Can Chemotherapy Cause Difficulty Swallowing, and How to Cope

Yes, chemotherapy can contribute to difficulty swallowing (dysphagia), most often by causing mouth and throat sores (oral mucositis) or dry mouth, which make swallowing painful. ^[1] Chemotherapy given with head and neck radiation can further increase swallowing problems, and some regimens (for example, oxaliplatin) can trigger transient throat sensations that feel like trouble swallowing. ^{[2] [3]}

Why swallowing can be hard during chemotherapy

• Mouth and throat sores: Many cancer treatments, including chemotherapy, can inflame the lining of the mouth and throat, causing ulcers that make swallowing painful. ^[1] Painful mouth sores can make it hard to eat and drink and may lead to weight loss if not managed. ^[4]
• Dry mouth (xerostomia): Chemo and other treatments can reduce saliva, making it hard to chew and move food, and increasing discomfort with swallowing. ^[5]
• Combined effects with radiation: When chemotherapy is given with radiation to the head and neck (chemoradiation), swallowing difficulty can be more pronounced. ^[2]
• Cold-induced throat sensations with oxaliplatin: Oxaliplatin can cause laryngopharyngeal dysesthesia an acute, often cold-triggered sensation of throat tightness or difficulty breathing/swallowing during or shortly after infusion. ^[3]

Red flags that need urgent care

• Inability to swallow liquids, drooling, or choking
• Signs of dehydration (dark urine, dizziness), rapid weight loss, or fever
• Severe throat pain with inability to take medicines
• Sudden throat tightness, difficulty breathing, or voice changes during infusion (possible oxaliplatin reaction) ^[3]

If any of these occur, contact your care team immediately or seek emergency care. ^[3]

Evidence-based ways to cope

1) Soothe mouth and throat sores

• Choose soft, moist, bland foods (e.g., mashed potatoes, yogurt, smoothies, oatmeal, soups). ^[6] Eat warm or cool (not very hot or very cold) foods to reduce pain. ^[6]
• Take small bites, chew well, and eat slowly to reduce irritation. ^[6]
• Avoid spicy, acidic, rough, or very salty foods and juices that can sting sores. ^[7]
• Use prescribed mouthwashes or topical treatments for mucositis as directed by your team. ^{[6] [8]} If pain persists, ask about additional medications to control mucositis and pain. ^{[6] [9]}

2) Relieve dry mouth to aid swallowing

• Rinse your mouth right before eating to moisten tissues and stimulate taste. ^[6]
• Sip water frequently; sugar-free saliva substitutes or lozenges can help. (General dry mouth care guidance supports moisturizing and lubrication strategies.) ^[5]
• If pills are hard to swallow, ask your clinician if your medications can be crushed or given in alternate forms; some should not be crushed. ^[5]

3) Nutrition strategies to maintain strength

• Eat smaller, more frequent meals to meet calorie and protein needs without overwhelming your mouth or throat. ^[10]
• Add high-calorie, high-protein drinks (e.g., oral nutrition shakes) between meals if solids are too painful. ^[11] If weight loss is rapid or oral intake is inadequate, a temporary feeding tube may be recommended to maintain nutrition. ^[12]
• Work with a clinical dietitian experienced in oncology to tailor textures and choices that are easier for you to swallow while meeting nutritional goals. ^{[13] [14] [15]}

4) Swallow therapy and exercises

• Ask for a referral to a swallowing specialist (speech-language pathologist). They can assess your swallowing, teach exercises to keep swallowing muscles strong, and recommend safer textures or posture strategies during meals. ^{[16] [17]} Early involvement helps maintain function during and after treatment. ^[16]

5) Special case: Oxaliplatin-related throat sensations

• Preventive steps include avoiding cold air and cold foods/drinks just before, during, and for 1–2 days after oxaliplatin. ^[3]
• If throat tightness or difficulty swallowing occurs during infusion, the infusion should be stopped and managed by the care team. ^[3]

Practical meal and self-care tips

• Keep foods soft and moist: braise, stew, or blend; add sauces, gravies, or broths. ^[15]
• Serve foods lukewarm or cool; avoid extremes of temperature. ^[6]
• Use a straw for liquids if comfortable, and try thicker liquids (smoothies) if thin liquids cause coughing.
• Maintain gentle oral hygiene (soft brush, fluoride toothpaste) after meals to lower infection risk and discomfort. ^[7]
• Protect lips with moisturizers to reduce cracks that can worsen pain with eating. ^[7]

When to talk to your care team

• Persistent or worsening pain with swallowing
• Weight loss, dehydration, or inability to meet calorie/protein needs
• Any breathing difficulty, severe chest pain, or sudden changes during infusions
• Questions about medicine forms, mouth rinses, or pain control options

Early communication helps your team adjust doses, prescribe mucositis and pain treatments, and arrange nutrition and swallow therapy support. ^{[2] [6] [15]}