Radiation: Appetite And Oral Problems

Radiation therapy can cause loss of appetite, or mouth or throat problems that can make it difficult for your loved one to get the proper nutrition.

Will Eating Be A Problem?

Sometimes radiation treatment causes loss of appetite and interferes with eating, digesting, and absorbing food. Try to eat enough to help damaged tissues rebuild themselves. It is not unusual to lose 1 or 2 pounds a week during radiation therapy. You will be weighed weekly to monitor your weight.

It is very important to eat a balanced diet. You may find it helpful to eat small meals often and to try to eat a variety of different foods. Your doctor or nurse can tell you whether you should eat a special diet, and a dietitian will have some ideas that will help you maintain your weight. Coping with short-term diet problems may be easier than you expect. There are a number of diet guides and recipe booklets for patients who need help with eating problems.

If it’s painful to chew and swallow, your doctor may advise you to use a powdered or liquid diet supplement. Many of these products are available at drugstores and supermarkets and come in a variety of flavors. They are tasty when used alone or combined with other foods such as pureed fruit, or added to milkshakes. Some of the companies that make these diet supplements have recipe booklets to help you increase your nutrient intake. Ask your nurse, dietitian, or pharmacist for further information.

You may lose interest in food during your treatment. Fatigue from your treatments can cause loss of appetite. Some people just don’t feel like eating because of stress from their illness and treatment or because the treatment changes the way food tastes. Even if you’re not very hungry, it’s important to keep your protein and calorie intake high. Doctors have found that patients who eat well can better cope with having cancer and with the side effects of treatment. Medications for appetite enhancement are now available; ask your doctor or nurse about them.

The list below suggests ways to perk up your appetite when it’s poor and to make the most of it when you do feel like eating.

  • Eat when you are hungry, even if it is not mealtime.
  • Eat several small meals during the day rather than three large ones.
  • Use soft lighting, quiet music, brightly colored table settings, or whatever helps you feel good while eating.
  • Vary your diet and try new recipes. If you enjoy company while eating, try to have meals with family or friends. It may be helpful to have the radio or television on while you eat.
  • Ask your doctor or nurse whether you can have a glass of wine or beer with your meal to increase your appetite. Keep in mind that, in some cases, alcohol may not be allowed because it could worsen the side effects of treatment. This may be especially true if you are receiving radiation therapy for cancer of the head, neck, or upper chest area including the esophagus.
  • Keep simple meals in the freezer to use when you feel hungry.
  • If other people offer to cook for you, let them. Don’t be shy about telling them what you’d like to eat.
  • Keep healthy snacks close by for nibbling when you get the urge.
  • If you live alone, you might want to arrange for “Meals on Wheels” to bring food to you. Ask your doctor, nurse, social worker, or local social service agencies about “Meals on Wheels.” This service is available in most large communities.

If you are able to eat only small amounts of food, you can increase the calories per serving by:

  • Adding butter or margarine.
  • Mixing canned cream soups with milk or half-and-half rather than water.
  • Drinking eggnog, milkshakes, or prepared liquid supplements between meals.
  • Adding cream sauce or melted cheese to your favorite vegetables.

Some people find they can drink large amounts of liquids even when they don’t feel like eating solid foods. If this is the case for you, try to get the most from each glassful by making drinks enriched with powdered milk, yogurt, honey, or prepared liquid supplements.
Mouth Care

Radiation treatment for head and neck cancer can increase your chances of getting cavities in your teeth. Mouth care designed to prevent problems will be a very important part of your treatment. Before starting radiation therapy, make an appointment for a complete dental/oral checkup. Ask your dentist and radiation oncologist to consult before your radiation treatments begin.

Your dentist probably will want to see you often during your radiation therapy to help you care for your mouth and teeth. This is a good way to reduce the risk of tooth decay and help you deal with possible problems such as soreness of the tissues in your mouth. It’s important that you follow the dentist’s advice while you’re receiving radiation therapy. Most likely, your dentist will suggest that you:

  • Clean your teeth and gums thoroughly with a soft brush at least 4 times a day (after meals and at bedtime).
  • Use a fluoride toothpaste that contains no abrasives.
  • Floss gently between teeth daily if you flossed regularly before your illness. Use waxed, non-shredding dental floss.
  • Rinse your mouth gently and frequently with a salt and baking soda solution especially after you brush. Use 1/2 teaspoon of salt and 1/2 teaspoon of baking soda in a large glass of warm water. Follow with a plain water rinse.
  • Apply fluoride regularly as prescribed by your dentist.

Your dentist can explain how to mix the salt and baking soda mouthwash and how to use the fluoride treatment method that best suits your needs. You can probably get printed instructions for proper dental care at the dentist’s office. If dry mouth continues after your treatment is complete, you will need to continue the mouth care recommended during treatment. Always share your dentist’s instructions with your radiation nurse.

Dealing With Mouth Or Throat Problems

Soreness in your mouth or throat may appear in the second or third week of external radiation therapy and it will most likely have disappeared within a month or so after your treatments have ended. You may have trouble swallowing during this time because your mouth feels dry. Your doctor or dentist can prescribe medicine for mouth discomfort and tell you about methods to relieve other mouth problems during and following your radiation therapy. If you wear dentures you may notice that they no longer fit well. This occurs if the radiation causes your gums to swell. You may need to stop wearing your dentures until your radiation therapy is over. It’s important not to risk denture-induced gum sores because they may become infected and heal slowly.

Your salivary glands may produce less saliva than usual, making your mouth feel dry. Unfortunately dry mouth may continue to be a problem even after treatment is over. You may be given medication to help lessen this side effect. It’s helpful to sip cool drinks throughout the day. Although many radiation therapy patients have said that drinking carbonated beverages helps relieve dry mouth, water probably is your best choice. In the morning, fill a large container with ice, add water, and carry it with you during the day so that you can take frequent sips. Keep a glass of cool water at your bedside at night, too. Sugar-free candy or gum also may help; be careful about overuse of these products as they can cause diarrhea in some people. Avoid tobacco and alcoholic drinks because they tend to dry and irritate your mouth tissues. Moisten food with gravies and sauces to make eating easier. If these measures are not enough, ask your dentist, radiation oncologist, or nurse about products that either replace or stimulate your own saliva. Artificial saliva and medication to increase saliva production are available.

Tips On Eating

You may find that it’s difficult or painful to swallow. Some patients say that they feel as if something is stuck in their throat. Soreness or dryness in your mouth or throat can also make it hard to eat. Some of the following tips may help to make eating more comfortable:

  • Choose foods that taste good to you and are easy to eat.
  • Try changing the consistency of foods by adding fluids and using sauces and gravies to make them softer.
  • Avoid highly spiced foods and textures that are dry and rough, such as crackers.
  • Eat small meals, and eat more frequently than usual.
  • Cut your food into small, bite-sized pieces.
  • Ask your doctor for special liquid medicines to reduce the pain in your throat so that you can eat and swallow more easily.
  • Ask your doctor about liquid food supplements that are easier to swallow than solids. They can help you get enough calories each day to avoid losing weight.
  • If you are being treated for lung cancer, it’s important to keep mucus and other secretions thin and manageable; drinking extra fluids can help.
  • If familiar foods no longer taste good, try new foods and use different methods of food preparation.

What Side Effects Occur To The Head And Neck?

Some people who receive radiation to the head and neck experience redness, irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. Try not to let these symptoms keep you from eating.

Other problems that may occur during treatment to the head and neck are a loss of taste, which may diminish appetite and affect nutrition, and earaches (caused by hardening of ear wax). You may notice some swelling or drooping of the skin under your chin as well as changes in the skin texture. Your jaw may also feel stiff and you may be unable to open your mouth as wide as before treatment. Jaw exercises may help ease this problem. Report all side effects to your doctor or nurse and ask what you should do about them.

If you are receiving radiation therapy to the head or neck, you need to take especially good care of your teeth, gums, mouth, and throat. Side effects from treatment to these areas commonly involve the mouth, which may be sore and dry. Here are a few tips that may help you manage mouth problems:

  • Avoid spices and coarse foods such as raw vegetables, dry crackers, and nuts.
  • Remember that acidic foods and liquids can cause mouth and throat irritation.
  • Don’t smoke, chew tobacco, or drink alcohol.
  • Stay away from sugary snacks because they can promote tooth decay.
  • Clean your mouth and teeth often, using the method your dentist or doctor recommends.
  • Use only alcohol-free mouthwash; many commercial mouthwashes contain alcohol, which has a drying effect on mouth tissues.

© Copyright FamilyCare America, Inc. All Rights Reserved.

Reprinted from Radiation Therapy and You: A Guide to Self Help During Cancer Treatment, developed by the United States National Institutes of Health National Cancer Institute, September 1999.

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