Keypoints

Unexplained weight loss and loss of appetite

Unexplained weight loss as a result of non-Hodgkin's lymphoma can mean patients becoming malnourished, making them feel tired more quickly and more vulnerable to infections.

Importantly, patients who are malnourished are also less likely to be able to cope with treatments, such as chemotherapy, and more likely to have delays in their treatment due to, for example, their blood count being too low to have the next course of drugs.

Loss of appetite may be the result of the non-Hodgkin's lymphoma itself or its treatment. Both radiotherapy and chemotherapy can cause nausea, while chemotherapy drugs can sometimes make food taste different, both of which can make eating less appealing.

The lymphoma team may suggest that the patient see a dietician to increase their appetite and help build up their weight. The dietician may prescribe nutritional supplements such as high-energy drinks, which may also help patients who are having difficulty swallowing or have a sore throat as a result of their treatment. Some drugs, such as corticosteroids and cannabis-derived drugs such as dronabinol, may also be of benefit, and patients should discuss these with their doctor or lymphoma team to see if they are appropriate.

There are many different diets described in books, newspapers and magazines. However, it is important that patients maintain a well-balanced diet, so always ask the lymphoma team or the dietician for advice, as not all diets will be appropriate. However, there are some adjustments that patients can make to their meals more appealing and help increase their weight. These include:

• Eating smaller meals more often, including snacks, such as biscuits, toast, cheese and crackers, between meals
• Avoiding the preparation of food, if possible
• Eating cold food rather than hot food and avoiding food with strong odours
• Using full cream milk and full fat yoghurts instead of low-fat alternatives
• Using extra butter, margarine or oil on bread, potatoes, pasta, rice and vegetables, and extra mayonnaise or oil-based salad dressings on sandwiches and salads
• Adding extra cheese to pizzas, sauces, soups and pasta
• Using extra honey or sugar with cereals, drinks, fruit and vegetables

However, some diets that might ordinarily appear to be healthy might actually harm a patient with non-Hodgkin's lymphoma who has, for example, neutropenia (see Low numbers of blood cells, below) after chemotherapy. Such patients should avoid salads, raw meat or blue cheese, as there is an increased risk of infection from such foods.