Proton Therapy for Head and Neck Cancers

For patients with complex head and neck tumors, proton therapy allows us to treat the tumors effectively while minimizing the radiation dose to vital structures such as the eyes, mouth, and brain. That means a patient’s vision, smell, taste, and swallowing may not be affected by proton therapy. It also means side effects such as nausea, severe dry mouth, difficulty swallowing, loss of taste, and thyroid dysfunction are not as severe with proton therapy.

But some head and neck cancer patients will experience skin irritations, mouth sores, sore throat and painful swallowing due to the tumor and treatment location. 

As nurses at MD Anderson Proton Therapy Center, we get a lot of questions from head and neck cancer patients and caregivers about managing these proton therapy side effects. Here’s how we answer some of the most common ones.

How do I deal with skin irritations from proton therapy?

We recommend that patients wash the affected skin daily with mild moisturizing soap to cleanse. Use an unscented moisturizer starting on the first day of treatment. Do not use anything abrasive on the skin, and avoid wearing shirts with collars. Use an electric razor, and avoid aftershaves or perfumes. Do not apply makeup to the affected area and avoid direct sunlight.

Why is oral care important during proton therapy?

Oral care is important during and after treatment. Mouth sores can become infected, so practice good oral hygiene and tell your care team about any symptoms. Use baking soda and salt rinses four to six times a day. This helps the PH balance and reduces bacteria in your mouth. Brush your teeth with a soft toothbrush after every meal and at bedtime. Avoid commercial mouthwashes that contain a large amount of salt or alcohol.

Also be sure to perform the jaw and neck exercises as instructed by your medical team. These exercises will help with stiffness or tightening of the jaw and neck, mouth opening challenges, and difficulty chewing.

How do I avoid unwanted weight loss?

Many cancer patients lose weight unexpectedly because they struggle with nausea or cannot eat well during treatment. Proper nutrition can help you maintain your weight and hydration, which helps ensure successful treatment results. Good nutrition will also improve your quality of life during and after cancer treatment.

Eating soft, moist foods and avoiding anything that irritates your mouth, such as spicy, rough, acidic, extreme temperatures, or carbonated drinks. If you’re having trouble eating, you may want to try meal replacement drinks like Boost and Ensure. It's also important to talk to your doctor about any vitamins, nutritional or herbal supplements you're taking. 

You should also avoid drinking alcohol or using tobacco products, as these habits can increase treatment side effects.

How can I prevent dry mouth?

Dry mouth can make eating, speaking, and sleeping more difficult. Without saliva, patients also run the risk of increased bacterial growth, bone infection, and nutritional deficiencies.

You can avoid dry mouth by chewing sugar-free gum, over-the-counter saliva substitutes, and staying hydrated. It also helps to swish a baking soda/water solution around your mouth a few times a day. It may be beneficial to sleep with a cool-mist humidifier next to your bed during and after treatment as well.

How can I reduce fatigue?

Fatigue is a normal and often expected side effect of cancer treatment. Try taking naps earlier in the day so that you don’t disrupt your sleep pattern.

Some patients find their fatigue improves with light exercise such as walking. Be sure to check with your care team before starting a new exercise routine.

What can I expect after proton therapy for head and neck cancers?

Side effects from proton therapy may continue or even increase for two to three weeks after treatment for head and neck cancer patients. Be sure to continue the regimen your care team recommends for caring for your mouth, throat, skin, and maintaining proper nutrition. It usually takes four to six weeks for your body to heal after proton therapy.

Remember, your care team is here for you and will provide resources and specific product recommendations for your side effects. Be sure to follow them. The patients that do the best are those who get ahead of their side effects.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

I’ve prepared for a lot of big moments and competitions in my 30 years of coaching college and high school basketball. But nothing could have prepared me for hearing that I had cancer.

I’d noticed that my allergies got bad earlier that year but did not think anything of it. My wife, Jacquie, a physician’s assistant, had heard what sounded like me snoring while I was watching television. After I assured her that I was awake, she insisted I get checked out at the emergency room.

The doctor could not get the scope down my nose during the examination. He ordered a CT scan and biopsy. I would soon learn that I had tumors behind my sinus cavity, which turned out to be nasopharyngeal cancer.

I was completely shocked. I was thinking I just had a sinus infection. It took me a couple of days  to compartmentalize the news and process what to do next.

My family had just recovered from my wife’s liver transplant in Aug. 2018. So, learning that I had cancer almost exactly one year later, all I could think about was how our kids were going to take the news.

Getting to MD Anderson for nasopharyngeal cancer treatment

Since my wife has been a physician for 20 years, she helped me research the top hospitals for my type of cancer. There were no doubts that I wanted to come to MD Anderson. 

During my first appointment, I met with my care team to review my case. They decided that I didn’t need surgery, and instead recommended chemotherapy and proton therapy.

I received induction chemotherapy, followed by concurrent chemotherapy under the care of my oncologist, Mehmet Altan, M.D. I wore the bag for one week on and two weeks off. I experienced fatigue and lost weight from my appetite changes. That was then followed by seven weeks of proton beam radiation.

My radiation oncologist, Brandon Gunn, M.D., and his team made me feel at ease. Everything about him was comfortable. He didn’t sugarcoat anything and explained the steps of my proton therapy treatment plan. He had a way of simplifying things so that I could understand what to expect. This helped my overall mindset tremendously.

Every single one of the staff at MD Anderson are rock stars! The radiation therapists at the Proton Therapy Center were able to tell when I was having a good or bad day. They made me feel like I was their only patient each day. I felt like they truly cared and that reassured me that I was in the right place getting the best treatment possible.

Coping with side effects from nasopharyngeal cancer treatment

Going through treatment was the hardest thing I’ve had to do. Mid-way through proton therapy, I experienced fatigue, as well as difficulty with swallowing and keeping an appetite. My wife put a small refrigerator in our bedroom with different types of protein drinks and water. Staying hydrated helped me heal faster. Dr. Gunn and his care team provided medicine to help keep me comfortable and kept reminding me to be consistent with drinking fluids. 

Following my care team’s recommendations is what kept me going. Even though I was tired, I had to do it. Once I figured that out, it made all the difference. I got in the rhythm of drinking six bottles of water a day, as well as protein drinks and soft foods and soups.

I tried to continue coaching the first few weeks of treatment. But as I grew increasingly tired, I stayed home to rest every day after treatment.

I remember doing a lot of praying and reevaluating some things in my life. I realized the things that are most important, my family, children and parents. I really love being a coach, and I wanted to be able to pour more into my players and make a difference in their lives.

Embracing life after cancer treatment

I’ll never forget the morning of Nov. 27, 2019. At 6 a.m., I got to ring the gong at the Proton Therapy Center with my wife, family and friends around me. It was the biggest victory of my life thus far – beating cancer.

My side effects subsided about four to six months after treatment. My taste buds, swallowing function and appetite came back. I stuck with soft foods for several weeks. Today, I make a point to eat healthy and keep my diet to only chicken, rice, pasta and vegetables.

My advice for others facing nasopharyngeal cancer

As I learned from my own cancer experience, it's important to stay as positive as you can. There will be good and bad days. I like to keep people laughing, so having the right mindset really helps. When doctors tell you drink water, do it! They are telling you this to put you in a situation to get better.

As tough as it might get, stay consistent and don’t ever lose sight of the finish line.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.