Page last updated: April 2024
The information on this webpage was adapted from Understanding Pancreatic Cancer - A guide for people with cancer, their families and friends (2024 edition). This webpage was last updated in April 2024.
Expert content reviewers:
This information was developed based on clinical practice guidelines, and with the help of a range of health professionals and people affected by cervical cancer:
- Prof Lorraine Chantrill, Honorary Clinical Professor, University of Wollongong, and Head of Department, Medical Oncology, Illawarra Shoalhaven Local Health District, NSW
- Karen Baker, Consumer
- Michelle Denham, 13 11 20 Consultant, Cancer Council WA
- Prof Anthony J Gill, Surgical Pathologist, Royal North Shore Hospital and The University of Sydney, NSW
- A/Prof Koroush Haghighi, Liver, Pancreas and Upper Gastrointestinal Surgeon, Prince of Wales and St Vincent’s Hospitals, NSW
- Dr Meredith Johnston, Radiation Oncologist, Liverpool and Campbelltown Hospitals, NSW
- Dr Brett Knowles, Hepato-Pancreato-Biliary and General Surgeon, Royal Melbourne Hospital, Peter MacCallum Cancer Centre, and St Vincent’s Hospital, VIC
- Rachael Mackie, Upper GI – Clinical Nurse Consultant, Peter MacCallum Cancer Centre, VIC
- Prof Jennifer Philip, Chair of Palliative Care, University of Melbourne, and Palliative Medicine Physician, St Vincent’s Hospital, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, VIC
- Lucy Pollerd, Social Worker, Peter MacCallum Cancer Centre, VIC
- Rose Rocca, Senior Clinical Dietitian – Upper GI, Peter MacCallum Cancer Centre, VIC
- Stefanie Simnadis, Clinical Dietitian, St John of God Subiaco Hospital, WA
Pancreatic cancer and its treatment can affect your ability to eat, digest and absorb essential nutrients.
During and after treatment, it’s important to make sure you are eating and drinking enough to maintain your weight and avoid malnutrition or dehydration.
Different foods can affect people differently, so you will need to experiment to work out which foods cause problems for you. Most people will also have to take a special tablet to help with digestion.
Coping with changes
Changes to the way you eat may make you feel anxious, particularly when you know eating well is important. Some people find it difficult to cope emotionally with the changes to how and what they can eat.
Finding ways to enjoy your meals can help you feel more in control and improve your quality of life. It may help to talk about how you feel with your family and friends.
You can also call 13 11 20 cancer support – our experienced cancer nurses can arrange for you to speak with a Cancer Connect volunteer who has had a similar cancer experience.
Some people find that complementary therapies such as relaxation, meditation and acupuncture help them cope with diet and nutrition problems.
Always tell your cancer care team if you are using or would like to try any complementary therapies.
Cancer and emotions
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Seeing a dietitian
If you have ongoing problems with food and eating, talk to a dietitian. Dietitians are experts in nutrition who can give you specialist advice on how to cope with nutrition-related problems and eating difficulties throughout different phases of the disease.
A dietitian can prepare eating plans for you and give you advice about nutritional supplements. Dietitians work in all public and most private hospitals. There may be a dietitian connected to your cancer treatment centre.
Dietitians Australia can also help you find an Accredited Practising Dietitian who works in your area and specialises in cancer.
If your GP refers you to a dietitian, you may be eligible for a Medicare rebate to help cover the cost. If you have private health insurance, you may be able to claim part of the cost.
Nutritional supplements
If you can’t eat a balanced diet or are losing too much weight, your doctor or dietitian may suggest nutritional supplements such as Sustagen, Ensure, Fortisip or Resource.
These provide energy, protein and other nutrients that can help you maintain your strength. A dietitian can recommend the right nutritional supplement for you and let you know where to buy it and how much to use.
Nutritional supplements should be taken in addition to the foods you are able to eat and are best used as snacks between meals. Supplements are available as:
- ready-made drinks, bars, puddings and custards
- powders to mix with milk or water, or to sprinkle on food.
Enzyme replacement therapy
The pancreas produces digestive enzymes to help break down food. When you have pancreatic cancer, or have had pancreatic surgery, your body may not be able to make enough of these digestive enzymes.
This will affect your ability to digest food, particularly fat and protein, and to absorb vital nutrients. This is often referred to as pancreatic exocrine insufficiency (PEI). Signs of PEI include:
- abdominal pain
- bloating and excessive wind
- diarrhoea or oily stools that are pale in colour, frothy, loose and difficult to flush
- weight loss.
To help prevent these symptoms, your doctor may prescribe pancreatic enzymes (e.g. CREON), sometimes with acid-suppressing medicine.
The dose will be adjusted depending on your symptoms and diet. It may take time to get this balance right. A dietitian can help you and your doctor work out the correct dose.
Taking enzyme supplements
- Take enzyme capsules with water and the first mouthful of food to ensure adequate mixing. With larger meals or meals that take longer to consume (more than 15–20 minutes), you may also need to take them halfway through the meal.
- Always take enzymes when having food or drink that contains fat or protein. Slightly higher doses may be needed with high-fat meals (e.g. fried foods, pizza). You don’t need to take enzymes for simple carbohydrates that digest easily (e.g. fruit, fruit juice, black tea, coffee).
- Take enzyme supplements as prescribed. Do not change the dose without first talking to your doctor or dietitian.
Maintaining your weight
During and after treatment for pancreatic cancer, changes to what you can eat, how you feel about eating and how your body absorbs food can all lead to unplanned weight loss.
This can cause a loss of strength, increase fatigue and affect how you cope with treatment. The tips below may help.
Have regular nourishing meals
Eat small meals frequently (e.g. every 2–3 hours) and have a regular eating pattern rather than waiting until you’re hungry. Keep ready-to-eat food on hand for when you are too tired to cook (e.g. tinned fruit, yoghurt, frozen meals).
Ensure that meals and snacks are nourishing and include protein such as meat, chicken, fish, dairy products, legumes (e.g. lentils, chickpeas), eggs, tofu, nuts and nut butters.
Choose nourishing drinks (e.g. milk, smoothies). A dietitian may also suggest nutritional supplement drinks.
Load up your food
There are different ways to add extra kilojoules to your food:
- add milk powder to cereals, sauces, mashed vegetables, soup, drinks, egg dishes and desserts
- add cheese to sauces, soup, baked beans, vegetables, casseroles, salads and egg dishes
- add sugar, honey or golden syrup to cereals, porridge or drinks
- use a powdered nutritional supplement recommended by your dietitian.
It’s okay to focus on eating foods that you enjoy. Gaining or maintaining weight is more important at the moment than avoiding extra fat and sugar.
Adjust to taste and smell changes
You may find your sense of taste changes after treatment. If food tastes bland, add extra flavouring such as herbs, lemon, lime, ginger, garlic, honey, chilli, pepper, Worcestershire sauce, soy sauce or pickles.
Eating moist fruits such as berries or sucking boiled lollies can help if you have a bitter or metallic taste in your mouth.
If food smells bother you, ask family or friends to do the cooking. You may also prefer cold food or food at room temperature without a strong smell.
Talk to a dietitian
A dietitian can help if you are finding it hard to work out the right foods to help gain weight. You should also check with a dietitian before cutting out particular foods.
Nausea and vomiting
Nausea and vomiting can occur because of the cancer or its treatment. For some people, just the thought of treatment, eating or the smell of food can make them feel unwell.
There is a range of anti-nausea medicines (antiemetics) that you can take regularly to control symptoms. If the one you are prescribed doesn’t work, let your doctor or nurse know so you can try another medicine.
Let your doctor know if vomiting lasts for more than a day or if you can’t keep any fluids down, as you may become dehydrated. Signs of dehydration include a dry mouth, dark urine, dizziness and confusion.
If you have persistent vomiting, the duodenum (the first part of the small bowel) may be blocked, so see your doctor as soon as possible. You may need surgery to clear the blockage.
Coping with nausea
- Eat and drink slowly. Chew food well.
- Some anti-nausea medicines need to be taken half an hour before meals – ask your doctor about this.
- Try to eat a little bit at regular intervals – not eating or skipping meals can make nausea worse.
- Suck on boiled lollies. Try peppermint-flavoured or lemon-flavoured lollies.
- Avoid strong odours and cooking smells.
- Snack on bland foods such as dry crackers or toast.
- Drink ginger beer, ginger ale or ginger tea, or suck on candied ginger.
- Listen to The Thing About Cancer podcast episode on appetite loss and nausea.
Steps to recovery after vomiting
- Take small sips – don’t try to force food down. Sip small amounts of liquid as often as possible. Try flat dry ginger ale, cold flat lemonade, weak cordial, or cold apple or orange juice.
- Introduce nourishing fluids – if the vomiting has stopped but you still feel sick, slowly introduce more nourishing fluids. Start with cold or iced drinks. Prepare milk or fruit drinks with some water so they are not too strong. You can also try diluted fluids such as clear broth or weak tea.
- Start solid food – next, try to eat small amounts of solid foods, such as plain dry biscuits, toast or bread with honey or jam, or congee (rice porridge) with little texture. Stewed fruits and yoghurt are also good. Aim to eat small amounts of food often, rather than three large meals a day.
- Return to a normal diet – as soon as you can, increase your food intake until you are eating a normal, balanced diet. Limit rich foods, such as fatty meats or full-cream dairy products. Your doctor or dietitian may suggest extra nourishment (such as nutritional supplements) on your good days to make up for the days you can’t eat properly.
Diarrhoea
Diarrhoea is when your bowel motions become loose, watery and frequent. You may also get abdominal cramping, wind and pain.
Pancreatic cancer treatments, other medicines, infections, reactions to certain foods, and anxiety can all cause diarrhoea.
Managing diarrhoea
- Drink plenty of liquids (e.g. water, fruit juice, weak cordial) to replace lost fluids.
- Try lactose-reduced milk or soy milk if you develop a temporary intolerance to the sugar in milk (lactose). This can sometimes occur when you have diarrhoea. Small amounts of hard cheese and yoghurt are usually okay.
- Avoid alcohol and limit caffeine and spicy foods as these can all make diarrhoea worse.
- Always let your treatment team know about any bowel changes. For further support and tips, you can call the National Continence Helpline on 1800 33 00 66.
If these tips don’t work, talk to your doctor about whether to take anti-diarrhoea medicine.
You should also let your doctor know if your stools are pale in colour, oily, very smelly, float and are difficult to flush, or you notice an oily film floating in the toilet.
This may be a sign that you do not have enough pancreatic enzymes. You may need to start enzyme replacement therapy or adjust your dose.
Diabetes
Insulin is a hormone that controls the amount of sugar in the blood. Diabetes, or high blood sugar levels, can occur if your pancreas is not making enough insulin.
This is why some people develop diabetes shortly before pancreatic cancer is diagnosed (when the cancer is affecting how much insulin the pancreas can make) or soon after surgery (when some or all of the pancreas has been removed).
The way diabetes is managed varies from person to person but often includes both dietary changes and insulin injections. Sometimes medicines are given as tablets that you swallow.
Your GP can help you manage the condition, but you will usually be referred to an endocrinologist, a specialist in hormone disorders.
You may also be referred to a dietitian for help with your diet and to a diabetes specialist nurse, who can help to coordinate your care and provide support.
Coping with diabetes
- Eat small meals and snacks regularly to help control blood sugar levels.
- Talk to your endocrinologist or GP about medicines to help control the diabetes.
- If you are taking diabetes medicine, include high-fibre carbohydrate foods at every meal to avoid low blood sugar levels. Wholegrain breads and cereals, vegetables and fruit are all suitable foods.
- Talk to your doctors and dietitian for more information about diabetes.
- Get in touch with the National Diabetes Services Scheme. They can provide advice on managing diabetes.