Deborah Howland, dietitian

Specialist dietitian at Torbay and South Devon NHS Foundation Trust, working with people who have head and neck cancer and in the intensive care unit

Deborah HowlandMy main aim, for every patient I see, is to improve their quality of life and make the most of every day that they’re here.

For as long as they need us

In my work at Torbay Hospital I meet all people diagnosed with head and neck cancer before they start any treatment. We check that they’re not having any problems eating or drinking, then we look after them right the way through their treatment and for as long as they need afterwards. 

Our cancer patients will often become exhausted and run down from all the side-effects of gruelling treatment. This can mean that they are not eating well and therefore not fuelling their body adequately. It’s like a car running on empty. 

As treatment starts we aim to optimise nutritional intake, to ensure patients are well prepared to face the challenges treatment can bring – making sure that they’re eating and drinking enough, ensuring they’re getting the right nutrients for really good health. We also look at improving their body composition and muscle mass by making sure they’re exercising and keeping active which has been shown to improve quality of life in people facing treatment for cancer.

A privilege to support people

It’s lovely when people have successful treatment outcomes, but even if they don't it’s a privilege to support people at the end of their lives, working closely with community palliative care teams and different support teams. My main aim, for every patient I see, is to improve their quality of life and make the most of every day that they’re here.

People having treatment for head and neck cancer often say to me that they could be eating cardboard. Their food has no taste, its texture is grainy and gritty in their mouths, and it’s really difficult for them to push the food around their mouth because their tongues are very sore – they’ve got ulcers, and lots of mucositis. We counsel them to use their painkillers and mouthwashes effectively, and to adjust the texture of foods to make eating easier.

Nevertheless, taste changes and a dry mouth are such difficult side-effects to cope with, and eye-opening World Cancer Research Fund (WCRF) figures showed that nearly half of cancer patients in the UK who’ve gone through treatment didn’t receive any dietary advice that could help ease some of the side-effects. When going through cancer, eating can be a challenge and knowing what to eat can be very difficult and sometimes confusing. That's why WCRF’s Eat well during cancer booklet is really important, and will help many people living with cancer. There are some invaluable tips on how different foods can help them cope with some of the common treatment side-effects. It has been written by specialist dietitians, like me, who work with cancer patients, so they can be confident the information is accurate and practical.

I use it regularly with people before they start treatment. I’m really fortunate that we get to see our patients weekly – more often if they need it – so I can provide tailored, practical advice to every patient. But it’s really useful to have a general booklet – it’s got great recipes and tips, and patients can keep it at home or in their bag to browse when they’re out and about. It helps to promote independence and empowers them to manage their own health conditions – a key aim. 

Food central to socialising

Another challenge during treatment is people’s emotional wellbeing – often including a sense of bereavement towards food. For most people, food is a central part of their social lives – we use it to console people (with cups of tea, for example) or to celebrate (birthday cake). Suddenly people who’ve always really enjoyed food can find themselves unable to eat or drink because it’s painful and sore, swallowing is very difficult or their mouths are extremely dry, and they’ve lost their identity as somebody who participates in activities around eating and drinking. They can experience low mood and social isolation. Our reassurance and support here is vital – hopefully the effects of treatment will be short term and with our help they'll be able to enjoy food and drinking again.

Patients’ muscle mass can also decrease and their weight can drop – if this happens, I’ll see them more frequently to ensure we’re making the most of every mouthful they are eating. Often we do have to use feeding tubes, to make sure they’re getting all the nutrients they need. That can be hard to get used to, but it’s an absolute lifeline. The solutions we can give via feeding tubes contain all the goodness they need, and so many patients tell me how much better they feel with those nutrients inside them, having felt so run down and exhausted. If safe to do so though, we encourage them to keep trying to eat something every day, and I encourage softer fruits and vegetables prepared in a manageable way to provide additional anti-oxidants.

Treatment can also make it very painful to talk, which makes repeating things over and over very frustrating. We try to review our patients as a support team to help with this – we have a consultant, a speech language therapist, specialist nurse and a radiographer as well as a dietitian, so that they don't have to repeat things lots of times.

I always make fellow health practitioners aware of the Eat well during cancer booklet – it’s available through our hospital’s chemotherapy unit and of course it’s available free.

Moving on

I look after our head and neck cancer patients until they don't need me any more – we’re lucky that we’ve got a ‘moving on’ group at Torbay Hospital which supports people getting back into the routine of life – starting to make their cancer and the treatment more in the past than a focus for the present.  

For all of us, it’s so important that the food and drink we put in our bodies is nutritious – we are what we eat. WCRF’s Cancer Prevention Recommendations are a brilliant way to encourage people to make practical changes to their diets. The resources are all evidence based and use the most recent scientific studies to support the literature produced. 

I feel really lucky to be able to use the WCRF resources and have seen first-hand the positive impact that they have on people’s wellbeing.