Coping With the Side Effects of Chemotherapy

Biba Caggiano is a world-renowned chef, author, television personality, restauranteur, and cancer survivor. Over the last 35 years, Biba has published seven best-selling cookbooks, hosted 100 episodes of her internationally syndicated cooking show Biba’s Italian Kitchen, and opened Biba restaurant in Sacramento, CA. In remission for nearly four years, she devotes time to educate and inspire the public with her story through Strength for Living, an educational program focused on the important role that nutrition can play for cancer patients, which is located at www.cancer.com.

Dr. Vincent Caggiano has practiced medical oncology for 40 years, with long-standing roles as a medical director and clinical researcher. His primary focus has been on helping breast cancer patients through early symptom recognition and fast, effective treatment, as well as by speaking at public forums.

ONG: Can you tell us about your experience as a cancer survivor?

BC: I was in total denial. Then, I realized that it was there and it was not going to go away unless we took it out; so that is exactly what we did. It was not an easy thing because chemotherapy, surgery, and radiation all have serious effects on you. But it was needed. I had a great deal of support from my husband and from my doctor. When you get to a situation in life when there’s no way out, you just have to do what people tell you to do. I kept working through the ordeal because I was able to take the proper medication. I developed some anemia, and I didn’t have any strength, so it was very hard for me to put in a 12-hour day at the restaurant. The medication that I took, Procrit, really helped me so that I was able to cook in the restaurant. I didn’t stop and think “What if?” I kept working.

ONG: What role can nutrition play in helping cancer patients?

BC: The chemotherapy changes your taste buds; everything tastes metallic. You’re not interested in food, but during this time you have to eat more than ever. So, you really have to be selective in what you eat. You might need the help of a dietician. Or you can go to www.cancer.com [where] there is the Strength for Living section, to which I contributed a bunch of recipes that can help patients. Some people develop mouth sores, so eating is a very hard thing to do. I had to change the food that I was eating. I couldn’t eat the things I used to: anything that was too spicy, too lemony, too vinegary—all the strong tastes that I always loved. So, I would have rice with butter. I would make risotto with cheeses instead of seafood. There are a lot of adjustments you can make.

ONG: Dr. Caggiano, what recommendations do you make in regards to nutrition for patients who are on chemotherapy?

VC: I think it’s important that the patients realize that maintaining nutrition is as essential as getting the chemotherapy, and the hormone therapies, and the radiation, and everything else. It’s part of living, and we’ve got to continue living as best we can, and we’ve got to make those adjustments. Every patient has to make an adjustment and find the right formula for their life and for their diet, and nutrition plays a very, very important, but under-recognized, role in helping the patient overcome the difficulties that are encountered.

ONG: Biba, do you think the physicians who treated you emphasized the importance of nutrition enough in improving your quality of life and that of their other cancer patients?

BC: I was a little disappointed; I had a fabulous doctor, [but] I don’t think there is enough emphasis on that side. I think nutrition is very important. It should be addressed a little more.

VC: We oncologists tend to give too little importance to some of the things that are important to the patient. We give a lot more importance to the dose of chemotherapy—the right dose, the right drug, the right formula—radiation therapy, and when to do surgery. But we tend to give lip service to the dietician, and dieticians are very good in giving you general guidelines and advice. But it’s up to each patient to find the right food, the right formula, and what’s best for them.

ONG: Some side effects of chemotherapy include symptoms like a feeling of fullness, taste dysfunction, anemia, nausea, strong heartburn, and fatigue. What are some of the things you’ve learned help relieve or prevent these side effects? What food choices are best when you are experiencing some of these side effects?

BC: I didn’t have heartburn, and as far as fullness, I was eating so little that I was never really full. The food choices for me were that I needed to eat bland foods, which is something nobody wants. But, it was only for a short amount of time. You try to give it additional taste with mild ingredients.

VC: Some patients eat small amounts of food and they feel full or satiated. We advise frequent, small feedings during the day.

ONG: Biba, can you tell us what makes your recipes on Cancer.com so unique and especially appropriate for patients undergoing chemotherapy?

BC: They are simple. They are straight-forward. They don’t have ingredients that are offensive. For example, if you do a simple risotto just with parmigiano or any other cheese that you like—and you can put in a few green vegetables, because it’s important that you get your greens, too—that is a great dish. Get seafood, put it in parchment, and put it in the oven; there is nothing to it. In 10 minutes, the dish is done. You never know the circumstances of the person with cancer, so I try to simplify the recipes and at the same time offer good, nutritious food choices.

ONG: If you could give other cancer patients one piece of advice for getting through the hardest times, what would it be?

BC: Surround yourself with family and friends; it is the most important thing. Don’t stay home and think “What happened to me?” Just go out and help other people. Do whatever you can to be with other people. There is nothing better than the support of the people you love.

ONG: How did you end up working with Ortho Biotech? What has the experience been like, and do you have plans to continue collaborating in the future?

BC: I certainly will [collaborate with Ortho Biotech in the future]. They are a terrific company. They were looking for somebody who was in the food business, who was visible, and who had had cancer. And I fit the bill, unfortunately; I wish I didn’t have to. I think I’m doing something nice. The more education that we [make available], the more people—women or men—will begin to relax and realize that there a lot of little things you can do out there to make this disease feel a little less stressful.

ONG: Dr. Caggiano, how can patients be helped in their battle against chemotherapy side effects, such as anemia, fatigue, and nausea?

VC: I think patients have to be given hope. Tell them there are going to be some rough times, but they’re going to be brief, and that we have medication now that can prevent or treat the anemia that’s associated with chemotherapy, we have medication that can prevent infections by raising the white blood cell count, and we have very effective medicines to prevent nausea and vomiting. The horror stories that people have heard about chemotherapy from 10 or 20 years ago are no longer valid because we have so many more medications, treatments, and supportive care measures that we can use today. So, I think it’s very important to put the patient in the right frame of mind and then to stress the importance of family, friends, nutrition, and all the other supportive things that we tend to kind of neglect…those very things that are very important to patients. And I tell my patients “Try to live your life as normally as possible. Sure, you’re going to be at risk for infection because your white blood cells are going to be depressed. But I advise for you to go to work.” Many would disagree with me, but I feel it’s important that patients feel that they’re still active, still in control, and still doing things. That doesn’t mean they should let their guard down.

ONG: What are your thoughts on exercise?

VC: Just like nutrition, I think that’s very important, too. Try to keep your body in as good a shape as possible.

BC: I was on my treadmill as soon as the nausea from the chemotherapy disappeared. I wasn’t walking very fast, but I was on my treadmill basically every day. You have to help yourself a little bit. You can’t expect all the doctors and medication to make you feel better.

ONG: Dr. Caggiano, how did you help Biba get through her battle against cancer, from diagnosis through treatment and after?

VC: I helped expedite things. I was always there for her when she needed me. Patients go through a very stressful time, and every pimple becomes a cancer to them. You have to give support. You have to show them the way and make it easier for them.

BC: I’m very lucky, because not everyone with cancer sleeps with a doctor. So, I would wake him up in the middle of the night, and say “Oh my gosh, look, I’m turning this way, it hurts. What do you think it is?” [He would say] “go back to sleep.” Because of course I had fears, but 20 years ago most women were dying. Today, there is hope; this is a message that should get out there loud and clear.

ONG: Dr. Caggiano, what are the top five questions patients should ask their physicians about cancer and chemotherapy?

VC: 1) “Do you have medicines to prevent the nausea and vomiting? I want the right ones.” 2) “Will I be exposed to infection, how can I prevent it, and what should I do [if I get an infection]?” 3) “Can you offer any specific dietary recommendations?” 4) “Can I see my family and friends?” And 5) “Is there anything I should or should not do?” The answers to some of those questions depend on the individual patient.

ONG: What can patients expect when they are put on chemotherapy?

VC: Their life will be disrupted—their usual schedule and routine. And that’s hardest for patients; suddenly you’re at the mercy of a doctor and nurses scheduling chemotherapy at odd hours of the day several days a week for several weeks. The potential side effects of chemotherapy are very frightening, and when the doctor reads the long list of potential side effects, many patients get frightened. But it’s important for the doctor to accurately state “These side effects are manageable and do not occur in many patients or all patients, but I want to warn you of the possibility.” Patients become aware that their life changes a bit, their values change. It’s important for them to get through this, and when they are finished with it, they’re a better and more whole person, and they look at life differently.

BC: I almost dare to say that you become a better person, because you are being put into a place where you really didn’t want to go and then you know how mortal we are, and you don’t take things for granted as much.

ONG: Dr. Caggiano, do you often recommend to your patients that they utilize online resources like Cancer.com when researching their cancer and treatment options? Are there any other sites to which you regularly refer your patients?

VC: I tell my patients “Use whatever resources you can. Use the Internet.” I try to keep ahead of my patients and also caution them that source reliability is very important. I encourage my patients: “Please let me see everything that you read on the Internet, because there is good, but there is also bad.” Medscape, WebMD, the University of Pennsylvania website, and Cancer.com are the [websites] I generally recommend.

Alleviating Chemotherapy-Induced Taste Dysfunction

• Use measuring devices when cooking; do not “cook by taste.”
• Optimize food texture, aroma, temperature, and color to improve the overall food experience.

Source: Smell and Taste Disorders: A Primary Care Approach. American Family Physician

• Ask your physician about zinc sulfate for expediting the return of taste.
• Use plastic utensils if foods taste metallic.
• Use sugar-free lemon drops, gum, or mints when experiencing a metallic or bitter taste.
• Add spices and sauces to foods.
• Eat meat with something sweet, such as cranberry sauce, jelly, or applesauce.
• Substitute poultry, fish, eggs, and cheese for red meat.
• Try a vegetarian or Chinese cookbook for useful nonmeat, high-protein recipes.

Source: Nutrition in Cancer Care

Alleviating Chemotherapy-Induced Anemia

• Use measuring devices when cooking; do not “cook by taste.”
• Eat foods high in iron.
• Eat/drink foods that help your body absorb iron, like orange juice, strawberries, broccoli, or other fruits and vegetables with vitamin C.
• Don’t drink coffee or tea with meals.
• Calcium can hurt your absorption of iron. Talk to your healthcare provider (HCP) about the best way to get enough calcium, too.

Source: womenshealth.gov

Alleviating Chemotherapy-Induced Nausea and Vomiting

• Avoid solid food immediately after treatment.
• Drink and tolerate clear liquids, such as sports drinks, ginger ale, lemon-lime sodas, or unsweetened fruit juices before trying plain water.
• Consider avoiding caffeine and alcohol.
• Try warming drinks to room temperature.
• Once able to tolerate solid foods, start with bland foods, and eat small, frequent meals throughout the day.
• Avoid your favorite foods on days you feel sick.

Source: Management of CINV

Biba’s Recipes for Patients Receiving Chemotherapy

Risotto With Asparagus and Saffron

6 cups chicken broth, homemade or low-sodium canned

1/3 teaspoon powdered saffron

2 pounds thin asparagus tips

4 tablespoons (1/2 stick) unsalted butter

1/3 cup finely minced shallots

2 cups Arborio, Carnaroli, or Vialone Nano rice

1 cup dry white wine

1/2 cup freshly grated Parmigiano-Reggiano cheese

Salt to taste

Heat the broth in a medium saucepan and keep it warm over low heat. Place the saffron in a small bowl and mix with 1/2 cup of the hot broth.

Steam or boil the asparagus tips until tender, but still a bit firm to the bite, 2 to 3 minutes.

Melt 3 tablespoons of butter in a large skillet over medium heat. When butter begins to foam, add the shallots and cook, stirring until soft, 6 to 7 minutes. Add the rice and stir quickly for 1 to 2 minutes, until rice is translucent and well coated. Add the wine and stir constantly until wine is almost completely reduced. Add 1/2 cup of broth or just enough to cover the rice. Cook, stirring until most of the broth has been absorbed. Continue in this manner, adding broth 1/2 cup or so at a time, about 12 minutes.

Add asparagus and saffron broth and cook, stirring constantly. Add broth until the rice is tender, but firm, 6 to 7 minutes.

When most of the broth is incorporated, add remaining butter and 1/4 cup of the Parmigiano. Stir quickly until the butter and cheese are melted and the rice has a moist, creamy consistency. Season and serve with the remaining Parmigiano.

Nutritional Tips

This may be a good dish for patients with mouth dryness and difficulty chewing and swallowing, and very good for those experiencing gastrointestinal problems. The shallots may be eliminated for those who are having trouble tolerating smells from these ingredients or who are experiencing gastrointestinal problems.

Salmon Baked in Parchment

4 sheets of parchment paper cut into 12- x 16-inch rectangles

Olive oil

4 salmon steaks, about 8 ounces each

Salt and fresh ground black pepper to taste

4 tablespoons minced sun-dried tomatoes, packed in oil

Extra virgin olive oil to taste

Preheat the oven to 400°F.

Place a sheet of parchment paper on a work surface, brush lightly with the oil, and put salmon in the center of one half of the sheet. Season salmon with salt and pepper, top with about 1 tablespoon of sun-dried tomatoes, and drizzle with extra virgin olive oil. Fold the empty part of the parchment sheet over the fish and fold both edges of the parchment together to make a 1-inch tight border.

When all the bundles have been wrapped, place them on a baking sheet and bake about 10 minutes. When done, the fish should be a bit translucent on the inside, and the bundles should have swollen to a rich brown color.

Transfer bundles to serving dishes and cut each parchment open with a small knife.

Serve with a mixed green leafy salad.

Nutritional Tips

This recipe provides a good source of protein which may help in the growth and repair of cells damaged by chemotherapy. The tomatoes provide a good source of lycopene (antioxidant).