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Lorraine Spotten
Supervisors:
Prof. Declan Walsh, MSc, FACP, FRCP (Edin)
Dr. Clare Corish, PhD, MINDI
November 2015
Subjective Taste and Smell Changes
in Treatment-Naive Patients
with Solid Tumours
1
Taste and Smell Changes (TSCs)
Frequent in cancer (1,2)
Mostly studied (3,4,5):
May occur pre-treatment in diverse cancer sites (6,7,8)
Mechanisms poorly understood (9)
May be part of a symptom cluster (10)
Can affect nutritional status (11)
2
Image sources:
http://isis-innovation.com/licence-details/companion-diagnostic-for-chemotherapy-side-effects/
http://www.express.co.uk/news/uk/225689/Radiotherapy-can-save-thousands
http://oncolex.org/head-and-neck-cancer
Aims and Objectives
3
AIM:
Examine prevalence, severity and characteristics of TSCs
Non-H&N patients with solid tumours pre-CT or RT
OBJECTIVES:
To investigate the association between:
Tumour type and TSCs
Demographics and TSCs
TSCs and nutritional risk
TSCs and other nutrition impact symptoms
Methodology
Radiation oncology OPD
• N=40
• 6 weeks Image source: http://www.simext.com/images/methodology.png
4
Inclusion Exclusion
• Diagnosis of cancer
• May have had surgery
• Age ≥ 18 years old
• Able to understand and speak
English
• Witnessed signed consent form
• Previous chemotherapy
• Previous radiotherapy
• Head and neck cancer
• ECOG performance status ≥4
• Life expectancy
Methodology
• Taste and smell survey (12)
• Abridged Patient-Generated Subjective Global Assessment (13)
• Measured Body Mass Index
• Demographic data
• Data Analysis: SPSS®, Version 22.0
Image source: http://www.simext.com/images/methodology.png
5
12. Modified from Heald et al., 1998
Overview of Recruitment Process
Total screened for eligibility:
96
Eligible:
52
Agreed to meet with researcher:
40
Completed study:
40
6
Key Baseline Sample Characteristics
7
70% Newly Diagnosed
(n = 28)
58%
Male (n=23)
55% overweight/obese
(n=32)
38%
breast cancer (n=15)
Median age: 66
(IQR 55-74) 38%
prostate cancer
(n=15)
Key Baseline Sample Characteristics
8
70% Newly Diagnosed
(n = 28)
58%
Male (n=23)
55% overweight/obese
(n=32)
38%
breast cancer (n=15)
Median age: 66
(IQR 55-74) 38%
prostate cancer
(n=15)
Key Baseline Sample Characteristics
9
70% Newly Diagnosed
(n = 28)
58%
Male (n=23)
55% overweight/obese
(n=32)
38%
breast cancer (n=15)
Median age: 66
(IQR 55-74) 38%
prostate cancer
(n=15)
Main Findings
10
1. Prevalence of TSCs
48% (n=19)
Moderate or severe (n=11)
Mainly:
Females (n=11/17)
Breast cancer (n=9/15)
Image source: https://sciencebasedlife.files.wordpress.com/2012/03/0008db75-22f1-1cbf-b4a8809ec588eedf_1.gif
11
2. Characteristics of TSCs
Intensity:
No change (60%, n=24)
Stronger sweet taste (n=9)
Stronger salty taste (n=7)
Of these:
Stronger odour (n=4)
Weaker odour (n=4)
Quality:
‘Bad taste’ (n=22)
Sour (n=7)
3. TSCs and Nutritional Risk
Patients at nutritional risk
tended to have TSCs
(P=0.057)
93% due CT/RT (n=37)
Image sources:
http://www.goddessofthegarden.com/wp-content/uploads/2011/07/lemon1.jpg
http://anymanfitness.com/wp-content/uploads/2014/05/weight-scale-help.jpg
TSCs and Cluster Symptoms
TSCs commonly co-occurred with :
Dry mouth (n=14/17, P
TSC and Cluster Symptoms
TSCs commonly co-occurred with :
Dry mouth (n=14/17, P
TSC and Cluster Symptoms
TSCs commonly co-occurred with :
Dry mouth (n=14/17, P
TSC and Cluster Symptoms
TSCs commonly co-occurred with :
Dry mouth (n=14/17, P
TSC and Cluster Symptoms
TSCs commonly co-occurred with :
Dry mouth (n=14/17, P
Strengths and Limitations
Novel
Generalisable
Statistical significance,
despite small sample
Questionnaires (14,15)
100% completion rate
upon meeting with
researcher
Convenience sampling
Performance status
Interview bias
Confounders
Missing data on
medications
17
Image sources:
http://www.bigstockphoto.com/image-1516141/stock-photo-tick-sign
http://www.clker.com/clipart-3584.html
Study Implications
CLINICAL
Routine screening at
diagnosis
Cluster symptoms
Use of common
terminology
Clinical guidelines
Individualised care
Treatments
RESEARCH
Longitudinal assessment
Validation of ‘Taste and
Smell Survey’ (12)
Pathophysiology and
characteristics
Dietary intake data
Symptom clusters
18
Image sources:
http://pmclinical.com/
http://lod-lam.slis.kent.edu/RESEARCH.html
Conclusions
1. TSCs in almost half of treatment-naive cancer patients
2. May be tumour-induced
3. Mainly reported by females and breast cancer patients
4. Majority at nutritional risk reported TSCs
5. TSCs significantly associated with:
Dry Mouth
Early Satiety
Fatigue
6. Further research and clinical guidelines needed
19 Image source: http://pixshark.com/conclusion-paragraph-clipart.htm
Acknowledgements Prof. Declan Walsh
Dr. Clare Corish
Dr. Cliona Lorton
Dr. Niamh O’Donoghue
Ms. Pauline Ui Dhuibhir
Dr. Brenda O’Connor
Dr. Moya Cunningham
Dr. Nazmy El Beltagi
Dr. Charles Gillham
.....and all the staff at Our Lady’s Hospice, St. James’s Hospital and St. Luke’s Radiation Oncology Network for their kindness and support throughout.
20 Image source: http://matthewlpowers.com/tag/thank-you/
Thank you for listening
21 Image source: http://godlessmom.com/10-questions-i-have-never-been-asked-about-atheism-
answered/question-mark-red-3d-glossy/
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22
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