Diagnosed
Nutrition

Eating Problems

Changes in taste or smell
People often report that the flavour of food changes during cancer treatment. Common comments are that ‘all food tastes the same’, ‘food is like cardboard’, ‘food has a metallic taste’, and ‘I no longer like the taste of my favourite food’.
 
Usually this is a temporary issue experienced during the period of treatment and for a short time afterward, but unfortunately taste changes can be long lasting in some patients. It may also take some time to be able to resume enjoyment of food you find off-putting during treatment.
 
Changes to the flavour of food are highly individual and can be unexpected and quite frustrating especially if food is a large part of your social life and a source of daily enjoyment.
 
If you have a sore mouth, sore throat or swallowing difficulties, talk to your doctor, speech pathologist, dentist or dietitian as some of the following suggestions won't be suitable. The following information may be useful in preparing you for what to expect and for minimising symptoms. The tips also include suggestions for exploring new flavours during treatment.

Tips:
  • If food tastes bland, make use of seasonings such as fresh herbs, lemon, lime, ginger, garlic, soy sauce, oyster sauce, honey, chilli, pepper or Worcestershire sauce.
  • If you're overly sensitive to strong flavours, minimise use of chilli, spices, carbonated drinks, mints or chewing gum. Choose subtly flavoured alternatives instead.
  • It's common to go off meat during treatment. If you find meat less appetising, try and rely on other good protein sources such as cheese, eggs, nuts, dairy food, baked beans, kidney beans, lentils, chick peas or soy products.
  • Beer, wine, coffee and tea may taste different or be off putting because of the smell, taste or texture. Try not to let this interfere with your social life – choose non–alcohol alternatives or try a milkshake, fresh juice or hot chocolate.
  • If the smell of food is bothering you, try cold food or reheat prepared meals in the microwave so the cooking odour doesn’t put you off eating. Stay out of the kitchen, if possible, when food is being prepared. Ask family or friends to cook.
  • If you experience a bitter or metallic taste in the mouth, try refreshing food or liquids to combat this taste such as nibbling on moist fruit including berries or melon or suck boiled lollies (try ginger flavoured) or sip flavoured drinks.
  • Sometimes a bad taste in the mouth can be a result of an unhealthy or dry mouth. Keep your teeth and mouth clean by brushing and rinsing often.
  • You may go off favourite food but equally you may now tolerate (and even enjoy) food you previously didn't consume. It's common for preferences for sweet or savoury food to reverse during treatment. Trial and error while you're experiencing flavour problems is key.


Mouth problems
Some cancer treatments cause mouth ulcers or change the amount and thickness of saliva in your mouth. These changes can make your mouth feel hot, dry or uncomfortable, and chewing or swallowing may become difficult and painful. Tooth and gum problems can occur and your lips can become dry.

Chewing and swallowing problems
People that have cancer in or around the mouth and throat may experience chewing and swallowing problems. Sometimes radiotherapy and chemotherapy to this area can also cause temporary problems. If teeth are extracted, chewing may be more difficult.
 If you have pain when chewing or swallowing, tell your doctor who will be able to give advice on suitable medications. If you have severe difficulty swallowing for a considerable period of time, a feeding tube may be considered to ensure you get adequate nutrition. Your dietitian, speech pathologist and doctor can guide you through this.

Dry or coated mouth
When your mouth is dry you're at increased risk of getting infections such as oral thrush and tooth decay which will make eating harder.

Ensure good oral hygiene. Keep your mouth clean and prevent infections with regular mouthwashes and gargles. Make sure you use an alcohol–free mouthwash to avoid further irritation to the mouth. Speak with your dentist or health care team about mouth rinses or lubricants most suitable for you during treatment.



Food you may wish to avoid:

  • Rough, crunchy or dry food (chips, nuts, dry biscuits, toast). Soften food by dipping them into milk, soups, tea and coffee.
  • Food that sting your mouth, e.g. salty food, spices, fruit juice, vinegar and alcohol.
  • Food (or drinks) that are very hot or very cold. Extreme temperatures may irritate your mouth or throat.
  • Choose food that are moist or moisten food by adding sauces, gravies, margarine, cream, custard etc.
  • Sip on fluids with all your meals and snacks.
  • Try sugar–free chewing gum or sucking on mints to stimulate the flow of saliva.
  • Sucking on ice or frequent sips of fluid (try different types) may be helpful. 

Changing food textures
You may need to change the consistency of your food by chopping, mincing or pureeing to make them easier to manage. Don't persist with a solid diet if it's taking you a lot longer to chew and swallow, or if you're experiencing coughing, choking or food sticking in your mouth or throat.

If you're having problems with your dentures, only wear them at meal times, or take them out and try softer food that doesn’t need to be chewed. If you're receiving radiation therapy to the head or neck area, you may need to discuss when to wear your dentures with your doctor or radiation therapist.
 
If you're experiencing problems swallowing normal food and fluids, notify your doctor who may refer you to a speech pathologist for assessment.
 
A speech pathologist can continue to monitor your swallowing after treatment, and modify the texture of your food once the side effects that are affecting your ability to swallow and chew begin to diminish.
 
Sometimes people may need to remain on a texture modified diet after their treatment; however this is different for everyone and will depend on the type of cancer, treatment or surgery received.


Food textures
Soft diet Soft food can be chewed but not necessarily bitten. Food should require minimal cutting and be easily broken up with a fork. Food should be moist or served with a sauce or gravy to increase moisture content. Food may be naturally soft or may be cooked or cut to alter its texture.
Minced and moist diet Food should be soft and moist and easily form into a ball in the mouth. Small lumps can be broken up with the tongue rather than biting or chewing. Food should be easily mashed with a fork and may be presented as a thick puree with obvious lumps in it. Lumps are soft and rounded with no hard or sharp lumps.
Smooth pureed diet Food is smooth, moist and lump free. It may have a grainy quality and is similar in consistency to commercial pudding. Food can be moulded, layered or piped. For more suggestions about what food can be included in a soft, minced or pureed diet refer to the table below.
Texture Modified diet
If you've been told that you need to follow a texture modified diet it can be difficult to think of food to eat. Your dietitian can help to identify certain food and fluids that will be easy to eat and drink. The following table provides some suggestions for food from each of the different texture modification categories.
Food Type Soft Minced and moist Smooth pureed
Meat Casseroles with small pieces of tender meat, stew, mince dishes, moist fish dishes. Minced or well cooked meat, chicken or fish. Serve with extra gravy or sauce. Pureed meat, chicken or fish blended with gravy or sauce until smooth. Serve with extra gravy or sauce.
Meat alternatives Omelettes, quiche, scrambled or poached eggs, baked beans or other cooked legumes, soft tofu. Poached, scrambled or boiled eggs, soft tofu, minced or mashed baked beans, cottage cheese, soufflé (small pieces). Pureed scrambled or poached eggs, pureed baked beans or legumes. Soft cooked silken tofu.
Drinks Commercial nutritional supplements. If you're having ongoing difficulties swallowing, your speech pathologist may suggest thickened fluids. Commercial nutritional supplements. If you're having ongoing difficulties swallowing, your speech pathologist may suggest thickened fluids. Commercial nutritional supplements. If you're having ongoing difficulties swallowing, your speech pathologist may suggest thickened fluids.
Cereals Well-cooked soft rice or porridge. Soft noodles with soup. Soft bread without crusts, use mayonnaise, butter or wet topping to moisten bread. Breakfast cereals or oats well moistened with milk (avoid dried fruit or nuts and crunchy breakfast cereals e.g. muesli). Soft pastry. Other soft cooked grains. Porridge. Well cooked, moist noodles or pasta dishes e.g. macaroni cheese. Well moistened dry breakfast cereal with little texture.
 
Strained or pureed porridge Serve with extra coconut (e.g. bubur lambuk) Pureed rice or noodles.
Fruit (avoid acidic fruits) Fresh fruit that's naturally soft e.g. banana, mango, watermelon, honeydew, pear. Canned and stewed fruits. Pureed fruit. Soft, canned or cooked fruits without seeds or skins. Mashed soft fresh fruits e.g. banana. Pureed fruit. Pureed fruit or mashed soft fruit pushed through a sieve (no pieces) or blender.
Vegetables, legumes Well–cooked vegetables diced, mashed or served in small pieces (e.g. cauliflower, carrot, potato, radish, spinach) Well-cooked legumes Soft well–cooked vegetables that can be mashed easily with a fork. Well-cooked legumes, partially mashed or blended. Pureed vegetables (blended until smooth with no lumps), pureed legumes, vegetable soups strained or blended to remove lumps.
Soup Meat, chicken and/or beans with vegetables homemade or canned. Soups with easy to chew meats or vegetables. Piece size should be less than 0.5cm. Blended homemade or canned soup. Smooth with no lumps. Add milk, cream or oil.
Dairy food and desserts All dairy and desserts except dry cakes or anything with nuts, seeds, dried fruits, coconut or pineapple or other hard fresh fruits such as apple. Milk, milkshakes, custard, ice cream, baked egg custard, mousse, soft cheesecake (no crust), yoghurt, jelly, pudding, tofufa, bubur kacang. Milk, milkshakes, thin custard, ice cream, mousse, yoghurt (no pieces).
Reviewed By:
Jenelle Loeliger, Head - Nutrition Department, Peter MacCallum Cancer Centre, VIC; Kate Aigner, Cancer Information Consultant, Cancer Council Helpline ACT; Ian Anderson, Consumer; Dr Anna Boltong (Clinical Dietitian), Unit Head, Cancer Information and Support Service, Cancer Council Victoria, VIC; Clare Hughes, Nutrition Program Manager, Cancer Council NSW; Bridget Kehoe, Public Health Coordinator (Nutrition and Physical Activity), Cancer Council QLD; Steve Pratt, Nutrition and Physical Activity Manager, Cancer Council WA; and Roswitha Stegmann, Helpline Nurse, Cancer Council WA.
Reviewed By:
Chan Wan Thung, dietitian, NCSM.