Managing Oral Complications of Head and Neck Radiation

Common Side Effects of Radiation Therapy

  • Xerostomia (Dry Mouth)
  • Mucositis (Sore Mouth and Throat)
  • Oral Infections (e.g. Candidiasis)
  • Alteration of Taste and Smell
  • Odynophagia (Pain with Swallowing)

Facts About Radiation Therapy

  • Radiation treatments are painless.
  • External radiation treatment does not make you radioactive.
  • Treatments are usually scheduled every day except Saturday and Sunday.
  • You need to allow at least 30 minutes for each treatment session although the treatment itself takes only a few minutes.
  • It's important to get plenty of rest and to eat a well-balanced diet consisting of fruits and vegetables, whole grains, lean meats and lowfat dairy products during the course of your radiation therapy.
  • Skin in the treated area may become sensitive and easily irritated.
  • Side effects of radiation treatment are usually temporary, although some may persist for months or even years, and they vary depending on the area of the body that is being treated.

Nutrition

Radiation therapy may affect swallowing, taste, and appetite, and therefore can contribute to nutritional deficits. Your nutrition during therapy is vital to help you tolerate the side effects of treatment. Additional support, such as dietary modifications or enteral nutrition (feeding tube) may be a safe and effective way to allow you to maintain nutrition and hydration until you can return to eating normally again.

Nutritional Suggestions

 

Improving Your Appetite

  • Plan a daily menu in advance
  • Eat small, frequent, high calorie meals (every 2 hours)
  • Eat in a calm, comfortable environment
  • Arrange for help in preparing meals
  • Add extra protein and calories to meals with fortified drinks
  • Prepare and store small portions of favorite foods
  • Consume one third of daily calorie and protein requirements at breakfast
  • Snack between meals
  • Seek foods that appeal to your sense of smell
  • Be creative with desserts
  • Experiment with different foods
  • Perform frequent oral care to relieve symptoms and decrease aftertastes

What You Can Do For Taste

  • Eat small, frequent meals and healthy snacks
  • Be flexible. Eat when you are hungry rather than at set mealtimes
  • Use plastic utensils if foods taste metallic
  • Try your favorite foods
  • Plan to eat with family and friends
  • Try new foods when you are feeling your best
  • Substitute poultry, fish, eggs, or cheese for red meat
  • Try a vegetarian cookbook for non-meat, high-protein recipes
  • Use sugar-free hard candy, gum, or mints for metallic or bitters tastes in the mouth
  • Add spices and sauces to foods if able to tolerate
  • Eat meat with something sweet, such as cranberry sauce, jelly, or applesauce

Is Eating Painful?

Try these tips:

  • Eat soft foods that are easy to chew and swallow – Soft fruits, cottage cheese, mashed potatoes, macaroni & cheese, custards, puddings, jello, milk shakes, scrambled eggs, oatmeal, and mashed vegetables
  • Avoid foods that irritate the mouth – Citrus fruits and juices, spicy or salty foods, rough, coarse, or dry foods including raw vegetables, toast, and crackers
  • Cook foods until soft and tender
  • Cut foods into small pieces
  • Use a straw to drink liquids
  • Eat foods cold or at room temperature
  • Add gravy, broth, or sauces to increase moisture content
  • Practice good mouth care, use a water pick if available
  • Supplement meals with high-calorie, high protein drinks
  • Numb the mouth with flavored ice pops or ice chips

Drink More Water!

  • Adequate hydration is important for overall health.
  • Drink 8-12 cups of liquids daily; take a water bottle whenever you leave home
  • Drink even when you are not thirsty
  • Add foods to your diet that contain high fluids such as soups, ice pops, and jello
  • Limit consumption of caffeine products including pop, coffee, and tea
  • Drink liquids after and/or between meals to increase overall consumption of both liquids and solids.
  • Ask about antiemetics for relief from nausea and vomiting
  • Limit consumption of caffeine products including pop, coffee, and tea
  • Drink liquids after and/or between meals to increase overall consumption of both liquids and solids.
  • Ask about antiemetics for relief from nausea and vomiting

How To Perform Good Oral Care

  • Clean your mouth after each meal
  • Brush your teeth 2-3 times per day for 2-3 minutes using a soft-bristle toothbrush
  • Rinse your toothbrush in hot water every 15-30 seconds to soften the bristles
  • Allow your toothbrush to air dry between brushings
  • Mild-tasting toothpastes that contain flouride are less likely to irritate your mouth and will help prevent cavities
  • If mild toothpastes cause irritation to your mouth, try a solution of 1 teaspoon of salt added to 1 quart of water • Rinsing your mouth should be performed 3-4 times during brushing and additionally as needed for cleaning
  • If your mouth is dry, rinsing may not be enough for cleaning after meals, brushing and flossing may be needed
  • Rinses may be made with salt and/or baking soda solutions including:
    – 1 teaspoon of salt in 4 cups of water
    – 1 teaspoon of baking soda in 1 cup (8 oz.) of water
    – One-half teaspoon of salt and 2 tablespoons of baking soda in 4 cups of water (especially good for thick saliva)
  • Flossing should be performed gently, once a day
  • Don’t forget about your lips. Use moisturizers and other lip care products to prevent drying and cracking

Pain Control

Tell your doctor or nurse if you experience discomfort or pain at any time during your treatment. They may be able to prescribe a medication to help you feel better.

Additonal Resources

See the National Cancer Institute Web site for: Eating Hints for Cancer Patients: Before, During, and After Treatment. You can also download a copy of this booklet.
Or call toll free 800-4-CANCER

American Cancer Society Web site  has a section on Managing Eating Problems Caused by Radiation Therapy. Or call toll free 800-ACS-2345

See the National Oral Health Information Clearinghouse for Head and Neck Radiation Treatment and Your Mouth.  You can also download a copy of this booklet.
301-402-7364
 

References

Nutrition in Cancer Care. (2006). National Cancer Institute. Retrieved April 4, 2007, from http://www.cancer.gov

Radiation therapy for head and neck cancer. (2007). RT Answers-Answers to Your Radiation Therapy Questions. Retrieved February 23, 2007, from http://www.rtanswers.org