Taste and smell dysfunction in childhood cancer survivors.

Reduced or altered taste and smell function may occur as a side-effect of cancer therapy. This can lead to altered nutrient and energy intake. Some studies have suggested that taste and smell dysfunction can persist many years after treatment completion but this has not been previously assessed in survivors of childhood cancer. The aim of this study is to determine if taste and smell dysfunction is present in childhood cancer survivors (CCS). Food preference and Quality of Life was also assessed.
Fifty-one child cancer survivors (mean age: 19.69±7.09years), more than five years since treatment completion, (mean: 12.4years) were recruited from the long term follow-up clinics at two Sydney-based children's hospitals. Taste function was assessed using a 25 sample taste identification test comprising five concentrations each of sweet, salty, sour and bitter tastes and water. Smell function was assessed by determining the ability of participants to identify 16 common odorants. The participants' Quality of Life was assessed using the Functional Assessment of Anorexia Cachexia scale and food preferences were assessed using a 94-item food liking tool.
Taste dysfunction was found in 27.5% of participants (n=14), and smell dysfunction in 3.9% (n=2) of participants. The prevalence of taste dysfunction was higher than that seen in the non-cancer population. The child cancer survivors' appeared to "like" the less healthy food groups such as flavoured beverages, takeaway and snacks over healthier food groups such as vegetables and salad. No correlation was found between those with a taste dysfunction and their food "likes".
A high level of taste dysfunction was found in CCS though there did not appear to be an issue with smell dysfunction. Further work is also needed to assess whether a taste dysfunction do play a role in the dietary habits of CCS.

Affiliation

Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, NSW 2031, Australia; Discipline of Paediatrics, School of Women's & Children's Health, UNSW Medicine, The University of NSW 2031, Australia. Electronic address: r.cohn@unsw.edu.au.

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Reduced or altered taste and smell function may occur as a side-effect of cancer therapy. This can lead to altered nutrient and energy intake. Some studies have suggested that taste and smell dysfunction can persist many years after treatment completion but this has not been previously assessed in survivors of childhood cancer. The aim of this study is to determine if taste and smell dysfunction is present in childhood cancer survivors (CCS). Food preference and Quality of Life was also assessed.
Fifty-one child cancer survivors (mean age: 19.69±7.09years), more than five years since treatment completion, (mean: 12.4years) were recruited from the long term follow-up clinics at two Sydney-based children's hospitals. Taste function was assessed using a 25 sample taste identification test comprising five concentrations each of sweet, salty, sour and bitter tastes and water. Smell function was assessed by determining the ability of participants to identify 16 common odorants. The participants' Quality of Life was assessed using the Functional Assessment of Anorexia Cachexia scale and food preferences were assessed using a 94-item food liking tool.
Taste dysfunction was found in 27.5% of participants (n=14), and smell dysfunction in 3.9% (n=2) of participants. The prevalence of taste dysfunction was higher than that seen in the non-cancer population. The child cancer survivors' appeared to "like" the less healthy food groups such as flavoured beverages, takeaway and snacks over healthier food groups such as vegetables and salad. No correlation was found between those with a taste dysfunction and their food "likes".
A high level of taste dysfunction was found in CCS though there did not appear to be an issue with smell dysfunction. Further work is also needed to assess whether a taste dysfunction do play a role in the dietary habits of CCS.

A major problem for patients with cystic fibrosis (CF) is the maintenance of adequate nutrition to maintain normal growth. The hypotheses that poor nutrition could be due to smell and/or taste dysfunction has been pursued in several studies with contradictory results. None, however, investigated whether inadequate nutrition is due to CF patients having different liking for foods compared to healthy children and whether liking can be linked to specific changes in smell or taste function. Here, the relationships between food liking, BMI, and smell and taste function in 42 CF and 42 healthy 5- to 18-year olds is pursued. A three-choice 16-item odor identification test and a gustatory identification test involving five concentrations of sweet, sour, bitter, and salty tastes, were used to assess chemosensory function. Food liking was assessed using a 94-item questionnaire. Patients identified significantly fewer odors than controls (89.8% vs. 95.7% correct; P < 0.001). However, only a few patients were affected and their loss of olfactory function was not substantial and unlikely to affect their liking for foods. Taste identification was similar for the two groups (patients 92.6% vs. controls 94.2% correct). There was no correlation between age and odor identification ability, but taste performance improved with age (r = 0.39, P < 0.05), suggesting cognition was the cause. Patients liked several types of foods and high-fat foods more than the controls. Both groups had a similar liking for low-fat foods and both liked high-fat foods more than low-fat foods. No significant relationships existed between FEV(1) and smell or taste function or liking for foods, the BMI of the groups were similar and there was no relationship between BMI and smell or taste function. The results indicate that the abnormal eating behavior reported for many CF patients is not due to changes in chemosensory function which remains normal in most CF patients at least to 18 years of age.

2012Nov
Support Care Cancer
Support Care Cancer 2012 Nov 9;20(11):3019-23. Epub 2012 Aug 9.

The intensive conditioning regimens of a pediatric blood and marrow transplant (BMT) can limit voluntary intake leading to a risk of malnutrition. Poor dietary intake is likely multi-factorial with a change in taste and smell function potentially being one contributing factor limiting intake, though this is not well studied. This research aimed to assess the taste and smell function of a cohort of pediatric BMT patients.
A total of ten pediatric BMT patients (8-15 years) were recruited to this study. Smell function was assessed using a three-choice 16-item odour identification test. Taste function was assessed using five concentrations of sweet, sour, salty and bitter tastants. All tests were completed at admission to transplant and monthly until taste and smell function had normalised.
At the 1-month post-transplant assessment, one third of participants displayed some evidence of taste dysfunction and one third smell dysfunction, but there was no evidence of dysfunction in any patient at the 2-month assessment.
Contrary to reports of long-term loss of taste and smell function in adults, dysfunction early in transplant was found to be transient and be resolved within 2 months post-transplant in children. Further research is required to determine the causes of poor dietary intake in this population.

Changes in the taste of food have been implicated as a potential cause of reduced dietary intake among cancer patients. However, data on intensity and hedonic responses to the four basic tastes in cancer are scanty and contradictory. The present study aimed at evaluating taste intensity and hedonic responses to simple beverages in 47 anorectic patients affected by gastrointestinal cancer and in 55 healthy subjects. Five suprathreshold concentrations of each of the four test substances (sucrose in black current drinks, citric acid in lemonade, NaCl in unsalted tomato juice, and urea in tonic water) were used. Patients were invited to express a judgment of intensity and pleasantness ranging from 0 to 10. Mean intensity scores directly correlated with concentrations of sour, salty, bitter, and sweet stimuli, in both normals and those with cancer. Intensity judgments were higher in cancer patients with respect to sweet (for median and high concentrations, P<0.05), salty (for all concentrations, P<0.05), and bitter tastes (for median concentration, P<0.01). Hedonic function increased with the increase of the stimuli only for the sweet taste. A negative linear correlation was found between sour, bitter, and salty concentrations and hedonic score. Both in cancer patients and in healthy subjects, hedonic judgments increased with the increase of the stimulus for the sweet taste (r=0.978 and r=0.985, P=0.004 and P=0.002, respectively), and decreased for the salty (r=-0.827 and r=-0.884, P=0.084 and P=0.047, respectively) and bitter tastes (r=-0.990 and r=-0.962, P=0.009 and P=0.001, respectively). For the sour taste, the hedonic scores remained stable with the increase of the stimulus in noncancer controls (r=-0.785, P=0.115) and decreased in cancer patients (r=-0.996, P=0.0001). The hedonic scores for the sweet taste and the bitter taste were similar in cancer patients and healthy subjects, and these scores were significantly higher in cancer patients than in healthy subjects for most of the concentrations of the salty taste and all the concentrations of the sour taste. The present study suggests that cancer patients, compared to healthy individuals, have a normal sensitivity, a normal liking for pleasant stimuli, and a decreased dislike for unpleasant stimuli. Moreover, when compared to controls, they show higher hedonic scores for middle and high concentrations of the salty taste and for all concentrations of the sour taste. Further studies are needed to evaluate whether these changes observed in cancer patients translate into any alteration in dietary behavior and/or food preferences.

2013Jan
Oncol Nurs Forum
Oncol Nurs Forum 2013 Jan;40(1):E4-13

To describe the prevalence of issues with taste function in survivors of head and neck cancer.
Exploratory, cross-sectional.
Outpatients from Saint Louis University Cancer Center in Missouri.
92 adult head and neck cancer survivors, heterogeneous in cancer site, treatment type, and time post-treatment, ranging from three months to more than 28 years after completion of therapy.
Taste discrimination was assessed using high, medium, and low concentrations of sweet, salty, sour, and bitter tasting solutions.
Taste, percentage of weight change, tumor site and stage, treatment type, and time since completion of therapy.
Eighty-five of 92 participants had some measurable taste dysfunction. Confusion between bitter and sour and the inability to discriminate among the different concentrations of the sweet solutions were common. Statistically significant weight loss was associated with dysgeusia.
Taste dysfunction was a persistent problem across all categories of head and neck cancer treatments, sites, and stages. Participants who reported the loss of one or more specific taste modality performed poorly on the taste test. However, participants could not accurately predict which taste was most severely impaired.
Taste dysfunction is a long-term treatment-related side effect for head and neck cancer survivors. Assessing for taste changes and dysgeusia are important nursing considerations, as taste loss is distressing and associated with decreased appetite. Future studies are needed to identify interventions to help patients better manage and adapt to this long-term complication of cancer therapy.
Flavors are recognized by taste, texture, aroma, thermal quality, and visual cues. A disruption of one or more of those sensory experiences alters flavor recognition. Having intact taste sense but impaired flavor recognition is possible. Finally, taste is not accurately self-reported because it is commonly confused with flavor recognition.

Affiliation Details

  • Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, NSW 2031, Australia; Discipline of Paediatrics, School of Women's & Children's Health, UNSW Medicine, The University of NSW 2031, Australia. Electronic address: r.cohn@unsw.edu.au.
  • Kids Cancer Centre
Affiliation Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, NSW 2031, Australia; Discipline of Paediatrics, School of Women's & Children's Health, UNSW Medicine, The University of NSW 2031, Australia. Electronic address: r.cohn@unsw.edu.au.