Children treated for cancer often experience side effects such as nausea, vomiting and mucositis. These affect food intake and increase the risk of malnutrition. Poor nutritional status can lead to increased infections, decreased survival and poorer quality of life in children with cancer. Therefore, it is important for a child with cancer to be and remain well-nourished during treatment. Changes in smell and taste caused by chemotherapy can also affect nutritional intake. The sense of smell plays an important role in stimulating appetite and the sense of taste in deciding whether or not to eat.
Strips & Sticks
On Friday, April 12, Mirjam van den Brink will defend her PhD thesis titled ‘The flavor of chemotherapy. Exploring smell and taste function in children with cancer’ at Maastricht University for research she conducted at the Tissing group of the Princess Máxima Center. She studied the nature and extent of changes in smell and taste and their impact on quality of life and eating behavior of children with cancer. Mirjam: 'I followed 94 children with cancer (6-18 years old) during and after chemotherapy. Smell and taste function was measured six weeks, three months and six months after diagnosis and three months after the last chemotherapy treatment. I used ‘Taste Strips’ and ‘Sniffin' Sticks’ for this purpose. The child places the paper strips, which contain sweet, sour, salty and bitter tastes in different concentrations, on the tongue and smells the odor dispensing sticks, which contain different odors in various concentrations. Previously, we tested taste function of 609 healthy children at the NEMO Science Museum to establish normal values for this taste test.’
Sensitivity to smell and taste
Tests show that olfactory sensitivity is generally higher during treatment, especially in children with ALL and also compared to healthy children. In contrast, taste function seems to be reduced during chemotherapy. Taste loss seems to be relatively more common in children with lymphomas and solid tumors. Mirjam van den Brink: 'In addition to the tests, we also used questionnaires from KLIK and interviewed several children. The questionnaires show that children say that food does not taste good (63%) and that food/odors make them nauseous (48%). This has a negative impact on their quality of life. Food suddenly tastes bad and different from what they are used to. One child said: ‘Coke tastes like vomit’. Another child said: ‘I smelled good food everywhere, but when it ended up in my mouth, I didn’t like it. It was just really annoying to go through that, it makes you not want to eat.’ In addition, many children are bothered by smells in their environment, such as food smells, the smell of alcohol, but also the perfume of healthcare professionals.
Individualized nutritional counseling
Changes in smell and taste are very common. Sometimes smells and tastes are perceived better or worse, sometimes they are completely different than before. Individual (nutritional) advice is therefore the best approach to deal with changes in smell and taste, says Mirjam van den Brink. ‘Healthcare professionals need to be better informed about the occurrence and consequences of changes in smell and taste. As a result, they can make more frequent referrals to a dietitian for optimal counseling regarding changes in smell and taste in children with cancer. I would also say to all healthcare professionals, leave your perfume at home!’