In addition to chewing and swallowing difficulties that patients with upper gastrointestinal cancers experience, they also can experience side effects of treatment which have an impact on eating. Side-effects can vary from person to person and not everybody will experience them. Chemotherapy can result in many of the side effects discussed below. Radiation therapy usually affects the area being treated e.g. receiving treatment to the head and neck and oesophagus may result in difficulty eating and swallowing. Surgery to remove a tumour can result in problems eating and digesting a normal diet. For some people tube feeding may be necessary post-surgery.

Sore Mouth

Some chemotherapy drugs may result in sores forming in the mouth, or mouth pain. Treatments to the head and neck area often result in a sore mouth and it can make eating and swallowing quite difficult.

• Eat soft foods like puddings and yogurts. Moisten foods with gravy or sauces to make them easier to eat.
• Puree foods to make them easier to eat and swallow.
• Avoid rough textured foods like toast and foods that are overly tart, salty or vinegar based.
• Sip fluids throughout the day.
• Cold foods such as ice-cream (if allowed) can help soothe a sore mouth.

Dry Mouth

Chemotherapy and radiation therapy can damage salivary glands and thicken saliva or reduce the amount of saliva in your mouth. This results in a dry mouth. This makes it a lot more difficult to eat and enjoy food.

• Sip fluids throughout the day to moisten your mouth.
• Maintain good dental health and oral hygiene. Milk helps protect teeth.
• Soft, minced and moist, smooth pureed foods are easier to eat.
• Add sauces to moisten foods.
• Avoid salty foods as well as spicy food, caffeine and alcohol which dry out your mouth further.
• Chewing gum may help to stimulate saliva.
• Try rinsing your mouth with one of these mouth rinses before meals:
  • Baking soda with water (1/4 tsp baking soda to 1 cup water)
  • Salted water (1/8 tsp salt to 1 cup water)
  • Flavoured soda water
  • Sparkling soda water

Chewing Difficulties

Depending on the severity and cause of chewing problems, certain approaches may work better for some patients than for others. Try different types of foods with the goal of eating a nutritious diet that has enough calories, protein, vitamins and minerals.

Here are some more tips:

• Eat soft, smooth foods, such as yogurt, pudding, or ice cream.
• Mash or blend foods, or add blended vegetables or ground meats to casseroles or soups.
• Moisten dry foods with broth, sauce, butter or milk.
• Take sips of water or other liquids while eating to keep the mouth and food moist.
• Try softer versions of your favourite fruits or vegetables, like applesauce or pureed carrots; switch to softer fruits and vegetables, such as bananas or peas; or consider eating baby food.
• Cut food into small bites and chew slowly and thoroughly.
• If you are losing weight, eat smaller, more frequent meals that are high in protein and calories, such as eggs, milkshakes, casseroles and nutritional shakes.
• Avoid dry, coarse or hard foods and foods that need a lot of chewing.

Taste and Smell Changes

Some people with cancer find that their taste changes, although this is usually temporary. Foods that once appealed to you may no longer be desired. Your sensitivity to smells may increase and your taste may decrease or often patients find that they have a metallic taste in their mouth. Foods may seem bitter, bland or salty.

• Try new foods and eat whatever appeals to you. You may suddenly like foods that you once disliked.
• Rinse your mouth with a solution of water and baking powder before and after eating to help normalise taste.
• Cold or lukewarm foods have a weaker taste and smell and may be more tolerable.
• If food tastes too bland, add herbs, seasoning, spices, garlic or onions to boost flavour. Fat is a great flavour carrier so add fats to meals freely.
• If there is metallic taste in your mouth, rinse your mouth regularly and try eating with plastic utensils instead of metal ones.
• Marinating meats can help to mask any metallic tastes.
• Sharp-tasting foods like fresh fruit can be refreshing and leave a pleasant taste in the mouth.
• Re try foods every 2-3 weeks as the taste may have returned to normal.

Poor Appetite

A change in appetite is very common during cancer treatment. Your favourite foods may no longer appeal to you, you may have a reduced appetite or you may not want to eat at all. Without forcing yourself to eat, it is important to try to eat small amounts regularly, to avoid weight loss.

• Eat whenever you feel hungry. If you are hungriest in the morning then eat your biggest meal at that time.
• Eat frequent small meals to avoid feeling uncomfortably full. Snack often and avoid large, off-putting portions. Make these snacks high in calories and protein.
• Limit drinks before and during meals as they fill you up.
• Limit fibre as it fills you up quickly.
• Bland foods may be easier to tolerate.

Nausea and Vomiting

Nausea is when you feel sick, have an unpleasant feeling in your stomach or throat, feel dizzy, clammy and don’t want to eat. The most common cause of nausea and vomiting is chemotherapy, radiation therapy or upper gastrointestinal surgery. You should discuss these symptoms with your doctor as anti-sickness medications can ease nausea and prevent you throwing up.

In general:

 

• Eat little and often. Avoid skipping meals; this can lead to hunger which worsens nausea.
• Bland, cold foods have less taste and smell and will be better tolerated.
• Avoid greasy, spicy, and sugary foods with a strong odour.
• Drink flat ginger ale or include ginger in meals, as ginger soothes nausea.
• Avoid your favourite foods when nauseated, as you may grow to dislike them.
• Avoiding eating 1-2 hours before treatment it may lessen nausea.
• Try not to prepare meals when nauseated and rest after meals.