Can immunotherapy cause difficulty swallowing, and how can you cope?

Yes, immunotherapy can sometimes be linked to difficulty swallowing (dysphagia), though it’s less common than with radiation or some chemotherapies. Mouth and throat side effects such as mouth sores, pain with swallowing (odynophagia), and inflammation of the esophagus (esophagitis) can occur with certain immune checkpoint inhibitors and combination regimens. These issues may make it hard to eat, drink, or keep hydrated. ^{[1] [2]}

How immunotherapy can affect swallowing

• Mouth and throat sores: Some immunotherapy treatments can cause painful sores in the mouth and throat, which can make chewing and swallowing uncomfortable and reduce your fluid and food intake. ^[1]
• Upper GI inflammation (esophagitis): Immune-related inflammation can affect the esophagus, causing dysphagia, pain with swallowing, nausea or vomiting, and occasionally bleeding. These are recognized, though less frequent, immune-related adverse events with drugs like nivolumab and in certain combinations. ^{[2] [3]}

When to contact your care team

• Pain when eating or swallowing, frequent mouth sores, or inability to drink enough to stay hydrated should prompt a call to your oncology team, as early treatment prevents complications. ^[1]
• Sudden or severe dysphagia, chest pain with swallowing, vomiting blood, black/tarry stools, or rapid weight loss require urgent evaluation to rule out esophagitis or bleeding. ^[2]

Practical coping strategies at home

• Gentle mouth care: Rinse every 4–6 hours (and as needed) with an alcohol-free mouthwash or a homemade salt/baking soda solution to soothe tissues and reduce irritation. ^[4]
• Be kind to your mouth: Use a soft-bristle toothbrush; avoid alcohol-based mouthwashes, acidic, salty, or spicy foods; avoid very hot foods and tobacco. ^{[4] [1]}
• Choose easy-to-swallow foods: Prefer soft, moist foods (eggs, fish, casseroles, stews), and add sauces, broths, oils, or gravies to keep foods moist and easier to swallow. ^[5]
• Eat and drink smart: Take small, frequent meals; cut food into small pieces; sip fluids throughout the day, aiming for at least 8–10 cups unless restricted by your clinician. ^[5]
• Use a straw for liquids to bypass sore areas in the mouth, if comfortable. ^[6]
• Lip and oral comfort: Keep lips moisturized; ask whether oral cryotherapy (cooling the mouth) is appropriate for your specific treatment to reduce mouth soreness. ^[1]

What your clinicians may do

• Assess severity and cause: Your team may examine your mouth and throat and consider endoscopy if esophagitis is suspected. Immune-related esophagitis is managed based on severity.
• Supportive medications: Depending on findings, they may prescribe pain relievers, topical anesthetic rinses, acid suppression, and in immune-related esophagitis, consider corticosteroids when appropriate. ^[2]
• Nutrition support: If eating and drinking are difficult, they may involve a dietitian, recommend high-calorie/protein liquids, or short-term feeding support to prevent dehydration and weight loss. ^[7]

How this differs from radiation side effects

Radiation to the head and neck commonly causes swallowing difficulties due to mucositis, dry mouth, thick saliva, swelling, pain with swallowing, and later scarring; symptoms often start within 1–2 weeks of radiation and may improve several weeks after it ends. While this pattern is classic for radiation, some features can overlap with immunotherapy side effects. ^{[8] [9]}

Red flags that need urgent care

• Inability to keep fluids down or signs of dehydration (dizziness, dark urine). ^[1]
• Severe chest or throat pain with swallowing, vomiting blood, or black/tarry stools. ^[2]
• Rapidly worsening swallowing difficulties or significant, unintentional weight loss. ^[7]

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Quick reference: What to do and why

• Rinse mouth with alcohol-free solution every 4–6 hours; consider salt/baking soda solution. Reason: reduces irritation and helps healing. ^[4]
• Avoid spicy, acidic, salty, and very hot foods; avoid tobacco and alcohol mouthwashes. Reason: prevents worsening of sores and pain. ^{[1] [4]}
• Choose soft, moist foods; add sauces and gravies; small, frequent meals; use a straw if helpful. Reason: easier, safer swallowing and better nutrition/hydration. ^{[5] [6]}
• Call your team if pain with swallowing, frequent sores, or poor oral intake occur. Reason: early intervention prevents complications. ^[1]
• Seek urgent care for severe symptoms (bleeding, severe pain, black stools). Reason: could indicate esophagitis or bleeding requiring prompt treatment. ^[2]

By recognizing symptoms early and using gentle oral care, soft-moist foods, and timely medical support, most people can manage swallowing difficulties during immunotherapy and stay hydrated and nourished. ^{[1] [4] [5] [2] [7]}