Nutrition Advice: Head, Neck & Chest Area

For patients receiving radiation therapy to the head, neck and/or chest area.

Introduction and Brief Description

Radiation therapy to the head, neck, chest and bones in the upper back area can cause difficulty swallowing (odynophagia/dysphagia), dry mouth (xerostomia), taste changes and/or mouth/esophageal sores (mucositis and esophagitis). You can experience some of these nutrition-related side effects or none at all. Early nutrition care can help to decrease the severity of these side effects of treatment, help you maintain your body weight and keep you more comfortable.

It is important to note that the side effects of treatment often do not disappear immediately after the radiation finishes, but can take weeks or a few months to resolve. A gradual return to a healthy diet is advised.

Nutrition Suggestions

The side effects from radiation therapy listed above often do not happen at the start of treatment but can appear a few weeks into your treatment plan. Please be aware of any changes in ease and comfort when chewing or swallowing, and report them to your healthcare team. The following are some nutrition suggestions to start at the beginning of treatment in an effort to minimize the possible effects of radiation.

  1. Minimize or avoid the consumption of acidic foods such as tomatoes, and tomatoes products, vinegar, and citrus fruit juice (orange, pineapple and grapefruit).
  1. Minimize or avoid the consumption of spicy foods. Examples of spices that are known to irritate the stomach include: chili powder, cayenne, jalapeno pepper, mustard, and black pepper. Preparing your own food from scratch makes it easier to control the amount and type of seasoning being used. If you do choose processed foods, be particularly careful with spicy canned soups, sauces, stews, frozen or canned entrees.

IF YOU START HAVING DIFFICULTY CHEWING AND SWALLOWING:

  1. Notify your Dietitian, Nurse and Doctor.
  2. Consider consuming four to five (4-5) smaller meals instead of three (3) larger meals; this helps with digestion and reduces the stress on the stomach. In addition, it is recommended that you eat slowly and chew your food thoroughly.
  3. Remember to drink healthy liquids like water, juice* and decaffeinated beverages to keep your body hydrated and to moisten your mouth if it is dry.
  4. Consider using plastic utensils instead of metal if changes in taste are a problem and a metallic taste develops in the mouth Also, try marinating meat, chicken and/or fish with a sweeter fruit juice and if possible, adding mild spices to enhance the flavor of foods.
  5. Limit/avoid substances that we know cause irritation to the lining of the mouth and stomach; examples include hot peppers, garlic, onions and vegetables in the leek family.
  6. Limit firm/hard foods such as pretzels, chips, popcorn, hard-crusted breads, and toasted bread.
  1. Avoid foods and beverages that are very hot or very cold. Exposure to extreme temperatures can further aggravate the lining of the mouth and throat, causing discomfort and even damage. Room-temperature and slightly warmer or colder foods and beverages are often better tolerated.
  2. Limit/avoid the consumption of carbonated beverages. The carbonation can cause discomfort and if you have reflux from the treatment or chemotherapy, it will further aggravate your system.
  3. Limit/avoid caffeine-containing beverages because they can dehydrate rather than hydrate you. Examples of this type of beverage include: caffeinated coffee and tea, colas and some additional sodas that have caffeine added…Mountain Dew®, and certain root beers and orange-flavored sodas.
  4. Consume plenty of non-caffeinated beverages and foods that are liquid at room temperature such as Jell-O®*, ice cream*, and Italian ices*. If your mouth is dry, adding liquids, sauces and juices to foods and meals will help to ease swallowing.

Medications

  1. If you are getting radiation to the head and neck area, artificial saliva preparations (some need prescriptions) can make chewing and swallowing easier; however, many cancer survivors say that simply drinking water throughout the day can really help keep the mouth moist.
  2. If you are being treated to the head and neck region, remember to practice good mouth care by repeatedly rinsing with a salt, baking soda and warm water mixture as instructed by the nurses.
  1. Liquid aloe gel, and a swish and swallow preparation like Pink Magic (prescription) are two options used to ease swallowing pain and make eating more pleasant.
  2. The doctor or nurse may also suggest pain medication (some need prescriptions) to help decrease the pain with eating and drinking.

The following foods, which are soft, moist and good sources of calories and other nutrients, will help if you are eating less and needing to gain/maintain your weight

  • Hummus/Baba Ganoush
  • White rice
  • Fruit sauces such as apple
  • Eggs
  • Pasta with butter/oil/crm sauce
  • Ripe bananas
  • Fish
  • White bread
  • White grape juice
  • Ground meat and poultry
  • Hot cereals
  • Cranberry juice
  • Milk Shakes
  • Mashed potatoes
  • Fruit nectars such as pear
  • Cheese, Yogurt, Custard
  • Soups and Stews
  • Gelatin with whipping cream

Commercially prepared liquids such as those made by Ensure, Boost and Carnation Instant Breakfast can be very effective and easy ways to get extra nutrition.

*Please do not disregard previously defined dietary restrictions for heart disease, diabetes or any other condition unless discussed with dietitian, nurse and doctor.

For any additional questions or needed information, please call your registered oncology dietitians, Kathryn Hamilton or Mary Giselle Ulbrich at 973-971-6232.