Preparing for chemotherapy or radiotherapy

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Prehabilitation for people with head and neck cancer having radiotherapy or chemo-radiotherapy

This information leaflet has been written for people who will be having radiotherapy or chemo-radiotherapy to the head and neck region.

What is prehabilitation?

It means preparing for treatment by improving your:

• Nutrition
• Physical fitness
• Psychological wellbeing

Why do it?

It can help you to:

• Improve your resilience to the side-effects of treatment
• Enhance your recovery
• Feel more in control

What do I need to do?

• Read through this booklet
• Take advantage of the information and support that is being offered
• Use the next few weeks to get ready for your treatment

Nutrition

Radiotherapy or chemo-radiotherapy to the head and neck region is likely to affect how well you are able to eat. It is
important that you prepare for treatment by using the next few weeks to make sure your body is as well-nourished as it can be.

By keeping well-nourished you will be able to:

• Reduce the risk of infections
• Heal more quickly
• Maintain your strength and energy levels
• Maintain your quality of life
• Cope better with your treatment
• Prevent your treatment being delayed or re-planned because your mask doesn’t fit properly

What should I eat and drink to prepare for treatment?

There are no special foods that you should eat and no foods that you need to avoid. Have a good, balanced diet based on foods you enjoy and try to follow the guidelines below:

1. Eat a diet that is high in energy (calories) – aim to maintain your weight, or put on a few pounds if you have lost weight recently. Even if you are overweight at the moment, your body needs to be sustained with nutrition before and during treatment and you should aim to maintain your weight until you are fully recovered.
2. Eat a diet that is high in protein. Aim to include good sources of protein with every meal. High protein foods include:
   a. Meat and poultry
   b. Fish and seafood
   c. Cheese and milk
   d. Eggs
   e. Pulses (eg lentils, beans, chickpeas)
   f. Quorn, tofu and other soya protein foods and soya drink
   g. Nuts and seeds.
3. Aim for five portions of vegetables and fruit each day. A portion is 80g – that is about 3 tablespoons of veg (eg peas, carrots, greens), one medium fruit (eg apple, banana), two small fruits (eg easy peelers) or a handful of grapes. A small glass of fruit juice (150ml) can count as one of your five a day.
4. Include potatoes, rice, pasta, bread, cereals or other starchy foods with your meals to provide energy. Where possible choose wholegrain versions and leave the skins on, for extra fibre.
5. Have desserts and extra snacks between meals if you need them to keep your weight up.
6. Aim to drink 1.5 to 2.5 Litres of non-alcoholic fluids a day. This can include water, tea and coffee, herbal teas, squash,
   milky drinks. Don’t drink more than 14 units of alcohol a week. If you are finding it difficult to maintain your weight, if you have a reduced appetite, if you have any problems with swallowing or you have special dietary issues, please contact your dietitian on the number at the end of this leaflet for more individual advice.

Getting ready for treatment

It is useful to prepare for treatment by stocking your freezer and store cupboard with easy to eat and ready prepared meals and snacks. For instance you could freeze portions of softer, easier to chew foods like shepherd’s pie, casseroles and stews; ice cream is useful to have in the freezer as it can be soothing if your mouth becomes sore. Make sure you have a good supply of easy to eat tinned/ premade foods in your store cupboard, e.g. custard and rice pudding, soups (choose ‘cream of’ soups and lentil or meat based soups if possible), ready brek or Weetabix which can be soaked in warm milk to soften, evaporated and condensed milk, tinned meats and tuna fish etc.

If you have diabetes

If you have Type 1 or Type 2 diabetes the side effects of chemotherapy and radiotherapy can disrupt your blood glucose levels. You may need to monitor your blood glucose more often and you may need adjustments to any diabetes medication you take. To prepare for treatment, please contact your diabetes nurse or GP to discuss the best way to manage your diabetes during treatment.

Contact your dietitian

Physical fitness

It is important that you prepare for treatment by using the next few weeks to make sure you are as physically fit as possible. This doesn’t mean you need to train for a marathon – any improvements to your current level of fitness will help.

By taking control and improving your fitness you will be able to:

• Minimise loss of muscle mass and strength
• Cope better with your treatment
• Have more energy
• Heal more quickly
• Maintain your quality of life.

How can I improve my physical fitness?

There is specialist support available to you free of charge, to help you improve your fitness and we encourage everyone, no matter what your current level of fitness, to take advantage of this service:

The Brighter Outlook programme offers free physical activity to anyone living in Sussex who has been diagnosed with cancer, to help you get more active and improve your health before, during and after treatment. They offer group-based physical activity classes via Zoom or if you prefer one-to-one support, they will design a programme of exercises for you to complete independently, taking into account your current level of fitness and exercise preferences.

Ask your specialist nurse for a referral to Brighter Outlook, or if you prefer you can self-refer using the form on their website.

All types of physical activity will help you improve or maintain your fitness and your strength. Here are some more suggestions:

The Horizon centre runs a variety of activity sessions you can do from home – these are a mixture of Microsoft Teams and face to face sessions. This is very easy to use – just give them a call and they can help you get set up! Call 01273 468 770 or email [email protected].
There are many fitness videos online that you can do at home. The NHS has a selection of different types of exercise sessions. There are options for all fitness levels including seated exercises. Have a browse and give them a try!
Stay active around the house with daily activities such as housework, vacuuming, hanging the washing, gardening. Climb the stairs more often.

Take a walk every day, gradually building up your speed and distance. Some people like to count their steps with their smart phone, aiming to increase the number of steps each day. To improve your muscle strength it is important to combine physical activity with good nutrition. Read the nutrition information we have provided and also consider having a protein based snack soon after an activity session – this could be something like peanut butter or cheese and biscuits, or a glass of milk or high-protein yoghurt.

Psychological wellbeing

It is normal for people to experience many different emotions when they are given their diagnosis and learn about their treatment plan, and these can be difficult to cope with. It is common to feel anxious and afraid. Partners, family and friends may also have some of the same feelings. You may also have practical concerns, eg. about your finances while you are having treatment.

What psychological support is available to me?

It often helps to talk to someone and support is available to help you cope with your feelings and practical concerns, and prepare psychologically for treatment. Your Clinical Nurse Specialist or Macmillan support worker are available should you need support. They can provide emotional support and can refer you for specialist counselling if needed. The nurse or support worker will make sure you have their contact details so you can get in touch with the team at any time.

Their contact details are:

The Macmillan Horizon Centre has a wide range of wellbeing and support services which all our patients can access. We encourage you to complete the Macmillan registration form in this pack, pop in to the Horizon centre reception, or call them on 01273 468770 to find out more about what is on offer.

You can call the Macmillan Support Line on 0808 808 00 00 7 days a week, 8am-8pm. They offer emotional support and practical information, e.g. about welfare rights and Macmillan grants.

The Brighton & Hove Wellbeing Service have a range of self-help resources which you can access on their website.

If you would like to chat to someone who has gone through a similar experience, The Brighton Head and Neck Phone Buddies are volunteers who have gone through a head and neck cancer themselves, or have cared for a loved one. They know first-hand how hard it can be to cope emotionally, physically and practically.

A Buddy is usually present at Wednesday clinic, or they can be contacted through the Horizon Centre, as above.
There are two support groups specifically for people with head and neck cancer:

The Swallows is a national support group for patients, carers and family members. It has monthly meetings, a 24 hr helpline and also offers free care packs. You can have a look at their website or call their 24/7 support line on 07504 725059