Cancer patients should only eat food that is fully cooked while avoiding raw salads to reduce the risk of bacterial infection. Photo by Rohanis Shukri.

Safe and sufficient food intake is paramount for cancer patients in treatment, writes Aznim Ruhana Md Yusup

IT is normal for people to lose their appetite when they're feeling poorly. Food becomes less appealing, and everything tastes bland and bitter. But that does not change the fact that they still need to eat to keep up their strength and get better.

Meanwhile, cancer treatments such as chemotherapy or radiotherapy can cause side effects including loss of appetite, nausea, soreness in the mouth and throat, constipation and fatigue. The medication may leave an unpleasant taste in the mouth, further putting patients off their food.

But with treatment taking months or even years, it's vital to maintain a regular diet that supplies all the nutrients needed for the body to function and recover.

"Food gives us energy, and cancer patients need a lot of energy to fight the disease," says dietitian Nur Hayati Azmi from KPJ Ampang Puteri Hospital. "Our principal in dietetics for cancer patients is high calorie and high protein."

Both cancer and the drugs used to fight it can change the way the body normally absorbs nutrients. A high calorie diet helps the patient from losing weight and becoming malnourished. Meanwhile, protein is needed for cell growth and repair. It is also the key nutrient for keeping the immune system healthy.

Nur Hayati says: "A dietitian can calculate the patient's daily calorie requirement based on their weight and other factors. Meanwhile, their protein requirement is roughly between 1.2 and 1.5g per kilogramme of their body weight, compared to a healthy person's protein portion of 0.8g per kilogramme."

“Food gives us energy, and cancer patients need a lot of energy to fight the disease” - Nur Hayati Azmi. Photo by Hafiz Sohaimi.



Severe weight loss by cancer patients is known as cachexia. It stems from loss of appetite and changes in the body's metabolism due to the cancer. Cachexia physically weakens the individual, and can lead to death.

"When we don't eat, the body will process our energy reserves such as glycogen or fat in order to function," says Nur Hayati. "Without eating sufficiently for days or months, the patient can become cachexic."

According to Nur Hayati, cancer patients in hospital are prescribed a specific calorie requirement, which is rationed in their meals throughout the day. If the patient doesn't finish their food, the hospitals will top up the nutritional requirements with supplements, such as high-protein milk.

"For cancer patients, eating can be tricky because their appetite and palate change. So we advise them to have small and frequent feedings. We also try to accommodate and give them what they feel like eating, because it's better than not eating at all."

Patients who are not in hospital will have their weight or muscle mass monitored by their doctors during consultation. If there's cause for concern, a dietitian will be called in to help develop an eating plan.

Commercially produced ice-cream is safe to eat but the raw fruit and vegetable garnish is considered a risk. Photo by Siraphol S. from


While it's important for cancer patients to keep eating, it's also necessary to ensure that the food is safe to eat. Cancer treatments can leave the patient with a weakened immune system, putting them at risk of bacterial infections.

"The bacteria we're concerned about include salmonella, E. coli and listeria," says Nur Hayati. "When your immune system is weak, it's difficult to fight off infections. The bacteria may not cause death directly but it can cause diarrhoea, resulting in dehydration and further weakening the body."

To reduce the risk, cancer patients are put on a neutropenic diet. It's not so much about the type of food they need to eat, but how the food is prepared. Everything must be fully cooked, the dairy pasteurised and the water boiled.

This means no raw fruits or vegetables such as salads, or cured meats and fish. No half-boiled eggs or runny yolks, only fully cooked eggs. Nuts which are raw must be avoided, so too probiotic drinks. Processed fast food meals are considered risky, and not advisable.

But mass-produced and commercially-made food items such as fruit juice, ice-cream, biscuits or bread are generally okay because of food safety standards.

However, it is best to eat home-cooked meals made from raw, natural ingredients. This way, the patient can be assured that the food is clean and prepared safely. Flavourful and aromatic spices, herbs and oil can be added to entice the patient.

Raw fruits with a thick, protective skin like a banana can be consumed safely, as long as it is washed and peeled completely. Nur Hayati adds that some leeway may be given to small amounts of raw vegetables, provided that they are washed thoroughly with vegetable detergent.

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