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Taste Can Change, Outcomes Shouldn’t: Oral Nutritional Supplements with Tailor Made Flavours to Address Sensory Alterations in Cancer Patients

 By Louise Daly, PhD & Virginie Pouyet, PhD
 

Cancer patients may develop taste and smell alterations throughout the course of cancer (before and during) and last up to one year after treatment, with up to 70% of cancer patients experiencing taste changes during chemotherapy and radiotherapy [Spotten et al 2017]. Sensory alterations have been reported to adversely impact patients’ social-emotional function and overall quality of life [Alvarez-Camacho et al 2016; de Vries et al 2016].

Sensory Alterations and Malnutrition Risk
Sensory alterations in patients with cancer are associated with a decrease in appetite and reduced energy and nutrient intake. It has previously been reported that sensory alterations can contribute to a substantial decrease in calorie intake between 430–1100 kcal/day, adversely affecting nutritional status, leading to weight loss and increased risk of malnutrition in this patient population [Spotten et al  2017; Brisbois et al 2011; McGreevy et al 2014]. Malnutrition is associated with a higher morbidity and mortality rate, more complications and poorer tolerance of anti-tumour therapy [Ryan et al 2019; Van Cutsem and Arends 2005].

Timely assessment of nutritional state and involvement of the dietitian should be standard practice and part of integrated care for patients with cancer. Nutritional counselling and the prescription of oral nutritional supplements (ONS) are recommended nutritional therapies in cancer patients at risk of malnutrition. These interventions help ensure adequate provision of energy and protein attenuate weight loss and malnutrition [Arends et al 2017]. Nutritional interventions in cancer patients such as ONS can improve overall energy and protein intake, body weight, muscle mass and quality of life [Sánchez-Lara et al 2014; Kim et al 2019Ziętarska et al 2017; Tan et al 2020; van der Meij et al 2010].

     
 

This study shows that taste alterations in cancer patients may impact the palatability and liking of different ONS flavours. Since a liking of ONS is an important factor associated with ONS compliance, and essential to optimise the benefits of nutritional support, the presence of sensory alterations should be both evaluated and considered both when prescribing or developing oral nutritional supplements for cancer patients.” 

Louise Daly, Nutritional Oncology Scientist at Danone Nutricia Research

 
     

 

The Challenge of ONS Compliance and Sensory Changes
The observed benefits of ONS on nutritional status and clinical outcomes are dependent on patient compliance with ONS. Acceptability and liking of ONS are important factors for compliance. Therefore, more efforts on the sensory design of ONS are needed to personalise nutritional support and optimise palatability and acceptability of ONS thus helping support patient compliance. To compensate for sensory alterations, some patients describe the need for more intense taste stimuli by deliberately adding more spices, salt and ginger to their meals helping stimulate a sensory response; conversely others describe a need for less intense flavours [Boltong et al 2012; de Vries et al 2016].

     
 

Understanding sensory physiology changes in cancer patients and involving them in the design of ONS is key to provide a better experience of and compliance with ONS and ultimately improve patients' nutritional and health status.”

Virginie Pouyet, User Experience Design Manager at Danone Nutricia Research

 
     

 

Tailoring ONS Flavours for Cancer Patients  
A recent study, conducted by de Haan et al. 2021 [de Haan et al 2021] evaluated the acceptability of 5 prototype ONS flavours in a compact, high protein, high energy formula (300 kcal, 18 g protein, 125 ml). These prototype ONS had tailor-made sensory design to help address the unique taste profiles of cancer patients. Of these flavours, two included a cooling sensation with menthol and 2  a warming sensation with hot pepper derivates to activate trigeminal nerves. 1 flavour had a neutral profile to support patients with hypersensitivity to smells and odours by not providing additional stimuli. 

Overall, 50 patients were included in the study, of which 30 (60%) reported taste alterations and 13 (26%) experienced smell alterations (all patients with smell alterations had taste alterations). Within the study, 5 prototypes (cool lemon, cool red fruits, hot tropical ginger, hot mango & neutral) were tested in randomised, blinded, sequential-monadic test.

The study found that 3 adapted flavours (cool red fruits, neutral and hot tropical ginger) were rated positively by patients, particularly in those with taste alterations and were associated with increased “like score” for cool red fruits (Δ=+0.9) and neutral (Δ=+1.0) flavors. Importantly, patients with taste alterations demonstrated a larger variation in overall liking of ONS flavours compared to patients without taste alterations. These findings highlight that the presence of taste and smell alterations should be evaluated and considered when prescribing or developing ONS for cancer patients.

 

     
 

Key Points

1.  Taste and smell alterations are often reported by patients with cancer receiving systemic antitumor therapy. These can affect up to 70% of patients.

2.  Taste and smell alterations are considered important contributors of malnutrition in cancer patients. Sensory alterations are associated with a decrease in appetite and a reduction in energy and nutrient intake, adversely affecting patients nutritional status and leading to subsequent weight loss [Spotten et al 2017; Brisbois et al 2011; McGreevy et al 2014].

3.  Nutritional support is important in the management of malnutrition in patients with cancer. If normal oral intake is not sufficient to meet energy and protein needs, oral nutritional supplements (ONS) are a well-established step to support an adequate intake. The effectiveness of ONS depends on the acceptability of the product by the patient and patient compliance.

4.  In a new study of 50 cancer patients [de Haan et al 2021], 5 prototype tailor-made ONS with cooling and warming sensations, and a neutral profile were tested in patients. Three of the flavours were particularly acceptable to patients.

5.  Cancer patients with taste alterations demonstrated a larger variation in overall liking score per product flavour compared to patients without taste alterations. This suggests that taste and smell alterations may impact sensory perception and palatability of ONS. The presence of taste alterations should be considered when developing or prescribing ONS for patients with cancer.