Palliative Care

Living with pancreatic cancer is not easy; a support system is critical in helping a patient cope with both the emotional and day-to-day aspects of this aggressive disease. Patients worry about caring for themselves and their families, and continuing daily activities. Concerns about pancreatic cancer treatments, managing side effects, and hospital stays are also common.

Pancreatic cancer support groups are available to help. In these groups, patients or their family members get together to share what they have learned about coping with their disease and the effects of treatment. Doctors, nurses, and other members of the health care team can answer questions about treatment, diet, working, or other matters. Meeting with a social worker, counsellor, or member of the clergy can be helpful to those who want to discuss their concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, emotional support, or other services to aid in living with pancreatic cancer. Patients and caregivers may want to talk with a member of their health care team about finding a pancreatic cancer support group.

Another option is to ask your specialist, GP, or hospital nurse about referral to a symptom control nurse. These are specialist nurses who can work with you and your doctor to help control your cancer symptoms and improve your well-being.

Diet, Nutrition and Managing Symptoms

People with pancreatic cancer have many nutritional challenges to overcome. A dietitian can be a valuable resource for patients living with pancreatic cancer. They will work with you to develop an eating plan catered specifically for your needs and will typically involve keeping fat intake low and carbohydrate intake high. In addition, it is important to develop meal plans that incorporate a broad range of foods and to eat small nutritionally balanced meals frequently.
You must consume a diet that contains a wide variety of nutrients so you can maintain your weight and have energy to remain active. Your diet should be rich in protein and calories. Here are a few general diet tips:

  • Drink plenty of fluids each day to combat dehydration and improve appetite
  • Eat five to six small meals each day
  • Avoid consuming unhealthy calories found in sweets and junk food
  • Eat fish and lean meat
  • Eat red meat only sparingly
  • Milk products can be a good source of protein
  • Eat plenty of fresh fruit and vegetables as long as they do not trigger diarrhea

Loss of Appetite and Nausea

Nausea is a common symptom of pancreatic cancer that may occur for many different reasons. Some chemotherapy drugs, radiation therapy, as well as other prescribed medications can also cause nausea. Diet should focus on easily tolerated foods that are usually bland, low in odour, and low in fat and fibre content. Getting enough fluids is important to prevent dehydration. If nausea is severe, please see your doctor. Helpful tips if you are experiencing loss of appetite and nausea:

  • Eat small, frequent meals of easily digestible food
  • Rooms that are too warm or stuffy may make nausea worse
  • Try dry starchy foods such as crackers or dry toast, especially if it has been several hours since your previous meal or snack
  • Choose foods that are cold or room temperature. They can have fewer odors and be more easily digested
  • Avoid greasy, spicy, hot, or very sweet food
  • Avoid your favourite foods wh en you are nauseated to prevent permanent dislike for this food
  • Slowly sip cold, clear juices, ginger ale, or other carbonated beverages
  • Restrict fluids with meals
  • Try peppermint or ginger tea or sucking a candy flavored with peppermint, wintergreen or lemon can help, especially if you have unpleasant tastes in your mouth
  • Try high calorie medical nutritional supplements to help get calories and nutrients without
  • Try relaxation techniques
  • Wear loose clothing
  • Talk to the doctor about anti­emetic (anti­nausea) medications

Helpful hints for the caregiver

  • Offer small amounts of food and beverages often
  • Allow your loved one to say “no” but make sure they stay hydrated
  • Keep track of the amount of fluid they take each day
  • Consult a doctor if they continue to vomit when taking fluids
  • Cook when your loved one is not home so they are not exposed to odours. If this is not possible please open a window
  • If friends or family offer to help, have them cook a meal at their home
  • Remove all garbage as it may contain odours that can make nausea worse

Diarrhea

Diarrhea is a common problem with pancreatic cancer patients. If it is posing a serious issue, the diet should be limited to simple, easy-to-digest food, then expanded as the diarrhea subsides. A diet consisting of bananas, rice, applesauce, toast (called the BRAT diet), and clear liquid can help with severe diarrhea. Imodium® (loperamide) can be easily obtained at a pharmacy. This drug slows the gastrointestinal system and reduces the amount of fluid lost in the stool.

Helpful tips if you are experiencing diarrhea:

  • Eat 5­6 small meals a day
  • Talk to a dietitian about enzymes or anti­diarrhea medication
  • Avoid or try to limit the amount of fatty, greasy, or fried foods including high fat meats or cheeses, whole or 2% milk, rich desserts, fast food, and foods with added oil, butter, margarine, sour cream, cream cheese, or salad dressing
  • Limit use of hot spices
  • Eat fewer fruits or vegetables and choose juices instead. High intake of insoluble fiber food such as whole grain breads/cereals, raw fruits with thick peels, raw vegetables, and nuts can increase intestinal motility
  • Avoid gas­forming foods, including vegetables in the cabbage or onion family, dried beans, corn, popcorn, and chewing gum
  • Cut back your usage of carbonated beverages. It is suggested that they be left open for at least 10 minutes prior to drinking
  • Choose beverages that are decaffeinated versions of your favourite beverages including tea
  • Drink lots of fluids to prevent dehydration. It is recommended to drink an additional cup of fluid after each bowel movement. Good choices include broth, jello, and popsicles
  • Watery diarrhea may occur after eating foods high in sugar, like rich desserts, or if symptoms of high blood sugar are present. Symptoms of high blood sugar include increased thirst and urination
  • Keep a diary of your diet and bowel movements as it may identify trigger foods for you

Helpful hints for the caregiver

  • Peel fruits and vegetables
  • Keep track of the amount of fluid they take each day
  • Consult a doctor if they continue to vomit when taking fluids
  • Stock snack foods such as crackers, applesauce, soups, Jello or drinks like Gatorade that will help replace lost sodium and potassium. Bananas can help replace lost potassium
  • Use broths to flavour and moisten food
  • Avoid deep frying foods

Fluid Intake

Staying hydrated is very important in the management of diarrhea. It is essential to consume enough clear liquids to make up for the volume of fluid lost due to the diarrhea. This amount is in addition to the usual daily intake. If the diarrhea is severe, 12 to 16 cups or more of fluid per day is recommended. In addition to plain water, you should include beverages that contain some sugar and electrolytes, such as over-the-counter formulations for diarrhea or Gatorade. If diarrhea persists, it is important to seek medical attention.

Loss of Pancreatic Digestive Enzyme Production

Patients with pancreatic cancer, especially after surgery, may have digestive enzyme deficiencies. This means that it is difficult to break down one or more types of food components into absorbable forms. The undigested food, therefore, provides no nutrient or caloric value to the patient, and unintentional weight loss may result. The diarrhea that commonly accompanies digestive enzyme deficiencies further contributes to weight loss. To treat this problem, supplemental digestive enzymes may be prescribed and should be taken with your meals or snacks.

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