Abstract
Purpose:
The present study examined the prevalence of changes in the taste and smell of food among men with advanced prostate cancer who were receiving hormone therapy and/or chemotherapy.
Method:
Participants were 75 men with advanced prostate cancer treated at an academic medical center. They completed a prospective survey about nausea while eating, taste and smell of food, and appetite periodically during a mean of 1.3 years of follow-up. Demographics, treatments, and weight data were extracted from electronic health records. Logistic regression analyses were used to examine the associations between presence of the symptoms surveyed, treatments, and weight loss of ≥10%.
Results:
Participants experienced poor taste of food (17%) and poor smell of food (8%) during the study. Nausea was associated with an increased likelihood of experiencing poor taste (50.0% v 12.3%, OR=7.13, P=.008) and smell (30.0% v 4.6%, OR=8.86, P=.016) of food. Poor taste of food was associated with an increased likelihood of experiencing poor appetite (35.0% v 10.9%, OR=12.43, P<.001). Participants were more likely to experience poor taste of food at any point in the study if they were being treated with denosumab (35.0% v 10.9%, OR=4.40, P=.020) or docetaxel (41.7% v 12.7%, OR=4.91, P=.022). Participants were more likely to experience ≥10% weight loss if experiencing poor taste of food (38.4% v 8.6%, OR=6.63, P=.010) or poor appetite (60.0% v 6.6%, OR=21.38, P<.001).
Conclusion:
Clinicians should query patients for changes in taste and smell of food, especially if they are experiencing weight loss.
Introduction
The capacity to enjoy food, dually affected by perceptions of taste and smell, is important for quality of life, mood, social interactions, and nutrition [1]. Unfortunately, cancer treatments are often associated with changes in taste and smell, yet these important parameters are typically unqueried in structured patient reported outcome measures [2]. For example, one study of patients with heterogeneous cancer diagnoses suggested that oncologists missed 7 in 10 cases of taste changes [3]. According to a 2017 systematic review, changes in taste and smell are highly prevalent among patients receiving head and neck radiotherapy (50–70%), but estimates vary widely among patients receiving chemotherapy (15–70%), and limited oncology studies have examined changes in taste and smell in other cancers [4]. Furthermore, known prior studies of cancer patients using hormone and/or immunotherapies have not examined changes in taste and smell [4]. The mechanisms by which radiotherapy and chemotherapy affect taste and smell are well-established [1]. Although the literature has predominantly focused on those treatments, there is a long-standing history of using additional therapies such as hormone therapy in the treatment of prostate and other cancers [5,6]. Given that prostate cancer is highly prevalent and commonly treated with such therapies [5,7], we examined the prevalence of changes in the taste and smell of food among advanced prostate cancer patients receiving hormone therapy and/or chemotherapy.
Methods
This study was approved by the Tulane University Internal Review Board. Participants were men with prostate cancer treated at an academic medical center from June 2015 to August 2017. They completed a prospective survey-based study comprised of de novo questions on a 5-point scale regarding taste and smell of food, appetite, and nausea while eating over the past two weeks. Participants were coded as having poor taste, poor smell, or poor appetite if they rated these as bad or very bad. Participants were coded as experiencing nausea if they reported feeling sick or nauseated when eating sometimes, often, or most of the time. Participants completed the same survey at follow-up visits during the study period. For each participant, we coded whether each symptom was present (a) on the initial survey and (b) during any study survey. Point prevalence refers to the proportion of participants experiencing symptoms at the initial survey, and period prevalence refers to the proportion experiencing symptoms on any survey. We extracted data on demographics, treatments, and weight from the electronic health record. Statistical analyses used descriptive statistics and logistic regression with an alpha-level of .05.
Results
Participants were 75 men with prostate cancer. Table 1 provides descriptive statistics characterizing cohort demographics, survey responses, and weight changes. On the initial survey, the point prevalence estimates were 5.3% (4/75) for nausea while eating, 8.0% (6/75) for poor taste of food, 5.3% (4/75) for poor smell of food, and 9.3% (7/75) for poor appetite. Participants completed a mean of 2.43 (SD=1.00) surveys over 1.32 (SD=0.59) years of follow-up; period prevalence estimates were 13.3% (10/75) for nausea while eating, 17.3% (13/75) for poor taste of food, 8.0% (6/75) for poor smell of food, and 13.3% (10/75) for poor appetite. Nausea was associated with an increased likelihood of experiencing poor taste (50.0% v 12.3%, OR=7.13, P=.008) and smell (30.0% v 4.6%, OR=8.86, P=.016) during the study. Poor taste of food was uniquely associated with an increased likelihood of experiencing poor appetite (35.0% v 10.9%, OR=12.43, P<.001). Participants were more likely to experience poor taste of food during any point in the study if treated with denosumab (35.0% v 10.9%, OR=4.40, P=.020) or docetaxel (41.7% v 12.7%, OR=4.91, P=.022). Association does not clearly implicate causality. Participants were more likely to experience ≥10% weight loss if experiencing poor taste of food (38.4% v 8.6%, OR=6.63, P=.010) or poor appetite (60.0% v 6.6%, OR=21.38, P<.001) during the study.
Table 1.
Descriptive Statistics
| N (%) or M (SD) | 75 |
|---|---|
| Baseline age (years) | 68.62 (8.36) |
| Diagnosis of metastatic castration-resistant prostate cancer | 48 (64.0%) |
| Baseline time since diagnosis, years | 2.89 (2.08) |
| Race, White | 62 (82.7%) |
| Race, African American | 11 (14.7%) |
| Baseline weight (lbs.) | 206.6 (43.4) |
| Treatment | |
| Hormone therapy a | 66 (88.0%) |
| Chemotherapy | 15 (20.0%) |
| Bone antiresorptive | 20 (26.7%) |
| Survey Responses | |
| Number of follow-up surveys completed | 2.43 (1.00) |
| Years of follow-up | 1.32 (0.59) |
| Point Prevalence at Study Entry b | |
| Nausea while eating | 4 (5.3%) |
| Poor taste of food | 6 (8.0%) |
| Poor smell of food | 4 (5.3%) |
| Poor appetite | 7 (9.3%) |
| Period Prevalence During Study c | |
| Nausea while eating | 10 (13.3%) |
| Poor taste of food | 13 (17.3%) |
| Poor smell of food | 6 (8.0%) |
| Poor appetite | 10 (13.3%) |
| Weight Change d | |
| ≥10% weight loss at follow-up | 10 (14.1%) |
Note: Values indicate N (%) for categorical variables or M (SD) for continuous variables.
FDA approved hormone therapies (other than LHRH analogues)
Proportion reporting a given symptom on the initial survey that they completed.
Proportion reporting a given symptom on any survey during the study period.
Weight change based on a 71 participant sample (94.7% of original), as longitudinal weight data were only available for these participants.
Discussion
In a sample of men undergoing advanced prostate cancer treatment, we found that approximately 17% experienced poor taste of food and 8% poor smell of food during 1.3 years of follow-up. Poor taste of food was associated with poor appetite and ≥10% weight loss.
Changes in taste and smell are associated with unfavorable medical outcomes (e.g., nutritional deficiencies and weight loss) and worse quality of life (e.g., decreased enjoyment of eating) [8]. Clinicians should query patients for these changes, particularly in those experiencing weight loss or receiving therapies linked to taste or smell changes [9]. Although changes in taste and smell are difficult to treat pharmacologically, clinicians can involve patients in problem-solving to mitigate the psychosocial impact of symptoms [10,11]. For example, clinicians can help patients maintain weight by identifying foods or flavors less affected. Similarly, if the ritual of eating has an important symbolic value for patients as a social gathering with family, clinicians can help patients to find additional ways of maintaining social functioning.
In conclusion, our findings have implications for symptom management and future research on treatment-associated changes in taste and smell. These data suggest that cancer treatment-associated changes in the taste and smell of food warrant additional detailed clinical assessment in men with prostate cancer receiving hormone therapies and/or chemotherapy. As these important symptoms are typically under-assessed in current symptom evaluations, more prospective research in different cancers, closely tracking time to symptom onset, and with more therapies (such as immunotherapies and targeted therapies) is warranted.
Acknowledgments
Funding
The authors did not receive support from any organization for the submitted work.
Footnotes
Conflicts of interest/Competing Interests
The authors have no relevant financial or non-financial conflicts of interest to report.
Declarations
Ethics Approval
This study was approved by the Tulane University Internal Review Board (IRB #758052).
Consent to Participate
Informed consent was obtained from all individual participants included in the study.
Consent for Publication
Not applicable.
Availability of data and material
Not applicable.
Code availability
Analyses were conducted using SPSS 26.0 (IBM).
Publisher's Disclaimer: This Author Accepted Manuscript is a PDF file of a an unedited peer-reviewed manuscript that has been accepted for publication but has not been copyedited or corrected. The official version of record that is published in the journal is kept up to date and so may therefore differ from this version.
Contributor Information
Sarah Alonzi, Loyola University New Orleans, Department of Psychology, New Orleans, LA 70118.
Michael Hoerger, Tulane University, Departments of Psychology, Psychiatry, and Medicine (Oncology), and Tulane Cancer Center, 6400 Freret Street, 2007 Percival Stern Hall, New Orleans, LA 70118; University Medical Center of New Orleans, Department of Palliative Medicine & Supportive Care, New Orleans, LA 70112.
Laura M. Perry, Tulane University, Department of Psychology, New Orleans, LA 70118.
Lydia D. Chow, Keck School of Medicine of the University of Southern California, Department of Internal Medicine, Los Angeles, CA 90033.
Charlotte Manogue, Tulane University, Tulane Cancer Center, New Orleans, LA 70112.
Patrick Cotogno, Tulane University, Tulane Cancer Center, New Orleans, LA 70112.
Emma M. Ernst, Tufts University School of Medicine; 145 Harrison Ave. Boston, MA 02111.
Elisa M. Ledet, Tulane University, Tulane Cancer Center, New Orleans, LA 70112.
Oliver Sartor, Tulane University, Departments of Medicine and Urology, and Tulane Cancer Center, New Orleans, LA 70112.
References
- 1.Hong JH, Omur-Ozbek P, Stanek BT, Dietrich AM, Duncan SE, Lee YW, Lesser G (2009) Taste and odor abnormalities in cancer patients. J Support Oncol 7 (2):58–65 [PubMed] [Google Scholar]
- 2.Nolden AA, Hwang L-D, Boltong A, Reed DR (2019) Chemosensory Changes from Cancer Treatment and Their Effects on Patients’ Food Behavior: A Scoping Review. Nutrients 11 (10):2285. doi: 10.3390/nu11102285 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Newell S, Sanson-Fisher RW, Girgis A, Bonaventura A (1998) How well do medical oncologists’ perceptions reflect their patients’ reported physical and psychosocial problems? Data from a survey of five oncologists. Cancer 83 (8):1640–1651 [PubMed] [Google Scholar]
- 4.Spotten LE, Corish CA, Lorton CM, Ui Dhuibhir PM, O’Donoghue NC, O’Connor B, Walsh TD (2017) Subjective and objective taste and smell changes in cancer. Annals of Oncology 28 (5):969–984. doi: 10.1093/annonc/mdx018 [DOI] [PubMed] [Google Scholar]
- 5.Sartor O, de Bono JS (2018) Metastatic Prostate Cancer. New England Journal of Medicine 378 (7):645–657. doi: 10.1056/NEJMra1701695 [DOI] [PubMed] [Google Scholar]
- 6.Jackisch C (2019) Overcoming endocrine resistance in neoadjuvant endocrine therapy for early breast cancer. Lancet Oncol 20 (9):1185–1187. doi: 10.1016/s1470-2045(19)30500-5 [DOI] [PubMed] [Google Scholar]
- 7.Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA: a cancer journal for clinicians 66 (1):7–30 [DOI] [PubMed] [Google Scholar]
- 8.Coa KI, Epstein JB, Ettinger D, Jatoi A, McManus K, Platek ME, Price W, Stewart M, Teknos TN, Moskowitz B (2015) The Impact of Cancer Treatment on the Diets and Food Preferences of Patients Receiving Outpatient Treatment. Nutrition and Cancer 67 (2):339–353. doi: 10.1080/01635581.2015.990577 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Blackwood HA, Hall CC, Balstad TR, Solheim TS, Fallon M, Haraldsdottir E, Laird BJ (2020) A systematic review examining nutrition support interventions in patients with incurable cancer. Support Care Cancer 28 (4):1877–1889. doi: 10.1007/s00520-019-04999-4 [DOI] [PubMed] [Google Scholar]
- 10.Hoerger M, Greer JA, Jackson VA, Park ER, Pirl WF, El-Jawahri A, Gallagher ER, Hagan T, Jacobsen J, Perry LM, Temel JS (2018) Defining the Elements of Early Palliative Care That Are Associated With Patient-Reported Outcomes and the Delivery of End-of-Life Care. J Clin Oncol 36 (11):1096–1102. doi: 10.1200/jco.2017.75.6676 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Hoerger M, Wayser GR, Schwing G, Suzuki A, Perry LM (2019) Impact of Interdisciplinary Outpatient Specialty Palliative Care on Survival and Quality of Life in Adults With Advanced Cancer: A Meta-Analysis of Randomized Controlled Trials. Ann Behav Med 53 (7):674–685. doi: 10.1093/abm/kay077 [DOI] [PMC free article] [PubMed] [Google Scholar]