This research article was published by Emerald Publishing Limited, 2022Purpose – The lack of food-based dietary guidelines for managing cancer among hospitalized patients has led to an increasing economic burden on the government and families in low- and middle-economy countries. There have been increasing medical costs due to delayed recovery, readmission and mortality. The purpose of this study is to contribute in reducing these effects by developing context specific food-based dietary guidelines to assist health-care professionals and caregivers in planning diets for cancer patients. Design/methodology/approach – For seven days, the dietary intakes of 100 cancer patients in the hospital were recorded using weighed food records. Data on the costs of commonly consumed foods during hospitalization were obtained from hospital requisition books as well as nearby markets and shops. The information gathered was used to create optimal food-based dietary guidelines for cancer patients. Findings – Most patients did not meet the recommended food group and micronutrient intake according to their weighed food records. Sugar intake from processed foods was (51 6 19.8 g), (13% 6 2%), and calories (2585 6 544 g) exceeded recommendations. Optimized models generated three menus that met the World Cancer Research Fund 2018 cancer prevention recommendation at a minimum cost of 2,700 Tanzanian Shillings (TSH), 3500TSH, and 4550TSH per day. The optimal dietary pattern includes nutrient-dense foods from all food groups in recommended portions and within calorie limits. Originality/value – Findings show that optimal dietary guidelines that are context-specific for managing cancer in hospitalized patients can be formulated using culturally acceptable food ingredients at minimum cost.