Decoding Dysgeusia: Taste Dysfunction in Head and Neck Cancer Patients Receiving Radiation Therapy

Abstract

Taste dysfunction (dysguesia) in patients receiving radiotherapy (RT) leads to decline in numerous quality of life outcomes. How to measure this robustly remains a challenge that needs to be addressed to enable effective approaches to prevent or to treat this complication. This study seeks to characterize the ability to measure and characterize radiation-induced dysgeusia with a patient reported outcome measure of asking patients to provide a relative percentage of their taste function. Utilizing prospectively collected data at the point of care in our institutional Oncospace database, patients treated for head and neck cancers reported percent of preserved taste function data for time points at baseline, weekly through radiotherapy, and at every three months through 24 months. The average assessment of percent taste function at each time point was plotted from baseline to 24 months. A multivariate analysis was conducted to assess for patient, tumor, or treatment factors with respect to taste function. From 2010-2016, 164 patients with taste function assessments and who had bilateral neck and pharyngeal RT were identified with a mean age of 59 years, male (77%) of Caucasian (71%), African-American (20%) and Other (9%) ethnicities. 46% had an advanced T stage (T3-T4); 55% had an advanced N stage (N2b, N3), and 4% had nasopharynx, 76% oropharynx, 1% oral cavity, and 19% had hypopharynx/larynx primaries. 51% of patients had no surgical intervention. 74% had chemotherapy as part of their regimen. Taste function declined rapidly from baseline to the end of RT, with the lowest measure (<14 points of 100) at the end-of-treatment measure. Taste function slowly recovered after RT, at a rate of 0.8 points improvement for every 10 days (p<.001). Patients who had surgery prior to RT had the least change in taste function. The mean dose to the parotid and advanced nodal stage significantly affected taste function. (P=0.01) Higher dose was associated with slower recovery: for every additional 1 Gy increase in dose, taste function recovered 0.4 points lower. None of the following factors affected taste function: age, gender, race, primary tumor site, or use of chemotherapy. Patient-reported percent in taste function follows a characterizable pattern of loss and recovery during and following radiotherapy. Advanced nodal stage and mean parotid dose significantly affected patient-reported taste function. This study identifies a simple patient reported question that may be a promising method to evaluate radiation-related dysgeusia that warrants further evaluation.