Swallowing FAQs
Q: What are the side effects of radiation therapy for the treatment of head and neck cancer, and will these side effects change my swallowing?
A: There are immediate and long-term effects of radiation therapy for the treatment of head and neck cancer. The immediate effects may include dry mouth, burning sensations, sore throat, sore tongue or lips, ulcerations, difficulty with denture retention, and abnormal taste and smell. Whether you develop cavities in your teeth will depend on your oral hygiene. A build-up of plaque on your teeth can occur due to the altered flow of saliva. Fluoride treatments are recommended to prevent tooth decay. The long-term effects may include limited ability to open the mouth (trismus), fibrosis (excess tissue formation), dead tissue (soft-tissue necrosis), and swelling.
These side effects can alter swallowing function depending on how much therapy you receive and which area receives the radiation. Patients usually have the most difficulty during the course of treatment and need to make changes in their diet to prevent swallowing discomfort. After radiation therapy, patients appear to be more interested in trying to eat different kinds of foods again, but they may need to be re-evaluated to determine what foods are the safest to swallow.
Q: Do I need to have a specialist check my swallowing when I
begin radiation therapy?
A: It is very helpful to have swallowing tests before and after radiation therapy to note any changes that have occurred. These tests will provide your doctor with information that will direct the most appropriate treatment plan to help you achieve your swallowing and nutrition goals.
A fiberoptic endoscopic evaluation of swallowing (FEES) is a swallow test that involves the use of a small camera to view the structures of the throat during swallowing. Undergoing this examination before radiation begins will allow your doctor to compare the changes that occur after treatment, and it will help to determine what kinds of foods and liquids are the safest and most manageable for you during treatment.
Swallowing exercises will be recommended after the initial evaluation. It is important to exercise the muscles used in swallowing both during and after treatment to prevent scar tissue from developing.
Q: What can I expect when I go through radiation therapy?
A: You may start to notice one to two weeks into your treatment that your mouth is dry. By the third week of your treatment, you may start to notice that certain foods are more difficult to swallow. Most people need to change the types of foods they eat because of ulcerations in the mouth. These ulcerations can cause burning sensations, especially when they come in contact with spicy or acidic foods and drinks. Your taste buds also are radiated at the time of your treatment, since they are in the treatment area. They become inactive during this period, so your taste may change, and you won’t recognize some flavors. However, in about three months, you should start regaining some taste. You might want to marinate meats in fruits, sauces, or soy sauce to add flavor.
Q: Will the radiation do anything to my teeth?
A: As a result of the radiation therapy, saliva production may decrease and the consistency of the saliva in your mouth may change. Saliva protects your teeth from bacteria, so these changes may make your teeth more susceptible to bacterial attack.
You also may be eating more foods that have a higher sugar content to maintain your weight. Because the excess sugar will attract bacteria that can cause tooth decay, it is very important for you to clean your mouth well, especially before and after you eat. You may also want to use an alcohol-free mouthwash such as Biotene.
If your mouth is the area being treated with radiation, you should see your dentist regularly, even if you wear dentures. Do not wear your dentures while undergoing therapy.
Q: Will I develop a sore throat?
A: A sore throat is the main side effect of radiation therapy for head and neck cancers, but each patient will react differently depending upon the dose of radiation received.
Q: What should I do for a sore throat?
A: Gargle with a mixture of one teaspoon of salt and one teaspoon of sodium bicarbonate (baking soda) in a quart of water six to eight times a day or more, and before and after each meal.
Q: What can I do about dry mouth?
A: Frequently drink small amounts of water or juice or a high-calorie supplement such as Boost or Ensure. There is no limit to the amount of liquid you can consume while you are having radiation therapy. Keep a glass of water or juice at your bedside to drink during the night if you need it. Include more moist foods in your meals such as gravies, sauces, sour cream, and macaroni and cheese. Add extra butter to help lubricate your mouth and increase your calories.
Chew ice chips or sugarless gum, drink ginger ale, or use an artificial saliva formula to increase moisture in your mouth, especially immediately before eating.
If your saliva is thick, try sipping pure papaya juice. Papaya contains natural substances that will help thin the thick saliva. There are artificial saliva substitutes that may relieve the dryness. Check with your doctor. Some artificial saliva substitutes have side effects such as excessive sweating and diarrhea.
Q: Some days swallowing seems to be more difficult than others. Is this normal?
A: This is normal because you may have more swelling some days than others. Increased swelling will make swallowing more difficult. If you consistently notice that it is more difficult to swallow, call your doctor.
Q: Should I continue to try to swallow things that I can manage, even if I have a feeding tube in place?
A: Continue to use the muscles involved in swallowing as much as possible. If you are able to swallow water safely, then it is important to continue. Water may help relieve some of the dryness in your mouth and throat. If you do nothing at all, those muscles may tighten more, causing swallowing to be even more difficult when you complete radiation therapy.
Q: I have noticed that my swallowing is becoming worse now
that my radiation therapy has ended. What should I do?
A: You may be experiencing some of the late effects of radiation
treatment, which may include a tightening sensation due to swelling and a narrowing of the passageway where food travels (esophagus). You should consult your doctor for further recommendations. Sometimes this area can be stretched by a procedure called dilatation.
Nutrition FAQs
Q: What are the goals of nutrition during radiation therapy for head and neck cancers?
Nutrition during radiation therapy should help the patient feel better, retain their strength and energy, maintain their normal weight and the body’s nutrition stores, decrease the risk of infection, and help the patient to tolerate treatment-related side effects, and to recover as quickly as possible.
Q: During the course of radiation therapy, will I be able to eat the same kinds of foods that I normally eat?
A: It will depend on the area of the head and/or neck that is receiving treatment and the amount and frequency of radiation you are receiving. Usually, the side effects of radiation prevent patients from eating a regular diet. A bland diet is often recommended. If you are undergoing chemotherapy along with radiation therapy, you may experience a loss of appetite. Most people seem to drink more liquids and eat less solid food during radiation therapy. If this occurs, an evaluation by a registered dietitian is recommended.
Q: Why am I constipated, and what can I do about it?
A: Emotions, pain medication, and the lack of bulk in your diet — any or all of these may cause constipation. Your lower intestine needs bulk in order to function properly. If you have not been eating or drinking enough, it is possible that stool will not form in your lower intestine for two or three days. This is normal. The following suggestions may help:
Try to relax.
Engage in light daily exercise. Even a brisk walk is helpful for normal bowel function.
Eat meals regularly and slowly, and chew your food well.
Eat cooked carrots, bananas and other fruits and vegetables. Before breakfas drink juices (prune juice) or a glass of warm water with a teaspoon of lemon juice added.
Drink plenty of fluids.
Q: Why can't I taste the food that I eat?
A: Your taste buds also are radiated at the time of your treatment since they are in the treatment area. They become inactive during this period, so your taste may change, and you won’t recognize some flavors. However, in about three months you should start regaining some taste. You might want to marinate meats in fruits, sauces, or soy sauce to add flavor.
Q: What if I don’t feel like eating?
A: It is very normal for appetite to decrease during treatment. Your regular routine of daily living has changed, and there are a lot of new things to get used to, including your taste for food and ability to eat. You may also feel tired, which can decrease your desire to eat and to enjoy food.
Make an effort to keep mealtime pleasant. Remember that eating well is one of your most important medicines. Try to “eat with your eyes.” At mealtime, stimulate your appetite with a nice table setting, pleasant colors, favorite aromas, and a peaceful atmosphere.
- The following tips also may help to stimulate your appetite:
- Walk or participate in another light activity.
- Eat small, frequent meals and snacks.
- Make food preparation an easy task by choosing foods that are easy to prepare and eat.
- Select high-protein and high-calorie snacks.
- Drink a nutritional supplement to provide additional calories, protein, and other nutrients. A registered dietitian can recommend a good brand to meet your needs.
- Avoid beverages with no nutritional value such as black coffee and tea.
- Plan meals to include your favorite foods.
- Make eating a pleasurable experience, not a chore. Liven up your meals by using colorful place settings. Play background music during meals.
- Try not to eat alone; invite a guest to share your meal or go out to dinner.
- Use your imagination to increase the variety of food you're eating.
- Use colorful garnishes such as parsley and red or yellow peppers to make food look more appealing and appetizing.
Q: Will I need a feeding tube during my treatment?
A: Most likely, yes. A sore throat is the main side effect of radiation therapy for head and neck cancers. If your sore throat is severe, you may be unable to take in enough food and liquids by mouth to maintain your weight or avoid dehydration. Your doctor will place a feeding tube temporarily into your stomach (a gastrostomy tube), which will allow you to maintain adequate nutrition without having to swallow all of the food that you need. It is important to continue swallowing even with a gastrostomy tube in place. Otherwise, your swallowing muscles may atrophy, causing permanent swallowing problems and making it difficult to stop using the gastrostomy tube even after the course of radiation treatment is completed.
Q: How should I wean myself from the feeding tube?
A: Try keeping a food record of everything you eat and drink. The time period varies greatly from one patient to the next. In addition to safety and nutrition factors, a patient's medical status plays a huge role. The ultimate goal of swallowing therapy is to have every patient fed orally. Feedings by mouth should be safe and adequate to maintain nutrition and hydration.