Navigating Nutritional Challenges in Cancer Survivorship and Care

Denise B. Reynolds, RD

Atrium Health Levine Cancer

Nutrition is an important and often overlooked aspect of the oncology treatment paradigm that could significantly impact the health and quality of life of patients undergoing radiation therapy, chemotherapy, and other modalities for cancer.

Denise B. Reynolds, RD, spoke with CancerNetwork® about common nutritional challenges she observes in patients undergoing treatment for cancer or in cancer survivors, as well as strategies she employs to help mitigate their frequency and severity. Specifically, she addressed common treatment-emergent adverse effects (TEAEs) associated with cancer treatment, such as nausea and vomiting, weight gain/loss, taste and smell alterations, and mucositis or dysphagia.

She began by highlighting appetite-related concerns that emerge with the cancer itself, with a particular focus on weight loss. Reynolds expressed that unintentional weight loss often prompts patients to consult with a dietitian. Furthermore, she touched upon the use of nutritional supplements in patients with cancer, suggesting that some iron supplementation may be used for anemia, but she discouraged the use of immune-boosting supplementation, which can interfere with cancer treatment.

Reynolds then outlined strategies for combating various TEAEs, such as foods having a metallic taste and electrolyte-enriched beverages for nausea, and counteracting taste changes with contrasting food types, such as adding spices to patients who report food tasting bland. For longer-term health in patients who have finished treatment or who are cancer survivors, Reynold’s practice recommends patients adhere to the New American plate diet, which restricts the intake of animal proteins and encourages a greater consumption of fruits, vegetables, whole grains, nuts, and fiber, which she expressed may help patients reach and maintain a healthy weight.

In conclusion, she touched upon optimal strategies for collaboration among dietitians and oncologists.

CancerNetwork: What are some of the most common nutritional challenges you see in patients with cancer, and how do you approach these?

Reynolds: Many times, the cancer itself will cause issues with appetite, [gastrointestinal] upset, things like that: it is different for everyone. Cancer treatment can make those situations worse, but some of the issues that they have start with weight loss, which is one of the reasons why they go to their doctor. They [may say] “I have lost this weight. I do not know why I am not eating.” They may know that they have a loss of appetite, but they do not feel like they have done anything to create that weight loss themselves. It was not intentional, and that is one of the things that drives them to the doctor to figure out what is going on with them.

Are there any specific vitamins or minerals that you find are consistently deficient in patients with cancer, and do you recommend supplementation?

Reynolds: It is different for every cancer, and cancer treatment is individualized. There are issues. For example, if you have nausea and vomiting, then you are [likely] losing a lot of fluid [and] you are not keeping the calories down. Overall, if someone is eating well, they should not be deficient in any specific vitamins. Now, the cancer treatment itself can cause anemia, because you are breaking down cells––breaking down red blood cells. A physician may ask that you take iron or may have an iron infusion. If you are deficient in vitamin D, which so many of us are, even without cancer, they might recommend a vitamin D supplement. Other than that, we do not recommend any supplements while you are receiving cancer care.

Certain supplements can be high in, say, antioxidants, and that can interfere with the chemotherapy [or] radiation. For [patients] who do not recognize that, they [may] have friends and family who give them high-powered supplements or drink something that helps boost their immune system, so to speak. We do not want that. That can interfere with some of the treatment that we offer our patients.

What nutritional strategies do you recommend to ensure adequate intake [and combat vomiting and nausea]?

Reynolds: As a dietitian, you will probably often hear me say small, frequent meals… quite a bit, [Many] times, you cannot eat a [food in volume or] sit down and eat a regular-sized meal. Eating a little bit throughout the day will help keep your nutrition level up, and it may actually help with the nausea. Unlike certain nausea that you get when you have the flu or food poisoning, you do not feel like eating, and you do not want to put anything in your stomach, but having something in your stomach during the nausea and vomiting from chemotherapy can help quell some of that nausea.

I think of it a lot like pregnancy nausea. I tell [patients] to keep crackers by their bed, to eat first thing in the morning to help quell that nausea. It is similar. Crackers, dry toast, and chicken noodle soup are things that are bland and comforting, things without [many] smells, because that smell can also trigger nausea for [patients], and trying to keep things as simple as possible. Replacing fluids–ginger ale can be helpful. Sometimes plain water can be a bit nauseating. Having something with electrolytes in it, like a Gatorade or a Pedialyte [may help].

What advice would you give patients to help cope and combat taste and smell changes?

Reynolds: One of the most common taste changes that we see is with one chemotherapy that makes [many] things taste like metal, and in those cases, we recommend using plastic forks or using chopsticks [and] eating foods that are frozen vs canned. Getting frozen vegetables and frozen fruits, vs canned [and] drinking out of a plastic bottle or with a straw so that you are not touching that metal, may help].

Some of the other taste changes we hear about are things tasting [abnormally] bitter. In that case, adding a bit of sweetness to your food can help, even if it’s a citrusy type of flavor.Chicken with orange sauce, or beef with orange sauce, something like that, will help bring a little bit of sweetness to the food and make it not taste quite so bitter. If something tastes bland, which we get [frequently] with our radiation patients, instead of adding extra salt, which we know is not good for you, adding strong spices like oregano, or if they can tolerate something spicy, go for a bit of hot sauce or chili powder, or something like that [can help].

If they are having any issues with their mouth––sore mouth or anything––then, of course, we want to avoid the spicy foods. All that being said, [we try] balancing whatever taste that you have with the opposite. If things are too sweet, balance it with something bitter. If something is too bitter, balance it with something sweet.

How do you manage the nutritional needs of patients with mucositis or dysphagia?

Reynolds: The mucositis and the mouth sores that can come from chemotherapy can also come from radiation to the head and neck. That beam can hit and cause inflammation on the inside of the mouth. Then dysphagia is trouble swallowing. The first thing is to try something soft, trying, say, scrambled eggs or a chicken salad, vs a chicken breast. Something that is soft and moist will be a bit easier to [swallow].

Things that are cold soothe the mouth. [Many] times, we have patients who will hold ice in their mouth to help freeze that area a little bit, make it feel a bit more soothing. Rinsing the mouth out––keeping good oral care during that time [will help] if you are having sores in your mouth, which can lead to bacteria, and it can lead to things like gingivitis and infections of the mouth. Keeping the mouth rinsed clean with something, [an alcohol-free rinse], because [alcohol] would burn.

Spicy foods can be painful if you are having issues with dysphagia. Again, the softer foods, adding moisture, and cooking foods. If you are eating meat, cooking it in a crock pot can help bring some of the moisture back to the food and help it go down a bit easier. Adding gravies and sauces to foods can help with that as well.

For patients who have survived cancer, what nutritional advice would you give to help them promote even longer-term health?

Reynolds: We always follow the American Institute for Cancer Research guidelines. They have something called the New American plate, and it is similar to a Mediterranean-style diet, in that we are reducing the amount of red meat that they are eating, and then fish and chicken are in smaller portion sizes. We are trying not to overload [them] with animal proteins and bring back those fruits and vegetables, nuts, seeds, whole grains, increasing the amount of fiber that someone is getting, trying to get someone to reach a healthy weight, whether they are underweight or overweight. [We are] trying to get their nutrition status back to where they are reaching that healthy weight again.

Not necessarily nutrition-based, but we always want to get people moving again if they can. Fatigue is a common lingering effect for cancer survivors after they have finished their treatment, but eating a good, healthy diet, rich in fruits and vegetables and whole grains, and getting in some exercise can help with that fatigue. Lastly, staying hydrated, because it's easy to get dehydrated, even again, for a healthy person. Making sure that, as a survivor, you are staying hydrated can also affect fatigue.

What is the best way for clinicians to collaborate with a registered dietitian to improve patient outcomes?

Reynolds: We have 18 dietitians here at Atrium Health, and most of our dietitians are helping patients while they are [undergoing] active treatment, and they are helping with those nutrition impact symptoms: the nausea, [gastrointestinal] upset, taste changes, weight loss, and all of the things that come surrounding a cancer treatment. Helping someone be the best they can to get through that treatment, just ask the nurse, ask your doctor for a referral to a dietitian, and we are more than happy to come talk to you, either on the phone or while you are in the clinic.

Is there anything else that you would like to highlight today?

Reynolds: [Remember] that food is fuel. We are always here to answer questions for you, whether it is about supplements or a particular food or a something you have heard [or to correct] misinformation. We can help clear that up for you. Always ask questions, always be your best advocate, and we are all here to help you through this journey.

Reference

Setting Your Table to Prevent Cancer. American Institute for Cancer Research. Accessed September 2, 2025. https://tinyurl.com/w7pfsc9d