Pancreatic cancer


Managing dietary problems

Pancreatic cancer, and treatments such as surgery, chemotherapy and radiation therapy, can affect your ability to eat, digest and absorb food. This can have a significant impact on nutrition.

Common problems include:

  • weight loss
  • poor appetite and feeling full quickly
  • changes in taste and smell
  • diarrhoea or other changes in bowel habits
  • nausea and/or vomiting
  • poor digestion (maldigestion) and absorption (malabsorption) of fats and proteins caused by a lack of pancreatic enzymes
  • diabetes caused by inadequate insulin production.

This section provides general suggestions about how to manage these problems. What you can eat and drink will depend on your individual circumstances. People who have a Whipple procedure may have many questions and concerns about their diet following the surgery. The suggestions below may be helpful when you start to eat after surgery.

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. See below for information on finding a dietitian.

See Nutrition and Cancer or call Cancer Council 13 11 20 to speak to a Cancer Connect volunteer who has had a similar cancer experience.

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 Hospital Formula, Ensure, Fortisip and Resource. These contain energy, protein and other nutrients. Glucose powder supplements provide little nutrition and are rarely recommended.

Nutritional supplements should be taken in addition to your usual meals, i.e. as snacks between meals. They are available ready-made as drinks or bars, or in powdered form that can be mixed with milk, water and food. Ask a dietitian where to buy supplements, and to advise you on the type and quantity.

Seeing a dietitian

Dietitians work in all public and most private hospitals. There may be a dietitian connected to your cancer treatment centre – check with your specialist or cancer care coordinator.

The Dietitians Association of Australia (DAA) can also help you locate an Accredited Practising Dietitian who works in your area and specialises in cancer or has experience with particular clinical conditions. Visit daa.asn.au or call them on 1800 812 942.

If your GP refers you to a dietitian, you may be eligible for a Medicare rebate. Most private health insurers provide a rebate depending on your type and level of cover.

The DAA has information on the typical fee for private dietitian consultations.

Coping with dietary issues

Poor appetite

  • Eat small meals frequently, e.g. every 2–3 hours. Have your biggest meal of the day when you are hungriest.
  • Ensure that meals and snacks are nourishing and include protein, e.g. meat, chicken, fish, dairy products, eggs, tofu and nuts.
  • Choose nourishing drinks such as milk. Nutritional supplement drinks may be prescribed after surgery.
  • Add milk powder to cereals, sauces, desserts, mashed vegetables, soup, drinks and egg dishes.
  • Add cheese to sauces, soup, baked beans, vegetables, casseroles, salads and egg dishes.
  • Add golden syrup or honey to cereal, fruit and drinks.
  • Talk to a dietitian before cutting out particular foods.
  • Relax any low-cholesterol and other dietary restrictions. Gaining weight or maintaining your weight is more important than avoiding extra fat and sugar.

Changes in taste or smell

  • If food tastes bland, use seasoning, e.g. herbs, lemon, lime, ginger, garlic, honey, chilli, pepper, Worcestershire sauce, soy sauce or pickles.
  • Some drinks may taste different or be off-putting because of the smell or texture. Choose milkshakes, fresh juice, hot chocolate and other non-alcoholic drinks.
  • Choose cold food or food at room temperature without a strong smell.
  • If cooking odours affect you, ask family or friends to cook.
  • If you have a bitter or metallic taste in your mouth, eat moist fruits such as berries or suck boiled lollies.
  • Try plain breakfast cereals with less added sugar, such as porridge or bran flakes, instead of cereals with added dried fruit, honey or other sweeteners.
  • If you don't feel like eating meat, try other protein sources, e.g. cheese, eggs, nuts, dairy foods or legumes.

Diarrhoea

  • Talk to your doctor if your stools are pale in colour, smell particularly bad, or float and are difficult to flush. 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.
  • Talk to your doctor about whether to take anti-diarrhoea medicine.
  • Drink plenty of liquids (e.g. water, fruit juice or weak cordial) to replace lost fluids.
  • Avoid alcohol and limit caffeine and spicy foods as these can make diarrhoea worse.
  • Try soy milk or lactose-reduced milk if you develop a temporary intolerance to the sugar in milk (lactose). This can sometimes occur when you have diarrhoea. Cheese and yoghurt in small amounts are usually okay.
  • If diarrhoea occurs 15 to 30 minutes after eating, you may be experiencing dumping syndrome. Speak to your treatment team about this.

Nausea

  • Talk to your doctor about taking anti-nausea medicine half an hour before some meals.
  • Snack on bland foods such as dry crackers or toast.
  • Try to eat a little bit at regular intervals – not eating can make nausea worse.
  • Eat and drink slowly. Chew food well.
  • Avoid strong odours and cooking smells.
  • Suck peppermint or lemon-flavoured boiled lollies.
  • Drink ginger beer, ginger ale or ginger tea, or suck on candied ginger.
  • See below for tips on dealing with vomiting.

Jan's story

"After I had Whipple's surgery, eating was hard and it was a balancing act getting it right.

"I found that I would fill up quickly, but it helped to eat smaller meals. I also can't drink a lot of liquids. A lunchtime meal of a cup of tea and a soup is out of the question.

"My taste buds had changed and chocolate was no longer appealing but ice-cream was okay. Fatty foods didn't settle well at all. The more unprocessed the food, the easier it was to handle. My tolerances have increased over the years, and trial and error has helped."

Tell your cancer story.

Vomiting

Vomiting can occur as a result of the cancer or its treatment. For some people, just the thought of treatment or eating or the smell of food can make them feel unwell.

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. There are a range of effective anti-nausea medicines (which are known as anti-emetics). If the one you are prescribed doesn't work, ask to try another type.

If you have persistent vomiting, the duodenum (the first part of the small bowel) may be blocked, so it is important to see your doctor as soon as possible. A blocked duodenum may be relieved with surgery.

Steps to recovery after vomiting

1 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.

2 Introduce nourishing fluids

If the vomiting has stopped but you still feel sick, sip on drinks slowly in small frequent amounts. 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.

3 Start solid food

Next, eat small amounts of solid foods, such as plain dry biscuits, toast or bread with honey or jam. Stewed fruits and yoghurt are also good. Aim to eat small regular food portions frequently, rather than three large meals a day.

4 Return to 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 fullcream dairy products. Your doctor or dietitian may suggest extra nourishment (such as supplements) on your good days to make up for the days you can't eat properly.

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 a combination of dietary changes and medicines. 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 adjusting your diet.

Coping with diabetes

  • Eat small meals and snacks regularly to help control blood sugar levels.
  • Your GP or endocrinologist can prescribe medicines to help control the diabetes.
  • If you are taking diabetes medicine, you need to 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.
  • For more information about diabetes, talk to your doctors and dietitian. You can also contact Diabetes Australia on 1300 136 588 or visit diabetesaustralia.com.au.

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 affects the body's 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 bowel movements (stools) that are pale in colour, frothy, loose and difficult to flush; and weight loss.

To help prevent these symptoms, your doctor may prescribe pancreatic enzymes, sometimes with acid-suppressing medicine. The dose will be based on, and adjusted to, your symptoms and dietary intake. It may take time to get this balance right.

Taking enzyme supplements

  • Take enzyme capsules with water and the first mouthful of food to ensure adequate mixing. With larger meals, you may need to also take them halfway through the meal.
  • Always take enzymes when consuming any food or drink that contains fat or protein. Slightly higher doses may be needed with high-fat meals, e.g. fried foods and pizza. You don't need to take enzymes for simple carbohydrates that digest easily, e.g. fruit, fruit juice, black tea and coffee.
  • Always take enzymes as prescribed. Do not change the dose without talking to your doctor or dietitian first.

Key points

  • Pancreatic cancer and its treatment can have a significant impact on eating and nutrition.
  • The effect of surgery and other treatments on what you can eat and drink will vary from person to person.
  • Common nutrition-related problems include poor appetite, feeling full quickly, nausea and vomiting, changes in taste, altered bowel patterns, and poor digestion and absorption of food. These factors can contribute to significant weight loss.
  • It is important to eat a nourishing diet with regular meals and snacks. Often a diet high in energy and protein is needed to prevent or limit weight loss.
  • You may be advised to take nutritional supplements if you are finding it hard to eat well or are losing too much weight.
  • Dietitians are experts in nutrition who can give you advice on eating problems. They are found in all public and most private hospitals.
  • Vomiting can be prevented or relieved with anti-nausea medicines. Once vomiting stops, gradually return to your normal diet.
  • Some people will develop diabetes before pancreatic cancer is diagnosed or soon after surgery. Management usually requires both dietary changes and medicines. You may be referred to both an endocrinologist and a dietitian to help you control the condition.
  • If you develop pancreatic exocrine insufficiency (PEI), pancreatic enzymes will be needed to help you digest and absorb fats and proteins. Talk to a dietitian experienced in managing PEI.

Expert content reviewers:

Dr Lorraine Chantrill, Senior Staff Specialist Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, and Honorary Research Fellow, Garvan Institute of Medical Research, NSW; Jennifer Arena, Pancreatic and Neuroendocrine Cancer Care Coordinator, Northern Sydney Cancer Centre, Royal North Shore Hospital, and Northern Cancer Institute, NSW; Dr Michael Briffa, Southern Adelaide Palliative Services, Flinders Medical Centre, SA; Rachel Corbett, 13 11 20 Consultant, Cancer Council Victoria; A/Prof Nick O'Rourke, The University of Queensland, Chairman of General Surgery, Head of Hepatobiliary Surgery, Royal Brisbane and Women's Hospital, QLD; Steve Pendry, consumer; Caley Schnaid, Accredited Practising Dietitian, Northern Cancer Institute and Wellac Lifestyle, NSW; Deane Standley, Consumer.

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