Meal Planning When Caregivers Are Helping

Caregivers end up in charge of food by default. It is the one part of cancer treatment that seems to sit inside your control. You cannot change a scan result, but you can make soup.

That instinct is good and it is also where most caregivers get hurt. Food becomes a scoreboard. A refused plate feels like a refused rescue. This page is about building a system that feeds the person well without turning every meal into a test.

Most treatment runs on a cycle, and appetite tends to track it. Take someone on a three-week chemotherapy cycle. They often have a rough stretch in the first few days after infusion. Then comes a flat patch, then a better week before the next round.

Spend one cycle just watching. Note which days food went down easily and which foods came back up or were left. You are not looking for a diet. You are looking for a pattern you can cook to.

Keep the list somewhere visible. A single sheet on the fridge headed "worked" and "did not work" beats any recipe book, because it is specific to this person, this month.

The National Cancer Institute is unusually concrete about this. It suggests eating small meals every two to three hours, about five or six meals a day, rather than three large ones.

A few details from that same guidance are worth copying exactly:

• Eat something within an hour of waking. Appetite is often best early.
• Use a cue to remember. NCI suggests an alarm, or a TV show or radio ad break.
• Prepare small portions of favorite foods in advance, so a good moment is not wasted on cooking.

If swallowing is hard, NCI suggests sitting upright when you eat and staying upright for at least 30 minutes afterward.

When the volume of food is small, the density matters. NCI suggests adding whole milk to cereal, full-fat cheese to toast, eggs and soups, and creamy sauces to pasta. It also suggests making milkshakes or smoothies with whole milk or yogurt to raise calories.

Oral nutrition supplements have a place too. NCI says to sip nutrition supplement drinks, such as Ensure and Boost, between meals. Ask the dietitian which kind suits you.

Sometimes the person is eating and still losing weight. This is not a failure of your cooking.

The clinical term is cachexia. The NCI professional summary quotes an expert definition. It calls cachexia a multifactorial syndrome with an ongoing loss of skeletal muscle mass. This loss cannot be fully reversed by conventional nutrition support. It leads to progressive loss of function.

If that is what is happening, more food will not fix it, and pushing harder only costs you both. What helps is telling the team early, so that other options can be considered while there is still time for them to matter.

NCI also says that food and fluids should not be forced on someone who is at the end of life, because doing so can cause discomfort or choking.

Ask the team how often they want the person weighed. Use the same scale each time.

NCI says to speak with the doctor or dietitian right away if weight starts to drop. It also says to report a weight loss of more than 3 to 5 pounds in one week to the doctor. A number on a chart is far more persuasive at an appointment than "he has not been eating much."

Most days the menu should follow whatever is worst right now.

• Nausea. NCI suggests cold foods such as popsicles, pudding, yogurt and gelatin. It also suggests bland, starchy foods such as toast, rice, plain pasta and crackers, and sipping fluids through the day.
• Sore mouth. NCI suggests softer foods. It says to avoid foods that are crunchy, salty, spicy or sugary, and alcohol.
• Taste changes. NCI suggests switching red meat for chicken, eggs, fish, turkey, beans or dairy. Use plastic utensils if food tastes metallic.
• Diarrhea. NCI suggests plenty of fluids and foods such as peeled boiled potatoes, soup, bananas, applesauce and crackers. It says to avoid alcohol, milk and dairy, spicy foods, caffeine, dried beans, high-fat foods and fruit juice.
• Constipation. NCI says to drink plenty of liquids and stay active. Check with the doctor before taking any medicine for constipation. Fiber can make constipation worse for some people, so ask the doctor first.
• Fatigue. Choose foods that need no chewing and no cooking. This is what the freezer is for.

Food safety runs underneath all of it, because treatment lowers the white cells that fight infection. Cook poultry to 165°F, ground meat to 160°F, and whole cuts of beef, pork and fish to 145°F. Use a food thermometer. NCI says to keep hot foods hot and cold foods cold.

Call 911 or go to the nearest emergency department for:

• Black or tarry stool
• Blood in vomit, or vomit that looks like coffee grounds
• Bleeding that will not stop
• Sudden confusion, or being hard to wake
• Sudden inability to urinate at all

If the person is on chemotherapy, had a stem cell transplant, or has low white blood cells, call the care team right away, day or night, for:

• A temperature of 100.4°F (38°C) or higher
• Chills, a sore throat, mouth sores, or burning when urinating
• Redness or swelling where a catheter enters the body
• Any other sign of infection

Do this even if the temperature is normal. A normal temperature is not permission to wait.

Call the care team for:

• Weight that drops more than 3 to 5 pounds in a week, or keeps drifting down
• Not being able to keep fluids down
• Swallowing that hurts, or food that sticks
• Vomiting, diarrhea or constipation that is severe or does not improve
• Eating becoming a source of conflict between you

• Can we be referred to an oncology dietitian, and how soon?
• What is a realistic weight goal here: gain, hold, or slow the loss?
• How many calories and how much protein should we aim for each day?
• Are supplement drinks worth it for us, and which kind?
• Is appetite loss here treatable with medicine?
• What should I stop worrying about?

See Helping a Loved One Eat During Cancer Treatment, Food Safety During Cancer Treatment, Smoothies and Liquid Nutrition During Treatment, and Food and Fluid Plan for Chemo Day.

• https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss
• https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-pdq
• https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-hp-pdq
• https://www.cancer.gov/about-cancer/treatment/side-effects/infection
• https://www.cdc.gov/food-safety/foods/weakened-immune-systems.html