Tips for managing eating problems

Feeling very tired (fatigued) is a common side effect of cancer treatment. It can also be caused by the cancer itself. Cancer-related tiredness is different for everyone. It often gets better after treatment ends. But it may continue for months or sometimes years.

When you are very tired, you may struggle to cook your meals. You may even feel too tired to eat.

There are things you can do if you are feeling too tired to cook or eat:

• Use frozen meals, tinned foods and ready meals. Read and follow cooking instructions carefully. Cook all foods properly to avoid any risk of food poisoning.
• If your family or friends offer to help, ask them to do the shopping or cook for you.
• Rather than going shopping for food, arrange an online delivery. Many supermarkets offer this. Or use a local meal-delivery company.
• Ready meals can be expensive, but they can be a good option when you feel too tired to cook.
• If you have a freezer, prepare food when you are feeling less tired. Make more than you need and freeze portions to use when you are too tired to cook.
• It may be easier to eat smaller meals more often, rather than 3 bigger meals.
• If you find a main meal too much to prepare or eat, have a snack meal. For example, baked beans, eggs or cheese on toast, or a bowl of soup with added cream or grated cheese. Or you could have a pudding such as apple crumble and custard or fruit and ice cream.
• If you really do not want to eat, try a nourishing drink. For example, you can make a smoothie with bananas, peaches, strawberries or other soft fruit (fresh or frozen). Add these to a blender or liquidiser with fortified milk, plant-based milk, fruit juice, ice cream or yoghurt. You can fortify milk by adding 2 to 4 tablespoons of dried milk powder to 570ml (1 pint) of full-fat milk and mixing it together. Keep it in the fridge.
• Ask your doctor, nurse or dietitian for advice. They may prescribe or recommend supplement drinks.
• If you feel you need more help at home with cooking, talk to your GP or a dietitian. They may be able to arrange for you to have meals delivered, or for someone to help you prepare your food.

We have more information on coping with fatigue that you might find helpful.

Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it may be more active than usual.

Chemotherapy, targeted therapy, immunotherapy, radiotherapy and surgery can all cause diarrhoea. Treatment can affect the healthy cells that line the digestive tract, which causes diarrhoea. Other causes of diarrhoea can include infection or other medications, such as antibiotics.

Diarrhoea can be a temporary, mild side effect. But for some people, it can be severe. If you have diarrhoea, tell your doctor or nurse. They can check the cause to find the best way to manage it. They may prescribe anti-diarrhoea medicines.

If your diarrhoea is caused by radiotherapy, chemotherapy, targeted therapy or immunotherapy, you must take the anti-diarrhoea medicines prescribed by your doctor. You need to do this even if you change your diet.

If you have diarrhoea after surgery to remove part of your bowel talk to your doctor or specialist nurse before changing your diet.

Sometimes diarrhoea can be severe. Contact the hospital straight away if:

• you have diarrhoea at night
• you have diarrhoea 4 or more times in a day
• you have a moderate or severe increase in stoma activity
• the anti-diarrhoea drugs do not work within 24 hours.

Here are some tips that can help with diarrhoea:

• Drink at least 2 litres (31/2 pints) of fluids each day. This will help replace the fluid lost from diarrhoea.
• Avoid drinking alcohol and coffee.
• Eat small, frequent meals made from light foods. This could be white fish, poultry, well-cooked eggs, white bread, pasta or rice.
• Eat your meals slowly.
• Eat less fibre, such as cereals, raw fruits and vegetables, until the diarrhoea improves.
• Avoid greasy, fatty foods such as chips and beef burgers, and spicy foods like chilli.

Antibiotics can kill the healthy bacteria normally found in the bowel. Live yoghurt or yoghurt drinks contain bacteria that may replace the healthy bacteria. This may help ease diarrhoea caused by antibiotics.

Some cancer treatments can make you feel sick (nausea). This includes some chemotherapy, hormonal therapy, targeted therapy and immunotherapy drugs. Radiotherapy to the brain, stomach, bowel or close to the liver can also make you feel sick. Some painkillers or antibiotics can cause nausea. You may also get nausea if you have constipation or liver damage.

If you feel sick and do not want to eat, try to make sure you drink plenty of fluids. Nourishing drinks such as milky drinks can make sure you get nutrients such as protein. When you start eating again, start with light foods, such as thin soups. You can slowly build up to a more varied diet.

We have more detailed information about coping with nausea and vomiting.

You may lose your appetite during cancer treatment. This may be because:

• you feel sick
• you have a sore mouth
• food and drink tastes different
• you are constipated or have diarrhoea.

If side effects of treatment are stopping you eating your normal diet, talk to your doctor or nurse. They can try to find ways to help manage your side effects.

It is important that you eat enough to keep as well as possible. If you do not want to eat, ask your cancer doctor or nurse to refer you to a dietitian. If you are at home, your GP or district nurse may be able to refer you to a community dietitian.

A dietitian can look at what you are eating and help you get the nutrients you need. They can advise you on which foods are best for you, and whether any supplement drinks would be helpful.

These tips might help:

• Have smaller meals more often. Use a smaller plate and make your food look attractive to eat.
• Eat at the times that work best for you, even if it is at different times to other people. Try to eat your meals in a room where you feel relaxed.
• Keep snacks handy between meals. These can include nuts, crisps, dried fruit or cheese and crackers. If you need something softer, try yoghurt, peanut butter or fromage frais.
• You may find it easier to eat cold foods that do not need cooking, or ready-made foods that can go straight into the oven.
• Some people find drinking a small amount of alcohol just before, or with, food helps stimulate their appetite. Check with your doctor that you can have alcohol.
• Have nourishing drinks as well as small meals. These might include milkshakes, yoghurt drinks or fruit juices. These can contain a lot of sugar which can damage your teeth. Rinse your mouth out with water after having sugary drinks and brush your teeth regularly.
• If you have family or friends who would like to help, ask them to cook for you.
• Sometimes medicines can be used to help stimulate your appetite. These include a low dose of steroids or the hormone medroxyprogesterone. Your doctor may prescribe these for you.

Everyone’s appetite changes and you may have good and bad days. Make the most of the good days by eating well and treating yourself to your favourite foods.

If you have recently had surgery, you may need advice about the best foods for you. Talk to a dietitian or your specialist nurse or doctor about this.

Some medicines, such as steroids, may increase your appetite. You might want to eat much more than usual. Try to eat healthy foods such as fruit and vegetables instead of sweets and crisps. This is so you do not gain too much weight. We have more information about healthy eating.