My name is Claire and I am a Specialist Macmillan Head and Neck Dietitian at Derriford.
Firstly, let me start by saying I absolutely love my job, every day is different, varied and I feel a valued member of the Head and Neck team. Often, Dietitians are perceived as the ‘food police’ putting people on diets to help them lose weight. However, there is so much more to our roles that often people are not always aware of.
Hopefully this blog will give you an insight into the work I do
I see patients undergoing all types of treatment for head and neck cancer including radiotherapy, chemotherapy and/or surgery. I follow patients through the whole of their journey, from diagnosis to five-years post-treatment and I get to know my patients very well – this is one of the reasons I love my job!
The treatment for Head and Neck Cancer is brutal; patients can suffer from dry mouth, ulcers, thick, sticky secretions, pain, swallowing problems, nausea, loss of appetite and taste changes. As you can imagine, due to these side effects it becomes very difficult for a patient to eat and drink – and this is where I come in. So thought I might give you a little insight into a patient’s journey and how my role fits in.
My role in their journey
As soon as a patient is diagnosed with Head and Neck Cancer, I see them in a pre-assesment clinic alongside the Clinical Nurse Specialist and the Speech and Language Therapist. During this clinic I discuss the potential side effects of treatment which may impact on their ability to eat and drink and we discuss ways in which they can optimise their nutritional intake.
Depending on the size of their tumour and the treatment modality, a patient may also require a feeding tube before starting treatment. A feeding tube can help support a patient during their treatment, as it is a route for nutrition, hydration and medication if they are unable to swallow. The thought of having a feeding tube sticking out of their stomach can be very daunting and often patients seem to be more concerned about this procedure than the cancer treatment itself! During this appointment I talk them through the procedure and processes and provide them with information, hopefully helping to ease any concerns or worries they may have.
Working as part of an MDT
During a patient’s chemo/radiotherapy treatment, I see them every week for six-weeks alongside a Speech and Language Therapist. I monitor their weight, dietary intake, bloods, hydration, bowels and we assess the severity of the side effects of treatment.
I provide practical dietary advice on suitable foods to choose, texture modification, portion sizes, meal patterns, food fortification, the use of dietary supplements and feeding tubes in order to optimise their nutritional status. I am often advising patients to add cream, cheese and butter to foods, the opposite to what you might think a Dietitian does! Providing dietary advice can help to correct nutritional deficiencies, aid recovery, prevent treatment interruptions, prevent hospital admissions and maximise patient motivation.
After treatment, initially patients get seen in another joint clinic based in the Mustard Tree. Two weeks after treatment are often the worst in terms of side effects and we call this ‘peak reaction’. Nutrition at this stage is crucial for recovery and I provide advice and support in order to maximise their nutritional intake.
I then follow patients up on a monthly basis in a Head and Neck Clinic alongside the consultant. If patients are still struggling, we then invite them back to a joint Dietitian and SALT clinic where we provide support, discuss various strategies for dealing with the longer lasting side effects of treatment and set individualised goals.
Our aim is to get patients eating and drinking again, and to remove their feeding tubes as quickly as possible. Often patients need to adapt their diets in order to do this and eating and drinking may never be the same. However, I hope that our input helps them achieve a ‘new normal’ and helps improve their quality of life and motivation to eat and drink.
Why do I do it?
I am in awe of my patients and how they cope. I love eating, socialising and having meals out with friends and family, food is such a massive part of our lives! I can’t imagine how I would cope if someone told me I was going to have treatment that would stop me from doing these things.
However, my patients do and I am amazed by their positivity, resilience and motivation to cope. I feel my role is important and has a positive impact in supporting patients throughout their journey. Hopefully you feel the same way after reading my blog and can see there is much more to being a Dietitian!
Claire is writing as part of the #WeCare2 campaign that will be running across our Trust communications. Look out for more from Dietetics, and their AHP and HCS colleagues, on our social media pages, Trust screensavers, Daily Email, Vital Signs and much more.