癌症治療吃不下?癌症飲食少量多餐並兼顧均衡飲食!

2022/07/22講糖編輯部
「癌友黃奶奶因化療疲憊,食欲很差也常吃不下,全家人都很擔心黃奶奶後續的治療,聽鄰居說要多吃肉才有體力抗癌,這樣真的對嗎?」(延伸閱讀:被診斷出癌症好慌張!飲食該如何調整才能幫助治療呢?)

想要維持營養兼顧血糖?掌握癌症飲食3大原則!

癌症時胃口差吃不下,治療的藥物常引起身體發炎,血糖也會較難管理,照護家屬可以參考以下3大飲食原則準備!
  1. 製作均衡的飲食:全穀雜糧、豆魚蛋肉為優先,挑選病人愛吃的食材、烹調方式,避免聽信坊間偏方或採取其他極端飲食
  2. 避免單次進食太多:可以採取少量多餐的進食方式,像是將一餐的份量分成兩次吃,由一天3正餐變成3正餐加3點心!吃東西時不要喝大量的水,盡量避免把胃空間佔用掉!此時建議留意高血糖症狀,維持定期測量血糖的習慣
  3. 拋掉舊有健康觀念:多吃菜、多喝水、少油少鹽等,看似健康的飲食概念,在胃口不好時,容易讓病人吃得更少,營養狀況反而變糟
    • 想吃什麼就吃:不是一定要吃「健康」的食物,像糙米很健康,但不好咀嚼,可能降低病人吃的意願,導致熱量攝取下降
    • 先吃全穀雜糧類食物、豆魚蛋肉類食物:胃有多餘空間,再多吃蔬菜、水果等

「吃」得舒適,讓癌症末期營養不煩惱

如果癌症已進入末期,最需要考量的是身體舒適程度,給予想吃的、能接受的食物、飲食方式,不強迫進食!
  1. 避免易產氣如豆漿、地瓜等、味道過重如臭豆腐、榴槤等,病人無法接受的食物
  2. 家人多陪伴、聊天等,可能增加病人進食意願
這時若胃口不佳、吃不好但血糖藥照舊時,需特別注意低血糖的發生,建議一開始就跟醫師討論病人降血糖藥物或胰島素的正確使用方式!
抗癌期間營養狀況的好壞,取決於食物是否真的有吃下肚!戰勝癌症的關鍵在於「體力」,糖友記得按時自我血糖監測,有任何疑惑立即諮詢專業營養師,可能幫助減少焦慮、不安的情緒,也有助於控制病情!
參考文獻:
  1. Uptodate:The role of parenteral and enteral/oral nutritional support in patients with cancer
  2. Physical activity guidelines. In: Rehabilitation Issues During Cancer Treatment and Follow-Up, European Society for Medical Oncology (ESMO). Available at: https://oncologypro.esmo.org/education-library/esmo-handbooks/rehabilitation-issues-during-cancer-treatment-and-follow-up/Physical-Activity-Guidelines (Accessed on January 14, 2021).
  3. Andreyev, H.J., et al., Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer, 1998. 34(4): p. 503-9.
  4. Dewys, W.D., et al., Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med, 1980. 69(4): p. 491-7.
  5. Senesse, P., et al., Nutritional support during oncologic treatment of patients with gastrointestinal cancer: who could benefit? Cancer Treat Rev, 2008. 34(6): p. 568-75.
  6. Barret, M., et al., Nutritional status affects treatment tolerability and survival in metastatic colorectal cancer patients: results of an AGEO prospective multicenter study. Oncology, 2011. 81(5-6): p. 395-402.
  7. Jagoe, R.T., T.H. Goodship, and G.J. Gibson, The influence of nutritional status on complications after operations for lung cancer. Ann Thorac Surg, 2001. 71(3): p. 936-43.
  8. Rey-Ferro, M., et al., Nutritional and immunologic evaluation of patients with gastric cancer before and after surgery. Nutrition, 1997. 13(10): p. 878-81.
  9. Salas, S., et al., Nutritional factors as predictors of response to radio-chemotherapy and survival in unresectable squamous head and neck carcinoma. Radiother Oncol, 2008. 87(2): p. 195-200.



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飲食5大正確方向,幫助維持體重又有好體力

癌症治療過程中,更要好好維持身體營養狀況,飲食設定需朝這5大方向去努力!
  1. 改善治療的效果和耐受度
  2. 維持穩定的體重,避免營養不良發生
  3. 改善外科手術、藥物的治療效果
  4. 降低化療副作用的強度
  5. 讓病人有較好的生活品質
體重的減輕對癌症病人來說很常見,然而,可能會降低生活質量、疾病預後也會較不好,體重減輕可能是以下4個原因。
  1. 口腔黏膜潰瘍,造成吃東西不舒服
  2. 因消化道問題,無法攝取或無法吸收足夠的熱量
  3. 食慾不振、腸道不適
  4. 代謝異常
癌症治療過程中,病人的身體營養狀況非常重要,研究發現如果營養狀況不佳,容易出現這4個問題
  1. 會降低各種癌症的總體存活率
  2. 會降低手術和藥物治療效果
  3. 增加化療相關毒性發生:化療是以細胞毒性藥物消滅或抑制體內癌細胞,但有時候會造成相關的器官損傷
  4. 病人生活品質較差

治療初期,哪2個飲食種類能幫助我抗癌?

除了腸道、口腔等相關癌症會影響進食狀況之外,大部分的癌友會因心情不好而胃口差,學習調適情緒、維持良好的用餐心情格外重要!
三餐都要注意飲食均衡、吃足熱量和蛋白質,幫助保持較好的治療前體重。
  1. 全穀雜糧類:
    生病治療可能會減少活動量,糖友可維持生病前足夠的份量,像是熱量建議為1800大卡的糖友,一天全穀雜糧攝取約12份,約是3個平碗的米飯量
    若體重變輕,建議回診時跟營養師討論,是否要增加全穀雜糧攝取量
  2. 豆魚蛋肉類:
    治療時,蛋白質食物可每天酌量增加2份,像是肉類約一個掌心大小、一塊市場板豆腐、或兩杯豆漿等

糖友在癌症初期不可避免會感到徬徨、不安,但心情的調適相當重要,身體營養狀況攸關治療結果,對於營養、飲食有任何疑問都應尋求幫助,盡可能諮詢營養師,要有充分的體力才能與癌症對抗!
參考文獻:
  1. Uptodate:The role of parenteral and enteral/oral nutritional support in patients with cancer
  2. Physical activity guidelines. In: Rehabilitation Issues During Cancer Treatment and Follow-Up, European Society for Medical Oncology (ESMO). Available at: https://oncologypro.esmo.org/education-library/esmo-handbooks/rehabilitation-issues-during-cancer-treatment-and-follow-up/Physical-Activity-Guidelines (Accessed on January 14, 2021).
  3. Andreyev, H.J., et al., Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer, 1998. 34(4): p. 503-9.
  4. Dewys, W.D., et al., Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med, 1980. 69(4): p. 491-7.
  5. Senesse, P., et al., Nutritional support during oncologic treatment of patients with gastrointestinal cancer: who could benefit? Cancer Treat Rev, 2008. 34(6): p. 568-75.
  6. Barret, M., et al., Nutritional status affects treatment tolerability and survival in metastatic colorectal cancer patients: results of an AGEO prospective multicenter study. Oncology, 2011. 81(5-6): p. 395-402.
  7. Jagoe, R.T., T.H. Goodship, and G.J. Gibson, The influence of nutritional status on complications after operations for lung cancer. Ann Thorac Surg, 2001. 71(3): p. 936-43.
  8. Rey-Ferro, M., et al., Nutritional and immunologic evaluation of patients with gastric cancer before and after surgery. Nutrition, 1997. 13(10): p. 878-81.
  9. Salas, S., et al., Nutritional factors as predictors of response to radio-chemotherapy and survival in unresectable squamous head and neck carcinoma. Radiother Oncol, 2008. 87(2): p. 195-200.