Experiences and consequences of altered taste, flavour and food hedonics during chemotherapy treatment

Smell and Taste Alterations in Patients Receiving Curative or Palliative Chemotherapy-The CONKO 021-ChemTox Trial

Previous data regarding chemotherapy-induced olfactory and gustatory dysfunction (CIOGD) are heterogeneous due to inconsistent study designs and small numbers of patients. To provide consistent, reliable data, we conducted a cohort study using standardized testing. Patients diagnosed with lymphoma, leukemia, or gastrointestinal malignancies were examined up to five times (T1 to T5), beginning prior to chemotherapy. We examined patients receiving temporary treatment up to 12 months post-therapy. Clinical assessment included extensive questionnaires, psychophysical tests of olfactory and gustatory function, and measurement of peripheral neuropathy. Statistical analysis included non-parametric tests to evaluate the longitudinal development of CIOGD. Our data (n = 108) showed a significant decline in olfactory and gustatory testing during chemotherapy (p-values < 0.001). CIOGD appeared stronger among patients above 60 years, while sex did not matter significantly. However, we identified distinct associations between CIOGD and reported anorexia as well as with higher neuropathy scores. Self-assessment appeared less sensitive to chemosensory dysfunction than psychophysical testing. Post-therapy, olfactory and gustatory function regenerated, though baseline levels were not attained within 6 to 12 months. In conclusion, our data highlight the wide prevalence and slow recovery of CIOGD. Understanding CIOGD as a potential neurotoxic effect may disclose new therapeutic prospects.

Describing taste changes and their potential impacts on paediatric patients receiving cancer treatments

OBJECTIVES

Taste changes are common among paediatric patients receiving cancer treatments although specific descriptions and associations are uncertain. Primary objective was to describe the number of paediatric patients receiving cancer therapies who experienced taste changes, its impact on food intake and enjoyment of eating, and coping strategies.

METHODS

This was a cross-sectional study that included English-speaking paediatric patients aged 4-18 years with a diagnosis of cancer or haematopoietic stem cell transplantation recipients receiving active treatment. Using a structured interview, we asked participants about their experience with taste changes, impacts and coping strategies. The respondent was the paediatric patient.

RESULTS

We enrolled 108 patients; median age was 11 years (IQR 8-15). The taste changes reported yesterday or today were food tasting bland (34%), bad (31%), different (27%), bitter (25%), extreme (19%), metallic (15%) or sour (12%). Taste changes were associated with decreased food intake (31%) and decreased enjoyment in eating (25%) yesterday or today. The most common coping strategies were eating food they liked (42%), eating strong-tasting food (39%), drinking liquids (35%), brushing teeth (31%) and sucking on candy (25%). Factors significantly associated with food tasting bad were as follows: older age (p=0.003), shorter time since cancer diagnosis (p=0.027), nausea and vomiting (p=0.008) and mucositis (p=0.009).

CONCLUSIONS

Among paediatric patients receiving cancer treatments, taste changes were common and were associated with decreased food intake and enjoyment in eating. Common coping strategies were described. Reducing nausea, vomiting and mucositis may improve taste changes.

Evaluating the efficacy of auricular acupuncture for chemotherapy-induced taste alterations: A pilot randomized controlled trial

PURPOSE

Irrespective of the development of acupuncture-based interventions, clinical evidence regarding their efficacy remains controversial owing to issues with the study design and an unclear risk of bias. This study aimed to evaluate the efficacy of auricular acupuncture in managing taste alterations in patients with cancer undergoing platinum-based chemotherapy.

METHODS

We conducted a pilot randomized controlled trial involving 73 patients randomly assigned to an auricular acupuncture or a control group. The primary outcome was the severity of chemotherapy-induced taste alterations, and the secondary outcomes included quality of life and negative emotions of the patients.

RESULTS

A total of 49 participants completed the study. Compared to the control group, patients in the auricular acupuncture group showed significant reductions in discomfort, general taste alterations, and total scores on the Chemotherapy-induced Taste Alteration Scale (all p < 0.05). Furthermore, we observed significant improvements in quality of life, including physical function (p = 0.007), role function (p = 0.006), emotional function (p = 0.016), nausea and vomiting (p = 0.021), appetite loss (p = 0.046), and significant improvements in anxiety and depression (p < 0.01).

CONCLUSIONS

Our findings suggest that auricular acupuncture may be a beneficial intervention for managing chemotherapy-induced taste alterations in patients with cancer receiving platinum-based chemotherapy. It may also contribute to improvements in quality of life and negative emotions. However, these results are preliminary, and further evaluation with larger randomized controlled trials is necessary.

Taste alterations in patients following hematopoietic stem cell transplantation: A qualitative study

Objective

This study aims to explore the experiences and consequences of taste alterations in patients undergoing HSCT, how they respond to these changes, and the factors that influence their responses.

Methods

In this descriptive qualitative study, face-to-face semi-structured individual interviews were conducted with 31 patients undergoing HSCT in a comprehensive hospital in Hubei, China. The interview data were transcribed and analyzed using Colaizzi's seven-step analysis. The Symptom Management Theory was applied to design the study and identify key themes.

Results

Three key themes were identified from the theory: (1) the complexity and diversity of taste experiences; (2) coping strategies; and (3) the multifaceted challenges of coping. Taste alterations in HSCT patients were characterized by diversity and dynamism. Patients employed three distinct coping styles in response to taste alterations: active coping, reluctant submission, and passive coping. These coping styles were influenced by various factors, including the specific treatment modalities of HSCT, individual patient characteristics, and the healthcare environment.

Conclusions

The experience of taste alterations among HSCT patients is intricate and varied, and the importance of addressing this symptom can easily be underestimated. Management of taste alterations is influenced by multiple factors. Nursing staff should give careful attention to taste alterations in HSCT survivors, enhance their expertise in managing taste alterations, provide robust health education, conduct regular screening and assessments, and formulate individualized intervention plans to assist patients in actively and effectively managing taste alterations.

Effect of Regular Consumption of a Miraculin-Based Food Supplement on Taste Perception and Nutritional Status in Malnourished Cancer Patients: A Triple-Blind, Randomized, Placebo-Controlled Clinical Trial-CLINMIR Pilot Protocol

Taste disorders are common among cancer patients undergoing chemotherapy, with a prevalence ranging from 20% to 86%, persisting throughout treatment. This condition leads to reduced food consumption, increasing the risk of malnutrition. Malnutrition is associated not only with worse treatment efficacy and poor disease prognosis but also with reduced functional status and quality of life. The fruit of Synsepalum dulcificum (Daniell), commonly known as miracle berry or miracle fruit, contains miraculin, a taste-modifying protein with profound effects on taste perception. The CLINMIR Protocol is a triple-blind, randomized, placebo-controlled clinical trial designed to evaluate the regular consumption of a food supplement containing a miraculin-based novel food, dried miracle berry (DMB), on the taste perception (measured through electrogustometry) and nutritional status (evaluated through the GLIM Criteria) of malnourished cancer patients under active antineoplastic treatment. To this end, a pilot study was designed with 30 randomized patients divided into three study arms (150 mg DMB + 150 mg freeze-dried strawberries, 300 mg DMB, or placebo) for three months. Throughout the five main visits, an exhaustive assessment of different parameters susceptible to improvement through regular consumption of the miraculin-based food supplement will be conducted, including electrical and chemical taste perception, smell perception, nutritional and morphofunctional assessment, diet, quality of life, the fatty acid profile of erythrocytes, levels of inflammatory and cancer-associated cytokines, oxidative stress, antioxidant defense system, plasma metabolomics, and saliva and stool microbiota. The primary anticipated result is that malnourished cancer patients with taste distortion who consume the miraculin-based food supplement will report an improvement in food taste perception. This improvement translates into increased food intake, thereby ameliorating their nutritional status and mitigating associated risks. Additionally, the study aims to pinpoint the optimal dosage that provides maximal benefits. The protocol adheres to the SPIRIT 2013 Statement, which provides evidence-based recommendations and is widely endorsed as an international standard for trial protocols. The clinical trial protocol has been registered at the platform for Clinical Trials (NCT05486260).

Taste loss in cancer patients: clinicians' perceptions of educational materials and diagnostic tools

PURPOSE

Cancer therapy is essential and lifesaving; however, it can have short- and long-term consequences on patients' health. Up to 87% of cancer patients report changes in taste function, yet patients report a lack of support from clinicians regarding their experience with taste loss during and following treatment. Thus, the objective of this study was to assess clinicians' knowledge and experience with managing patients with taste loss and identify potential gaps in the availability of educational materials and diagnostic tools.

METHOD

In an online survey, sixty-seven participants who identify as clinicians and practice in the United States and work with cancer patients that complain of taste problems answered questions on their knowledge and experience supporting cancer patients experiencing changes in taste function and provided their opinion on access to educational materials.

RESULTS

The current study reports gaps in participants' knowledge of taste and taste disorder terminology, with 15.4% correctly defining both taste and flavor and roughly half were familiar with specific taste disorder classifications. Over half of the participants reported not having access to adequate information to help their patients manage taste alterations. Only two-thirds of participants reported routinely asking patients if they are experiencing changes in taste function.

CONCLUSION

Clinicians' responses emphasized the need to improve access to educational materials regarding taste changes and increase the availability of information regarding management strategies. Addressing these inequities in education and improving the standard of care is the first step in improving the care for cancer patients suffering from altered taste function.

Taste and Smell Disorders in Cancer Treatment: Results from an Integrative Rapid Systematic Review

Taste and smell disorders (TSDs) are common side effects in patients undergoing cancer treatments. Knowing which treatments specifically cause them is crucial to improve patients' quality of life. This review looked at the oncological treatments that cause taste and smell alterations and their time of onset. We performed an integrative rapid review. The PubMed, PROSPERO, and Web of Science databases were searched in November 2022. The article screening and study selection were conducted independently by two reviewers. Data were analyzed narratively. Fourteen studies met the inclusion criteria and were included. A high heterogeneity was detected. Taste disorders ranged between 17 and 86%, while dysosmia ranged between 8 and 45%. Docetaxel, paclitaxel, nab-paclitaxel, capecitabine, cyclophosphamide, epirubicin, anthracyclines, and oral 5-FU analogues were found to be the drugs most frequently associated with TSDs. This review identifies the cancer treatments that mainly lead to taste and smell changes and provides evidence for wider studies, including those focusing on prevention. Further studies are warranted to make conclusive indication possible.

Oral Somatosensory Alterations in Head and Neck Cancer Patients-An Overview of the Evidence and Causes

Food-related sensory alterations are prevalent among cancer patients and negatively impact their relationship with food, quality of life, and overall health outcome. In addition to taste and smell, food perception is also influenced by somatosensation comprising tactile, thermal, and chemesthetic sensations; yet studies on oral somatosensory perception of cancer patients are lacking to provide patients with tailored nutritional solutions. The present review aimed to summarise findings on the oral somatosensory perception of head and neck cancer (HNC) patients and the potential aetiologies of somatosensory alterations among this population. Subjective assessments demonstrated alterations in oral somatosensory perception such as sensitivity to certain textures, spices, and temperatures. Physiological changes in oral somatosensation have been observed through objective assessments of sensory function, showing reduced localised tactile function and thermal sensitivity. Changes in whole-mouth tactile sensation assessed using texture discrimination and stereognosis ability seem to be less evident. Available evidence indicated oral somatosensory alterations among HNC patients, which may affect their eating behaviour, but more studies with larger sample sizes and standardised assessment methods are needed. Unlike other types of cancers, sensory alterations in HNC patients are not only caused by the treatments, but also by the cancer itself, although the exact mechanism is not fully understood. Prevalent oral complications, such as xerostomia, dysphagia, mucositis, and chemosensory alterations, further modify their oral condition and food perception. Oral somatosensory perception of cancer patients is an under-investigated topic, which constitutes an important avenue for future research due to its potential significance on eating behaviour and quality of life.

The impact of injury of the chorda tympani nerve during primary stapes surgery or cochlear implantation on taste function, quality of life and food preferences: A study protocol for a double-blind prospective prognostic association study

BACKGROUND

The chorda tympani nerve (CTN) is a mixed nerve, which carries sensory and parasympathetic fibres. The sensory component supplies the taste sensation of the anterior two-thirds of the ipsilateral side of the tongue. During middle ear surgery the CTN is exposed and frequently stretched or sacrificed, because it lacks a bony covering as it passes through the middle ear. Injury may cause hypogeusia, ageusia or altered taste sensation of the ipsilateral side of the tongue. To date, there is no consensus regarding which type of CTN injury (sacrificing or stretching), during middle ear surgery, leads to the least burden for the patient.

METHODS

A double-blind prospective prognostic association study was designed in a single medical centre in the Netherlands to determine the effect of CTN injury on postoperative taste disturbance and quality of life. 154 patients, who will undergo primary stapes surgery or cochlear implantation will be included. The taste sensation, food preferences and quality of life of these patients will be evaluated preoperatively and at one week, six weeks and six months postoperatively using the Taste Strip Test, Electrogustometry, supplementary questionnaire on taste disturbance, Macronutrient and Taste Preference Ranking Task, Appetite, Hunger and Sensory Perception questionnaire and Questionnaire of Olfactory Disorders to assess the association of these outcomes with CTN injury. Evaluation of olfactory function will only take place preoperatively and at one week postoperatively using the Sniffin' Sticks. The patient and outcome assessor are blinded to the presence or absence of CTN injury.

DISCUSSION

This study is the first to validate and quantify the effect of chorda tympani nerve injury on taste function. The findings of this study may lead to evidence-based proof of the effect of chorda tympani injury on taste function with consequences for surgical strategies.

TRIAL REGISTRATION

Netherlands Trial Register NL9791. Registered on 10 October 2021.

Factors influencing adherence to healthy eating behaviors among adult colorectal cancer survivors: a systematic mixed method review

PURPOSE

Under the umbrella of social cognitive theory, we examined the influences of personal, environmental, and behavioral factors on adherence to healthy eating behaviors among colorectal cancer survivors.

METHODS

Based on Pluye and Hong's framework, a systematic mixed studies review was conducted. An extensive search strategy was applied in PubMed, Web of Science, Embase, CINAHL, and PsycINFO (from date of record to 2022 January 22). The pillar integration process was employed to integrate the extracted data. The Mixed Methods Appraisal Tool was used to appraise the quality of all retained studies.

RESULTS

Twenty-eight studies with a total sample size of 5106 were included in the analysis, with 15 quantitative studies, 12 qualitative studies, and 1 mixed method study. The critical appraisal showed that 22 of the 28 studies (79%) were rated with five stars, while 6 (21%) were rated with four stars. The personal factors influencing adherence to healthy eating behaviors among colorectal cancer survivors included outcome expectancies, self-efficacy, psychological factors, knowledge about healthy eating, demographic and disease characteristics, environmental factors incorporated outside information on healthy eating, power of surrounding people, social activities, cultural milieus, socioeconomic status, and education. The behavioral factors included self-regulation of diet, goals, and other behaviors closely related to healthy eating behaviors.

CONCLUSIONS

Adherence to healthy eating behaviors among colorectal cancer survivors was influenced collectively by personal factors, environmental factors and behavioral factors.

Perceptions of Older Adults with Hematological Cancer on Diet and Exercise Behavior and Its Role in Navigating Daily Tasks

Diet and exercise are associated with the maintenance of physical function, independence and better health-related quality of life in cancer survivors. Adherence to healthy diet and exercise guidelines, however, remains low. The aim of this study was to explore the perceptions of hematological cancer survivors (HCS, ≥50 years) on the role of diet and exercise in navigating daily tasks using a qualitative descriptive research method. Eligible HCS completed an online survey gathering demographic information including physical functioning, exercise frequency, malnutrition and frailty risk. Following a semi-structured telephone interview, thematic analysis was used. Nine HCS (67 ± 2 years) were included in the final analysis, with 55.5% sufficiently active, three at risk of malnutrition and five of frailty. Three primary themes reflected the survivors' perceptions: (1) beliefs about the impact of diet and exercise on physical and mental wellbeing, (2) the ability to overcome barriers to adhere to healthy diet and exercise behavior, and (3) diet and exercise empowered and gave hope. Participants had a more nuanced understanding of the role of exercise in physical function but lacked insight into the role of a healthy diet. Knowledge, support and instruction were key enablers of diet and exercise behavior, with community connection a unique enabler identified in this group.

The impact of changes in taste, smell, and eating behavior in children with cancer undergoing chemotherapy: A qualitative study

Background and aims

Taste changes are the third most common bothersome symptom during treatment in children with cancer. However, it is still unclear what the essence of these taste changes are, to what degree concomitant changes in sense of smell qualify this bothersome treatment symptom and how much of an impact these changes have on the life of children with cancer. The aim of this study was to explore characteristics of both taste and smell changes and to gain insight into the impact of these changes in children with cancer receiving chemotherapy.

Methods

Semi-structured interviews were performed until data saturation was achieved in each age group (6–12, 13–17 years). This resulted in an in-depth description of taste and smell changes, including its impact on the life of 27 children with various cancer types receiving chemotherapy. Thematic analysis of interview data was performed.

Results

Interview data could be grouped into three main themes, namely changes in (1) taste, (2) smell, and (3) eating behavior. As expected, most children reported experiencing taste and smell changes just after start of treatment, but changes varied greatly between children; that is, some reported changes in intensity (increased or decreased), whereas others reported different perceptions or preferences (from sweet to savory). Taste and smell changes (regardless of direction) negatively impacted quality of life, with these changes commonly described as “disappointing” or “frustrating.” Interestingly, particular chemotherapeutic agents were frequently mentioned regarding taste and smell changes, prompting sensory-specific coping strategies. Children's eating behavior changed in terms of alterations in food liking and appetite, sometimes due to chemosensory changes, but children also mentioned specific medication or hospital food being responsible for their altered eating behavior.

Conclusions

Both taste and smell changes are common in children with cancer. The essence of these changes varies widely, but taste and smell changes are generally considered bothersome treatment symptoms. Ways to cope with taste or smell changes specifically were described by the children warranting further research and offering the opportunity for enhancing patient-centered care.

Prevalence and incidence of chemotherapy-induced taste alterations in adult cancer patients: a systematic review protocol

OBJECTIVE

This study will synthesize the available evidence on the prevalence and incidence of chemotherapy-induced taste alterations in adult cancer patients.

INTRODUCTION

Taste and smell alterations in cancer patients due to chemotherapy affect patients' quality of life and can cause malnutrition. Recent knowledge about the incidence and prevalence of chemotherapy-induced taste alterations may enable tailored food interventions for this specific population. Describing variations in taste changes in subgroups of chemotherapy is important to inform taste steering interventions.

INCLUSION CRITERIA

The review will consider studies that include adult cancer patients who are receiving or have received chemotherapy as a treatment for an oncologic issue. It will include studies that investigate the prevalence and incidence of chemotherapy-induced taste alterations that have been assessed objectively or subjectively by patient-reported outcomes.

METHODS

A systematic search will be performed of the following databases: MEDLINE (PubMed), CINAHL (Ovid), Embase, and OpenSIGLE. Analytical, observational, and cross-sectional studies will be considered. All studies will undergo critical appraisal, data extraction, and synthesis. Data will be extracted using the JBI standardized data extraction tool for prevalence and incidence. Type and frequency of treatment and cytostatic agent will be extracted. The population will be described by age and gender. In addition, study methods and proportions of interest to the review question will be extracted. Pooled prevalence estimates will be calculated using a random effects model.

SYSTEMATIC REVIEW

PROSPERO CRD42020136706.

Alterations in taste and smell associated with SARS-CoV-2: An exploratory study investigating food consumption and subsequent behavioural changes for those suffering from Post-Acute Sequelae of COVID-19

Objective: To explore food consumption and subsequent behavioural changes amongst PASC suffers associated with alterations in taste and smell. Design: A qualitative study involving five focus groups. Setting: Birmingham and Leicester, England, United Kingdom. Participants: Forty-seven Post-Acute Sequelae of COVID-19 sufferers. Results: Shifts in taste and odour were very common with disgusting or unpleasant notes being perceived in many foods, including animal products rich in protein. Food consumption patterns varied affecting nutrition status, individuals weight, types of foods consumed, cooking habits, coping mechanisms, anxieties, family and social interactions. Individuals expressed the need to taste something or experience normal tastes and flavour. Low pH foods, highly processed foods which may contain large amounts of refined sugars as well as cold processed food were the preferred items for consumption. Conclusion: Olfactory dysfunction was related to the consumption of nutrients that require moderation and to the quality of life. Intervention at an early stage is necessary in order to help avoid such complications and thus, this work informs medical practitioners and health workers of the variety of food choices that are more acceptable for people suffering from altered tastes and odour perception.

Individual Differences in Chemosensory Perception Amongst Cancer Patients Undergoing Chemotherapy: A Narrative Review

Chemotherapy is an aggressive form of treatment for cancer and its toxicity directly affects the eating behavior of many patients, usually by adversely affecting their sense of smell and/or taste. These sensory alterations often lead to serious nutritional deficiencies that can jeopardize the patient's recovery, and even continue to affect their lives once treatment has terminated. Importantly, however, not all patients suffer from such alterations to their chemical senses; and those who do, do not necessarily describe the side effects in quite the same way, nor suffer from them with equal intensity. The origin of these individual differences between cancer patients undergoing chemotherapy treatment has not, as yet, been studied in detail. This review is therefore designed to encourage future research that can help to address the perceptual/sensory problems (and the consequent malnutrition) identified amongst this group of patients in a more customized/personalized manner. In particular, by providing an overview of the possible causes of these large individual differences that have been reported in the literature. For this reason, in addition to the narrative bibliographic review, several possible strategies that could help to improve the chemosensory perception of food are proposed.

Multicenter, prospective, observational study of chemotherapy-induced dysgeusia in gastrointestinal cancer

PURPOSE

Dysgeusia is an adverse event caused by chemotherapy. Although retrospective studies have shown zinc administration improves dysgeusia, there have been no prospective studies. The present study examined effects of zinc therapy on dysgeusia in patients with gastrointestinal cancer.

METHODS

This multicenter, prospective, observational study enrolled patients with dysgeusia during chemotherapy treatment. Patients received no intervention (control), polaprezinc p.o., or zinc acetate hydrate p.o., and serum zinc levels were measured at 0 (baseline), 6, and 12 weeks. Dysgeusia was assessed using CTCAE v5.0 and subjective total taste acuity (STTA) criteria using questionnaires at baseline and 12 weeks.

RESULTS

From February 2020 to June 2021, 180 patients were enrolled from 17 institutes. There were no differences in mean baseline serum zinc levels among the groups (67.3, 66.6, and 67.5 μg/dL in the no intervention, polaprezinc, and zinc acetate hydrate groups, respectively. P = 0.846). The changes in mean serum zinc levels after 12 weeks were - 3.8, + 14.3, and + 46.6 μg/dL, and the efficacy rates of dysgeusia were 33.3%, 36.8%, and 34.6% using CTCAE and 33.3%, 52.6%, 32.7% using STTA in the no intervention, polaprezinc, and zinc acetate hydrate groups, respectively. The STTA scores improved in all groups, with significant improvement observed in the polaprezinc group compared with the no intervention group (P = 0.045).

CONCLUSION

There was no significant correlation between the degree of serum zinc elevation and improvement in dysgeusia, suggesting that polaprezinc, but not zinc acetate hydrate, was effective in improving chemotherapy-induced dysgeusia.

TRIAL REGISTRATION

UMIN000039653. Date of registration: March 2, 2020.

Oral Propolis, Nutritional Status and Quality of Life with Chemotherapy for Breast Cancer: A Randomized, Double-Blind Clinical Trial

Chemotherapy-induced side effects include an impaired nutritional status and reduced quality of life in patients. The contribution of propolis, as a co-adjuvant nutritional supplement in cancer treatment, is suggested due to its functional characteristics and biological activities such as antitumoral activity, DNA protection, free radicals scavenging, and immune stimulation; however, clinical trials to support these effects in cancer patients are necessary. This is a randomized, double-blind, placebo-controlled clinical trial to assess the effect of propolis vs. placebo on the nutritional status and quality of life in patients diagnosed with breast cancer who are receiving chemotherapy (No. IRCT2016062828679N1). A total of 60 patients from the Oncology Clinic at Tohid Hospital, Sanandaj, Iran were randomized to receive propolis (250 mg/two times per day for three months) or a placebo. After three months of intervention, energy intake of patients who received propolis increased significantly compared to placebo group (p = 0.000). The quality of life also showed significant improvements in patients receiving propolis, particularly with regards to emotional functioning (p = 0.03), global QoL functioning (p = 0.04), and financial difficulties (p = 0.01) compared to the control group. Propolis is suggested an adequate and safe therapeutic option to improve the nutritional status and quality of life in patients diagnosed with breast cancer receiving chemotherapy. However, more trials are needed in order to draw robust conclusions with regard to its efficacy in chemotherapy-induced side effects.

Transitioning the eating experience in survivors of head and neck cancer

PURPOSE

Applying the Social Cognitive Transition (SCT) Model of Adjustment as an interpretive framework, this mixed-methods case series explored how head and neck cancer (HNC) survivors participate in the dimensions of the eating experience (described as physiological, psychological, social, cultural).

METHODS

This was a sub-study of a primary study, "The Natural History and Impact of Taste Change in Oncology Care." Qualitative interviews and quantitative data (questionnaires and exams) were intersected to examine and describe the complexities of transitioning the eating experience after treatment for HNC. Triangulation of qualitative and quantitative data within and across cases was examined to produce rich descriptions of the changes and transitions in the eating experience.

RESULTS

Four case studies were detailed. All reported some taste and/or smell changes. Each case described worry about weight loss and the decreased ability to engage and finding meaning in the eating experience. Each expressed coping strategies that drew upon the social and cultural dimensions of their prior eating experience that brought meaning and purpose to the post-treatment eating experience.

CONCLUSIONS

This case series explored the impact of taste and oral function and the participant's pre- and post-treatment mental model of the eating experience. Application of the SCT Model of Adjustment to the eating experience in adults with HNC provided a deeper insight into how cognitive adaptation and coping strategies supported transition in identity related to the eating experience following cancer therapy.

Love, joy and necessity - A phenomenological study of food and meals in adolescents and young adults with cancer receiving high-emetogenic chemotherapy

PURPOSE

This study explored how the phenomenon of meals appeared in the interrelationship between adolescents and young adults (AYAs) receiving high-emetogenic chemotherapy, their next of kin and health professionals in the clinical setting.

METHOD

Data were collected by 140 h of participant observation conducted to gain insights into the nature of how meals appeared in the interrelationship between 12 AYAs (age 15-29 years), their next-of-kin and health professionals. The AYAs were patients with oncological and haematological diseases recruited from three university hospital departments. Data analysis was guided by van Manen's hermeneutic-phenomenological approach.

RESULTS

The essential meaning of the phenomenon may be characterized by the overarching theme; 'Seeking the joy of meals in the shadow of treatment' and the following three themes: 'Meals as a necessary evil' (AYAs); 'Meals as a matter of love' (next-of-kin); and 'Meals in the shadow of medical treatment' (health professionals).

CONCLUSIONS

Meals is a multi-facetted and complex phenomenon that has different meanings to AYAs, next-of-kin and health professionals. To the AYAs, meals emerged as a necessary evil in connection with which urges to eat occurred as glimpses of desire. Prominent feelings of powerlessness and food as love were highlighted by the next-of-kin, whereas food and meals appeared secondary to treatment for health professionals, reflecting the traditional biomedical paradigm. The findings revealed that adopting a holistic approach to AYAs concerning meals can have the potential to increase their food intake.

Liposomalization of Oxaliplatin Exacerbates the Non-Liposomal Formulation-Induced Decrease of Sweet Taste Sensitivity in Rats

Here, we investigated whether or not the characteristics of the oxaliplatin-induced sweet taste sensitivity were altered by PEGylated liposomalization of oxaliplatin (liposomal oxaliplatin), which enhances its anticancer efficacy. Liposomal oxaliplatin and oxaliplatin were intravenously and intraperitoneally, respectively, administered to male Sprague-Dawley rats at the total dose of 8 mg/kg. A brief-access test for evaluation of sweet taste sensitivity on day 7 revealed that both liposomal oxaliplatin and oxaliplatin decreased the sensitivity of rats, the degree with the former being greater than in the case of the latter. Liposomalization of oxaliplatin increased the accumulation of platinum in lingual non-epithelial tissues, through which taste nerves passed. The lingual platinum accumulation induced by not only liposomal oxaliplatin but also oxaliplatin was decreased on cooling of the tongue during the administration. In the current study, we revealed that liposomalization of oxaliplatin exacerbated the oxaliplatin-induced decrease of sweet taste sensitivity by increasing the accumulation of platinum/oxaliplatin in lingual non-epithelial tissues. These findings may suggest that reduction of liposomal oxaliplatin distribution to the tongue on cooling during the administration prevents exacerbation of the decrease of sweet taste sensitivity, maintaining the quality of life and chemotherapeutic outcome in patients.

The Mystery of "Metal Mouth" in Chemotherapy

Of all the oral sensations that are experienced, "metallic" is one that is rarely reported in healthy participants. So why, then, do chemotherapy patients so frequently report that "metallic" sensations overpower and interfere with their enjoyment of food and drink? This side-effect of chemotherapy-often referred to (e.g., by patients) as "metal mouth"-can adversely affect their appetite, resulting in weight loss, which potentially endangers (or at the very least slows) their recovery. The etiology of "metal mouth" is poorly understood, and current management strategies are largely unevidenced. As a result, patients continue to suffer as a result of this poorly understood phenomenon. Here, we provide our perspective on the issue, outlining the evidence for a range of possible etiologies, and highlighting key research questions. We explore the evidence for "metallic" as a putative taste, and whether "metal mouth" might therefore be a form of phantageusia, perhaps similar to already-described "release-of-inhibition" phenomena. We comment on the possibility that "metal mouth" may simply be a direct effect of chemotherapy drugs. We present the novel theory that "metal mouth" may be linked to chemotherapy-induced sensitization of TRPV1. Finally, we discuss the evidence for retronasal olfaction of lipid oxidation products in the etiology of "metal mouth." This article seeks principally to guide much-needed future research which will hopefully one day provide a basis for the development of novel supportive therapies for future generations of patients undergoing chemotherapy.

Flavor alterations in cancer treatment: Extrinsic factors as a means of augmentation

Flavor, comprising taste, smell and somatosensory inputs, is commonly altered in patients undergoing chemotherapy resulting in malnutrition leading to cachexia. A narrative review considered taste and smell alterations associated with malignancies treated using chemotherapy and the various interventions proffered to lessen alterations. Many of the currently used interventions directed towards enhancing intrinsic factors of food appeared ineffective in encouraging intake of adequate nutrition to ward off complications of malnutrition. Counselling is used in some cases with positive results. The use of extrinsic influences commensurate with the principles of food behavior and gastronomy are considered as a means of providing purpose to patients to accommodate flavor loss which when integrated with counseling and appropriate intrinsic factors are potentially a means of curtailing malnutrition and enhancing the psychological status of the patient. The close association between the cephalic phase responses (CPRs) and the control of eating and digestive behaviors is multifaceted, and when the influences of taste and smell are diminished, other contributing factors guiding CPRs may compensate a deficit. The need for the application of a consistent lexicon is essential when describing taste and smell alterations.

Self-reported taste and smell alterations and the liking of oral nutritional supplements with sensory-adapted flavors in cancer patients receiving systemic antitumor treatment

PURPOSE

Taste and smell alterations (TAs and SAs) are often reported by patients with cancer receiving systemic antitumor therapy and can negatively impact food intake and quality of life. This study aimed to examine the occurrence of TAs and SAs and investigate the impact of TAs on overall liking of oral nutritional supplements (ONS) with warming and cooling sensations.

METHODS

Patients receiving systemic antitumor therapy completed a questionnaire on sensory alterations and evaluated overall liking of 5 prototype flavors of Nutridrink® Compact Protein (hot tropical ginger (HTG), hot mango (HM), cool red fruits (CRF), cool lemon (CL), and neutral (N)) on a 10-point scale via a sip test. Differences between patients with and without TAs were investigated using permutation analysis.

RESULTS

Fifty patients with various cancer types and treatments were included. Thirty patients (60%) reported TAs and 13 (26%) experienced SAs. Three flavors were rated highly with a liking score > 6 (CRF 6.8 ± 1.7; N 6.5 ± 1.9; HTG 6.0 ± 2.0). Larger variation in ONS liking scores was observed in patients with TAs with or without SAs (4.5-6.9 and 4.6-7.2, respectively) vs. patients without TAs (5.9-6.5). TAs were associated with increased liking of CRF (Δ = + 0.9) and N (Δ = + 1.0) flavors.

CONCLUSIONS

TAs and SAs are common in patients with cancer undergoing systemic antitumor therapy. Patients with TAs were more discriminant in liking of ONS flavors compared to patients without TAs, and sensory-adapted flavors appeared to be appreciated. The presence of TAs should be considered when developing or selecting ONS for patients with cancer.

TRIAL REGISTRATION

Registration at ClinicalTrials.gov (NCT03525236) on 26 April 2018.

Characteristics of taste alterations in people receiving taxane-based chemotherapy and their association with appetite, weight, and quality of life

PURPOSE

There is limited evidence on the effect of chemotherapy-associated taste alteration. This study aimed to evaluate taste alteration characteristics in patients receiving taxane-based chemotherapy and investigate the association of taste alterations with appetite, weight, quality of life (QOL), and adverse events.

METHODS

This cross-sectional study evaluated 100 patients receiving paclitaxel, docetaxel, or nab-paclitaxel as monotherapy or combination therapy. Taste alterations were evaluated using taste recognition thresholds and severity and symptom scales. Taste recognition thresholds, symptoms, appetite, weight, and adverse events were compared between patients with and without taste alterations, and logistic regression analysis was performed to identify risk factors.

RESULTS

Of the 100 patients, 59% reported taste alterations. We found significantly elevated taste recognition thresholds (hypogeusia) for sweet, sour, and bitter tastes in the taste alteration group receiving nab-paclitaxel (p = 0.022, 0.020, and 0.039, respectively). The taste alteration group reported general taste alterations, decline in basic taste, and decreased appetite. Neither weight nor QOL was associated with taste alterations. Docetaxel therapy, previous chemotherapy, dry mouth, and peripheral neuropathy were significantly associated with taste alterations.

CONCLUSIONS

Almost 60% of patients receiving taxane-based regimens, especially docetaxel, reported taste alterations. Taste alteration affected the patient's appetite but did not affect the weight or QOL. Docetaxel therapy, previous chemotherapy, dry mouth, and peripheral neuropathy were independent risk factors for taste alterations.

Chemosensory perception and food preferences in colorectal cancer patients undergoing adjuvant chemotherapy

BACKGROUND AND AIM

Cancer is one of the major public health problems, with colorectal cancer being one of the most occurring types of cancer. During treatment, patients may experience changes in their dietary intake due to side-effects of treatment, like changes in chemosensory perception, i.e. smell and taste function. This study investigated alterations in chemosensory perception and food preferences in colorectal cancer patients during and after adjuvant chemotherapy.

METHODS

Objective olfactory and gustatory function were measured by the Sniffin' Sticks and the Taste Strips test. Subjective smell and taste perception were determined with a questionnaire, while food preferences were assessed with a computer-based ranking task. To investigate changes during chemotherapy, patients undergoing adjuvant chemotherapy were measured before the start, halfway through (approximately 3 months after the start of adjuvant chemotherapy), and within one month after finishing chemotherapy (longitudinal measurements, n = 15 patients). As a comparison group, colorectal cancer patients not undergoing chemotherapy (n = 20), underwent the same measurements at similar time points. To measure changes after treatment, chemosensory perception and food preferences of patients who had undergone chemotherapy treatment were measured once, either at 6, 12 or 24 months after diagnosis (cross-sectional measurements; n = 20 for all time points). Changes during treatment were assessed using linear mixed model analyses, and changes after treatment were assessed with a one-way ANOVA or a Kruskal Wallis test.

RESULTS

Objective olfactory and gustatory function did not differ statistically significantly between any of the groups and at any time point during or after treatment (all p > 0.05). In contrast, subjective smell (F(1,84) = 8.17, p = 0.005) and taste (F(1,99) = 4.08, p = 0.046) perception were rated statistically significantly lower by patients undergoing chemotherapy than the comparison group during treatment. At 6 months after diagnosis, patients who underwent chemotherapy rated their subjective taste perception significantly lower than patients at 12 and 24 months after treatment (F(2,57) = 12.05, p = 0.002). Food preferences did not change during treatment, or thereafter (all p > 0.05). Preference for protein-rich foods was positively correlated with objective gustatory function (r = 0.36, p < 0.001), while the preference for low-energy foods showed a negative correlation with objective gustatory function (r = -0.28, p = 0.004).

CONCLUSIONS

Similar to other cancer patient populations, mainly subjective smell and taste perception are affected in colorectal cancer patients undergoing adjuvant chemotherapy. Changes in objective olfactory and gustatory function in relation to chemotherapy were not detected by the tests used in our study nor did food preferences change. However, it should be noted that subjective changes in smell and taste perception can affect subsequent flavor perception and food enjoyment, which might negatively impact eating behavior and nutritional intake.

Validation of the Chinese version of chemotherapy-induced Taste Alteration Scale among patients with head and neck cancer undergoing radiotherapy

PURPOSE

To validate the Chinese version of the Chemotherapy-induced Taste Alteration Scale (CiTAS) among patients with head and neck cancer (HNC) undergoing radiotherapy (RT).

METHODS

Patients with HNC undergoing RT were enrolled from a cancer hospital. Data were collected by face-to-face interview. Patients' subjective taste alterations (TAs) were assessed by the CiTAS. The content validity was evaluated by five experts. Confirmatory and exploratory factor analysis were used to assess construct validity. Convergent validity was assessed by the correlation between the CiTAS score and the Quality of Life Questionnaire-Core 30 (QLQ-C30) score. A single-item subjective intensity taste alteration question and quartiles of RT duration were used to assess the discriminant validity. The reliability was assessed by the Cronbach's alpha and test-retest reliability.

RESULTS

253 patients participated this investigation and 25 patients completed twice. Confirmatory factor analysis showed that the original CiTAS structure with four dimensions was not applicable to patients with HNC undergoing RT. The Chinese version of modified-CiTAS (m-CiTAS) retained 17 items (the item "bothered by the smell of food" was deleted) loading onto three factors: decline in taste, discomfort, and phantogeusia and parageusia. The m-CiTAS showed acceptable correlations with the QLQ-C30. It could effectively discriminate the intensity of subjective TAs according to the single-item question and quartiles of RT duration. The m-CiTAS showed acceptable internal consistency (Cronbach's alpha = 0.573-0.958) and test-retest reliability (r = 0.726-0.831, P < 0.05).

CONCLUSIONS

The Chinese version of m-CiTAS is an acceptable and applicable instrument to evaluate TAs among patients with HNC undergoing RT.

Taste and smell disturbances in cancer patients: a scoping review of available treatments

PURPOSE

Taste and smell disturbances in patients affected by cancer are very common, but often under-recognized symptoms. If not addressed properly, they may impact nutritional status, food enjoyment, and quality of life. Treatment tools available for clinicians to manage chemosensory alterations are limited and are often based on personal clinical experiences. The aim of this study was to assess current oncological and palliative care literature through a scoping review, in order to identify available treatments for taste and smell alterations in cancer patients.

METHODS

Medline, Embase, CINAHL, ProQuest Dissertations and Theses, and Google Scholar were searched from inception until January 2020, with subject headings relevant to the domains of chemosensory alterations, palliative, and cancer care. A total of 10,718 English and French language publications were reviewed, yielding 43 articles on the researched topic.

RESULTS

The heterogeneity of selected articles led to difficulties in interpretation and analysis of the available evidence. Included publications differed in study design, population sample, anticancer treatments, and measures of assessment for taste and smell disturbances. A broad variety of treatment options were described including zinc and polaprezinc, radio-protectors, vitamins and supplements, anti-xerostomia agents, active swallowing exercises, nutritional interventions, delta-9-tetrahydrocannabinol, and photobiomodulation.

CONCLUSION

This scoping review identifies the current state of knowledge regarding chemosensory alterations within supportive cancer care. Despite not reaching firm conclusions, this article offers therapeutic venues to further explore in larger and more methodologically sound studies.

Diet and weight management by people with nonmetastatic colorectal cancer during chemotherapy: mixed methods research

Aim: To investigate self-management of dietary intake by colorectal cancer patients receiving chemotherapy. Methods: A questionnaire was administered to 92 patients with nonmetastatic colorectal cancer receiving chemotherapy treatment at a UK cancer center in 2018–19. A maximum variation sample of 20 patients who completed the questionnaire were interviewed. Results: More than three in five patients were at nutritional risk but fewer than one in five were concerned about dietary intake or weight. Self-management of diet and weight was inconsistent with achieving the nutritional intake recommended by clinical guidelines on nutrition in cancer. Conclusion: There is potential for psychoeducation to support change in self-management of nutritional risk, with implications for better treatment tolerance and outcomes including quality of life.

Patient-reported taste change assessment questionnaires used in the oncology setting: A narrative review

PURPOSE

Patient-reported questionnaires to assess taste changes (TC) among patients with cancer and the common domains or aspects assessed by those questionnaires are identified in this narrative review. Taste changes are a prevalent symptom experienced by patients with cancer that impact food choice and enjoyment, reduce food intake, and diminish quality of life. Appropriate assessment is essential to detect and manage this symptom.

METHOD

A systematic search of relevant databases between 1999 and 2018 yielded 1959 articles; 38 articles were included in the review.

RESULTS

Seventeen questionnaires designed specifically to assess patient-reported taste changes among patients with cancer are described in the review. Seven domains were identified among the questionnaires; the most frequently assessed domain was the description of the taste change in 14 questionnaires). Timeframe, scoring, number of items and domains, and item phrasing varied greatly among questionnaires and the approach to domain and item evaluation was inconsistent. Comprehensive questionnaires (n = 7) assessed five or more domains to characterize the taste change experience. The majority of questionnaires have been cited only once or twice.

CONCLUSION

Patient-reported taste change assessment in oncology has been achieved by a large number of diverse questionnaires; no standard tool or approach is used. Development of a question bank of validated or standardized taste change modules or items may strengthen the consistency and applicability of research in this area.

Oral examination findings, taste and smell testing during and following head and neck cancer therapy

PURPOSE

Diet and nutrition are critical in health and disease and are highly impacted by the presence and treatment for head and neck cancer (HNC). The purpose of this paper is to present oral examination findings and taste and smell test results in patients during and following HNC.

METHODS

Patients with HNC were evaluated during and following radiation therapy with/without chemotherapy. Oral examination findings including mucositis, saliva, oral hygiene (plaque levels, gingivitis), and taste and smell testing was completed on all subjects. NCI Common Terminology Criteria for Adverse Events (CTCAE) 4.0, and the Scale of Subjective Total Taste Acuity (STTA) were used to provide patient report of symptoms.

RESULTS

Mucositis and pain affected oral diet during therapy and improved in follow-up. Weight loss of 5% during and 12% following treatment was identified. Tobacco use was associated with increased severity of mucositis and increased weight loss. The subjects maintained excellent oral hygiene as reflected in plaque levels and gingivitis. Spicy/pungent perception was the most strongly disliked of testing stimuli. Umami and fat taste perception were reported of highest intensity during HNC treatment and rated as moderate in intensity after treatment. These results suggest improvement in these taste functions over time following treatment. Salt taste was of high intensity and associated with strong dislike in follow-up.

CONCLUSIONS

In HNC patients, oral status and taste change occurs throughout the cancer trajectory and represent potential concerns in cancer survivorship. Taste change (as evaluated by taste testing) occurred in all HNC patients, whereas olfactory changes occurred in 30% of cases. Management of oral changes and symptoms should be considered in all HNC patients in addition to dietary and nutritional guidance in patient care to promote oral intake. Continuing study of taste changes may further define this problem and support dietary and nutritional guidance and product development.

Chemosensory Changes from Cancer Treatment and Their Effects on Patients' Food Behavior: A Scoping Review

Individuals undergoing treatment for cancer can experience changes in taste or smell that are often assumed to affect constructs related to food behavior, although this relationship is rarely measured directly. To ascertain the extent to which measured changes in taste and smell during and after cancer treatment affect food behavior, we conducted a scoping review and completed a comparative analysis for studies that met our criteria, which were: they directly measured cancer patients’ (a) psychophysical response to taste and/or olfactory stimuli, and (b) food behavior (including food enjoyment, food preference, dietary intake) in people affected by cancer. Eleven studies met these criteria and were included in the review. All 11 studies evaluated taste and five also measured smell. A comparative analysis exploring taste and food behavior shows that a reduced sweet taste function (decreased sensitivity) was associated with a reduced intake of a variety of different macro and micro nutrients, reduced appetite, and overall lower energy intake. One out of six studies that measured smell and food measured observed changes in olfactory function following cancer treatment. There were no significant relationships reported between olfactory measures and food behavior. Taste changes that arise from cancer treatment appear to have a direct effect on food behavior, although there is a need for more research using standardized measures and larger sample sizes. A better understanding of taste alterations and their implications for dietary intake and food enjoyment will support optimal nutritional health by identifying strategies to help patients eat well during and after cancer treatment.

Changes in taste among pediatric patients with cancer and hematopoietic stem cell transplantation recipients

PURPOSE

Changes in taste is a common bothersome symptom in children receiving cancer treatments. However, little is known about how pediatric cancer patients experience this symptom. The objective was to describe how children receiving cancer treatments experience taste alterations and the approaches they use to address the issue.

METHODS

In this qualitative study, we included English-speaking children 4-18 years of age with cancer or hematopoietic stem cell transplantation recipients who were actively receiving cancer treatment or who had completed therapy. Using a semi-structured questionnaire, we asked questions about the experience of altered taste sensation. We asked about its characteristics, impacts and identified coping strategies.

RESULTS

We included 50 children. Children experienced changes in taste in a heterogeneous fashion although commonly described food as tasting "different", "not right" or "funny". While change in food preferences due to taste alterations was common, specific choices varied. Many found changes started with treatment initiation or mid-way through treatment, and some found that symptoms persisted up to 9 months following treatment completion. Actions taken to address taste changes were sucking on candy, brushing teeth and modifying food choices.

CONCLUSIONS

The experience of changes in taste was common yet highly variable in its presentation and resultant changes in food preferences. Taste changes did not always resolve soon after treatment completion. Future research should identify ways to manage this symptom in pediatric cancer patients.

Effect of lactoferrin on taste and smell abnormalities induced by chemotherapy: a proteome analysis

Cancer patients receiving chemotherapy often experience taste and smell abnormalities (TSA). To date, the underlying molecular mechanisms of this frequent side-effect have not been determined and effective treatments are not available. This study assessed the feasibility of lactoferrin (LF) supplementation as a treatment for TSA and investigate the related mechanisms through salivary proteome analysis. Nineteen cancer patients with established TSA following chemotherapy administration were enrolled in this study. Cancer patients and additional 12 healthy subjects took LF supplements, 3 tablets per day (250 mg per tablet), for 30 days. Saliva was collected at three timepoints: baseline, 30-day LF supplementation, and 30-day post-LF supplementation. Patient's TSA level, salivary proteome, and salivary minerals at each LF treatment stage were analyzed. High TSA level was associated with high concentration of salivary Fe and loss of critical salivary immune proteins. LF supplementation significantly decreased the concentration of salivary Fe (P = 0.025), increased the abundance (P < 0.05) of salivary α-amylase and Zn-α-2-GP, and led to an overall increase of expression (≥2-fold changes) of immune proteins including immunoglobulin heavy chain, annexin A1, and proteinase inhibitor. Abundance of α-amylase and SPLUNC2 were further increased (P < 0.05) at 30-day post-LF supplementation in cancer patients. At the same time, total TSA score was significantly reduced (P < 0.001) in chemotherapy patients. This study demonstrated the feasibility of developing lactoferrin supplementation as a treatment to reduce TSA caused by chemotherapy and improve cancer patient's oral immunity.

A longitudinal mixed methods study on changes in body weight, body composition, and lifestyle in breast cancer patients during chemotherapy and in a comparison group of women without cancer: study protocol

Background

More than 60% of women diagnosed with early stage breast cancer receive (neo)adjuvant chemotherapy. Breast cancer patients receiving chemotherapy often experience symptoms such as nausea, vomiting and loss of appetite that potentially affect body weight and body composition. Changes in body weight and body composition may detrimentally affect their quality of life, and could potentially increase the risk of disease recurrence, cardiovascular disease and diabetes. To date, from existing single method (quantitative or qualitative) studies is not clear whether changes in body weight and body composition in breast cancer patients are treatment related because previous studies have not included a control group of women without breast cancer.

Methods

We therefore developed the COBRA-study (Change Of Body composition in BReast cancer: All-in Assessment-study) to assess changes in body weight, body composition and related lifestyle factors such as changes in physical activity, dietary intake and other behaviours. Important and unique features of the COBRA-study is that it used I) a “Mixed Methods Design”, in order to quantitatively assess changes in body weight, body composition and lifestyle factors and, to qualitatively assess how perceptions of women may have influenced these measured changes pre-, during and post-chemotherapy, and II) a control group of non-cancer women for comparison. Descriptive statistics on individual quantitative data were combined with results from a thematic analysis on the interviews- and focus group data to understand patients’ experiences before, during and after chemotherapy.

Discussion

The findings of our mixed methods study, on chemotherapy treated cancer patients and a comparison group, can enable healthcare researchers and professionals to develop tailored intervention schemes to help breast cancer patients prevent or handle the physical and mental changes they experience as a result of their chemotherapy. This will ultimately improve their quality of life and could potentially reduce their risk for other co-morbidity health issues such as cardiovascular disease and diabetes.

Clinical, dietary and demographic characteristics interfering on quality of life of cancer patients

OBJECTIVE

To estimate the dietary intake of cancer patients and its relation with clinical and demographic characteristics, and to assess the contribution of dietary intake, appetite/symptoms and clinical and demographic characteristics to their quality of life.

METHODS

The consumption of energy and macronutrients of patients was estimated. The relation between dietary intake and clinical and demographic characteristics was evaluated by analysis of variance. The intake of energy and macronutrient of the patients was compared to the nutritional recommendations using 95% confidence interval. The Cancer Appetite and Symptom Questionnaire (CASQ) and the European Organization for Research and Treatment of Cancer (EORTC QLQ C-30) were used to assess appetite/symptoms and quality of life, respectively. The psychometric properties of the instruments were estimated. A structural equation model was prepared.

RESULTS

In this study, 772 cancer patients (63.1% women) participated. There was a significant relation between dietary intake and work activity, economic class, specialty field of cancer, type of treatment and nutritional status. Patients' energy and macronutrients intake was below recommended values. Both CASQ and EORTC QLQ C-30 were refined to fit the data. In the structural model, impaired appetite, more symptoms, presence of metastasis, being female and of higher economic classes were characteristics that significantly contributed to interfering in patients' quality of life.

CONCLUSION

The dietary intake of oncology patients did not reach the recommended values. Different characteristics impacted on quality of life of patients and should be considered in clinical and epidemiological protocols.

Eating Experiences, Sweet Preference, and Weight Gain in Women During Chemotherapy for Breast Cancer: A Mixed Methods Study

Weight gain during breast cancer treatment has not been explained yet. This study aimed to explore eating experience and its relationship with weight gain and sweet preference and intake in women in chemotherapy treatment for breast cancer. Thirty-one patients indicated for adjuvant (n = 16) or neoadjuvant (n = 15) chemotherapy containing anthracyclines were evaluated. Weight, sweet preference in cashew juice (weight/volume, 3, 6, 12, 24, and 36%), and sweet food intake frequency ["healthy sweets" (HS) for fruits and natural juices and "nonhealthy sweets" (NHS) for other sweets] were assessed prior to initiating (T0) and after the fourth chemotherapy cycle (T1). A semistructured interview was applied at T1. At baseline, patients were 46.7 ± 11.6 years old and the mean body mass index (BMI) was 29.3 ± 7.1 kg/m². The patients' weight and BMI increased, as did the HS intake, with positive correlation between HS intake and weight change (r = 0.38; P = 0.039). Baseline sweet preference is correlated to NHS intake at T0 (r = 0.51; P = 0.004) and influences NHS intake change. The interview analysis showed opposite food behaviors: at times driven by self-care and, at other times, driven by the emotional vulnerability, which may contribute to the weight gain observed.

Alterations in emotional responses (pleasantness/unpleasantness) induced by sniffing food odors during chemotherapy in patients with lung cancer

Background

Patients receiving chemotherapy experience anorexia and food aversion in their daily lives, and one of the causes is the smell of food. However, it is not clear why the aversion to these smells occurs. This study aimed to determine the emotional responses of patients when they sniff representative food odors during chemotherapy and to investigate factors influencing smell-induced food aversion.

Methods

The subjects were 26 patients with lung cancer undergoing chemotherapy with carboplatin. A visual analog scale (VAS) was used to evaluate whether they felt unpleasantness, with a focus on nizakana (simmered fish) and citrus fruits odors. This evaluation was performed both before and 2 days after the patients were administered carboplatin.

Results

The results revealed that the VAS scores of emotional responses due to the sniffing of each food sample did not differ significantly (P = 0.942) before and during chemotherapy. However, the smell of nizakana with added ammonia altered VAS scores of the emotional responses significantly during chemotherapy (P = 0.015). Moreover, patients with lung cancer who had a heightened level of odor awareness in their daily lives felt more unpleasantness by sniffing nizakana with added ammonia (correlation coefficient [rs] = -0.437, P = 0.026). However, patients with a lower odor awareness level felt no unpleasantness.

Conclusions

The present findings suggest that patients with food aversion during chemotherapy are those with heightened odor awareness level; furthermore, this happens when they sense smells characteristic of substances harmful to the body.

Taste changes as a metaphor for biographical disruption: A qualitative study in patients undergoing haematopoietic stem cell transplantation

PURPOSE

and objective: The treatment side effects of patients undergoing haematopoietic stem cell transplantation can cause various eating difficulties. The objective of this study was to explore the significance of eating experiences and taste changes from the perspective of patients undergoing haematopoietic stem cell transplantation.

METHOD

This was a qualitative, exploratory study based on semi-structured interviews applied during hospitalisation for haematopoietic stem cell transplantation. Thematic content analysis and the biographical disruption concept were used as theoretical references to explore the results.

RESULTS

Twenty patients were studied. The overarching theme identified from the results was deconstruction of the taste reference resulting from sensory taste change, loss of eating references and changes to the hedonic relationship with food caused by the treatment. In addition to this deconstruction, participants described the reformulation of eating habits as a way of coping with the disease, which affected the eating experience and motivated the dietary strategies adopted.

CONCLUSIONS

Taste changes during haematopoietic stem cell transplantation are related to both biological issues and metaphysical aspects. This study raises the meaning of loss of sensory references and their symbolic aspects. These results were important to expand our view to include other aspects that can contribute to improving the care given to these individuals.

Innovative food products for cancer patients: future directions

One of the main challenges for cancer patients under treatment is to prevent and tackle malnutrition. The current clinical nutrition market offers different food supplements or oral nutritional support products (mainly milkshakes or modified texture products) for cancer patients under risk of malnutrition. However, it is worth mentioning that these products do not address the pleasure of eating, since they do not meet sensory requirements, such as taste and smell alterations, nor patients' food preferences, leading to a big impact on their quality of life (QOL). Still, controversy remains regarding the specific nutritional requirements for cancer patients during the disease. Several randomized controlled clinical trials yield opposite results when using different bioactive compounds such as omega-3 fatty acids or antioxidants in order to prevent malnutrition or improve QOL. The use of 'omics' technologies in oncology, such as membrane lipidomics, as a powerful tool to provide new insights for the understanding of diet and cancer and their interacting metabolic pathways, will be discussed. The better knowledge of specific requirements (nutrients, sensory parameters and food preferences) for cancer patients provides valuable information for the food industry in the design of customized food products capable of preventing malnutrition, alleviating symptoms and improving QOL. © 2017 Society of Chemical Industry.

Dealing with taste and smell alterations-A qualitative interview study of people treated for lung cancer

Taste and smell alterations have been recognized as common symptoms in relation to various cancers. However, previous research suggests that patients do not receive sufficient support in managing taste and smell alterations. Therefore, the objective of this study is to investigate how persons with experience from lung cancer-related taste and smell alterations reason about resources and strategies offered and used to manage these symptoms. Data from semi-structured individual interviews with 13 women and four men were analyzed with qualitative content analysis. We used Kleinman’s now classic medical anthropological model of local health care systems, consisting of the personal, professional, and folk sector, to interpret and understand how people respond to sickness experiences in their daily lives. By presenting the findings using this model, we demonstrate that most strategies for dealing with taste and smell alterations were undertaken in the personal sector, i.e. in participants’ daily lives, on an individual level and in interaction with family, social networks and communities. Taste and smell alterations implied two overarching challenges: 1) adjusting to no longer being able to trust information provided by one’s own senses of taste and/or smell, and 2) coming to terms with taste and smell alterations as a part of having lung cancer. Health care professionals’ involvement was described as limited, but appeared to fulfil most participants’ expectations. However, through provision of normalizing information, practical advice, and to some extent, emotional support, health care professionals had potential to influence strategies and resources used for dealing with taste and smell alterations. With this study, we further the understanding of how people deal with lung cancer-related taste and smell alterations and discuss the role of health care professionals for this process.

Psychosocial Support in Cancer Cachexia Syndrome: The Evidence for Supported Self-Management of Eating Problems during Radiotherapy or Chemotherapy Treatment

People receiving cancer treatment are at nutritional risk. Their eating problems can lead to malnutrition and weight loss. Involuntary weight loss is also a defining characteristic of tumor-induced cachexia. Weight loss is associated with poor tolerance of treatment, poor treatment outcomes, morbidity, and mortality. Support for self-management of nutritional risk may protect against malnutrition and be important in multimodal therapies to arrest the progression of cachexia. Nurses can help patients by supporting self-management of eating problems. This scoping review is about eating problems during cancer treatment. It considers patient experience and self-management of eating problems during cancer treatment for the proactive management of malnutrition and cachexia. It draws on a systematic search of Medline, CINAHL, PsycINFO, and the Cochrane Library for publications about people with cancer who have eating problems during treatment. Limits were English language; January 2000 to December 2017; adults. The search found studies about eating problems in patients treated with chemotherapy or radiotherapy for head-and-neck cancer, lung cancer, gastrointestinal cancer, breast cancer, testicular cancer, and ovarian cancer. Nutritional counseling can improve nutritional intake, quality of life, and weight. However, the patient perspective on self-management and how to motivate engagement in nutritional care is unexplored. There is a potential for reducing nutritional risk during cancer treatment using psychoeducation to support behavioral change, thus empower self-management of eating problems. Benefits are likely in subgroups of people receiving cancer treatment, such as those with head and neck, gastrointestinal, and lung cancers.

Oral health impacts of medications used to treat mental illness

BACKGROUND

Many psychotropic medications affect oral health. This review identified oral side effects for antidepressant, antipsychotic, anticonvulsant, antianxiety and sedative drugs that are recommended in Australia for the management of common mental illnesses and provides recommendations to manage these side-effects.

METHODS

The Australian Therapeutic Guidelines and the Australian Medicines Handbook were searched for medications used to treat common mental health conditions. For each medication, the generic name, class, and drug company reported side-effects were extracted from the online Monthly Index of Medical Specialties (eMIMs) and UpToDate databases. Meyler's Side Effect of Drugs Encyclopaedia was used to identify additional oral adverse reactions to these medications.

RESULTS

Fifty-seven drugs were identified: 23 antidepressants, 22 antipsychotics or mood stabilisers, and 12 anxiolytic or sedative medications. Xerostomia (91%) the most commonly reported side effect among all classes of medications of the 28 identified symptoms. Other commonly reported adverse effects included dysguesia (65%) for antidepressants, and tardive dyskinesia (94%) or increased salivation (78%) for antipsychotic medications.

CONCLUSIONS

While xerostomia has often been reported as a common adverse effect of psychotropic drugs, this review has identified additional side effects including dysguesia from antidepressants and tardive dyskinesia and increased salivation from antipsychotics. Clinicians should consider oral consequences of psychotropic medication in addition to other side-effects when prescribing. For antidepressants, this would mean choosing duloxetine, agomelatine and any of the serotonin re-uptake inhibitors except sertraline. In the case of antipsychotics and mood stabilisers, atypical agents have less oral side effects than older alternatives.

Impact of chemotherapy on perceptions related to food intake in women with breast cancer: A prospective study

Breast cancer (BC) treatment includes mostly chemotherapy (CT), which can cause side effects like nausea, taste changes, early satiety, slow gastric emptying and xerostomia. In this way, the individual’s relationship with food may change during the treatment. The aim of this study was to evaluate the impact of chemotherapy on perceptions related to food intake of women with BC. Fifty-five women with BC were followed, and data were collected at three periods during first-line CT: beginning (T0), intermediate (T1) and end (T2). A visual analogue scale (VAS) (0 to 10 cm) for hunger, appetite for various food categories and meal enjoyment was investigated. The frequency and intensity of side effects were evaluated using a 4 cm scale. The results showed a higher prevalence of taste changes in T1 (p = 0.044) and more nausea in T1 and T2 (p = 0.018). Furthermore, the intensity of nausea was higher in T2 (p = 0.01) than in the other periods. We observed moderate hunger in T0, T1 and T2 (p = 0.113), but the overall appetite increased between T0 and T2 (p = 0.003). Meal enjoyment was reduced from T0 to T1and returned back to the initial value in T2 (p = 0.021). The appetite for salty (p = 0.004) and spicy (p = 0.03) foods was increased in T1. There was an increase of body weight (p = 0.008), body mass index (BMI) (p = 0.009) and waist circumference (WC) (p = 0.03) during CT. CT changes food hedonism, increasing the overall appetite and the appetite for salty and spicy foods. Moreover, we observed the negative impact of CT on meal enjoyment and an increase in side effects and anthropometric parameters.

Protein calorie malnutrition, nutritional intervention and personalized cancer care

Cancer patients often experience weight loss caused by protein calorie malnutrition (PCM) during the course of the disease or treatment. PCM is expressed as severe if the patient has two or more of the following characteristics: obvious significant muscle wasting, loss of subcutaneous fat; nutritional intake of <50% of recommended intake for 2 weeks or more; bedridden or otherwise significantly reduced functional capacity; weight loss of >2% in 1 week, 5% in 1 month, or 7.5% in 3 months. Cancer anorexia-cachexia syndrome (CACS) is a multifactorial condition of advanced PCM associated with underlying illness (in this case cancer) and is characterized by loss of muscle with or without loss of fat mass. Cachexia is defined as weight loss of more than 5% of body weight in 12 months or less in the presence of chronic disease. Hence with a chronic illness on board even a small amount of weight loss can open the door to cachexia. These nutritional challenges can lead to severe morbidity and mortality in cancer patients. In the clinic, the application of personalized medicine and the ability to withstand the toxic effects of anti-cancer therapies can be optimized when the patient is in nutritional homeostasis and is free of anorexia and cachexia. Routine assessment of nutritional status and appropriate intervention are essential components of the effort to alleviate effects of malnutrition on quality of life and survival of patients.