Thrush is a common cause of symptoms and side-effects affecting the mouth during cancer treatment. It’s easy to treat, so it’s important to get this checked if you’re concerned.

Thrush is a fungal infection (candida) that can affect the mouth (oral thrush) particularly if your immunity is low. If you have thrush in your mouth you may notice a variety of symptoms – these are listed below. If it’s left untreated, the symptoms will persist and may cause further problems. Your mouth will continue to feel uncomfortable which can make eating and drinking more difficult.

Symptoms can include:

• Painful, burning sensation in the mouth
• Loss of taste or an unpleasant taste
• White patches in the mouth that can often be wiped off, leaving behind red areas that may bleed slightly
• Redness inside the mouth and throat and cracks at the corners of the mouth.

Oral thrush isn’t contagious. Let your healthcare team know if you think you have oral thrush as it can easily be treated with anti-fungal medication which they can prescribe.

Problem foods and drinks to avoid

• Dry and rough foods like biscuits/rice cakes/ toast can be scratchy and difficult to eat
• Acidic foods like citrus fruits, fruit juices or tomatoes can sting the mouth
• Salty, spicy, and pickled foods can be painful to eat (consider reducing the amount of seasoning in savoury dishes).

Soothing foods and drinks

• Opt for bland foods and drinks
• Let hot food and drinks cool down as they can be painful
• Opt for colder food and drinks
• Eat cold yoghurt or drink cold milk based drinks
• Suck ice cubes or lollies
• Add ice to drinks
• Ice cream or sorbet that’s not too acidic e.g. apple, mango or pear can be a pleasant dessert

Utensils

• If you find drinking painful try using a straw
• Use a teaspoon to help avoid food coming into contact with sore parts of your mouth.

Soft moist foods

• Moisten savoury foods with sauce, gravy or mayonnaise
• Moisten sweet foods with yoghurt/blended fruit/fruit compote/cream/custard/ice cream

Talk to your healthcare team about mouthwashes or painkillers that may help.

Tips for easier eating and drinking:

• Take frequent sips of fluid to help keep your mouth moist.
• Ensure a good fluid intake – most people need around six–eight glasses/mugs (1.5–2 litres) of fluid each day, but this can vary. Normally, the colour of your urine is the best indicator. It should be a pale yellow colour if
  you are drinking enough.
• Stimulate saliva production by:
  • Chewing gum (sugar free) or sucking ice cubes, ice lollies made with fruit juice, or sweets
  • Adding citrus juice to drinks, eating pineapple chunks (be cautious if you also have a sore mouth).
• Cut food up small so that less chewing is needed.
• Choose soft moist food
• Avoid alcohol and very hot drinks, these can make symptoms worse.

Mouth care:

• Brush your teeth and mouth regularly using fluoride toothpaste.
• Use a small water spray to moisten your mouth regularly.
• Use a lip balm to help prevent and protect lips from cracking and becoming sore.
• Avoid mouthwash that contains alcohol or glycerine as this can make symptoms worse.

Talk to your healthcare team about trying a moisturising mouth gel or an artificial saliva spray.

Soft moist food ideas

Meal, side dish and snack ideas

• Cereals soaked in cold or warm milk, porridge
• Scrambled or poached eggs, omelette
• Soup
• Small pieces of tender meat/poultry/fish/
• Quorn™/tofu served with a gravy or sauce e.g. casserole/stew/goulash/curry
• Meat/fish/vegetable pies or dishes topped with mashed potatoes e.g. cottage pie/fish pie/moussaka. Add extra sauce/gravy to moisten if needed
• Well-cooked pulses (lentils, peas and beans) e.g. baked beans with a sauce, dhal or hummus
• Couscous/quinoa, with a dressing or sauce
• Rice dishes with sauce/risotto
• Soft noodles/gnocchi with a sauce
• Pasta with a sauce e.g. macaroni cheese or pasta bake
• Soft well-cooked vegetables
• Polenta
• Boiled/baked potatoes or sweet potatoes (without the skins) mashed with milk/soft cheese/cream/crème fraîche/butter/margarine.

Dessert ideas

• Tinned/stewed/soft fruit/fruit compote
• Jelly
• Milk puddings e.g. rice pudding/yoghurt/ mousse/custard
• Ice cream/sorbet
• Other desserts may be moistened with any of the suggestions above, or crème fraîche/cream.

Difficulty with swallowing can arise particularly after radiotherapy to the head, neck and chest area.

Tips for when swallowing is difficult:

• Chose soft/moist/smooth foods – (see above for soft moist food ideas)
• A food processor, hand blender or liquidiser can be used to alter the consistency of foods if needed.
• When blending food, add fluid to achieve an appropriate consistency. It’s better to use nutritious fluids such as gravy, sauces, milk or custards rather than just water.
• Sip fluids between mouthfuls.
• Remove skins and stalks from fruits/vegetables. Avoid or sieve varieties containing pips and seeds e.g. frozen berries.
• Remove crusts from bread and opt for non-seeded varieties.
• Try to take your time, chew food well, and have small portions more frequently.
• Avoid rough, fibrous, lumpy, hard or crunchy foods that are difficult to swallow.

If you’ve been given specific advice from your medical team, dietitian or speech therapist please continue to follow this.

Most people experience taste changes particularly if they’re undergoing chemotherapy. Dealing with these changes requires patience and willingness to experiment with different flavours and combinations of food and drinks.

It’s important to ensure that you brush your teeth and mouth regularly using fluoride toothpaste. Choose plastic or bamboo cutlery if you have a metallic taste in your mouth.

If you have an unpleasant taste in your mouth you may find sipping drinks such as lemon juice/cordial in water, herbal tea or fizzy drinks refreshing. Chewing gum or sucking mints/sweets may also be helpful. Strong flavours can also be helpful to overcome an unpleasant taste or lack of taste e.g. curried/marinated foods or strong cheeses. Using herbs, spices, chilli or garlic can be an easy way to give extra flavour to dishes. Dressings, vinegars or sauces can be added to foods to improve their flavour also. Hot/warm foods are easier to taste than cold foods.

Sharp foods such as citrus fruits (lemon/lime/grapefruit), berries, pineapple or rhubarb can help to stimulate the taste buds and saliva production which can help freshen the mouth. Fruit puree or compote can be added to sweet foods to enhance their taste. Be careful if your mouth is also sore, as spicy/sharp food and drinks may make this worse. Cold, smooth and moist foods can be soothing for a sore mouth – check the soft moist food ideas above for more information.

If nausea and vomiting is caused by medical treatment, your doctor may need to prescribe anti-sickness medication. These medicines work in different ways so it may take time to find the right one for you.

Let your healthcare team know if the medicines you’ve been prescribed aren’t working well for you.

Some dietary changes may be helpful:

General tips:

• Keep your mouth clean, moist and fresh
• Try a dry snack early in the morning such as toast or a plain cracker or biscuit to settle your stomach
• Try eating something every two to three hours, some people find that going for long periods without eating can make nausea worse
• Eat in relaxed surroundings, anxiety can worsen symptoms
• Sit up and stay sat up for a short time after eating
• Ginger or peppermint can help to settle the stomach (try chopped fresh ginger or fresh mint and a slice of lemon in hot water, ginger ale, ginger beer, ginger biscuits, or sucking mints).

Foods that may make nausea worse are:

• Fatty or rich foods including fried foods
• Spicy foods
• Foods with strong smells can also make symptoms worse:
  • Open a window to allow fresh air in the room where you eat
  • Set up your eating area away from where food is cooked and served and close any doors to minimise food smells
  • Let someone else cook or try using ready prepared meals so you’re not surrounded by cooking smells before eating.

If you’re feeling nauseous you may need to change your normal approach to eating. This may involve some experimenting to see what you’re able to tolerate.

Generally, many people find that colder foods are better tolerated as they produce less smell. Other common preferences include dry, salty or plain foods.

Please let your healthcare team know if your symptoms continue. Often a change in medication can help prevent or reduce nausea.