Where to start in managing diet problems
This page has information on how to start getting help with diet problems and who can help when you have cancer. There is information on
If you have a problem with diet, digestion or weight loss, you need to talk to your doctor, cancer nurse or dietician. If you talk to your doctor first, they will most likely refer you to the hospital dietician for help. This is because dieticians are experts in these problems. Many cancer units and hospitals now have dieticians particularly for people with cancer. So they have a lot of knowledge and experience about the problems you may face. They will work with your doctor to decide together how best to manage your diet problems. Other people who may be important in helping to manage your diet problems include your family and friends, Macmillan nurses, social worker and religious leaders. There is more information about how these people can help you in the section on your feelings about diet problems.
Before anything can be done, your doctor and dietician will need to know a lot about your illness and diet. This is called a nutritional assessment. Your doctor or dietician will ask you a lot of questions about the history of your illness and your appetite and weight. This may seem like too much to deal with if you are very tired, weak or sick. But it is extremely important that you are properly assessed for your nutritional problems so you get the right treatment.
Your doctor will examine you and possibly arrange some other tests and investigations. You may be asked
- What is your normal weight?
- Have you been on any type of diet over the past 6 months?
- Have you lost or gained weight over the past 6 months? If so, how much?
- What do you eat in a typical day?
- In the last 6 months, have you changed the amount or type of food that you normally eat?
- Do you ever have diarrhoea or constipation?
- Do you ever feel sick?
- Do you ever vomit? If so, how often and when?
- Have you lost your appetite?
- Do you have any problems with eating, such as a sore or dry mouth?
- Does food taste any different to you since you were diagnosed with cancer?
- Do you have problems with swallowing or chewing?
- Do you often feel tired?
- Do you ever feel dizzy or confused?
- What medicines are you taking?
Your doctor will take into account any other medical conditions that may affect your nutritional needs, such as diabetes. After you have answered these questions your doctor will examine you. This will involve checking your body for signs of poor nutrition, including
- Examining your abdominal area, mouth (gums and tongue) and skin
- Taking your blood pressure and pulse
- Checking your weight
- Looking for loss of fat and muscle tissue
- Looking for signs of dehydration (dry skin, thirst, low urine output) or fluid build up (swollen ankles or abdomen)
You may also have urine and blood tests to give your doctor more information about your body and how it is absorbing food. But a detailed history of your diet and weight often tell more than laboratory tests.
The National Institute for Health and Clinical Excellence (NICE) has issued guidance on nutritional support for adults. This guidance says that patients should be screened for signs of malnutrition, or for risk of becoming malnourished. This screening should be done when people are admitted to hospital or at your first outpatient appointment, and involves checking your body mass index (BMI), assessing weight loss and looking at risk factors for malnutrition.
The aim of the assessment is to make sure people get the help they need. This will help them recover quicker from their illness and treatment. And have a higher quality of life.
You are probably the most important person in making sure that your nutritional problems are kept under control. Let someone know if
- You have lost your appetite
- You feel sick
- You are in pain
- You are concerned about your weight
Don't just try to cope on your own. Don't be afraid to ask questions and get your doctors and nurses to explain things to you in simple terms. People who understand their diet problems are much more able to cope and improve their situation. You can find a list of questions you might want to ask in this section. There are some excellent booklets about how to deal with nutritional problems and cancer, many of which are free. Look in our reading list and organisations pages for more information.
Your specialist cancer doctors and nurses are there to help you and are skilled in treating all problems related to cancer and treatment. Your GP will also be willing to help. What they suggest will depend on
- Any treatments that you are having
- How long you have had the problem
- How bad it is
- What is causing it
- If the problem is likely to be temporary
You can bring your diet problems to your doctor or nurse - whoever you feel most comfortable talking to. They work as a team and will pass important information on.
Dieticians play an extremely important role in managing diet problems in cancer. Most cancer hospitals have dieticians specifically trained in looking after people with cancer. Their training involves a university degree and clinical training. They can answer your questions and help you deal with any problems you have with eating. They can recommend specific meals, snacks, and food, and how food might need to be prepared to help you eat. For example, a pureed diet may help if you are having problems swallowing.
If you need it, your dietician can plan a special diet to make sure you get all the calories and nutrients you need. They may also recommend ‘meals in a drink’ that you can have if you can't face a meal. The drinks can be bought from the chemist or are available on prescription. There are many other types of nutritional supplements which can help to boost your intake of nutrients. Your dietician will advise whether any of these will help you.
If you have a more serious problem and need drip or tube feeds your dietician will be very involved in this. They can also help arrange for any cultural or religious dietary needs while you are in hospital.
A pharmacist will check that the type and dose of any drug prescribed for you is safe. If you need drugs to boost your appetite or to prevent weight loss, your pharmacist will check that you can take these safely with any other medicines you are having, including drip feeds or tube feeds.
Speech therapists don't just help people with speech problems. They also help people who have difficulty swallowing after surgery, radiotherapy, or due to the cancer itself. They will assess you, and can advise on the right texture of food or fluid to help you swallow safely.
Nutritionists can give useful help and advice for some people being treated for cancer. A nutritionist is a health specialist who knows about food and nutritional science and about using nutrients to help people recover from illness. Nutritionists have varying levels of education, from little or no education to a bachelor's, master's, or doctoral degree. The term 'nutritionist' or 'nutritional therapist' is not a legally protected term and can be used by anyone. Most nutritionists are not employed through the NHS and you generally pay for their advice. It is important to check that any nutritionist you see is properly trained and you can do this by contacting The Nutrition Society.
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