Eating may be challenging after head and neck cancer treatment. Certain therapies can affect the ability to chew and swallow. After surgery, some people need a feeding tube or nutrition given through their veins until they’re able to eat again.
You may work with a nurse or speech-language pathologist to learn how to swallow again. Your physician may also refer you to a dietitian who can help you select foods that support your recovery and are easy to eat after treatment.
Here are some specific nutrition tips if you have head and neck cancer treatment side effects:
- Pick soft, bland, moist or room-temperature foods. You can also puree foods in a blender or dunk your food in milk, coffee or tea to make it easier to swallow. Try calorie-dense foods like yogurt, pudding, cheese or cottage cheese.
- If you have pain when swallowing or mouth sores, avoid irritating foods, like spices, seasonings and acidic foods like citrus fruits and tomato sauce.
- Practice good posture while you’re eating.
- Take your time when chewing and swallowing.
- Take all medications as prescribed to minimize chewing- and swallowing-related side effects.
- Practice good oral hygiene. Brush and floss twice a day and see a dentist regularly for checkups.
- Avoid alcohol-based mouthwashes.
- Drink plenty of water and other fluids, especially if you experience dry mouth. You can also eat tart foods, like fruit popsicles, lemon sorbet or candies as tolerated.
- If you experience a metallic taste in your mouth and can tolerate acidic foods, try eating tart foods like citrus fruits, lemon wedges, lemonade and vinegar. Use plastic utensils instead of metal. Season your foods well.
- While acidic or spicy foods can be irritating to the mouth and throat, they are fine to eat if you can tolerate them. Your tolerance level may change throughout treatment.
In general, a healthy diet is comprised of a variety of foods. Check with a dietitian to learn about your body’s unique nutrient and caloric needs.
When you are faced with a cancer diagnosis, nutrition can be an important part of your journey. Eating a well-balanced diet before, during and after cancer treatment can help you feel better, maintain your strength and speed your recovery.
Here are some more tips for making healthy choices during your cancer journey:
- Maintain a healthy weight. Unintentional weight loss is common when you have head and neck cancer. This can be due to cancer treatments or cancer itself. Monitor your weight closely. If you are losing more than one to two pounds per week consistently, discuss with your healthcare team how you can increase your calorie intake.
- Eat small, frequent meals throughout the day. Eating frequent small meals will ensure your body is getting enough calories, protein and nutrients to tolerate treatment. Smaller meals may also help reduce treatment-related side effects like nausea. Try eating five to six small meals per day or “mini” meals every three hours.
- Choose high-protein foods. Protein supports cell and tissue repair. It also helps strengthen your immune system. Aim to eat protein at every meal and snack. Sources of lean protein include:
- Dairy substitutes
- Lean meats such as chicken, fish or turkey
- Low-fat dairy products such as milk, yogurt and cheese
- Nuts and nut butters
- Soy foods
- Include whole-grain foods. Whole-grain foods provide a good source of carbohydrates and fiber, which help keep your energy levels up. Good sources of whole grain foods include:
- Whole wheat bread
- Brown rice
- Whole grain pasta
- Eat a variety of fruits and vegetables every day. Fruits and vegetables offer the body antioxidants, which can help fight against cancer. Choose a variety of colorful fruits and vegetables to get the greatest benefit. Try to eat a minimum of five servings of whole fruits and vegetables daily.
- Choose sources of healthy fat. Avoid fried, greasy and fatty foods; instead, opt for baked, broiled or grilled foods. Healthy fats include:
- Olive oil
- Avocado oil
- Limit sweets and added sugars. Foods and drinks high in added sugars—such as desserts, candy, muffins, granola bars, many cereals and soft drinks—provide little nutritional benefit and often take the place of other foods that are better for you.
- Cut back on refined carbohydrates. Processed, refined carbohydrates can spike your blood sugar and lack many of the nutrients and fiber your body needs. Refined, processed carbohydrates include:
- Regular pasta
- White bread
- Pizza crust
- Potato and corn chips
- Sugary cereals
- Instant oatmeal
- White rice
- French fries
- Limit or avoid red and processed meat. Red meat includes beef, pork, veal, lamb and venison. Processed meat includes sausage, bacon, salami, hot dogs and other deli meats.
- Try new foods. Your preferences and tolerance to certain foods and drinks may change during cancer treatment. Be open to trying new foods. You may realize you now like something you didn’t previously enjoy.
- Stay hydrated. Drinking enough fluids during cancer treatment is important for preventing dehydration. Aim to drink 64 ounces of fluid daily. Avoid drinking large amounts of caffeinated beverages. Too much caffeine can lead to dehydration.
- Drink alcohol in moderation, if at all. Alcohol may contribute to dehydration, can lower the abilities of your immune system and provides no beneficial nutrients.
- Take care of your oral hygiene. Certain treatments, like radiation and chemotherapy to the head and chest, can irritate the esophagus, throat and mouth. This can make eating and swallowing challenging. Practice good oral hygiene by brushing your teeth with a gentle toothbrush and toothpaste after meals and flossing at least once a day.
- Talk to your healthcare team before taking any vitamins or supplements. Some medications and cancer treatments may interact with vitamins and supplements. Choose food first as your main source of nutrients.
- Most importantly, know that your cancer journey is unique to you and your treatment. You may experience side effects that affect your ability to follow these suggestions. If you are struggling with any side effects, such as loss of appetite, nausea, diarrhea, vomiting or any other nutrition concerns, your needs may be different. A registered dietitian can suggest nutrition guidelines that will be appropriate for your cancer journey.
The immune system is weakened during all types of head and neck cancer treatment. Unfortunately, not all chemotherapy medications are able to tell the difference between healthy cells and cancer cells. For this reason, perfectly healthy red and white blood cells are damaged or killed during treatment and shortly thereafter. The result is that the body is not as good at fighting illness and infection.
A common term used to refer to a very low neutrophil (white blood cell) count is neutropenia. Paying special attention to food safety during cancer treatment to reduce the risk of exposure to foodborne illness may also be referred to as a “neutropenic diet.” The following are some simple tips to minimize exposure and avoid infection and illness when the immune system is compromised.
Keep hands and surfaces clean:
- Wash your hands often and well, especially before and after handling food. Be sure to wash hands with warm water and soap for at least 20 seconds. Pay special attention to your fingernails and the backs of your hands.
- Keep raw and cooked foods separate. Do not reuse any utensils, cutting boards, plates and bowls once they have been touched by raw meat or eggs. Items that have been used for preparing raw meats or eggs should be washed in hot, soapy water or put in the dishwasher. It is best to keep a separate cutting board for meat and fruits/vegetables. Have an extra clean cutting board available for additional preparation as well.
- When shopping for and storing raw meats, keep them away from other foods and cover the packages with extra plastic wrap or use plastic bags. This will prevent any liquids from leaking onto other foods or surfaces. Store meat and eggs toward the bottom of the refrigerator to prevent any dripping on other foods below.
- Wash your produce well. You should wash all of your fruits and vegetables under running water, even if you don’t plan to eat the peel, because germs can transfer when slicing or peeling.
- Toss suspicious foods. Throw away cracked eggs, slimy or moldy produce and any food that looks or smells unusual.
- Put perishable foods in the refrigerator within two hours of preparing them. Dishes made with mayonnaise, eggs and cream should be put away within one hour. If food has been left out longer, throw it away.
- Thaw food in the refrigerator, never at room temperature. Use defrosted foods as soon as they’re thawed and never refreeze them.
- Before opening canned foods, wash the top of the can with soap and water to avoid contamination.
- Clean your countertops, cutting boards and sink with hot, soapy water or a solution of one part bleach and 10 parts water.
- When reheating food in the microwave, stir often to prevent cold spots.
- Bring groceries inside and refrigerate them right away. Never leave groceries in a hot car.
- When dining out, request clean silverware set on a napkin or clean tablecloth. Don’t use utensils that are placed directly on the table. Pack up your own leftovers rather than having the server do it for you.
Cook food thoroughly:
- Avoid raw meat such as sushi, undercooked eggs (make sure eggs are at least “over easy” and not “sunny side up”), and other meats that have not been cooked to a proper internal temperature.
- Cook all eggs until both the white and the yolk are firm.
- Use a meat thermometer to make sure that all meats are cooked to the proper internal temperature prior to eating.
- Raw or undercooked meats
- Unpasteurized milk and juices
- Soft cheeses made with unpasteurized milk such as feta, blue cheese, Roquefort, Stilton, brie or farmer’s cheese
- Processed meats such as luncheon meats and anything else from a deli counter
- Refrigerated meat spreads or pâté
- Smoked fish or precooked shrimp or crab meat
- Sprouts, such as bean sprouts, alfalfa sprouts or broccoli sprouts
- Pre-cut fresh fruit and vegetables
- Unwashed fresh fruits and vegetables
- Unroasted or raw nuts and seeds
- Raw tofu or tempeh
- Food from salad bars instead or buffets
- “Fresh” salad dressings, salsas and sauces sold in the refrigerated section of the grocery store
- Raw apple cider
- Raw honey
- Unrefrigerated cream-filled pastries
- Food from dented, swollen or rusted cans
- Ice cream or frozen yogurt from soft-serve machines
- Free food samples
- Food past its use-by or sell-by date
The guidelines above were created with those who have severely weakened immune systems in mind. Consult your physician or healthcare team for regular updates on your blood counts and the status of your immune system.