Nutrition and advanced cancer

If cancer spreads from where it started to other areas of the body (secondary or metastatic cancer), problems with eating and drinking may occur or get worse. It’s common for people living with advanced cancer to lose their appetite. This often leads to weight loss and malnutrition. Controlling symptoms that affect your ability to eat or drink will help improve your quality of life. Soft foods and clear liquids may be easier to digest. It’s okay to focus on eating foods you enjoy.

Nausea and vomiting

Many people with advanced cancer have problems with ongoing nausea and vomiting. Nausea and vomiting may be caused by pain medicines, cancer growth, blockage in the bowel, slower digestion, or high calcium levels in the blood (hypercalcaemia). Feeling tired or anxious may make the nausea worse.

See How to cope with nausea and vomiting for suggestions that may help reduce these problems, and ask your doctor about what medicines may help.

Mouth problems

People with advanced cancer may have a dry mouth or a sore mouth and throat. These problems may be caused by drinking less or by some types of treatment. If chewing and swallowing become difficult, it may be necessary to change the texture of your food. 

Blockage in the bowel

Cancer, surgery or changes to digestion in or near the abdomen sometimes cause the bowel to become blocked (bowel obstruction). This can also happen if the cancer comes back. Because faeces (stools or poo) cannot pass through the bowel easily, you may have symptoms such as nausea (feeling sick), vomiting, constipation or abdominal discomfort and pain. To relieve the symptoms of a bowel obstruction, you may be given medicines including laxatives and enemas, or have a small tube (stent) put in that helps keep the bowel open. The stent is inserted through the rectum using a flexible tube called an endoscope.

Cachexia

People with advanced solid tumours (e.g. cancer of the lung, pancreas, oesophagus, stomach, liver and bowel) may develop a muscle-wasting syndrome known as cachexia. This means the way the body uses protein, carbohydrates and fats changes, and it can burn up energy faster. Symptoms include:

• loss of weight, including loss of fat and muscle mass
• feeling sick (nausea)
• feeling full after eating small amounts
• anaemia (low numbers of red blood cells)
• weakness and fatigue
• inflammation in the body (shown on a blood test).

Your doctor or dietitian will talk to you about the best way to manage cachexia. They may suggest eating more foods high in energy, fat and protein, and taking nutritional supplements, or medicines such as appetite stimulants. Your doctor may also suggest you see an exercise physiologist or physiotherapist to develop an exercise plan to help strengthen your muscles.

If you continue to have problems maintaining your nutrition, your treatment team may recommend feeding through a tube in the nose (nasogastric or NG tube) or stomach (often known as a PEG or RIG tube). However, each person is different and, depending on your situation, tube feeding may or may not be recommended. Your treatment team will give you more information.

Use of medicinal cannabis

Medicinal cannabis refers to a range of prescribed products that contain the two main active ingredients, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC and CBD are cannabinoids. Other types of cannabinoids include cannabis, which is also known as marijuana, weed and pot.

Cannabinoids are chemicals that act on certain receptors found on cells in our body, including cells in the central nervous system. There is no evidence that medicinal cannabis can treat cancer.

There is some evidence that cannabinoids can help people who have found conventional ways to treat symptoms and side effects unsuccessful (e.g. chemotherapy induced nausea and vomiting). To date, published studies have shown medicinal cannabis to have little effect on appetite and weight.

In Australia, it is illegal to sell cannabis for personal or recreational use. With the exception of the ACT, it is also illegal to grow, possess or cultivate cannabis for recreational or personal use (as compared with use for medicinal purposes with an appropriate licence).

The Australian Government has legalised access to medicinal cannabis for medicinal purposes. Any doctor can apply to the Therapeutic Goods Administration (TGA) for approval to prescribe medicinal cannabis. The laws about how medicinal cannabis is given and regulated vary on a state-by-state basis. For more information, talk to your doctor or see the TGA’s medicinal cannabis information.