Lorraine Spotten

Supervisors:

Prof. Declan Walsh, MSc, FACP, FRCP (Edin)

Dr. Clare Corish, PhD, MINDI

November 2015

Subjective Taste and Smell Changes

in Treatment-Naive Patients

with Solid Tumours

1

Taste and Smell Changes (TSCs)

Frequent in cancer (1,2)

Mostly studied (3,4,5):

May occur pre-treatment in diverse cancer sites (6,7,8)

Mechanisms poorly understood (9)

May be part of a symptom cluster (10)

Can affect nutritional status (11)

2

Image sources:

http://isis-innovation.com/licence-details/companion-diagnostic-for-chemotherapy-side-effects/

http://www.express.co.uk/news/uk/225689/Radiotherapy-can-save-thousands

http://oncolex.org/head-and-neck-cancer

Aims and Objectives

3

AIM:

Examine prevalence, severity and characteristics of TSCs

Non-H&N patients with solid tumours pre-CT or RT

OBJECTIVES:

To investigate the association between:

Tumour type and TSCs

Demographics and TSCs

TSCs and nutritional risk

TSCs and other nutrition impact symptoms

Methodology

Radiation oncology OPD

• N=40

• 6 weeks Image source: http://www.simext.com/images/methodology.png

4

Inclusion Exclusion

• Diagnosis of cancer

• May have had surgery

• Age ≥ 18 years old

• Able to understand and speak

English

• Witnessed signed consent form

• Previous chemotherapy

• Previous radiotherapy

• Head and neck cancer

• ECOG performance status ≥4

• Life expectancy

Methodology

• Taste and smell survey (12)

• Abridged Patient-Generated Subjective Global Assessment (13)

• Measured Body Mass Index

• Demographic data

• Data Analysis: SPSS®, Version 22.0

Image source: http://www.simext.com/images/methodology.png

5

12. Modified from Heald et al., 1998

Overview of Recruitment Process

Total screened for eligibility:

96

Eligible:

52

Agreed to meet with researcher:

40

Completed study:

40

6

Key Baseline Sample Characteristics

7

70% Newly Diagnosed

(n = 28)

58%

Male (n=23)

55% overweight/obese

(n=32)

38%

breast cancer (n=15)

Median age: 66

(IQR 55-74) 38%

prostate cancer

(n=15)

Key Baseline Sample Characteristics

8

70% Newly Diagnosed

(n = 28)

58%

Male (n=23)

55% overweight/obese

(n=32)

38%

breast cancer (n=15)

Median age: 66

(IQR 55-74) 38%

prostate cancer

(n=15)

Key Baseline Sample Characteristics

9

70% Newly Diagnosed

(n = 28)

58%

Male (n=23)

55% overweight/obese

(n=32)

38%

breast cancer (n=15)

Median age: 66

(IQR 55-74) 38%

prostate cancer

(n=15)

Main Findings

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1. Prevalence of TSCs

48% (n=19)

Moderate or severe (n=11)

Mainly:

Females (n=11/17)

Breast cancer (n=9/15)

Image source: https://sciencebasedlife.files.wordpress.com/2012/03/0008db75-22f1-1cbf-b4a8809ec588eedf_1.gif

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2. Characteristics of TSCs

Intensity:

No change (60%, n=24)

Stronger sweet taste (n=9)

Stronger salty taste (n=7)

Of these:

Stronger odour (n=4)

Weaker odour (n=4)

Quality:

‘Bad taste’ (n=22)

Sour (n=7)

3. TSCs and Nutritional Risk

Patients at nutritional risk

tended to have TSCs

(P=0.057)

93% due CT/RT (n=37)

Image sources:

http://www.goddessofthegarden.com/wp-content/uploads/2011/07/lemon1.jpg

http://anymanfitness.com/wp-content/uploads/2014/05/weight-scale-help.jpg

TSCs and Cluster Symptoms

TSCs commonly co-occurred with :

Dry mouth (n=14/17, P

TSC and Cluster Symptoms

TSCs commonly co-occurred with :

Dry mouth (n=14/17, P

TSC and Cluster Symptoms

TSCs commonly co-occurred with :

Dry mouth (n=14/17, P

TSC and Cluster Symptoms

TSCs commonly co-occurred with :

Dry mouth (n=14/17, P

TSC and Cluster Symptoms

TSCs commonly co-occurred with :

Dry mouth (n=14/17, P

Strengths and Limitations

Novel

Generalisable

Statistical significance,

despite small sample

Questionnaires (14,15)

100% completion rate

upon meeting with

researcher

Convenience sampling

Performance status

Interview bias

Confounders

Missing data on

medications

17

Image sources:

http://www.bigstockphoto.com/image-1516141/stock-photo-tick-sign

http://www.clker.com/clipart-3584.html

Study Implications

CLINICAL

Routine screening at

diagnosis

Cluster symptoms

Use of common

terminology

Clinical guidelines

Individualised care

Treatments

RESEARCH

Longitudinal assessment

Validation of ‘Taste and

Smell Survey’ (12)

Pathophysiology and

characteristics

Dietary intake data

Symptom clusters

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Image sources:

http://pmclinical.com/

http://lod-lam.slis.kent.edu/RESEARCH.html

Conclusions

1. TSCs in almost half of treatment-naive cancer patients

2. May be tumour-induced

3. Mainly reported by females and breast cancer patients

4. Majority at nutritional risk reported TSCs

5. TSCs significantly associated with:

Dry Mouth

Early Satiety

Fatigue

6. Further research and clinical guidelines needed

19 Image source: http://pixshark.com/conclusion-paragraph-clipart.htm

Acknowledgements Prof. Declan Walsh

Dr. Clare Corish

Dr. Cliona Lorton

Dr. Niamh O’Donoghue

Ms. Pauline Ui Dhuibhir

Dr. Brenda O’Connor

Dr. Moya Cunningham

Dr. Nazmy El Beltagi

Dr. Charles Gillham

.....and all the staff at Our Lady’s Hospice, St. James’s Hospital and St. Luke’s Radiation Oncology Network for their kindness and support throughout.

20 Image source: http://matthewlpowers.com/tag/thank-you/

Thank you for listening

21 Image source: http://godlessmom.com/10-questions-i-have-never-been-asked-about-atheism-

answered/question-mark-red-3d-glossy/

References

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1. DeWys, WD. and Walters, K. Abnormalities of taste sensation in cancer patients. Cancer, 1975, 36(5), pp.1888-

1896.

2. Kamath, S., Booth, P., Lad, T.E., Kohrs, M.B., McGuire, W.P. Taste thresholds of patients with cancer of the

esophagus. Cancer, 1983, 52(2), pp.386-389.

3. Zabernigg, A., Gamper, E.M., Giesinger, J.M., Rumpold, G., Kemmler, G., Gattringer, K., et al. Taste

alterations in cancer patients receiving chemotherapy: a neglected side effect? Oncologist, 2010, 15, pp.913-920.

4. Baharvand, M., Shoaleh Saadi, N., Barakian, R., Moghaddam, E.J. Taste alteration and impact on quality of life

after head and neck radiotherapy. Journal of Oral Pathology and Medicine, 2013, 42, pp.106-112.

5. Leyrer, C.M., Chan, M.D., Peiffer, A.M., Horne, E., Harmon, M., Carter, A.F., et al. Taste and smell

disturbances after brain irradiation: a dose-volume histogram analysis of a prospective observational study.

Practical Radiation Oncology, 2014, 4, pp.130-135.

6. Williams, L.R. and Cohen, M.H. Altered taste thresholds in lung cancer. American Journal of Clinical

Nutrition,1978, 31(1), pp.122-125.

7. Harris, A.M., Griffin, S.M. Postoperative taste and smell deficit after upper gastrointestinal cancer surgery--an

unreported complication. Jounal of Surgical Oncology, 2003, 82(3), pp.147-150.

8. Steinbach, S., Hundt, W., Zahnert, T., Berktold, S., Böhner, C., Gottschalk, N., et al. Gustatory and olfactory

function in breast cancer patients. Supportive Care in Cancer, 2010, 18(6), pp.707-713.

9. Hutton, J.L., Baracos, V.E., Wismer, W.V. Chemosensory dysfunction is a primary factor in the evolution of

declining nutritional status and quality of life in patients with advanced cancer. Journal of Pain and Symptom

Management, 2007, 33, pp.156-165.

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10. Walsh, D. and Rybicki, L. Symptom clustering in advanced cancer. Supportive Care in Cancer, 2006, 14,

pp.831-836.

11. Aapro, M., Arends, J., Bozzetti, F., Fearon, K., Grunberg, S.M., et al. Early recognition of malnutrition

and cachexia in the cancer patient: a position paper of a European School of Oncology Task Force. Annals of

Oncology, 2014, 25, pp.1492-1499.

12. Heald, A.E., Pieper, C.F., Schiffman, S.S. Taste and smell complaints in HIV-infected patients. AIDS, 1998,

12, pp.1667-1674.

13. Gabrielson, D.K., Scaffidi, D., Leung, E., Stoyanoff, L., Robinson, J., Nisenbaum, R., et al. Use of an

abridged scored Patient-Generated Subjective Global Assessment (abPG-SGA) as a nutritional screening tool

for cancer patients in an outpatient setting. Nutrition and Cancer, 2013, 65, pp.234-239.

14. McGreevy, J., Orrevall, Y., Belqaid, K., Wismer, W., Tishelman, C., Bernhardson, B.M. Characteristics of

taste and smell alterations reported by patients after starting treatment for lung cancer. Supportive Care in

Cancer, 2014, 22, pp.2635-2644.

15. Belqaid, K., Orrevall, Y., McGreevy, J., Månsson-Brahme, E., Wismer, W., Tishelman, C., et al. Self-

reported taste and smell alterations in patients under investigation for lung cancer. Acta Oncologica, 2014, 53,

pp.1405-1412.