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  • Head

  • Dry mouth

    Why it happens: 

    Dry mouth is often caused by chemotherapy or radiotherapy to the head and neck area, and also by certain medicines (e.g. morphine). Dry mouth may cause difficulty in wearing dentures and can make it more difficult to taste and enjoy foods. It is important to have good mouth (oral) hygiene including regular dental check-ups especially if you have dry mouth in the longer term.

    Helpful tips:

    • Drink plenty of liquids throughout the day. Aim for eight cups of fluid a day as a minimum. This does not always have to be water but can include things like squash drinks, juice, or tea and coffee.
    • Try very sweet or tart flavoured foods and beverages, such as lemonade, or chew sugar free chewing gum. These foods may help your mouth make more saliva. Be careful if you also have a tender mouth or sore throat as the sweet or tart foods could cause pain in the mouth.
    • Sucking on sweets, mints, ice lollies, frozen desserts or ice cubes can help your mouth to make more saliva. Chewing gum can also help with stimulating the flow of saliva.
    • Try choosing soft, moist meal options as these may be easier to chew and swallow. You may find it helps to add gravy and sauces to your meals. This tip can also help with tasting the food
    • Make sure you talk to your Healthcare Professional about the symptoms you are experiencing so that they can prescribe artificial saliva or moisturising mouth gels if it is needed.
    • Talk to your Healthcare Professional about oral nutritional supplements (also available in tangy flavours) if you are struggling to eat enough and are losing weight.

    Sore mouth

    Why it happens: 

    A sore mouth can be caused by certain chemotherapy drugs, radiotherapy to the head or neck region, or fungal infections in the mouth. This can make eating and drinking very uncomfortable.

    Helpful tips:

    Soreness usually resolves with time, but there are certain foods that can irritate an already tender mouth. Eating the right foods and taking good care of your mouth, teeth, and gums, can usually make eating more comfortable.

    • Make sure you talk to your Healthcare Professional about the symptoms you are experiencing so that they can prescribe mouthwashes and/or pain medications if it is needed. 
    • Drink plenty of fluids to help keep your mouth moist.
    • Try soft and moist foods that are easy to chew and swallow such as soups, mashed potatoes, pasta dishes with plenty of sauce, milkshakes, mashed potatoes, scrambled eggs, minced meats, custard, jelly and tinned soft fruit.
    • Cold or frozen foods can help soothe the mouth, for example ice-cream, frozen drinks and ice cubes.
    • Foods that may sting your mouth include citrus fruits and drinks such as lemon, orange and grapefruit. Spicy or salty foods and rough, coarse and dry foods may also be difficult to eat.
    • Talk to your Healthcare Professional about oral nutritional supplements. These are often milk based and may be more soothing especially when you have a sore mouth and throat. These can also be chilled or frozen to provide a refreshing alternative that is still high in calories and protein.
    • Good mouth care is important when you have a sore mouth to avoid or reduce infections arising from the mouth

    Taste changes

    Why it happens: 

    Chemotherapy or radiotherapy, infections in the mouth, certain medications and sometimes the cancer itself, may cause food and drinks to taste different. Foods may start to taste metallic or bitter, or some foods will lose their taste. These taste changes are usually temporary but could be permanent in some patients. You may find that foods you usually enjoy do not taste the same or taste unpleasant. To avoid restricting your diet, causing weight loss, it is important to focus on foods that you are able to eat more easily.

    Helpful tips: 

    The following hints and tips may help you to manage these taste changes. However, it is important to remember that everyone is affected differently by their treatment and there is no fool proof way to prevent changes to your sense of taste.

    • Focus on eating the foods that you enjoy the most. Avoid foods that are more difficult to eat but try them again every few weeks as your taste may change again.
    • Use plastic utensils if food tastes metallic.
    • Add strong flavours to foods, such as garlic, herbs, and spices and try marinating red meats with wine or soy sauce to make meats taste better.
    • If you no longer enjoy the taste of red meat (e.g. beef), try chicken, eggs, cheese or mild- tasting fish instead (e.g. cod and haddock).
    • Try eating foods cold or at room temperature, as they will have less of an odour. Try ice lollies, yogurt, frozen yogurt, cold hard boiled eggs, juices, cottage cheese, smoothies and shakes.
    • Tart foods such as citrus fruits, tomatoes and yogurt may have more of a pleasant taste. However, if you have a sore mouth or throat, tart or citrus foods may cause pain or discomfort.
    • Good oral hygiene is important and so it is important that you rinse your mouth clean and brush your teeth regularly.
    • If you are struggling to eat enough, talk to your Healthcare Professional about oral nutritional supplements. These are available in a variety of styles including milkshake, juice, dessert, yogurt-styles are also available and may be better tolerated if you have taste changes.

    Swallowing Difficulties

    Why it happens: 

    The medical term for swallowing difficulties is known as dysphagia. Some people with dysphagia have problems swallowing certain foods or liquids, and others cannot swallow anything at all.

    Other signs of dysphagia include:

    • Coughing or choking when eating or drinking.
    • Bringing food back up, sometimes through the nose.
    • A sensation that food is stuck in the throat or chest.

    Untreated swallowing difficulties can cause repeated chest infections and/or weight loss over time. You should talk to your Doctor or other Healthcare Professional if you have difficulties swallowing. Dysphagia is usually caused by cancers of the mouth, throat or oesophagus, but can also be caused by the weight loss experienced in other types of cancer due to muscle weakness in the throat and neck.

    The severity of dysphagia depends on the location of the tumour and the extent of surgery in certain cancers, as well as the impact of certain types of chemotherapy and radiotherapy. The management of dysphagia usually depends on its type and underlying cause, which is usually diagnosed after your ability to swallow has been tested by a Speech and Language Therapist.

    Dysphagia can be managed in a variety of ways which can include:

    • Speech and language therapy to learn new swallowing techniques.
    • Changing the consistency of food and drinks to make them safer to swallow.
    • Alternative forms of feeding, such as tube feeding through the nose or stomach to ensure adequate hydration and nutrition.
    • Treating the narrowing of the oesophagus with surgery, by stretching or inserting a metal tube otherwise known as a stent.

    Helpful tips:

    If you are having any difficulties with swallowing seek advice from your Doctor or Healthcare Professional who may suggest assessment by a Speech and Language Therapist.
    Some foods are more difficult for people with dysphagia to swallow, such as:

    • Foods that require a lot of chewing.
    • Foods that have many small particles, like seeds, skins, stalks, etc.
    • Dry and/or crumbly foods.
    • Foods that combine liquids and solids such as soups containing meat, fish and vegetable pieces.
    • Thin liquids such as water and juice.
    • Foods that become liquid in your mouth, such as ice cream and jelly.

    The content of this page was reviewed by Saira Chowdhury
    Specialist Upper GI Oncology Dietitian
    Guys & St Thomas' NHS Foundation Trust
    January 2015