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In this section we are going to look at the importance of nutrition and eating well when suffering from cancer of the head and neck. A healthy diet is a balanced diet.
A balanced diet is a diet that provides the correct nutrients at the right time. In health we need:
- Carbohydrates: bread, potato, rice, pasta are filler foods and together with sugars are required to provide energy for our muscles and for our brain..
- Protein: fish, other sea food, meat, poultry, dairy and vegetable protein from pea’s beans and pulses. These provide amino acids the building blocks for skin, muscle, hair, nails hormones and many other biological,neurological and healing processes.
- Fats and oils: These often get bad press but we need a good compliment of all kinds of fats and oils in our diet. We need them for our immune system, brain and many other organs. Some are better for us than others. A balanced diet requires small amounts of saturated and unsaturated fats and oils. All meats will contain saturated fat, trim off any visible fats and grill or bake. Some oils come from vegetable sources. Oil from fish is good for the heart and it’s recommended that we eat oily fish once or twice per week.
- Fruits and Vegetables: These provide us with fibre, vitamins, minerals, antioxidants and fluids. Most fruits and vegetables are fairly low in calories that’s why people otherwise in good health who need to lose weight are often asked to increase their fruit and vegetable intake, and decrease their fat and carbohydrate intake.
- Dairy: milk, cheese, eggs, butter, yoghurt. A mixture of fat protein and carbohydrates. Often high in calories and saturated fats, but also available with reduced saturated fat and sugar content
- Fluids: foods contain a surprising amount of fluid but we also need to drink through the day, water, tea, coffee, juices etc. Our requirements change from day to day depending on our environment and degree of activity. If you feel thirsty you are already dehydrated!
All of the above constitute the makings of a balanced diet when taken at the right time, in the right amounts, at the right frequency.Even the most balanced diets can result in weight gain if eaten in excess, or weight loss, if sparsely consumed.
EATING WELL WHEN UNWELL
When we are ill, our nutritional requirements change, and focus on food can become tiresome. Frustratingly, just when we need to increase certain nutrients our appetite disappears. .
It may be helpful then, to understand that quality is more important than volume and for some enteral feeding may be required. Enteral feeding simply by- passes the need to chew and swallow. It may be via a naso -gastric tube (NG) tube passed into the stomach through the nose. Or if enteral feeding is required for a longer period of time a PEG tube may be placed directly into the stomach via the stomach wall to allow delivery of optimal nutrition when you are unable to chew or swallow effectively. We will look at this in more detail later .
Many people diagnosed with cancer will experience a reduction in their interest and desire for food. This can be for many reasons, physical, psychological and functional. Patients diagnosed with cancer of the throat mouth or neck present with many different challenges.
Here we have also to acknowledge ‘The Elephant in the Room’. Just when you need to improve your diet, or increase your intake you are unable to, due to one, or many of the physical and psychological aspects of your illness,- obstruction, dry mouth, lesions weakness anxiety or depression.
Your Dietitian if you have one,will take into consideration your likes, dislikes, existing conditions, nutritional requirements and any physical barriers that exist and will create an eating plan that will be achievable, practical, of the correct consistency and as nutritionally complete as your condition allows.. Not all hospitals will have access to a dietitian. Speak to your Consultant and ask for a referral to a Dietitian if a specialist Dietitian is not a member of your medical team..
Because Head neck and throat cancers are so diverse and the areas affected may impact strongly on ability to eat, swallow taste smell and communicate it is not possible to consider every aspect of any individuals experience but we hope we can be of some general assistance and help boost your ability to choose wisely for your own situation.
It is possible the medical team treating a head and neck cancer patient will recommend a PEG feeding tube – PEG stands for Percutaneous endoscopic gastrostomy. Percutaneous means through the skin, endoscopic means a tube and gastrostomy means an opening into the stomach. So a PEG basically is tube inserted through the skin and into the stomach,
This is to enable delivery of optimal fluids and nutrients to your body at a time when oral intake would be too painful or inadequate. Patients are individuals, there is no ‘ One size fits all’ approach. Your medical team will assess and advise you as to the best way forward for your recovery.
It is advisable to ask lots of questions so patients and their carers can understand why a treatment is being recommended. If you cannot think what to ask or want to be sure you have covered everything have a look at our questions to ask your doctor section.
HINTS AND TIPS FOR EATING WELL
There is no specific diet for cancer patients. What is recommended is that any diet taken is nutritious, calorie and protein dense and one which provides a vast array of vitamins, minerals and antioxidants.Of course your appetite and ability to consume some foods may be altered and this is the challenge.We have put together some hints and tips for a good nutritious diet. Each patient is an individual though and should listen to their own medical team and specifically their dietitian/nutritionist for personalised advice.
- Start a nutrition diary where you can keep a note of what food and calories you have taken each day and you can also use as a place to express thought and feelings as you go through treatment. This can be useful for some people to not only express their feelings but also to chart their progress as they go through treatment. It can feel like slow progress sometimes and having a reminder of how far you have progressed can be helpful.
- Remember that ‘healthy eating’ can be construed wrongly. Labels of ‘healthy’ may actually mean ‘restricted’ if for example the information is sourced from a reduction diet regime or other dietary regime not specific to your situation.Some ‘healthy’ diets will be poor in essential fatty acids and protein because they are designed for weight reduction.
- Include plenty of oily fish, lean protein such as chicken, turkey, pork, beef and dairy products such as milk, cheese, cream, yoghurt.
- Forget low fat or reduced fat products you need these fatty acids to work together with other vitamins and minerals and to help maintain your weight.
- Make your drinks count. Using juicers to make antioxidant, vitamin and mineral packed fruit and vegetable drinks and smoothies. Add milk or yoghurt or ice cream to these and you increase the calorie content.
- Make creamy soups rich in vegetables and taste. Using a blender to whizz to a smooth consistency can make them easier to swallow. Some soups, for example chicken and sweetcorn, can have extra nutritional value by adding an egg to them.
- Use a slow cooker or crock pot for casseroles rich in protein from soft, long cooked beef, lamb, or chicken with vegetables that simply melt in your mouth.
- If your mouth or throat is sensitive avoid highly acidic fruits in your drinks or smoothies.
- If your mouth feels ‘claggy’ and you cannot clear thickened saliva make sure you are well hydrated and try fresh pineapple. The enzymes in fresh pineapple (which is called bromelain) will break down the proteins in your saliva and help clear your mouth. Tinned pineapple will not do this as the enzymes are lost in the canning process. WARNING! This can really sting, so if your mouth is acutely ulcerated you may not be able to do this.
- Avoid tough or stringy foods as they can be hard to swallow.
- If nausea is a problem try some dry foods like unsalted crackers, toast or dry cereal.
- Remember every calorie counts and you should follow a diet that prior to treatment is dairy rich, protein rich and is full of fruits and vegetables to accompany and supplement. Eat more frequently, drink adequately and aim to increase your weight if you can before you embark on your treatment.
- Remember sweets and chocolates, crisps and biscuits, cakes and pastries are all on the menu for you prior to treatment. Enjoy these in moderation, they should be an extra addition to your diet, not a replacement for more nutritious foods.
- Immediately prior to radiotherapy you are recommended to have had small frequent nutrient dense meals. Stop eating at least one hour before therapy.
- If you have to travel to hospital, prepare food to eat on the way. Plan a stop on the journey and keep well hydrated. Don’t assume you will be able to get a snack at the hospital. They may have a poor choice available or no choice at all. Plan ahead.
- Be extra careful with hygiene. You may be more vulnerable to viruses or food borne bacterial infections. Keep in mind things like food temperature, how food you are eating is being stored and who has been handling the food.Be aware of hygiene when eating out too: buffet type meals could be a risk if you are having radiation therapy or chemotherapy (you don’t know who made the food, how long it has been at room temp, has it been reheated)
As with everything each individual is different. We have provided these hints and tips as a general guideline but we would urge any patient to consult with a dietitian as soon as they can during their treatment journey. A personalised consultation will ensure that individual requirements can be explored and catered too. If a nutritionist/dietitian is not part of your care plan we would urge you to ask for a referral to ensure individual needs are being met.
In order to ensure that patients are getting the right amount of calories and nutrition dietary supplements are often used to ensure that patients can get nutrition in an easy to swallow form. There are lots of different ways to supplement meals and drinks to give them more calories and nutrients. A dietitian will be able to help by ensuring that a throat cancer patient is getting the right, nutritionally complete supplements.
Here are some examples of supplements which a head and neck cancer patient might encounter. We have listed some brands but this does not imply endorsement – we are providing them as examples of what is available and links to their websites which have serving suggestions and further information.
There are quite a few different supplements available. There are lots of different brand names and the supplements given to a patient will vary from hospital to hospital – depending on who the hospital has a contract with. A dietitian will be able to assess a patient’s individual needs and ensure that the right supplements are being used.
There are many high energy drinks available in the supermarket, such as milkshakes and smoothies. Some drinks are fortified with vitamins and minerals and can be a quick and easy to get a lot of nourishment when the throat is too sore to eat solid foods.
• Build Up is available in sweet and savoury flavours. The sweet flavoured drinks are mixed with milk. You can add ice cream to make a thick milk shake. Build Up soup is easy to make by just adding boiling water.
• Complan is available in sweet and savoury flavours and is mixed with milk or water.
• Nutrament is available in sweet flavours from most large supermarkets.
Drinks with a milk like consistency .These are like milkshakes and are available in a wide variety of flavours. There are also some savoury choices.
- Ensure Plus milkshake style Ensure TwoCal Resource Energy
- Enshake Calshake Scandishake
- Fortisip Ensure Plus Fibre
- Fresubin 2kcal drink Fortisip Compact
- Fresubin protein energy drink
Juice/squash flavoured drinks. These are non-milky and have a similar taste to squashes and cordials. They are also available in a wide variety of flavours.
- Ensure Plus Juce Fortijuce Resource Fruit
- Providextra drink
Yoghurt flavoured drinks. This is a yoghurt-based drink available in fruit flavours. It has a similar taste to drinking yoghurt.
- Fortisip Yogurt Style Ensure Plus yoghurt style
Energy supplements are available as powders and liquids. Ask your dietitian for advice on how much to use each day. They can be added to both food and drinks. Glucose polymer powders are highly soluble, tasteless powders that dissolve easily in liquids and most soft food.
- Maxijul supersoluble powder Vitajoule
- Polycal powder Caloreen
There are Glucose drinks which you can get in orange or neutral flavours.
- Polycal Maxijul Liquid – is an example of glucose liquid.
As you can see there are lots of products available which can help a patient get the right amount of nutrition when going through treatment for cancer. We have provided this for information only, for an individual nutrition plan please speak to your dietitian/nutritionist.
If there is not a dietitian as part of your care programme please remember that you can ask to be referred to a dietitian.
It is one of those facts of life that as we get older, we often pay less attention to following a healthy dietary regime. For some, that means a tendency to indulge in unhealthy snacks such as crisps and chocolate at the expense of proper meals. Others find that they go in the opposite direction, losing interest in food and skipping meals entirely.
Of course, the irony is that the later years are exactly when we should be paying more attention to what we eat, not less – and this is doubly the case for those who are battling with throat cancer or indeed any serious illness.
If you think following a better diet means living on boring, tasteless food and saying goodbye to all your favourites, think again. By following these simple tips, you can get back to enjoying mealtimes, and do your body a favour at the same time.
There is lots of help available though and we have compiled a list of useful resources which will guide you through the support that is available to patients and their families.