Nutrition And Fitness in Cancer Treatment: How to Do It Right

 In Cancer Care Guide, Cancer Treatment

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Good nutrition and fitness are essential for everyone’s health, more so for people undergoing cancer treatment. But how to maintain proper nutrition intake and activity level when one is suffering from side effects such as nausea, vomiting, fatigue and pain? 

In this article, we explain the various battles cancer patients are fighting, including the daily struggles to eat and stay active, the symptoms and side effects that affect their appetite and physical activity, and outline strategies to deal with them. As patients, it is imperative that we understand these challenges are prevalent among people living with cancer, and that there are ways to alleviate them. As family members and caregivers of someone with cancer, the knowledge can help you provide better care, support and compassion to your loved one. 

Why is it hard to maintain nutrition and fitness during cancer treatment?

Most patients with cancer experience symptoms, which can be changes in the body due to cancer itself, or side effects related to cancer treatment. The range and severity of symptoms vary depending on the type and stage of cancer, as well as the treatment they are undergoing. 

According to research, pain and fatigue are the two most common symptoms among people with cancer. Other frequently reported symptoms involve both physical and emotional aspects, such as lack of appetite, low self-esteem, nausea, bloatedness, nervousness, irritation, loss of weight. Topping it off with the emotional and mental toll that comes with a cancer diagnosis, it is easy to see why daily activities like eating and moving around can be a struggle for cancer patients.

In fact, it is estimated that one in two cancer patients suffers from under-nutrition and malnutrition, while three in five experience weight loss 6 months after diagnosis. Nutritional deficiency among cancer patients is a prevalent issue, which has been linked to reduced therapy compliance and treatment effectiveness. Conversely, being well-nourished can potentially boost your overall strength, tolerance of therapies, recovery and quality of life. 

Importance of nutrition in cancer treatment

Food is ingested and transformed by the body through the nutrition process to generate energy for tissue repair, development, and maintenance. During recuperation from illnesses, a healthy and adequate diet can help boost the immune system, repair damaged tissues and provide the body with the energy it needs for healing. On the other hand, a diet lacking in essential nutrients can slow down the recovery process, increase the risk of complications, and affect treatment outcomes. Various studies have proven this linkage between malnutrition and the worsening of the cancer patients’ prognosis and quality of life.

Here are some of the benefits of proper nutrition during cancer recuperation:

  • Adequate nutrition can help to maintain the patient’s overall strength, immunity and well-being during treatment, which can help them respond better to oncological therapies.
  • Proper supply of certain nutrients, such as protein, are essential to the process of repair and rebuilding of damaged tissues caused by cancer or its treatment.
  • Good nutrition can help to reduce the impact of cancer symptoms and side effects of the body, which helps to free up reserves to fight cancer.
  • Overall, sufficient nutrition is believed to play a role in improving treatment efficacy and outcomes. 

Oncologists are aware of malnutrition risks among patients and often play an active role in promoting good nutrition. However, their influence is limited, since much of the work is done at home. Further, dietary habits and the impact of side effects differ widely among individuals. Cancer patients, therefore, are encouraged to take the lead in ensuring good nutrition during cancer treatment. If you need personalised advice, ask your physician for a referral to a dietician or nutritionist. Under the guidance of a dietician, you will be able to develop appropriate nutrition goals and a tailored nutrition plan, including foods you should take and avoid in your own case.

Strategies to ensure sufficient nutrition for cancer patients

As we discussed above, eating a sufficient amount of healthy food can be a battle of its own for cancer patients. Though each person’s tolerance and preference is unique, generally speaking, maintaining proper nutrition intake revolves around the following aspects: 

  • Ensuring sufficient intake of essential nutrients required by the body for recovery from cancer and its treatment, including protein, fiber, healthy fat, healthy carbohydrates, vitamins, minerals, and water.
  • Making adjustments to meal schedule, type of food and amount of food for optimal daily intake. For instance, if you experience loss of appetite, you can try eating more during breakfast when you are likely to be hungry after a full night’s sleep, followed by smaller meals at shorter intervals during the day.
  • Finding ways to fulfil nutrition intake without making it an arduous task. This is a time when snacking is often encouraged. Having a smoothie instead of plain water is a good way to add calories and nutrients to your daily intake. You can also add spices to your food or try new recipes to stimulate appetite. Be as creative as you can!
  • Asking for and taking medications to relieve side effects that affect food consumption and digestion, such as anti-nausea and anti-constipation medications. 
  • Staying physically active, as much as you can comfortably tolerate. Physical activities can help to reduce fatigue, boost appetite, and prevent loss of muscle mass. 
  • Getting support from family or a caregiver with meal preparation if you do not feel well enough to do it yourself. Ask family members or friends to have a meal with you if that helps. We tend to eat more in good company. 
  • Consulting your doctor about your nutritional or weight concerns. They can make modifications to your treatment plan, prescribe you medications for side effects and refer you to a nutritionist as necessary. 

Note that while weight loss is generally a sign of nutrition deficiency in cancer treatment, weight gain is not always a good indicator of sufficient nutrition intake. Certain hormonal therapies and immunotherapies are known to cause the side effect of weight gain. Some people with cancer gain weight due to fluid retention (i.e., edema) and increase in body fat due to lack of physical activity. Therefore, it is vital to focus on the quality of the nutrition consumed and the weight gained, rather than just the quantity. 

How to cope with cancer side effects affecting your appetite and nutrition intake

For patients experiencing cancer symptoms and side effects, appetite and nutrition can suffer. Common symptoms and side effects that may directly interfere with the patient’s nutrition include: 

  • Nausea and vomiting, which may occur with chemotherapy, radiation or targeted therapy
  • Digestive problems such as diarrhoea, constipation, and bloatedness, which can affect patients undergoing chemotherapy or having cancer affecting the gastrointestinal tract
  • Mouth and throat problems (mouth sores, ulcers, etc), which are more common among patients receiving radiotherapy to the head and neck
  • Fatigue and body weakness
  • Loss of appetite

We wrote about these cancer side effects and their causes in another blog post. In this article, we focus on how to address these side effects to maintain good nutrition intake. 

To counter nausea and vomiting:

  • Avoid consuming a heavy meal just before chemotherapy or radiotherapy
  • Take anti-nausea medications (i.e., antiemetics) as prescribed by your doctor and when you start to feel queasy.  
  • Try household nausea relief foods & drinks like herbal teas such as ginger, peppermint, chamomile tea or ginger candies
  • Schedule smaller but more frequent meals throughout the day
  • Anxiety and nervousness can also trigger nausea. Try relaxation techniques like deep breathing, meditation, music & art therapy and seek counselling, psychotherapy as you need. 

To recover from diarrhoea:

  • Hydrate well to replenish the fluid you lose with each bowel movement
  • Try electrolyte-infused beverages to restore electrolyte balance in the body
  • Ask your doctor if probiotics are for you. In some cases, they can help to correct the imbalance in the gut microbiota due to diarrhoea
  • Avoid food and drinks that can upset the stomach, such as oily, spicy food, carbonated drinks and for some people, dairy products. 

To treat constipation:

  • Include high-fiber foods in your diet, such as fruits, vegetables and legumes
  • Stay hydrated by ensuring intake of 2 litres of water everyday
  • Ask your doctor for laxatives (i.e., stool softeners)
  • Exercise as you can tolerate. Physical activity can help prevent constipation.

To overcome mouth, throat and dental issues:

  • Go for a dental clearance before starting chemotherapy or other treatments. Addressing tooth decay prior to therapy and maintaining good oral hygiene thereafter is important to avoid infection from the mouth spreading to the rest of the body. 
  • Speak to your doctor if you experience a mouth ulcer, mouth sore or difficulty swallowing. There are ulcer creams and gels to speed up healing. Specialised therapists can work with you to ease the issue with dysphagia (i.e., difficulty swallowing)  
  • Switch to soft or liquid food until the problem is resolved. Using a straw when drinking also helps to keep food away from sensitive areas. 
  • Avoid spicy food and hot food that irritates the ulcer. 

To fight against fatigue:

  • Eat well and drink sufficient fluids to keep energy reserves up
  • Exercise moderately. If you feel tired, try walking for a short duration first, then increase duration and intensity and try brisk walking, swimming and cycling
  • Spread your activities throughout the day and take breaks in between
  • Address other symptoms that may exacerbate fatigue, like nausea and vomiting or diarrhoea.  

To stimulate appetite:

  • Add more of your favourite foods to your diet, as long as they are nutritious and healthy
  • Get sufficient water intake everyday. But avoid drinking too much liquids with meals, which can make you feel full quickly. Take only small sips of liquid if your mouth is dry.
  • Make food and mealtime more appetising with suitable amounts of herbs and spices, new recipes, colourful attractive presentation, and enjoyable dining companions 
  • Planning meals in advance can boost your appetite, by making you look forward to the meals and reduce the stress of ‘what to eat now’ when mealtime comes
  • Get plenty of rest but also try to be active when you feel well enough to do so. Exercise can boost appetite, improve fatigue and improve your mood.
  • Talk to your doctor and manage symptoms that directly or indirectly affect your appetite. It is hard to eat well when we are constantly tired or in pain but light exercise and pain relievers can help. Other direct causes like mouth ulcers, mouth sores, difficulty swallowing should also be discussed and addressed.
8 Ways to Stimulate Appetite in Cancer Patients

To boost calorie and nutrition intake

  • Eat whenever you feel hungry, as well as at scheduled times
  • Load up on breakfast, this is usually when you are most hungry
  • Have small frequent meals or snacks throughout the day 
  • Keep healthy snacks on hand so you can easily munch them 
  • Add calories and nutrients to drinks with juices, smoothies or shakes 
  • Try nutritional supplement drinks. Ask your doctor or cancer care team if you are not sure which brand to try. 

Top nutrients and foods cancer patients need for healing

A healthy diet for cancer patients supplies the body with adequate amounts of essential nutrients that are beneficial for healing. Each type of cancer, treatment and patient’s profile may require a different nutrition focus. However, broadly speaking, the following groups of foods make up an healthy, balanced and nutritious diet for cancer patients: 

  • Proteins

Known as the building blocks of life, protein exists in every cell in the human body. Protein is essential for repairing damaged tissues and building new cells. For cancer patients who are at risk of losing weight and muscle mass, protein helps to maintain muscle volume and strength. Good sources of proteins include lean meats, poultry, fish, egg, legumes, beans, nuts, and dairy products. 

  • Fiber

Fiber helps to maintain a good gut health, improve digestion and prevent constipation, a side effect some cancer patients may experience. There are 2 types of fiber. Soluble fiber can be beneficial for digestion, blood sugar and blood cholesterol control. Insoluble fiber makes the stool softer and easier to pass. Good sources of fiber can be found in whole grains, fruits, and vegetables.

  • Vitamins and minerals

Our bodies’ enzymatic functions, which are crucial for enhancing immune function, lowering inflammation, and antioxidant protection, are assisted by vitamins and minerals, such as vitamin A, C, D, E, folic acid, iron, zinc, magnesium. Food items you can eat to get these nutrients are fruits, vegetables, milk, yogurt, and fortified cereal. Among the produce, leafy greens, berries and colourful fruits and vegetables are often rich in antioxidants and should be included.

  • Healthy fats

Healthy fats aids with energy production, cell membrane development and vitamin absorption. It is important to get healthy fats including mono- and polyunsaturated fatty acids through diet because the body can not make them. Vegetable oils, nuts, seeds, avocado and fish are good sources of healthy fats.

  • Healthy carbohydrates

Also known as carbs, carbohydrates are the body’s primary source of energy which the body needs to fight off illnesses. When choosing carbs, go for whole grains, bran, and oats that have undergone little processing. Whole grains are richer in fiber, vitamins and other nutrients compared to processed foods. 

  • Water

Staying hydrated is crucial for food to break down and get absorbed by the body. Drinking enough water also helps to prevent constipation and keep the kidney healthy. Furthermore, cancer symptoms and side effects such as vomiting or fever can cause dehydration, requiring replenishing through diet. Make sure you nourish yourself with sufficient liquid everyday from drinking and eating. In addition to water, you can get your liquid intake from juices, shakes, smoothies, clear broth and soup. 

A few words about superfood: Some foods are said to be superfoods that can prevent or cure cancer. In fact, they are often foods that contain high levels of certain nutrients that may benefit cancer patients or our general health. There has not been any scientific evidence of a single food being able to prevent or treat cancer. Instead of sticking to a specific superfood, it is crucial to have a balanced healthy diet that provides all the essential nutrients that the body needs for recovery.

Top Nutrients and Foods Cancer Patients Need

Foods cancer patients should avoid

Equally important to what foods to eat is what foods to avoid. The general guideline is to avoid unhygienic and unhealthy food. Examples of such food you should avoid are:

  • Processed foods & fast foods

This group of food has been directly and indirectly linked to the risk of cancer. Cancer patients should limit consumption of foods that are high in added fat, starches or sugars, such as french fries, hamburgers, sugary drinks, and donuts. Processed meat, in particular, is categorised as Class 1 carcinogens by the World Health Organisation and should be avoided by cancer patients. Examples of these foods are salami, bacon, ham, sausage, hot dogs, pepperoni, and deli meat. 

  • Raw foods and undercooked foods

Avoiding raw and undercooked foods is an important part of food safety guidelines for cancer patients. Always make sure meats, eggs, seafood are fully and hygienically prepared. Don’t eat foods that contain uncooked eggs, raw fish, or undercooked shellfish, such as home-made mayonnaise, sashimi, and sushi. Salad, however, can be safely consumed if it is freshly prepared and washed properly. 

  • Unpasteurized foods

Unpasteurized foods can be a hidden source of microbes that can cause foodborne diseases. These include unpasteurized milk and cheeses manufactured from unpasteurized milk, and other raw milk products. Lightly cooked or raw fish, such as sushi. Soft-cooked eggs or foods that contain raw eggs, such as homemade mayonnaise. Unpasteurized cheeses and dairy products.

  • Unwashed fruits and vegetables

Vegetables and fruits are good and safe to eat only if they are washed and cleaned properly. Always wash fruits and vegetables under clean running water before eating them.

  • Alcohol

It is best to steer clear from alcohol during your cancer treatment. It may worsen side effects and in some cases, interact with the drugs you are taking. Similarly, although not a food, smoking cigarettes should be avoided during cancer treatment as well. This includes secondary smoking.

Foods Cancer Patients Should Avoid

Importance of exercise and fitness in cancer treatment

We have mentioned above that fitness helps with appetite and nutrition. On its own, numerous studies indicate that regular exercise may significantly enhance both psychological and physical well-being for patients with all types of cancer during all stages of therapy. Physical activity is found to improve fatigue, decrease the severity of side effects from cancer therapies and enhance mental health. There is also evidence that exercises during cancer treatment and thereafter, including both cardio and strength training exercises, help to reduce the risk of cancer recurrence and improve survival rate. 

Yet, maintaining fitness is a challenge for cancer patients, similar to maintaining nutrition. A survey conducted by National Cancer Centre, Singapore (NCCS) reveals that though almost 9 in 10 cancer patients are motivated to exercise after completing their treatment, more than half of them find it hard to engage in physical activity due to cancer symptoms and side effects. For people with cancer, exercising is not just a matter of will. It is also a matter of capability. They need guidance from medical professionals on how to get started as well as support and encouragement from loved ones and peers to keep going. 

Typically, exercises for cancer patients will depend on the following:

  • The cancer type
  • Treatment plan
  • The current treatment side effects
  • Level of fitness
  • Presence of comorbidities (i.e., existing conditions that you have besides cancer)

When you work with a healthcare professional, make sure they are aware of all the above, for exercise guidance that best suits you. Some cancer therapies, such as surgery, and some types of cancer, such as those affecting the bone, may require you to refrain from exercises or certain movements for a while. If you experience pain or mobility issues, you may want to engage a physical therapist who specialises in helping you manage pain, restore function and start exercising in safety. Joining rehabilitation sessions guided by healthcare professionals and/or organised by cancer support groups and cancer centres is also a good idea. 

Easy cardio exercises to start for cancer patients

Even if you were not active prior to your cancer diagnosis, you can begin moving safely and effectively with the aid of a fitness program that is tailored to your specific requirements. It is best to consult your doctor or cancer care team before starting any exercise program. 

Here are some light exercises that suit most cancer patients during cancer treatment.

  • Deep breathing exercises

Exercises that focus on breathing increase oxygen to your lungs, thereby increase your endurance and reduce tension and anxiety. Besides, breathing difficulties might occur while receiving therapy, making it difficult for you to carry out your daily activities. Here are the instructions and demonstrations to help you get started.

  • Stretching

Stretching exercises help your muscles relax and boost your blood circulation, which in turn can help speed up the healing process for your body. Stretching can also be beneficial if you have been idle for a long while receiving treatment. You may stretch your quadriceps by lying down and lifting one leg into the air. Or you can extend your shoulders by pulling one arm across your breast with the other – this stretching exercise can be done in standing, sitting or lying position.

  • Cardio

Light cardio exercise is one of the exercises cancer patients can start first before engaging in more intense strength training exercises. This type of workout helps to increase the heart rate and give strength to the lungs. It can also prevent constipation. The simplest way you can perform cardio is by taking a walk. Start with a short walk at a comfortable pace first, then gradually work up to 150-300 minutes a week. As you feel stronger, you can increase speed to brisk walking and add strength training exercises.

Strength training during and after cancer treatment

A strength training is any exercise that requires the muscle to work harder than usual. It typically requires you to work against a resistance force or lift a weight, hence the terms ‘resistance training’ or ‘weight training’. Strength training is crucial in improving muscle mass, protecting your bone and improving overall physical functioning. It is beneficial to adults of all ages, including the elderly. A study involving 100 frail nursing home residents shows that progressive strength training over a period of 10 weeks can help the frail elderly improve muscle strength, mobility and function, gait and balance, and nutritional absorption. In contrast, nutrient supplementation without exercising does not produce this result. 

Strength exercises, however, have the risk of causing injuries if not done correctly. Thus, you are recommended to check with your doctor and have someone to assist, coach you or correct your form if necessary. 

Here are some generally safe and easy-to-perform strength training exercises you can do during and after cancer treatment:

  • Sit to stand 
  • Single leg stand
  • Standing lateral leg raise
  • Wall-assisted squat
  • Wide leg squat

Always remember to warm up and cool down before and after exercising. Exercise demonstrations are available in multi-languages on the YouTube channel of Health Promotion Board Singapore such as this Strength, Balance and Flexibility Exercise and these 7 easy exercises to stay active.

Avoid the following while exercising during your cancer treatment:

  • Avoid exercising when your energy is low
  • Avoid exercising when you feel pain or dizzy or short of breath
  • Avoid ramping up exercises or returning to pre-treatment physical activity level too quickly 
  • Avoid going to a crowded gym to avoid infections, if your doctor confirms your immunity is low
  • Avoid dehydration, drink water as often as possible
  • If you work with a physical therapist, make sure not to miss the appointments as your physiotherapist will regularly reassess you for recommendations of exercises
Easy Cardio and Strength Exercises for Cancer Patients

Takeaway message

Good nutrition and fitness are key to the recovery and quality of life of cancer patients. From a patient’s point of view, nutrition and fitness should be considered a part of a cancer treatment plan. And it should be continued even after cancer treatment is completed. 

We hope the article provides cancer patients and their families with general ideas to make eating well and working out easier and more enjoyable. You are recommended to consult your oncologist and cancer care team for advice to tailor your diet and exercises to your specific needs, symptoms and treatment goals. Above all, cancer patients need a lot of ongoing support and encouragement from their caregivers, families and friends to get better faster. Sometimes, just being there for them, having a nice healthy meal or taking a walk together can help to lessen their burden and improve their strength.

Dr Donald Poon

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