Taste Function in Adults Undergoing Cancer Radiotherapy or Chemotherapy, and Implications for Nutrition Management: A Systematic Review

The Association Between Vulnerability and Taste Changes in Older Cancer Patients Undergoing Chemotherapy

This study aimed to examine the association between taste changes and vulnerability in elderly cancer patients undergoing chemotherapy. A cross-sectional study was conducted among older cancer patients undergoing chemotherapy in Wuxi, China. The Chemotherapy-induced Taste Alteration Scale (CiTAS) was used to measure taste alteration. The Vulnerable Elders Survey (VES) was used to measure vulnerability status. The univariate, correlation, and hierarchical regression analyses were applied to assess the association between taste changes and vulnerability. Of 200 older cancer patients, 123 (61.5%) participants were non-vulnerable. The univariate analysis revealed significant distribution differences of vulnerability in education level, smell abnormalities, drinking history, chemotherapy cycle, and taste changes. The level of taste changes was positively correlated with vulnerability (r = 0.401, p < 0.01). Results of the regression analysis indicated that vulnerability in older cancer patients was significantly associated with higher odds of "phantogeusia and parageusia" (OR = 4.505, p < 0.001). Taste changes may be an important influencing factor of vulnerability in older cancer patients.

Effects of selective taste steering of bread and soups on quality of life in adult cancer outpatients who experience chemotherapy-induced taste alterations

PURPOSE

To investigate the effectiveness of selective taste steering (STS) to hyper personalize bread and soup for adult cancer outpatients with chemotherapy-induced taste alterations.

METHODS

This multicentre study included two groups of adult cancer outpatients with CiTA, all receiving dietary advice as standard care. In one group, STS was applied to bread and soups for three months. Outcomes were compared using validated scales and a structured questionnaire at baseline and after one and three months of follow-up.

RESULTS

At baseline, 19.3% of all patients (N = 160) had a normal nutritional status. Compared to the intervention group, undernutrition in the control group increased significantly after 1 month (p < .001) and 3 months (p < .001). In the intervention group, the score for 'appetite loss' decreased after 1 month (p < .001) and remained low after 3 months of follow-up (p < .001). The 'fatigue, ' 'nausea/vomiting' and 'diarrhea' symptom scores in the intervention group decreased significantly (p < .001, <.001 and < .002, respectively).

CONCLUSION

STS decreased loss of appetite and improved palatability and food intake as well as food-related symptoms of QOL in adult cancer outpatients with CiTA These findings are clinically relevant and support a hyper-personalized approach to malnutrition in cancer patients.

Cross-Lagged Panel Network Analysis of Symptoms in Patients with Gastric Cancer Undergoing Postoperative Chemotherapy

OBJECTIVES

To develop temporal symptom networks at three postoperative chemotherapy time points and investigate the longitudinal relationships between 18 symptoms in patients with gastric cancer undergoing postoperative chemotherapy in China.

METHODS

Symptom prevalence and severity were measured using the M. D. Anderson Symptom Inventory (MDASI) and Gastrointestinal Cancer Module of the MDASI (MDASI-GI) at T1, T2, and T3 on the day after the first, third, and sixth chemotherapy sessions, respectively. Cross-lagged panel network (CLPN) models were employed to examine the temporal dynamics of the 18 symptoms and their interrelationships.

RESULTS

In total, 379 participants were included. Dry mouth had the highest out-prediction (r = 0.101) and out-strength (r = 0.863) values during T1→T2. The strongest direct effect was observed for the change in taste → lack of appetite (β = 0.38) during T2→T3. Feeling bloated had the highest values for out-strength (r = 0.910), out-prediction (r = 0.215), and bridge strength (r = 1.010) during the T2→T3 period. The two CLPNs showed medium to high stability based on the centrality stability coefficients of out-strength and in-strength.

CONCLUSIONS

Lack of appetite can be improved during chemotherapy by managing vomiting and taste changes. Attention should be paid to the dry mouth and feeling bloated, as they are the strongest predictors in the early and middle stages of treatment.

IMPLICATIONS FOR NURSING

Understanding the relationship between symptoms during chemotherapy in patients with postoperative gastric cancer can help clinicians identify targets for intervention at different times.

The influence of pediatric cancer treatment on taste perception and food hedonics: a systematic review

CONTEXT

Children with cancer are at risk of poor nutritional status during treatment and into survivorship. Objectively measured taste perception and self-reported food hedonics are 2 factors that may influence food intake.

OBJECTIVE

This 2-armed systematic review examined whether chemotherapy and radiotherapy affect (1) taste perception and (2) hedonic experiences of children and survivors of childhood cancer.

DATA SOURCE

A 2-armed systematic literature search was conducted in the Medline, CINAHL, Embase, and PsychInfo database until June 2022. The effects of cancer treatment on objective taste perception or food hedonics (ie, food liking or aversion and appetite) were examined.

DATA EXTRACTION

Peer-reviewed articles published in English of studies that included children (aged <18 years) or survivors of childhood cancer (any age) were reviewed. Risk of bias was determined using the Evidence Analysis Library by the Academy of Nutrition and Dietetics.

DATA ANALYSIS

A total of 1417 articles in the taste search arm and 3862 articles in the hedonics search arm were identified. Of these, 9 and 4 articles were eligible for review, respectively. Cancer treatment had highly variable effects on taste perception during treatment and into survivorship. Learned food aversions were experienced by children receiving chemotherapy treatment and liking of meats and salty foods by children with cancer was affected. The impact of treatment on appetite varied.

CONCLUSIONS

Cancer treatment did not uniformly affect taste perception. Food liking may be negatively affected, and learned food aversions may develop during cancer treatment. To establish the clinical relevance of childhood cancer treatment on taste perception and food hedonics, more research is required.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no.CRD42020207127.

Assessment of taste alteration and its correlation with nutritional status and quality of life among cancer patients undergoing chemotherapy

BACKGROUND

Chemotherapy is the most commonly utilized therapeutic strategy among the numerous cancer treatments. These chemotherapeutic agents have a variety of adverse reactions, one of which is taste alteration (TA), which substantially influences the patient's nutritional status and quality of life (QoL).

OBJECTIVE

The study aims to assess TAs, associated factors, and the nutritional status and QoL of cancer patients undergoing chemotherapy.

METHODS

An observational cross-sectional study was carried out for 6 months, among cancer patients diagnosed with TA. Data was collected using a chemotherapy-induced taste alteration scale (CiTAS). Demographic details of the patients, factors associated with TA, details regarding chemotherapeutic agent used, number of current chemotherapy cycles etc, were recorded using a self-designed data collection form. Nutritional status and QoL on cancer patients were collected using Mini nutritional assessment - short form (MNA-SF) and EuroQol 5 dimension 5 levels (EQ5D5L), respectively, and statistical package for the social sciences (SPSS) software version 29 was used for the analysis of data.

RESULTS

A significant association was observed between TA and QoL. There was also a significant association between TA and predisposing factors such as nausea and dry mouth, which was obtained from the Chi-square test. Male patients were found to have higher TA than female patients. TA has also affected various aspects of QoL, such as mobility, pain, and discomfort. Patients experiencing mouth dryness or xerostomia had higher TA than others. A negative association was seen between TAs and nutritional status.

CONCLUSION

This study shows a significant relationship between gender and TA, dry mouth, nausea, and TA. Several QoL factors like mobility, pain/discomfort, and TA were also observed. Despite this study not observing any statistical association between nutritional status and TA, clinically, most of the patients with higher TA were malnourished. This study concluded that there was a relationship between TA and QoL and that nausea and dry mouth are the predisposing factors for TA.

From cells to subcellular organelles: Next-generation cancer therapy based on peptide self-assembly

Due to the editability, functionality, and excellent biocompatibility of peptides, in situ self-assembly of peptides in cells is a powerful strategy for biomedical applications. Subcellular organelle targeting of peptides assemblies enables more precise drug delivery, enhances selectivity to disease cells, and mitigates drug resistance, providing an effective strategy for disease diagnosis and therapy. This reviewer first introduces the triggering conditions, morphological changes, and intracellular locations of self-assembling peptides. Then, the functions of peptide assemblies are summarized, followed by a comprehensive understanding of the interactions between peptide assemblies and subcellular organelles. Finally, we provide a brief outlook and the remaining challenges in this field.

Chemosensory function and food perception is affected in COPD, but unrelated to sarcopenia risk

BACKGROUND & AIMS

Patients with advanced COPD often have difficulty maintaining sufficient dietary intake. Chemosensory function influences food choice and intake but is often overlooked in dietary assessment and intervention strategies. This study aimed to assess differences in chemosensory function and hedonic evaluation of food between patients with COPD and age- and gender-matched healthy controls. Additionally, a possible association between increased risk of sarcopenia or frailty and chemosensory impairments was explored.

METHODS

We recruited 53 COPD patients (34 males, mean age 66.6 ± 7.6 years) and 53 controls (25 males, mean age 68.4 ± 5.7 years). Chemosensory function was assessed using a smell threshold, smell identification (Sniffin' Sticks, Burghart) and taste recognition test (Taste Strips, Burghart) and through self-report. Sensory properties (appearance, smell, taste, mouthfeel) of four standardized food products were evaluated on 9-point hedonic rating scales. Sarcopenia risk was assessed with the SARC-F.

RESULTS

The COPD group scored lower on both the smell (p = 0.026 for threshold, p = 0.001 for identification) and taste recognition tests (p < 0.001) and also reported more smell and taste impairments (p < 0.001) compared to controls. Hedonic evaluation of food items' appearance (p = 0.009) and smell (p = 0.033) was lower in COPD patients. Within the COPD group, risk of sarcopenia was not associated with chemosensory function.

CONCLUSION

This study demonstrates that COPD patients have poorer chemosensory function and experience more impairments compared to controls. COPD patients also tend to evaluate foods less positive than do their controls but within COPD patients, sarcopenia risk is not associated with chemosensory function.

Cancer Care and Nutrition Counseling: The Role of the Oncologist in Patient Learning and Behavior Change

Background

Cancer remains a leading chronic disease in the United States with a high burden of disease and challenging treatment protocol. Nutrition is critically linked to long-term health outcomes and recovery rates among cancer patients, but there remains a persistent gap in clinician training regarding functional nutrition. This study interviews patients to understand their experiences of nutrition support they received while in cancer treatment.

Objectives

Understand patient experiences and needs regarding cancer treatment (i.e., surgery, chemotherapy, radiation, and/or immunotherapy) and available nutrition counseling.

Methods

This was a multi-phase study incorporating survey data (n = 50) and follow-up, semi-structured interviews (n = 20) of cancer patients in the Mid-Atlantic United States. Interview participants included those undergoing active cancer treatment (n = 7) and those in remission at the time of contact (n = 13). Participants shared their experiences receiving treatment and their perspectives regarding the quality of care they received in outpatient oncology clinics. Central to this study was a discussion regarding the quality of nutrition counseling they received while in treatment.

Results

Five themes emerged through data collection and analysis: (1) patients need additional education regarding nutrition, (2) personalized resources are not readily available, (3) perceptions from patients that oncologists receive little formal nutrition training related to cancer, (4) oncologists' attitude toward nutrition may influence patient care, and (5) patients seek nutrition information through informal sources. Commonly, patients had little access to licensed dieticians or other professionals capable of providing lifestyle recommendations.

Conclusions

The results of this study are being used to develop a clinician toolbox of resources, recommendations, and services that can be shared with patients seeking additional information regarding nutrition and diet change.

Acute Taste Dysfunction in Oropharyngeal Cancer Patients after Transoral Robotic Surgery

OBJECTIVES

To compare taste changes after transoral robotic surgery (TORS) to taste changes in healthy controls.

METHODS

Oropharyngeal cancer patients receiving TORS and healthy controls were recruited. Participants underwent posterolateral and whole-mouth psychophysical taste testing (identification, intensity, and hedonics) at baseline and at 2 weeks postoperatively (patients) or follow-up (controls). Surgeons reported suspension time and glossopharyngeal nerve injury (GNI) based on the identification and sacrifice of the nerve. A Clinical Global Impression (CGI) of taste symptoms was completed at each session ("My sense of taste bothers me" on a 5-point scale from Never [1] to Always [5]). A taste disorder (TD) was a CGI of 3 (Sometimes) or worse. Within-subject changes in CGI and psychophysical scores were computed. "Worsened taste" was a CGI increase by ≥1 point at follow-up.

RESULTS

Of 69 participants, most (33/37 tumor, 31/32 controls) had normal baseline taste (CGI < 3). 14/33 (42%) TORS patients and no controls developed new TDs at follow-up. More smokers (7/9) had worsened taste than nonsmokers (19/60, difference = 46% [95% CI 16%-76%]). More patients without GNI (6/22) than with GNI (0/15) had postoperative phantogeusia (difference = 27% [95% CI 9-45%]). Tumor-ipsilateral taste identification (TI) decreased more in patients (-11.3%) than controls (0.8%, difference = 12.2% [95% CI 5.0-19.3%]). Suspension time was not associated with worsened taste symptoms or psychophysical changes.

CONCLUSIONS

Patient-reported taste changes after TORS are frequent. Compared to healthy controls, TORS patients have decreased tumor-ipsilateral TI. Suspension time and GNI are unlikely to cause symptomatic TDs. Further investigations of the etiology and long-term symptom burden of TORS-associated TDs will aid in the management of oropharyngeal cancer patients.

LEVEL OF EVIDENCE

3 (non-randomized controlled cohort study) Laryngoscope, 133:3520-3528, 2023.

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

Objective

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

Methods

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

Results

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

Conclusions

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

Heterogeneity of vulnerability and taste changes in older cancer patients undergoing chemotherapy: a latent class analysis

PURPOSE

Taste changes and vulnerability are commonly co-occurring in oncology patients undergoing chemotherapy. However, few studies explored the association and the inter-individual variability of these two conditions. This study aimed to identify heterogeneous subtypes of vulnerability and taste changes in older cancer patients undergoing chemotherapy, and explore individuals' characteristics and risk factors.

METHODS

In this cross-sectional study, the latent class analysis (LCA) was conducted to identify the heterogeneous subgroups of patients with distinct vulnerability and taste change profiles. Differences in sociodemographic and clinical characteristics among the subpopulation were evaluated using parametric and nonparametric tests. Multinomial logistic regression was performed to investigate predictors of taste change-vulnerability subgroup classification.

RESULTS

Three subgroups of those older cancer survivors were identified from the LCA: Class 1 (27.5%)-"Moderate taste change and low vulnerability", Class 2 (29.0%)-"Low taste change and moderate vulnerability", Class 3 (43.5%)-"High taste change and high vulnerability". 98.9% of Class 3 reported taste changes and 54.0% reported vulnerability. Results from multinomial logistic regression indicated that patients in Class 3 were more likely to report experiencing mouth dryness and high blood pressure, and have received more than 3 cycles of chemotherapy.

CONCLUSION

The findings could provide new insights into the association between taste changes and vulnerability in older cancer adults receiving chemotherapy. Identifying different latent classes of taste changes and vulnerability would be helpful for developing interventions tailored to the heterogeneous survivors.

A matter of taste: alteration in patients with cancer

Taste alteration (dysgeusia) is a common nutritional impact symptom in people affected by cancer, as a result of either the cancer itself or its treatments. It can have a significant impact on oral intake and nutritional status. Taste alteration can also have a negative impact on food behaviours and quality of life. There is a paucity of evidence both on how the problem is assessed in patients and on strategies and guidelines to manage it. This article gives an overview of taste alterations in cancer, highlights recent reviews and summarises some key practical management themes.