Introduction
Lung cancer is one of the most common types of cancer1 and is known to cause 18% of cancer-related deaths all around the world.2 Lung cancer mainly presents with symptoms of a persistent cough, breathlessness, and unexplained weight loss. Although the treatment modality used depends on the cancer type and stage, proper nutrition may provide essential care for the symptoms patients experience and improve their overall health during and after treatment.
Proper nutrition helps maintain body weight and strength, reduces treatment side effects, and generally enhances well-being. This article aims to offer practical dietary advice for better recovery and manageability of treatment among lung cancer patients.1,2
The role of nutrition in lung cancer
Impact of diet on cancer
Diet plays a crucial role in the development and progression of cancer. Poor nutrition can weaken the immune system, making it harder for the body to combat cancer cells. On the other hand, a balanced diet supports overall health and can enhance the effectiveness of cancer treatments.
Cancer-related malnutrition
Up to 70% of lung cancer patients experience malnutrition or muscle loss, which can worsen prognosis and reduce survival rates. Nutritional support can help mitigate these adverse effects by maintaining muscle mass and improving quality of life.2
Weight and muscle mass
Maintaining a healthy weight and muscle mass is crucial. Nutritional interventions, including individualised dietary counselling and increased protein intake, have shown benefits in patient outcomes. Omega-3 fatty acids, in particular, may help reduce inflammation and support muscle maintenance during treatment.3,4
Nutrition during treatment
Maintaining a healthy diet
While under the process of treatments like chemotherapy, radiation, and surgery, a balanced diet should be maintained. However, it is generally more challenging to meet nutritional needs as these treatments usually present side effects of nausea, vomiting, and lack of appetite, which all combat nutritional efforts.2,3,4
Managing side effects
Strategies to manage these side effects include:
- Eating small, frequent meals
- Choosing nutrient-dense foods
- Adjusting food textures to ease swallowing difficulties
- In some cases, enteral or parenteral nutrition may be necessary
Post-treatment nutrition
Recovery needs
Post-treatment, the body requires a balanced diet to recover and rebuild. This includes sufficient:2,3,4
- Protein, to repair tissues
- Vitamins and minerals to support immune function
- Healthy fats for energy
Long-term dietary changes
Long-term dietary adjustments can help prevent recurrence and support overall health. Some key recommendations are emphasising:2,3,4
- Whole foods
- Reducing processed foods
- Maintaining a healthy weight
Essential nutrients for lung cancer patients
Proteins
Proteins are essential for healing tissues and activating immune cells. Specific amino acids like arginine and cysteine play crucial roles. Arginine supports the immune system and improves blood flow to wounds, while cysteine aids collagen synthesis.
- Lean meats
- Fish
- Legumes
- Nuts
All are excellent sources of protein that support immune function and tissue repair.
Carbohydrates
Carbohydrates are an essential energy source, especially for patients undergoing intensive cancer treatments.5,6,9
Recommended sources include:
- Whole grains
- Brown rice
- Whole wheat bread
- Whole Oats
- Buckwheat
- Fruits
- Bananas
- Apples
- Grapes
- Mangoes
- Vegetables
- Broccoli
- Carrots
- Sweet Potatoes
- Corn/Sweetcorn
All offer essential vitamins, minerals, and fibre that aid in overall health and recovery.
Fats
Focus on healthy fats like omega-3 fatty acids that have anti-inflammatory and antioxidant effects, which are very beneficial for patients during cancer treatment.5,6
Recommended sources of omega-3 fatty acids are:
- Fatty fish
- Salmon
- Mackerel
- Sardines
- Tuna
- Nuts and seeds
- Flaxseeds
- Walnuts
- Chia seeds
The omega-3s found in these sources support immune function and reduce inflammation.
Vitamins and minerals
The following list of vitamins and minerals support a majority of your bodily functions, which are essential for maintaining during cancer treatment:5,6,9
- Vitamin D: Supports immune function
- Sources: sunlight, fortified dairy products, fish
- Calcium: Essential for bone health, which can be compromised during treatment
- Sources: dairy products, leafy greens, fortified foods
- Iron: Important for preventing anaemia, which is a common issue in cancer patients
- Sources: lean meats, beans, fortified cereals
- Vitamin C and E: Antioxidants that protect your immune system cells from damage
- Sources: citrus fruits, berries, vegetables, nuts, seeds, vegetable oils
- Selenium and Zinc: Selenium boosts your immune response and resistance to infections, while zinc supports your immune cell function
- Sources: Brazil nuts, meat, shellfish, legumes
Hydration
Adequate fluid intake is crucial for overall health and recovery as it helps manage side effects such as nausea and vomiting.5,6
Tips for ensuring adequate fluid intake:
- Drink plenty of water throughout the day
- Consume hydrating fruits and vegetables
- Watermelon
- Strawberries
- Cantaloupe
- Cucumber
- Tomatoes
- Bell Peppers
- Avoid beverages that can cause dehydration, such as those with caffeine or alcohol.
Dietary recommendations for lung cancer patients
Managing symptoms through diet
Strategies for dealing with nausea, loss of appetite, and taste changes may include:3, 10
- Have mild-tasting foods that are easy to prepare
- Eat small, frequent meals
- Try different flavours and spices to enhance the taste
- Use plastic or bamboo utensils to minimize metallic flavours
- Rinse your mouth before meals with a mixture of salt and baking soda in water to refresh your palate
Foods that are easy to eat and digest include:3, 10
- Potatoes and salads as base layers with various toppings.
- Soft, creamy foods like oatmeal, eggs, yoghurt, milkshakes, and nutrition drinks.
- Pureed foods can be made from nearly any dish and thinned with appropriate liquids.
Immune-boosting foods
Foods that support the immune system:
- Include high-protein toppings on salads, such as chicken or tuna salad, canned salmon, chicken or beef strips, cottage cheese, beans, tofu, or hard-boiled eggs
- High-calorie toppings like cheese, creamy dressings, nuts, guacamole, olive oil, flaxseeds, and dried fruit can also be beneficial3, 10
- Aim to include a variety of these immune-boosting and nutrient-rich foods in each meal
- Experiment with different combinations of flavours and textures to find what works best during treatment
Foods to avoid
- Avoid alcohol, very hot or spicy foods, foods with strong odours, overly sweet or greasy foods, and those high in simple sugars
- High-fibre foods and items that cause gas should be limited if experiencing diarrhoea
- Acidic, tart, or salty foods can cause discomfort when dealing with mucositis or esophagitis3, 10
Practical tips and meal ideas
Shopping and meal preparation
Meal planning and list-making
- Plan meals and snacks ahead of time to ensure a balanced diet throughout the week
- Create a grocery list based on planned meals to streamline shopping and ensure all necessary ingredients are purchased
Batch cooking
- Prepare large batches of meals that can be portioned and frozen for later use, making it easier to manage mealtimes when energy levels are low
Healthy snacks
- Keep a supply of healthy snacks such as nuts, yoghurt, and fruit for quick and easy nutrition between meals
Food safety
- Focus on food safety, especially if the immune system is compromised. Wash fruits and vegetables thoroughly, cook meats to safe temperatures, and avoid raw or undercooked foods3,8,9,10
Sample meal plans
To save you the hassle, here are some meal ideas to have for your breakfast, lunch, dinner and snacks.3,8,9,10
Breakfast
- Smoothies: Blend fruits, yoghurt, and a handful of spinach for a nutrient-rich breakfast
- Oatmeal: Top with nuts, seeds, and berries for added protein and antioxidants
- Egg Dishes: Scrambled eggs with vegetables or a frittata can provide a good source of protein and vitamins
Lunch
- Salads: Use a variety of greens, vegetables, lean proteins (chicken, tuna, beans), and healthy fats (avocado, nuts)
- Sandwiches: Whole grain bread with lean meats, plenty of vegetables, and a spread like hummus or avocado
Dinner
- Grilled Fish: Serve with quinoa and steamed vegetables for a balanced meal rich in omega-3 fatty acids
- Stir-fry: Combine lean protein (chicken, tofu), a variety of vegetables, and brown rice or noodles
Snacks
- Yoghurt Parfaits: Layer yoghurt with granola and fresh fruit
- Nut Mixes: A mix of nuts and dried fruit provides a quick and nutritious snack
- Energy Bars: Look for bars high in protein and fibre but low in added sugars
What support and resources are available?
Personalised nutrition advice
For all lung cancer patients, personalised nutrition advice can:
- Significantly enhance treatment responses
- Prevent side effects
- Shorten recovery time
- Improve prognosis
- Increase the quality of life
Dietitians can provide specialised guidance on dietary needs and can tailor meal plans, and strategies to manage treatment-related side effects such as nausea, vomiting, and appetite loss.
Nutritional counselling helps in maintaining muscle mass, managing weight, and ensuring adequate nutrient intake, which is crucial for patients undergoing chemotherapy or radiation therapy.6,8
How to find a qualified dietitian
- Patients can seek recommendations from their healthcare team, oncologists, or cancer treatment centres
- Many cancer centres have in-house dietitians who specialise in oncology nutrition
- Professional organizations such as the Academy of Nutrition and Dietetics or the American Institute for Cancer Research can provide directories of qualified dietitians6,8
Support groups
Connecting with other lung cancer patients:6,8
- Support groups provide emotional support, practical advice, and a sense of community for lung cancer patients.
- These groups can be found through cancer treatment centres, local hospitals, or online platforms dedicated to cancer support.
- Peer support from others who have faced similar challenges can be invaluable in coping with the disease and its treatment.
Summary
- Proper nutrition in the diet management of lung cancer significantly affects the progression and outcome of treatment, as well as the quality of life of the patient
- A balanced diet rich in protein, carbohydrates, healthy fats, vitamins, and minerals supports immune function, maintains muscle mass, and promotes recovery
- Individual dietary strategies in managing side effects can ensure that patients get proper nutrition during and after treatment, thus reducing the impacts of malnutrition on the overall prognosis
- Emphasising the importance of nutrition, along with personalised dietary advice and support, can enhance the well-being and treatment success of lung cancer patients
References
- NHS. Lung cancer. [Internet]. nhs.uk. NHS. [updated 1 November 2022; cited 7 June 2024]. Available from: https://www.nhs.uk/conditions/lung-cancer/.
- World Health Organisation, WHO. Lung cancer. [Internet]. who.int. World Health Organisation, WHO [updated 26 June 2023; cited 7 June 2024]. Available from: https://www.who.int/news-room/fact-sheets/detail/lung-cancer.
- Kiss N. Nutrition support and dietary interventions for patients with lung cancer: current insights. Lung Cancer (Auckl). 2016 [cited 7 June 2024]; 7:1–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310694/.
- Hultin G. Nutrition for People with Lung Cancer. [Internet]. foodandnutrition.org. Food & Nutrition Magazine [updated 27 May 2022; cited 7 June 2024]. Available from: https://foodandnutrition.org/from-the-magazine/nutrition-for-people-with-lung-cancer/.
- American Lung Association. Nutrition for Lung Cancer Patients. [Internet]. lung.org. American Lung Association [updated 7 June 2024; cited 7 June 2024]. Available from: https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/treatment/stay-healthy/nutrition.
- Kasprzyk A, Bilmin K, Chmielewska-Ignatowicz T, Pawlikowski J, Religioni U, Merks P. The Role of Nutritional Support in Malnourished Patients With Lung Cancer. In Vivo. 2021 [cited 7 June 2024]; 35(1):53–60. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880748/.
- Climan A. A Lung Cancer Diet? Foods To Eat and Avoid. [Internet]. mylungcancerteam.com. MyLungCancerTeam [updated 22 April 2024; cited 7 June 2024]. Available from: https://www.mylungcancerteam.com/resources/a-lung-cancer-diet-foods-to-eat-and-avoid.
- What are the Dietary Recommendations for Lung Cancer Patients? Bing [Internet]. [cited 7 June 2024]. Available from: https://www.bing.com/search?q=What+are+the+Dietary+Recommendations+for+Lung+Cancer+Patients%3F&qs=n&form=QBRE&sp=-1&lq=0&pq=what+are+the+dietary+recommendations+for+lung+cancer+patients%3F&sc=0-62&sk=&cvid=3079E3630D494505918A97DCD4B358EC&ghsh=0&ghacc=0&ghpl=&ntref=1.
- MOFFITT Cancer Center. Foods that Prevent and Fight Lung Cancer. [Internet]. moffitt.org. MOFFITT Cancer Center [cited 7 June 2024]. Available from: https://www.moffitt.org/cancers/lung-cancer/faqs/foods-that-prevent-and-fight-lung-cancer/.
- Abramson Cancer Center. Guide to Nutrition during Lung Cancer Treatment. [Internet]. med.upenn.edu. Ambramson Cancer Center [cited 7 June 2024]. Available from: https://www.med.upenn.edu/lung2022/assets/user-content/documents/guidetonutritionduringlungcancertreatment111721carly-(1).pdf.