Oral Cancer Complications: Dysgeusia

Highlights

Dysgeusia is another common oral complication which presents during cancer treatment. Dysgeusia is defined as an abnormal or impaired sense of taste, an unpleasant alteration of taste sensation or a distortion or perversion of the sense of taste.

Taste is complex, with 5 tastes noted: sour, salt, sweet, bitter and umami.  In addition “spicy” taste is mediated by c-fibers and fat may be appreciated by specific receptors and by texture.  Taste along with texture, temperature and smell and visual clues yields flavor and impacts dietary choices.  

Taste alteration has important implications for patients undergoing cancer therapy as it impacts their nutritional intake, overall health and ultimately, quality of life. Many patients after experiencing dysgeusia have mentioned that if they had known ahead of time what to expect, they would not have undergone the cancer therapy.

Contributing factors

• Hyposalivation
• Oral secretion of medications/drugs
• Changes in oral flora
• Untreated oral infections/dental decay
• Lipid peroxidation of epithelial cells
• GERD
• Oral mucositis
• Depression
• Diabetes
• Surgical damage to nerves V, VII, IX, S
• CNS disease

Prevention and Management of Dysgeusia

• Dietary counselling
• Food preparation to include seasonings, spices to increase the umami quality
• Food supplements such as dietary shakes to ensure adequate nutrition
• Zinc may play a role as may nerve or centrally acting interventions (eg: megestrol, cannabinioids and clonazpam/neurontin)
• Management of oral disease and xerostomia
• CNS-acting medications (clonazepam, gabapentin, marinol, megestrol)
• Management of oral pain/nausea