Savor Health

Understanding new medical jargon, learning about seemingly foreign treatment modalities, and handling myriad appointments with different specialists can be overwhelming.

Here’s a basic guide to understanding radiation therapy as it applies to the head and neck cancers as well as what to expect when receiving head and neck radiation.

 

Radiation Jargon

  • Fractionation – Radiation delivery is usually “fractionated,” or spread out, into small doses over a five to six week period during which one receives radiation daily for five days.
  • Simulation – Before you receive your radiation, you will be given an appointment for a ‘simulation’ date. The simulation appointment is the treatment planning session during which your radiation treatment is mapped out. This is an extremely important appointment as the dosage and exact location of the radiation that will be delivered are determined at this time.  During the simulation appointment, you will lie on your back and a mesh facemask may be fabricated to maintain your positioning. If a mask is fabricated, you will wear this mask at every appointment. It is recommended that you visit a dental oncologist prior to the simulation as the measurements and planning completed during the simulation appointment are based on how you present the day of the simulation so any changes in your mouth, such as loss of teeth, will result in changes in the measurements and planning of the radiation dosage.
  • Mouth Guards – Before undergoing radiotherapy, your dentist may recommend that you wear radiation mouth guards during your treatment. When radiation hits metal in a person’s mouth, the radiation scatters and may be associated with an increased risk for developing mouth sores. Thus, it is often recommended that patients wear custom radiation mouth guards when undergoing radiation if the metal in their mouth will be in the field of the radiation. The mouth guards do not eliminate the risk of developing mouth sores, but may help reduce the risk by preventing the soft tissue from directly touching the intraoral metal. Nonetheless, radiation mouth guards are not always indicated. They are recommended depending on the amount of metal fillings you have in your mouth, the dosage of radiation that you will receive, and the location of the radiation.
  • After Simulation – After the simulation appointment, you will be given an appointment to return for a set-up appointment as well as treatment sessions.

 

Radiation Side Effects

  • Xerostomia/Hyposalivation – Xerostomia is the medical term for the sensation of dry mouth. Hyposalivation signifies a reduction in salivary flow and is an objective, measurable entity. Radiation therapy affecting the head and neck where the salivary glands are in field of radiation is associated with salivary gland atrophy. Radiation doses of 25 Gy or greater are associated with hyposalivation, reduced salivary flow and function. In addition to reduced flow, the saliva produced is ropey, thick and predominantly mucus. The extent of hyposalivation and xerostomia felt is linked to the dosage of radiation received as well as the location of the field of radiation. As saliva acts as a natural buffer in the mouth, bathing and lubricating the teeth and oral tissues, reduced salivary flow leaves patients prone to an increased risk for dental decay. Additionally, xerostomia is associated with taste alterations, difficulty swallowing and difficulty speaking.
  • Trismus – Trismus is the medical term for limited or reduced opening of the jaw. Trismus is often seen three to six months after radiation therapy due to radiation fibrosis. The degree of trismus varies depending on the radiation dosage, the location of the radiation as well as the patient’s medical history and age. Nasopharyngeal and oropharygneal carcinoma treatment appears to be more commonly associated with trismus than other head and neck cancers.
  • Pharyngitis/Sore Throat – Depending on the location of the radiation, some patients may experience a sore throat. Although you may be tempted to dissolve on lozenges throughout the day, it is important to dissolve sugar-free lozenges to prevent rapidly developing rampant dental decay. The extent of the sore throat and duration is related to the radiation dosage and field of radiation.
  • Mucositis – literally inflammation of the mucosa, is characterized by mouth sores, intraoral redness, and a burning sensation. It is an acute side effect and is also associated with chemotherapy. Not all patients experience mucositis. Additionally, the extent and degree of mucositis varies among patients. Traditionally, mucositis is most commonly seen in the second week of radiation therapy, and patients experience resolution weeks after completing radiation treatment.
  • Hypogeusia/Dysgeusia – Hypogeusia signifies a reduced taste sensation, while dysgeusia means an altered sense of taste. It is very common to experience taste alterations or loss of taste sensation while undergoing treatment. Many patients state that the first taste bud to change is that which is responsible for sweetness. The extent of taste loss and the duration of taste alteration depend on several factors including radiation dosage, location of the radiation field, and the salivary flow. Saliva enhances the body’s ability to detect taste. Radiation doses of 60 Gy or higher may be associated with permanent taste alterations depending on the location of the tongue within the radiation field.
  • Osteoradionecrosis (ORN) – Osteoradionecrosis of the jaw (ORN) is a condition characterized by an area of exposed bone in the maxillofacial area that was previously irradiated. It is a complicated and involved pathological process. Essentially, ORN is a late side effect of radiation therapy, occurring six months to one year after treatment and is associated with radiation doses of greater than 60 Gy. It is most commonly associated with trauma to the tissues overlying the bone rather than direct trauma to bone such as extractions or periodontal (gum) surgery. Nonetheless, ORN can occur spontaneously. Regular dental visits may help to minimize the risk for developing ORN. Additionally, prior to receiving radiation therapy, it is advisable to visit a dental oncologist for a pre-radiation dental evaluation. Prior to receiving radiation to the head and neck, any non-restorable teeth that will be in the field of radiation should be extracted. Extractions of teeth in the field of radiation (if the total radiation dosage was greater than 50-60 Gy) after radiation therapy should be avoided.
  • Nutritional Deficiency – Nutritional deficiencies may occur as a result of the loss of taste sensation, dry mouth and mouth sores. Despite these side effects, it is important to maintain caloric intake to prevent weight loss.

 

Preventing Side Effects

It is important to visit a dental oncologist before beginning radiation therapy for a thorough dental evaluation. At this evaluation, the dentist will determine if you need any dental treatment prior to beginning radiotherapy. Dental treatment such as tooth extraction(s) may be recommended before beginning treatment depending on where you will be receiving radiation and the dosage that will be delivered. If extractions are recommended, it is ideal to allow 10-14 days of healing time prior to starting radiation therapy.

 

Summary

Visiting a dental oncologist prior to receiving head and neck radiation therapy helps minimize the risks of developing the side effects.

If you are given radiation mouthguards, remember to bring them to your simulation appointment and leave them there so that you wear them at every radiation treatment session.

If you have a tooth/teeth extracted, you should ideally allow for 10-14 days of healing time prior to starting radiation therapy.

After receiving radiation therapy to the head and neck, be sure to inform your dentist of your radiation history before any invasive dental procedures as they may not be indicated depending on the dosage and location of your radiotherapy.

 

Further Reading

  1. Epstein, Joel, Carl Haveman, Michaell Huber, Douglas Peterson, Jacqueline Plemons, Spencer   Redding, Nicholas Sanfilippo, Mark Schubert, and Stephen Sonis. Oral Health in Cancer Therapy: A Guide for Health Care Professionals. 2008. Monograph compilation from 2008 Conference. University of Texas Health Science Center, San Antonio.
  2. Radiation Therapy for Cancer.” National Cancer Institute. National Cancer Institute, n.d. Web. 08 Oct. 2014.
  3. Radiation Therapy to the Head and Neck.” Memorial Sloan Kettering Cancer Center. Memorial Sloan Kettering Cancer Center, n.d. Web. 09 Oct. 2014.

 

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Susan started Savor Health after losing a close friend to a brain tumor and, through that experience, becoming aware of the significant unmet nutritional needs of people with cancer.  Struck by the fact that her friend was told “nutrition doesn’t matter” and “eat whatever you want,” Susan read the evidence-based literature on the subject, interviewed oncologists, oncology nurses and oncology dietitians, as well as patients and caregivers, and found that, in fact, nutrition does matter in oncology. Armed with solid scientific evidence supporting the clinical and quality of life benefits of proper nutrition, Susan left Wall Street and created Savor Health, an AI-based provider of personalized and clinically appropriate nutrition solutions for cancer patients, their caregivers and health enterprises. Susan brings to Savor Health over 25 years of industry experience in healthcare and business as well as expertise in strategy, finance and management.

Susan is an outspoken and tireless advocate for cancer patients receiving proper nutrition and nutrition support before, during and after treatment. She strongly believes that the U. S. healthcare system requires new innovation to transform it into a more holistic and integrated system of care whereby multiple disciplines coordinate care together for the benefit of the whole patient. As part of this, her goal is for nutrition to be an integral component of such an integrated cancer care delivery system.  Susan’s commitment to the field of oncology extends beyond Savor Health to volunteer work at Memorial Sloan Kettering Cancer Center in pediatrics and as a runner for Fred’s Team to raise money for research at Memorial Sloan Kettering. Susan participated in the Cancer Moonshot in June of 2016 where she was a breakout session group “igniter” tasked with starting and leading discussion. Susan’s first book, the Meals to Heal Cancer Cookbook, was published in March 2016.

In addition to her role as CEO of Savor Health, Susan speaks nationally about the importance of ensuring proper nutrition in the cancer patient and on topics including leadership and startups. She has been a speaker at the Harvard Medical School’s Career Advancement and Leadership Skills for Women in Healthcare, ESMO World Congress on GI Cancer, BioPharm America, AARP Live @50+, Lake Nona Impact Forum, and IIR ePharma Summit.

Prior to starting Savor Health, Susan had a successful career on Wall Street as a healthcare services investment banker working at prestigious firms including Donaldson, Lufkin & Jenrette, Wasserstein Perella and Robertson Stephens. Susan earned a B.A. from Duke University and M.B.A. from the University of Virginia’s Darden Graduate School of Business.

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Marissa Buchan is a registered dietitian, with advanced practice certifications in Oncology Nutrition (CSO) and Clinical Research (CCRP). She received her Bachelor’s degree in Psychology from Duke University, and Master’s of Science degree in Clinical Nutrition from New York University. Marissa worked for 10 years at Memorial Sloan Kettering Cancer Center in both the clinical research and nutrition departments.  In addition to counseling patients before, during, and after cancer therapy, she spearheaded nutrition-research efforts for the bone marrow transplant service. She has co-authored over 20 articles and has a particular interest in the role of nutrition on the intestinal microbiota and its impact on patient outcomes. When Marissa’s not wearing her lab coat, she’s in her apron whipping up healthy and delicious recipes that you can find on her blog, Get Off Your Tush and Cook.

Marissa is Chief Operating Officer of Savor Health where she leads operations working with the technology, clinical, and business development teams and management. Prior to assuming the role of COO in March 2020, Marissa was Vice President, Clinical Research and Operations at Savor Health where she worked closely with Savor Health’s Chief Medical Advisor, Scientific Advisory Board, and Clinical Operations Team to evaluate, design and conduct clinical research.  She also counsels patients on oncology nutrition issues and contributes to the Company website’s clinical content.

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Dr. DeFrance has a unique background including clinical interventional cardiologist, chief medical officer, educator, outcomes researcher and entrepreneur. He has expertise in Lifestyle medicine in which he was board certified in 2020 and is highly interested in the prevention and reversal of chronic disease. Dr. DeFrance also has expertise in appropriate utilization of technology in medicine, healthcare economics, value-based metrics, and educational design and delivery. He worked as Chief Medical Officer for HealthHelp, one of the largest specialty benefit managers in the US, and led large teams of healthcare professionals in writing evidence based appropriate care guidelines and rule sets which improve the quality and safety of medicine for over 20 million people in the US while also creating sustained savings in healthcare. He has also designed clinical decision support systems that are currently in use helping to improve patient care.

In 2018 Dr. DeFrance founded MedMentor Education, a company that provides state of the art CME content using the latest in eLearning science and online delivery platforms. Dr. DeFrance is also the founder and President of Digimedica, a consulting and educational design and delivery company for healthcare professionals, hospitals, and universities. He is passionate about creating systems to optimize knowledge transfer and has won numerous awards for teaching excellence during his career. He is an expert in cardiovascular CT imaging and has taught more than 3,000 physicians how to perform and interpret cardiac CT nationally and internationally and has lectured extensively on this subject.

Dr. DeFrance has a stellar reputation in the medical field and continues work to improve the quality and safety of patient care in the US.

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Alyson is a registered nurse and is certified in oncology nursing (OCN) through the Oncology Nursing Society (ONS). She also has her certification as an ONS Biotherapy and Chemotherapy Provider. Alyson studied nursing at Thomas Jefferson University where she obtained her Bachelor’s of Science in Nursing (BSN). Since starting her nursing career in 2004, Alyson has had a strong dedication and commitment to oncology patients. She has worked inpatient specializing in Bone Marrow and Peripheral Blood Stem Cell Transplantation. Alyson currently works in outpatient oncology at the North Shore-LIJ Monter Cancer Center. Alyson is part of the clinical team at Savor Health where she counsels patients on oncology and oncology nutrition issues and contributes to website and other Savor Health content.

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Chelsey is a Registered Dietitian and Board Certified Specialist in Oncology nutrition (CSO). She completed her Dietetic Internship at Northwell Health, received her BS in Dietetics at the University of Wisconsin-Madison, and her MS in Nutrition at Stony Brook University’s School of Medicine. Chelsey works as an outpatient dietitian at Mount Sinai covering all of the downtown cancer services at Mount Sinai Beth Israel and Philips Ambulatory Care Center. Chelsey works with patients and families before, during and after treatment to optimize their nutrition through dietary counseling and support. Chelsey has experience counseling clients with a variety of diagnoses including breast cancer, lung cancer, prostate cancer, head & neck cancer, and more. Chelsey also enjoys sharing nutrition knowledge with her peers by running a monthly Employee Wellness program that showcases healthy topics, recipes and food demos.

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Michelle is a Registered Dietitian specializing in oncology. She works as a clinical dietitian at an ambulatory cancer center in New York City and is a consultant for Savor Health. She is passionate about educating oncology patients on the importance of nutrition during their fight against cancer and helping them to optimize their nutrition through all phases of treatment. Michelle received her Bachelor of Science degree in dietetics from the University of Wisconsin-Madison and her Master of Science degree in Clinical Nutrition from New York University.

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Denise Sievering is a Registered Dietitian who is board certified in Oncology Nutrition as well as Nutrition Support. A fluent Spanish speaker, Denise joined the Savor Health team to support Spanish speaking cancer patients and to continue to expand the Platform’s nutritional strategies and recommendations in Spanish. Denise holds a Bachelor of Science degree from Rutgers University, and completed her internship at New York Presbyterian Hospital (NYP). Denise started her career as a registered dietitian at NYP-Columbia University Medical Center, primarily covering inpatient Oncology units. Denise also holds a Master of Arts degree in Mental Health Counseling from New York University, and incorporates her advanced training in motivational interviewing and empathic listening in her patient encounters, particularly those whose lives have been forever changed by a cancer diagnosis. A New Jersey native, Denise now resides in sunny San Diego, CA where she works as a part-time outpatient Oncology dietitian at Scripps Health-MD Anderson Cancer Center, and also works as an inpatient dietitian at Kaiser Permanente. In her spare time, Denise can be found at a mom-and-pop taco shop, one of the many local craft breweries, and exploring her new city of San Diego with her husband and her rescue pup, Ripley.

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Karen is a Registered Dietitian, Board Certified Specialist in Oncology Nutrition and registered in New York as a Certified Dietitian Nutritionist. Fluent in Spanish, Karen joined the Savor Health team to support Spanish speaking cancer patients and to continue to expand the Platform’s nutritional strategies and recommendations in Spanish. Karen received her Bachelor of Science degree from Ithaca College and her Master of Science degree from Hunter College. She works as an outpatient oncology dietitian in New York. Karen often works with local community centers to host nutrition programs for cancer survivors and their families, leading classes on how to live healthier lifestyles throughout their continuum of care. The American Institute of Cancer Research selected to showcase one of her many programs at their conference in 2019. Karen has written for and lent commentary to various publications and truly enjoys teaching people how to eat better. She loves to cook and strongly feels that healthy food doesn’t have to taste bad.

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Allie is a Registered Dietitian and a Certified Specialist in Oncology (CSO). She joins Savor in 2023, bringing years of experience from the John Theurer Cancer Center in New Jersey, where she worked with patients with a variety of cancers. Her goal is to help people feel their best, both mentally and physically, when physical health challenges arise. She believes in the power of nutrition ever since the impact it made on her athletic career as a volleyball player during college. Allie graduated with her Bachelor of Science degree from University of Maryland-Baltimore County and has her Master’s degree in Human Nutrition from the University of Wisconsin Stout. She enjoys travelling, enjoying different cuisines, cooking, and hiking and other outdoor activities with her family and dog.

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Julia Penberg is a seasoned healthcare professional with more than 30 years of experience focusing on maximizing operational excellence, leading clinical program development and building strong cross-functional teams. Her previous roles include overseeing the performance of clinical managers and nurse practitioners across multiple markets within United Healthcare-Optum’s Medicare Advantage and dual-eligible special needs populations, payer outreach and program development at Mayo Clinic, ground level specialty hospital development and direct patient care as a family and dermatology nurse practitioner. Julia volunteered as an operating room nurse and nurse practitioner on several mission trips to Romania and was a support group leader for the Kansas City chapter of the International Myeloma Foundation. Her motivation throughout her career has been with wellness promotion, disease risk modification and ensuring the best patient experience across the health continuum. Ms. Penberg received an MBA from the University of Dallas; a MS in Nursing from the University of Kansas and a BS in Nursing from the University of Texas-Austin. She is board certified as a Family Nurse Practitioner.

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Rachel is a Registered Dietitian and Board Certified Specialist in Oncology Nutrition (“CSO”). She joined NYP-Columbia as the outpatient oncology dietitian in 2020 after working at Jamaica Hospital Medical Center for two years. Rachel completed her dietetic internship through Keene State College in 2017. She is pursuing an MS in Integrative Nutrition at Stony Brook University and has a BS in Human Nutrition, Foods and Exercise from Virginia Tech. Rachel provides nutrition counseling to all types of oncology patients and helps them understand the mental and physical benefits of nutrition as an ally in their fight against cancer. In her free time she enjoys slow meals with family and friends, Pilates, and tending to her fire escape garden.

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Allie Werner is a Registered Dietitian at Fresenius Kidney Care where she provides medical nutrition therapy diet counseling to patients on Dialysis. She received her Bachelor’s Degree in nutrition from Indiana University and completed her Master’s Degree and dietetic internship at Loyola University Chicago. In her free time she enjoys spending time with friends and family, checking out the amazing food scene in downtown Chicago, and exercising on her Peloton bike.

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Immersed in the tech world for a decade, I've coded, led teams, and honed my skills in architecture and design. As a tech enthusiast, I've seamlessly woven through full-stack projects, fusing my love for code with the art of leadership.

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Mohit is a full-stack developer with expertise in Python and JavaScript, known for his efficient coding and ability to deliver scalable software solutions. His technical contributions are highlighted on GitHub and Stack Overflow, demonstrating his commitment to the tech community and problem-solving skills. With a solid educational foundation and a diverse project portfolio, Mohit excels at navigating complex challenges and is well-equipped to contribute to dynamic software projects.

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Rayna McCann is a Registered Dietitian and Board Certified Specialist in Oncology Nutrition. She is a Registered Yoga Teacher and yoga4cancer certified. She received her BS in Nutrition at Penn State University and her MS from Stony Brook University. For work, Rayna wears many hats in the world of nutrition and worked for years in clinical settings focusing on oncology nutrition. She is also an Adjunct Professor and passionate about inspiring the future of dietitians. Throughout her career, she has received awards recognizing her dedication to patient safety and her contributions to improving malnutrition awareness. In 2022, Rayna was proud to accept the ‘Dietitian of the Year’ award through the Long Island Academy of Nutrition and Dietetics. Rayna has co-authored abstracts for poster presentations within the American Institute for Cancer Research conference, as well as, the Nutrition and Dietetics Food and Nutrition Conference Expo and subsequent publication. She has enjoyed authoring articles, including an article for The Cure magazine regarding Multiple Myeloma and nutrition. When Rayna is not participating in nutrition related activities, she is dedicated to dog rescue.

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