Dietitians

What is the role of the Dietitian in my care?

Head and neck cancer treatment causes a variety of side effects, some of which are likely to impact your ability to manage a ‘normal’ diet. You may experience difficulties eating and drinking even before treatment starts due to the location of the disease, for example swallowing problems or pain on eating. A dietitian will be able to advise you on your diet at each stage of the treatment journey, helping to ensure your diet remains as balanced as possible.

Why does nutrition matter?

Difficulties eating and drinking can result in weight loss and nutritional deficiencies. There is good evidence that weight loss before, during and after treatment can result in poorer outcomes. Staying well-nourished will:

• Make you feel stronger and help you cope with treatment

• Reduce the risk of unplanned hospital admissions

• Reduce the risk of developing infections and other complications

• Help you recover and heal after finishing treatment

How will treatment affect my eating?

The type of problems you experience with eating and drinking will vary depending on the type and duration of your treatment. The team caring for you will advise you on these problems and side effects of planned treatment. These may include:

Difficulty chewing

Difficulty swallowing

Pain related to eating and drinking

Taste changes

Mouth dryness

Nausea and/or vomiting

How will my diet change during treatment?

There are a variety of medications and therapeutic interventions which will reduce the impact of treatment on eating and drinking. It is important that medication and therapy regimens are closely followed in order to achieve the best possible symptom management.

A dietitian can advise you on the most appropriate dietary interventions for you throughout your treatment. These include:

· Food fortification: adding extra calories and protein into food and drinks to help prevent weight loss.

· Changes to meal patterns e.g. small and frequent meals if your appetite is poor.

· Texture modification: altering the consistency of foods so that they are easier to swallow e.g. soft, puree or liquid diets.

· Oral nutritional supplements: milk or juice based drinks available on prescription and used to supplement food intake.

· Tube feeding: if you are unable to eat and drink enough, your dietitian may recommend tube feeding.

Will I need tube feeding?

Your dietitian or medical team will be able to advise you on whether tube feeding is expected to be required during your treatment. A tube may be required for a short period, for example whilst your tissue heals after surgery, or for a number of weeks or months, for example if treatment side effects have affected swallowing. The most commonly used feeding tubes are:

· Nasogastric tube (NGT): a thin tube passed up the nostril, down the throat and into the stomach

· Gastrostomy tubes (PEG, RIG): tubes sited directly through the abdominal wall into the stomach

In some cases feeding tubes will be placed prior to treatment starting in anticipation of swallowing difficulties. Although feeding tubes are relatively common place, not everyone undergoing treatment for head and neck cancer will require a tube. Speak to your medical team for further advice.

Further support

If you have any concerns or questions about your diet, speak to your doctor about referring you to a specialist head and neck cancer dietitian.

The Macmillan cancer support website offers a range of reliable information resources. Further information on eating problems and cancer treatment can be found on the Macmillan website:

Macmillan also host an active online community which includes a forum, member blogs, and ‘ask a dietitian’ feature.

Cancer Research UK produce information on living with cancer, including eating problems:
https://www.cancerresearchuk.org/about-cancer/mouth-cancer/living-with/eating

For more information on tube feeding, see the PINNT website:

Patient experience

“The dietitian was interested in my situation and my food preferences. She gave me a wonderful range of options which were realistic for my life situation (living with a cancer in my tongue). She was concerned and helpful in practical ways. This consultation has been really helpful”

"Practical ways of managing diet, broken down into small manageable steps. Positive approach with just the right amount of information."