Abstract
Introduction: Taste changes are common during chemotherapy. Currently, limited evidence-based guidelines exist for the effective management of chemotherapy induced dysgeusia in adult cancer outpatients. In this study, chefs gastro-engineering combine medical and para-medical assessments with innovative insights from gastrological sciences such as selective taste management to improve the taste of bread for cancer outpatients.
 Method: The oncologists from the participating hospitals referred eligible patients to a chef-led taste center. The chef gastro-engineering carries out a taste assessment and combines these results with the food preferences of the patient as well as any advice of the dietician and/or the speech therapist to develop personalized recipes, in this case a recipe for personalized bread. The patients were asked to bake and consume this personalized bread at home, with the help of their family caregiver. The effects of this innovative self-care intervention were measured after 1 month follow-up.
 Results: Included patients (N=112) are randomly divided in a bread-baking (intervention) group (N=54) and a control group (N=58). Over 80% of the bread baking patients perceived personalized bread as equally or more tasteful than usual bread despite their stressful chemotherapy-induced dysgeusia. After one month follow-up a significant loss of bodyweight (p .021) and Body Mass Index (p .025) is observed in the control group while in the bread-baking group this loss was not significant (p .968 and p .956 respectively). Only 17% of the bread baking group required some telephone or online assistance in order to correctly apply their personalized recipe. In-depth Interviews with the patients and their caregivers revealed the highly empowering effect of this innovative self-care intervention. In 60% of the cases, the bread was prepared by the family caregiver. Compliance was high and no side effects were reported.
 Conclusion: A chef-led taste center appears to be able to accurately and safely address the chemotherapy-induced dysgeusia in adult cancer outpatients. Thanks to this integrated and hyper-personalized approach to a stressful side effect of chemotherapy, more than 80% of the participants were able to enjoy tasty bread again despite dysgeusia. Given the positive effect on patient empowerment and since baking personalized bread at home is safe and feasible, this approach should be extended to other meal components. A chef-led taste center should be structurally anchored in the transmural integrated care pathway for adult cancer pati
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