An easier to eat, nourishing diet: For patients who have a sore mouth

This is to help you if you are experiencing pain or discomfort when chewing or swallowing food or drink, due to your cancer or the side effects from your treatment.

Food and drink choices have a significant influence on your health and how you feel during and after your treatment. It is important to try and maintain your weight and strength as much as possible both during and after treatment.

This advice aims to make your diet as nourishing and comfortable as possible. It also includes tips for planning your food and drink around your treatment days and how to manage a high energy, high protein diet on a budget.

If you have diabetes, this information may have advice on food and drinks that are high in sugar or fat. Please seek the advice of your dietitian, doctor or diabetes nurse if you have any concerns.

If you follow a plant-based or vegan diet, there are examples throughout of appropriate meals, snacks and drinks. You will also find examples of how to enrich your diet.

This information is not suitable for people who have been advised to follow a texture modified diet by a speech and language therapist. Separate information on the most appropriate texture can be made available for you.

If you experience any of the following symptoms below, then you may have a swallowing difficulty and require a speech and language therapy referral for further assessment:

coughing while swallowing food or fluids,
difficulty breathing after eating/drinking,
wet or gurgly voice after eating/drinking,
residual food/fluid still present in the mouth despite swallowing, or
unexplained chest infections.

Please inform a member of your medical team if you experience any of the symptoms above. You may require a referral to the speech and language therapist for further assessment. They will be able to advise you on the safest texture of diet and food.

General tips and advice

This information includes ideas on plant-based options to eat and drink; if you feel you would like more advice regarding a plant-based diet, please speak to your dietitian.
If you feel overwhelmed by large portions at mealtimes, try smaller and more frequent meals and snacks.
Try using smaller plates, bowls or cups/glasses when serving food or drinks – this may reduce the possibility of feeling over-faced by large servings or portions.
Make the most of times in the day when you feel most hungry. Keep a diary of when you eat best and other times when your appetite is smaller – you might find a pattern each day and then plan your meals with this in mind.
Make the food or drinks you have as nourishing as possible by enriching them. If you don’t feel you can face solid food, then a nourishing drink may be easier to manage.
To get as much energy as you can from food/meals, try to avoid ‘low fat’, ‘diet’ or ‘low calorie’ in the short term.
Keep meals simple if you need to; you may find ready-made meals, cooking meals in bulk and storing/freezing them, or using convenience foods will help you to manage your energy levels at home (not needing to cook or food shop frequently).
If you have the offer of support with cooking or food shopping, accepting this may help you maintain your energy levels during and after your treatment. Online food shopping or using meal delivery services may also be helpful if you are feeling fatigued.
Patients having treatment as an outpatient may miss meals due to additional appointments or unexpected delays when they visit The Christie. It is important that your try and avoid missing any meals. Consider preparing snacks and drinks to bring with you during the time away from your home. You may also wish to use the facilities at The Christie; the hospital restaurant, shops or the vending machines.
If you have pain swallowing food or drinks that are very hot, cold, salty, spicy, acidic or that contain vinegar, it might be best to avoid them.
Try to keep your mouth as clean as possible. Use mouthwashes and pain relief medications regularly as advised by your doctor.

Meal suggestions

Breakfast

Porridge or instant oat cereal made with whole milk, plant-based milk or fortified milk. Enrich with cream, honey, syrup, jam or smooth nut butters.
Overnight oats (oats soaked overnight in whole milk, plant-based milk or fortified milk) mixed with stewed apple and honey.
Breakfast cereals soaked in hot or cold milk (avoid cereals with nuts or dried fruit if they cause more pain when chewing or swallowing).
Full fat yoghurt, soya yoghurt, fromage frais or plant-based Greek style yoghurt.
Greek yoghurt with oats, stewed fruit or mashed banana and honey.
Omelette, scrambled, poached, fried or boiled eggs can be served with baked beans and mashed avocado.
Scrambled tofu with baked beans.
Skinless sausages, frankfurters or vegetarian sausages e.g. Quorn sausages served with baked beans and hash browns.

Snacks

Homemade, tinned or packet soup.
Ice-cream, sorbet or frozen yogurt.
Full fat yoghurt, soya yoghurt, fromage frais or plant-based Greek style yoghurt.
Humous with soft breads.
Tinned or stewed fruits in juice served with rice pudding, custard or yogurt.
Banana bread or pancakes with spreads, nut butters or yogurt.
Custard or soya custard.
Rice pudding.
Meat dumplings.
Meat buns.
Ideas for snacks to bring to hospital visits: soft crisps that melt in your mouth, soft biscuits or sponge fingers e.g. jaffa cakes, boiled egg mashed with mayonnaise/salad cream, slice of crustless quiche, soft crustless bread sandwich or rolls with moist fillings e.g. egg, tuna or avocado with plenty of sauce, salad cream or mayonnaise.

Main meals

Shepherd’s pie with mushy peas and butternut squash.
Cottage pie served with root vegetable mash or steamed baby leaf spinach.
Slow cooked beef or chicken casserole/stew (meat should be very tender).
Beef or vegetable lasagne with soft-boiled or roasted vegetables.
Quiche filling or crustless quiche with a soft pastry base.
Tofu curry with boiled rice.
Spaghetti with tender meat, soya or Quorn pieces in a bolognese sauce.
Baked potato (avoid the skin) with toppings such as baked beans in tomato sauce, grated or cottage cheese, tinned tuna or salmon in sauce.
Corned beef hash served with baked beans.
Macaroni cheese.
Stuffed pasta shells served in bolognese sauce.
Mushroom ragu topped with grated cheese and served with couscous, boiled rice, pasta or creamy mashed potato.
Fish in a creamy sauce, served with mashed potato and soft vegetables (make sure there are no bones in the fish).
Slow cooked chickpea or butternut squash curry.
Potato curry served with dahl and rice.
Bean stew.
Mixed bean tagine with couscous.

Desserts

Rice pudding or semolina.
Coconut milk rice pudding.
Custard (larger supermarkets may offer a range of flavours) with stewed fruit, soft sponge cake or trifle.
Soya custard.
Stewed fruit e.g. apple, pear or rhubarb with fresh cream.
Tinned apricots in juice served with yoghurt, custard, soya custard, ice-cream or sorbet.
Milk or fruit jelly.
Angel Delight.
Silken tofu chocolate mousse.
Cheesecake or banoffee pie (must be a soft biscuit base).
Crème brûlée or crème caramel.
Lemon posset or chocolate ganache chocolate/chocolate sauce.
Homemade ice-lollies made with blended fruit and coconut milk.
Dairy-free ice cream with melted vegan chocolate/chocolate sauce.
Sorbet or vegan sorbet.
Custard buns.

Enriching your diet

Eating foods high in calories (energy) and protein is important to support you during times when your appetite is poor, or you are losing weight.

Energy is essential to fuel day-to-day tasks such as washing and dressing, preparing meals or cooking, travelling to and from treatment, work or social events. Treatment for cancer itself can often cause fatigue; if you are not getting enough energy and protein from your diet you may find it even more difficult to tolerate the treatment or recover from its side effects.

Both energy and protein are essential for wound healing (such as skin breakdown from radiotherapy). Getting enough protein from our diet will help build, maintain or repair the muscles our body uses for various functions including breathing, swallowing, walking, climbing stairs or exercising.

If you have lost weight or your appetite is poor, you may find it helpful to enrich your food. This section offers some suggestions of ways in which you can increase the energy and protein content of your food or drinks, without necessarily increasing the size of your portions.

Fats and dairy produce:

Add soft or grated cheese to mashed or jacket potatoes, soups, pasta, scrambled egg, or melt and pour cheese over soft-cooked vegetables.
Add cream, yoghurt, fromage frais or crème fraiche to casseroles, soups, curries or pasta dishes.
Add butter, margarine, plant-based margarines or nut butters to vegetables, curries, casseroles, stews, soups or potato.
Use generous amounts of oil or spreads when cooking.
Add mayonnaise or salad cream, vegan mayonnaise or salad cream to tuna, chicken or egg e.g.as a jacket potato filling.
Add ground almond nuts, smooth nut butters (such as peanut, hazelnut, almond or cashew) or hazelnut chocolate spread to porridge.
Add nut butters to curries or stews.

Sugars:

Add sugar, honey, maple syrup or jam to porridge, Ready brek, milk puddings (such as rice pudding, semolina or custard), yoghurts, mousse, ice-cream or sorbet.

Sometimes patients visit their dentist before commencing treatment and are advised to limit their sugar intake. You may therefore wish to use fats and dairy produce more often to enrich your meals.

Fortified cow’s milk:

Mix 4 tablespoons of skimmed milk powder into 1 pint (568mls) of whole milk and mix well.

Fortified plant-based milk:

Add 2 scoops of protein powder (60g) into 1 pint of plant-based milk and mix well. You may find this easier using a blender or smoothie maker.

Store this fortified milk in the fridge and use across the day; in cereals or porridge, when making soups, mashed potato or scrambled eggs, milky puddings or homemade drinks.

Some plant-based milks, particularly unsweetened versions, are low in energy and protein. Soya milk often has the highest protein content, but some varieties can be low in calories. Check and compare the food labels of plant-based milks before you buy.

Nourishing drinks

Hot milky drinks such as Horlicks, Ovaltine, cocoa or hot chocolate.
Milkshakes with added ice cream.
Powdered drinks such as Complan, Aymes shake or Foodlink Complete, which come in a range of sweet or savoury flavours, can replace a light meal when made up with milk. Try adding yoghurt, blended fruit, ice cream or crushed ice.

There are a wide variety of nutritional supplement drinks and soups available on prescription, including plant-based and vegan options. You may wish to discuss these options with your dietitian, doctor or GP.

Foods that may be difficult to manage

Food characteristic	Example of food
Hard or dry foods	Nuts, dry cereals, raw vegetables, unripe fruit, boiled sweets, dry cake/sponge, thick or doughy breads e.g. bagels or baguette
Tough foods	Beef/steak Pork/beef/chicken that is no longer tender or served with a sauce or gravy
Chewy foods	Sweets, dried fruit, toffee, marshmallows, pizza
Crispy foods	Crackling, crispy bacon, breakfast cereals (if not soaked in milk), foods in breadcrumbs or batter
Crunchy foods	Raw vegetables, unripe fruit, popcorn
Sharp foods	Potato crisps, pringles
Food with pips or seeds	Apple or pumpkin seeds, oranges, melon (avoiding or removing the seeds should make them okay to try)
Food with bone or gristle	Chicken or fish with bones in them Meat with gristle
Sticky or gummy foods	Bubblegum, rice cakes or Rice Krispie bars/squares
Stringy foods	Green beans, rhubarb, pineapple

Eating well on a budget

Unfortunately, when some people are diagnosed with cancer, they may have to stop working due to their physical health or extended periods of time receiving treatment/ recovering. This in turn can influence their income and financial wellbeing.

Below are some tips and advice on eating well on a budget:

Meal planning – this can help you to focus your weekly food shop on only the essential things you need each time you visit the supermarket.
If you are using the oven or slow cooker, why not batch cook or make double/triple portions, avoiding the need to cook again the next day(s) and potentially reducing wastage. Ideas include stews, casseroles, soups, or curries.
Remember the energy used by a slow cooker or air fryer will depend on the temperature chosen – the higher the temperature, the higher your energy bill.
Always check your kitchen first – before food shopping, take a note of what you already have in your cupboards and freezer. You may have items that can be used up as part of your meal plan (tinned foods, rice, pasta, sauces, oils, frozen fruit, or vegetables, etc).
Write a list – following a shopping list may help avoid impulsive buying in the shops.
Shop around and compare the prices of your regular items – supermarket own brand products are often cheaper that branded ones but taste similar.
Within supermarkets and convenience stores, some brands will pay to have their items displayed at ‘eye level’ or on the end of the isle, with the view to catching the buyer’s attention easier. Look out for lower shelved items which may be cheaper, or check if they have a frozen option which may be cheaper still e.g. fruit, veg, fish, meat, etc.
Stock up – if you have space at home, stock up on less expensive items with a long shelf life such as UHT milk, frozen or tinned vegetables, dried, frozen or tinned fruits, oats, cereals, pasta, rice, or quinoa.
Avoid shopping when hungry; this may lead to cravings and impulsive purchases.
Your local council or community association may be able to share information with you on local support schemes or initiatives which offer food vouchers, free or subsidised lunch clubs, cooking classes or community fridges (where locals bring/share/exchange items with one another at no cost).

Pureeing your food

Sometimes patients experience such significant pain when chewing and swallowing food, they may need to take things a step further and puree their meals. Pureed foods of a very smooth consistency/texture may take less time to chew and swallow, making mealtimes quicker and more comfortable to manage.

Food can be pureed using a liquidiser, blender or food processor. You may also use a sieve to remove any lumps before serving.

Practical tips when pureeing food

You may find it easier to blend small quantities at a time.
You may need to add extra gravy, sauce, cream or soup to make blending the food easier.
Vegetables or meat products should be well cooked until soft/tender prior to being pureed.

Food group	Tips when pureeing
Bread, cereals, pasta and potato These are carbohydrate-containing foods, which are rich in energy.	Bread can be hard to puree. Avoid using freshly baked bread and tear the bread into very small pieces before adding to the liquidiser. Bread can be soaked in a liquid, e.g. stock to create a puree texture. Pasta should be cooked until soft (usually for 10-12 minutes) then add a creamy sauce before pureeing. Try a nourishing cream or cheese-based sauce. Potatoes should be cooked until very soft and then pureed or mashed using generous amounts of milk or cream with butter. Do not puree for too long as the potato can go sticky. Alternatively, use instant mash made up with whole milk and added cream cheese, grated cheese, cream or butter. Small porridge oats, instant oat sachets or Ready Brek can be made with warm whole milk and served when very smooth and creamy. Cereals do not puree well. When soaked in whole milk until soft, they may be easier to manage.
Meat, poultry, fish, eggs and pulses These are protein-containing foods, which your body uses for growth and repair of muscle strength and function.	Fish: it is best to use boneless fish, otherwise it may not be safe to eat. Meat and poultry should be well cooked and then trimmed to remove any skin, gristle or fat. Cut into small cubes before adding gravy or sauce and pureeing. Beans, pulses and lentils. These should be cooked until very soft before pureeing in a sauce.
Milk and dairy produce These foods are often rich in calcium which is essential for maintaining strong and healthy bones and teeth. Higher energy and protein options are readily available	Most plain yoghurts are already smooth and creamy and should be tolerable as they are. Some yoghurts with larger pieces of fruit or added oats/granola/biscuit crumbs may require some chewing. You may wish to blend or sieve these before eating. Hard cheeses can be finely grated and then added into creamy smooth soups, sauces, or mashed potato. Soft, spreadable cheese options are also available.
Fruit and vegetables These foods are rich in fibre, vitamins and minerals which help to regulate our bowel movements and also strengthen our immune system.	Tinned, frozen or peeled fresh fruit and vegetables will be easier to puree than any dried options. Vegetables should be cooked until very soft prior to then pureeing. Tinned fruit may need to be drained before pureeing. Try serving them with custard, rice pudding, cream or ice-cream. Some fruit or vegetables with pips, seeds, string or skins may need to be sieved e.g. pineapple, kiwi fruit, tomato, peas, runner beans or celery.
Ready-made meals/desserts If you are experiencing fatigue during or after treatment, these options may be convenient for you. They might contain a mix of different food textures and therefore may need to be blended prior to eating.	Initially, cook or heat the item as per the cooking instructions on any packaging. Then puree into a smooth consistency using a blender or food processor. You may wish to add additional gravy or sauce before pureeing. Examples of ready meals which may need pureeing after cooking include shepherd’s or cottage pie, beef casserole, fish pie, lasagne, stew, cauliflower cheese or corned beef hash. Some desserts such as sponge, fruit crumble or cheesecake may need to be blended along with custard, ice-cream, rice pudding or instant whip to make them easier to eat.

Food group

Tips when pureeing

Bread, cereals, pasta and potato

These are carbohydrate-containing foods, which are rich in energy.

Bread can be hard to puree. Avoid using freshly baked bread and tear the bread into very small pieces before adding to the liquidiser. Bread can be soaked in a liquid, e.g. stock to create a puree texture.

Pasta should be cooked until soft (usually for 10-12 minutes) then add a creamy sauce before pureeing. Try a nourishing cream or cheese-based sauce.

Potatoes should be cooked until very soft and then pureed or mashed using generous amounts of milk or cream with butter. Do not puree for too long as the potato can go sticky. Alternatively, use instant mash made up with whole milk and added cream cheese, grated cheese, cream or butter.

Small porridge oats, instant oat sachets or Ready Brek can be made with warm whole milk and served when very smooth and creamy.

Cereals do not puree well. When soaked in whole milk until soft, they may be easier to manage.

Meat, poultry, fish, eggs and pulses

These are protein-containing foods, which your body uses for growth and repair of muscle strength and function.

Fish: it is best to use boneless fish, otherwise it may not be safe to eat.

Meat and poultry should be well cooked and then trimmed to remove any skin, gristle or fat. Cut into small cubes before adding gravy or sauce and pureeing.

Beans, pulses and lentils. These should be cooked until very soft before pureeing in a sauce.

Milk and dairy produce

These foods are often rich in calcium which is essential for maintaining strong and healthy bones and teeth.

Higher energy and protein options are readily available

Most plain yoghurts are already smooth and creamy and should be tolerable as they are.

Some yoghurts with larger pieces of fruit or added oats/granola/biscuit crumbs may require some chewing. You may wish to blend or sieve these before eating.

Hard cheeses can be finely grated and then added into creamy smooth soups, sauces, or mashed potato.

Soft, spreadable cheese options are also available.

Fruit and vegetables

These foods are rich in fibre, vitamins and minerals which help to regulate our bowel movements and also strengthen our immune system.

Tinned, frozen or peeled fresh fruit and vegetables will be easier to puree than any dried options.

Vegetables should be cooked until very soft prior to then pureeing.

Tinned fruit may need to be drained before pureeing. Try serving them with custard, rice pudding, cream or ice-cream.

Some fruit or vegetables with pips, seeds, string or skins may need to be sieved e.g. pineapple, kiwi fruit, tomato, peas, runner beans or celery.

Ready-made meals/desserts

If you are experiencing fatigue during or after treatment, these options may be convenient for you.

They might contain a mix of different food textures and therefore may need to be blended prior to eating.

Initially, cook or heat the item as per the cooking instructions on any packaging. Then puree into a smooth consistency using a blender or food processor. You may wish to add additional gravy or sauce before pureeing.

Examples of ready meals which may need pureeing after cooking include shepherd’s or cottage pie, beef casserole, fish pie, lasagne, stew, cauliflower cheese or corned beef hash.

Some desserts such as sponge, fruit crumble or cheesecake may need to be blended along with custard, ice-cream, rice pudding or instant whip to make them easier to eat.

An easier to eat, nourishing diet: For patients who have a sore mouth or who experience pain when chewing or swallowing food