Nutrition Tips for During and After Head and Neck Cancer Treatment

M.A., Health Writer
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Most of us take eating for granted — until we can't do it normally. When you have head and neck cancer, treatments can affect this experience. "Food expresses personality, culture, and community. Suddenly, the act of eating, which used to be so normal and enjoyable, can be extra-challenging," says Greta Macaire, oncology dietitian nutritionist at the UCSF Helen Diller Family Comprehensive Cancer Center in San Francisco. Here she explains what you can expect after head and neck cancer treatment.

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Head and neck cancer treatments affect appetite

A 2017 study in Nutrition Research says up to 80 percent of people with head and neck cancers are malnourished due to lifestyle and risk factors. You may undergo surgery followed by radiation, or a combination of radiation and chemotherapy. Treatments can reduce appetite or cause nausea, pain, and difficulty when swallowing, known as dysphagia, or mucositis. Cells lining the gastrointestinal tract are susceptible to ulceration and infection, causing mouth sores and more.

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Try foods that help with mucus

Your body works to heal itself. For example, irritation to salivary glands from cancer and treatment may produce thick, ropy saliva or mucus, along with mouth sores. Natural enzymes in papaya can help thin saliva, says Macaire, so try papaya juice or mix papaya in a smoothie. Carbonated water helps reduce mucus thickness and improves hydration. There’s no way to prevent mucositis, but a 2016 Journal of Global Oncology study found that oral glutamine, an amino acid, helped delay its onset and severity.

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Stay interested in food

Chemotherapy and radiation — which can damage the taste buds and salivary glands — can also greatly alter your sense of taste. "Patients may say that food has no taste or even sometimes tastes like garbage," Macaire tells HealthCentral. "Also, developing a profound dislike for eating can impact other areas of your life, such as social relationships and even business meetings." It's important to stay interested in food, focus on what you can eat, and make a plan to maintain your nutrition intake.

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Drink lots of fluids

Macaire says she helps patients stay nourished and pay attention to whole-body wellness during treatment. Drinking enough fluids ranks high because staying hydrated helps prevent dry mouth and mouth sores. Water should be the first beverage of choice, but if you're losing too much weight, focus on liquids with calories, such as smoothies and soups. Plan to carry fluids with you, and a small bottle of mouth rinse for frequent rinsing, to help prevent infections.

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Try to maintain your weight

"A 5 percent unintentional weight loss, even if you're overweight, can negatively impact treatment outcome," Macaire says. If you can't eat a large meal, eat frequently throughout the day: six small meals on schedule. Prevent mouth irritation by avoiding hot, spicy foods containing pepper or chili powder, as well as highly acidic vinegars and citrus fruits such as lemons. Both caffeine and alcohol can dry out mucus membranes too. Focus on soft, moist, soothing foods such as yogurt or tofu.

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How to deal with a feeding tube

You may have a feeding tube a few weeks after surgery, removed before radiation or staying in place until after treatment. Your speech-language therapist will evaluate swallowing to determine whether you can eat. "Start with a soft liquid or blenderized diet — smoothies and soups — then transition to a soft, solid diet," Macaire says. "Eating normally preserves musculature and function, and prevents atrophy of swallowing muscles." Your therapist can share exercises to strengthen those muscles.

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Maintain dental health

Radiation usually begins about six weeks after surgery, around when you're ready to resume a regular diet. "It's important to have a dental evaluation before starting treatment," says Macaire. "If you have poor dentition, [the arrangement and number of your teeth,] your doctor and dentist may recommend having some teeth pulled. This also affects how and what you eat. Your oncology dietitian nutritionist will counsel you about how to stay well-nourished in that situation."

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Eat lots of protein

"Every bite needs to count," says Macaire. "We'll focus on high calories and high protein to preserve lean body mass and maintain healthy immune cells. Soft proteins are recommended: beans, lentils, tofu, nut butters, eggs, yogurt, and smoothies with protein powder. Eating lean meat, chicken, or fish that's soft, ground, or blenderized works well. Treatment side effects may preclude eating multiple textures, but you can still 'eat' favorite tastes pureed into one cohesive mixture."

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Avoid dry foods

Side effects may continue for months or may never go away completely, Macaire says. "Most people can't tolerate dry, coarse foods like dry breads or crackers. Adding sauces, gravies, or broths makes eating more pleasant. Smoothies, soups, and hot cereals are ideal. Healthy oils, like olive or avocado, boost calories, and tofu adds protein. If eating fruits and vegetables is difficult, baby food or pureed vegetables in individually packaged, squeezable pouches maintains fiber intake."

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Take part in your treatment

Your recovery is a team effort, and you're a key team player here. The goal is for you to eat well and comfortably so you stay as healthy as possible — and a positive attitude will really help. Good nutrition is a major part of this, so be proactive and communicate any side effects to your health care team, which ideally includes a registered dietitian who specializes in oncology nutrition. Don't hesitate to ask for help from them, and from family and friends.