Side effects from oesophageal cancer treatment

You may lose your appetite because of the effects of cancer itself, the treatment, or other side effects, such as feeling sick, not enjoying the smell of food, or feeling upset.

Tips to manage loss of appetite include:

• Eat small meals frequently, e.g. every 2–3 hours. Keeping to a regular eating pattern rather than waiting until you are hungry will mean your body gets the nourishment it needs to.
• Use a smaller plate – a big plate of food may put you off.
• Eat what you feel like, when you feel like it. Have cereal for dinner or a main meal at lunch.
• Include a variety of foods in your diet.
• Sip fluids throughout the day.
• Replace water, tea and coffee with drinks or soups that add energy (kilojoules/calories), such as milk, milkshake, smoothies, replacement drinks or soup.
• Relax dietary restrictions – maintaining your weight or regaining weight you have lost is more important than avoiding full-fat and other high-energy foods.
• Gentle physical activity can stimulate appetite – take a short walk around the block.
• Eat with others.

Some treatments and their side effects can change the way some foods taste or smell. Chemotherapy can change the taste receptors in the mouth. Food may taste bitter or metallic or may not have as much flavour as before. You may say things like “food tastes like cardboard”, “food tastes metallic”, or “I’ve gone off things I used to enjoy eating”. It is common to have taste changes and it can take several months for taste changes to return to normal.

If you have a sore mouth, mucositis, thrush, sore throat or swallowing difficulties, talk to your doctor, speech pathologist, dentist or dietitian – some suggestions will not be suitable.

Tips on managing changes in taste include:

• Add extra flavour to food if it tastes bland – like fresh herbs, lemon, lime, ginger, garlic, soy sauce, honey, chilli, or pepper.
• Experiment with different food, as your tastes may change.
• If meat tastes bad during treatment, replace it with other protein sources like cheese, eggs, nuts, dairy foods, baked beans, lentils, or chickpeas.
• Add small amounts of sugar to food if it tastes bitter or salty.
• Use a straw when drinking.
• Change from using metal cutlery to plastic or bamboo cutlery.

Ways to manage changes in smell include:

• Eat cold food or food at room temperature (hot food smells more).
• Reheat pre-prepared meals in the microwave so the cooking smell doesn’t put you off.
• Stay out of the kitchen, if possible, when food is being prepared.
• Ask family or friends to cook.
• Use the exhaust fan, open the kitchen window or cook outside to help reduce cooking smells.

Feeling sick and vomiting are often side effects of cancer, its treatment, or some medicines. They often occur together, but not always.

Nausea

Is stomach discomfort and the sensation of wanting to vomit. Nausea can be a precursor to vomiting the contents of the stomach and may be caused by treatment, stress, food odours, gas in the gastrointestinal tract, motion sickness or even the thought of having treatment.

Tips on how to cope with nausea:

• Have a light snack before treatment and wait a few hours before eating again.
• Eat small meals 5–6 times during the day. Going without food for long periods can make nausea worse.
• Snack on dry or bland foods, e.g. crackers, toast, dry cereals, bread sticks or pretzels.
• Choose cold foods or foods at room temperature instead of hot, fried, greasy or spicy foods.
• Eat and drink slowly and chew your food well.
• Try foods with ginger, e.g. ginger biscuits, or ginger beer.
• Avoid foods that are overly sweet, fatty, fried, spicy or oily, or that have strong smells.
• Brush teeth regularly to help reduce unpleasant tastes that may make you feel nauseated.
• Do not eat your favourite food when feeling nauseated to avoid developing a permanent dislike
• Suck on hard lollies – flavoured with ginger, peppermint, or lemon.
• Try ginger food and drink items, such as candied ginger, ginger beer, ginger ale, or ginger tea. Talk to your dietitian doctor or pharmacist about ginger supplements.
• Take anti-nausea medicines as prescribed. Let the doctor know if the medicines don’t seem to be working.

Vomiting

Vomiting is the forcible emptying (“throwing up”) of stomach contents through the mouth. Vomiting can follow nausea and may be caused by treatment, stress, food odours, gas in the gastrointestinal tract, motion sickness or even the thought of having treatment.

Vomiting is more serious than nausea. Vomiting can cause dehydration and increase the risk of malnutrition. See a doctor if you are vomiting for more than one day, especially if you cannot keep water down.

Tips on how to cope with vomiting:

• See your doctor if you can’t keep fluids down, or if vomiting lasts for more than 24 hours, as you may become dehydrated.
• Take small sips of water or clear liquids, such as ginger ale, soda water or sports drinks like Gatorade or Hydrolyte. Dilute sweet drinks. If you feel like a fizzy drink, open it, and let it sit for 10 minutes or so, and drink it when it’s a bit flat. Sucking on crushed ice cubes or an iceblock can be soothing.
• Once you are handling step 1 okay, try some different drinks, such as consommé and clear broths, weak tea, herbal tea, fruit drinks, beef and chicken stocks. Have small, frequent meals and snacks throughout the day.
• Introduce bland, starchy foods, such as plain biscuits, bread or toast with honey or jam, peanut butter, rice, yoghurt or fruit. Trying to attempt small, frequent servings.
• Consume a little bit more each time until you are eating a well-balanced diet.

After treatment chewing and swallowing may be difficult and painful. Surgery, radiotherapy, and chemotherapy can cause temporary problems. People with dentures who have lost weight may also find their teeth become loose, which can make eating difficult.

Signs that you are having problems with chewing and swallowing include taking longer to chew and swallow, coughing or choking while eating or drinking, or food sticking in your mouth or throat like a ball.

Tips on chewing and swallowing:

• Change how you prepare your food by chopping up smaller or pureeing.
• Let your doctor know that you are having issues and get a referral to see a speech pathologist and dietitian.
• A speech pathologist can monitor your ability to swallow and suggest modifications to the texture of your food once your ability to swallow and chew begins to improve. A dietitian can ensure you are meeting your nutritional needs.

Some chemotherapy drugs and some pain medicines can make your mouth dry, cause mouth ulcers, or change the amount of saliva in your mouth. A dry mouth can increase the risk of tooth decay and infections such as oral thrush, which will make eating harder.

Tips to lesson discomfort with mouth sores:

• Suck on ice cubes.
• Eat soft foods – stews, soups, scrambled eggs and smoothies.
• Cold foods and fluids may be more comfortable than hot.
• Avoid ‘coarse’ foods that can irritate your mouth, such as crackers, toast, nuts and seeds
• avoid spicy or very hot foods.
• Use a straw and direct liquids away from the areas where mouth sores are most painful.
• Talk to your doctor about medication or mouth washes to help manage the pain and allow you to eat more comfortably.
• Ulcers may also be present in your digestive tract, causing discomfort in the stomach or bowel and diarrhoea.

Tips to relieve a dry mouth:

• Suck on ice cubes.
• Keep your mouth clean with regular mouthwashes to prevent infections.
• Gargle with 1⁄2 tsp salt or 1 tsp bicarbonate of soda in a glass of water.
• Choose an alcohol-free mouthwash to avoid irritating your mouth further.
• Use a soft toothbrush when cleaning your teeth.
• Ask your dentist or health care team about suitable mouth rinses or oral lubricants.
• Limit alcohol and coffee as these are dehydrating fluids, and avoid smoking.
• Avoid ‘coarse’ foods that can irritate your mouth, such as crackers, toast, nuts and seeds.
• Avoid spicy or very hot foods.
• Soften food by dipping it into milk, soup, tea or coffee.
• Moisten with sauce, gravy, cream, custard.
• Sip fluids with meals and throughout the day.
• Chew sugar-free gum to stimulate the flow of saliva.

Living with cancer and its treatments can result in changes to your bowel habits. This could be differences in the appearance, consistency, and/or the smell of your stools.

Constipation

This is when your bowel motions are infrequent and difficult to pass. It can be caused by different factors including: regularly taking opioid medicines; having a diet low in fibre; not getting enough exercise; not having enough fluids to drink (dehydration); or having a low overall food intake.

Tips on how to manage constipation:

• Soften stools by drinking 8–10 glasses of fluid a day, e.g. water, herbal tea, milk-based drinks, soup, prune juice.
• Eat foods high in fibre, e.g. wholegrain breads, cereals or pasta; raw and unpeeled fruits and vegetables; nuts and seeds; legumes and pulses.
• If you are increasing the amount of fibre in your diet, increase fluids to prevent the extra fibre making constipation worse.
• Ask your doctor about using a laxative, stool softener and/or fibre supplement.
• Exercise – check with your doctor, exercise physiologist or physiotherapist about the amount and type of exercise that is right for you.

Diarrhoea

This means your bowel motions are watery, urgent and frequent. You may also get abdominal cramping, wind and pain. Frequent loose stools can occur because you are not digesting food or absorbing nutrients properly, cancer treatment, medicines, infections, reactions to certain foods and anxiety can all cause diarrhoea.

Diarrhoea can result in dehydration, so it’s important to stay hydrated by drinking extra fluids. Every time you have a loose bowel movement you should drink an extra cup of non-caffeinated fluid. If you have diarrhoea for several days, see your doctor so he/she can determine the cause and help to manage your diarrhoea. Your doctor may decide to prescribe you anti-diarrhoea or over-the-counter medication. In some cases, Creon © may be recommended.

Tips on how to manage diarrhoea:

• Drink plenty of fluids to avoid becoming dehydrated. Water and diluted cordials are better than high-sugar drinks, alcohol, caffeinated fluids – remember signs of dehydration are smaller amounts of dark urine.
• Choose low-fibre foods, e.g. bananas, mashed potato, rice, pasta, white bread, oats, steamed chicken without the skin, white fish.
• Avoid foods that increase bowel activity, e.g. spicy, fatty or oily foods; caffeine; alcohol or artificial sweeteners.
• Try soy milk or lactose-free milk if you develop a temporary intolerance to milk (lactose).
• Don’t eat too many raw fruit and vegetable skins and wholegrain cereals as they may make diarrhoea worse.
• Avoid foods and drinks that are high in sugar, such as cordial, soft drinks and lollies – especially if you’ve had a Whipple’s procedure.
• Avoid foods sweetened with artificial sweeteners such as sorbitol, mannitol and xylitol. These are often marketed as ‘sugar-free’.
• It may also help to eat small, frequent meals throughout the day, rather than three large meals.

Some cancers and treatments can cause heartburn, which is a burning sensation in the upper chest, oesophagus and/or throat. It is caused by the contents of the stomach coming back up into the oesophagus (reflux).

Heartburn may make you feel too uncomfortable to eat much, which could lead to weight loss. If the tips below do not relieve heartburn, let your doctor know as medication may help.

Tips to manage heartburn:

• Avoid large meals; try to eat 3 small meals and 3 small snacks throughout the day.
• Eat slowly and take the time to enjoy your meal. Avoid wearing tight clothing while eating, especially belts.
• Sip fluids between meals, rather than drinking large amounts at mealtimes.
• Limit or avoid foods that may make heartburn worse, e.g. chocolate, highly seasoned spicy foods, high-fat foods (e.g. fried food, pastries, cream, butter and oils), tomato and tomato products, citrus fruits, coffee (including decaf), strong tea, soft drinks and alcohol.
• Straight after eating, sit upright for at least 30 minutes and avoid lying down or activities that involve bending over (e.g. gardening).

Your doctor may also give you some medications to help prevent or manage these side effects.

Peripheral neuropathy is caused by damage to the peripheral nerves. These are the nerves in the body outside the brain or spinal cord. Peripheral neuropathy may be caused by cancer, cancer treatments or other health problems. It most commonly affects the hands and feet.

The most common symptoms of peripheral neuropathy can include:

• Tingling, burning, numbness or pain in the hands or feet
• Difficulty doing up buttons and picking up small items
• Loss of feeling especially in the hands and feet
• Problems with balance or walking, and clumsiness

Peripheral neuropathy caused by cancer treatment will get better over time with proper treatment and care. Be safe. If you notice changes in your walking, stance, fine and gross motor skills, or balance speak to your doctor as soon as possible and also ask for a referral to an occupational therapist, exercise physiologist or physiotherapist.

Tips to manage peripheral neuropathy:

• Use a night light.
• Keep clutter and rugs off the floors.
• Have clear paths to the toilet and bedroom.
• Use handrails where possible.
• Use nonslip mats in the shower and bathroom.
• Be careful on slippery and wet floors.
• Do not walk around bare footed.
• Wear shoes and slippers that fit well.
• Use a walking stick if you need to.
• Wear gloves when washing up, cleaning and gardening.
• Test water temperature with your elbow.
• Take care when cutting food and opening cans or jars.
• Keep your skin moisturised to prevent cracking.
• Check your hands and feet daily for signs of injury, rubbing, redness or infection.
• Ask for help if you need it, e.g. to do up buttons and shoes.
• Find clothes and shoes that are easy to put on and take off.
• Avoid driving if symptoms are severe.