Chemosensory Patients in Cancer Patients (Week 3 Lecture 1) Flashcards
A healthy sense of taste and smell….
- Positively influences appetite, food choice, dietary intake and nutritional status.
- Results in food enjoyment and enhanced food-related quality of life.
Sensory Nutrition
links chemosensation and food choice.
NIS
Nutrition Impact Symptoms: reduce appetite, nutritional status and quality of life for patients with cancer.
* Anorexia
* Pain
* Nause
* Vomiting
* Diarrhea
* Early Satiety
* Taste & smell distortion
* Mucositis
* Fatigue
* Depression
How does TSA change over the course of chemotherapy treatment?
At each next cycle the symptoms increase
prevalency of TSAs in cancer patients
On average, studies report a prevalence of 60 to 75% overall patient groups (Drareni et al. 2019)
According to the review of Hovan et al. (2010):
* 50% of patients treated only with CT
* 66% of patients treated only with RT
* 75% of patients treated with CT & RT
* 15% of RT-treated patients experience TSAs post- treatment.
86% of patients with advanced cancer (Hutton et al. 2007)
How might TSA progress?
- Symptoms from cancer (disease, treatment) interfere with eating
- taste & smell perception is changed
- food choice is restricted
- specialized nutritional needs develop
- Eating experience changes
flavour
the combined perception of aroma, taste and oral taste sensations
* smell is accounts for about 80% of what we taste
Chemosensation
The combined perception of gustation and olfaction (taste and smell)
Challenges of communicating TSAs
- ‘Technical’ versus ‘everyday’ terminologies; clinician versus patient perspectives
- Patients may identify a change in liking of foods prior to, or instead of, a TSA
What question is more useful to patients to identify TSA?
Have you ever noticed that a food tastes different than it used to?
* … a food smells …?
How do clinicians and researchers assess taste and smell function?
A variety of clinical tests are available to determine thresholds (intensity of
stimulus) and to assess identification ability (quality).
* Use of taste threshold assessments was prevalent in the 1970’s and 1980’s; use of smell assessments is more recent.
Current clinical testing tools
- taste strips
- BSIT - Sniffin’ Sticks and Brief Smell Identification Tests (BSIT)
- scratch and sniff test (if normal sense of smell would get it correct)
Current approaches to taste and smell testing
- ‘Whole mouth’ taste assessments to parallel the eating experience (glucose in koo-laide, NaCl in tomato juice)
- Basic taste assessments in food matrices
- Usually assessment of both taste and smell
- Self-assessment tools (Patient Reported Outcomes; PRO)
- Interviews in qualitative studies provide rich descriptions of patient experiences.
Self-Assessment Measures of TSA
- Individual items on Quality of Life, symptom assessment and nutrition assessment tools → E.g. PG-SGA (“tastes bother me”)
- Symptom specific tools → Short questionnaires, Comprehensive surveys
The strengths of a self- assessment tool?
- Patient perception of TSA dictates food choice
- The quantitative dimension allows population stratification and statistical associations to other data (i.e. energy intake, quality of life, severity to weight loss)
- The qualitative dimension generates a description of the impact of the TSA
Study looking at the impact of TSA amoung patients with advanced cancer
66 advanced cancer patients completed:
* The Taste and Smell Survey
* A 3 day dietary record for analysis of energy, macronutrients and food groups
* A quality of life tool (FAACT: Functional Assessment of Anorexia/ Cachexia Therapy)
Found that the more severe TSA was there was
* ↓ energy intake (including protein)
* ↑ weight loss
* ↑ time to death
* ↓ QoL
What dietary patterns have been found to maybe be associated with severe TSA?
As TSA increased in severity and number of complaints…
* daily energy and protein intake decreased
* dietary pattern shifted to bland and liquid ‘foods’
associated not causal
TSA in head and neck patients
TSA is can extend well beyond post treatment
* Patients (n=160) received treatment for HNC (RT or CRT,+/- surgery) and were capable of oral intake and completed all three study time points. TSA were highest at the end of treatment (post treatment) and persisted after treatment for many patients
* ‘Taste’ was the 4th most important QOL issue at end treatment and 2.5 months post-treatment
* The eating experience is exacerbated by a plethora of oral complications
Changing nature of TSA over time
It varies greatly on the individual but tastes can changes drastical from normal to weaker/stronger/mixed
* Trajectory of self-reported sweet taste intensities relative to time of diagnosis for patients (n=42) providing data at all three study time points
Effects of taste changes on patients’ usual activities
What contributes to TSA?
Alterations in taste perception in cancer are multi-factorial.
Parameters to consider when developing a new product for cancer patients
Provide pleasure of eating, prevent malnutrition and provide a better QOL
Selective taste management
Food choice or individual foods are refined by the individual to reflect their unique taste preferences.
Study → Intervention group received IMTD (Interventions to Mitigate Taste Dysfunction)
* Manage dry mouth and enhance food liquefaction,
* Focus on mindful eating; ‘eating as a sensory experience’,
* Individualized seasoning adjustment and food choices based on taste assessment results.
Study → After patient taste assessments, personalized bread formulations were provided by chefs.
* Of the participants, 11 participated in interviews to describe the experience; 5 themes were identified
