One of our first social experiences as a human being begins with food. Eating is a part of our culture, engrained in our social constructs, our traditions, and eventually becomes tied into our personal identity. It can provide us with a sense of comfort and a feeling of home. For many cancer survivors, treatment can temporarily disrupt the homeostasis of one of our most basic needs by affecting our enjoyment of food.
Some of my prior posts have focused on tips and guidelines for managing other side effects such as nausea and vomiting and taste changes. Fortunately there is a large role for nutrition to play in also managing many other side effects from cancer treatments until they begin to resolve on their own. Today’s focus will be on symptom management for mouth sores or sore throat, as this can play a large role in cancer survivors not being able to meet basic nutrition needs. As discussed in prior posts, maintaining good nutrition during cancer treatment is key to tolerating treatments better, having less treatment delays, and preserving energy and lean body mass…not to mention better enjoyment of food.
Your mouth and throat can become inflamed as a result of inflammation of the mucous membranes that line your mouth and your throat. This can be caused by treatments that affect the rapidly diving cells in the mouth and esophagus, which cause a condition called mucositis. This can make it difficult to eat and swallow. Irritation to the mouth or throat can put you at risk for dehydration, weight loss, and poor eating or malnutrition due to pain. This is most common in people with head and neck cancer that undergo radiation or chemo or those with conditions like diabetes or AIDS, and those that are younger or older adults can also be more at risk (or these conditions can make mouth sores worse). You are also more likely to experience mouth sores with combined chemo and radiation, radiation to the head and neck, stem cell transplants, high dose chemotherapies, or those who receive some of the following chemo’s: Capecitabine (Xeloda), Cisplatin (Platinol), Cytarabine (Depocyt), Doxorubicin (Doxil or Adriamycin), Etoposide (Etopophos), Docetaxel (Taxotere), Fluorouracil (5-FU), Epirubicin (Ellence), Methotrexate (Trexall), Paclitaxel (Taxol), Pemetrexed (Alimta), among others. Speak with your healthcare professionals about your risk for this or other common side effects in order to be better prepared for nutrition or medical interventions if needed.
What can you do if you have an irritated throat, irritated mouth, or mouth sores?
1. Choose foods that require little to no chewing, such as bland, soft, and most foods with extra sauces, dressings, or gravies to help with swallowing and maximize calorie intake. Try cottage cheese, applesauce, custards, puddings, yogurts, jello, casseroles, mac’n’cheese, soft cooked eggs, cream soups, noodles, pasta with cream sauce (no tomato sauce), mashed potatoes, grits, oatmeal, smoothies, or nutrition supplement drinks like Ensure, Boost, Orgain, Equate, or Carnation Instant Breakfast, etc…
2. Avoid abrasive, hard, tart, and spicy foods as these can irritate the mouth or throat. Also avoid raw veggies, raw fruits, chips, pretzels, nuts, seeds, crackers, or anything else that can scrape the mouth. Additionally, don’t eat citrus, tomatoes, vinegar, drink alcohol, smoke or chew tobacco, or drink carbonated beverages.
3. Experiment with temperatures of foods—warm, cool, or icy—to find out which temperature is most soothing for you. Avoid hot foods. Try chilled foods such as popsicles, frozen yogurt, sherbet, ice cream, or smoothies. Sucking on frozen foods at the start of a meal may help with temporarily numbing the mouth to help you eat better. Suck on ice or frozen fruit (unless you are receiving a chemotherapy that makes you sensitive to cold things like Oxaliplatin).
4. Eat small meals frequently and chew slowly to maximize your nutrition intake. Cut foods into small pieces or grind, mash, blend, or puree foods as needed in a blender to make it easier to eat. You may need to add liquids to get a better consistency. Milk, cream, juice, broth, or nutrition supplements may help to add more calories. Baby food is also an option worth considering if you don’t have the energy to blend or puree food at home.
5. Try some soothing foods to provide relief such as a cucumber soup or smoothie, frozen melon balls, honey or even buttermilk. Yes, I said buttermilk! I’ve had patients swish and swallow it prior to eating, to help coat the mouth, and to allow for temporary relief when eating. It’s worth a try.
6. Speak with healthcare professionals about medicines that can also help with numbing or soothing your mouth or throat. Topical agents like Orajel for example (if the pain is so severe it makes it too hard to eat) or agents like Magic Mouthwash can be used for 15-20 minutes prior to meals.
7. Keep good oral care! Use alcohol free mouthwashes, lessen the time you wear your dentures, floss gently, swish and swallow (rinse) your mouth with 1 to 2 oz of homemade salt with baking soda solution. Sip and swish and then spit the solution to rinse and clean your mouth (do not swallow). Do this gently before and after meals and at bedtime or as instructed by your medical team.
8. Drink plenty of fluids to focus on warm or cool milk based beverages, non-acidic fruit or drinks (diluted if necessary), flat beverages and cream or broth based fluids.
9. Try liquids with a straw to help with bypassing sores or irritation in the mouth or throat.
Mouth sores or throat irritation can be mild to severe and sometimes it doesn’t last very long or can last for a few months after treatment. If you cannot eat ~50% of what you ate prior to treatment and are losing weight (even if it’s just a little bit), you may need a nutrition or medical intervention to help support your nutrition status during treatment. Make sure your healthcare team is updated on any changes or issues you are experiencing. These tips may help you in addition to what your medical team recommends. Try a few things and see what works for you to keep your nutrition status optimal and see if you can meet with a dietitian at your facility or call your insurance company to see if a dietitian is on staff to help you as needed. Hopefully, you’ll be eating regularly again in no time!