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WASHINGTON (AP) - Ric Haury is fighting both tonsil cancer and a second battle - trying not to waste away, even as the radiation and chemotherapy needed to save him make it impossible to eat normally.

First a week of nausea. Then a throat too painfully swollen to swallow anything more solid than gravy-laden mashed potatoes. Then his appetite disappeared. Now his saliva has, too.

Haury is lucky - so far he's lost only 15 pounds. But it's a constant battle.

About half of all cancer patients suffer serious weight loss and malnutrition, a wasting syndrome that makes surviving harder. But experts say there are ways to head it off and wish more patients were like Haury, armed with the help of a nutrition specialist almost from the moment of diagnosis.

"Unfortunately with the vast majority of patients, quite often nutrition is an afterthought," says David Grotto of the American Dietetic Association. "The key message is to be aggressive with nutrition before they develop a problem."

Wasting, also called cancer anorexia or cancer cachexia, is not just losing excess fat but vital muscle. Wasting makes therapy harder to tolerate, and studies suggest patients who lose more than 5 percent of their original weight have a worse prognosis than stable-weight patients.

Tumors themselves can cause the wasting, particularly gastrointestinal cancers. But therapies often are to blame. Radiation and, to different degrees, different chemotherapy regimens can cause nausea, appetite suppression, mouth sores, difficulty swallowing, dry mouth or - one of the most common problems - strangely altered taste.

Nausea is the best-known side effect, although for many patients it is periodic, striking for a few days and then abating until the next treatment, says Abby Bloch, an American Cancer Society nutrition consultant.

And anti-nausea medications developed in the last decade bring relief to many patients. But some of the most potent are very expensive and not covered by all insurance plans, so clinics may not give them until a patient complains, Bloch says. That's "unfortunate because these medications have made enormous differences for individuals who are able to use them."

The taste problem, however, often comes as a shock because doctors seldom warn about it, Bloch says. Some patients develop an aversion to a particular food: meat tastes rotten or bread like sawdust. But many get a metallic taste in their mouths so bad they simply can't bear to eat.

Add a sore or dry mouth that makes chewing difficult, and it's not unusual to go days with very little food - risking electrolyte imbalances that can make patients pass out even before much weight loss is apparent.

Once wasting is diagnosed, doctors may try different medications to stimulate appetite. But the cancer society and dietitian group stress that nutritionists often can help prevent or minimize the side effects before someone's too sick.

Help ranges from little tips - suck lemon wedges or lemon drops and keep hydrated to cut that metallic taste; choose crackers, sherbet or rice when nauseated - to customized care that may include special high-calorie liquid foods.

But access to nutritionists can be a problem. Some hospitals, like the Cleveland Clinic where Haury sought care, routinely include a cancer nutritionist as part of the treatment team. For patients who seek nutrition help on their own, insurance typically doesn't pay for it, or for those special liquid meals. A registered dietitian charges $65 to $150 an hour.

Yet it's cheaper to keep a patient from needing tube-feeding, which insurance does cover, laments Haury's wife, Beverly.

The Stow, Ohio, man is responding well to cancer treatment. Now his challenge is packing at least 2,200 calories a day into an all-liquid diet to keep strong.

Menus evolve as treatment progresses, a Cleveland Clinic nutritionist helped the couple learn. Crackers helped nausea, but as radiation inflamed Haury's throat, gravy helped foods slide down. Now that he eats no solids and has no appetite, Mrs. Haury is scouting creative recipes for extra-fat, extra-protein milkshakes tasty enough that her husband will force down at least 20 sips a half-hour.

"That is a struggle," she says. "He has a strong will, but you have to be creative."

Copyright 2002 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Nutrition Tips

Tips from cancer specialists to patients whose cancers and therapies cause side effects that lead to severe weight loss:

Don't expect the same side effects as another patient. Even people undergoing the same treatment have different degrees of side effects.

A snack before chemotherapy or radiation may be more tolerable than treatment on an empty stomach. Sometimes treatment lasts several hours; bring food with you.

Bland foods, sour candy or dry crackers help nausea. Don't eat your favorite foods when nauseated - vomiting may create a lasting psychological aversion to them. Fatty, fried, very spicy or very sweet foods also are hard to tolerate.

If your mouth has a constant metallic taste, try plastic utensils. Before eating, brush teeth or rinse mouth with salt water, water and baking soda, even tea or ginger ale. Some people find bland potatoes or bananas more palatable; others mask the metal taste with spices or acidic foods such as lemon wedges. Suck lemon drops or mints or try frozen foods, such as liquid food supplements frozen into ice cubes.

Sip water slowly through the day. Dehydration exacerbates some side effects.

Small, frequent meals, eaten slowly, are easier to tolerate than three big ones.

Pack calories and protein into smaller volumes of food. For example, some cancer patients sip milkshakes made with whole milk, heavy whipping cream, powdered milk, powdered egg whites and different fruits, packing 700 calories and 18 grams of protein into one glass.

Simple blood tests can detect muscle deterioration, nutrition imbalances and electrolyte imbalances before major weight loss occurs.

On the Net: The National Cancer Institute

American Cancer Society

The American Dietetic Association

The National Comprehensive Cancer Network guidelines on anti-nausea drugs

Copyright 2002 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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