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Ferreira MH, Bezinelli LM, de Paula Eduardo F, Pereira AZ, Hamerschlak N, Corrêa L. Photobiomodulation minimizes taste changes during hematopoietic cell transplantation: A randomized clinical trial. JOURNAL OF BIOPHOTONICS 2024; 17:e202400095. [PMID: 38850248 DOI: 10.1002/jbio.202400095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/10/2024]
Abstract
Prevention and treatment protocols for taste changes observed during hematopoietic cell transplantation (HCT) are not well-established. The purpose of this study was to assess the efficacy of photobiomodulation (PBM) in relieving taste changes and preventing lingual papillae atrophy. HCT patients received PBM (n = 42) on the tongue dorsum using an InGaAIP laser (660 nm, 100 mW, 1.1 W/cm2, 8.8 J/cm2). During the HCT conditioning (T0), severe neutropenia (T1), and after neutrophil engraftment (T2), taste acuity for sweet, bitter, sour, and salty solutions, and clinical appearance of lingual papillae were compared with those of a placebo group (n = 43). PBM significantly reduced hypogeusia, ageusia, and parageusia at T1 and T2, and also successfully prevented papillae atrophy during all the analyzed HCT periods. In conclusion, PBM enhanced taste acuity during HCT. The decrease in papillae atrophy indicated a potential regenerative effect of this therapy on tongue mucosa.
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Affiliation(s)
- Mariana Henriques Ferreira
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Pathology Department, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Luciana Corrêa
- Pathology Department, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Rosati D, Mastino P, Romeo M, de Soccio G, Pentangelo D, Petrella C, Barbato C, Minni A. Taste and Smell Alterations (TSAs) in Cancer Patients. Diseases 2024; 12:130. [PMID: 38920562 PMCID: PMC11203271 DOI: 10.3390/diseases12060130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/30/2024] [Accepted: 06/19/2024] [Indexed: 06/27/2024] Open
Abstract
Recently, smell and taste disorders have seen renewed interest, as these symptoms are frequent complications of SARS-CoV-2 infection, since approximately 60% of patients affected by COVID-19 have shown olfactory and gustatory alterations. Otolaryngology pays attention to taste and smell abnormalities (TSAs), especially when associated with oncology. TSAs are common symptoms in people affected by cancer, yet they are ignored and underestimated. The clinical outcome of TSAs in cancer evidences the importance of identifying them with chemotherapy or radiotherapy in general, and they are associated with many types of cancer. We recognize the findings of the literature on TSAs in cancer, evaluating how it is important to consider and identify these disorders concerning reduced food enjoyment or inappropriate nutrient intake, and modulating the nutritional status, quality of life, and impact of therapy. This review aims to critically evaluate and recognize the assessment and clinical perspectives of taste and smell disorders in a cancer population.
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Affiliation(s)
- Davide Rosati
- Division of Otolaryngology-Head and Neck Surgery, Ospedale San Camillo de Lellis, ASL Rieti-Sapienza University, Viale Kennedy, 02100 Rieti, Italy; (D.R.); (P.M.); (M.R.)
| | - Pierluigi Mastino
- Division of Otolaryngology-Head and Neck Surgery, Ospedale San Camillo de Lellis, ASL Rieti-Sapienza University, Viale Kennedy, 02100 Rieti, Italy; (D.R.); (P.M.); (M.R.)
| | - Martina Romeo
- Division of Otolaryngology-Head and Neck Surgery, Ospedale San Camillo de Lellis, ASL Rieti-Sapienza University, Viale Kennedy, 02100 Rieti, Italy; (D.R.); (P.M.); (M.R.)
| | - Giulia de Soccio
- Division of Otolaryngology-Head and Neck Surgery, Ospedale San Camillo de Lellis, ASL Rieti-Sapienza University, Viale Kennedy, 02100 Rieti, Italy; (D.R.); (P.M.); (M.R.)
| | - Daniele Pentangelo
- Division of Otolaryngology-Head and Neck Surgery, Ospedale San Camillo de Lellis, ASL Rieti-Sapienza University, Viale Kennedy, 02100 Rieti, Italy; (D.R.); (P.M.); (M.R.)
| | - Carla Petrella
- Institute of Biochemistry and Cell Biology (IBBC), National Research Council (CNR), Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Roma, Italy;
| | - Christian Barbato
- Institute of Biochemistry and Cell Biology (IBBC), National Research Council (CNR), Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Roma, Italy;
| | - Antonio Minni
- Division of Otolaryngology-Head and Neck Surgery, Ospedale San Camillo de Lellis, ASL Rieti-Sapienza University, Viale Kennedy, 02100 Rieti, Italy; (D.R.); (P.M.); (M.R.)
- Department of Sense Organs DOS, Sapienza University of Rome, Viale del Policlinico 155, 00161 Roma, Italy
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López-Plaza B, Álvarez-Mercado AI, Arcos-Castellanos L, Plaza-Diaz J, Ruiz-Ojeda FJ, Brandimonte-Hernández M, Feliú-Batlle J, Hummel T, Gil Á, Palma-Milla S. Efficacy and Safety of Habitual Consumption of a Food Supplement Containing Miraculin in Malnourished Cancer Patients: The CLINMIR Pilot Study. Nutrients 2024; 16:1905. [PMID: 38931260 PMCID: PMC11207068 DOI: 10.3390/nu16121905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Taste disorders (TDs) are common among systemically treated cancer patients and negatively impact their nutritional status and quality of life. The novel food approved by the European Commission (EFSA), dried miracle berries (DMB), contains the natural taste-modifying protein miraculin. DMB, also available as a supplement, has emerged as a possible alternative treatment for TDs. The present study aimed to evaluate the efficacy and safety of habitual DMB consumption in malnourished cancer patients undergoing active treatment. An exploratory clinical trial was carried out in which 31 cancer patients were randomized into three arms [standard dose of DMB (150 mg DMB/tablet), high dose of DMB (300 mg DMB/tablet) or placebo (300 mg freeze-dried strawberry)] for three months. Patients consumed a DMB tablet or placebo daily before each main meal (breakfast, lunch, and dinner). Throughout the five main visits, electrochemical taste perception, nutritional status, dietary intake, quality of life and the fatty acid profile of erythrocytes were evaluated. Patients consuming a standard dose of DMB exhibited improved taste acuity over time (% change right/left side: -52.8 ± 38.5/-58.7 ± 69.2%) and salty taste perception (2.29 ± 1.25 vs. high dose: 2.17 ± 1.84 vs. placebo: 1.57 ± 1.51 points, p < 0.05). They also had higher energy intake (p = 0.075) and covered better energy expenditure (107 ± 19%). The quality of life evaluated by symptom scales improved in patients receiving the standard dose of DMB (constipation, p = 0.048). The levels of arachidonic (13.1 ± 1.8; 14.0 ± 2.8, 12.0 ± 2.0%; p = 0.004) and docosahexaenoic (4.4 ± 1.7; 4.1 ± 1.0; 3.9 ± 1.6%; p = 0.014) acids in erythrocytes increased over time after DMB intake. The standard dose of DMB increased fat-free mass vs. placebo (47.4 ± 9.3 vs. 44.1 ± 4.7 kg, p = 0.007). Importantly, habitual patients with DMB did not experience any adverse events, and metabolic parameters remained stable and within normal ranges. In conclusion, habitual consumption of a standard 150 mg dose of DMB improves electrochemical food perception, nutritional status (energy intake, fat quantity and quality, fat-free mass), and quality of life in malnourished cancer patients receiving antineoplastic treatment. Additionally, DMB consumption appears to be safe, with no changes in major biochemical parameters associated with health status. Clinical trial registered (NCT05486260).
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Affiliation(s)
- Bricia López-Plaza
- Food, Nutrition and Health Platform, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain; (L.A.-C.); (S.P.-M.)
- Medicine Department, Faculty of Medicine, Complutense University of Madrid, Plaza de Ramón y Cajal, s/n, 28040 Madrid, Spain
| | - Ana Isabel Álvarez-Mercado
- Department of Pharmacology, University of Granada, 18071 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain; (J.P.-D.); (F.J.R.-O.); (Á.G.)
- Institute of Nutrition and Food Technology “José Mataix”, Centre of Biomedical Research, University of Granada, Avda. del Conocimiento s/n, Armilla, 18016 Granada, Spain;
| | - Lucía Arcos-Castellanos
- Food, Nutrition and Health Platform, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain; (L.A.-C.); (S.P.-M.)
| | - Julio Plaza-Diaz
- Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain; (J.P.-D.); (F.J.R.-O.); (Á.G.)
- Department of Biochemistry and Molecular Biology II, University of Granada, 18071 Granada, Spain
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Francisco Javier Ruiz-Ojeda
- Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain; (J.P.-D.); (F.J.R.-O.); (Á.G.)
- Institute of Nutrition and Food Technology “José Mataix”, Centre of Biomedical Research, University of Granada, Avda. del Conocimiento s/n, Armilla, 18016 Granada, Spain;
- Department of Biochemistry and Molecular Biology II, University of Granada, 18071 Granada, Spain
- CIBEROBN (CIBER Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marco Brandimonte-Hernández
- Institute of Nutrition and Food Technology “José Mataix”, Centre of Biomedical Research, University of Granada, Avda. del Conocimiento s/n, Armilla, 18016 Granada, Spain;
- Department of Biochemistry and Molecular Biology II, University of Granada, 18071 Granada, Spain
| | - Jaime Feliú-Batlle
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain;
- CIBERONC (CIBER Cancer), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Medicine Department, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain
| | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany;
| | - Ángel Gil
- Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain; (J.P.-D.); (F.J.R.-O.); (Á.G.)
- Institute of Nutrition and Food Technology “José Mataix”, Centre of Biomedical Research, University of Granada, Avda. del Conocimiento s/n, Armilla, 18016 Granada, Spain;
- Department of Biochemistry and Molecular Biology II, University of Granada, 18071 Granada, Spain
- CIBEROBN (CIBER Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Samara Palma-Milla
- Food, Nutrition and Health Platform, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain; (L.A.-C.); (S.P.-M.)
- Medicine Department, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain
- Nutrition Department, Hospital University La Paz, 28046 Madrid, Spain
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Milla SP, Luna PPG, Casariego AV, González FV, Folgueras TM, Jáuregui OI, Rey SG, Fernández AC, Plaza BL, Quintana TC, de Luis Román DA. Adherence and impact of an oral nutritional supplement enriched in leucine, EVOO, EPA and DHA, and beta-glucans on the coverage of energy and protein requirements in patients with cancer and malnutrition: Alisenoc study. Nutrition 2024; 120:112355. [PMID: 38341907 DOI: 10.1016/j.nut.2024.112355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/22/2023] [Accepted: 01/05/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of an enhanced ONS (enriched in EPA, DHA, leucine, and beta-glucans) on the dietary intake of cancer patients. METHODS A randomized, double-blind, parallel, controlled, and multicenter clinical trial was conducted in patients with cancer and malnutrition. The trial compared prescribed dietary advice and two packs per day, for 8 weeks, of a hypercaloric (400 kcal/pack) and hyperproteic ONS (20 g/pack) with fiber and specific ingredients (leucine, EPA and DHA, and beta-glucans) (enhanced-ONS) versus an isocaloric and isoproteic formula (standard-ONS) without specific ingredients. Food intake was assessed with a 3-day dietary survey, and adherence to the supplement with a patient self-completed diary. RESULTS Thirty-seven patients completed the intervention period. The combined intervention of dietary advice and ONS managed to increase the energy intake of the overall cohort by 792.55 (378.57) kcal/day, protein by 40.72 (19.56) g/day. Increases in energy and nutrient intakes were observed in both groups, both in dietary intake and associated exclusively with the supplement. The group that received the enhanced-ONS ingested a greater volume of product when there was a greater severity of malnutrition; a tumor location in the head, neck, upper digestive area, liver, or pancreas; more advanced stages of the tumor; or the receipt of more than one antineoplastic treatment. CONCLUSION The use of an enhanced-ONS helps meet the nutritional requirements of cancer patients, especially those who have a more compromised clinical condition, with high adherence, good tolerance, and acceptance.
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Affiliation(s)
- Samara Palma Milla
- Endocrinology and Nutrition Department, Hospital Universitario La Paz, Madrid, Spain.
| | - Pedro P García Luna
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Alfonso Vidal Casariego
- Endocrinology and Nutrition Department, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Tomás Martín Folgueras
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | - Olatz Izaola Jáuregui
- Center of Endocrinology and Nutrition, Medicine School, University of Valladolid, Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Silvia García Rey
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | - Daniel A de Luis Román
- Center of Endocrinology and Nutrition, Medicine School, University of Valladolid, Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Mazzoleni B, Ferrari G, Savioni F, Gravante F, Lopane D, Dacomi A, Coldani C, Tomaiuolo G, Cattani D, Anastasi G, Mancin S. Non-pharmacological strategies to alleviate dysgeusia in patients undergoing chemotherapy: A systematic review. Eur J Oncol Nurs 2024; 70:102569. [PMID: 38593535 DOI: 10.1016/j.ejon.2024.102569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/10/2024] [Accepted: 03/16/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Dysgeusia is a common side effect in oncology patients, significantly impacting their quality of life. This systematic review aims to evaluate the effectiveness of non-pharmacological strategies in treating dysgeusia in patients undergoing chemotherapy or radiotherapy. METHODS Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive literature search across five databases: PubMed, Embase, Cochrane Library, CINAHL, and the British Nursing Database. We used the Joanna Briggs Institute Critical Appraisal Tools to assess the quality of the included studies. A harvest plot was used to synthesise evidence about the differential effects of population-level interventions. RESULTS Nine studies of non-pharmacological strategies to manage dysgeusia were included. These studies encompassed a variety of interventions, including oral applications and supplements, instrumental techniques, and educational programs. The review identified promising interventions such as cryotherapy and Miraculine supplementation, which showed potential in mitigating taste alterations. Instrumental techniques like photobiomodulation therapy and complementary and integrative medicine approaches, including acupuncture and herbs, were also found to be beneficial. Educational and self-management strategies emerged as effective interventions for empowering patients to manage dysgeusia. Despite the diversity of interventions and the limitations of the included studies, such as small sample sizes and geographical differences, these findings underscore the potential of non-pharmacological strategies in managing dysgeusia. CONCLUSION The results support the integration of these strategies into clinical practice, highlighting the importance of multidisciplinary approaches to improve patient care. Further research should prioritize rigorous studies to enhance evidence and explore long-term effects.
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Affiliation(s)
- Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giulia Ferrari
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Francesco Gravante
- Department of Anaesthesiology, Intensive Care Unit, Local Health Autority of Caserta, Caserta, Italy
| | - Diego Lopane
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandra Dacomi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Chiara Coldani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuseppina Tomaiuolo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Daniela Cattani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuliano Anastasi
- Department of Trauma, AOU G. Martino University Hospital, Messina, Italy
| | - Stefano Mancin
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
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Loves R, Green G, Joseph-Frederick Z, Palmert S, Plenert E, Schechter T, Tomlinson D, Vettese E, Zahra S, Zupanec S, Dupuis LL, Sung L. Describing taste changes and their potential impacts on paediatric patients receiving cancer treatments. BMJ Support Palliat Care 2023; 13:e382-e388. [PMID: 34049968 DOI: 10.1136/bmjspcare-2021-002951] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/12/2021] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Robyn Loves
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Gloria Green
- Division of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zakia Joseph-Frederick
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Sasha Palmert
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Erin Plenert
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Serena Zahra
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Sue Zupanec
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Department of Pharmacy, The Hospital for Sick Children, Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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7
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Ho PJ, Khng AJ, Tan BKT, Lim GH, Tan SM, Tan VKM, Tan RSYC, Lim EH, Iau PTC, Chew YJ, Lim YY, Hartman M, Tan EY, Li J. Alterations to DNA methylation patterns induced by chemotherapy treatment are associated with negative impacts on the olfactory pathway. Breast Cancer Res 2023; 25:136. [PMID: 37932858 PMCID: PMC10626732 DOI: 10.1186/s13058-023-01730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/15/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Exposure to cytotoxic chemotherapy treatment may alter DNA methylation (DNAm) in breast cancer patients. METHODS We performed DNAm analysis in 125 breast cancer patients with blood drawn before and after chemotherapy, using the Illumina MethylationEPIC array. DNAm changes of 588,798 individual CpGs (including 41,207 promoter regions) were evaluated using linear regression models adjusted for monocyte proportion. Gene set enrichment analyses (GSEA) were conducted to identify key Gene Ontology (GO) biological processes or Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways associated with chemotherapy. Results were validated in a separate cohort of breast cancer patients who were treated (n = 1273) and not treated (n = 872) by chemotherapy (1808 blood, 337 saliva). RESULTS A total of 141 differentially methylated CpGs and 11 promoters were significantly associated with chemotherapy after multiple testing corrections in both the paired sample and single time point analyses. GSEA of promoter regions (pre-ranked by test statistics) identified six suppressed biological processes (p < 4.67e-8) related to sensory perception and detection of chemical stimuli, including smell perception (GO:0007606, GO:0007608, GO:0009593, GO:0050906, GO:0050907, and GO:0050911). The same six biological processes were significantly suppressed in the validation dataset (p < 9.02e-14). The KEGG pathway olfactory transduction (hsa04740) was also found to be significantly suppressed (ppaired-samples = 1.72e-9, psingle-timepoint-blood = 2.03e-15 and psingle-timepoint-saliva = 7.52e-56). CONCLUSION The enrichment of imprinted genes within biological processes and pathways suggests a biological mechanism by which chemotherapy could affect the perception of smell.
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Affiliation(s)
- Peh Joo Ho
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Genome, Singapore, 138672, Republic of Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Alexis Jiaying Khng
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Genome, Singapore, 138672, Republic of Singapore
| | - Benita Kiat-Tee Tan
- Department of Breast Surgery, Singapore General Hospital, Singapore, Republic of Singapore
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore
- Department of General Surgery, Sengkang General Hospital, Singapore, Republic of Singapore
| | - Geok Hoon Lim
- KK Breast Department, KK Women's and Children's Hospital, Singapore, 229899, Republic of Singapore
| | - Su-Ming Tan
- Division of Breast Surgery, Changi General Hospital, Singapore, Republic of Singapore
| | - Veronique Kiak Mien Tan
- Department of Breast Surgery, Singapore General Hospital, Singapore, Republic of Singapore
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore
| | - Ryan Shea Ying Cong Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore
- Oncology Academic Programme, Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Elaine Hsuen Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore
| | - Philip Tsau-Choong Iau
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, 119228, Singapore
- Department of General Surgery, Ng Teng Fong General Hospital, 1 Jurong East St 21, Singapore, 609606, Republic of Singapore
| | - Ying Jia Chew
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, 119228, Singapore
- Department of General Surgery, Ng Teng Fong General Hospital, 1 Jurong East St 21, Singapore, 609606, Republic of Singapore
| | - Yi Ying Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Republic of Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, 119228, Singapore
| | - Ern Yu Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, 308433, Republic of Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Republic of Singapore
| | - Jingmei Li
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Genome, Singapore, 138672, Republic of Singapore.
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Republic of Singapore.
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López-Plaza B, Gil Á, Menéndez-Rey A, Bensadon-Naeder L, Hummel T, Feliú-Batlle J, Palma-Milla S. 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. Nutrients 2023; 15:4639. [PMID: 37960292 PMCID: PMC10648678 DOI: 10.3390/nu15214639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
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).
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Affiliation(s)
- Bricia López-Plaza
- Nutrition Research Group, La Paz University Hospital Institute for Health Research (IdiPAZ), 28046 Madrid, Spain;
- Medicine Department, Faculty of Medicine, Complutense University of Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain
| | - Ángel Gil
- Department of Biochemistry and Molecular Biology II, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria IBS.GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain
- Institute of Nutrition and Food Technology “José Mataix”, Centre of Biomedical Research, University of Granada, Avda. del Conocimiento s/n, Armilla, 18016 Granada, Spain
- CIBEROBN (CIBER Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | | | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany;
| | - Jaime Feliú-Batlle
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain;
- CIBERONC (CIBER Cancer), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Medicine Department, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain;
| | - Samara Palma-Milla
- Medicine Department, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain;
- Nutrition Department, Hospital University La Paz, 28046 Madrid, Spain
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9
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Obayashi N, Sugita M, Shintani T, Nishi H, Ando T, Kajiya M, Kawaguchi H, Ohge H, Naito M. Taste-taste associations in chemotherapy-induced subjective taste alterations: findings from a questionnaire survey in an outpatient clinic. Support Care Cancer 2023; 31:552. [PMID: 37658917 DOI: 10.1007/s00520-023-08013-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Chemotherapy-induced taste alteration is a side effect that can result in malnutrition and reduced quality of life in cancer patients. However, the underlying causes of this phenomenon remain unclear, and evidence-based treatments have not been established. This study focused on patients' subjective symptoms of taste alterations aimed to explore how the sensitivity to basic tastes changes due to anticancer agents and how alterations in one taste perception are associated with changes in other tastes during chemotherapy. METHODS A cross-sectional questionnaire-based interview survey was conducted on 215 patients undergoing chemotherapy. The subjective sensitivity to each basic taste was assessed using a visual analog scale, and the incidence of taste alterations due to different chemotherapy regimens was calculated. Multivariate logistic regression analysis was performed to determine whether there were associations between changes in one taste sensitivity and changes in other taste sensitivities. RESULTS Approximately half (49.5%) of the patients experienced chemotherapy-induced taste alterations. An analysis of subjective changes in basic tastes revealed that the salt and umami taste systems were more sensitive to chemotherapy than other taste systems. Patients with altered sensitivity to sweet taste were significantly more likely to report altered sensitivity to salt, bitter, and sour tastes. Moreover, umami-salt and bitter-sour taste sensitivities were significantly related to each other. CONCLUSION This study suggests that changes in subjective sensitivities to one basic taste during chemotherapy may be accompanied by changes in other tastes in specific combinations. Considering taste associations in dietary guidance may help improve the nutritional status of cancer patients experiencing taste alterations due to chemotherapy.
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Affiliation(s)
- Nami Obayashi
- Department of General Dentistry, Hiroshima University Hospital, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8551, Japan.
- Center of Oral Clinical Examination, Hiroshima University Hospital, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8551, Japan.
- Department of Physiology and Oral Physiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Makoto Sugita
- Department of Physiology and Oral Physiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553, Japan
| | - Tomoaki Shintani
- Center of Oral Clinical Examination, Hiroshima University Hospital, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Hiromi Nishi
- Department of General Dentistry, Hiroshima University Hospital, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Toshinori Ando
- Center of Oral Clinical Examination, Hiroshima University Hospital, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Mikihito Kajiya
- Center of Oral Clinical Examination, Hiroshima University Hospital, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Hiroyuki Kawaguchi
- Department of General Dentistry, Hiroshima University Hospital, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Mariko Naito
- Department of Oral Epidemiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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10
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Silva ARP, Bodanezi AV, Chrun ES, Lisboa ML, de Camargo AR, Munhoz EA. Palliative oral care in terminal cancer patients: Integrated review. World J Clin Cases 2023; 11:2966-2980. [PMID: 37215429 PMCID: PMC10198072 DOI: 10.12998/wjcc.v11.i13.2966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/07/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Palliative care (PC) aims to improve quality of life in patients and its families against life threatening diseases, through suffering’s prevention and relief. It is the duty of the dental surgeon to possess the knowledge needed to treat a patient with little life span, in order to establish an adequate treatment plan for each situation.
AIM To synthesize the published evidence on oral conditions, impact, management and challenges in managing oral conditions among palliative patients.
METHODS Articles were selected from PubMed and Scopus electronic platforms, using a research strategy with diverse descriptors related to “palliative care”, “cancer” and “oral health”. The article’s selection was done in two phases. The first one was performed by the main researcher through the reading of the abstracts. In the second phase two researchers selected eligible articles after reading in full those previous selected. Data was tabulated and analyzed, obtaining information about what is found in literature related to this subject and what is necessary to be approached in future researches about PC.
RESULTS As results, the total of 15 articles were eligible, being one a qualitative analysis, 13 (92.8%) clinical trials and one observational study. Of the 15 articles, 8 (53.4%) involved questionnaires, while the rest involved: one systematic review about oral care in a hospital environment, 2 oral exams and oral sample collection, one investigation of terminal patient’s (TP) oral assessment records, 2 collection of oral samples and their respective analysis and one treatment of the observed oral complications.
CONCLUSION It can be concluded that the oral manifestations in oncologic patients in terminal stage are, oral candidiasis, dry mouth, dysphagia, dysgeusia, oral mucositis and orofacial pain. Determining a protocol for the care of these and other complications of cancer – or cancer therapy – based on scientific evidence with the latest cutting-edge research results is of fundamental importance for the multidisciplinary team that works in the care of patients in PC. To prevent complications and its needed to initial the dentist as early as possible as a multidisciplinary member. It has been suggested palliative care protocol based on the up to date literature available for some frequent oral complications in TP with cancer. Other complications in terminal patients and their treatments still need to have further studying.
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Affiliation(s)
- Ana Rute Preis Silva
- Department of Dentistry, Federal University of Santa Catarina, Florianopolis 88040-379, Brazil
| | - Augusto Vanni Bodanezi
- Department of Dentistry, Federal University of Santa Catarina, Florianopolis 88040-379, Brazil
| | - Emanuely Silva Chrun
- Department of Pathology, Federal University of Santa Catarina, Florianopolis 88040900, Brazil
| | - Mariah Luz Lisboa
- Professor Polydoro São Thiago Ernani Hospital, Federal University of Santa Catarina, Florianopolis 88040900, Brazil
| | - Alessandra R de Camargo
- Department of Dentistry, Federal University of Santa Catarina, Florianopolis 88040-379, Brazil
| | - Etiene Andrade Munhoz
- Department of Dentistry, Health Science Centre, Federal University of Santa Catarina, Florianopolis 88040-379, Brazil
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11
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Hiroyuki Otani, Amano K, Morita T, Miura T, Mori N, Tatara R, Kessoku T, Matsuda Y, Tagami K, Mori M, Taniyama T, Nakajima N, Nakanishi E, Kako J, Shirado AN, Yokomichi N, Miyashita M. Impact of taste/smell disturbances on dietary intakes and cachexia-related quality of life in patients with advanced cancer. Support Care Cancer 2023; 31:141. [PMID: 36715776 DOI: 10.1007/s00520-023-07598-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/17/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE Taste and smell are used to enjoy meals; however, impairments of these sensory perceptions seriously impact health and eating habits. This study is aimed at investigating the impact of taste and smell disturbances on dietary intakes and cachexia-related quality of life (QOL) in patients with advanced cancer. METHODS Using a self-report questionnaire, we surveyed patients with advanced cancer undergoing treatment at 11 palliative care centers. Multivariate analyses were conducted to explore the impact of taste and smell disturbances on dietary intakes and cachexia-related QOL. Dietary intakes were assessed using the Ingesta-Verbal/Visual Analog Scale, while taste and smell disturbances were assessed using an 11-point Numeric Rating Scale (NRS). Cachexia-related QOL was assessed using the Functional Assessment of Anorexia/Cachexia Therapy Anorexia Cachexia Subscale (FAACT ACS). RESULTS Overall, 378 patients provided consent to participate. After excluding patients with missing data, data were analyzed for 343 patients. Among them, 35.6% (n = 122; 95% [confidence interval (CI)] 0.28-0.38) and 20.9% (n = 72; 95% CI 0.17-0.25) experienced disturbances in taste (NRS ≥ 1) and smell (NRS ≥ 1), respectively. Multivariate analyses revealed that, independent of performance status and cancer cachexia, taste and smell disturbances were significantly associated with worse dietary intakes and deteriorating FAACT ACS scores. CONCLUSION More severe taste and smell disturbances were associated with poorer dietary intakes and cachexia-related QOL. Diagnosing and treating such disturbances may improve dietary intakes and cachexia-related QOL, regardless of performance status and cachexia.
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Affiliation(s)
- Hiroyuki Otani
- Department of Palliative and Supportive Care, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume City, Fukuoka, 830-8543, Japan. .,Department of Palliative Care Team and Palliative and Supportive Care, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
| | - Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka, 433-8558, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa City, Chiba, 277-8577, Japan
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Ryohei Tatara
- Department of Palliative Medicine, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Takaomi Kessoku
- Department of Palliative Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, 236-0004, Japan.,Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, 236-0004, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai City, Osaka, 591-8555, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai City, Miyagi, 980-8575, Japan
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka, 433-8558, Japan
| | - Tomohiko Taniyama
- Department of Clinical Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, 1 Katsuragosyo-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8087, Japan
| | - Nobuhisa Nakajima
- Division of Community Medicine and International Medicine, University of the Ryukyus Hospital, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0215, Japan
| | - Erika Nakanishi
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai City, Miyagi, 980-8575, Japan.,Graduate School of Public Health, St. Luke's International University, OMURA Susumu & Mieko Memorial St. Luke's Center for Clinical, Academia 5th Floor 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Jun Kako
- College of Nursing Art and Science, University of Hyogo, 13-71 Kitaoji-cho, Akashi City, Hyogo, 673-8588, Japan
| | - Akemi Naito Shirado
- Miyazaki Medical Association Hospital, 738-1 Funato Shinbeppu-cho, Miyazaki, 880-0834, Japan
| | - Naosuke Yokomichi
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka, 433-8558, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai City, Miyagi, 980-8575, Japan
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12
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Buttiron Webber T, Briata IM, DeCensi A, Cevasco I, Paleari L. Taste and Smell Disorders in Cancer Treatment: Results from an Integrative Rapid Systematic Review. Int J Mol Sci 2023; 24:ijms24032538. [PMID: 36768861 PMCID: PMC9916934 DOI: 10.3390/ijms24032538] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
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.
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Affiliation(s)
| | - Irene Maria Briata
- Division of Medical Oncology, E.O. Galliera Hospital, 16128 Genoa, Italy
| | - Andrea DeCensi
- Division of Medical Oncology, E.O. Galliera Hospital, 16128 Genoa, Italy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London E1 4NS, UK
| | - Isabella Cevasco
- Department of Health Professions, E.O. Galliera Hospital, 16128 Genoa, Italy
| | - Laura Paleari
- Research, Innovation and HTA Unit, (A.Li.Sa.) Liguria Health Authority, 16121 Genoa, Italy
- Correspondence: ; Tel.: +39-010-5484-243
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13
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Wismer WV. Sensory and consumer science support for the food sensory preferences of cancer survivors. Curr Opin Food Sci 2023. [DOI: 10.1016/j.cofs.2023.100990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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14
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The role of saliva in taste dysfunction among cancer patients: Mechanisms and potential treatment. Oral Oncol 2022; 133:106030. [PMID: 35868097 DOI: 10.1016/j.oraloncology.2022.106030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/21/2022] [Accepted: 07/15/2022] [Indexed: 01/17/2023]
Abstract
Two of the highest prevalent symptoms reported by cancer patients are taste dysfunction (17.6-93%) and dry mouth/xerostomia (40.4-93%). While it has been hypothesized that reduced saliva may impair taste function, few studies investigate the co-occurrence of taste and dry mouth symptoms in cancer patients. This review provides a summary of the physiological relationship between saliva and taste, focusing on taste transduction mechanism, regulation of the taste sensitivity, and protection of taste receptor cells, including the impact of cancer treatments and malignancy on saliva function, salivary components, and the mechanisms in which it can negatively impact the taste function. Here, the authors present a scoping review of the recent literature reporting on the association between taste dysfunction and dry mouth in cancer patients, including reports of non-pharmaceutical liposomal agents or drugs taken to improve dry mouth symptoms that also assess taste dysfunction. Considering the complexities of cancer and cancer treatment, understanding the physiological relationship between saliva and taste function may provide important insight into identifying treatments for alleviating taste dysfunction and dry mouth symptoms. There are substantial research gaps given the limited studies assessing the co-occurrence of taste loss and dry mouth and inconsistencies in the assessment of these symptoms. Clinical studies examining taste dysfunction will provide a foundational groundwork that will help understand the relationship between taste and saliva. Considering the increased rates in survivorship and the significant negative impact of taste dysfunction on quality of life, more research is needed to reduce the suffering of cancer patients.
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15
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Razmovski-Naumovski V, Luckett T, Amgarth-Duff I, Agar MR. Efficacy of medicinal cannabis for appetite-related symptoms in people with cancer: A systematic review. Palliat Med 2022; 36:912-927. [PMID: 35360989 DOI: 10.1177/02692163221083437] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Anorexia (loss of appetite) is a prevalent and distressing symptom in people with cancer, with limited effective interventions. Medicinal cannabis has shown promise in improving appetite-related symptoms in people with cancer. AIM To assess the efficacy of medicinal cannabis for improving appetite-related symptoms in people with cancer, considering measures and outcomes, interventions and toxicity. DESIGN Systematic review with narrative approach to synthesis and meta-analysis. DATA SOURCES Databases (MEDLINE, CINAHL, CENTRAL), websites and trials registries were searched from inception to February 2021. Included studies were randomised controlled trials (RCT) in English peer-reviewed journals comparing medicinal cannabis with placebo and/or another intervention. Study quality was assessed using the Cochrane risk of bias tool. RESULTS Five studies were included that compared medicinal cannabis interventions (dronabinol, nabilone and cannabis extract) either with placebo (n = 4) or megestrol acetate (n = 1). Measures and trial endpoints varied, but efficacy was demonstrated in one trial only, in which dronabinol significantly improved chemosensory perception and other secondary outcomes (taste of food, premeal appetite, proportion of calories consumed as protein) compared with placebo. Cannabis interventions were generally well tolerated across studies, regardless of the product or dose, although the comprehensive measurement of toxicities was limited. CONCLUSION Evidence from RCTs that medicinal cannabis increases appetite in people with cancer is limited. Measures, outcomes and interventions were variable, and toxicities have not been comprehensively evaluated. Future research should carefully consider biological mechanisms to guide more nuanced selection of endpoints and interventions, including product, dose and administration.
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Affiliation(s)
- Valentina Razmovski-Naumovski
- South West Sydney Clinical Campuses, School of Medicine & Health, University of New South Wales (UNSW), Sydney, NSW, Australia.,Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.,IMPACCT - Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation, Faculty of Health, University of Technology Sydney (UTS), NSW, Australia
| | - Tim Luckett
- IMPACCT - Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation, Faculty of Health, University of Technology Sydney (UTS), NSW, Australia
| | - Ingrid Amgarth-Duff
- IMPACCT - Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation, Faculty of Health, University of Technology Sydney (UTS), NSW, Australia
| | - Meera R Agar
- South West Sydney Clinical Campuses, School of Medicine & Health, University of New South Wales (UNSW), Sydney, NSW, Australia.,Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.,IMPACCT - Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation, Faculty of Health, University of Technology Sydney (UTS), NSW, Australia.,South West Sydney Local Health District (SWSLHD), Sydney, NSW, Australia
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16
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Di Meglio J, Dinu M, Doni L, Rossi G, Giorgione R, Colombini B, Antonuzzo L, Sofi F. Occurrence of Dysgeusia in Patients Being Treated for Cancer. Nutr Cancer 2022; 74:2868-2874. [PMID: 35196919 DOI: 10.1080/01635581.2022.2042569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aims of this study were to assess the presence of dysgeusia in patients receiving anticancer therapy and to explore possible factors influencing its occurrence. A total of 242 adult patients with histological diagnoses of malignant neoplasia and undergoing all types of anticancer treatment were included in the analysis. Data were collected from May 2019 to November 2019 at the Unit of Medical Oncology of Careggi University Hospital, Florence, Italy. Dysgeusia was assessed using the Chemotherapy-induced Taste Alteration Scale (CiTAS), while treatment-related symptoms were assessed using the Common Terminology Criteria for Adverse Events (CTCAE). Patients were aged 68 ± 13 years, mostly males (65%). A large proportion of them was undergoing chemotherapy (42.2%), while the others were receiving immunotherapy (20.7%), hormone therapy (15.5%), targeted therapy (12.8%), or a combination of them. Overall, 21.5% of patients reported dysgeusia, 17.4% nausea, 10.7% dysosmia, 9.9% xerostomia, 4.5% mucositis, and only 3.7% vomiting. The targeted therapy showed the greatest adverse effects, followed by chemotherapy, immunotherapy, and hormone therapy. When patients with dysgeusia were analyzed, phantogeusia and parageusia was the most affected dimension of gustatory disorders. Significant differences (p < 0.05) in CiTAS scores were found according to treatment-related symptoms for nausea and mucositis.
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Affiliation(s)
- Jaclyn Di Meglio
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Laura Doni
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Gemma Rossi
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | | | - Barbara Colombini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Clinical Nutrition Unit, Careggi University Hospital, Florence, Italy
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17
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Parke SC, Langelier DM, Cheng JT, Kline-Quiroz C, Stubblefield MD. State of Rehabilitation Research in the Head and Neck Cancer Population: Functional Impact vs. Impairment-Focused Outcomes. Curr Oncol Rep 2022; 24:517-532. [PMID: 35182293 DOI: 10.1007/s11912-022-01227-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Management of head and neck cancer (HNC) typically involves a morbid combination of surgery, radiation, and systemic therapy. As the number of HNC survivors grows, there is growing interest in rehabilitation strategies to manage HNC-related comorbidity. In this review, we summarize the current state of HNC rehabilitation research. RECENT FINDINGS We have organized our review using the World Health Organization's International Classification of Function (ICF) model of impairment, activity, and participation. Specifically, we describe the current research on rehabilitation strategies to prevent and treat impairments including dysphagia, xerostomia, dysgeusia, dysosmia, odynophagia, trismus, first bite syndrome, dysarthria, dysphonia, lymphedema, shoulder syndrome, cervicalgia, cervical dystonia and dropped head syndrome, deconditioning, and fatigue. We also discuss the broader impact of HNC-related impairment by exploring the state of rehabilitation literature on activity, participation, psychosocial distress, and suicidality in HNC survivors. We demonstrate that research in HNC rehabilitation continues to focus primarily on impairment-driven interventions. There remains a dearth of HNC rehabilitation studies directly examining the impact of rehabilitation interventions on outcomes related to activity and participation. More high-quality interventional studies and reviews are needed to guide prevention and treatment of functional loss in HNC survivors.
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Affiliation(s)
- Sara C Parke
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Arizona, Phoenix, USA.
| | - David Michael Langelier
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre Toronto, Ontario, Canada
| | - Jessica Tse Cheng
- Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, TX, Houston, USA
| | - Cristina Kline-Quiroz
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, TN, Nashville, USA
| | - Michael Dean Stubblefield
- Department of Physical Medicine and Rehabilitation - Rutgers New Jersey Medical School, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, NJ, 07052, West Orange, USA
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18
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Lesser GJ, Irby MB, Taylor RC, Snavely A, Case D, Wang A, Dietrich A, Duncan S. Lactoferrin supplementation for taste and smell abnormalities among patients receiving cancer chemotherapy. Support Care Cancer 2021; 30:2017-2025. [PMID: 34642792 DOI: 10.1007/s00520-021-06609-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/29/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Taste and smell abnormalities (TSA) are common in patients receiving chemotherapy and may lead to altered nutritional intake, treatment withdrawal, and impaired quality of life. Lipid peroxidation in the oral cavity is one cause of TSA. Lactoferrin (LFN), an iron-binding salivary protein, reduces production of lipid oxidation byproducts and has been shown to reduce perception of unpleasant flavors. To assess the feasibility of LFN as a treatment for TSA, we conducted pilot investigations among patients with cancer who self-reported TSA following onset of chemotherapy. The primary objective was to assess change in subjective taste and smell perception from baseline to completion of 30 days of LFN supplementation. METHODS Patients were treated with 750 mg LFN daily for 30 days and followed for an additional 30 days without LFN. TSA was measured via the taste and smell questionnaire (TSQ) including taste (score 0-10), smell (score 0-6), and composite scores (0-16) (0 = no TSA) at baseline, day 30, and day 60. RESULTS A total of 26 patients enrolled; 19 remained on study at day 30 and 17 at day 60. Baseline mean TSQ scores were 6.5 (taste), 3.1 (smell), and 9.6 (composite). By day 30, mean composite TSQ score improved by 1.7 (p = 0.018); taste and smell improved by 0.6 (p = 0.062) and 1.1 (p = 0.042), respectively. From baseline to day 60, mean composite TSQ score improved by 3.8 (p < 0.0001); taste and smell improved by 1.9 (p = 0.001) and 1.8 (p = 0.003). CONCLUSIONS Further evaluation of LFN is warranted to determine its value for improving self-reported TSA among patients receiving chemotherapy.
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Affiliation(s)
- Glenn J Lesser
- Department of Internal Medicine, Section On Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
| | - Megan B Irby
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Anna Snavely
- Department of Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Douglas Case
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Aili Wang
- Key Laboratory of Coarse Cereal Processing, School of Food and Biological Engineering, Chengdu University, Chengdu, China
| | - Andrea Dietrich
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Susan Duncan
- Department of Food Science and Technology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
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Liu J, Lv C, Wu D, Wang Y, Sun C, Cheng C, Yu Y. Subjective Taste and Smell Changes in Conjunction with Anxiety and Depression Are Associated with Symptoms in Patients with Functional Constipation and Irritable Bowel Syndrome. Gastroenterol Res Pract 2021; 2021:5491188. [PMID: 34589124 PMCID: PMC8476287 DOI: 10.1155/2021/5491188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with functional constipation (FC) and irritable bowel syndrome (IBS) often report psychological abnormalities and decreased eating enjoyment. Several patients also complain of changes in the sense of smell and taste, but these are often disregarded clinically. AIMS Therefore, there is a need to determine whether taste/smell disturbances and psychological abnormalities are present in patients with FC or IBS and whether these are related to the severity of lower gastrointestinal symptoms. METHODS A total of 337 subjects were recruited, including FC (n = 115), IBS (n = 126), and healthy controls (n = 96). All participants completed questionnaires evaluating taste and smell (taste and smell survey (TSS)), Lower Gastrointestinal Symptoms Rating Scale (LGSRS), Hamilton anxiety scale (HAMA), and Hamilton depression scale (HAMD). TSS recorded information on the nature of taste and smell changes (TSCs) and the impact of these changes on the quality of life. LGSRS was used to assess the severity of lower gastrointestinal symptoms; HAMA and HAMD scales were used to reflect the psychosocial state. This study protocol was registered on the Chinese Clinical Trial Registry (No. ChiCTR-2100044643). RESULTS Firstly, we found that taste and smell scores were higher in patients with IBS than in healthy controls. Secondly, for FC and IBS patients, LGSRS was significantly correlated with the taste score (Spearman's rho = 0.832, P < 0.001). LGSRS was also significantly correlated with HAMA (Spearman's rho = 0.357, P = 0.017) and HAMD (Spearman's rho = 0.377, P = 0.012). In addition, the taste score was significantly correlated with HAMD (Spearman's rho = 0.479, P = 0.001), while the smell score was also significantly correlated with HAMD (Spearman's rho = 0.325, P = 0.031). Thirdly, 60.87% and 71.43% of patients complained of taste abnormality, while 65.22% and 71.43% had smell abnormality in the FC and IBS groups, respectively. Meanwhile, 47.83% and 47.62% of patients suffered from anxiety, while 43.48% and 57.14% suffered from depression in the FC and IBS groups, respectively. Finally, we found significant differences in the taste, smell, HAMD, and LGSRS scores between the female and male IBS groups (P < 0.050). CONCLUSIONS TSCs and psychological disorders are prominent in FC and IBS patients. Taste abnormalities, as well as anxiety and depression, are significantly correlated with LGSRS. Awareness of this high prevalence of taste/smell abnormalities and the psychological changes among patients with FC and IBS may help better predict and understand the severity of symptoms.
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Affiliation(s)
- Jie Liu
- Department of Gastroenterology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Chaolan Lv
- Department of Gastroenterology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Dandan Wu
- South District of Endoscopic Center, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Ying Wang
- South District of Endoscopic Center, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Chenyu Sun
- Internal Medicine, AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, 60657 Illinois, USA
| | - Ce Cheng
- The University of Arizona College of Medicine at South Campus, 2800 E Ajo Way, Tucson, 85713 AZ, USA
| | - Yue Yu
- Department of Gastroenterology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
- South District of Endoscopic Center, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
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20
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Molecular and Neural Mechanism of Dysphagia Due to Cancer. Int J Mol Sci 2021; 22:ijms22137033. [PMID: 34210012 PMCID: PMC8269194 DOI: 10.3390/ijms22137033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 12/21/2022] Open
Abstract
Cancer is one of the most common causes of death worldwide. Along with the advances in diagnostic technology achieved through industry–academia partnerships, the survival rate of cancer patients has improved dramatically through treatments that include surgery, radiation therapy, and pharmacotherapy. This has increased the population of cancer “survivors” and made cancer survivorship an important part of life for patients. The senses of taste and smell during swallowing and cachexia play important roles in dysphagia associated with nutritional disorders in cancer patients. Cancerous lesions in the brain can cause dysphagia. Taste and smell disorders that contribute to swallowing can worsen or develop because of pharmacotherapy or radiation therapy; metabolic or central nervous system damage due to cachexia, sarcopenia, or inflammation can also cause dysphagia. As the causes of eating disorders in cancer patients are complex and involve multiple factors, cancer patients require a multifaceted and long-term approach by the medical care team.
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21
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Larsen AK, Thomsen C, Sanden M, Skadhauge LB, Anker CB, Mortensen MN, Bredie WLP. Taste alterations and oral discomfort in patients receiving chemotherapy. Support Care Cancer 2021; 29:7431-7439. [PMID: 34080053 DOI: 10.1007/s00520-021-06316-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/25/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Taste alterations (TA) and oral discomfort in cancer patients are neglected side effects of the disease and treatments. They contribute to poor appetite, decrease food intake and affect quality of life, leading to adverse outcomes such as malnutrition and depression. The study aimed to explore TAs in relation to other oral conditions causing discomfort in cancer patients. Additionally, the correlation between patients' acidity of saliva and experienced TAs and oral discomfort was evaluated. METHODS A case study including 100 patients diagnosed with cancer receiving chemotherapy or immunotherapy. Data were collected using two questionnaire forms: the Chemotherapy-induced Taste Alteration Scale (CiTAS) and an additional information questionnaire. Saliva samples were collected for each patient and measured with a pocket pH meter. Data were analysed using descriptive statistics, and comparisons were performed using the Kruskal-Wallis H test, Mann-Whitney U test and Fisher's exact test. RESULTS The prevalence of reported TAs was 93%. Patient age, oral discomfort and swallowing difficulty were found to be significant factors for experienced TAs (p < 0.05). No correlation between patients' acidity of saliva and reported TAs and oral discomfort was found. CONCLUSION CiTAS proved to be a convenient tool to collect information about TAs in cancer patients. Using the CiTAS tool, a high prevalence (93%) of reported TAs in cancer patients receiving chemo- or immunotherapy was found. CiTAS provides a fast and cheap recognition of symptoms and causes of TAs that can be addressed.
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Affiliation(s)
- Anne Kathrine Larsen
- Main Kitchen, Kulinarium, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
| | - Christine Thomsen
- Main Kitchen, Kulinarium, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Mathilde Sanden
- Main Kitchen, Kulinarium, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Lotte Boa Skadhauge
- Centre for Nutrition and Bowel Diseases, Department of Clinical Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Camilla Bundgaard Anker
- Main Kitchen, Kulinarium, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Marie Nerup Mortensen
- Main Kitchen, Kulinarium, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Wender L P Bredie
- Department of Food Science, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark
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