Swallowing Problems

Cancer and its treatments can sometimes have effects that cause a person trouble with swallowing. It may be a short-term side effect of certain treatments, such as chemotherapy or radiation to the throat or chest. It may also be caused by mouth sores, an infection of the mouth or esophagus (the swallowing tube that goes from the throat to the stomach), or other problems. Trouble swallowing, or difficult swallowing is called dysphagia.

What causes swallowing problems?

Swallowing problems can be caused by different health problems, including certain types of cancer. There can be problems with motor function, meaning messages sent from the brain aren't getting to the esophagus to tell it to swallow. This can be caused by a problem in the brain or nervous system, such as a stroke, nervous system disorder, neuropathy, or tumor affecting the brain. Or, there can be something blocking food or fluids during swallowing, such as a large clump of food, foreign object, a narrowing of the esophagus, or a tumor in or pressing on the esophagus.

People with cancer may have swallowing problems because of side effects of certain treatments. For example, people who have mouth sores (mucositis) due to chemotherapy, targeted therapy, or radiation therapy to the head and neck may have pain when swallowing. Many people who are getting radiation therapy to the head and neck area also have dry mouth due to reduced saliva which can make swallowing difficult.

Other problems, such as having too much saliva, hiccups, heartburn, and indigestion can also make swallowing difficult at times.

What to look for

  • Gagging, coughing, or vomiting of food as you try to swallow
  • Weight loss
  • Drooling or the sense you have too much saliva (spit)
  • Little or no saliva
  • Inside of mouth is red, shiny, glossy, or swollen
  • Open sores in the mouth
  • Pain in throat or mid-chest when you swallow
  • Feeling as if food is “sticking” on its way down
  • White patches or a coating on the inside of the mouth

What the patient can do

  • Eat bland foods that are soft and smooth but high in calories and protein (such as cream-based soups, pudding, ice cream, yogurt, and milkshakes).
  • Take small bites, and swallow each bite completely before taking another.
  • Use a straw for liquids and soft foods.
  • Try thicker liquids (such as fruit that has been pureed in the blender or liquids with added thickeners), because they’re easier to swallow than thin liquids.
  • Mash or puree foods (such as meats, cereals, and fresh fruits) so that they’re as soft as baby food. You might need to add liquids to dry foods before blending.
  • Dunk breads in milk to soften.
  • Refrigerate food (the cold helps numb pain) or serve cool or lukewarm. If pain gets worse with cold foods, try them at room temperature.
  • Try crushed ice and liquids at meals.
  • Frequent small meals and snacks may be easier to manage.
  • Crush pills or tablets and mix in juice, applesauce, jelly, or pudding. (Check with your nurse or pharmacist first, because some pills can be dangerous if crushed or broken. Others react badly with certain foods or must be taken on an empty stomach.)
  • Avoid alcohol and hot, spicy foods or liquids.
  • Avoid acidic foods, such as citrus fruits and drinks and fizzy soft drinks.
  • Avoid hard, dry foods such as crackers, pretzels, nuts, and chips.
  • Sit upright to eat and drink, and stay that way for a few minutes after meals.
  • If you gag, cough, spit, feel pain or have other problems swallowing, try eating soft or liquid foods. You might be able to swallow thick fluids more easily than thin liquids. If you can't to eat enough regular foods to meet your nutritional needs, drink high-calorie and high-protein liquids.
  • If mouth pain is a problem, use a numbing gel or pain reliever, such as viscous lidocaine (by prescription) or ask about taking pain medicine before eating. (See Mouth Sores.)
  • Ask about seeing a speech-language pathologist or swallowing therapist. These are health professionals who can teach you how to swallow better and how to decrease coughing and choking when you eat and drink.

To make foods easier to swallow, try these thickeners

  • Gelatin: Use to help soften cakes, cookies, crackers, sandwiches, pureed fruits, and other cold food. Mix 1 tablespoon unflavored gelatin in 2 cups hot liquid until dissolved; pour over food. Let food sit until saturated.
  • Tapioca, flour, and cornstarch: Use to thicken liquids. Note that these must be cooked before using.
  • Commercial thickeners: Follow label instructions, and use to adjust a liquid’s thickness
  • Pureed vegetables and instant potatoes: Use in soups. Note that these change the food’s flavor.
  • Baby rice cereal: Use to make a very thick product.
  • If thin liquids are recommended for you, try these: coffee, tea, soft drinks, liquid nutritional supplements, Italian ice, sherbet, broth, and thin cream-based soups.
  • If thick liquids are recommended for you, try these: buttermilk, eggnog, milk shakes, yogurt shakes, and ice cream.

What caregivers can do

  • Offer soft, moist foods. Baked egg dishes, tuna salads, and thick liquids such as yogurt may be easier to swallow.
  • Offer soft desserts that don't require much chewing (like ice cream, pudding, soft cakes)
  • Use ground meats and ground meat casseroles, or fish. Sauces and gravies make meats easier to swallow.

Call the cancer team if the patient

  • Gags, coughs, or chokes more than usual, especially while eating or drinking
  • Has a severe sore throat
  • Has a red, shiny mouth or ulcers in the mouth or on tongue
  • Has a fever higher than their usual or higher than the level instructed by the cancer care team when taken by mouth
  • Has trouble breathing
  • Has chest congestion
  • Has problems with food “sticking” as it goes down
  • Cannot swallow medicines or eat

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Besser J, Grant BL, American Cancer Society. What to Eat During Cancer Treatment. Atlanta, GA: American Cancer Society; 2018.

Gallegos C, Brito-de la Fuente E, Clave P, Costa A, Assegehegn G. Nutritional aspects of dysphagia management. Advances in Food Nutrition Research. 2017;81:271-318.

Kenny C et al. Dysphagia prevalence and predictors in cancers outside the head, neck, and upper gastrointestinal tract. Journal of Pain Symptom Management 2019;58(6):949-958.

National Comprehensive Cancer Network. Clinical practice guidelines in oncology: Palliative care. Version 2.2019. Accessed at www.nccn.org/professionals/physician_gls/pdf/palliative.pdf on January 21, 2020.

Rogers M. Dysphagia. In Camp-Sorrell D, Hawkins RA. Clinical Manual for the Oncology Advanced Practice Nurse, Second Ed. Pittsburgh, PA: Oncology Nursing Society; 2014:621-626.

Starmer H, Edwards J. Clinical decision making with head and neck cancer patients with dysphagia. Seminars in Speech Language. 2019;40(3):213-226.

 

 

References

Besser J, Grant BL, American Cancer Society. What to Eat During Cancer Treatment. Atlanta, GA: American Cancer Society; 2018.

Gallegos C, Brito-de la Fuente E, Clave P, Costa A, Assegehegn G. Nutritional aspects of dysphagia management. Advances in Food Nutrition Research. 2017;81:271-318.

Kenny C et al. Dysphagia prevalence and predictors in cancers outside the head, neck, and upper gastrointestinal tract. Journal of Pain Symptom Management 2019;58(6):949-958.

National Comprehensive Cancer Network. Clinical practice guidelines in oncology: Palliative care. Version 2.2019. Accessed at www.nccn.org/professionals/physician_gls/pdf/palliative.pdf on January 21, 2020.

Rogers M. Dysphagia. In Camp-Sorrell D, Hawkins RA. Clinical Manual for the Oncology Advanced Practice Nurse, Second Ed. Pittsburgh, PA: Oncology Nursing Society; 2014:621-626.

Starmer H, Edwards J. Clinical decision making with head and neck cancer patients with dysphagia. Seminars in Speech Language. 2019;40(3):213-226.

 

 

Last Medical Review: February 1, 2020 Last Revised: February 1, 2020

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