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Cancer Treatment Radiation = Mouth Sores = Poor Nutrition. Soft, delicious solutions?

A dear friend of mine is undergoing daily radiation for treatment of an oral cancer. She's one week into a six week treatment and has developed painful mouth sores. She is in her 80s and has family who will cook, is a lifelong CH and having a terrible time finding something to eat that is delicious, soft and protein-rich. She prefers savory to sweet flavors, but that could change. I've suggested oyster stew, savory custards, chicken liver pate, puree of peas w/mint, rice pudding, Thai butternut squash soup, shrimp-scallop-sole terrine and many other possibilities. She also needs extra calories as she's too thin, per her physician.

Anything acidic, crisp or that needs chewing is O-U-T for obvious reasons. Thank you, hounds. This is a very special lady, deserving of much kind attention.

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  1. how about a

    nice creamy polenta with a mushroom and marsala reduction

    lasagne with bechamel

    chicken and dumplings

    baked eggs with ham, cheese and truffle oil

    1. It may sound cliche, but if she has people who can cook for her, I'd recommend homemade chicken soup. Instead of the traditional noodles, they could use rice, or a small pasta like ditalini. Extra chicken, minced finely, could be added to increase the protein value.

      1. souffle

        basted, coddled, shirred eggs.

        polenta with delicious add-ins. would that be too gritty?


        scrambled eggs with cream cheese.

        all the best to your friend.

        1. The Autumn Soup with Bacon on epicurious is caloric and delicious, and makes a huge batch, and freezes well to boot. http://www.epicurious.com/recipes/rec...

          Saffron risotto with plenty of butter and parmesan cheese.

          Red lentil stew with onions, garlic, ginger, carrots, and curry powder/paste in coconut milk and chicken stock, then pureed, is super-protein-rich and delicious.

          Hummus is nice by itself. Split pea soup is good too. For the occasional sweet or breakfast item, smoothies with frozen fruit and silken tofu.

          1. There is a cookbook called (I believe) Cancer Survival Cookbook, and has recipes that address the needs based on the type and stage of treatments (e.g. pureed, soft, low fibre, low fat, etc). It also provides nutritional information. I am not at home at the moment, but will follow-up with the exact title, author and ISBN for you.

            1. we've had a similar book by eileen behan called Cooking Well for the Unwell. perhaps your library would have it.

              1. Thanks to all who have answered, so far. I have forwarded your suggestions and ordered THE CANCER SURVIVAL COOKBOOK from Amazon. Will search for COOKING WELL FOR THE UNWELL as it seems to be out of print.

                Your help is truly appreciated and I'm humbled by your caring thoughtfulness. Thank you.

                1. Egg drop soup or avgolemono - the eggs add extra protein.

                  1 Reply
                  1. re: dubedo

                    egg drop sounds great, but avgolomeno might be too acidic because of all the lemon. it is yummy though.

                    what about mashed roasted sweet potatoes? lots of fibre, lots of vitamins. she could top with sour cream or yogurt for extra protein and calcium.

                  2. Ice cream four times per day!!

                    1. make frittas- eggs cheese fresh herbs
                      quiche- broc and cheese iss easy
                      twice baked potatoes with sour cream butter cheese, cook pototo then let it col. slice in half. cut out inside. add some some milk some butter and sour cream and bake. add some paprika and salt. on top if they can tolerate.
                      also choc pudding is dandy. rice pudding homemade with some whipp cream should add some pounds.

                      make some tasty shakes and add some bananna- nothing citrus like.some ice, milk, fruit icecream

                      that should get her started

                      1. How about egg salad and deviled eggs? You can keep them in the refrigerator and serve as a snack. Cream soups would also go down easily..clam chowder, corn chowder, etc. I make a sichuan tofu dish with silken tofu that is delicious. Any chinese tofu dish would probably work, as would pho....the vietnamese beef noodle soup. If you went to a chinese dim sum place, many items are easy to eat. Rice noodle wrappers are non-abrasive in the mouth. Taro root cakes are delicious and savory, har gow shrimp dumplings are soft, etc.

                        1. Matzah Ball Soup is always good. We have a friend going through chemo and bring it to her home and she loves it.

                          Micheal Milken, the Junk Bond King, recently wrote a dietary book for cancer survivors, based on his battle with cancer, I have bought if for people on AMAZON. It might offer some good choices.

                          I wish the best for your friend and hope she is able to be comfortable.

                          1. My mom, when she underwent exactly the same kind of treatment some thirty-five years ago, found the things she liked best were tapioca pudding with eggs beaten into it, and lemon sponge pudding from a recipe in the Joy of Cooking. It was strange that the lemon wasn't too acidic, but it wasn't -- I suppose because there was a lot of milk in it. For what it's worth, she survived the treatment and two recurrences, to die of something else thirty years later.

                            1. I've made the twice-baked goat cheese souffles on epicurious and think they'd be perfect:


                              They puff up beautifully the second time they're baked, so it would be very easy to whip some up and keep them in her fridge (or freezer) where they'd be just 10 minutes away from ready. (I think they'd adapt to all different kinds of flavors.


                              Also, when my Mom went through similar mouth sores, she enjoyed these asparagus flans:


                              We also pureed broc, cauliflower, or whatever and mixed in crab and cheese--to up the flavor and the protein.

                              Good luck to you and to your friend, and as you're trying to support her, know her taste buds may (probably will) change and things she once liked may be distasteful; if she doesn't seem to be eating what you bring (and she can't/won't tell you why), try moving toward blander/less odiferous offerings.

                              Take care.

                              1. Mouth sores are so awful I hope we can help make your friend a little more comfortable.I have a similar challenge in that my mom, 90, lost her lower denture and can only eat soft things.Mom was very happy with a bowl of cream of corn soup. Sweat down a small onion in butter and sprinkle flour over it to make a roux. Pour in about 1/3 cup milk, stir until thick. Add corn broth and (I get it in Trader Joe) and 8oz of frozen corn. If you don't have corn broth add two large cans of creamed corn. Season with nutmeg and a little salt and pepper.

                                1. Vichyssoise -- really smooth, rich (high calorie). Lots of rich soups fit the bill: cream of tomato, butternut squash, etc.

                                  1. Dont know about delecious but cottage cheese has plenty of protein and is soft, mix it with a little buttermilk or yogurt will liven it up a bit.

                                    1. Plain chawan mushi-tofu-cream of wheat,mashed potatoes with plenty butter and cream, Underwood Deviled ham, Vienna sausages. My husband had a very bad toothache with a vacationing dentist, so he stuck it out for 6 days eating these soft foods.

                                      1. This may sound silly, but graham crackers or ginger snaps soaked in whole milk and mashed is a nice sweet treat that requires no chewing. Serve with mashed bananas and a bit of rum, or on top of pureed pears or applesauce. Soften a bit of good vanilla ice cream and serve mit.

                                        Also, pureed butternut and sweet potato with a bit of mascarpone cheese to beef up the calorie count. Or Mexican crema which is so far superior to U.S. style sour cream.

                                        Yogurt smoothies with homemade preserves to sweeten. Load them up with fresh seasonal fruits.

                                        At 80 years, watch out for things too concentrated in fats. They can upset the stomach and result in an irritable bowel syndrome-type response. That would be no fun on top of what she's enduring already.

                                        2 Replies
                                        1. re: toodie jane

                                          Those are really excellent suggestions. I had not thought of the possible high-fat problem.

                                          No cancer in the family so far, but I do have experience with people with chewing problems. I'm sure there will be great suggestions in the cookbooks recommended.

                                          Fat aside ...

                                          Refried beans are good and easy to handle when you can't chew. Add cheese if that is ok.

                                          Mashed potatoes do it for me always ... settle the stomach and are warm and comforting. Melted cheese can be added for protein and they can be cooked in chicken broth instead of water. Or add milk which has protein. You can do a lot with mashed potatoes.

                                          Scrambled eggs are good ... you can gussie them up with herbs.

                                          Smooth desserts like puddings (as mentioned), mousse, ice cream ... and cheese cake ... big calorie hit there.

                                          Depending on the fat problem and what she likes... pate, chopped chicken livers, soft cheeses like brie ... they can be put on soft white bread ... just get rid of crusts.

                                          I helped out with one woman other than my mom who was having chewing problems ... you would think it would work .. but she hated baby food ... I tried some and didn't blame her. Even a few sick cats wouldn't touch it ... but you can always give it a try.

                                          Yogurt is good too if she likes that. Tasty smooth soups as mentioned are good too.

                                          You want the biggest bang for the buck calorie-wise because often people in that situation aren't interested in eating for an extended amount of time.

                                          There are those drinks like Ensure, but quite frankly, I can't think of anyone who liked those except when they were starving. I tried them and they kind of suck.

                                          As mentioned fruit sauces like apple. Bananas are good. Italian food is good if the pasta is put aside .. so cannoli is good, just eat the cheese/sauce and skip the noodles ... though I'm not sure if the tomato sauce would be too acidic.

                                          Eggs can be incorporated in a lot of stuff like mashed potatoes or shakes or even oatmeal ... don't sweat the choleserol unless doctors say otherwise ... the woman is in her 80's. It takes a while to build up. Please don't jump on me for that last unless you have experience in this situation. I'm just being practical. The most important thing is eating. All the rest is incicental. Again, work with the doctor or dietician.

                                          1. re: rworange

                                            As I was hospicing my Mother some Doctors tried to tell us she shouldn't have any salt. Well my Mom was dying, did they really think I was going to deprive her of salt. IMO at that stage of life they should get anything they want.

                                        2. how about congee made with chicken stock? very nutritious (and delicious!)

                                          1. When I was young and had hand, foot mouth disease, the only thing I could eat was chicken broth with hard boiled egg yolk dissolved in it. It was so good and nutritious.

                                            1. Homemade ricepudding with extra eggs beaten into it, and homemade English-style or baked custard with pureed fruit are both very easy to eat and nourishing.
                                              If she prefers savoury tastes, maybe congee or very soft risotto? And of course any kind of soup you can imagine...

                                              1. If she can handle baby food, that's what I ate one time when my mouth was raw. I wonder if acidolphus would help her?

                                                1 Reply
                                                1. re: ncs821

                                                  you can get a special food mill to make regular food into baby food. about $15-20. Then anything can be served if it doesn't upset the plumbing.


                                                2. I bought a used copy of "Cooking Well for the Unwell" on Amazon. Lots of great tips for increasing nutrition for small appetites and specifically soft mouth issues...they recommend finely ground meat (beef, turkey, lamb, or pork) with gravy, soft casseroles with the same, chopped egg, tuna or chicken with mayonnaise salads, mashed pureed veggies, cooked hot cereals, pancakes, muffins. Bread puddings, custards. Avoid whole grains and nuts. Really really helpful.

                                                  1. Ideas that come to mind...
                                                    -Avocado shakes made with full-fat dairy
                                                    -Guacamole (easy on the acid component, of course)
                                                    -Avocado is also good when paired with scrambled eggs

                                                    And if avocados are prohibitively expensive...

                                                    -Tonnato sauce (I know this usually goes over another protein, but I always thought the sauce was good enough to eat with a spoon :)
                                                    -Lassis (sweet or savory- I make the savory kind with toasted cumin, black peppper and mint)
                                                    -Banana pudding (the southern staple made with vanilla pudding and vanilla wafers)
                                                    -Smoked salmon spread (crackers not necessary :)
                                                    -Chocolate mousse
                                                    -Pureed black bean soup (well-cooked chunks of sweet potato, Mexican crema, sour cream, maybe a little chipotle could be added or blended in for a different flavor
                                                    -Dahl (I use Masoor lentils with ginger, onion, cumin, coriander, turmeric, salt and cayenne)
                                                    -Mashed cauliflower with sour cream and horseradish

                                                    Best wishes for your friend and all those who care for her,including you....

                                                    1. Hi again, Sherri,

                                                      Not sure if this will appeal to your friend but I did an oatmeal search this morning (bored with my breakfast) and came across a link about savory oatmeal. Never would have thought of it. May not sound gourmet but could perhaps be soothing and tasty and something a bit different.
                                                      Here's the link:

                                                      Also, one thing I've learned is that when trying to feed someone who is having difficulty it helps to offer very small amounts in small dishes. Just the visual of a cereal bowl full of rich soup can seem overwhelming and turn the diner off before even beginning. Sorry if that seems too obvious. I had to be taught that at one time.

                                                      good luck.

                                                      1. I had gastric bypass surgery in the past year and had to live on soft foods for a while. Getting in enough protein was always the problem. However, some of my diet mainstays...

                                                        Cottage cheese--you can mix it with different herbs for a savory punch, or try it with cinnamon and brown sugar for a sweet treat.

                                                        Cheese grits--cook them with milk for extra smoothness and more protein.

                                                        Cream soups--mixed with mashed potatoes to make them more hearty.

                                                        Peanut butter with mashed banana--deelish and if she can tolerate bread, you can make a sandwich

                                                        Yogurt and more yogurt

                                                        Oatmeal with apples or bananas cooked until mushy with cinnamon and honey

                                                        Refried beans with cheese and sour cream

                                                        Protein shakes. You can make them to suit her individual tastes and unlike Ensure, they can actually taste good: Milk and fruit in the blender with whey protein powder. There's an unflavored protein powder called Beneprotein that can be added to almost anything to enhance nutrition. You can get it at www.Walgreens.com. If you can get her to drink a protein shake every day, it will go a long way to supplementing her nutritional needs.

                                                        God Bless and God Speed to you and your ailing friend.

                                                        1. another vote for souffles and risottos. but how about goulash/stews? When they are cooked long enough they are good and soft. (I like my goulash best after three days of repeated reheating when it is more thick soup than anything else)

                                                          1. Sherri, My neighbor finished his treatment 2 months ago. He did chemotherapy and radiation at the same time, for about 5 weeks straight. One of those treatments was done only once a week, I can't remember which. He also developed the mouth sores and I know it was extremely difficult for him. We took their family many meals. Towards the end, he was fed through a port in this shoulder area because he couldn't keep food down. When he was able to eat, I made quiche which he liked because it was soft and nutritious. I read that chemo/radiation patients would do well to eat miso soup because it helps rid the body of excess metals. i don't know if that's true or not but I've taken it to him a few times. It's quite simple to make or always available for take out at a good Japanese restaurant. Good luck to your friend. By the way, our friend just came back with a clear cat scan and his doctors are considering him a success story.

                                                            1. Just like to add Quinoa to the list.

                                                              Tastes like a polenta/kasha mix and is soft and fluffy and has a lot of great nutrition and is very filling.

                                                              for info, go to http://www.quinoa.net


                                                              1. as a nutrition student who just took a course in nutrition in disease I would recommend speaking to a dietician or nutritionist about calorie intake.

                                                                The above poster made a comment on fat, this may not be true. While some people cannot tolerate a lot of fat (I have IBS and this is true for me too), there isnt a problem in most cases. As far as this person is concerned, I wouldnt limit or avoid it unless there is a problem. It would be important to try to incorporate calorie dense foods into the patients diet, as it may be difficult to get all of the nutrients into her if she is in pain and nauseauted. Things like ice cream and cream based soups, or cheeses may fit into this catoegory. As for the tidbit on soup and clearing metals, this isnt true. Soup, like any other food will break down into its macronutrients in the gut, and wouldnt be more helpful in this regard than a piece of steak.

                                                                Also keep in mind that eldery people get easily dehydrated, and the risk is higher when intake and appetite is decreased. Once again soups would be useful in this regard, as would smoothies, apple sauce, pudding to some extent. Nauseau is a common symptom of cancer treatment so keeping food smells to a minimum and tastes neutral can be helpful. If she wants flavour, bring it on of course!

                                                                Hopefully things will improve shortly, especially with the mouth sores. It's hard to get elderly people to eat enough often, so the more you can get her to enjoy the better. Hopefully it won't come to parenteral nutrition, as the another hound mentioned (fed through the portal vein in the chest through a tube, liquid solutions and emulsions, no real food, can you imagine?!). I'm sure with you feeding her, she will be just fine! Good luck to you!

                                                                1 Reply
                                                                1. re: cupcakez

                                                                  I love you. Despite being a student, you have a real solid take on the situation. I just wanted to add though that parenteral nutrition, in whatever form, while not the best, isn't as scary as it sounds and is nothing to be afraid of if it comes to that. My mom lived over five years that way ... but it really freaked me out in the beginning. For some people it is a short term solution, others permament.

                                                                2. Yogurt will help with the mouth sores

                                                                  1. Sherri, you've gotten some excellent suggestions. Mashed potatoes, poached eggs and creamy soups are good.

                                                                    I myself have found that Ensure High Protein shakes are not that bad. I serve them cold, add ice cream, a little milk. This goes into the blender and it's okay. The thing with Ensure is it contains loads of vitamins and your friend would be getting her daily nutritional requirements if she drank 2-3 bottles daily in addition to whatever else she eats and drinks. The chocolate shake is tasty especially with ice cream.

                                                                    Tip: this may seem obvious but always serve liquid drinks with a straw. It's less painful to consume with mouth sores and goes down easier.

                                                                    All the best - you are a wonderful friend!

                                                                    1. My mom lived on cheesecake when she was in chemo -- and you should be able to find plenty of recipes for savory ones.

                                                                      1. I'd recommend a fish pie - basically a fish pudding topped with mashed potatoes

                                                                        as requested: soft, protein rich, savory, delicious and not acidic

                                                                        Boil some potatoes...

                                                                        Poach a mix of salmon and cod in milk.
                                                                        Set fish aside and make a bechamel with the poaching liquid.
                                                                        Mix the fish and bechamel, can also add herbs or veggies e.g. peas, corn...

                                                                        Make mashed potatoes

                                                                        Spoon fish into a casserole and top with the mashed potatoes

                                                                        Bake at 350 for about half an hour

                                                                        1. A way to get protein into somebody who can't chew is Shrimp Bisque. Drop raw in-shell shrimp into boiling water (use a pint of water per pound of shrimp). Cover. Let come back to a full boil then remove from fire. Let set until cold. Save water. Shell shrimp. Put through Cuisinart. Make soup base using shrimp water, milk, cream in desired combination (plus butter and flour of course). Be VERY careful about seasoning if person has sore mouth as salt may hurt. Add Cuisinarted shrimp. Add a teaspoon of ketchup for color. Adjust consistency and seasoning. Add a little sherry if that would be agreeable. This freezes nicely.

                                                                          1. To all of your wonderful suggestions, I say THANK YOU!!! (yes, I'm shouting because I'm so excited with the results). I've just spoken with my friend again and this is the first time she has sounded like herself. She is absolutely thrilled with the sugestions, so far, and says that she would have never have thought of all the delicious possibilities. She thanks you, her family thanks you and I thank you. (I would be cooking for her if she didn't live 2000 miles away, so there is a frustration factor here for me)

                                                                            Tonight, she reported that she was eating liver pate (sans crackers), sliced avocado, deviled eggs and a garlic custard. She has enjoyed various creamy soups & bisques, risotto, polenta that was made by whirling porcini in a blender and adding the "dust", rice puddings - both sweet & savory, scarmbled eggs of every description, mashed potatoes & carrots and many more treats.

                                                                            Again, hounds, I thank you. The outpouring of care and great information is heartwarming. Chowhound is a terrific community.

                                                                            1. hey, i'm 16 and i have leukemia i'm and suffering from really bad mouth sores. and i just wanted to say thank you! to everyone! i got some really good ideas from this and i just got some food in me without too much pain! so thank you everyone!! and the one other thing that i've found that is good and very nutritious! its just a drink made with half and half, a little bit of vanilla, some sugar, and a raw egg. i added a little bit of raspberry syrup to give it more flavor. i understand i'm kinda late to help you out lol but this helped me out, so maybe it can help someone else out. and egg drop soup is great lol. okay well i hope she is doing better, and thankyou all for great advice!

                                                                              1 Reply
                                                                              1. re: coffiibean

                                                                                coffiibean--all the best to you in your treatment, but can you really eat raw eggs????

                                                                                Please ask your medical team if this is wise. An impaired immune system may not be able to handle this.

                                                                                Your team should be able to give you books or specialized diet instructions on what to what and what not to eat. Some of the info is counter-intuitive, so it's always better to ask first, eat later.

                                                                                I'm glad you have the interest in keeping your nutrition up. Keep your spirits up too, get all the hugs you can find, listen to uplifting music, tune out the chaos and strife of daily life. Concentrate on getting and being well, and keep your eyes on the prize, toots!


                                                                              2. Try a real ragu: ground beef, lots of carrots and celery, light on the tomato and spices. This worked very well in a similar situation. You can do this with soft pasta and it slips right down.