Revision topics for this scenario include:

• Radiation-induced xerostomia (dry mouth): causes, pathophysiology and management
• Head and neck cancer and radiotherapy: common side effects including mucositis, xerostomia and osteoradionecrosis
• Saliva substitutes and artificial saliva products available in the UK (BNF Chapter 12)
• Oral hygiene in oncology patients: importance of dental review and fluoride use
• Macmillan Cancer Support and NHS resources for patients undergoing radiotherapy
• NICE guidance on supportive care in head and neck cancer
• Communication skills in oncology: empathy, active listening and patient-centred care

You are a hospital pharmacist on the oncology ward. A patient has requested to speak with you regarding dry mouth side effect she is experiencing during her radiotherapy treatment.

To do:

1. Listen to the patient’s concerns and take a thorough history of her symptoms.
2. Provide appropriate advice and practical solutions to manage her dry mouth.

You have 10 minutes. 
You have access to the BNF.

Guidance for actor: 

How to play this role: Speak slowly and a little quietly throughout. Pause more often than feels natural, and swallow or take a sip of water before longer sentences. Your mouth is uncomfortably dry, so your speech sounds slightly effortful and you may clear your throat occasionally. 

You are Margaret Collins (Mah-greh-t, Col-inz).

Opening statement: ‘I was told I could speak to the pharmacist. I’ve been having a really horrible dry mouth since starting my radiotherapy and I just don’t know what to do about it.’

Patient information:

• Name: Margaret Collins

• Date of birth: 14/03/1969 (Age: 57)

• Past medical history:

  • ‘I have head and neck cancer - I’m currently having radiotherapy to my neck area."

• Medication history:

  • "For my cancer I have a drip called se-tux-im-ab once a week, and I have the radiotherapy Monday to Friday. I've had about three weeks of it so far."
  • "The hospital gave me some anti-sickness tablets, cyclizine I think, but I've only taken them a couple of times because I'm not nauseous."

   

• Allergies:

  • 'No allergies'

• Symptoms:

  • ‘My mouth has been incredibly dry since I started radiotherapy about three weeks ago.’
  • ‘It’s making it really hard to eat and swallow food; even soft foods are difficult.’
  • ‘I’m waking up at night because my mouth is so dry.’
  • ‘I’ve been sipping water throughout the day, but it only helps for a short time.’

• If the pharmacist asks:

  • ‘The dryness is constant, it doesn’t really come and go.’

  • 'I've lost about half a stone in the last month because eating is so hard.'
  • ‘My lips feel quite cracked and sore too.’
  • ‘I haven’t tried any specific products for dry mouth yet, just water.’
  • Dentist: ‘I haven’t had any dental problems recently but I haven’t seen a dentist since starting radiotherapy.’
  • Lifestyle: 'I don’t smoke and I don’t drink alcohol.’
  • Negative symptoms:
    • ‘I haven’t noticed any mouth ulcers or white patches in my mouth.’
    • ‘I haven’t noticed any bleeding from my mouth or gums.’
    • ‘I don’t have any difficulty breathing.’

At this point, the student should acknowledge that your dry mouth is a common and expected side effect of radiotherapy to the head and neck area, caused by damage to the salivary glands.

The student should offer you advice and practical solutions for managing dry mouth. If they do not offer advice spontaneously, prompt them by asking:

• ‘Is there anything I can use or do to help with this?’

The student should also advise you on oral hygiene and when to seek further help. If they do not, prompt them by asking:

• ‘Is there anything else I should be doing to look after my mouth?’

Referral Criteria for Radiation-Induced Xerostomia

1. Macmillan Cancer Support, 2023. Dry mouth and radiotherapy. [online] Available at: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/dry-mouth [Accessed 1 July 2026]

2. NICE, 2016. Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over. NICE guideline NG36. [online] Available at: https://www.nice.org.uk/guidance/ng36 [Accessed 1 July 2026]

3. Joint Formulary Committee, 2025. British National Formulary. [online] London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk [Accessed 1 July 2026]

4. Davies, A.N., 2005. The management of xerostomia: a review. European Journal of Cancer Care, 6(3), pp.209-214. Available at: https://doi.org/10.1046/j.1365-2354.1997.00047.x

5. Oral Health Foundation, 2023. Dry mouth. [online] Available at: https://www.dentalhealth.org/dry-mouth [Accessed 1 July 2026]