The American Cancer Society (ACS) recently released guidelines for the care of head and neck cancer survivors. These guidelines summarize best practices for the care of adults who have undergone treatment for head and neck cancer.
I was encouraged to see that the guidelines address many long-term and late-effect nutrition-related challenges. Here are a few that were listed:
- Changes in how foods taste are most pronounced about 2 months after radiation treatment. Changes may include complete lack of taste, or lowered or heightened sensitivity to the taste of foods. The guidelines recommended consulting a registered dietitian for assistance in finding dietary options to meet nutritional needs. These often include adjusting food temperature, and seasonings, and ultimately finding palatable substitute foods or supplements to meet nutritional needs.
- Difficult or painful swallowing may result in food and liquids entering your windpipe (aspiration), pneumonia and weight loss. A swallowing therapist can help you determine which consistencies or textures of foods and fluids are safe to consume. A nutritionist can teach you how to prepare foods and recommend the types and number of servings for a safe and healthy diet. When swallowing is not possible or the risk of choking is very high, a feeding tube may be recommended.
- Dry mouth and mouth sores can be the result of damage to the salivary glands from surgery or radiation. Lack of saliva not only causes dry mouth, it also causes increased thirst, tooth decay and oral infections. Suggested tips for people with dry mouth include: sipping water throughout the day, drinking milk with meals, and avoiding beverages that contain caffeine, sugar or alcohol. It may also be necessary to avoid spicy and highly acidic foods, which can aggravate mouth problems. Rinsing with a mixture of 1/4 teaspoon salt and 1/2 teaspoon baking soda dissolved in 1 quart of room-temperature water may help rehydrate the mouth.
- Gastroesophageal reflux disease (GERD) is common among head and neck cancer survivors and increases risk for aspiration and possibly secondary esophageal cancer. Recommendations for managing GERD include elevating the head of the bed, not eating or drinking at least 3 hours before bedtime, and avoiding alcohol and caffeine. Medications such as proton pump inhibitors and antacids may be prescribed.
- Difficulty opening the mouth can result from surgery or radiation treatment. This can lead to painful and limited ability to bite into and chew foods. In turn, food selections may be limited to soft or pureed foods. Again, a dietitian can assist with planning a diet that meets nutrition and calorie goals.
- Loss of appetite and significant weight loss. Loss of appetite can be caused by any of the problems listed above and can result in significant weight loss. Recommendations focus on increasing calories and protein, and making every bite and sip count. Protein supplements, meal-replacement beverages, and frequent small meals are helpful.
Nutrition challenges for head and neck cancer survivors vary according to an individual's physical needs, abilities and desires. The guidelines assist primary care providers in caring for head and neck cancer survivors and connecting them helpful resources.
If you, a family member or friend is a head and neck survivor, what nutrition challenges have you encountered? What did you find helpful? Let's learn from each other.
Aug. 20, 2016
- Cohen EE, et al. American Cancer Society Head and Neck Cancer Survivorship Guideline. CA: A Cancer Journal for Clinicians. 2016;66:203.
- Barbara Woodward Lips Patient Education Center. Caring for your mouth during and after radiation therapy. MC1947. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015.
- Dysphagia. http://www.mayoclinic.org/diseases-conditions/dysphagia/basics/definition/con-20033444. Accessed Aug. 18, 2016.
- Kalaskar AR. Management of chemotherapy induced dysguesia: An important step towards nutritional rehabilitation. International Journal of Physical Medicine and Rehabilitation. 2014;2:198.
- Eating during cancer treatment: Tips to make food tastier. http://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer/art-20047536. Accessed Aug. 18, 2016.
- Heidelbaugh JJ. Proton pump inhibitors and risk of vitamin and mineral deficiency: Evidence and clinical implications. Therapeutic Advances in Drug Safety. 2013;4:125.
- No appetite? How to get nutrition during cancer treatment. http://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer/art-20045046. Accessed Aug. 18, 2016.