Nutrition Questions Before Cancer Treatment Starts

There is usually a short gap between the day you learn the plan and the day treatment starts. It is an uncomfortable stretch of waiting, and it is also the most useful window you will get for nutrition. Almost everything on this page is easier to arrange now than in week six, when you are tired and your mouth hurts.

None of it requires you to change how you eat. It is groundwork.

Weight is the single number your team will track hardest, and it only means something if there is a number to compare it against.

Weigh yourself on your own scale, in the morning, before breakfast. Write the date next to it. Then find out roughly what you weighed six months ago, because that comparison matters more than most people realize.

The NCI professional summary uses set cutoffs when defining cancer cachexia, a wasting syndrome. Losing more than 5 percent of your body weight over six months counts. So does losing more than 2 percent if your body mass index is already under 20, or if you have sarcopenia (loss of muscle mass). Knowing your six-month number tells your team, on day one, whether you have already crossed one of those lines.

Once treatment starts, tell your team about any fast or unplanned weight loss right away.

Being asked "how is your eating?" is not a screen. A screen sorts people into "at risk" or "not at risk," and that can lead to a dietitian referral.

Two validated tools show up repeatedly in NCI's professional guidance, both validated for hospital and outpatient cancer settings. The Malnutrition Screening Tool, or MST, is two questions long. The Patient-Generated Subjective Global Assessment, or PG-SGA, is longer. It covers weight history, food intake, symptoms, and daily activities.

Ask which one your center uses and ask to be screened before treatment starts rather than after a problem shows up.

This is the most commonly missed item on the list, and the timing is specific.

NCI advises an oral health checkup at least a month before cancer treatment begins. That gap exists so the mouth has time to heal from any dental work. Cavities, broken teeth, loose crowns or fillings, and gum disease all get worse under treatment, and a mouth infection during chemotherapy is a far bigger problem than a filling.

NCI notes that anyone having high-dose chemotherapy, a stem cell transplant, or radiation therapy should have an oral care plan in place before treatment starts.

Nutrition side effects are not random. They follow the treatment, and NCI lists them by type.

• Chemotherapy tends to bring appetite loss, nausea and vomiting, constipation, diarrhea, dry mouth, mouth or throat sores, taste changes, and trouble swallowing.
• Radiation depends on where the beam points. Head and neck radiation can bring dry mouth and taste changes. Abdominal radiation can bring nausea and diarrhea.
• Surgery needs extra nutrients for healing. It can bring appetite loss and trouble swallowing.
• Immunotherapy can bring fatigue, fever, nausea, vomiting, and diarrhea.

For other treatments, such as targeted therapy or stem cell transplant, ask the team what to expect.

Ask which two or three are most likely for you, and ask what the plan is for each before it happens.

Bring every bottle from the cabinet to the first appointment. Vitamins, minerals, herbs, protein powders, and anything a friend recommended.

NCCIH is direct about the risk: some herbs may make chemotherapy drugs less effective. On vitamins and minerals it says the effects of taking them during cancer treatment, including antioxidant supplements, are uncertain. Because they might interfere with chemotherapy or other cancer therapies, it says you should discuss their use with your health care providers.

That is a conversation to have once, before day one, rather than a decision to make alone halfway through.

NCI's own advice for this window is practical. Fill the refrigerator, pantry, and freezer with food you will actually eat. Cook ahead and freeze in portions. Choose foods high in protein and calories.

The point is not stockpiling. It is that on the bad days you will eat whatever takes the least effort, so the least-effort option should already be something worth eating.

Treatment lowers the white blood cells that fight infection, so a foodborne illness lands harder. The rules are federal and easy to learn now.

The CDC says to keep the refrigerator at 40°F or below. Do not leave perishable food out for more than 2 hours, or 1 hour if it is above 90°F. Use a food thermometer. Cook poultry to 165°F and ground meat to 160°F. Whole cuts of beef and pork need 145°F, then a 3-minute rest.

The CDC lists raw or undercooked meat, poultry, and seafood, unpasteurized dairy, unwashed produce, and raw dough as riskier foods. Ask your team which foods to avoid and when.

This sounds like a dark subject for a first appointment. It is better raised early than in a crisis.

NCI says that if eating becomes impossible, your team may talk with you about tube feeding or IV nutrition. Ask early whether either could be part of your plan.

• Am I at nutritional risk right now, and what did the screen show?
• Can I be referred to an oncology dietitian before treatment starts?
• Which nutrition side effects should I expect from my regimen, and when?
• Which of my supplements should I stop, and which are fine to continue?
• When do the food safety restrictions begin, and how long do they last?
• I have diabetes or kidney disease. How does that change the advice?
• Who do I call about eating problems between appointments?

Read next: Nutrition During Cancer Treatment, Are Supplements Safe During Cancer Treatment?, Food Safety During Cancer Treatment, Feeding Tube Basics During Cancer Treatment, and Smoothies and Liquid Nutrition During Treatment.

• https://www.cancer.gov/about-cancer/treatment/side-effects/nutrition
• 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/mouth-throat/oral-complications-pdq
• https://www.nccih.nih.gov/health/cancer
• https://www.cdc.gov/food-safety/prevention/index.html