Managing nutrition-related side effects during head and neck cancer treatment [9:46]

Managing nutrition-related side effects during head and neck cancer treatment video transcript

Hi.

My name's Katie and I'm a dietitian from the Sir Charles Gardner Osborne Park Hospital Group.

In this video I'm going to speak to you about managing nutrition related side effects of head and neck cancer treatments. Common side effects that you may experience from radiotherapy and chemo radiotherapy that affect the way that you eat, and drink include fatigue, and loss of appetite, nausea and vomiting, difficulty swallowing, mouth issues such as mouth sores, dryness in your mouth, and thickened saliva, and changes in your taste and smell. Having some of these side effects can mean that you miss meals, that you eat smaller portions, or that you do not get enough nutrition and hydration in, resulting in weight loss. During your treatment it's important that you focus on eating well and maintaining your weight.

Whilst watching this video please keep in mind that everyone's treatment experience is different. These treatment side effects may or may not occur, and side effects do change over time. If you are experiencing these side effects, we would recommend you speak with your health care team as they are there to support you during your treatment.

During your treatment you may find it hard or tiring to eat. We would recommend that you eat foods that are high in calories and protein so that you're making the most of each mouthful. If you were struggling to eat regular portions of meals, we would encourage you to eat smaller, more frequent meals throughout the day. Don't rely on your appetite to tell you when to eat. Try and eat every two to three hours and eat via the clock. You may find it helpful to have nourishing drinks, as these may be easier for you to consume. We would also encourage you to fortify your meals where possible. For more information on high energy, high protein foods and food fortification please see our other videos.

It can be common for patients to experience nausea during chemotherapy and radiotherapy treatment, particularly in your final few weeks of treatment. Similar to if you have a reduced appetite or fatigue, we would recommend that you focus on smaller more frequent meals throughout the day. Try to chew your food well and eat slowly and try to make the most of the times of the day when you're feeling more hungry, or when your nausea is managed better. You may find it helpful to avoid foods that may trigger your nausea. This may include hot foods that have a smell, so focus on foods that are colder or more room temperature. You may also find it helpful to focus on dry, more bland foods. It is important to stay well hydrated if you are experiencing nausea and vomiting. Continue to sip fluids throughout the day, particularly if you are struggling to keep foods down. Your doctors may recommend that you take a regular anti-nausea medication prior to your meals, so it is important to take these medications as prescribed.

Difficulty or pain on swallowing can be common with head and neck cancer patients. This may be due to the cancer itself and where it is located, prior surgery, or side effects of radiotherapy treatment. You may also experience difficulty chewing if you have had teeth removed prior to starting your treatment. Difficulty swallowing can affect the amount that you can eat and drink and can result in weight loss if it is not addressed. A speech pathologist is an expert in swallowing and speech, and during your treatment they will assess your swallow and provide recommendations to ensure that your swallowing is safe, and to help it to be more comfortable for you. As your radiotherapy treatment progresses you may need to modify the texture of your foods. This may be recommended by your doctors, nurses, or dietitians, to make swallowing more comfortable. Your speech pathologist may also recommend specific textures of foods to eat such as soft, minced and moist, puree and liquid diet. If you are struggling to swallow liquids, they may also recommend thickening your fluids to ensure that your swallowing is safe. Your doctors may prescribe pain relief to take prior to your meals. It is important to take this pain relief as prescribed as it can help make swallowing less painful for you. If you are modifying the texture of your foods, we would recommend that you fortify your foods with things such as butter, margarine and cooking oils. You may also use milk powders and products such as Sustagen Neutral. This way you're making the most of each mouthful when you do eat. For more information on food fortification see our other video on high energy high protein eating.

If you are unable to eat and drink enough during your treatment you may require a feeding tube. A feeding tube would be used to ensure that you are getting in enough nutrition and hydration and maintaining your weight during your treatment. You may also require a feeding tube after surgery whilst the healing process occurs and until it is safe for you to eat and drink again. Some feeding tubes go into your stomach via a thin tube that is placed through your nose and down your throat. This can be referred to as a nasal gastric tube and is usually required for short-term use. A gastrostomy tube is usually placed for a longer-term period of feeding or it can be permanent. This feeding tube is placed directly into the stomach via an opening in the abdomen and may also be referred to as a peg or a rig. If our feeding tube is required this will be discussed with your dietitian, doctor, speech pathologist, and nurses.

Surgery or treatment for head and neck cancer can affect the salivary glands which can result in a dry mouth or thick and ropey saliva. This is one of the most common side effects patients experience during head and neck cancer treatment and it can result in difficulties eating and drinking, it can also result in issues with gums or dental decay. Your oral health specialists will give specific recommendations on how to keep your mouth and teeth healthy during your treatment. If you are experiencing a dry mouth, we would encourage you to focus on soft and moist foods. Add extra gravies and fluids to your food and avoid hard crunchy or difficult to chew foods. We would encourage you to sip fluids regularly over the day and during the night. Avoid alcohol and caffeine because this can be dehydrating and keep a glass of water by your bed at night. Your health care team may recommend an oral lubricant product such as a mouth gel, spray or mouthwash which can be purchased from your pharmacy. If you're experiencing thick or ropey saliva, regular mouth rinses throughout the day or after your meals may be helpful. A nebulizer can also help in breaking down saliva so speak to your speech pathologist or doctors to see if this may be helpful for you.

Also known as oral mucositis, mouth sores, mouth ulcers and a sensitive mouth can make it difficult to eat, drink and talk. This is a common side effect of chemotherapy and radiotherapy, and it is usually short-term, meaning it will resolve as you finish your treatment. If you are experiencing this, we would recommend that you focus on soft and moist foods. Modify the texture of your foods as needed and include nourishing drinks. We would encourage you to rinse your mouth regularly throughout the day, in the morning, before you go to bed, and after your meals. Speak with your nurses for recommended mouthwashes. Your doctors may also prescribe some pain medication to take before you eat your meals. It is important to take this to help numb the area and reduce pain on eating and swallowing.

Many patients who have had surgery for head and neck cancer or are undergoing radiotherapy or chemotherapy treatment may experience loss of taste or smell. If you're experiencing changes to taste and smell we recommend experimenting with different foods, flavours, textures, and temperatures to make meals more enjoyable. Add extra seasoning such as herbs and garlic, lemon and lime, and marinades to your food. We would recommend rinsing your mouth out before and after meals to keep your mouth clean, and choosing foods which look or taste appealing. It may also be helpful to have a distraction whilst you're eating or drinking such as watching TV, reading a book, or sharing meals with family and friends.

We hope this video has been helpful. For further support in managing side effects of your treatment speak with your health care team. For further information on nutrition during your treatment see our other videos or ask to speak with your dietitian.

Click the links in the video description below to download some more dietary information.