Nutrition During Treatment for Head and Neck Cancer

Some patients being treated for head and neck cancers are malnourished before even starting treatment. If you are malnourished, it means you are not getting the nutrients or foods you need to help keep your body healthy. Malnourishment may get worse once treatment starts because the side effects of treatment can make it hard to eat and drink. These side effects are:

• Loss or change in taste.
• Mucositis (mouth sores).
• Xerostomia (dry mouth).
• Fatigue.
• Nausea and/or vomiting.

It is important to manage these side effects and treat nutrition problems early to help cancer treatments work better. Even as little as a 5% weight loss can affect how you handle and respond to treatment (your tolerance).

A Registered Dietitian (RD) can help you make changes to your diet to make sure you are meeting your nutritional needs. Your cancer center may have dieticians on staff or may be able to recommend one to you.

You may need to change the consistency (texture or thickness) of the food you eat. The following are diet changes commonly recommended for patients treated for head and neck cancers. You may switch from one diet to another depending on your dietitian’s recommendations. For example, when you are on a full liquid diet, you may be able to move on to a pureed diet if tolerated. If you are still having trouble, you may switch to a diet that has nutritional supplements. Each diet is discussed below.

Regular Diet as Tolerated

A regular diet means eating a variety of foods from all food groups, including vegetables, fresh fruits, whole grains, lean proteins, and low-fat dairy products. The USDA has more information about what a typical meal should look like to help with proper nutrition. During cancer treatment, you may want to include some high-calorie and high-protein foods to help you not lose weight.

Soft Diet

A soft diet is made up of foods that can be easily mashed with a fork. These foods are easier to chew and swallow. Examples are:

• Tender-cooked chicken, turkey, or pork cut into small pieces, or ground meat moistened with gravy.
• Flaky fish.
• Tuna, chicken, or egg salad, finely chopped and moistened.
• Soft-cooked or canned vegetables cut into small pieces.
• Ripened banana or soft canned fruit.
• Well-cooked pasta or macaroni moistened with gravy or sauce.

Pureed or Blenderized Diet

Most foods can be pureed or put into a blender and made into a consistency that is easier to swallow. After food is pureed, it does not need to be chewed, only swallowed. Pureed food should still be able to hold its shape on a spoon. Examples are:

• Mashed white or sweet potatoes.
• Smooth apple sauce or other pureed fruits (smooth, no chunks).
• Pureed vegetables (smooth, no chunks).
• Pureed chicken, turkey, pork, red meat, or fish. Use broth or gravy to puree these foods and to make them taste better.

Full Liquid Diet

A full liquid diet means eating foods that are smooth, pourable liquids. Examples are:

• All beverages like water, milk, juice, coffee, and tea.
• Thin cream of wheat or oatmeal.
• Yogurt, pudding, ice cream (no pieces of fruit, chocolate, nuts, etc), smoothies, milkshakes.
• Blenderized soups (may use broth to make them smoother).
• Blenderized fruits and vegetables (may need juice to make them thinner).

If swallowing is an issue or it is unsafe to drink thin liquids, there are different levels of thickness for liquids. A speech or occupational therapist will help decide which level of thickness is safest for you. The different levels of thickness are:

• Thin (includes all liquids).
• Nectar-thick, which is the consistency of apricot or tomato juice. A thickening agent can be added to a thin liquid to thicken it to a nectar-thick consistency.
• Honey-thick liquids, whichcan be poured but are very slow. A thickening agent can be added to a thin liquid to thicken it to a honey-thick consistency.

When using a thickening agent, it is important to use the correct thickener and to follow the directions on the package. Some products come already thickened. Talk with your dietitian about how to get thickening packets and thickened liquid packets.

Nutritional Supplements for Your Diet

If you are still having a hard time keeping up with your nutritional needs, your dietitian may suggest adding supplements to your daily diet. There are a few products, both prescribed and available over-the-counter in pharmacies/grocery stores, that help with nutrition. Popular supplements are protein powders that can be added to smoothies, milkshakes, and some cooked items. There are also high-calorie and high-protein drinks like Ensure® and Boost® products. Talk with your dietitian about the supplements that are best for you. Some of these supplements also have high levels of sugar, so be sure to look at nutritional labels and ask your care team if you have any questions.

Eating Food as Tolerated Along with a Feeding Tube

Despite your best efforts, you may not be able to meet your nutritional needs by eating food and supplements. The side effects of the cancer and treatments may be so serious that you may need a feeding tube placed to help supplement the food you eat. There are a few types of tubes that can be placed. Your provider will talk with you about which feeding tube is best for you. These tubes can be temporary (short-term) or permanent (long-term). You will be prescribed a liquid nutrition that can be given through the tube into your stomach either by a pump or manually. This liquid nutrition will replace the nutrients you are unable to eat and drink.

Keep in mind that diet consistency changes are likely temporary based on the surgery and treatment you’ve had. It is important to talk openly and honestly with your dietitian and providers to find the best ways to help with your nutrition throughout treatment.