Now that you are about to start a course of chemoradiation you should be aware that this may have an effect on your appetite, taste, ability to swallow and energy levels. During your chemoradiation you may also be travelling considerable distances on a daily basis. This can contribute to tiredness and you may feel too tired to eat or less inclined to prepare meals. All these factors can lead to weight loss.

Unfortunately, if you do lose weight rapidly or become dehydrated your treatment may be delayed, or even stopped altogether and you may have to be admitted to hospital.

What can you do to help?

It is important to try to stay healthy, well-nourished and hydrated. This will help you:

• avoid infections
• maintain your strength and energy levels
• maintain your quality of life
• complete your treatment without delays
• heal quickly.

By eating a diet high in protein and energy in the weeks before, during, and immediately after your treatment, you can help to prevent these problems.

Your dietitian will discuss your diet with you at the start of your treatment. If necessary, they will make suggestions as to how you can improve your intake and cope with side effects. It may also be necessary to modify the texture of your food during the treatment to help you swallow more easily.

The dietitian will assess you each week during your treatment. The length of this appointment will vary. They will discuss your diet and symptoms with you, measure your weight and will make suggestions as to how you can adapt your intake.

What symptoms to expect?

Tiredness

Chemotherapy and radiotherapy can both make you feel tired and this can last for a number of weeks after your treatment has finished. You may not feel like eating or preparing meals during this period.

Nausea and vomiting

Chemotherapy can make you feel nauseous. You will be prescribed anti-sickness drugs to help you cope with this symptom.

Chest pain and swallowing problems

The lining of the oesophagus can become irritated if it is in the radiotherapy treatment field. After two to three weeks you may experience discomfort or pain when swallowing. You will be prescribed medication to help you cope with this symptom. It may be uncomfortable to drink very hot or very cold drinks. The dietitian will advise you on how to alter your diet and will give you a copy of ‘Managing your swallowing difficulties’.

Cough

You may develop a dry cough or produce lots of mucus during or after your treatment. This could have an effect on your appetite. You need to inform your oncologist so they can advise you on appropriate treatment.

Breathlessness

Radiotherapy can cause you to feel breathless, which may impact on your eating. If you experience this your dietitian can give you advice to minimise the effect this may have on your nutritional status.

Taste changes

The chemotherapy can alter your taste and hence the ability to enjoy your food. Advice on this can be found in the Macmillan booklet ‘Eating problems and cancer’. This booklet is available from your dietitian or www.macmillan.org.uk

These side effects can get worse for up to two weeks post treatment and then will gradually settle over the next six to eight weeks after finishing treatment, but this can vary from person to person.

Is there anything else you can do?

• Be aware of hot foods and fluids. Your mouth will be able to cope but you will find them too painful once you have swallowed. Cool drinks and foods are soothing.
• Take small mouthfuls of food and chew very thoroughly before swallowing. Eating little and often may be helpful.
• Having a drink at hand to help wash food down is helpful.
• If you smoke, it is advisable to stop as smoking will make your symptoms worse.
• If you are taking medications, talk to your doctor about having them changed to soluble forms.
• Let us know if you are developing symptoms as we can ask the nurse/doctor to review you. If you are not in pain, it is more likely that you will be able to keep eating and drinking normally.
• Don’t wait for your weekly review to tell us about a problem. We are happy to see you when you need to be seen.