ACCC’s Improving Care in Gastric/GE Junction Cancer project seeks to better the quality of care for gastric and GE cancer patients treated at community cancer programs. This guest post by Colleen Gill, MS, RD, CSO, is the final blog in a series on gastric and GE junction cancers. Colleen Gill is outpatient dietitian at the University of Colorado Cancer Center, and she serves on the Advisory Committee for ACCC’s Improving Care in Gastric/GE Junction Cancer initiative.
More than 70 percent of patients with gastric cancer develop malnutrition, depleting muscle mass, slowing healing, and limiting the immune system.
The growth of any tumor within the stomach will limit intake and create problems with the digestion of food. Unfortunately, diagnosis of gastric cancer may be delayed due to symptoms—such as feeling extremely full after small amounts of food and abdominal pain or heartburn—that may be attributed to more common causes. As a result, malnutrition in gastric cancer patients can begin early. Nausea and vomiting are inevitable when there is tumor blocking either the gastro-esophageal junction or gastric outlet. Fatigue can result from iron deficiency anemia due to problems with iron absorption.
Patients with gastric cancer may undergo a combination of chemotherapy and radiation prior to surgery, and may be given adjuvant therapy after surgery as well. Treatment side effects may include inflammation, pain, nausea, and vomiting which can further affect a patient’s ability to eat and maintain weight.
Here are 8 strategies that may help the patient eat better, avoid excess loss of weight and muscle, and stay on treatment:
- Schedule 5 – 6 times to eat each day. Because stomach capacity is reduced due to tumor and/or surgery, patients can try eating smaller amounts of food at intervals during the day. Scheduling a cell phone reminder to eat can be helpful. Without some type of reminder to eat every two and one-half to three hours, patients can easily miss these opportunities, and limited stomach capacity makes it impossible to make up their calorie intake at a later meal.
- Choose softer foods. The stomach usually breaks down solid foods into smaller pieces through muscular contractions and acid secretion, but both functions may be limited by the cancer. Consider foods that are pre-processed, like shredded meats, and canned or cooked fruits and vegetables. Take advantage of foods that are already in soft “pureed” texture, like fish, refried beans, most dairy products, eggs, mashed potatoes, winter squash.
- Make it slick. Moist foods, or those with gravies and sauces, spread taste through the mouth, increasing palatability. These foods also slide down more easily.
- Make it easy. There are many prepared foods that will work for you, so tour the aisles of the grocery store with your goals in mind. Frozen/prepared pasta dishes, mini-quiches, and microwavable mashed potatoes, soups and breakfast dishes are available. Friends and family often offer their help which can be coordinated through websites like mealtrain.com or lotsofhelpinghands.com. Include liquid calories. They slip through narrow openings and are less likely to distend the walls of the stomach. Options include milk-like oral supplements, which are usually lactose free if that is a concern. Choose the “plus” versions for an extra 100 calories and higher protein levels. If milk is tolerated, many enjoy Carnation Instant Breakfast powder, stirred in, adding 130 calories. Scandishakes will add 440 calories and are well liked. Clear liquid drinks include Boost Breeze and Ensure Active, which some people also enjoy mixed with carbonated clear sodas. In the grocery store’s produce area, you’ll find fruit-based drinks such as those from Odwalla, Naked Juice, and Bolthouse that include versions with protein. All of these can be used as a base for smoothies, which should always include some source of protein.
- Create a list. Coming up with ideas for what to eat on the spur of the moment can be stressful. Create a “go to” list of options for your refrigerator (or wallet). This can help you avoid falling back on the same things over and over, which can lead to “burning out” on particular foods. Including the “extras” that add calories on your list. These can help ensure that each bite counts. For example, add cheese when you warm up refried beans or scramble an egg, or add walnuts or peanut butter to oatmeal. Jot down ideas for days when you struggle, so you can always “go to” something from the list. Use the list when making shopping lists, so that foods are available to you when you want them.
- Adjust your list by tolerance. Never cross something off your list until it has failed you more than twice. However, if you notice that higher fat or high fiber foods cause food to “sit” on the stomach for long periods of time, you may try lowering the content of fat/fiber in the food you eat and see if that is helpful. Journaling can help you see patterns.
- Keep food safe. Many patients with gastric cancer will be on acid suppressive therapies or have less secretion of acid as the result of their cancer. Without acid in the stomach, you have less protection from bacterial contamination in food. Be careful to take precautions to keep food safe: avoid letting food sit at room temperature (keep it cold or hot), wash your hands frequently, and avoid cross contamination by keeping surfaces clean and using separate cutting boards for raw meats and foods that won’t be cooked. Be cautious with self-service salad bars and high-risk foods. Use leftovers within 48 hours.
- Talk to your team about anything that is getting in the way of eating. They will have some solutions if you are having problems with nausea/vomiting, constipation, dehydration, sleeping, or anything else that is limiting your ability to eat. They can guide you about over the counter and prescription medications that may help, or schedule you for IV fluids or other procedures to deal with the problems. Waiting never resolves anything!