Your Oncology Nutritionist: Helping Throughout Your Cancer Journey

“Your Oncology Nutritionist: Helping Throughout Your Cancer Journey” was written by Jen Akimoto, RD & reviewed/edited by Aly Bouzek, MS, RDN. Jen is a Registered Dietitian at The Blending Dietitian.

Your Oncology Journey Starts

Chances are you or someone you know has been affected by cancer. If you are here, maybe you or someone you love has been diagnosed and you’re looking for help. 

Like Dorothy, on the yellow brick road, you will come upon obstacles but you’ll also come upon people who will offer you courage, knowledge, and love. 

You will meet many different characters on your journey, and the oncology nutritionist will be one that can provide support at all turns.

Oncology is the “Fancy” Name for Cancer

Oncology is defined as “a branch of medicine concerned with the prevention, diagnosis, treatment, and study of cancer”.

Like many medical terms, the word oncology is rooted in ancient Greek.

Onkos, which has evolved into onco-, means “bulk or mass” and -logy means “the study of.”

An oncologist is a doctor that specializes in treating cancer. Along your cancer journey, you may see several different oncologists that specialize in different areas of cancer treatment.

• A radiation oncologist is a specialist in treating cancer with radiation. 
• A medical oncologist deals with chemotherapy treatments for cancer. 
• A surgical oncologist treats cancer with surgery to remove cancer. 
• An oncology nutritionist is a registered dietitian, and member of your oncology team that focuses on your nutrition through your cancer journey.

Oncology Nutritionist or Oncology Dietitian?

You may see both names out there so let’s clear up how they are used. 

A registered dietitian can call themselves a nutritionist, but not the other way around. 

The terms registered dietitian (RD) and registered dietitian nutritionist (RDN) are regulated, meaning that someone has to go through very specific training to use these titles. 

An RDN has completed an undergraduate degree in nutrition, a master’s degree (though not yet required), an internship, and has passed a strenuous exam to be able to use that title. 

Once someone becomes an RDN, they can choose to obtain more specialized training. One of those areas of specialization is oncology. 

Again, they need to meet a minimum number of hours (2,000 hours) working with cancer patients and then take another exam to be able to say they specialize in oncology.

On the other hand, anyone who has an interest in nutrition or has taken a weekend course can call themselves a nutritionist. 

Would you let someone open your chest and do heart surgery if they just had a particular interest in heart health and read a few books? Probably not! So why seek advice and comfort from someone who’s taken a weekend course on nutrition and calls themself a guru?

To make sure someone who is qualified, check for the letters after their name – RDN for Registered Dietitian Nutritionist, or RD for Registered Dietitian. If a RDN or RD has an oncology specialization, they will have the letters CSO (Certified Specialist in Oncology Nutrition). 

You want someone with those letters of designation after their name so you know you’re getting sound nutrition advice from a professional.

For the purposes of this article, when the term oncology nutritionist is used, we are referring to a registered dietitian nutritionist who specializes in oncology.

Role of the Oncology Nutritionist

Good nutrition is important throughout your cancer journey. Staying well nourished can help you (1):

• feel better
• stay strong during your treatments
• tolerate the treatments better
• recover more quickly after treatment

Going through cancer treatment is hard on your body and may make good nutrition challenging at times.

Your oncology nutritionist can help you by assessing your needs and individualizing your nutrition plan to help you stay nourished.

Your Journey Starts: Request an Oncology Nutritionist

Cancer itself as well as cancer treatment is very catabolic, meaning that it uses a lot of energy and it breaks down muscle and fat in your body. You may have lost weight and muscle before you even got diagnosed. 

Asking your medical team (early in your cancer journey) to speak to an oncology nutritionist can help get you off to a strong start.

Assess Your Nutrition

To start, your oncology nutritionist will assess how you’re doing with eating and assess your nutritional status.

Maybe you were having symptoms which made you avoid certain foods or eat less than you normally do. This can mean that your body has been missing out on nutrients that it needs to stay healthy and strong. 

Your oncology nutritionist will ask you about what foods you eat, your pattern of eating, and your likes and dislikes. They may do a physical assessment as well that will help determine if you’ve lost muscle and fat. (2)

They will also identify your symptoms and determine what strategies will work best for you so that you are staying nourished as best you can.

Reaching Your Nutrition Goals

Your personal nutrition goals may vary from someone else with the same cancer. Your oncology nutritionist can help to identify your goals and plan ways to help you reach them. 

If you’ve lost weight, you are not alone; up to 40% of people have already lost weight at the time of diagnosis. 

Weight loss could mean that you’ve lost not only fat but muscle too. Maintaining your muscle is important (1,3):

• to keep you feeling well throughout your treatment
• to have the energy to complete your daily activities
• to have a good quality of life
• to recover faster

Getting enough protein is also important to maintain your muscle mass. The trouble is that many adults with cancer don’t meet the minimum protein requirements for healthy adults. And when you have cancer, you need even more protein to maintain your muscle. (1)

How much protein, calories, and fat your body needs will be individualized. Your oncology nutritionist will guide you and give you goals to help meet your specific needs. 

Cancer “Food” Myths

These days, there is so much information readily available online. It can be tempting to search for cures to all your ailments, including cancer. 

The internet certainly has a vast amount of helpful tools and information but, unfortunately, there is a lot of inaccurate information out there as well.

If you see something online about a particular “superfood” or particular nutrient that will fight your cancer, talk to your healthcare team and oncology nutritionist to learn more. They can give you specific advice about you and your cancer situation.

Treatments: Your Oncology Nutritionist is There for You

Your treatments may include chemotherapy, radiation or surgery, or a combination of these treatments. Your oncology nutritionist can help you with your nutrition as you work through this challenging stage in your journey.

Oncology Nutritionist: Medical Oncology During Chemotherapy and Radiation

Going through chemotherapy and radiation can be very hard on your body.

Some of the side effects you experience will make eating a challenge. 

We are going to review some common symptoms during cancer treatment that might affect your eating.

These tips may give you some ideas, but if you meet with an oncology nutritionist, they can give you individualized help.

When You Don’t Feel Like Eating

During cancer treatment, it is very common to lose your appetite. You may have a low mood or feel unwell and food just doesn’t appeal to you. (4)

Eating small snacks, often, throughout the day, can be easier to achieve than trying to sit down and have a big meal. 

Keep easy to grab foods in the fridge to make snacking more convenient. This could mean grabbing a pudding or yogurt, or having a couple crackers with cheese or peanut butter. 

Try high calorie foods that give you the most bang for your buck – like these High Calorie Smoothies. If you can’t drink a whole smoothie, then split it into a few snacks for the day.

When You’re Too Tired to Cook

Chemotherapy and radiation can make you feel tired. 

If you can, prepare some small meals for the freezer before you start your treatments. Or even better, ask friends and family to help out and stock your freezer.

Once you start treatments, you may have some days that are better than others. You can use those better days to do some food preparation and restock your freezer.

Portion out single servings and put them in the freezer for those days when you can’t do much more than get out of bed.

Pre-made meals are an option too. Depending on where you live, there may be home delivery services for ready-to-eat meals. 

Your nutritionist may have some resources for ready-to-eat meals in your area. They can also help you choose healthy frozen meals from your local grocery store.

When Your Digestive System Isn’t Happy

You may experience diarrhea or constipation while you are going through your treatments.

If you are having diarrhea, it’s important to stay hydrated. Drink liquids like broth, juice, and non-carbonated drinks. Talk to your nutritionist about foods you may want to avoid during this time. If your diarrhea is persistent, talk to your healthcare team and nutritionist.

Sometimes people can get constipated while going through cancer treatment. This may be because of a change in eating, lack of activity, or drinking less liquids. Talk to your nutritionist about slowly increasing your fiber and fluid intake.

It Hurts to Eat and Everything Tastes Wrong

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Some chemotherapy drugs and radiation can cause a dry, sore mouth and throat and make eating more difficult. It may also affect your taste buds and make foods taste “off” (some patients describe food as having a metallic or chemical taste or no taste at all). (4,5)

Your oncology nutritionist will help you with tips and tricks to make eating more manageable.

In the meantime, make sure you are drinking lots of liquids like water, broth, and milk. Sucking on popsicles can be soothing and will also keep you hydrated. 

Solid food may be harder to swallow when your mouth and throat hurt.

Try eating softer, cooked foods and keep everything moist. You can also add sauce or gravy to drier foods. You may even want to try mashing food into smaller pieces or using a blender* to puree your foods.

Foods that are salty, spicy, or acidic may make your mouth feel worse. In this case, try blander foods. 

You may want to try foods that you haven’t tried before, or foods that you didn’t even like before – they may taste good to you now. 

If you can’t taste, try eating foods with stronger flavors or add more herbs, spices, or condiments.

Your oncology nutritionist will be able to give more suggestions based on specific flavor changes you may have.

Are All Foods Safe?

Cancer treatments can make your immune system weaker and less able to fight infection. You need to be mindful of food safety to reduce the risk of food poisoning. 

Follow safe practices for food preparation and storage, like washing your hands before preparing food, storing food in the refrigerator within 2 hours of serving, and thawing meat in the refrigerator.  

If possible, try to avoid: 

• raw eggs
• undercooked or raw meats
• undercooked or raw fish
• unpasteurized dairy products
• food with any visible mold 
• additional food safety tips can be found at Canadian Cancer Society

Oncology Nutritionist: Surgical Oncology and Eating After Surgery

Not everyone has surgery as a part of their cancer treatment, but you may have surgery to remove your cancer. If your cancer is in part of your digestive tract, including your mouth, throat, esophagus, stomach, or intestine, then your eating after surgery may be affected.

If You Can’t Eat by Mouth

Having a treatment plan that includes surgery means that you should ask your medical team how your eating may change.

If you aren’t able to eat by mouth, then you may be started on nutrition through a feeding tube. 

Tube feeding is often a new concept for people.

Here is some basic information on tube feeds and intravenous nutrition. 

Your oncology nutritionist will figure out your calorie, protein, fat, fluid, and micronutrient (vitamins and minerals) needs. Then, they will help figure out if a specific feeding method is needed so that you can get your food and nutrition.

If, or when, you are ready to get back to eating, your oncology nutritionist will also help you determine what foods to eat.

When You Have to Eat Differently After Surgery

Sometimes after surgery, you may have to eat food differently. This may change short term or long term, depending on what surgery you have had and how your recovery is progressing.

For example, if you had surgery in your mouth, then there may be a short time when you can’t eat so that your incisions heal and swallowing gets easier for you. 

When you can start eating again, you will likely start with liquids. Then you may eat mushy or soft food for a while until everything has healed and your swallowing is back to normal.

Your nutritionist will help give you suggestions for food that is safe for you to eat. They will teach you about how to eat to stay nourished and help you heal.

Cancer Survivor: Now What Should You Eat?

You can still benefit from the advice from your oncology nutritionist when you have made it through your treatments and if your medical team says that you’re cancer free.

There is limited research on what specific diet or foods will prevent your cancer from coming back, but it is advised to follow healthy eating principles for cancer prevention.  

What does that look like?

As always, talk to your medical team about what is right for you and your recovery but here are some recommendations from the World Cancer Research Fund and the American Institute for Cancer Research.

Eat the Rainbow and Choose Whole Grains

You’ve probably heard it before: eat lots of colorful fruits and vegetables.

Don’t just eat the white stuff: choose whole grains.

Eating lots of fruits and vegetables and whole grains gives your body tons of nutrients and fiber.

Most of us aren’t getting enough fiber in our diets. But what is enough? 

You should aim to get at least 22 to 31 grams of fiber per day depending on your age and sex. 

For reference:

• 1 cup of black beans has 15 grams of fiber
• 1 cup of raspberries has 8 grams of fiber
• 1 medium potato (skin eaten) has more than 6 grams of fiber

Red Meat and Processed Food

Ok, you don’t need to be vegetarian. But if you do eat red meat, then try to eat it in moderation. 

Recommendations are to limit red meat to no more than 12 to 18 ounces per week. Also, try not to consume processed meats such as lunch meat, pepperoni, and other cured meats. 

Research suggests that eating too much red meat or processed meat can cause colorectal cancers. 

What About Alcohol?

Alcohol intake has been associated with some cancers such as mouth, throat, esophagus, liver, colorectal and breast cancer. 

Some people may not like to hear this recommendation, but when talking about cancer prevention, the recommendation is to avoid alcohol. You need to do what feels comfortable for you, but discuss your risk with your healthcare team to help you with your final decision.

It Takes a Village

Fighting this disease can feel like a never-ending journey at times. It will be important to have support people along the way. Enlist the help of anyone who offers and reach out for help when you need it.

Your healthcare team can often help with additional resources available in your community.

Nutrition will also be an important part of your cancer journey. Ask your healthcare team about speaking with an oncology nutritionist to get you off to a strong start, to keep you strong through your treatments, and to give you advice about healthy eating while you recover.