Drink Up
Keeping hydrated during therapy is essential for cancer patients.

By Elizabeth Whittington

What used to be a simple reminder by a family physician to drink eight glasses of water a day has turned into a business of fancy products for staying hydrated. Hydration packs and pricy bottled drinks aside, staying hydrated is especially important for cancer patients, given the side effects caused by treatment.

Dehydration occurs when the body takes in less fluid than it releases, such as with diarrhea, vomiting or sweating. Because of cancer treatments or the disease itself, hydration is essential to help flush out toxins and stay healthy. “Often patients don’t have the desire or energy to eat or drink, so when they do feel thirsty enough to do something about it, they may already be dehydrated,” say dietician D. Milton Stokes, RD. Symptoms include little or dark urine, fatigue, sunken eyes and skin that remains raised if pinched (called skin turgor). Signs of severe dehydration, such as low blood pressure, rapid heartbeat, dizziness and confusion, require immediate intravenous fluids.

Because traditional chemotherapies kill rapidly growing cells in the intestinal tract and stomach, vomiting and diarrhea are common side effects. Patients should inform their doctor of these side effects, especially if they last longer than 24 hours. “Diarrhea can cause patients to become dehydrated very quickly and not know it,” says Eric Cohen, an oncology nurse with Life with Cancer at Inova Fairfax Hospital. “People can lose a lot of fluid in a short amount of time.”

Proper hydration can alleviate common side effects like constipation and fatigue as well as rare and serious effects, such as kidney damage. Because the kidneys filter waste, chemicals and excess compounds from the blood, some chemotherapy drugs, such as Platinol® (cisplatin), Paraplatin® (carboplatin), methotrexate and interleukin-2, can damage the kidneys. Intravenous fluids are given during treatment, and drinking water before and after treatment is recommended to flush the toxins through more quickly.

Even patients with compromised immune systems can stay hydrated by drinking simple tap water compared with filtered or bottled water. “We never tell people they have to drink bottled water. Tap water is fine,” Cohen says. “There is no data saying [immunocompromised patients] get fewer infections with bottled water.” But sometimes water may not be enough since patients are at risk of electrolyte imbalance. Products such as Pedialyte®, Boost Breeze®, broths and sports drinks can restore electrolyte balance in the body.

Although many foods and beverages contain water, patients should limit caffeinated drinks and alcohol, which may increase urine and electrolyte depletion even further. “If people consume caffeine on an everyday basis, their bodies adjust to that, and they end up with more fluid than you would think,” Stokes says. “But if you only drink it once a week, then you may end up losing a little more fluid.” It’s also best to match each caffeinated beverage with a non-caffeinated one, or drink beverages with less caffeine.

Alcohol, on the other hand, is dehydrating, says Stokes. “If your doctor has given the green light that you can drink alcohol, definitely drink a glass or two of water right after each glass of alcohol.” It is also recommended that patients hydrate throughout the day by drinking a glass of water an hour, instead of following the old adage of eight glasses of water a day. “When they’re feeling their worst, just sipping something throughout the day is better than nothing,” Cohen says.

Tastes may change during treatment. To get the most nutrients and hydration, patients are encouraged to experiment with different foods, drinks and combinations of vegetable and fruit dips, as well as flavored waters, teas and mixed drinks. Hydration is an easy way to keep healthy and feel better, both during and after treatment. “Water is truly the most important nutrient in our diet,” Stokes says.