Nutrition During Treatment for Head and Neck Cancer

Patients being treated for head and neck cancers are frequently malnourished prior to even starting treatment. In most cases, they continue to be malnourished due to the side effects caused by the treatments of these cancers. These can include loss or change in taste, mucositis (mouth sores), xerostomia (dry mouth), fatigue, nausea, and vomiting. It is important to manage these side effects and treat nutrition problems early on in cancer treatment because it can improve prognosis. Even as little as a 5% weight loss can interfere with tolerance to treatment so it is important to find ways to optimize your intake.

To assist you in making appropriate diet changes or enhancements, seek out the support from the Registered Dietitian. One first step may be to change the consistency of food you eat. The following are diet changes commonly recommended for patients being treated for head and neck cancers. You may switch from one diet to another up and down the list, depending upon your dietitian’s recommendations. For example, when you are on a full liquid diet, you may be able to progress to a pureed diet if tolerated or if you are still having trouble maintaining proper nutrition, you may be switched to a diet that includes nutritional supplements. Each diet is detailed below.

Regular Diet as Tolerated

A regular diet consists of a variety of foods from all of the 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 maintain proper nutrition. During cancer treatment, you may want to include some high calorie and high protein foods to maintain your weight.

Soft Diet

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

• 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 well moistened.
• Soft cooked or canned vegetables cut into small pieces.
• Ripened banana or soft canned fruit.
• Well cooked pasta or macaroni well 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 even easier to swallow. After a food is pureed it does not need to be chewed, only swallowed. Pureed food still be able to hold their shape on a spoon. Examples include:

• 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 easily puree these foods into a palatable consistency.

Full Liquid Diet

A full liquid diet consists of foods that are smooth, pourable liquids. Examples include:

• All beverages including 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 smoother).
• Blenderized fruits and vegetables (may need juice to make thinner).

There are different thicknesses of liquids that can be suggested if safety with swallowing is an issue. This is usually determined by a speech or occupational therapist. They include:

• Thin, which 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 can 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. Speak to your dietitian about how to obtain thickening packets and thickened liquid packets.

Nutritional Supplements Appropriate for Your Diet

If you are still unable to maintain an appropriate nutritional status, your dietitian may suggest adding supplements to your daily diet. There are a number of products, both prescribed and available over-the-counter in pharmacies/grocery stores, that can provide nutrition in a small amount of food or liquid. Popular supplements include protein powders that can be added to smoothies, milkshakes, some cooked items, and high calorie and high protein drinks such as Ensure® and Boost® products. Speak to your dietitian about what products are best for you. Some products advertised to be healthy supplements may contain a large quantity of sugar, which may not be appropriate for your needs.

Eating Food as Tolerated Along with a Feeding Tube

Despite your best efforts, you may not able to meet your nutritional needs by eating food and supplements. The side effects of the cancer and treatments may be so severe that you will require a feeding tube to supplement the food you eat. There are several types of tubes that can be placed and your provider will determine which is best for you. These tubes can be temporary or permanent. You will be prescribed a liquid nutrition that can be infused 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 your surgery and treatment. It is important to maintain open and honest communication with your dietitian and providers so that together you can determine the best course of action to maintain proper nutritional status through the course of your treatment.