Radiotherapy/Chemotherapy

 Hi Merlin,

My name is Gail, and I’m one of the cancer information nurses on the Macmillan Support Line.

Thank you for getting in touch.

I’m so sorry to hear that your cancer has returned, and that you’re having to go through such an  intense course of radiotherapy and chemotherapy  especially after everything you went through earlier this year. That is an enormous amount to cope with, and it’s completely understandable that this feels overwhelming.

It sounds as though the difficulty you’re having with swallowing (which we call dysphagia) and the pain in your throat (known as mucositis) has become very severe, particularly if you’re now limited to soup and ice cream. This is, sadly, a very common and distressing side effect when radiotherapy targets the throat area. Many people find the soreness and burning sensation worsens during treatment and can peak a week or two after radiotherapy finishes.

The fact that soluble paracetamol and the antacid mouthwash aren’t helping suggests that your pain needs to be reviewed urgently. Getting you better pain control is the very first step we need to take, and here are the most important ways I’d encourage you to seek that support.

The most important thing is to let your oncology team know that your current medication isn’t working and that the pain is now affecting your ability to eat and drink. Please ask the team straight away about stronger pain relief. Your team can prescribe medications that are much more effective for this type of pain —often a stronger liquid pain relief like oral codeine or Oramorph. These can be used on its own or occasionally as part of a specialist mouthwash taken just before meals. These medicines are commonly used and can make a significant difference, helping swallowing to become more manageable.

Radiotherapy can cause inflammation and breakdown of the throat lining, and it can also increase the risk of oral thrush, both of which can add to the pain. There are additional gels or mouthwashes that may help. Also, as you are having chemotherapy, it is important to reach out to your 24 hr chemotherapy helpline straight away is there is any sign of infection, such as a temperature or chills. While you’re talking to them, please also ask them to check you over for mucositis or thrush.

We also want to make sure you have the right specialist support, so please ask your team to urgently refer you to a dietician and/or speech and language therapist (SALT) . A dietitian can help you maintain your weight and energy levels by recommending high-calorie, high-protein drinks and soft foods. They can also prescribe nutritional supplement drinks (such as Ensure or Aymes), which are designed to be much easier to swallow. Meanwhile, a speech and language therapist can assess how safe your swallow is and give you tailored advice and techniques to help reduce discomfort and the risk of choking.

While you're waiting for that review, you’re absolutely right to stick with very soft, smooth foods for now. To get the most nutrition from what you can manage, we want to boost those calories wherever possible. For soups, try stirring in cream, butter, cheese sauce, or smooth nut butter. For ice cream, blending it with milk or cream makes a more nourishing shake. It's also worth noticing that temperature really matters: many people find very cool or lukewarm foods easier to swallow than hot foods, which can irritate the throat further.

Please do contact your chemotherapy 24-hour helpline, Clinical Nurse Specialist (CNS), or the oncology ward as soon as you can. Getting your pain under better control is essential for helping you through the rest of your treatment.

If you’d like to talk things through in more detail, you’re very welcome to call us on the Macmillan Support Line on 0808 808 00 00. We’re here every day from 8am to 8pm, and we can help you think through questions to ask your team or talk about food and pain relief options in more depth.

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