Overview

When facing head and neck cancer, nutrition often becomes more than just eating; it becomes part of your treatment. A healthy, balanced diet for head and neck cancer can support your body, ease side effects, and improve recovery.

Between 40% and 80% of cancer patients may face malnutrition at various stages of their treatment, and those with head and neck cancer face an even greater risk due to the physical impact of the disease, often affecting eating and swallowing.¹ Malnutrition affects up to 90% of patients with head and neck cancer, drastically reducing treatment tolerance, wound healing, and quality of life.² Despite its importance, nutrition is often overlooked in cancer care, even though malnutrition can lead to delayed healing, reduced treatment tolerance, and poorer outcomes.^2,4,5

This article explores why nutrition matters in head and neck cancer, what to eat during different stages of care, and how to manage common barriers like dry mouth, taste changes, and swallowing difficulties. You’ll also find practical advice on when feeding support might be needed and how to optimise your diet before, during, and after treatment.

Let’s begin by looking at why patients with head and neck cancer are especially vulnerable to malnutrition.

Why nutrition is crucial during head and neck cancer

Proper nutrition helps your body stay strong, tolerate treatments like radiation and chemotherapy, heal faster, and maintain a better quality of life.

Malnutrition is widespread in head and neck cancer and often begins even before treatment starts due to a combination of physical and functional problems caused by the cancer itself.^4,5,7,8,9

Commonly, patients with head and neck cancer struggle to eat enough to maintain their weight, but without enough nutrition during radiation and chemotherapy, patients may:

• Lose weight rapidly
• Become weaker
• Heal more slowly
• Have difficulty tolerating or completing treatment

Losing excessive weight or becoming weak can delay treatment, increase the risk of complications, and slow down recovery. 

Maintaining weight is often difficult due to many factors, including:

The location of the tumour: Cancers in the mouth, throat, or neck can directly affect chewing and swallowing, making it hard to eat or drink.^4,5,6

Pain and discomfort: Patients often experience mouth sores, throat pain, or difficulty opening the mouth, leading to reduced food intake.^4,5,6,8,9

Alterations in smell and taste can make food unappetising, leading to a loss of appetite.^4,9

Surgery may alter the ability to chew and swallow.^10,14

Radiation and chemotherapy side effects may cause nausea, dry mouth, mucositis (mouth inflammation), and fatigue. These all have the potential to reduce your eating ability.^11,12,14

Psychological factors: Anxiety, depression, and emotional distress can further decrease appetite and interest when you have head and neck cancer; nutrition becomes a vital part of your treatment and recovery.^7,8,9

In summary, staying well-nourished is just as crucial as the cancer treatment itself, and when necessary, a feeding tube can be a beneficial tool rather than just a last resort.^7,8,9

Head and neck cancer treatments

Treatments can involve surgery, radiotherapy (RT), chemotherapy (CT), or a combination tailored to individual needs.

Researchers are exploring new approaches to minimise radiation doses and combine RT with immunotherapy, aiming to treat cancer effectively while reducing long-term side effects.²

Side effects of treatments

Various side effects can arise from treatments, including:

Surgery: Pain, swelling, numbness, speech difficulties, dysphagia (swallowing difficulties), taste changes, mouth opening limitations (trismus), altered appearance, and nutritional issues resulting in weight loss.

Radiotherapy: Side effects range from mild to severe, especially when combined with chemotherapy. Possible side effects can be present during and after treatment and include:

• Xerostomia (dry mouth)
• Sore mouth
• Osteoradionecrosis (bone damage)
• Fatigue (tiredness)
• Taste changes
• Dysphagia (swallowing problems)
• Lymphedema (swelling)
• Mouth infections and dental problems

Chemotherapy: Administered through veins or orally, it utilises cytotoxic drugs to destroy cancer cells. Side effects typically resolve after treatment and may include:

• Fatigue
• Nausea/vomiting
• Peripheral neuropathy (numbness)
• Appetite loss
• Taste loss
• Diarrhea/constipation
• Hair loss
• Anaemia
• Hearing loss

Weight loss and nutritional issues can arise from these treatments, highlighting the critical need for proper nutrition.

What to eat: nutrient-rich foods that help

A generally healthy diet for most people consists of:

• A variety of fruits, vegetables, and whole-grain products
• Moderate portions of lean proteins and dairy
• Limited amounts of sugar, alcohol, salt, and unhealthy fats (like those found in butter, certain meats, dairy products, fast food, and fried items)
• Limited amount of processed foods

Individuals with cancer often have unique dietary requirements that are similar to typical healthy eating guidelines. However, when facing cancer, it is crucial to maintain strength to cope with the side effects of treatment. For those who are healthy, consuming enough food usually isn't an issue. Still, managing intake can become quite challenging during cancer treatment for several reasons, including appetite loss as well as physical difficulty in eating, such as dry mouth and trouble swallowing.^14,15

Patients may benefit from increased protein and calories, which can be obtained by including more meat, fish, eggs, dairy, and plant-based proteins. Adding sauces and gravies can make eating meals easier if chewing or swallowing becomes difficult. Consulting with a dietitian can provide valuable guidance on any dietary adjustments that may be needed.⁶

Swallowing problems may make eating and drinking hard. Your doctor may refer you to a speech-language therapist to ensure your swallowing is safe. Speech and language therapists may also tell you about the type of textures that are easier for you to manage. Everyone's experience is different. One person may not find that eating is affected. In contrast, others may struggle and find different textures easier to manage than others. 

Your doctor may also refer you to a dietitian for specific nutritional advice to support cancer patients.¹⁵

If you require a soft diet, eating a variety of foods that are right for you can be challenging to stay healthy and prevent weight loss. 

Tips for a soft diet 

• Eat slowly and have small, frequent meals with snacks in between to boost nutritional intake
• Chew your food well and drink liquids in sips between bites
• Opt for naturally soft foods like bananas and yoghurt, and include liquid-based meals such as stews and casseroles
• Use sauces, gravies, cream, or custard to moisten foods
• Make milkshakes to add fruit and calories; consider using ice cream for extra nutrition
• Blend solid foods for easier consumption, and finely chop or mince meats and vegetables
• If you're tired, consider blending ready-made meals instead of cooking
• When mashing or blending for added calories, use milk or cream instead of water
• High-calorie drinks can help meet calorie needs and boost energy between meals
• Serve food at a comfortable temperature; warm foods can be soothing, and cold options like ice cream or yoghurt can also be comforting

Foods that need a lot of chewing or are harder to swallow. Some people may need to avoid these types of food. These include:

• Nuts and seeds
• Raw fruit and vegetables
• Fruit or vegetables with tough skins
• Tough meat
• Dry or crispy or sharp foods
• Bread
• Stringy foods like celery 

Nutrient-dense snacks that are easy to swallow include:

• Nut butter
• Eggs
• Cottage cheese
• Fortified drinks
• Milkshakes/smoothies, consider adding berries, leafy greens, and omega-3s for immune support

Managing eating problems during treatment

To manage eating problems during cancer, consider these practical strategies:

Swallowing difficulties: Using a blender to smooth solid foods can ease discomfort.

Dry mouth: Choose wet and soft foods if you have a sore mouth or throat. Avoid acidic, hot, or spicy foods. Combine solids with liquids like yoghurt or sauces, and limit sugar to prevent tooth decay. 

Saliva production: To stimulate saliva, try sugar-free hard candies or gum (especially mint, citrus, or cinnamon). Enhance flavours with sour or tart foods to stimulate taste buds. 

Hydration and exercise: Staying hydrated helps boost energy and combat fatigue. Moderate exercise may also provide relief from cancer-related fatigue.

Nausea and vomiting: Consult your healthcare professional if these symptoms prevent you from eating.

Tube feeding: For those with head and neck cancer, tube feeding can ensure sufficient nutrition during treatment, preventing severe weight loss and improving treatment tolerance. Various feeding tubes, such as short-term nasal tubes or long-term PEG tubes, can be placed preventively to avoid complications. Tube feeding should be seen as a means to maintain strength and complete treatment safely, aiding recovery, not a step backward in treatment.³

Sample meal ideas for better nutrition

Here are some easy and nutritious meal examples for a soft food diet to help you through your head and neck cancer treatment.

Breakfast:

• Porridge with nut butter and mashed banana
• Weetabix with whole milk and honey to taste
• Breakfast smoothie with full-fat yoghurt and fruit of your choice

Lunch:

• Creamy lentil soup with soft bread
• Tinned spaghetti with grated cheese
• Ratatouille topped with grated cheese
• Eggs or omelette

Dinner:

• Shepherd’s pie with gravy and soft vegetables
• Soft-cooked risotto
• Cod, mash, and parsley sauce with soft-cooked vegetables
• Baked salmon with mashed sweet potatoes
• Stews

Snacks:

• Avocado smoothies
• Full-fat yoghurt with honey
• Milkshakes
• Ice-cream
• Nut butter
• Cottage cheese
• Fortified drinks

Immune-supporting choices: berries, leafy greens, omega-3s. These can be added to smoothies or milkshakes. 

When to get help from a dietitian

Difficulty swallowing and dry mouth, known as nutrition impact symptoms, can significantly affect your health and treatment success. It's essential to promptly report these symptoms to your care team, including a dietitian who can provide personalised nutritional support for cancer patients.

Cancer patients are at high risk of malnutrition, with over 50% showing weight loss at diagnosis.^4,7 Nutritional health can decline during and after treatment. Addressing eating-related symptoms promptly can significantly impact recovery and quality of life.

Summary

Malnutrition affects up to 90% of patients with head and neck cancer, drastically reducing treatment tolerance, wound healing, and quality of life.² A healthy, balanced diet during head and neck cancer can support your body, ease side effects, and improve recovery. Cancer treatment can lead to various side effects, including difficulty in swallowing, dry mouth, loss of appetite, nausea, vomiting, and pain or discomfort. Everyone's experience is different. One person may find that eating is not affected. In contrast, others may struggle and find different textures easier to manage than others. Your doctor may also refer you to a dietitian for specific nutritional advice to support cancer patients. A soft diet may be recommended by your care team and can include soft, high-protein foods such as eggs, yoghurt, smoothies; easy-to-swallow options like soups, stews, and mashed vegetables; nutrient-dense snacks such as nut butter, cottage cheese, fortified drinks; and immune-supporting choices like berries, leafy greens, and omega-3s