def">nutrition</a>.</p><p id="CDR0000286996__589">A person who is not able to take in the right amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044651/" class="def">calories</a> and nutrients by mouth may be fed using the following: </p><ul id="CDR0000286996__761"><li class="half_rhythm"><div>Enteral nutrition: Nutrients are given through a tube inserted into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046335/" class="def">intestines</a>.</div></li><li class="half_rhythm"><div>Parenteral nutrition: Nutrients are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">infused</a> into the bloodstream. </div></li></ul><p id="CDR0000286996__590">Nutrition support can improve a person's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a> during cancer treatment, but may cause problems that should be considered before making the decision to use it. The patient, family, and healthcare team should discuss the harms and benefits of each type of nutrition support. For more information on the use of nutrition support at the end of life, see the <a href="#CDR0000286996__190">Nutrition Needs at End of Life</a> section.</p></div><div id="CDR0000286996__320"><h3>Enteral Nutrition</h3><div id="CDR0000286996__380"><h4>Enteral nutrition is also called tube feeding. </h4><p id="CDR0000286996__382">Enteral nutrition gives the patient nutrients in liquid form (formula) through a tube that is placed into the stomach or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046582/" class="def">small intestine</a>. The following types of feeding tubes may be used:
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</p><ul id="CDR0000286996__383"><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000644739/" class="def">nasogastric tube</a> is inserted through the nose and down the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439429/" class="def">throat</a> into the stomach or small intestine. This is used when enteral nutrition is only needed for a few weeks.
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</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476330/" class="def">gastrostomy tube</a> is inserted into the stomach, or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000686896/" class="def">jejunostomy</a> tube is inserted into the small intestine through an opening made on the outside of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>. This is usually used for long-term enteral feeding or for people who cannot use a tube in the nose and throat.
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</div></li></ul><p id="CDR0000286996__384">The type of formula used is based on the person's specific needs. There are formulas for people who have special health <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044911/" class="def">diabetes</a>, or other needs, such as religious or cultural diets.</p></div></div><div id="CDR0000286996__323"><h3>Parenteral Nutrition</h3><div id="CDR0000286996__394"><h4>Parenteral nutrition carries nutrients directly into the blood stream.
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</h4><p id="CDR0000286996__396">Parenteral nutrition is used when a person cannot take food by mouth or by enteral feeding. Parenteral feeding does not use the stomach or intestines to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463707/" class="def">digest</a> food. Nutrients are given to the patient directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>, through a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheter</a> inserted into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a>. These nutrients include proteins, fats, vitamins, and minerals. </p></div><div id="CDR0000286996__398"><h4>The catheter may be placed into a vein in the chest or in the arm.</h4><p id="CDR0000286996__400">A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045962/" class="def">central venous access catheter</a> is placed beneath the skin and into a large vein in the upper chest. The catheter is put in place by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044306/" class="def">surgeon</a>. This type of catheter is used for long-term parenteral feeding.<div id="CDR0000286996__797" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Central%20venous%20catheter&p=BOOKS&id=595011_CDR0000756806.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK66004.13/bin/CDR0000756806.jpg" alt="Central venous catheter; drawing of a central venous catheter that goes from a vein below the right collarbone to a large vein above the right side of the heart called the superior vena cava. An inset shows a central venous catheter in the right side of the chest with a clear plastic dressing over it." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Central venous catheter. A central venous catheter is a thin, flexible tube that is inserted into a vein, usually below the right collarbone, and guided (threaded) into a large vein above the right side of the heart called the superior vena cava. It is used to give intravenous fluids, blood transfusions, chemotherapy, and other drugs. The catheter is also used for taking blood samples. It may stay in place for weeks or months and helps avoid the need for repeated needle sticks.</p></div></div></p><p id="CDR0000286996__401">A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463728/" class="def">peripheral venous catheter</a> is placed into a vein in the arm. A peripheral venous catheter is put in place by trained medical staff. This type of catheter is usually used for short-term parenteral feeding for patients who do not have a central venous access catheter.<div id="CDR0000286996__798" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Peripheral%20venous%20catheter&p=BOOKS&id=595011_CDR0000771773.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK66004.13/bin/CDR0000771773.jpg" alt="Peripheral venous catheter; drawing of a peripheral venous catheter in a vein in the lower part of the arm with the catheter tubing clamped and capped off at the end." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Peripheral venous catheter. A peripheral venous catheter is a thin, flexible tube that is inserted into a vein. It is usually inserted into the lower part of the arm or the back of the hand. It is used to give intravenous fluids, blood transfusions, chemotherapy, and other drugs.</p></div></div></p><p id="CDR0000286996__402">The patient is checked often for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a> or bleeding at the place where the catheter enters the body.
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</p></div></div></div><div id="CDR0000286996__799"><h2 id="_CDR0000286996__799_">Medicines to Treat Loss of Appetite and Weight Loss</h2><div id="CDR0000286996__799.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000286996__800">Medicine may be given with nutrition therapy to treat loss of appetite and weight loss.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__803">Different types of medicine may be used to treat loss of appetite and weight loss.</a></div></li></ul></div><div id="CDR0000286996__800"><h3>Medicine may be given with nutrition therapy to treat loss of appetite and weight loss.</h3><p id="CDR0000286996__802">It is important that <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> that affect eating and cause weight loss are treated early. Both <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463725/" class="def">nutrition therapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482419/" class="def">medicine</a> can help lessen the effects that cancer and its treatment have on weight loss. </p></div><div id="CDR0000286996__803"><h3>Different types of medicine may be used to treat loss of appetite and weight loss.</h3><p id="CDR0000286996__805">Medicines that improve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454699/" class="def">appetite</a> and cause weight gain, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045492/" class="def">prednisone</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046617/" class="def">megestrol</a>, may be used to treat loss of appetite and weight loss. Studies have shown that the effects of these medicines may not last long, or there may be no effects. Treatment with a combination of medicines may work better than treatment with one medicine but may have more side effects.</p></div></div><div id="CDR0000286996__190"><h2 id="_CDR0000286996__190_">Nutrition Needs at End of Life </h2><div id="CDR0000286996__190.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000286996__455">Nutrition needs change at end of life.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__552">People with cancer and their families decide how much nutrition and fluids will be given at the end of life.</a></div></li></ul></div><div id="CDR0000286996__455"><h3>Nutrition needs change at end of life.</h3><p id="CDR0000286996__528">For people at the end of life, the goals of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463725/" class="def">nutrition therapy</a> are focused on relieving <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> rather than getting enough <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044697/" class="def">nutrients</a>. </p><p id="CDR0000286996__763">Common symptoms that can occur at the end of life include the following:</p><ul id="CDR0000286996__764"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044103/" class="def">Anorexia</a> (loss of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454699/" class="def">appetite</a>).</div></li><li class="half_rhythm"><div>Dry mouth.</div></li><li class="half_rhythm"><div>Swallowing problems.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390302/" class="def">Nausea</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390324/" class="def">Vomiting</a>.</div></li></ul><p id="CDR0000286996__765">People who have problems swallowing may find it easier to swallow thick liquids than thin liquids.</p><p id="CDR0000286996__457">People with cancer often do not feel much hunger at all and may want very little food. Sips of water, ice chips, and mouth care can decrease thirst in the last few days of life. Good communication with the healthcare team is important to understand the patient's changes in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044698/" class="def">nutrition</a> needs.</p></div><div id="CDR0000286996__552"><h3>People with cancer and their families decide how much nutrition and fluids will be given at the end of life.</h3><p id="CDR0000286996__554">People with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> and their <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000648947/" class="def">caregivers</a> have the right to make informed decisions. The person's religious and cultural preferences may affect their decisions. The healthcare team may work with the person's religious and cultural leaders when making decisions. The healthcare team and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454994/" class="def">registered dietitian</a> can explain the benefits and risks of using nutrition support for people at the end of life. In most cases, there are more harms than benefits if the person is not expected to live longer than a month.</p><p id="CDR0000286996__810">Possible benefits of nutrition support for people expected to live longer than a month include the following:</p><ul id="CDR0000286996__811"><li class="half_rhythm"><div> Improved <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</div></li><li class="half_rhythm"><div>Less risk of death due to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046014/" class="def">malnutrition</a>.</div></li><li class="half_rhythm"><div>Fewer physical, mental, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454766/" class="def">psychological</a> problems.</div></li></ul><p id="CDR0000286996__747">The risks of nutrition support at the end of life include the following:</p><ul id="CDR0000286996__748"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044348/" class="def">Sepsis</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044123/" class="def">bacteria</a> or their <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046622/" class="def">toxins</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a>) with the use of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390306/" class="def">parenteral nutrition</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046519/" class="def">Aspiration</a> (the accidental breathing in of food or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>) with the use of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390275/" class="def">enteral nutrition</a>.</div></li><li class="half_rhythm"><div>Sores and breakdown of the skin where the enteral feeding tube is inserted.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000306496/" class="def">Diarrhea</a> with the use of enteral and parenteral nutrition.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463706/" class="def">Complications</a> caused by fluid overload (a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> where there is too much fluid in the blood) with the use of enteral and parenteral nutrition.</div></li></ul></div></div><div id="CDR0000286996__667"><h2 id="_CDR0000286996__667_">Nutrition Trends in Cancer</h2><div id="CDR0000286996__667.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000286996__678">Some people with cancer try special diets to improve their prognosis.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000286996__679">Some people with cancer may take dietary supplements.</a></div></li></ul></div><div id="CDR0000286996__678"><h3>Some people with cancer try special diets to improve their prognosis.</h3><p id="CDR0000286996__669">People with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> may try special <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044660/" class="def">diets</a> to make their treatment work better, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439419/" class="def">prevent</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> from treatment, or to treat the cancer itself. However, for most of these special diets, there is no evidence that shows they work.</p><p id="CDR0000286996__670">
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<b>Vegetarian or vegan diet</b>
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</p><p id="CDR0000286996__671">It is not known if following a vegetarian or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000630963/" class="def">vegan</a> diet can help side effects from cancer treatment or the person's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a>. If the person already follows a vegetarian or vegan diet, there is no evidence that shows they should switch to a different diet.</p><p id="CDR0000286996__673">
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<b>Macrobiotic diet</b>
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</p><p id="CDR0000286996__674">A macrobiotic diet is a high-<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000285960/" class="def">carbohydrate</a>, low-fat, plant-based diet. No studies have shown that this diet will help people with cancer.</p><p id="CDR0000286996__675">
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<b>Ketogenic diet</b>
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</p><p id="CDR0000286996__676">A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000766471/" class="def">ketogenic diet</a> limits carbohydrates and increases fat intake. The purpose of the diet is to decrease the amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a> (sugar) the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> can use to grow and reproduce. It is a hard diet to follow because exact amounts of fats, carbohydrates, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">proteins</a> are needed.</p><p id="CDR0000286996__677">Several <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a> are recruiting people with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045698/" class="def">glioblastoma</a> to study whether a ketogenic diet affects glioblastoma tumor activity. People with glioblastoma who want to start a ketogenic diet should talk to their doctor and work with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454994/" class="def">registered dietitian</a>. However, it is not yet known how the diet will affect the tumor or its <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a>.</p><p id="CDR0000286996__807">Similarly, a study comparing the ketogenic diet to a high-fiber, low fat diet in women with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445074/" class="def">ovarian cancer</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444987/" class="def">endometrial cancer</a> found that the ketogenic diet was safe and acceptable. There is not enough evidence to know how the ketogenic diet will affect ovarian or endometrial tumors or their symptoms.</p></div><div id="CDR0000286996__679"><h3>Some people with cancer may take dietary supplements.</h3><p id="CDR0000286996__681">A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373932/" class="def">dietary supplement</a> is a product that is added to the diet. It is usually taken by mouth, and usually has one or more dietary ingredients. People with cancer may take dietary supplements to improve their symptoms or treat their cancer.</p><p id="CDR0000286996__682">
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<b>Vitamin C</b>
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</p><p id="CDR0000286996__683"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439435/" class="def">Vitamin C</a> is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044697/" class="def">nutrient</a> that the body needs in small amounts to function and stay healthy. It helps fight <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a>, heal wounds, and keep <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> healthy. Vitamin C is found in fruits and vegetables. It can also be taken as a dietary supplement. For information about the use of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046682/" class="def">intravenous</a> vitamin C as treatment for people with cancer, see <a href="/books/n/pdqcis/CDR0000742253/">Intravenous Vitamin C</a>.</p><p id="CDR0000286996__685">
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<b>Probiotics</b>
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</p><p id="CDR0000286996__686"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000658861/" class="def">Probiotics</a> are live <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044059/" class="def">microorganisms</a> used as dietary supplements to help with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463707/" class="def">digestion</a> and normal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446980/" class="def">bowel function</a>. They may also help keep the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046189/" class="def">gastrointestinal tract</a> healthy.</p><p id="CDR0000286996__687">Studies have shown that taking probiotics during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> can help prevent <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000306496/" class="def">diarrhea</a> caused by those treatments. People with cancer who are receiving radiation therapy to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> or chemotherapy that is known to cause diarrhea may be helped by probiotics. Similarly, studies are looking at potential benefits of taking probiotics for people with cancer who are receiving <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapy</a>.</p><p id="CDR0000286996__688">
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<b>Melatonin</b>
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</p><p id="CDR0000286996__689"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440118/" class="def">Melatonin</a> is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045713/" class="def">hormone</a> made by the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046226/" class="def">pineal gland</a> (tiny <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a> near the center of the brain). Melatonin helps control the body's sleep cycle. It can also be made in a laboratory and taken as a dietary supplement.</p><p id="CDR0000286996__690">Several small studies have shown that taking a melatonin supplement with chemotherapy and/or radiation therapy for treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045301/" class="def">solid tumors</a> may be helpful. It may help reduce side effects of treatment. Melatonin does not appear to have side effects.</p><p id="CDR0000286996__691">
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<b>Oral glutamine</b>
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</p><p id="CDR0000286996__692">Oral <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045446/" class="def">glutamine</a> is an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446104/" class="def">amino acid</a> that is being studied for the treatment of diarrhea and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045789/" class="def">mucositis</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">inflammation</a> of the lining of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046446/" class="def">digestive system</a>, often seen as mouth sores) caused by chemotherapy or radiation therapy. Oral glutamine may help prevent mucositis or make it less severe.</p><p id="CDR0000286996__694">People with cancer who are receiving radiation therapy to the abdomen may benefit from oral glutamine. Oral glutamine may reduce the severity of diarrhea. This can help people continue with their treatment plan.</p></div></div><div id="CDR0000286996__541"><h2 id="_CDR0000286996__541_">To Learn More About Nutrition and Cancer Care</h2><div id="CDR0000286996__556"><h3>National Cancer Institute</h3><p id="CDR0000286996__557">For information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044267/" class="def">(NCI)</a> about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044698/" class="def">nutrition</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> treatment, see <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a>.</p></div><div id="CDR0000286996__560"><h3>Organizations</h3><p id="CDR0000286996__561">For general nutrition information and other resources, see the following:</p><ul id="CDR0000286996__562"><li class="half_rhythm"><div>United States Department of Agriculture<ul id="CDR0000286996__573" class="simple-list"><li class="half_rhythm"><div><a href="https://www.myplate.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.myplate.gov/</a></div></li><li class="half_rhythm"><div><a href="https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">2020-2025 Dietary Guidelines for Americans</a></div></li></ul></div></li></ul><ul id="CDR0000286996__347"><li class="half_rhythm"><div>Academy of Nutrition and Dietetics
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<ul id="CDR0000286996__506" class="simple-list"><li class="half_rhythm"><div>800-877-1600
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</div></li><li class="half_rhythm"><div><a href="http://www.eatright.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www.eatright.org</a></div></li></ul>
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</div></li><li class="half_rhythm"><div>American Botanical Council
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<ul id="CDR0000286996__504" class="simple-list"><li class="half_rhythm"><div>800-373-7105
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</div></li><li class="half_rhythm"><div><a href="http://abc.herbalgram.org/site/PageServer?pagename=Homepage" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">abc.herbalgram.org</a></div></li></ul>
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</div></li><li class="half_rhythm"><div>American Cancer Society
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<ul id="CDR0000286996__505" class="simple-list"><li class="half_rhythm"><div>800-227-2345
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</div></li><li class="half_rhythm"><div><a href="https://www.cancer.org/healthy/eat-healthy-get-active.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www.cancer.org/healthy/eat-healthy-get-active</a></div></li></ul>
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</div></li><li class="half_rhythm"><div>American Institute for Cancer Research
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<ul id="CDR0000286996__507" class="simple-list"><li class="half_rhythm"><div>800-843-8114</div></li><li class="half_rhythm"><div>
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<a href="https://www.aicr.org/cancer-prevention/healthy-eating" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www.aicr.org/cancer-prevention/healthy-eating</a></div></li></ul></div></li><li class="half_rhythm"><div>American Society for Parenteral and Enteral Nutrition
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<ul id="CDR0000286996__508" class="simple-list"><li class="half_rhythm"><div>301-587-6315</div></li><li class="half_rhythm"><div>
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<a href="http://www.nutritioncare.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www.nutritioncare.org</a></div></li></ul>
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</div></li><li class="half_rhythm"><div>National Center for Complementary and Integrative Health (NCCIH)
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<ul id="CDR0000286996__510" class="simple-list"><li class="half_rhythm"><div>
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888-644-6226 (NCCIH Clearinghouse)
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</div></li><li class="half_rhythm"><div>866-464-3615 (toll free TTY)</div></li><li class="half_rhythm"><div><a href="https://nccih.nih.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">nccih.nih.gov</a>
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</div></li></ul></div></li><li class="half_rhythm"><div>
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Office of Dietary Supplements
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<ul id="CDR0000286996__511" class="simple-list"><li class="half_rhythm"><div>301-435-2920</div></li><li class="half_rhythm"><div>
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<a href="https://ods.od.nih.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ods.od.nih.gov</a></div></li></ul></div></li></ul></div><div id="CDR0000286996__204"><h3>Books</h3><ul id="CDR0000286996__346"><li class="half_rhythm"><div><b>American Cancer Society’s Healthy Eating Cookbook: A Celebration of Food, Friends, and Healthy Living</b>. 3rd ed. Atlanta, GA: The American Cancer Society, 2005.
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</div></li><li class="half_rhythm"><div>Bloch A, Cassileth BR, Holmes MD, Thomson CA, eds.: <b>Eating Well, Staying Well During and After Cancer</b>. Atlanta, GA: American Cancer Society, 2004.
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</div></li><li class="half_rhythm"><div>Ghosh K, Carson L, and Cohen E: <b>Betty Crocker’s Living with Cancer Cookbook: Easy Recipes and Tips Through Treatment and Beyond</b>. New York, NY: Hungry Minds, 2002.
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</div></li><li class="half_rhythm"><div>Weihofen DL, Robbins J, Sullivan PA: <b>Easy-to-Swallow, Easy-to-Chew Cookbook: Over 150 Tasty and Nutritious Recipes for People Who Have Difficulty Swallowing</b>. New York, NY: John Wiley & Sons, Inc., 2002.
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</div></li><li class="half_rhythm"><div>Wilson JR: <b>I-Can’t-Chew Cookbook: Delicious Soft Diet Recipes for People with Chewing, Swallowing, or Dry Mouth Disorders</b>. Alameda, Calif: Hunter House Inc., 2003.
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</div></li></ul></div></div><div id="CDR0000286996__605"><h2 id="_CDR0000286996__605_">Current Clinical Trials</h2><p id="CDR0000286996__TrialSearch_605_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000286996__AboutThis_1"><h2 id="_CDR0000286996__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000286996__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000286996__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000286996__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000286996__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000286996__AboutThis_6">This PDQ cancer information summary has current information about nutrition before, during, and after cancer treatment. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000286996__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000286996__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
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</p><p id="CDR0000286996__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/supportive-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Supportive and Palliative Care Editorial Board</a>.
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</p></div><div id="CDR0000286996__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000286996__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000286996__AboutThis_12">Clinical trials can be found online at <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the <a href="https://www.cancer.gov/contact/contact-center" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Information Service</a> (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000286996__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000286996__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000286996__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000286996__AboutThis_21">PDQ® Supportive and Palliative Care Editorial Board. PDQ Nutrition in Cancer Care. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389440]</p><p id="CDR0000286996__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 3,000 scientific images.
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</p></div><div id="CDR0000286996__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000286996__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000286996__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000286996__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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class="simple-list"><li><a href="#CDR0000286996__125" ref="log$=inpage&link_id=inpage">Overview of Nutrition in Cancer Care</a></li><li><a href="#CDR0000286996__151" ref="log$=inpage&link_id=inpage">Effects of Cancer Treatment on Nutrition</a></li><li><a href="#CDR0000286996__164" ref="log$=inpage&link_id=inpage">Nutrition Assessment in Cancer Care</a></li><li><a href="#CDR0000286996__177" ref="log$=inpage&link_id=inpage">Treatment of Symptoms</a></li><li><a href="#CDR0000286996__312" ref="log$=inpage&link_id=inpage">Types of Nutrition Support</a></li><li><a href="#CDR0000286996__799" ref="log$=inpage&link_id=inpage">Medicines to Treat Loss of Appetite and Weight Loss</a></li><li><a href="#CDR0000286996__190" ref="log$=inpage&link_id=inpage">Nutrition Needs at End of Life </a></li><li><a href="#CDR0000286996__667" ref="log$=inpage&link_id=inpage">Nutrition Trends in Cancer</a></li><li><a href="#CDR0000286996__541" ref="log$=inpage&link_id=inpage">To Learn More About Nutrition and Cancer Care</a></li><li><a href="#CDR0000286996__605" ref="log$=inpage&link_id=inpage">Current Clinical Trials</a></li><li><a href="#CDR0000286996__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65854/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" 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<title>Facebook</title>
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<path class="st10" d="M159,99.1h-24V88.4c0-5,3.3-6.2,5.7-6.2h16.8V60l-24.4-0.1c-22.1,0-26.2,16.5-26.2,27.1v12.1H90v22.5h16.9 v67.5H135v-67.5h21.7L159,99.1z"></path>
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<li class="list-inline-item"><a href="https://www.youtube.com/user/NLMNIH" aria-label="Youtube" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
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<title>Youtube</title>
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<style type="text/css">
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.st4 {
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fill: none;
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<circle class="st4" cx="124.2" cy="123.4" r="108.2"></circle>
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<path class="st5" d="M88.4,1037.4c-10.4,0-18.7,8.3-18.7,18.7v40.1c0,10.4,8.3,18.7,18.7,18.7h72.1c10.4,0,18.7-8.3,18.7-18.7 v-40.1c0-10.4-8.3-18.7-18.7-18.7H88.4z M115.2,1058.8l29.4,17.4l-29.4,17.4V1058.8z"></path>
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<p class="address_footer text-white">National Library of Medicine<br />
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<a href="https://www.google.com/maps/place/8600+Rockville+Pike,+Bethesda,+MD+20894/@38.9959508,-77.101021,17z/data=!3m1!4b1!4m5!3m4!1s0x89b7c95e25765ddb:0x19156f88b27635b8!8m2!3d38.9959508!4d-77.0988323" class="text-white" target="_blank" rel="noopener noreferrer">8600 Rockville Pike<br />
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Bethesda, MD 20894</a></p>
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<p><a href="https://www.nlm.nih.gov/web_policies.html" class="text-white">Web Policies</a><br />
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<a href="https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/freedom-information-act-office" class="text-white">FOIA</a><br />
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<a href="https://www.hhs.gov/vulnerability-disclosure-policy/index.html" class="text-white" id="vdp">HHS Vulnerability Disclosure</a></p>
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<div class="col-lg-3 col-12 centered-lg">
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<p><a class="supportLink text-white" href="https://support.nlm.nih.gov/">Help</a><br />
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<a href="https://www.nlm.nih.gov/accessibility.html" class="text-white">Accessibility</a><br />
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<a href="https://www.nlm.nih.gov/careers/careers.html" class="text-white">Careers</a></p>
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<nav class="bottom-links">
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<a class="text-white" href="//www.nlm.nih.gov/">NLM</a>
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<li>
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<a class="text-white" href="https://www.nih.gov/">NIH</a>
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<a class="text-white" href="https://www.hhs.gov/">HHS</a>
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<a class="text-white" href="https://www.usa.gov/">USA.gov</a>
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