Radiotherapy or Chemoradiotherapy (CRT) is commonly used to treat head and neck cancers in order to kill the cancer cells and reduce the chance of the cancer returning.

However, these treatments can lead to various side effects. Some common side effects of chemo radiotherapy for head and neck cancer include fatigue, nausea, vomiting, mouth sores, skin changes and weakened immune system.  In addition, chemo radiotherapy can also cause changes in appetite and digestion, leading to weight loss or malnutrition. Therefore, it’s important to take care of yourself during this time and maintain a healthy diet to help alleviate some of these side effects.

Side Effects of Chemoradiotherapy for Head and Neck Cancer

Fatigue: Feeling tired, weak, or exhausted, which can interfere with daily activities.

Skin changes: The skin in the treatment area may become red, dry, itchy, or blistered.

Mouth sores: Painful sores in the mouth, throat, or tongue, which can make eating and talking difficult.

Taste changes: Food may taste different or bland, which can cause loss of appetite and weight loss.

Difficulty swallowing: Feeling like food is getting stuck in the throat, or pain when swallowing.

Nausea and vomiting: Feeling sick to the stomach and vomiting, which can be caused by chemotherapy or radiation therapy.

Dry mouth: Reduced saliva production, which can cause a dry, sticky feeling in the mouth, difficulty speaking or swallowing, and an increased risk of cavities and infections.

Speech and hearing changes: Changes in voice quality, clarity, or volume, or hearing loss or tinnitus (ringing in the ears).

Changes in thyroid function: Radiation to the neck can affect the thyroid gland, leading to hypothyroidism or hyperthyroidism.

Dental problems: Increased risk of cavities, gum disease, and tooth decay due to dry mouth and weakened immune system.

It’s important to note that not all patients will experience all these side effects, and the severity can vary depending on the individual and the treatment regimen. It’s important to talk to your healthcare professional about managing these side effects and maintaining a good quality of life during and after treatment.

I am going to go over some of these now and discuss some tips to hopefully help with these side effects

Managing Side Effects

Tips

Taste Changes

Taste changes are a common side effect of head and neck cancer treatment, which can make food taste different or bland. Some people find a metallic or bitter taste or a reduced ability to taste certain foods.

Loss of taste or taste changes are often temporary but, in some cases, can continue for months and can cause considerable distress and loss of enjoyment in eating and drinking.  Foods can taste odd, metallic, too sweet or too salty or unusually bland.  Some find they are unable to tolerate strong flavours and prefer more bland food and drinks.  Everyone experiences differ, so choose the tips that suit your needs

The following are some tips to help manage taste changes

• it’s important to try different flavours and textures to find what is appealing.
• Try using herbs, spices, or condiments such as mustard, ketchup, or soy sauce can enhance the taste of food and make it more palatable.
• Trying different temperatures, such as cold, or frozen foods such as ice cream or smoothies or room temperature foods, can also help numb the taste buds and make food taste better.
• Some people find that using plastic utensils and avoiding metal utensils can help reduce the metallic taste in the mouth.
• Choosing foods that are high in protein, such as eggs, dairy, cheese, lean meats, and legumes split peas, lentils, chickpeas, houmous can also help maintain strength and energy levels.
• Drink plenty of fluids especially between meals and keep your mouth clean.  Try alternatives like herbal or peppermint eat, milk, fruit juice or flavoured squash
• avoiding alcohol, which can interfere with taste and cause dehydration.
• it may be helpful to eat smaller, more frequent meals throughout the day, rather than large meals, to prevent nausea and maintain energy levels.
• By experimenting with different foods and being patient, it’s possible to manage taste changes and maintain good nutrition during and after head and neck cancer treatment.
• By trying different strategies and being patient, it’s possible to manage taste changes and maintain adequate nutrition during and after chemoradiotherapy.
• Enhance taste with sauces, marinating, trying new foods, adding herbs and spices or zest
• Add herbs and spices, celery, onion, cinnamon, ginger or garlic to dishes for a stronger flavour
• Cold foods may be better like quiche, hummus, yogurt
• If you find meat unappetising try cheese, dairy foods, nuts, eggs, beans lentils, tofu, Quorn
• If you are put off by strong flavours try blander ones such as milky porridge, cheesy mashed potatoes, creamed chicken in white sauce with rice
• Retry foods, including those that are less familiar or that may not have been enjoyed in the past as tastes may change over time

Mucositis

To manage sore mouth, it’s important to keep the mouth clean and moist. Brushing the teeth and tongue gently with a soft-bristled toothbrush and fluoride toothpaste after each meal can help prevent infections and reduce pain. Rinsing the mouth several times a day with a solution of salt and baking soda can also help soothe soreness and reduce inflammation. Avoiding spicy, acidic, or crunchy foods and choosing softer, lukewarm or cold foods instead can help reduce irritation and make eating more comfortable. Drinking plenty of water and avoiding alcohol and tobacco can also help prevent further damage to the mouth and throat. It’s important to talk to your healthcare professional about managing sore mouth and preventing complications such as infections or difficulty swallowing. By taking proper care of the mouth, it’s possible to reduce pain and maintain good nutrition during and after chemoradiotherapy.

• Mucositis or sore mouth is a common side effect of head and neck cancer treatment, which can cause inflammation and painful sores in the mouth and throat.
• To help with mucositis you may find the following helpful
• avoid spicy, acidic, or crunchy foods, as they can further irritate the mucous membranes.
• choosing softer, lukewarm, or cold foods can help reduce discomfort and make eating more comfortable
• eat foods that are high in protein, such as eggs, dairy, lean meats, and legumes, as protein is important for maintaining strength and energy levels.
• Drinking plenty of water and other hydrating fluids, such as broths, soups, and smoothies, can also help soothe the mouth and prevent dehydration.
• use a straw to drink fluids,
• avoid alcohol, tobacco, and hot or spicy beverages, which can further irritate the mouth and throat.
• By choosing soft, nutritious foods and staying hydrated, it’s possible to manage mucositis and maintain good nutrition during and after head and neck cancer treatment. It’s important to talk to a healthcare professional about managing mucositis and preventing complications such as infections or difficulty swallowing.

Dry Mouth

Check you don’t have an infection. 

Dry mouth occurs when the salivary glands do not produce enough saliva, which can cause a dry, sticky feeling in the mouth, difficulty speaking or swallowing, and an increased risk of cavities and infections. To manage dry mouth, it’s important to stay hydrated by drinking plenty of water and other fluids and avoiding alcohol and caffeine which can further dehydrate the body. Chewing sugar-free gum or sucking on sugar-free candy can also stimulate saliva production and make the mouth feel less dry. It’s also important to maintain good oral hygiene by brushing and flossing the teeth regularly and using a fluoride mouthwash to prevent cavities. A healthcare professional may also recommend using artificial saliva products or prescription medications to stimulate saliva production. By taking proper care of the mouth and staying hydrated, it’s possible to manage dry mouth and prevent complications during and after head and neck cancer treatment.

• Try eating soft, easy to chew, moist foods with added sauces.
• Casseroles, slow cooked meats, fish pie, shepherd’s pie, cooked chicken in a sauce, vegetable bakes, mined meat dishes, Quorn mince dishes, risotto, softly cooked pulses in sauce like dahl.
• Soups are soothing and easy to eat but can be low in energy and nutrients.  Creamy ones that contain meat, chicken, beans or pulses may be more nutritious.  Add grated cheese, yogurt, crème fraiche; cottage cheese; chopped egg to boost the energy and protein content
• Add buttered bread and float on soups for extra energy
• For sweet options try mashed or stewed fruit, fruit compote with yogurt, custard, evaporated milk, ice cream, sorbet dairy or coconut milk, rice pudding, mil shakes crème caramel, milk jelly, soft cheesecake and tiramisu
• You may find it easier to eat smaller meals more frequently
• If you mouth is sore, it may be best to avoid spicy and hard crunchy foods
• Cold foods and drinks may be comforting e.g. chilled water, ice cream; ice lollies, drinking through a straw may help
• Acidic foods like vinegar, pickles, tomatoes, oranges, lemons and limes may be best avoided.  Try mango, peach, mandarin oranges, pears or apple juice instead
• Very salty foods such as chips, salted nuts and beef drinks may irritate soreness

Lack of saliva is a common side effect of head and neck cancer treatment, which can make it difficult to chew, swallow, and speak. To help with lack of saliva, it’s important to choose soft, moist, and easy-to-swallow foods, such as soups, stews, smoothies, and pureed fruits and vegetables. Foods that are high in moisture, such as watermelon, grapes, and cucumbers, can also help moisten the mouth and make eating more comfortable. It may be helpful to use gravies, broths, and sauces to moisten foods, and to avoid dry or hard foods, such as crackers, chips, and popcorn. Chewing sugar-free gum or sucking on sugar-free candy can also stimulate saliva production and make the mouth feel less dry. It’s important to stay hydrated by drinking plenty of water and other fluids, and to avoid alcohol and caffeine, which can further dehydrate the body. By choosing soft, moist, and hydrating foods and staying hydrated, it’s possible to manage lack of saliva and maintain good nutrition during and after head and neck cancer treatment. It’s important to talk to a healthcare professional about managing lack of saliva and preventing complications such as infections or difficulty swallowing.

Thick Saliva

Stay hydrated: Drinking plenty of water and other fluids can help thin out thick saliva and make it easier to swallow. Aim for at least 8-10 glasses of water or other hydrating fluids per day.

Avoid dry or sticky foods: Dry or sticky foods such as bread, crackers, peanut butter, and cheese can make thick saliva worse. Instead, choose moist, smooth, and slippery foods such as soups, broths, smoothies, and pureed fruits and vegetables.

Use moistening agents: Adding moistening agents such as olive oil, butter, or broth to foods can make them easier to swallow and reduce the thickness of saliva. Honey, maple syrup, or jelly can also help moisten the mouth.

Suck on ice chips: Sucking on ice chips can help reduce the thickness of saliva and make the mouth feel more comfortable. Avoid ice pops or sugary candies, which can cause further irritation.

Use a humidifier: Using a humidifier at home can help keep the air moist and reduce the thickness of saliva.

Limit alcohol and caffeine: Alcohol and caffeine can dehydrate the body and make thick saliva worse. Avoid or limit alcohol and caffeine-containing beverages such as coffee, tea, and soda.

Talk to a healthcare professional: A healthcare professional may recommend saliva-thinning medications or other treatments to help manage thick saliva. It’s important to talk to a healthcare professional about managing thick saliva and preventing complications such as infections or difficulty swallowing.

Sometimes it will be necessary to start on nutritional supplements at some point during your treatment. 

Supplements

Nutritional supplements may be recommended for patients who are at risk of malnutrition or have difficulty eating. Nutritional supplements can help fill nutrient gaps and support the body’s immune system during cancer treatment. These supplements can help maintain muscle mass and strength, and prevent deficiencies that can result from a restricted diet. However, it’s important to talk to a healthcare professional to incorporate nutritional supplements safely and effectively you’re your treatment plan.

Supplements are available in drinks, soups and desserts and various flavours.  They may also help you to cope better with treatment or recove from your treatment

Enteral feeding

Enteral feeding, also known as tube feeding, may be recommended if you are unable to eat or drink enough due to complications such as dysphagia or mucositis. Enteral feeding involves the use of a tube that is inserted through the nose or mouth and into the stomach or small intestine, allowing for liquid nutrition to be delivered directly to the digestive system. Enteral feeding can help provide essential nutrients and prevent malnutrition, while reducing the risk of aspiration (inhaling food or liquid into the lungs).. It’s important to work with a healthcare professional to determine the best type of enteral feeding and to monitor your progress, adjusting the feeding as needed. Additionally, enteral feeding should be used as a last resort, and efforts should be made to maintain oral intake as much as possible. By working with a healthcare professional, it’s possible to incorporate enteral feeding safely and effectively into your treatment plan.

Recipe

Fish chowder

Ingredients

25 grams butter or oil

1 large onion, chopped

2 sticks of celery, chopped

1 red pepper, cut into chunks

4 oz smoky bacon chopped

1 large potato, cut into chunks

¾ pint fish stock

450 grams white and smoked fish cut chunk

½ pint full fat milk

2 tsp cornflour

Salt and pepper

Melt some butter or use oil and sauté onion, celery, red pepper and potato and bacon for 5 minutes. 

Pour in the stock and simmer until potato is just tender

Gently stir in the fish

Mix cornflour into the milk and pour into the mixture

Bring to the boil and simmer for 5 minutes

Season with salt and pepper

Serve with buttered bread