In general, it is VERY IMPORTANT to continue to eat by mouth during radiation. Although many patients have a g-tube placed prior to heading into radiation, this tube should only be used to supplement what you are eating and drinking by mouth and ONLY as needed.
Keep swallowing
The muscles of the throat are similar to muscles in the other parts of the body. When these muscles are not used as much as they are used to, they begin to weaken. This is part of normal muscle physiology. Now consider the effects of radiation, most notably, fibrosis, which can be thought of like scar tissue in that it is tougher and less flexible than healthy muscle fibers. This fibrosis takes hold between the muscle fibers, and can limit how much they are able to move. For this reason, it is very important to keep the muscles moving during treatment.
What to eat
The SLP staff may give you specific instructions on what you should eat, although the general guideline is to eat as normally as possible! The body knows how much effort to exert when swallowing. For example, it takes more “muscle” to swallow a piece of meatloaf, than it does to swallow a sip of milk. Although the pain of radiation may cause many patients to consider limiting themselves to liquids, the bulkier the food you swallow, the more you are working the throat muscles.
The radiation effect to the esophagus is also important here. At rest, the esophagus is like a slender, flexible tube. As bulky foods move through, it stretches to expand around it as needed. Consider how a snake body expands around its prey when eating. Same thing! The upper portion of the esophagus is within the radiation field when the neck is being targeted. For this reason, it is important to swallow more bulky foods to ensure the regular “stretching” of this part of the esophagus. In this way, you are helping to discourage the fibrosis from taking a strong hold on the flexible muscular fibers of the esophagus.
When it hurts to swallow
Odynophagia is a term used to describe painful swallowing. Most patients experience odynophagia to some degree at some point during radiation as well as during the recovery period.
Odynophagia is important as it begins to impact not only what you feel like eating, but how well you are able to swallow. In general, odynophagia is the biggest reason most people feel they need to step down their diet, or even consider using the feeding tube. Your SLP staff can work with you to help find food choices that can minimize your pain when eating. Odynophagia can also be helped significantly by using special anesthetizing mouthwashes before meals. Your radiation oncologist can help you with this more.
Odynophagia also, however, has an impact on how effective the swallow is. In general, when it hurts to swallow, there is a tendency to have a weaker swallow. For this reason, many patients feel they cannot swallow as well. This usually, however, has more to do with the pain they experience. By managing the pain, it may allow for better swallow function. For this reason, if you are experiencing odynophagia, let your oncologist or SLP know so they can work with you to optimize what/how you eat.
The SLP staff will determine what you should be swallowing. Try to follow this advice as closely as possible. In general, most patients will alter their diets during radiation. Working closely with the SLP staff can ensure you are eating foods to help maintain your swallow as much as possible. Switching to the Low Acid Diet (hyperlink) can also be very helpful.
Loss of Appetite
A loss of appetite is extremely common during cancer treatment as well as recovery. There are several reasons patients lose their appetite during this time. It is important to understand that eating and appetite may no longer have a connection during your treatment/recovery period. It is important for you to eat well and sufficiently, whether by mouth or through a feeding tube, regardless of how hungry you may/may not be.
Nausea can be controlled with medications although it is important to notify your doctors or SLP staff if nausea is a significant issue. There is also medication to assist with improving appetite, but in most cases, patients are encouraged to eat regardless of appetite.
Think of eating like homework. Although you may not want to do it, you need to.
When nothing tastes right
Dysguesia is a term used to describe an altered sense of taste. In many cases, patients, can experience a loss of taste, where it becomes difficult to detect any flavor in the food. In other cases, many patients can report food tastes bad. Although some of the dysguesia may be a result of surgical changes, there may also be some neurologic impact of radiation to the nerves coming from the taste buds.
Although we have historically enjoyed food for its flavors, it’s important to continue eating even when food has lost its attraction. Not only is proper nutrition important for normal body function, it is especially important in helping to keep up your strength. Without proper nutrition, the body is not able to recover/heal as well following radiation as well.
Although it is nearly impossible to avoid some of the long-term affects of radiation, doing your part to keep everything working can help to ensure you remain as functional as possible after your treatment is completed and into the future.
Dysguesia
An instructional handout can be found here.
When foods don’t taste right, it ‘s very common for calorie intake to decrease, many times, significantly, leading to weight loss and malnutrition. In many cases, the most severe dysguesia may occur during the course of radiation treatment or post-operatively, when nutrition is critical to proper healing and recovery. Here are some ways to help cope with dysguesia in an effort to maintain proper nutrition and hydration.
- Room temperature or even slightly chilled foods may taste better than hot foods, especially during radiation treatment.
- Rinse your mouth with salted water before eating, as this will clear residue from the taste buds, which may otherwise contribute to an altered sense of taste.
- Avoid using metal dishes and utensils as these can make a metallic taste in the mouth even worse. Try using plastic utensils instead.
- Cooking with metal utensils and cookware can contribute to a metallic taste. Try using oven/stove safe glass cookware and plastic or wooden utensils when cooking.
- Avoid storing foods in aluminum foil as this can contribute to a metallic taste. Store foods in plastic ware. Using plastic wrap and wax paper is also good in this case.
- Never force yourself to eat anything that tastes very bad. Look for alternatives that are not as offensive to your sense of taste.
- Meats can often taste very bad, especially during radiation. Fish and eggs are excellent alternatives that usually are better tasting, especially during radiation.
- Milk and other dairy products are often well tolerated: These will NOT make your mucous production worse but they may coat any existing mucous. Clear and rinse as much of the mucous as possible before eating or drinking dairy products.
- Pasta is usually very well tolerated.
- Vegetables usually taste good, especially during radiation. Avoid tomatoes.
- Salt can help foods taste better, but it is important to follow your doctor’s guidelines regarding a healthy amount of salt intake.
- Rinse your mouth or suck on a hard candy to clear a bad taste. Lingering bad tastes can impact the tastes of other foods you may be eating.
Although all foods/liquids may taste different from normal, it is important to find nutritious foods/drinks that you can tolerate well. It is very important that good nutrition be maintained at all times. Also, continuing to eat by mouth as much as possible can help to preserve your ability to swallow. If you are having difficulty finding foods that taste ok, your doctor/SLP staff can guide you further in this regard.
xerostomia
Xerostomia is a term used to describe dry mouth and it is a very common side effect of radiation treatment. In many cases, the salivary glands are impacted by radiation treatment and this causes both a decrease in salivary production as well as a change to the viscosity of the saliva, most often becoming thicker and less moisturizing.
Swallowing is designed to be a lubricated event, with saliva providing the lubrication required to allow food to pass efficiently through the mouth and throat. Without this natural lubrication, dry foods will always have more difficult passage through the throat.
Additionally, while there is less saliva for lubrication, the saliva is produced is thicker and stickier. In essence, these altered secretions can actually serve to hinder the swallow instead of helping to lubricate. Think of the throat as being coated in tacky glue. In some cases, this can be the effect of the altered secretion production.
Although this may improve somewhat following recovery from radiation, there is typically a permanent change to the moisture level of the mouth and/or throat, depending on the focus of radiation. Although there is no way to reverse these effects, there are some medications that may help improve salivary production. Your doctors can discuss these options with you.
Swallowing with Xerostomia
Although the saliva production cannot be replaced, it is important to ensure a safe and effective swallow that lubrication is still present. The following tips can help improve your swallow outcome when you are experiencing dry mouth.
- Adhere to a SOFT MOIST diet, avoiding dry textures.
- Use extra sauces and gravies to help moisturize and lubricate the food you are eating.
- Avoid bread, this sticks to the drier surfaces of the mouth and throat.
- Chew thoroughly so there are no “chunks” as these are the most likely to not pass as well through the throat.
- Alternate solids with liquids while eating. Using liquid swallows to wash the food down can help move the food through a dry throat.
- Swallow several times per bite. It’s harder to swallow through a dry throat so the more you swallow, the more likely you are to effective move the food into the esophagus.
As always, if you are noticing increased difficulty swallowing, you are coughing or choking when you eat or feel like you are not able to eat enough by mouth, you should always contact the SLP staff for further evaluation. In many cases they can find ways to help you and ensure the safest and most effective way to eat.
Compensating for Xerostomia
Findings ways to compensate for the xerostomia is very important. While there are certainly comfort concerns, the mouth and throat are lined with tissues that are designed to stay moist. Taking sips of water, if cleared by your SLP, can assist in maintaining adequate moisture in the mouth and throat. Some patients find hard candies are helpful in this regard as well, although typically, you should avoid any containing peppermint, cinnamon, or ascorbic acid (lemon/sour flavors) as these may cause increased irritation to the mouth and throat.
There are also commercial products designed to help with xerostomia. We recommend the Biotene line of products which are specifically designed for patients with xerostomia.
Many patients have also found Oasis oral spray to be helpful in improving dry mouth comfort. Your pharmacist can assist you in locating these products.
When eating, the following tips can be helpful:
- Adhere to a SOFT MOIST diet, avoiding dry textures.
- Use extra sauces and gravies to help moisturize and lubricate the food you are eating.
- Avoid bread, this sticks to the drier surfaces of the mouth and throat.
- Chew thoroughly so there are no “chunks” as these are the most likely to not pass as well through the throat.
- Alternate solids with liquids while eating. Using liquid swallows to wash the food down can help move the food through a dry throat.
- Swallow several times per bite. It’s harder to swallow through a dry throat so the more you swallow, the more likely you are to effective move the food into the esophagus.
Improving the humidification, especially at night can also help with the extreme dryness many patients report after waking in the morning. As most adults breath through their mouth when sleeping, the mouth and throat can become extremely dry and parched. Using a humidifier by the bed will help to provide moisture to the air you breath in while sleeping.
