Why have I been referred to the dietitian?

The oncology dietitian is part of the Head and Neck Team. They will support you during your treatment and will be able to advise you how best to meet your nutritional needs.

Radiotherapy will have significant side effects which will affect your ability to eat, drink and swallow. If you have had surgery, you may already have problems with eating and drinking. It is important that you maintain your weight during treatment – even a small amount of weight loss can be significant as it can affect how well your mask fits and the accuracy of the target area for treatment.

If you do lose weight, your mask may not fit properly which may lead to a delay in your treatment while a new mask is made and the treatment is re-planned. Treatment may be postponed if you become dehydrated and need to be admitted to hospital.

Of course, it is also important for you to stay well-nourished and hydrated as this will help you to:

• maintain your strength and energy levels to help you cope with your treatment
• maintain your quality of life
• avoid infections
• heal quickly after treatment.

How will radiotherapy affect my ability to eat and drink?

The side effects of treatment will vary between individuals and can depending on whether your treatment is to the mouth only or mouth and neck. Generally, you will experience increased dryness, altered taste, pain, thickened secretions, poor appetite and tiredness.

These side-effects will gradually build up as the treatment progresses and will continue after the treatment has finished. Any of these side effects can affect your eating, causing you to lose weight.

What else can I expect?

The oncology dietitian has pre-assessed you, given you advice and answered any questions you may have had about your treatment. Your weight and height will have been recorded and you should aim to maintain your weight from now on.

You should contact the oncology dietitian if you are losing weight before you start your treatment.

During treatment they will assess you at least once a week to check your weight, intake and symptoms; and if necessary will suggest changes to your diet. As treatment progresses, the type of food and the amount you can eat will change. Most people are only able to manage fluids at the end of their treatment. You will be offered supplement drinks as you need them. You may need a feeding tube placed before you start your treatment.

Is there anything else I need to do?

• Be wary of hot foods and fluids.
• Cool drinks and foods help to soothe your throat.
• It is best to avoid alcohol as it may make the pain and dryness worse.
• If you smoke, it is advisable to stop as it will make your symptoms worse.
• If you are taking medications, talk to your doctor about having them changed to soluble forms.
• You will need to drink plenty of fluids. Milk may be easier to drink than water.
• Choose soft foods with plenty of sauce or gravy and have a drink to wash the food down.
• You may want to blend or puree your food but don’t feel that you have to.
• If your pain is under control, it is more likely that you will be able to keep eating and drinking.
• Don’t wait for your weekly review, ask to see us if you have a problem.

What happens when I finish treatment?

Once you have finished treatment the side effects can continue for up to two weeks. You should then start to feel as if you are recovering. It may take several months before you are eating a more normal diet, although this varies from person-to-person.

If you have a feeding tube, the oncology dietitian will refer you to the Home Enteral Nutrition (HEN) Service, who will continue to support you at home. The HEN Service is a specialist team of dietitians, dietetic assistants, nurses and clerical staff who support patients in the community with feeding tubes.

As you begin to eat and drink more you will become less dependent on the feeding tube. The HEN Service will guide you through this period. When you are able to eat enough they will ask the Head and Neck Team to consider removing the feeding tube. If you have further treatment planned the team may recommend that you keep the feeding tube even if you are not using it. Your feeding tube can be removed at home.

You will continue to be reviewed by the oncology dietitian in the Head and Neck Clinic. If you are having difficulties you will be offered a longer appointment with the oncology dietitian in the Support and Rehabilitation Clinic. If you prefer, we can refer you to a community dietitian who can see you closer to home.