How do I have an Easier to Eat, Nourishing Diet?

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Guidance to help people with cancer who have a sore mouth or difficulty chewing or swallowing to get all the nourishment they need through an easier to eat nourishing diet.

This information is not suitable for people with dysphagia.

Guidance published in July 2023, advises pregnant women and those with a weakened immune system to avoid eating ready-to-eat cold-smoked or cured fish, due to increased risk of severe illness from listeriosis. Older people should also consider the risks associated with eating these products. Products include smoked salmon, smoked trout and gravlax.

Please consider and advise your patients accordingly when using this resource.

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To facilitate improved dietary intake by increased energy and protein when following an easier to eat diet. For use with and by patients in acute care, on treatment and in palliative oncology care settings experiencing a range of side effects from cancer and/or treatment.

Enables clients and their carers understand how to adapt their diet to cope with a range of side effects associated with their cancer, treatment or other illness, and to improve their diet to achieve best possible health outcomes and quality of life.

The target group will know how to adapt their diet to enable them to cope with eating difficulties and challenges by:

  • Adapting food choices to cope with certain difficulties with eating and drinking associated with their health and treatments
  • Providing guidance to complement standard messages, adapting as appropriate to meet nutrition and hydration requirements.
  • Taking action to maintain a healthy mouth. 
  • Increasing energy and protein intake through promotion of healthy fats; inclusion of protein with each meal; higher energy plant-based dairy alternatives and limiting/not promoting refined sugar, saturated fats, processed meat and salt.
  • ESPEN guidelines on nutrition in cancer patients (2016).
  • ESPEN expert group recommendations for action against cancer-related malnutrition (2017).
  • ESPEN practical guidelines: clinical nutrition in cancer (2021).
  • WCRF Diet, Nutrition, Physical Activity and Cancer: a Global Perspective Report (2018).
  • Principles and guidance for prehabilitation within the management and support of people with cancer. National Institute for Health Research, Royal College of Anesthetists and MacMillian Cancer Support (2020).
  • Cancer Cachexia in Adult Patients: ESMO Clinical Practice Guidelines (2021).
  • Diarrhoea in adult cancer patients: ESMO Clinical Practice Guidelines (2018).
  • Dunne R.F. et al. Cachexia and sarcopenia in older adults with cancer: a comprehensive review. Cancers 2019, 11(12), 1861.
  • Cao A. et al. Effect of exercise on sarcopenia among cancer survivors: a systematic review. Cancers 2022, 14 (3), 786.
  • Supriya R. et al. Effect of exercise on secondary sarcopenia: a comprehensive literature review. Biology (Basel). 2021 Dec 30;11(1):51.
  • Curtis A.R. et al. Associations between dietary patterns and malnutrition, low muscle mass and sarcopenia in adults with cancer: a scoping review. Int. J. Environ. Res. Public Health 2022, 19(3), 1769.
  • Pimentel G.D. et al. High protein diet improves the overall survival in older adults with advanced gastrointestinal cancer. Clin Nutr, 40 (3) (2021), pp. 1376-1380.
  • Arends J. Energy and protein intake may have an impact on survival in patients with advanced cancer. Clinical Nutrition, Volume 41, Issue 1, 2022, Pages 266-267.
  • Exercise for cancer cachexia in adults. Cochrane Review (2021).
  • Joseph P.V. et al. Fatigue, Stress, and Functional Status are Associated With Taste Changes in Oncology Patients Receiving Chemotherapy. Journal of Pain and Symptom Management, Volume 62, Issue 2, 2021, Pages 373-382.e2.
  • Milliron B-J. et al. Eating Becomes Torturous: Understanding Nutrition-Related Cancer Treatment Side Effects among Individuals with Cancer and Their Caregivers. Nutrients, 2022, 14, 356.
  • Epstein J.B. et al. Oral examination findings, taste and smell testing during and following head and neck cancer therapy. Support Care Cancer, 2020, 28, 4305–4311.
  • Nolden A. et al. Co-occurring Gastrointestinal Symptoms Are Associated with Taste Changes in Oncology Patients Receiving Chemotherapy. Journal of Pain and Symptom Management, Volume 58, Issue 5, 2019, Pages 756-765.
  • Loerzel V.W. Symptom self-management: Strategies used by older adults receiving treatment for cancer. Clinical Journal of Oncology Nursing, 2018, 22(1), 83-90.
  • Nolden A.A. et al. Chemosensory Changes from Cancer Treatment and Their Effects on Patients’ Food Behavior: A Scoping Review. Nutrients 2019, 11, 2285.
  • Blackwood H.A. et al. A systematic review examining nutrition support interventions in patients with incurable cancer. Support Care Cancer, 2020 28, 1877–1889.
  • Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment (2020).
  • Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines (2018).
    Baguley B.J. et al. Nutrition therapy for the management of cancer-related fatigue and quality of life: a systematic review and meta-analysis. British Journal of Nutrition, 2019, 122(5), 527-541.
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NDR-UK Ref No: 9461
Classification: HP
Pack size: 10
Publication date: 2021
Last Review: 2023
Last Update: 09/23

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