“Everything tastes different” : The impact of changes in chemosensory perception on food preferences, food intake and quality of life during chemotherapy in cancer patients

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Taste and smell changes are common side effects during chemotherapy in cancer patient and may have an impact on food preferences, food intake and quality of life. However, these relations have hardly been studied systematically in specific cancer populations. The overall aim of this thesis was to assess how the sense of taste and smell change upon treatment with chemotherapy in breast cancer and oesophagogastric cancer patients, and to investigate their consequences in terms of food preferences, food intake and quality of life. To measure food preferences for both macronutrients and tastes, the Macronutrient and Taste Preference Ranking Task (MTPRT) was developed. in chapter 2, it was shown that by inducing sensory specific satiety for a standardized sweet and savoury meal, it is possible to detect shifts in preferences for both tastes and macronutrients with the MTPRT, and that these results are reproducible. In Chapter 3 we studied objective and subjective taste and smell perception and food preferences in advanced oesophagogastric cancer patients undergoing palliative chemotherapy. The result showed that only objective taste function decreases during chemotherapy, but other chemosensory measures were unchanged. A lower subjective taste perception was related to a lower preference for high-protein products. Therefore it is important to consider patients’ taste perception, when providing dietary advice to OGC patients Chapter 4 describes a study with similar outcome measures as chapter 3, but in breast cancer patients at several time points during and after chemotherapy, and compared to a healthy control group. The study showed that breast cancer patients like high-protein, high-fat, sweet and savoury products less during chemotherapy, thus showing altered preferences for macronutrients, but not for tastes. Furthermore, results showed a temporary decrease in taste and smell perception during chemotherapy. These findings show that patients should be informed prior to treatment on chemosensory changes, and that these changes should be monitored during treatment due to the consequences for nutritional intake and quality of life In chapter 5 we assessed the dietary intake of breast cancer patients before and during chemotherapy compared to a healthy control group, and associations with experienced symptoms during chemotherapy. It was shown that symptoms induced by chemotherapy were associated with lower total energy, protein and fat intake, which was manifested by a lower intake of specific food groups. Therefore, to ensure an optimal dietary intake during chemotherapy, it is important to monitor nutritional status and symptom burden during chemotherapy in breast cancer patients. To better understand the impact of chemosensory changes during chemotherapy on daily life, 13 advanced oesophagogastric cancer patients were interviewed (see chapter 6). Patients described a substantial impact of chemosensory and food-related changes on daily life (by changing daily routines), social life (eating being less sociable) and roles in the household (changing roles in cooking and grocery shopping). Finally, in chapter 7, we assessed the association between self-reported taste and smell perception and quality of life in breast cancer patients. A worse taste and smell perception was associated with a worse global quality of life, role, social and emotional functioning shortly after chemotherapy. In patients treated with trastuzumab, a worse taste and smell perception was still associated with quality of life, social and role functioning half a year after chemotherapy had ended. From the studies in this thesis we can conclude that chemotherapy mainly affects the sense of taste. The subjective perception of taste was associated with a lower preference for food products and lower energy intake. This indicates that it is not necessarily an actual change in the sense of taste or smell that has an impact on patients, but flavour perception as a whole and potentially a lower enjoyment of food. Moreover, these perceived changes in taste and smell can have a substantial impact on cancer patients’ lives, in a practical way by changing daily patterns of eating, but also socially and in roles in the household. A changed chemosensory perception during chemotherapy may lead to a worsened nutritional status, and could thereby negatively impact the response to chemotherapy. Therefore chemosensory perception should be monitored during chemotherapy. Future studies should further investigate the mechanisms behind chemosensory changes, factors that contribute to subjective taste perception and possible interventions to alleviate chemosensory changes during chemotherapy.