The Importance of Nutrition for Head & Neck Cancer Patients
Patients battling head and neck cancer face unique nutritional challenges due to the disease’s significant impact on swallowing liquids and consuming solid foods. Their heightened nutrient needs make proper nutrition crucial, not only to optimize healing post-surgery but also to bolster their tolerance for rigorous treatments. A well-maintained diet plays a key role in preserving lean body mass, preventing nutrient deficiencies, and boosting immune function. This approach not only reduces infection risks but also significantly improves the patient’s quality of life.
However, some patients will experience a loss of appetite during cancer treatment and, with a reduced interest in eating, may not realize how little nutrition they are getting. Nutritional specialists can help patients make sure they are meeting their nutritional needs both during and after treatment.
How a Nutrition Specialist Assesses a Patient’s Nutritional Status
A nutrition specialist will use a number of factors including age, sex, and critical illness to determine a patient’s daily caloric needs. One of the more commonly utilized standardized approach is based on the assumption that a normal healthy patient requires 25–30 kcal per kg of body weight. For patients with significant weight loss, malnourishment, or active cancer, this estimate typically increases to 30–35 kcal per kg of body weight.
Daily Calories for Patients (by Weight)
The table below shows the estimated caloric intake recommended for cancer patients who have significant weight loss, malnourishment, or undergoing treatment with active cancer.
| Patient Weight (lbs) | Daily Calories (kcal) |
|---|---|
| 100 | 1365–1590 |
| 120 | 1640–1910 |
| 130 | 1775–2070 |
| 140 | 1910–2230 |
| 150 | 2045–2385 |
| 160 | 2185–2545 |
| 170 | 2320–2705 |
| 180 | 2455–2865 |
| 190 | 2595–3025 |
| 200 | 2730–3185 |
| 210 | 2865–3345 |
| 220 | 3000–3500 |
| 230 | 3140–3660 |
| 240 | 3275–3820 |
| 250 | 3410–3980 |
Low End of Calorie Range = (YOUR WEIGHT (in lbs) ÷ 2.2) × 30
High End of Calorie Range = (YOUR WEIGHT (in lbs) ÷ 2.2) × 35
To determine whether or not a patient is nutritionally depleted, standard practice is for a nutrition specialist to use the ASPEN malnutrition criteria, based on the length of time a patient has had inadequate energy intake, the severity of weight loss, and clinical findings, such as muscle and fat loss assessed on physical examination, to determine if a patient is presenting with moderate or severe malnutrition.
Important Dietary & Treatment Topics
Limit/Avoid Irritating Foods & Liquids
Some foods and liquids can further irritate sensitive tissues in the mouth or throat that are undergoing treatment. It’s best to avoid foods from the list below.
- Spicy/acidic foods.
- Foods/beverages hot in temperature.
- Alcohol.
Hydration
- Minimize dry mouth symptoms by drinking lots of fluids.
- Avoid alcohol during treatment as alcohol can further dry out and irritate the mouth and throat. After treatment and when returning to a healthy diet, it is often recommended that head and neck cancer patients refrain from alcohol to reduce any risk of recurrence, or otherwise severely limit intake.
- Drink warm or cold liquids based on personal preference and comfort level.
- Drinking lemon water or sucking on hard lemon candies is recommended for increasing saliva but may irritate the mouth if undergoing radiation.
Protein
- Protein helps to repair body tissue and maintain a healthy immune system. Most adults need 0.8–1 g protein per kg of body weight per day, however needs may be higher (1.0–1.5 g/kg body weight/day) if patient is undergoing cancer treatment or recently had surgery
- Add protein to the diet to help meet nutritional needs
- Make shakes and high-calorie smoothies
- Examples of high quality protein: beef, chicken, fish, eggs, tofu, beans, lentils, milk, yogurt, cottage cheese, nuts, quinoa, soy milk, protein shakes
Vitamins
- Vitamins & Minerals First!
Patients should try to get the normal dose of vitamins/minerals from food first. However, if a patient is having difficulty meeting their nutritional needs, it may be beneficial for them to take a daily multivitamin. Ideally, a multivitamin should be chosen that doesn’t significantly exceed 100% of their daily needs. - Incorporate Zinc.
There is some research that suggests zinc may be beneficial to promote wound healing. A patient can supplement 220 mg zinc sulfate daily for 2 weeks. Any longer supplementation may lead to a copper deficiency.
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Calories
The necessary caloric intake depends on the patient’s age, body mass index (a metric factoring in height and weight), and their current disease state; but in general, patients undergoing treatment for head and neck cancer should consume approximately 30–35 calories/kg of body weight daily.
Meal Planning
If patients have trouble consuming adequate calories, there are several strategies that may help.
- Eat multiple small meals throughout the day.
- Keep healthy snacks nearby.
- Schedule meal times.
- Keep track of daily consumption with a nutrition tracker.
Diet Texture
- Patients may require soft foods that are easy to swallow and chew.
- Cut out foods that cause discomfort, are sharp or crunchy and require substantial effortful chewing.
Examples of Softer Foods
- Cooked cereals
- Soft bread
- Cooked or canned vegetables
- Scrambled eggs
- French toast
- Tuna salad
- Meatloaf
- Beef stew
- Macaroni & cheese
- Cottage cheese
- Yogurt
- Creamy soups
- Cheesecake
Oral Symptom Relief
The following baking soda mouth rinse recipe can be made at home to help manage post-treatment symptoms. Patients should rinse their mouths before and after meals with the rinse, being careful to swish and spit without swallowing the rinse.
Baking Soda Rinse Recipe
- ½ tsp salt
- 1 tsp baking soda
- 1 quart of water
For patients experiencing severe mucositis, their providers may prescribe Magic Mouthwash, which typically includes a combination of some of the following.
- Antihistamines or anticholinergic agents
- Anesthetics
- Antacids
- Antifungal agents
- Corticosteroids
- Antibiotics
Reliable Brands of Nutritional Supplements
Ensure, Boost, Enu, Orgain, and Kate Farms are all reliable brands. However, there are multiple available brands on the market that are safe and effective. The most important factor is to find a nutritional supplement that the patient prefers or even enjoys.
If a patient is having a difficult time consuming enough calories/protein, it is best to choose a concentrated supplement such as Ensure Enlive, Ensure Plus, Boost VHC, Boost Plus, Enu, etc. (ideally greater than 300 calories and more than 15 grams of protein per serving). For patients with diabetes, there are protein shakes that are low in sugar such as Glucerna shakes, Boost Glucose Control, Enu (which is naturally low in sugar).
Nutritional Needs After Radiation & Chemoradiation
Post-treatment side effects of radiation therapy include decreased salivation in 60–92% of patients and inflammation in the skin lining the mouth (mucositis) in most patients. Side effects following chemoradiation therapy are similar but with mucositis affecting almost all patients. Dry mouth and mucositis can negatively impact a patient’s eating. In particular, severe mucositis often presents as pain in the mouth. Combined with swallowing deficits, patients that experience this are not likely to meet their nutritional or even their hydration needs.
Useful Tips for Patients with Impaired Swallowing, Mucositis or Dry Mouth
- Avoid spicy foods, especially if the patient has mucositis.
- If decreased salivation is disrupting the ability to eat, consult a physician to see if the patient can use a medication called pilocarpine or a similar medication to stimulate salivary production.
- Sometimes a patient may need to supplement their diet with nutrients or even fluids through a feeding tube or an IV.
