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Taste and smell alterations, quality of life and food characterization among patients treated for head and neck cancer Open Access


Other title
Taste and Smell alterations
Head and Neck cancer
Quality of Life
Type of item
Degree grantor
University of Alberta
Author or creator
Alvarez-Camacho, Mirey
Supervisor and department
Wendy V. Wismer (Agricultural, Food and Nutritional Science)
Dr. Rufus A. Scrimger (Radiation Oncology, Cross Cancer Institute)
Examining committee member and department
Dr. Sunita Ghosh (Oncology)
Dr. Vickie E. Baracos (Oncology)
Dr. Vera Mazurak (Agricultural, Food and Nutritional Science)
Dr. Rhyna Levy-Milne (Oncology Nutrition, BC Cancer Agency)
Dr. Naresh Jha (Radiation Oncology, Cross Cancer Institute)
Department of Agricultural, Food, and Nutritional Science
Nutrition and Metabolism
Date accepted
Graduation date
Doctor of Philosophy
Degree level
Taste and smell alterations (TSAs) are among the most frequent and troublesome side effects reported by head and neck cancer (HNC) patients after treatment. The purpose of this research was to investigate TSAs among HNC patients, study the association of TSAs on patient quality of life (QoL) and the association between Physical-Function (PF) and food characterization among HNC patients. Intensity and liking for the basic tastes and smell were evaluated before (n=32), upon completion (n=31), 6 weeks (n=31) and 3-6 months (n=31) after treatment for HNC using suprathreshold solutions representing sweet, salty, sour, bitter and umami in commercial beverages. Milk and cream were used to test for creaminess perception and liking. Smell intensity and liking were evaluated using the Modified Brief Identification Smell Test. Vanilla solutions in water were used to assess retronasal intensity perception. Results revealed that taste intensity perception was impaired after treatment for all basic tastes, especially salty and umami. Liking scores did not respond to changes in tastant concentration after treatment. At 6 weeks and 3-6 months post-treatment, participants disliked the most concentrated solutions of salty, sour and bitter. Participants were able to perceive changes in retronasal intensity olfaction at all the time points. Repertory grid interviews were performed with orally-fed HNC patients (n=19) between 4-10 months post-treatment to characterize foods commonly eaten, avoided and eaten sometimes. Patients were stratified as better or worse PF (respectively ≥ or <61.7 on the Physical Function domain of the University of Washington Quality of Life (UW-QoL)). All patients used descriptors of taste, ease of eating, convenience, texture, potential to worsen symptoms and liking to characterize foods. Overall, avoided foods were characterized as having dry texture, while foods commonly eaten were characterized by their ease of eating and low potential to worsen symptoms. Descriptors of nutrition and smell were significant only for patients with worse PF to discriminate among foods. The association of TSAs with the overall QoL of HNC patients was analyzed using self-report measures of both TSAs (Chemosensory Complaint Score [CCS]) and QoL (UW-QoL version 3) before (n=126), upon completion (n=100) and at 2.5 months after treatment (n=85). CCS was a significant predictor of overall QoL (β= -1.84, p<0.0001), physical-function-QoL (β= -1.11, p=0.001), social-emotional-QoL (β= -1.74, p<0.0001) and overall function-QoL (β= -1.15, p<0.0001) regardless of whether patients were tube-fed or orally-fed. Taste was reported as an important symptom for both groups at the end of treatment and 2.5 months follow-up. This research reveals that intensity perception for salty and umami is impaired after treatment, while smell intensity perception was not affected. TSAs are perceived by patients as an important symptom at the end of treatment and 2.5 months post-treatment, and are an independent predictor of overall QoL, social-emotional-QoL and physical-function-QoL. Physical function influences the characterization of foods among post-treatment HNC patients, with descriptors of nutrition and smell being especially important for patients with worse physical function. Findings from this research highlight the need to incorporate assessment and management of taste and smell alterations within HNC patient nutrition education programs.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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File title: From the study reported on Chapter 2, I was responsible for data collection, analysis and manuscript composition. Dr. Sunita Ghosh assisted with data analysis and interpretation. Silvia Gonella contributed with manuscript edits. Dr. Rufus A. Scrim...
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