Over 90% of patients treated for head and neck cancer (HNC) experience eating and drinking difficulties after treatment (Ganzer et al., 2015). Beyond the physical challenges of treatment, such as dysphagia, xerostomia, altered taste, or changes in appearance, patients often report a profound disruption to the social aspects of eating and drinking. Mealtimes, once shared and spontaneous, become deliberate, embarrassing, and often avoided altogether. Social eating, or ‘eating with others’, is not just about food; it represents identity, normality, and human connection. Unfortunately, these social challenges are less recognised, and support for people living with and beyond HNC, and their families, can be limited.
To understand this further, we undertook a qualitative study with people living with and beyond HNC (Dornan et al., 2022a). Patients repeatedly described how eating in front of others became a “conscious process”, something that used to be natural but had become a source of anxiety, shame, and avoidance. Many avoided restaurants, family meals, or celebrations. Some ate beforehand; others chose ‘safe’ foods like soup or custard to reduce attention. For a few, social eating ceased altogether, while others developed strategies to minimise attention, such as eating beforehand, choosing only certain foods, or eating only with close family (Dornan et al., 2022a). Family involvement is also vital, though it must be handled sensitively. Well-meaning relatives can inadvertently increase pressure or fail to understand a patient's changed needs (Dornan et al., 2022b). Education and communication are key, while balancing the unique social eating needs and challenges of family members and loved ones (Dornan et al., 2022b).
We eat for more than just calories and nourishment. Eating with others provides connection, a sense of identity, and a way to participate in daily life, at home, at work, or in restaurants. Participants with HNC described this change as a “loss”, as they were unable to participate as frequently or with as much enjoyment as before treatment, placing them at risk of isolation and loneliness.
A growing body of psycho-oncology research recognises that social withdrawal, loneliness, and identity loss are common among cancer survivors (McElfresh et al., 2021). As our survivors live longer, the need for psychosocial care grows, not just to treat distress, but to support meaningful reintegration into life. For HNC patients, social eating is a prime example of where biopsychosocial care is needed. Practical strategies such as graded re-exposure, psychological interventions, and self-management tools can offer meaningful pathways back to shared meals. To support this, we developed a self-management tool for patients with HNC and their family members called Eating With Others (Dornan et al., 2025), which is currently used in clinical practice.
Early and iterative assessment of not just the physical aspects of eating, but also the psychological and social dimensions, is key. Patients in our study developed practical coping strategies, such as graded exposure, clear communication with restaurants, or bringing a family member to advocate on their behalf, but they often did so alone. Few had received professional support around this issue, despite its significance.
While this may not be the priority in the acute setting, for many patients who live for a long time, or permanently, with the impact of HNC and its treatment, it can be addressed in follow-up clinics and community care by all members of the healthcare team.
Equally, while our research focused on head and neck cancer, the principles are relevant across oncology. Patients with upper and lower gastrointestinal, pancreatic, or brain cancers may also face altered eating, body image concerns, or digestive effects that affect their social roles. Addressing these issues holistically is part of high-quality cancer care, where personalised, psychosocially informed care is essential across cancer types.
Reclaiming one’s place at the table isn’t just about swallowing safely, it’s about restoring confidence, autonomy, and joy. As healthcare professionals, we must empower patients to manage and live well in all aspects of their lives.
References
Ganzer, H., Rothpletz-Puglia, P., Byham-Gray, L., & Murphy, B. A. (2015). The eating experience in long-term survivors of head and neck cancer: a mixed-methods study. Supportive Care in Cancer, 23(11), 2741–2748. https://doi.org/10.1007/s00520-015-2730-9
Dornan, M., Semple, C., Moorhead, A., & McCaughan, E. (2021). A qualitative systematic review of the social eating and drinking experiences of patients following treatment for head and neck cancer. Supportive Care in Cancer, 29, 4899–4909. https://doi.org/10.1007/s00520-021-06062-7
Dornan, M., Semple, C., & Moorhead, A. (2022). “It’s part of our life now”: a qualitative exploration of the social eating experiences of family members of patients living with head and neck cancer. Supportive Care in Cancer, 30, 10159–10167. https://doi.org/10.1007/s00520-022-07427-2
McElfresh, J. J., Skiba, M. B., Segrin, C. G., Badger, T. A., Crane, T. E., Crist, J. D., & Thomson, C. A. (2021). Interventions for Loneliness Among Adult Cancer Survivors: A Systematic Review and Meta-Analysis. Journal of Psychosocial Oncology, 39(1), 1–45. https://doi.org/10.1080/07347332.2020.1867690
Dornan, M., Semple, C. J., & Moorhead, A. (2025). Eating with Others: planning, developing and optimising a self-management intervention to promote social eating for patients living with and beyond head and neck cancer. Supportive Care in Cancer. https://doi.org/10.1007/s00520-024-09083-0