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Food intake behaviour in advanced cancer – implications of taste and smell alterations, orosensory reward, and cannabinoid therapy Open Access


Other title
food intake behaviour
orosensory reward
taste and smell alterations
Type of item
Degree grantor
University of Alberta
Author or creator
Brisbois Clarkson, Tristin
Supervisor and department
Wismer, Wendy (Agricultural, Food, and Nutritional Science)
De Kock, Ingrid (Oncology)
Baracos, Vickie (Oncology)
Examining committee member and department
Baracos, Vickie (Oncology)
Mattes, Richard (Foods and Nutrition) Purdue University
Wismer, Wendy (Agricultural, Food, and Nutritional Science)
Proctor, Spencer (Agricultural, Food, and Nutritional Science)
De Kock, Ingrid (Oncology)
Department of Agricultural, Food, and Nutritional Science

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Food intake is regulated by both appetite and orosensory reward systems. Appetite systems stimulate or reduce hunger, while orosensory reward motivates consumption of high fat sweet foods, resulting in food enjoyment. The majority of advanced cancer patients suffer from malnutrition and wasting, which may be caused by a loss of appetite due to physiological changes or a hindered orosensory reward system due to taste and smell (chemosensory) changes or both. Orosensory reward systems were hypothesized to be impaired in advanced cancer. To understand the influence of chemosensory alterations on food intake and enjoyment, the nature (intensity) of chemosensory alterations in cancer patients and their relationship with ingestive behaviour and quality of life (QOL) were investigated (study 1). Advanced cancer patients (n=192) more frequently self-reported tastes and odours to be heightened rather than diminished (p=0.035). Patients with perceived chemosensory alterations had poorer QOL (p=0.0176) and lower caloric intake (p=0.0018) compared to patients with no alterations. Cannabinoids (e.g. Δ-9-tetrahydrocannabinol, Δ-9-THC) increase food intake by stimulating both appetite and orosensory reward systems as well as potentially enhancing chemosensory function. To palliate chemosensory alterations and poor appetite, advanced cancer patients (n=21, study 2) with these symptoms were randomized to receive either Δ-9-THC (2.5mg) or placebo oral capsules twice daily for 18 days. Compared to patients receiving placebo, Δ-9-THC-treated patients reported that food tasted better (p=0.04), they had improved chemosensory perception (p=0.026), increased preference and intake of high protein foods (p=0.008), and improved appetite (p=0.05), quality of sleep (p= 0.025), and relaxation (p= 0.045). Like cancer patients, tumour-bearing rats appeared to experience a loss of orosensory reward, showing tumour-associated anorexia when fed a rewarding diet to the same degree as on a usual diet (study 3). Δ-9-THC significantly increased caloric intake compared to vehicle for both tumour-bearing (p=0.0146) and healthy rats (p=0.0004), suggesting endocannabinoid-mediated appetite systems are functioning in this tumour model. The findings of this thesis suggest orosensory reward systems to be impaired in advanced cancer, decreasing the liking and motivation to eat. Δ-9-THC treatment may help to palliate perceived chemosensory alterations and loss of appetite and food enjoyment in advanced cancer.
License granted by Tristin Brisbois Clarkson ( on 2009-09-11T19:44:25Z (GMT): 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. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of the above terms. The author reserves all other publication and other rights in association with the copyright in the thesis, and except as herein 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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