Subjective and Objective Assessment of Taste and Smell Sensation in Advanced Cancer

Abstract

Context: Taste and smell abnormalities (TSA) occur throughout the cancer trajectory regardless of cancer primary site and contribute to cancer-associated malnutrition. TSA etiology is poorly understood. Tumor-related inflammation is a possible cause. Objective: This study examined the prevalence, characteristics, and severity of TSA in advanced cancer and explored the relationship between TSA and nutritional status. No previous study combined subjective and objective measures for both taste and smell assessment in this population. Method: Consecutive advanced cancer hospice patients were recruited. A modified version of the “Taste and Smell Survey” assessed subjective TSA. Validated taste strips and “Sniffin’ Sticks” were the objective measures. The abridged patient-generated subjective global assessment evaluated nutritional status. Results: A 93% prevalence of TSA in 30 patients with advanced cancer was identified. When subjective and objective evaluations were combined, 28 had taste abnormalities, 24 smell abnormalities, and 24 both. Taste changes included “persistent bad taste” (n = 18) and changes in how basic tastes were perceived. Half reported smell was not “as strong” as prediagnosis, while more than half (n = 16) had an objective smell abnormality. Most (97%) were at risk of malnutrition. Fatigue, dry mouth, early satiety, and anorexia were common nutrition-impact symptoms. No statistically significant relationship was found between TSA and malnutrition scores. Conclusions: TSA were highly prevalent. Subjective taste and smell changes did not always accord with objective TSA, suggesting both assessments are valuable. TSA characteristics varied, and particular foods tasted and smelled different and were not enjoyed as before. TSA are common, high-impact problems in advanced cancer.

The association of frailty with olfactory and gustatory dysfunction in older adults: a nationally representative sample

“…In addition to this, in the setting of comparatively basic taste testing, it is possible for there to have been participant confusion in applying taste adjectives, specifically, "sour-bitter" and "sour-salty" confusions have been documented in English-speaking subjects. 105,110,111 In this current study, higher frailty was observed in subjects with GD that was self-reported, but not measured. These results suggest a potential role for self-reported GD to inform assessments of patient frailty, but these results should be interpreted with caution given the previously demonstrated lack of agreement between measured and self-reported GD.…”

“…The objective taste tests in this survey included only salty and bitter tastes due to time constraints, omitting sweet, sour, and umami tastants. In addition to this, in the setting of comparatively basic taste testing, it is possible for there to have been participant confusion in applying taste adjectives, specifically, “sour‐bitter” and “sour‐salty” confusions have been documented in English‐speaking subjects 105,110,111 . In this current study, higher frailty was observed in subjects with GD that was self‐reported, but not measured.…”

“…GD may also be connected to frailty by treatments known to decrease taste sensitivity, including multiple medical therapies such as antihypertensives, 93,94 and chemotherapeutics [95][96][97] as well as local radiation, 98,99 or diseases with comorbid dysgeusia, including chronic kidney disease 100 and hepatitis C. 101 Importantly, this study did not find an association between frailty and measured GD, supporting previous work demonstrating a lack of concordance between self-reported and measured GD. [102][103][104][105][106] The relationship between subjective GD and frailty observed here may have been confounded by smell, as subjective measures of taste are strongly influenced by olfaction, specifically retronasal olfaction. 102,107,108 Similarly, mood and affect have also been shown to modulate perceptions of taste.…”

COVID-19–related anosmia is associated with viral persistence and inflammation in human olfactory epithelium and brain infection in hamsters

“…All patients had a detailed standardized clinical and rhinological examination performed by a certified ENT physician. Following measures were performed at inclusion: i) Taste and olfactory function evaluation by a self-questionnaire taste and smell survey (TTS) (48), and a visual analog scale (VAS) (49), and ii) Nasal brushing for collection of neuroepithelium cells and olfactory mucus. The participants self-assessed their smell and taste perception using a 100-mm VAS, where 0 mm indicated the inability to smell or taste and 100 mm indicated normal smell or taste perception (49).…”

COVID-19-associated olfactory dysfunction reveals SARS-CoV-2 neuroinvasion and persistence in the olfactory system

“…All patients had a detailed standardized clinical and rhinological examination performed by a certified ear nose throat consultant. Following measures were performed at inclusion: i) Taste and olfactory function evaluation by a selfquestionnaire taste and smell survey (TTS) (44), and a visual analogue scale (VAS) (45), and ii ) Nasal brushing for collection of neuroepithelium cells and olfactory mucus. The participants self-assessed their smell and taste perception using a 100-mm VAS, where 0 mm indicated the inability to smell or taste and 100 mm indicated normal smell or taste perception (45).…”