One question nearly always arises when Dr. Corrine Zarwan, an oncologist from Newton, or any of her Lahey Clinic colleagues in Burlington talk with a new patient about what to expect during cancer treatments.
"Patients almost always ask what they should be eating,'' Zarwan said. "And caregivers almost always ask what they should be serving."
Having worked in the field, with a specialty in women's cancers, for more than a decade, Zarwan said, she knows what to tell her patients, but shortly after she arrived at Lahey in 2008, a discussion with colleagues led her to do more than just prepare answers.
"It occurred to us that what would really be helpful would be a book designed around patients going through chemotherapy or cancer- related symptoms," she said.
She and a group of other physicians, including Dr. Keith Stuart, head of oncology at Lahey's Sophia Gordon Cancer Center, started preparing dishes with their patients in mind, and documenting their recipes. The result: "The Lahey Clinic Guide to Cooking Through Cancer: 100+ Recipes for Treatment and Recovery," published earlier this year by Countryman Press.
Through her experience treating and talking with patients, Zarwan knew that it was less a matter of what they should or should not eat in the weeks and months of treatment that lay ahead, and more a question of what they would want to eat.
Side effects that typically, though not always, accompany cancer treatment can interfere with both the process of eating and the enjoyment of food, with symptoms such as dry mouth, constipation, diarrhea, weight loss, mouth pain, and difficulty swallowing. The Lahey group decided to organize the book around such symptoms.
"First and foremost, we want this to be a helpful resource for our patients, something for them to turn to when they have questions about what to eat during their treatment, or ways to combat side effects of their treatment," Zarwan said.
"But we also want our recipes to look appealing to everyone, so that friends and family members will want to eat the same foods as the patients. It means everyone can sit around the table together, and the person in the room who is going through cancer treatment doesn't have to eat differently from the rest of the group."
So Zarwan, Stuart, and some of their colleagues formed a committee, rolled up their sleeves, and hit the kitchen.
"First we all gathered recipes and decided whether they were appropriate," Zarwan said. "Then we made modifications we thought were needed, and then everyone would take different recipes home and try them out. Typically we'd do our cooking at home on the weekends, and then bring in what we'd made on Monday for everyone to sample."
They invited other nurses, nutritionists, and physicians to provide input.
"The nutritionists in particular were helpful in giving us feedback about our recipes," Zarwan said. "They were very good about pointing out things we might not have thought of. For example, what foods were hard to digest or might cause an obstruction in a patient suffering from constipation, one of the many typical symptoms of cancer treatment. They also helped us to provide calorie counts and nutritional information for each recipe."
The Lahey book's recipes include fruit smoothies for patients with mouth sores, banana-flaxseed wraps for patients with constipation, and rice-flour pancakes for patients with diarrhea. In the section addressing nausea, perhaps the most frequently anticipated symptom of cancer treatment, the recipes are designed to smell enticing without overly strong or pungent odors.
Zarwan said she has always enjoyed cooking. As a girl, she would host sleepovers that featured breakfast for her family made by herself and her friends. Now, she often cooks with her two daughters: a 4-year-old who likes to help, and a 2-year-old more likely to be mirroring her mother's actions in her own play kitchen set.
Zarwan said she has come to recognize just in the few months since the book's publication how diverse its audience is. Initially she thought of it as a cookbook that would be used mostly by caregivers of people in cancer treatment — loving family members who wanted to nurture the patient as best they could with tempting meals. But she soon came to realize that it doesn't need to be a family member or intimate friend: The impulse to provide food to someone undergoing illness is far more widespread than that. Friends, neighbors, colleagues, fellow church members, anyone who might find themselves in the position of dropping off a meal, she said, can benefit from knowing what foods are especially appropriate and which ones to avoid.
Not in the cookbook, however, are references to foods specifically believed to fight cancer.
"There are many books about preventing or combating cancer, but this is not one of them," Zarwan said. "Our intent with this book is to help patients who do have cancer on their journey through the treatment, to make the treatment a little more tolerable, and to help them enjoy eating as they go through the process."
And to that end, Zarwan points with particular pride to the last section, which is titled "Celebrations." While it might seem unlikely that cancer patients would want to celebrate, the section reflects the book's focus on supporting their option to remain embedded in normal family life and social situations, she said.
"We included some recipes for special treats and cocktails, with the idea that it's not all about nausea and weight loss and sore mouths," she said. "There are times for enjoying more decadent and fun recipes. So we included lobster pot pie, cakes, cupcakes, and special alcoholic beverages.
"We wanted to end with something uplifting. People are likely to have the chance to celebrate birthdays, weddings, and other special events during the course of their treatment, and we want them to know it's fine to indulge sometimes."
Nancy Shohet West can be reached at nancyswest@ gmail.com.