The Mystery of "Metal Mouth" in Chemotherapy

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.

Metallic taste prevalence in patients treated for cancer: a systematic literature review and meta-analysis

BACKGROUND

Metallic taste (MT) is a taste abnormality often reported by cancer patients. The aim of this systematic review was to exhaustively report MT incidences in cancer patients and to evaluate the risk of bias in the pertinent studies in accordance with a meta-analysis approach.

METHODS

The research objective was to determine the prevalence of MT in patients treated for cancer. A literature search was conducted using PubMed, Web of Science, and Embase. The authors each screened articles and evaluated the eligibility and individual risk of bias for each article. Then, all of the results were compared. A meta-analysis was conducted on studies that specifically focused on MT evaluation.

RESULTS

Very few articles have been published on the incidence of MT among taste and smell abnormalities in cancerology (22 of 1674, 1.3%), and the quality of the reports on MT was often low. The most common bias was the methodology used for MT evaluation. Pooling the results of the 22 studies led to an estimated MT incidence in the cancer patient population of 29% (95% CI [0.21; 0.39]) with high and significant heterogeneity observed among the studies. A heterogeneity analysis was performed to identify the causal factors of this heterogeneity. The specific impact of MT on nutritional status (two) and quality of life (five) studies were reported, respectively, and without a specific evaluation of MT. There was no mention of oral health in any of the studies.

CONCLUSION

Although in clinical practice cancer patients often report MT, its incidence has only been reported in 22 studies, most of which have a moderate to severe risk of bias. Considering the rather high prevalence of MT, more research should be conducted in this field to better identify its causes and mechanisms.

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.

Metallic: A Bivalent Ambimodal Material Property?

Many metallic visual stimuli, especially the so-called precious metals, have long had a rich symbolic meaning for humans. Intriguingly, however, while metallic is used to describe sensations associated with pretty much every sensory modality, the descriptor is normally positively valenced in the case of vision while typically being negatively valenced in the case of those metallic sensations that are elicited by the stimulation of the chemical senses. In fact, outside the visual modality, metallic would often appear to be used to describe those sensations that are unfamiliar and unpleasant as much as to refer to any identifiable perceptual quality (or attribute). In this review, we assess those sensory stimuli that people choose to refer to as metallic, summarising the multiple, often symbolic, meanings of (especially precious) metals. The evidence of positively valenced sensation transference from metallic serviceware (e.g., plates, cups, and cutlery) to the food and drink with which it comes into contact is also reviewed.

Taste and Smell Function in Head and Neck Cancer Survivors

Survivors of head and neck squamous cell cancers (HNSCC) frequently complain of taste dysfunction long after radiation therapy is completed, which contradicts findings from most sensory evaluation studies that predict dysfunction should resolve few months after treatment. Therefore, it remains unclear whether taste and smell function fully recovers in HNSCC survivors. We evaluated HNSCC survivors (n = 40; age 63 ± 12 years, mean ± standard deviation) who received radiation therapy between 6 months and 10 years before recruitment and compared their responses to those of a healthy control group (n = 20) equivalent in age, sex, race, smoking history, and body mass index. We assessed regional (tongue tip) and whole-mouth taste intensity perception using the general Labeled Magnitude Scale and smell function using the University of Pennsylvania Smell Identification Test (UPSIT). To determine possible differences between groups in retronasal smell perception, we used solutions of sucrose with strawberry extract, citric acid with lemon extract, sodium chloride in vegetable broth, and caffeine in coffee and asked participants to rate perceived smell and taste intensities with and without nose clips. We found groups had similar UPSIT and taste intensity scores when solutions were experienced in the whole mouth. However, HNSCC survivors were less likely to identify low concentrations of bitter, sweet, or salty stimuli in the tongue tip relative to healthy controls. Our findings suggest persistent and subtle localized damage to the chorda tympani or to the taste buds in the fungiform papillae of HNSCC survivors, which could explain their sensory complaints long after completion of radiotherapy.

Explaining Crossmodal Correspondences Between Colours and Tastes

For centuries, if not millennia, people have associated the basic tastes (e.g., sweet, bitter, salty, and sour) with specific colours. While the range of tastes may have changed, and the reasons for wanting to connect the senses in this rather surprising way have undoubtedly differed, there would nevertheless appear to be a surprisingly high degree of consistency regarding this crossmodal mapping among non-synaesthetes that merits further consideration. Traditionally, colour-taste correspondences have often been considered together with odour-colour and flavour-colour correspondences. However, the explanation for these various correspondences with the chemical senses may turn out to be qualitatively different, given the presence of identifiable source objects in the case of food aromas/flavours, but not necessarily in the case of basic tastes. While the internalization of the crossmodal statistics of the environment provides one appealing account for the existence of colour-taste correspondences, emotional mediation may also be relevant. Ultimately, while explaining colour-taste correspondences is of both theoretical and historical interest, the growing awareness of the robustness of colour-taste correspondences would currently seem to be of particular relevance to those working in the fields of design and multisensory experiential marketing.

Metallic Sensation-Just an Off-Flavor or a Biologically Relevant Sensing Pathway?

Metallic off-flavors are a frequent theme in discussions of food product quality, with publications dating back over 90 years. The causes of this unpleasant perception are diverse, ranging from unfavorable concentrations of micronutrients, the use of artificial sweeteners, processing, packaging, and storage, to side effects of pharmaceutical or chemotherapeutic agents. However, the mechanisms behind metallic sensing and its contributions to taste, smell, and trigeminal nerve sensations are still poorly understood. Although even defining oral/nasal metallic sensation has proven difficult, thought should also be given to possible biological activities of food constituents eliciting a metallic sensation though activation of ectopically expressed chemoreceptors. This perspective seeks to summarize and connect research conducted on different food-borne stimuli of metallic sensation, their sensory evaluations up to more recent contributions addressing the mechanistic approaches to identify chemosensory-active food constituents, and their biological effects mediated by ectopically expressed chemosensory receptors. With this perspective, we hope to spark interest in fully characterizing the mostly unwanted metal off-flavor, thereby laying grounds for increased product quality on one hand and providing novel insights into chemosensory-associated biological functions of metallic sensation on the other hand, which might help to understand and combat these sensations experienced in various diseases and therapies, e.g., platinum-based chemotherapy.

Aging and the (Chemical) Senses: Implications for Food Behaviour Amongst Elderly Consumers

The growing aging population are increasingly suffering from the negative health consequences of the age-related decline in their senses, especially their chemical senses. Unfortunately, however, unlike for the higher senses of vision and hearing, there is currently nothing that can be done to bring back the chemical senses once they are lost (or have started their inevitable decline). The evidence suggests that such chemosensory changes can result in a range of maladaptive food behaviours, including the addition of more salt and sugar to food and drink in order to experience the same taste intensity while, at the same time, reducing their overall consumption because food has lost its savour. Here, though, it is also important to stress the importance of the more social aspects of eating and drinking, given the evidence suggesting that a growing number of older individuals are consuming more of their meals alone than ever before. Various solutions have been put forward in order to try to enhance the food experience amongst the elderly, including everything from optimising the product-intrinsic food inputs provided to the remaining functional senses through to a variety of digital interventions. Ultimately, however, the aim has to be to encourage healthier patterns of food consumption amongst this rapidly-growing section of the population by optimising the sensory, nutritional, social, and emotional aspects of eating and drinking. An experimental dinner with the residents of one such home where nostalgic-flavoured healthy ice-creams were served is described.

A review of the flavor profile of metal salts: understanding the complexity of metallic sensation

The oral sensation of metallic is a complex experience. Much of our current understanding of metallic sensation is from the investigation of metal salts, which elicit diverse sensations, including taste, smell, and chemesthetic sensations, and therefore meet the definition of a flavor rather than a taste. Due to the involvement of multiple chemosensory systems, it can be challenging to define and characterize metallic sensation. Here, we provide a comprehensive review of the psychophysical studies quantifying and characterizing metallic sensation, focusing on metal salts. We examine the factors that impact perception, including anion complex, concentration, nasal occlusion, and pH. In addition, we summarize the receptors thought to be involved in the perception of metallic sensation (i.e., TRPV1, T1R3, TRPA1, and T2R7) either as a result of in vitro assays or from studies in knock-out mice. By enhancing our scientific understanding of metallic sensation and its transduction pathways, it has the potential to improve food and pharmaceuticals, help identify suppression or masking strategies, and improve the ability to characterize individual differences in metallic sensation. It also has the potential to translate to clinical populations by addressing the disparities in knowledge and treatment options for individuals suffering from metallic taste disorder (i.e., phantom taste or "metal mouth"). Future psychophysical studies investigating the sensory perception of metal salts should include a range of compounds and diverse food matrices, coupled with modern sensory methods, which will help to provide a more comprehensive understanding of metallic sensation.