Impact of taste/smell disturbances on dietary intakes and cachexia-related quality of life in patients with advanced cancer

Correlation between taste and smell alterations and quality of life in patients treated with radiotherapy for nasopharyngeal carcinoma: a cross-sectional study in China

PURPOSE

Taste and smell alterations (TSAs) in nasopharyngeal cancer patients negatively impact their quality of life. This study is aimed at assessing the prevalence of TSAs in patients with nasopharyngeal carcinoma undergoing radiotherapy and at exploring the correlation between TSAs and quality of life.

METHODS

The research was a cross-sectional survey conducted from June 2023 to March 2024 in which the Taste and Smell Survey (TSS) questionnaires were administered to 135 patients receiving radiotherapy for nasopharyngeal cancer.

RESULTS

The mean total score on the TSS scale was 9.37 ± 4.595. A higher TSS score indicates more alterations. We enrolled 135 patients, 91.1% of whom reported alterations in taste and smell. The severity of alterations was classified as mild (6.7%), moderate (33.3%), and severe (51.1%). The occurrence of changes in taste sensitivity to salty, sweet, sour, and bitter flavors were 66.7%, 52.6%, 52.6%, and 53.3%, respectively, while olfactory sensitivity changes were found in 48.9% of the patients. Notably, a statistically significant correlation was found between cumulative dose of radiotherapy and the TSS score (p < 0.05). TSAs were significantly correlated with anxiety and overall quality of life (p < 0.05).

CONCLUSION

TSAs are prevalent among patients undergoing radiotherapy for nasopharyngeal carcinoma, with the majority experiencing moderate to severe alterations. The findings underscore the importance of implementing targeted interventions to address the sensory alterations and improve the patients' psychological well-being and life quality.

International Survey on Consensus Definition on Nutrition Impact Symptoms in Patients with Cancer

ABSTRACTA self-reported electronic questionnaire to advocate for a consensus definition of nutrition impact symptoms (NISs) was conducted in a diverse group of international healthcare providers. The questionnaire had 2 components: the definition of NISs and the relevance of each symptom as a NIS. Agreement on the tentative definition and 24 symptoms were evaluated using a seven-point Likert scale. For the factor validity and internal consistency of symptoms, an exploratory factor analysis was employed, and Cronbach's alpha coefficients (Cronbach's α) were calculated in each domain. A total of 66 healthcare providers responded. Regarding the tentative definition of NISs, the percentages of the number of participants with agree and strongly agree were 40.9% and 42.4%. Three conceptual groups were extracted as follows: 1) symptoms that interfere with patients' ability to ingest or digest nutrients, 2) symptoms that compromise patients' desire to eat and take nutrients, and 3) symptoms that indirectly compromise patients' food and nutrient intake. The values of Cronbach's α were 0.91, 0.92, and 0.87. We proposed a new definition - NISs are symptoms that compromise patients' desire or ability to eat, interfering with their nutritional needs and increasing the risk for malnutrition, loss of lean body mass, and impaired QOL.

Taste and Smell Alterations (TSAs) in Cancer Patients

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.

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

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

The role of pharmacists in multimodal cancer cachexia care

Cancer cachexia is a complex syndrome, and multidisciplinary management has the potential to improve patient outcomes and efficiency of care. Multidisciplinary management consists primarily of exercise, nutrition, and pharmacotherapy. The pharmacist's role in cancer cachexia is to contribute to appropriate pharmacotherapy practices. For example, anamorelin is an oral drug with ghrelin-like effects that may improve the pathogenesis of cancer cachexia by stimulating appetite and increasing food intake and body weight. Many patients with cancer cachexia are under treatment with anticancer agents, and pharmacists need to determine whether symptoms such as anorexia and nausea are due to cancer cachexia or anticancer agents. Based on that determination, they are then expected to suggest supportive care to the physician. Provision of multidisciplinary care for cancer cachexia requires communication with not only physicians but also with nurses, dietitians, and other professionals so that nutritional therapy can be provided at the time cachexia is detected. However, the role of pharmacists in the management of cancer cachexia is not well established, and there is no evidence that pharmacist interventions are of benefit to patients. In this article, to contribute to the treatment of cancer cachexia by multidisciplinary care, we describe the role of pharmacists in cancer cachexia as currently practiced at our hospital. We also consider future challenges to this type of multidisciplinary care. Evidence concerning multidisciplinary treatment of cancer cachexia is scarce, including therapeutic agents, and there is a current lack of collaboration among medical professionals and education in cancer cachexia. Solving these problems will require efforts in the practice and evaluation of treatment for cancer cachexia.