Key takeaways
- Depending on a person’s cancer and the type of treatment someone has had, there are a variety of issues with eating and digestion that can arise
- A dietitian specialising in cancer can support someone to find foods and drinks that people can tolerate and enjoy while making sure they’re getting the nutrients they need
- A dietitian and speech and language therapist will often work together to overcome challenges with eating and digestion after cancer treatment
- A speech and language therapist can support someone with their swallow function, and work with them on goals to restore quality of life
Cancer and its treatment can cause changes to a person’s body, which can include issues with eating or digestion. Some cancers grow in places that cause blockages in the digestive system or difficulty swallowing, while surgery to remove them – as well as any reconstruction needed – can also have an impact on these processes. Many people find that chemotherapy affects their appetite, and radiotherapy to certain areas can make eating uncomfortable. These factors and more can have a significant impact on someone’s ability to eat, enjoy and digest food, and use its nutrients, all of which can affect a person’s quality of life. In this article, Registered Dietitian Georgina Giebner and Speech and Language Therapist Samantha Holmes explain how they support people facing these challenges after cancer and cancer treatment.
How a dietitian can support with cancer-related eating and digestive problems
Georgina Giebner, Registered Dietitian, Perci Health
Depending on their cancer and the type of treatment someone has had, there are a variety of issues with eating and digestion that could arise. You or someone you’re caring for might have a small appetite, problems with swallowing, or might not be able to tolerate the consistency of certain foods. As a dietitian, I take a practical approach to these challenges. It’s my job to carry out an assessment and work with a person to meet their needs, as well as other professionals involved in their care – speech and language therapists, for example.
Coping with changes to swallowing and eating
Head and neck cancers, and the surgery, chemotherapy and radiotherapy used to treat them, can cause problems with swallowing. A person may find they choke on liquids, which puts them off wanting to drink. In this situation it might help to have thin liquids or soft, moist foods. Whatever the challenge, a speech and language therapist would recommend a modified texture diet, and as a dietitian I might provide a list of foods that support a person’s symptoms, or techniques to prevent problems like dehydration or constipation.
Head and neck cancer can also affect the salivary glands. Saliva is important for our sense of taste and enjoyment of food. It also starts breaking down food. Someone whose salivary glands have been impacted by cancer treatment can experience a low appetite, and are at risk of mouth infections like thrush. While a speech and language therapist can advise about mouth care and hygiene. My role as a dietitian would be to support a person to find things to eat that don’t require chewing, such as mash, gravy, custard or soups. We can also stimulate more saliva by squeezing lemon or lime onto food, as long as it doesn’t make the mouth sore.
Eating with others or outside in the sunshine can help you to enjoy your food more, and boost your appetite. Introducing more flavour to your food, with herbs, spices and moisture, all helps with taste and enjoyment
Georgina Giebner, Registered Dietitian, Perci Health
If someone is struggling to eat enough, we’ll work out how to enhance the diet they’re already eating and experiment with eating small amounts more often. We’ll also look at lifestyle. Eating with others or outside in the sunshine sounds simple but can help a person to enjoy their food more, and boost appetite. Introducing more flavour to food, with seasoning (as long as salt doesn’t make your mouth sore), herbs, spices and moisture, all helps with taste and enjoyment. I’ll offer recipes and other resources, including videos and leaflets, to support, and work around other factors like allergies. It’s a very bespoke approach.
Coping with changes to digestion
Radiotherapy on the pelvic area, which can be used to treat cancers like prostate, colon, cervical or sarcomas, can affect organs including the stomach, pancreas and bowel. This can result in symptoms similar to those of irritable bowel syndrome. Sometimes it can take years for someone to make the link between their symptoms and cancer treatment they had in the past. If this is happening to you, an important step is to keep a food diary of what you’re eating and your symptoms. This is really useful when you start seeing a dietitian.
There are several other ways that cancer treatment can cause problems with digestion. Someone may have had part of their bowel or stomach removed, which can cause diarrhoea or constipation, affect stomach acid (which is part of digestion) and affect how well nutrients are absorbed. I would assess someone’s symptoms and work with doctors to decide if any tests are needed, for example a blood test for anaemia, and potential medications. Surgery can also cause a narrowing of the bowel, which requires us to adapt fibre intake to avoid constipation or obstruction, in a way that doesn’t reduce the benefits in relation to heart disease or diabetes in later life.
Removal of the pancreas due to pancreatic cancer, can cause something called ‘pancreatic insufficiency’, and symptoms including diarrhoea or constipation. A dietitian can prescribe digestive enzymes to help the body break down food, so it can be more easily digested and absorbed. Radiotherapy to the pelvic area can cause ‘bile acid malabsorption’. When this happens the substance our bodies produce to help us digest fats is impacted and can cause bowel urgency, cramping and wind.
Nutritional deficiencies caused directly or indirectly by cancer treatment are important to address as they can be a risk factor for other conditions in later life, like osteoporosis. There may be a need to supplement the diet with extra vitamins and minerals. Cancer treatment can also alter the gut bacteria and cause intolerances to things like lactose or fructose. Whatever the challenge is, it’s my job to create the right diet to support a person’s symptoms, and help someone eat safely and enjoyably after cancer treatment.
Working with a speech and language therapist to support eating
Samantha Holmes, Speech and Language Therapist, Perci Health
Cancer in the mouth or throat, and its treatment, whether surgery or radiotherapy, affects a person’s eating and drinking. It’s the role of a speech and language therapist to help a person regain as much function as possible to reduce the impact of any swallowing difficulty on their ability to eat and drink.
Swallowing is a complicated set of movements, which can be altered by cancer treatment. When working with swallowing difficulties, safety is a big focus. Every time we swallow, our airway must temporarily close to protect our lungs from food or drink going down the wrong way. When this happens it’s called ‘aspiration’. Sometimes aspiration is obvious, and will result in coughing, but it can also happen silently. Part of the assessment I do is to find out how much the cancer and its treatment has affected a person’s ability to eat and drink safely. If someone is unable to eat and drink by mouth for a period of time, I’ll provide exercises aimed at keeping the muscles of speech and swallowing, such as the jaw muscles, tongue and soft palate moving, to prevent those muscles becoming weak.
If someone can continue eating and drinking by mouth as much as possible during treatment, they’ll have better long-term functional outcomes, so my role is to support this to the best of my ability
Samantha Holmes, Speech and Language Therapist
Research into head and neck cancer tells us that if someone can continue eating and drinking by mouth as much as possible during treatment, they’ll have better long-term functional outcomes, so my role is to support this to the best of my ability. I give advice on moving through a range of textures depending on a person’s ability to chew and swallow, and I’ll advise on making someone’s swallow more efficient or safer. I work closely with dietitians to find foods with the right textures. If someone has had a feeding tube, we work to keep their swallow functioning and help make decisions about when they can start eating and drinking by mouth again. This might be sips of water for weeks, then modified texture foods.
We work with people on goals that are meaningful for them, and the aim is to restore as much function as possible. If someone is having further treatment after surgery, such as radiotherapy, this affects how much rehabilitation can happen before the next treatment starts. There is generally a window of 12–18 months after treatment where someone will see the most progress in their rehabilitation. So we will be working really hard within this timeframe.
Cancer side-effects can have a significant impact on quality of life – not just for the person going through it, but for those caring for them. Our Cancer Nurse Specialists listen, provide guidance and coping strategies, and can point you to resources that can help. They also connect individuals with other Perci professionals, including speech and language therapists and dietitians, who are trained to support recovery and rehabilitation.
While we have ensured that every article is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns, please talk to one of our healthcare professionals or your primary healthcare team.
References
Maggie A Kuhn et al., ‘Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients’, PubMed, April 2023, https://pubmed.ncbi.nlm.nih.gov/36965195/
Borre, M.; Fassov, J.; Poulsen, J.L.; Christensen, P.; Laurberg, S.; Drewes, A.M.; Krogh, K. Dietary Intervention Improves Gastrointestinal Symptoms after Treatment of Cancer in the Pelvic Organs. J. Clin. Med. 2023, 12, 4766. https://doi.org/10.3390/ jcm12144766
Gastrointestinal symptoms of pelvic radiation disease (part 2): impact on patients and carers Helen Ludlow, Gastrointestinal Nursing 2020 18:3, 44-49
Phillips ME, Hopper AD, Leeds JS, et al, Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines, BMJ Open Gastroenterology 2021;8:e000643. doi: 10.1136/bmjgast-2021-000643