Cancer and its treatment can change the way you eat, how well your body absorbs nutrients from food, and the way your body uses the nutrients. Eating and drinking less than usual is very common when you have cancer, but it means the body may not get the energy, protein and other nutrients it needs. This can mean you lose weight without meaning to (unintentional weight loss). Unintentional weight loss is common in patients with cancer but may vary depending on the type of cancer you have.

If you are worried about unexplained weight loss or a poor appetite, either for yourself or for someone you care for, you can take the first step by using one of the simple self-screening tools available online: Malnutrition self-screening or via the Patients Association.

Information specific to eating problems with cancer and its treatments is available from the here to help page.

The results of the self-screening or the nutrition checklist must always be shared with your doctor, nurse or healthcare team; don’t make any changes to your diet without consulting a qualified healthcare professional first. If you find it difficult to start the nutrition conversation, the results can help you do so. Your healthcare professional may be able to offer advice and support or refer you to a dietitian for more expert advice.

Good nutrition is all about getting the balance right for you - the balance of nutrients that your body needs to function well, to cope with treatment and to help you get back on your feet. Eating and drinking well affects how you feel physically, from overall energy levels to how much you can do in the day. But your diet can also affect how you feel emotionally – not being able to eat when you know you need to can wear you down. Feeling nauseous or tired all the time can wear you down too.

Try to eat regular meals every day and include a wide variety of foods.

• Starchy carbohydrates like bread, potatoes, pasta, rice, chapattis and cereals give you energy, fibre, vitamins and minerals. Include some in each meal or snack.
• Dairy foods (or non-dairy alternatives) are good sources of calcium, protein and vitamins. Yoghurt, cheese and milk are easy and quick as snacks. Aim for 2-3 portions a day.
• Protein is needed for building and repairing body cells. Good sources include foods such as meat, fish, eggs, beans and pulses, nuts and meat alternatives (e.g. tofu or plant-based protein products). These foods are also sources of vitamins and minerals such as iron. Try to include at least 2 servings a day.
• Fresh, frozen, dried and canned fruit and vegetables all count as part of your ‘Five-a-day’. Unless there is a reason for you to eat less fibre, the fibre from fruit and vegetables can help your bowels by keeping stools soft and easy to pass and provide essential vitamins and minerals.
• Sugary and fatty foods should be eaten in small amounts. If, however, you need to increase the amount of calories you are eating to avoid or minimise weight loss, you may be advised to eat more fat and sugar for the calories they provide. If you’ve spent a large part of your life trying to eat healthily and reduce fat and sugar to keep your weight in check, eating more fat and sugar containing foods may feel strange. There are healthier types of fat you can consider using like vegetable oils and vegetable oil-based spreads.

Just as nutrition may not be at the front of your mind, it may not be at the front of your healthcare teams’ mind. If you are struggling to eat and drink, have lost weight unintentionally or you have concerns about your diet and its role in your care, talk to your healthcare professional. As cancer care should be holistic and address all your individual needs, it’s important to remember that you don’t need to wait to be asked about your diet. It’s ok for you to start the conversation about eating and drinking.

All patients with cancer should have a nutritional check as soon as a diagnosis of cancer is made. The nutritional check is often called ‘nutritional screening’. This should happen whether you have lost weight or not. Talk to your doctor, nurse or other healthcare professional to ask for nutritional screening.

Nutritional screening usually involves checking your weight and height and answering some short questions about your weight, appetite, food intake and any symptoms that might be making eating and drinking difficult or less enjoyable.

Nutritional screening should be repeated at regular intervals. If you’ve not had a nutritional screening for a while, ask your healthcare professional to do one.

What happens next?

If the nutritional check shows that you are at risk of undernutrition (often called malnutrition) then you should have a full nutritional assessment.

A nutritional assessment may include looking more closely at your body weight, body composition, the symptoms that affect how much and what you can eat, how cancer is affecting how your body absorbs or uses nutrients and what you are able to do physically.

It will help your healthcare professional to work out an individualised plan with you to help you manage the effects of cancer and its symptoms on your food intake, to help increase your nutritional intake and to keep physically active.