Prospective assessment of taste impairment and nausea during radiotherapy for head and neck cancer

Martini, Stefania; Iorio, Giuseppe Carlo; Arcadipane, Francesca; Olivero, Francesco; Silvetti, P.; Rampino, Monica; Garzino-Demo, Paolo; Fasolis, Massimo; Pecorari, Giancarlo; Airoldi, Mario; Ricardi, Umberto; Franco, Pierfrancesco

doi:10.1007/s12032-019-1269-x

Cited by 23 publications

(16 citation statements)

References 21 publications

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“…Olfactory function was unaffected, as the olfactory receptors were outside the irradiated field [14]. In a prospective questionnairebased study that also assessed hypo-ageusia during and after H&N RT or chemoradiotherapy, the maximum values were reached during the seventh week of RT, declined a month later, and approached baseline at 6 months from end of treatment [12]. Another study found that the highest prevalence of taste loss was seen 2 months after RT [7].…”

Section: Discussionmentioning

confidence: 99%

“…The standard treatments for most Head and Neck (H&N) cancers include surgery, radiotherapy (RT), and chemotherapy (CT). One of the main adverse events of these treatments is altered taste sensation [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] which has a major effect on quality of life (QoL). It is a significant cause of morbidity and affects patients' diet by causing loss of appetite, reduced oral intake, and may result in weight loss [8,17,18].…”

Section: Introductionmentioning

confidence: 99%

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The effect of radiotherapy on taste sensation in head and neck cancer patients – a prospective study

et al. 2020

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Background: One of the main side effects of head and neck (H&N) radiation therapy (RT) is alteration in taste sensation. It causes significant morbidity and has a major effect on quality of life (QoL). The aim of this study was to prospectively define the effect of RT on taste sensation (general, and four basic tastes) and correlate these findings with changes in saliva secretion and QoL questionnaires. Methods: Patients with H&N cancer treated with RT, in which the oral cavity was expected to receive a mean dose of 30 Gray (Gy). Patients were evaluated by Whole-Saliva Sialometry, validated Taste Strips and European Organization for Research and Treatment of Cancer H&N QoL questionnaires prior to RT (T0), mid-point of radiotherapy dose (T1), at the end of radiotherapy (T2) and 1 (T3), 3 (T4) and 12 months (T5) after completion of treatment course. Results: Twenty-eight patients were recruited, and 21 patients completed study procedures and were analyzed. Median age was 66 years (range 18-90). The most common tumor site was the oral cavity. The median prescribed radiation dose to the high dose volume was 66 (range 60-70). The median mean and max dose to the oral cavity were 25.1 (range 14-69) and 64.9 (range 30-70), respectively. There was a significant decrease in overall taste sensation between T0 and T1 and T2. With specific tastes, there were significant decreases in sensation of sweet and salty, a trend with bitter and no change with sour. All returned to baseline at T3 and onwards. There was no significant correlation between the max or mean dose to the oral cavity and overall taste sensation or between doses to different areas of the tongue and overall or specific tastes. At T0 there was a significant positive correlation between overall taste sensation and whole-saliva sialometry, and at T1 and T2 there were strong trends. There were significant declines in QoL scores during RT. Conclusions: We found a significant immediate reduction in taste sensation due to RT in H&N cancer patients with taste recovery 1 month after treatment completion. There were strong trends to a correlation with saliva production that requires further exploration.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effect of radiotherapy on taste sensation in head and neck cancer patients – a prospective study

et al. 2020

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“…Two recent studies [27][28] chose to use the Chemotherapyinduced Taste Alteration Survey (CiTAS), an 18-item scale assessing four dimensions of taste including decline in basic taste; discomfort, phantoguesia / parageusia and generalised alterations of taste [29].…”

Section: Subjective Measuresmentioning

confidence: 99%

“…The common terminology criteria for adverse events (CTCAE) was used as a clinician-reported objective assessment for dysgeusia in 3 recent studies [27,[30][31]. This tool is simplistic and categorises patients into groups based on whether dysgeusia has led to dietary changes or not.…”

Section: Subjective Measuresmentioning

confidence: 99%

“…Although prevalence of objective taste dysfunction was 33-35%, studies collecting subjective outcomes (using a variety of different measures) reported baseline taste alteration in 0-36% [21,32,[26][27][28]. Those studies that used validated patient-reported questionnaires reported consistent prevalence of around 13-19% [26,28].…”

Section: Prevalence Of Taste Dysfunction Prior To Radiotherapymentioning

confidence: 99%

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Taste dysfunction following radiotherapy to the head and neck: A systematic review

Gunn

Gilbert²,

Nenclares

et al. 2021

Radiotherapy and Oncology

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Background: An intact sense of taste provides pleasure, supports sustenance and alerts the body to toxins. Head and neck cancer (HNC) patients who receive radiotherapy (RT) are high-risk for developing radiation-induced taste dysfunction. Advances in RT offer opportunities for taste-preserving strategies by reducing dose to the gustatory organs-at-risk. Methods: PubMed, Medline and EMBASE were searched for publications reporting on taste, RT and HNC. Randomised trials, cohort studies and cross-sectional studies were included. Results: 31 studies were included in this review. Meta-analysed prevalence of acute taste dysfunction following RT was approximately 96% (95% CI 64 to 100%) by objective measures and 79% (95% CI 65 to 88%) by subjective measures, with the majority of patients showing at least partial recovery. Long-term dysfunction was seen in~25% of patients. Taste dysfunction was associated with sequalae including weight loss and reduced quality-of-life (QoL). Taste dysfunction was more common when the oral cavity, and specifically the anterior two-thirds of the tongue, was irradiated, suggesting a dose constraint for taste preservation might be feasible. Proton beam therapy and customised bite blocks reduced dose to the gustatory field and subsequent loss of taste. Conclusions: Taste dysfunction following RT is common and negatively affects patients' nutritional status and QoL. Decisions about treatment strategies, including choice of RT modality, dose distribution across the gustatory field and the use of adjuncts like bite blocks may be beneficial. However, evidence is limited. There is a pressing need for randomised studies or large prospective cohort studies with sufficient adjustment for confounders.

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Prospective Evaluation of Taste Function in Patients With Head and Neck Cancer Receiving Intensity-Modulated Radiotherapy

Chen

Hsu

Tsai

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEThe majority of the patients with head and neck cancer (HNC) experience taste dysfunction (TD) during or after radiotherapy (RT). However, prospectively collected data for taste dysfunction have been limited, especially in the era of intensity-modulated RT (IMRT). OBJECTIVE To evaluate the taste function in patients with HNC receiving IMRT by investigating the association between time course and recovery of TD in both acute and late phases. DESIGN, SETTING, AND PARTICIPANTS From August 2017 to November 2020, patients treated at the Chang Gung Memorial Hospital with curative or postoperative IMRT for HNC were enrolled in this prospective cohort study. The data analysis was performed from March 2021 to January 2022. EXPOSURES IMRT with and without concurrent chemotherapy. MAIN OUTCOMES AND MEASURES Taste function was measured using the whole-mouth solution method for 4 tastes (salt, sweet, sour, and bitter). Subjective evaluations (National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.03] and Subjective Total Taste Acuity scale) were used. Patient self-reported quality of life was evaluated using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N35). RESULTS A total of 87 patients (78 [90%] men and 9 [10%] women; mean [range] age, 58 years) were enrolled. Overall TD rates were 79 of 86 (91.9%), 63 of 83 (75.9%), 27 of 81 (33.3%), 5 of 56 (8.9%), and 2 of 30 (6.7%) during RT, and 1 week, 3 months, 6 months, and 1 year after RT, respectively. Positive correlation occurred between objectively measured taste loss for the 4 taste qualities and subjective perception of taste loss. Only oral cavity mean dose 4000 cGy or greater predicted TD 3 months after RT. The mean oral cavity doses to the predicted 15% (D 15 ), 25% (D 25 ), and 50% (D 50 ) probabilities were 25, 38, and 60 Gy at 3 months and 57, 60, and 64 Gy at 6 months, respectively. CONCLUSIONS AND RELEVANCEIn this cohort study, most patients still experienced TD during and at 3 months after RT. Only a few patients experienced long-term TD. A high oral cavity dose was associated with TD in patients with HNC receiving IMRT. Reducing oral cavity dose may promote early recovery of taste function after IMRT.

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Prospective assessment of taste impairment and nausea during radiotherapy for head and neck cancer

Cited by 23 publications

References 21 publications

The effect of radiotherapy on taste sensation in head and neck cancer patients – a prospective study

The effect of radiotherapy on taste sensation in head and neck cancer patients – a prospective study

Taste dysfunction following radiotherapy to the head and neck: A systematic review

Prospective Evaluation of Taste Function in Patients With Head and Neck Cancer Receiving Intensity-Modulated Radiotherapy

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