Caregivers play a vital role in helping cancer patients face the daily challenges of their diagnosis. While everyone’s needs may vary, caregivers are often asked to assist a patient with their meals. This help comes in many forms, from preparing a single dish to grocery shopping.
No matter what you’re asked to do, it’s important to make healthy, educated decisions that can effectively deliver the key nutrients a patient requires.
But how do you know what to look for when reviewing a recipe or walking through the grocery store? While most good nutrition habits are universal, there are a few things to keep in mind when cooking or shopping for a cancer patient.
For this episode, we sit down with Dana-Farber senior nutritionist Stacy Kennedy MPH, RD/LDN, CSO, who offers suggestions for caregivers.
Austin Fontanella: Now, it’s easy to say it’s important to practice good nutrition, but in a general overview, what does that mean?
Stacy Kennedy, MPH, RD/LDN, CSO: When we say ‘good nutrition’, we mean maintaining at least a baseline level of nourishment that keeps you functioning in your day — so, getting enough nutrients, whether that be calories or protein or certain vitamins or minerals. We [also] really want to make sure that patients going through treatment are able to find foods and beverages that they can tolerate and, hopefully, find ones that they can enjoy.
And in terms of the cancer patients themselves…what are some things that they should really keep in mind?
We know that during treatment, the need for protein and calories is higher to support the body’s basic functions. So, during treatment, making sure that you’re getting adequate protein each time you eat, that there’s a representative from the protein family, that you’re not shying away from extra calories or maybe intentionally adding them in. So, a drizzle of olive oil, a little extra avocado, things like that.
We want to make sure there’s that balance, and then ensuring that there are plant-based foods as well — so, fruits and vegetables, whether they’re cooked or blended in a smoothie or eaten raw, etc. We wanted to make sure those micronutrients are also making their way into the cancer patient’s day. And lastly is hydration — that’s another big part of this, too.
If you’re a caregiver, and a patient asks you to go to the grocery store and maybe buy something on their behalf — but they haven’t given you any restrictions or anything like that — what should you try to keep in mind or look for as you’re walking down the aisles?
I would want to actually find out from the patient how they’re feeling and what they feel like they might need. I can kind of give you a nice basic shopping list for sure, but I will say (and we’ll get more into this) that the way foods taste to patients can be very different during treatment. How foods feel in their stomach and how it kind of sits with them, chewing, swallowing, having a dry mouth. It’s important to check in with the patient before you go shopping for them. A lot of foods that they really loved before treatment might not be as appealing right now, so the usual things you might buy for them may need a little bit of a revision.
That makes a lot of sense. So, don’t just go out and buy whatever their favorite snack was maybe before they started treatment.
I would send a quick text or give a quick call and ask. But I think, in general, shopping would include healthy beverages. You might want to look for water, but you might want to look for healthy electrolyte beverages. A lot of patients, during treatment, need some electrolytes, so that might be something. Looking for simple foods — so, maybe potatoes and bananas and kind of easy-to-digest types of foods might be helpful. Looking for some color and variety would be great, too — so, kind of hitting up that produce section.
And most importantly, I would say, looking for items that either come in small packages or that are easy to portion into small amounts. I don’t want to do anything that’s against the environment and sustainability, but patients tend to get full quicker, and sometimes even seeing a lot of food can be a turn-off for appetite. Quick, easy, small packaged items they can keep with them or just snack without having to get up and make a big meal can be really helpful.
And not to talk in absolutes, but while you’re going through the grocery store, are there any maybe aisles or foods that you should really avoid?
No, I don’t think there’s necessarily a place to avoid. I think it’s really, within those aisles, understanding what’s best for the patient right now. So, a quick example would be with breads, right? Foods can be ‘healthy’, but are they healthy for somebody right now?
In general, we recommend whole grain bread — if you were shopping for someone, you would find a whole grain bread with plenty of fiber — but a patient who may be facing recent bowel surgery or who may be having excessive bowel movements won’t digest or tolerate that fiber as well. Someone at risk for an obstruction or something like that really shouldn’t have the whole grain and a lot of fiber. That’s something to really think about. A lot of times, that can be a shock for patients where we might recommend, “You might want to try this sourdough bread instead of the whole grain bread right now because your situation with your surgery.” That sort of thing.
Staying in the grocery store right now, if you’re going and shopping on behalf of somebody, would you recommend a grocery list? I know sometimes people like to walk up and down the aisles and just pick maybe what’s on sale or what looks good, but is there one or the other you should, say, maybe stick to, if you’re shopping for a cancer patient?
Yeah, I think the list can be very helpful. I actually think, for everyone, we know that’s a strategy, if you’re one of those people — and I know I’m so guilty of it myself sometimes. Don’t go hungry. You’re going to load up your cart, spend extra money, get things that weren’t really on your healthy eating plan.
As a general guideline, that’s great, but I think for patients a list is really important because that help of you, as a caregiver [who is shopping] is so valuable that you want to really maximize what you’re picking up. If they already have a staple at home, you don’t want to be getting something they don’t really need, and as I mentioned, the tastes and the desires can kind of really change on a whim, so checking in and having a purpose and not buying too much.
It’s going to be important to be willing to go frequently for the patient. I think that’s going to be really helpful, but obviously stocking up on staples — things that don’t go bad, if they can have peanut butter or almond butter, things like that can really be helpful for those protein and calories we talked about.
That almost sounds like that list, yes, you want to write down what you want to buy, but maybe also their preferences at the time.
What questions should you ask the patient, just to make sure you know exactly what to look for?
Sometimes an open-ended question is great, like “Are there any certain foods or beverages that you’re craving right now or that you’re doing well with?” but sometimes that’s an overwhelming question if somebody doesn’t have an appetite or things aren’t going great with eating, so you might even give a few prompts like “Oh, I’m going to the store, and I was going to pick up some eggs for myself — would you like for me to get some eggs for you, too?” Or you might say, “Hey, I know you love pasta — is that something that you’re still really enjoying right now? Is that something you would like me to get for you?”
Now, let’s say you’ve left the grocery store, you’re back at your home, and you love to cook, so you want to make a patient a dish of some sort. While you’re looking at the recipe, are there certain items you want to make sure you put into a dish like that? Or maybe certain items you want to avoid? Or is it kind of just like grocery shopping and really depends on how the patient is feeling?
Yeah, it’s going to always depend, but I think we know that patients need adequate protein, so I think that that would be something to look for as a hero item in that meal — so, looking for some protein, whether it comes from dairy, like Greek yogurt, or it’s coming from eggs or fish or chicken or nuts or seeds, all the great sources.
That would be one thing, and then I think, with the cooking, again, food safety is really, really important. When someone is going through treatment, we want to be extra careful. We want to monitor the temperature of food, like if it’s a meat or an animal protein, that you’re getting it to a hot enough temperature. We know that the danger zone is 40 degrees to 140 degrees Fahrenheit, so food that should be refrigerated needs to be refrigerated under 40 degrees. We don’t want to let it sit on the counter and get hot and spoil. We know that meat, that should be cooked through. We want it over 140, or it could be too raw and more potential for bacteria. Hand washing and all those kinds of things are really, really helpful to think about as well.
Now, you had mentioned earlier sometimes just an exorbitant amount of food might overwhelm a patient. If you’re preparing a dish, would you just give them a whole casserole kind of dish? Or do you suggest that people cut it up into kind of smaller portions for them?
I think it would depend…let’s say you were batch making a stew. You could put that into smaller containers that the patient could eat one now and then have, ready to go, in the fridge and in the freezer, and have it for a long time. If the patient has a family or other people in their home, the whole casserole might be perfect because somebody else is there to help portion it out, and everybody is eating.
I don’t know that there’s a hard-and-fast rule, but I do think thinking about the portion and the presentation, making food look pretty and attractive. When you’re sick, a lot of the foods that we think of to eat are very bland, but they also look very drab, and that’s not exciting and fun. So, we want eating to be enjoyable, too, maybe even thinking about music that you could bring that would be nice to listen to, and maybe even thinking about really pretty plates or a nice tablecloth and how the experience could be for the patient beyond the actual foods to help them overcome the barriers that exist around appetite from the treatment they’re going through.
OK, so when people are bringing over the whole kind of presentation, they’re thinking plates, they’re thinking music, but when it comes to the dish, is there anything you’ve noticed that a lot of patients will all say, “Oh, I really liked this going through treatment,” or something that you can make that has seemed to have been very positive?
It really depends on what people like to eat. I think one piece of feedback I often hear, I guess, on the other side of what NOT to do is the go-to for giving someone food is often dessert. It’s often indulgence foods, and that may not be what the patient wants. They might want to be following a cleaner diet. They might not digest sweets or heavy foods really well. They might want something simpler. They might want ‘a meal’ versus a treat. So, a lot of heavy casserole kinds of dishes and baked goods are not generally what patients are always needing or wanting. They might want more of another type of a home cooked meal, something more traditional to eat on a weeknight versus holiday meal with family.
Now, am I overthinking it to say, “Am I giving them a breakfast, a lunch, and a dinner?” Are you trying to mix up what you bring them? Or is that just getting into too into the weeds at this point?
No! You’re going to be the best at helping people because those are great questions to ask! Yes, people go for dinner, and that might be what somebody needs, but to your point, lunch is a huge struggle. Patients really struggle with lunch, especially sometimes if you’re home by yourself and if your energy is low, or even if you’re busy, if you’re a patient going through treatment, and you’re working and very busy. Doing meal prep at night and on the weekends is hard, so it may be lunch, it may be breakfast, snacks — any and all of the above, I think, would be greatly appreciated, but the idea of mixing it up is kind of fun. I think when groups start to coordinate for someone, that might be a helpful way to start to think about it, too.
I know we’ve spent the whole episode really talking about the patient, and if you’re a caregiver, what are some tips you have for them because they also have to take care of themselves? So, when it comes to just maybe making meals or going forward and trying to not only make sure they’re healthy but someone else is healthy, how should they balance that?
A lot of what we talked about was ‘how do you help your friend, your cousin, the person in your community?’ The day-in-day-out caregiver, the person that’s living there, it is a little bit of a different situation.
The idea of putting your own oxygen mask on first, just like on the airplane, is really, really important here. So, the caregiver needs to have time for self-care, even though it’s a lot. Chances are, they might be working. They are caring for somebody — it’s a lot of work. It’s a lot of time, but self-care, whether it’s through walking, meditation, certainly staying hydrated, making time for them to eat is important.
Trying to eat together can be helpful when that’s possible, but I think for the caregiver it’s trying to streamline their process — the types of foods that the patient is doing well with, how can they take those same ingredients and have a meal for themselves so that they’re not having to do two grocery shops or two different lists or make two different meals? Really try to come together so that it helps them to have a little bit more time.
And it sounds like you should try to use those ingredients, if possible, but you don’t have to eat exactly what the patient is eating.
If you want to do something else that will help you, you can do that.
Absolutely, yes. And I guess the last part is where the day-in-day-out caregiver can be really helpful with a patient who is struggling with appetite is that they may not have that internal desire to eat — so, that sort of presenting or helping keep the schedule and offering food at a regular time, or sending a text or a call to remind them can be helpful — but not pushing to eat a certain amount.
Patients will get full quicker, and that’s OK. It’s really kind of the caregiver’s job, so to say, to help the patient stick with this schedule of more frequent smaller meals, but it’s really the patient’s right to say when they’ve had enough. So, at one of those smaller frequent meals, the patient might take two bites and feel satisfied, or they just can’t eat anymore, and that’s OK.
What we want to avoid is the battle between the caregiver and the patient of ‘just take one more bite,’ ‘eat some more,’ ‘you didn’t finish your plate,’ and then that can just set up a really stressful dynamic, but it can also actually kind of hinder the patient’s appetite even further.
And lastly, not all patients are trying to gain weight. There are many patients going through treatment and many patients with a diagnosis where managing a healthy weight is actually important. So, while we talked about needing more protein and eating enough calories, again, back to the indulgent food gift basket, for many patients going through treatment for certain types of cancers, they may be trying to avoid excess weight gain. They may even be working with their doctor and dietician to lose small amounts of weight, even during treatment, in a healthy manner. For someone, a dessert basket may be perfect. For someone else, a fruit basket or a big salad might really be a better fit — so, just to kind of put that out there as well.
This article was originally published on November 14, 2019, by Dana-Farber Cancer Institute. It is republished with permission.