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HEAD AND NECK CANCER POST-TREATMENT NUTRITIONAL GUIDELINES

Cancer treatment may cause a number of different eating problems for patients.  Those problems may include:

Appetite Loss

  • When it is difficult to eat, drink a liquid or powdered meal replacement (such as carnation instant breakfast).
  • Eat 5-6 small meals throughout the day instead of 3 larger meals. 
  • Keep snacks nearby when you feel like eating.  Easy to carry snacks include peanut butter and crackers, nuts, dried fruit or granola bars.
  • Add extra protein and calories to your diet.
  • Drink liquids throughout the day-even when you do not want to eat.  Choose liquids that add calories and other nutrients such as soup, juice and milk.
  • Eat soft, cool or frozen foods.  These include yogurt, milkshakes and popsicles.
  • Sip only small amounts of liquids with meals.  Many people feel too full if they eat and drink at the same time.

Changes in Sense of Taste or Smell

  • Choose foods that look and smell good. 
  • Marinate foods.  This can improve the flavor of meat, chicken or fish.
  • Try tart foods and drinks.  This includes oranges and lemonade.  But do not eat tart foods if you have a sore mouth or throat.
  • Make foods sweeter.  If foods have a salty, bitter, or acid taste, adding sugar or sweetener to make them sweeter may help.
  • Add extra flavor to your foods.  Add herbs or spices to vegetable and meat.  Use barbeque sauce on meat or chicken.
  • Avoid foods and drinks with smells that bother you.
  • Keep your mouth clean by brushing and flossing or rinsing your mouth with water or tea before eating.  This will clear your taste buds before you eat.

Dry Mouth

  • Sip water throughout the day.  Carry a water bottle with you.  Aim for 8-12 cups of non-caffeinated liquids each day.
  • Have very sweet or tart foods and drinks, such as lemonade.  This will help with saliva production.
  • Chew gum or suck on hard candy, popsicles and ice chips.  These help with saliva production also.
  • Eat soft, moist foods that are cool or room temperature.  Try pureed cooked foods or soups.
  • Do not drink alcoholic beverages.  These make you mouth even drier.

Sore Throat and Trouble Swallowing

  • Eat 5-6 small meals throughout the day instead of 3 larger meals. 
  • Eat foods that are easy to swallow. 
  • Choose foods and drinks that are high in protein and calories.
  • Cook foods until they are soft and tender.
  • Cut food into small pieces or puree them in the blender.
  • Moisten food with sauce, gravy, or salad dressing.  This helps make food easier to swallow.
  • Sip drinks through a straw.  This may make them easier to swallow.
  • Do not eat or drink things that can burn or scrape your throat.  These include hot foods and drinks, spicy foods, foods and juices that are high in acid (such as tomatoes, oranges and lemonade), sharp, crunchy foods (such as chips) and drinks that contain alcohol.

Sore Mouth

  • Choose foods that are easy to chew.  Choose soft foods such as milkshakes, scrambled eggs and custards.
  • Cook foods until they are soft and tender.
  • Cut food into small pieces or puree them in the blender.
  • Drink with a straw.  This can help push the drinks beyond the painful part of your mouth.
  • Take small bites, which are easier to chew.
  • Eat cold or room temperature foods.  Your mouth may hurt more if food is too hot.
  • Suck on ice chips.  This may help numb and soothe your mouth.
  • Avoid certain foods and drinks when your mouth is sore.  These include citrus fruits and juices, spicy foods, tomatoes, ketchup, salty food, raw vegetables, sharp, crunchy foods (such as granola, crackers and chips) and drinks that contain alcohol.

Nausea and Vomiting

  • Eat 5-6 small meals throughout the day instead of 3 larger meals.
  • Eat dry foods upon awakening and throughout the day such as cracker, dry toast or breadsticks.
  • Avoid foods with a strong odor.  Bland foods and foods served cool or at room temperature may be easier to eat than hot and spicy foods.
  • Foods that are very sweet, fatty, greasy or spicy can aggravate nausea.
  • Sip fruit juices or sports drinks throughout the day.  This will help you get enough calories, nutrients and fluids.
  • Hard candies, such as lemon drops and peppermints can help to relieve nausea and get rid of the bad taste in your mouth.
  • If you are vomiting, be sure to drink plenty of clear liquids to prevent dehydration.

Weight Loss

  • Eat when it is time to eat rather than waiting to eat until you feel hungry.
  • Eat 5-6 small meals throughout the day instead of 3 larger meals. 
  • Eat foods that are high in protein and calories.  Good sources of protein include meat, fish, poultry, fish, eggs, diary products and peanut butter.
  • Drink milkshakes, smoothies, supplement drinks, juices, or soups if you do not feel like eating solid foods.  The can help to provide the protein, vitamins and calories your body needs.

Foods and Drinks that are Easy to Chew and Swallow

Types

Liquids

Main meals and other foods

  • Baby food
  • Casseroles
  • Chicken salad
  • Cooked refined cereals (such as Cream of Wheat®, Cream of   Rice®, instant oatmeal, and grits)
  • Cottage cheese
  • Eggs (soft boiled or scrambled)
  • Egg salad
  • Macaroni and cheese
  • Mashed potatoes
  • Peanut butter, creamy
  • Pureed cooked foods
  • Soups
  • Stews
  • Tuna salad
  • Custard

Desserts and Snacks

  • Flan
  • Fruit (pureed or baby food)
  • Gelatin
  • Ice cream
  • Milkshakes
  • Puddings
  • Sherbet
  • Smoothies
  • Soft fruits (such as bananas or applesauce)
  • Sorbet
  • Yogurt (plain or vanilla)

Meal replacements and supplements

  • Instant breakfast drinks (such as Carnation® Instant      Breakfast®)
  • Liquid meal replacements (such as Ensure®)
  • Clear nutrition supplements (such as Resource® Breeze, Carnation® Instant Breakfast® juice, and Enlive!®)

Ways to Add Protein to Your Diet

Types

Liquids

Hard or semisoft cheese

  • Melt on:
    • Sandwiches
    • Bread
    • Muffins
    • Tortillas
    • Hamburgers
    • Hot dogs
    • Meats and fish
    • Vegetables
    • Eggs
    • Desserts
    • Stewed fruit
    • Pies
  • Grate and add to:
    • Soups
    • Sauces
    • Casseroles
    • Vegetable dishes
    • Mashed potatoes
    • Rice
    • Noodles
    • Meatloaf

Cottage cheese/ricotta cheese

  • Mix with or use to stuff fruits and vegetables

Add to:

  • Casseroles
  • Spaghetti
  • Noodles
  • Egg dishes (such as omelets, scrambled eggs, and soufflés)

Milk

  • Use milk instead of water in drinks and in cooking
  • Use in hot cereal, soups, cocoa, and pudding

Nonfat instant dry milk

  • Add to milk and milk drinks (such as pasteurized eggnog and milkshakes)

Use in:

  • Casseroles
  • Meatloaf
  • Breads
  • Muffins
  • Sauces
  • Cream soups
  • Mashed potatoes
  • Macaroni and cheese
  • Pudding
  • Custard
  • Other milk-based desserts

Meal replacements, supplements,
and protein powder

  • Use "instant breakfast powder" in milk drinks and desserts
  • Mix with ice cream, milk, and fruit flavoring for a high-protein milkshake

Ice cream, yogurt, and frozen yogurt

  • Add to:
    • Carbonated drinks
    • Milk drinks (such as milkshakes)
    • Cereal
    • Fruit
    • Gelatin
    • Pies
  • Mix with soft or cooked fruits
  • Make a sandwich of ice cream or frozen yogurt between cake slices, cookies, or graham crackers
  • Mix with breakfast drinks and fruit, such as bananas

Eggs

  • Add chopped hard-boiled eggs to salads, salad dressings, vegetables, casseroles, and creamed meats
  • Make a rich custard with eggs, milk, and sugar
  • Add extra hard-boiled yolks to deviled egg filling and sandwich spread
  • Beat eggs into mashed potatoes, pureed vegetables, and sauces. (Make sure to keep cooking these dishes after adding the eggs because raw eggs may contain harmful bacteria.)
  • Add extra eggs or egg whites to:
    • Custard
    • Puddings
    • Quiches
    • Scrambled eggs
    • Omelets
    • Pancake or French toast batter

Nuts, seeds, and wheat germ

  • Add to:
    • Casseroles
    • Breads
    • Muffins
    • Pancakes
    • Cookies
    • Waffles
  • Sprinkle to:
    • Fruit
    • Cereal
    • Ice cream
    • Yogurt
    • Vegetables
    • Salads
    • Toast
  • Use in place of breadcrumbs in recipes
  • Blend with parsley, spinach, or herbs and cream to make a sauce for noodle, pasta, or vegetable dishes
  • Roll bananas in chopped nuts

Peanut butter and other nut butters

  • Spread on:
    • Sandwiches
    • Toast
    • Muffins
    • Crackers
    • Waffles
    • Pancakes
    • Fruit slices
  • Use as a dip for raw vegetables
  • Blend with milk and other drinks
  • Swirl through soft ice cream and yogurt

Meat, poultry, and fish

  • Add chopped, cooked meat or fish to:
    • Vegetables
    • Salads
    • Casseroles
    • Soups
    • Sauces
    • Biscuit dough
    • Omelets
    • Soufflés
    • Quiches
    • Sandwich fillings
    • Chicken and turkey stuffings
  • Wrap in pie crust or biscuit dough as turnovers
  • Add to stuffed baked potatoes

Beans, legumes, and tofu

  • Add to casseroles, pasta, soup, salad, and grain dishes
  • Mash cooked beans with cheese and milk

Ways to Add Calories to Your Diet

Type

Liquids

Milk Products

  • Use whole milk instead of low-fat
  • Put on hot or cold cereal
  • Pour on chicken and fish while baking
  • Mix in hamburgers, meatloaf, and croquettes
  • Make hot chocolate with milk
  • Add whipping cream to desserts, pancakes, waffles, fruit, and hot chocolate
  • Add sour cream to baked potatoes and vegetables.

Cheese

  • Melt on top of casseroles, potatoes, and vegetables
  • Add to omelets
  • Add to sandwiches

Granola

  • Use in cookie, muffin, and bread batters
  • Sprinkle on:
    • Vegetables
    • Yogurt
    • Ice cream
    • Pudding
    • Custard
    • Fruit
  • Layer with fruits and bake
  • Mix with dried fruits and nuts for a snack
  • Use in pudding recipes instead of bread or rice

Dried fruits (raisins, prunes, apricots, dates, figs)

  • Plump them in warm water, and eat for breakfast, dessert, or snack
  • Add to:
    • Muffins
    • Cookies
    • Breads
    • Cakes
    • Rice and grain dishes
    • Cereals
    • Puddings
    • Stuffings
    • Cooked vegetables (such as carrots, sweet potatoes, yams, and acorn or butternut squash)
  • Bake in pies and turnovers
  • Combine with nuts or granola for snacks

Eggs

  • Add chopped hard-boiled eggs to salads, salad dressings, vegetables, casseroles, and creamed meats
  • Make a rich custard with eggs, milk, and sugar
  • Add extra hard-boiled yolks to deviled egg filling and sandwich spread
  • Beat eggs into mashed potatoes, pureed vegetables, and sauces. (Make sure to keep cooking these dishes after adding the eggs because raw eggs may contain harmful bacteria.)
  • Add extra eggs or egg whites to:
    • Custards
    • Puddings
    • Quiches
    • Scrambled eggs
    • Omelets
    • Pancake or French toast batter

Fats

  • Fry foods in oil, butter or margarine
  • Add butter, margarine or oil to bread, potatoes, vegetables and soups
  • Use mayonnaise, salad dressings and peanut butter freely

Misc.

  • Choose higher calorie beverages like juice and whole milk and drink no calorie beverages like water, tea and coffee less often.
  • Choose fruits canned in syrup instead of water or juice.
  • Choose higher fat meats and cheeses.  These have more calories than lean meats and lowfat cheeses.
  • Add jelly and honey to breads and crackers

References:

  • National Cancer Institute.  "Eating Hints: Before, During and After Cancer Treatment”.  Available at: http://www.cancer.gov/cancertopics/eatinghints/page4.  Accessed December 2009.
  • American Dietetic Association.  “Oncology: Managing nausea and vomiting”.  Nutrition Care Manual 2009.
 
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