Skip to main content

Advertisement

SpringerLink
Log in

Oral examination findings, taste and smell testing during and following head and neck cancer therapy

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Diet and nutrition are critical in health and disease and are highly impacted by the presence and treatment for head and neck cancer (HNC). The purpose of this paper is to present oral examination findings and taste and smell test results in patients during and following HNC.

Methods

Patients with HNC were evaluated during and following radiation therapy with/without chemotherapy. Oral examination findings including mucositis, saliva, oral hygiene (plaque levels, gingivitis), and taste and smell testing was completed on all subjects. NCI Common Terminology Criteria for Adverse Events (CTCAE) 4.0, and the Scale of Subjective Total Taste Acuity (STTA) were used to provide patient report of symptoms.

Results

Mucositis and pain affected oral diet during therapy and improved in follow-up. Weight loss of 5% during and 12% following treatment was identified. Tobacco use was associated with increased severity of mucositis and increased weight loss. The subjects maintained excellent oral hygiene as reflected in plaque levels and gingivitis. Spicy/pungent perception was the most strongly disliked of testing stimuli. Umami and fat taste perception were reported of highest intensity during HNC treatment and rated as moderate in intensity after treatment. These results suggest improvement in these taste functions over time following treatment. Salt taste was of high intensity and associated with strong dislike in follow-up.

Conclusions

In HNC patients, oral status and taste change occurs throughout the cancer trajectory and represent potential concerns in cancer survivorship. Taste change (as evaluated by taste testing) occurred in all HNC patients, whereas olfactory changes occurred in 30% of cases. Management of oral changes and symptoms should be considered in all HNC patients in addition to dietary and nutritional guidance in patient care to promote oral intake. Continuing study of taste changes may further define this problem and support dietary and nutritional guidance and product development.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Epstein JB, Smutzer G, Doty RL (2016) Understanding the impact of taste changes in oncology care. Support Care Cancer 24:1917–1931

    Article  Google Scholar 

  2. Nguyen HM, Reyland ME, Barlow LA (2012) Mechanisms of taste bud cell loss after head and neck irradiation. J Neurosci 32:3474–3484

    Article  CAS  Google Scholar 

  3. Hovan AJ, Williams PM, Stevenson-Moore P, Wahlin YB, Ohrn KE, Elting LS, Spijkervet FK, Brennan MT, Dysgeusia Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO) (2010) A systematic review of dysgeusia induced by cancer therapies. Support Care Cancer 18:1081–1087

    Article  Google Scholar 

  4. Epstein JB, Barasch A (2010) Taste disorders in cancer patients: pathogenesis, and approach to assessment and management. Oral Oncol 46:77–81

    Article  Google Scholar 

  5. Keast RSJ, Costanzo A (2015) Is fat the sixth taste primary? Evidence and implications. Flavour 4:1–7

    Article  Google Scholar 

  6. Riedel K, Sombroek D, Fiedler B et al (2017) Human cell-based taste perception - a bittersweet job for industry. Nat Prod Rep 34:484–495

    Article  CAS  Google Scholar 

  7. Hawkes CH (2002) Anatomy and physiology of taste sense. Smell and Taste Complaints. Amsterdam: Butterworth Heinemann, pp 123–145

  8. Bromley SM, Doty RL (2015) Clinical disorders affecting taste: an update. In: Doty RL (ed) Handbook of olfaction and gustation, 3rd edn. Wiley, Hoboken, pp 887–910

    Chapter  Google Scholar 

  9. Boyce JM, Shone GR (2006) Effects of ageing on smell and taste. Postgrad Med J 89:239-241

  10. Epstein JB, de Andrade e Silva SM, Epstein GL et al (2019) Taste disorders following cancer therapy: report of a case series. Support Care Cancer 29:1–9. https://doi.org/10.1007/s00520-019-04758-5

    Article  Google Scholar 

  11. Abasaeed R, Coldwell SE, Lloid ME et al (2018) Chemosensory changes and quality of life in patients undergoing hematopoietic stem cell transplantation. Support Care Cancer 26:3553–3561

  12. Boltong A, Keast R, Aranda S (2012) Experiences and consequences of altered taste, flavour and food hedonics during chemotherapy treatment. Support Care Cancer 20:2765–2774

    Article  Google Scholar 

  13. Jensen SB, Mouridsen HT, Bergmann OJ et al (2008) Oral mucosal lesions, microbial changes, and taste disturbances induced by adjuvant chemotherapy in breast cancer patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:217–226

    Article  Google Scholar 

  14. Schiffman SS, Warwick ZS (1993) Effect of flavor enhancement of foods for the elderly on nutritional status: food intake, biochemical indices, and anthropometric measures. Physiol Behav 53:395–402

    Article  CAS  Google Scholar 

  15. Doty RL, Bromley SM (2004) Effects of drugs on olfaction and taste. Otolaryngol Clin North Am 37:1229–1254

  16. Kamal M, Barrow MP, Lewin JS, Estrella A, Gunn GB, Shi Q, Hofstede TM, Rosenthal DI, Fuller CD, Hutcheson KA, MD Anderson Head and Neck Cancer Symptom Working Group (2019) Modeling symptom drivers of oral intake in long-term head and neck cancer survivors. Support Care Cancer 27:1405–1415

    Article  Google Scholar 

  17. Ganzer H, Touger-Decker R, Byham-Gray L, Murphy BA, Epstein JB (2015) The eating experience after treatment for head and neck cancer: a review of the literature. Oral Oncol 51:634–642

    Article  Google Scholar 

  18. Sonis ST, Eilers JP, Epstein JB, LeVeque F, Liggett WH Jr, Mulagha MT, Peterson DE, Rose AH, Schubert MM, Spijkervet FK, Wittes JP (1999) Validation of a new scoring system for the assessment of clinical trial research of oral mucositis induced by radiation therapy or chemotherapy. Cancer 85(10):2103–2113

    Article  CAS  Google Scholar 

  19. Loe H (1967) The gingival index, the plaque index and the retention index systems. J Periodontol 38(suppl):610–616

    Article  Google Scholar 

  20. Smutzer G, Lam S, Hastings L et al (2008) A test for measuring gustatory function. Laryngoscope 118:1411–1416

    Article  Google Scholar 

  21. Doty RL, Shaman P, Kimmelman CP, Dann MS (1984) University of Pennsylvania smell identification test: a rapid quantitative olfactory function test for the clinic. Laryngoscope 94:176–178

    Article  CAS  Google Scholar 

  22. https://www.ahns.info/wp-content/uploads/2017/07/AJCC-8th-Edition-Major-Updates-in-Cancer-Staging.pdf. Accessed 19 May 2019

  23. Samim F, Epstein JB, Zumsteg ZA et al (2016) Oral and dental health in head and neck cancer survivors. Cancer Head Neck 1:14

    Article  Google Scholar 

  24. Epstein JB, Beier Jensen S (2015) Management of hyposalivation and xerostomia: criteria for treatment strategies. Compend Contin Educ Dent 36:600–603

    PubMed  Google Scholar 

  25. Ruo Redda MG, Allis S (2006) Radiotherapy induced taste impairment. Cancer Treat Rev 32:5417

    Article  Google Scholar 

  26. Jensen SB, Pedersen AM, Vissink A, Andersen E, Brown CG, Davies AN, Dutilh J, Fulton JS, Jankovic L, Lopes NN, Mello AL, Muniz LV, Murdoch-Kinch CA, Nair RG, Napeñas JJ, Nogueira-Rodrigues A, Saunders D, Stirling B, von Bültzingslöwen I, Weikel DS, Elting LS, Spijkervet FK, Brennan MT, Salivary Gland Hypofunction/Xerostomia Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO) (2010) A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer 18:1039–1060

    Article  CAS  Google Scholar 

  27. Epstein JB, Emerton S, Kolbinson DA, Le ND, Phillips N, Stevenson-Moore P, Osoba D (1999) Quality of life and oral function following radiotherapy for head and neck cancer. Head Neck 21:1–11

  28. Oates JE, Clark JR, Read J, Reeves N, Gao K, Jackson M, Boyer M, O'brien C (2007) Prospective evaluation of quality of life and nutrition before and after treatment for nasopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 133:533–540

    Article  Google Scholar 

  29. Yamashita H, Nakagawa K, Hosoi Y et al (2009) Umami taste dysfunction in patients receiving radiotherapy for head and neck cancer. Oral Oncol 45:e19–e23

    Article  Google Scholar 

  30. Shi HB, Masuda M, Umezaki T et al (2004) Irradiation impairment of umami taste in patients with head and neck cancer. Auris Nasus Larynx 31:401–406

    Article  Google Scholar 

  31. Yamashita H, Nakagawa K, Nakamura N et al (2006) Relation between acute and late irradiation impairment of four basic tastes and irradiated tongue volume in patients with head-and-neck cancer. Int J Radiat Oncol Biol Phys 66:1422–1429

    Article  Google Scholar 

  32. Thorne T, Olson K, Wismer W (2015) A state-of-the-art review of the management and treatment of taste and smell alterations in adult oncology patients. Support Care Cancer 23:2843–2851

    Article  Google Scholar 

Download references

Acknowledgments

We acknowledge assistance in data entry by Dr. Sifira Marques de Andrade e Silva, DDS, PhD, Medical Dental at Clion CAM Group, Salvador BA, Brazil, visiting dentist, Beverly Hills, CA.

Funding

We received funding provided by the Cancer Nutrition Consortium, and Hormel Inc.

Author information

Authors and Affiliations

  1. Beverly Hills, CA, USA

    Joel B. Epstein & Geena L. Epstein

  2. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Joel B. Epstein

  3. City of Hope Comprehensive Cancer Center, Duarte, CA, USA

    Joel B. Epstein

  4. Department of Research, Advocate Health Care, Chicago, IL, USA

    Dana Villines

  5. Department of Biology, Temple University, Philadelphia, PA, 19122, USA

    Gregory Smutzer

Authors
  1. Joel B. Epstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dana Villines
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Geena L. Epstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gregory Smutzer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joel B. Epstein.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

The authors have full control of all primary data and agree to allow the journal to review the data if requested.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Epstein, J.B., Villines, D., Epstein, G.L. et al. Oral examination findings, taste and smell testing during and following head and neck cancer therapy. Support Care Cancer 28, 4305–4311 (2020). https://doi.org/10.1007/s00520-019-05232-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-019-05232-y

Keywords

Search

Navigation