Impact of taste/smell disturbances on dietary intake and cachexia-related quality of life in patients with advanced cancer

doi:10.21203/rs.3.rs-2112903/v1

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Research Article

Impact of taste/smell disturbances on dietary intake and cachexia-related quality of life in patients with advanced cancer

https://doi.org/10.21203/rs.3.rs-2112903/v1

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Journal Publication

published 30 Jan, 2023

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Purpose

All five senses (i.e., sight, smell, hearing, taste, and touch) are used to enjoy meals; however, impairments in sensory perception, which are common among cancer patients, seriously impact health and cause eating-related distress.

Methods

Using a self-report questionnaire, we surveyed patients with advanced cancer undergoing treatment at 11 palliative care centers. Multivariate analyses were conducted to explore the impact of taste and smell disturbances on dietary intake and cachexia-related quality of life (QOL). Dietary intake was assessed using the ingesta-Verbal/Visual Analog Scale, while taste and smell disturbances were assessed using an 11-point Numeric Rating Scale (NRS). Cachexia-related QOL was assessed using the 12-item Functional Assessment of Anorexia/Cachexia Therapy (FAACT) Anorexia/Cachexia Subscale.

Results

Overall, 378 patients provided consent to participate. After excluding patients with missing data, data were analyzed for 343 patients. Among them, 35.6% (n = 122; 95% CI 0.28–0.38) and 20.9% (n = 72; 95% CI 0.17–0.25) experienced disturbances in taste (NRS ≥ 1) and smell (NRS ≥ 1), respectively. Multivariate analyses revealed that, independent of performance status and cancer cachexia, taste and smell disturbances were significantly associated with worse FAACT Anorexia/Cachexia Subscale scores and dietary intake.

Conclusion

More severe taste and smell disturbances were associated with poorer dietary intake and cachexia-related QOL. Diagnosing and treating such disturbances may improve dietary intake and cachexia-related QOL, regardless of performance status and cachexia. Additional research is required to establish effective treatment strategies for disturbances in taste and smell.

cancer

taste disturbance

smell disturbance

dietary intake

quality of life

cachexia

Severe sensory loss is common among patients with cancer [1]. Impairments in sensory perception can seriously impact health and nutritional status, activities of daily living, independence, and quality of life (QOL) [2]. All five senses play a role in one’s ability to enjoy meals [3]. Indeed, vision (e.g., vivid presentation of appetizing dishes), smell (e.g., the aroma of freshly baked bread), hearing (e.g., the sound of crispy bread), taste (e.g., slightly sweet cake), and touch (e.g., the sensation of food melting in the mouth and the feeling of swallowing) contribute differently to the eating experience. Thus, patients with cancer who have developed eating-related sensory loss may experience a reduction in dietary intake as well as eating-related distress. This complex disorder encompasses patients’ struggle to nourish themselves, the emotional and social consequences of the inability to maintain food intake, and profound disturbances in family relationships [4]. Many patients with cancer are presumed to be unable to taste owing to sensory loss. However, to our best knowledge, few studies have investigated the effects of eating-related sensory loss on distress in this population.

Previous studies reported that eating-related sensory disturbances are associated with cancer cachexia [5]. Cancer cachexia is a syndrome encompassing both physical and psychological symptoms that lead to psychosocial distress in patients with advanced cancer [4, 6]. Since many of these cachexia-related symptoms compromise dietary intake and drive weight loss, they are regarded as nutrition impact symptoms [4, 6–8]. Cancer cachexia is characterized by a negative protein and energy balance driven by the combination of reduced dietary intake and abnormal metabolism [9, 10]. Currently, there are no standardized strategies for managing cancer cachexia despite its high prevalence and negative impact on QOL [11, 12].

In previous studies regarding the impact of taste and smell on QOL, QOL was measured using the EORTC QLQ-C30 and the University of Washington QOL questionnaires, which measure overall QOL [13–15]. According to these studies, reports of better taste and smell function were significantly associated with a better overall QOL and better social functioning. However, the impact of these functions and eating-related sensory loss on cachexia-related QOL remains known. In the present study, we aimed to investigate the impact of taste and smell disturbances on dietary intake and cachexia-related QOL in patients with advanced cancer.

Design

The present research formed part of a multicenter self-report questionnaire-based study that aimed to develop measurement tools for evaluating the eating-related distress experienced by patients with advanced cancer. The study was conducted between July 2020 and July 2021 at specialist palliative care centers (i.e., palliative care outpatient services, hospital palliative care teams, and palliative care units) across 11 hospitals in Japan.

Participants

Consecutive eligible patients were enrolled if they were newly referred for palliative care at the participating institutes during the study period. All institutions were asked to collect data from a designated number of patients according to the size and status of the institution. The inclusion criteria were as follows: (1) newly referred to palliative care; (2) age ≥ 20 years; (3) diagnosis of locally advanced or metastatic cancer (including hematologic neoplasms); (4) awareness of the malignancy diagnosis; and (5) ability to respond to a self-reported questionnaire. The exclusion criteria were prohibition from eating by a primary physician for medical reasons and serious psychological distress recognized in an interview with the palliative care physician.

Measurements

Taste And Smell

Patients were asked to assess current taste and smell disturbances using an 11-point numerical rating scale (NRS) [16]. Higher scores indicated more severe disturbances in taste and smell.

Dietary Intake And Cachexia-related Qol

Patients were asked to assess their dietary intake using the ingesta-Verbal/Visual Analog Scale (ingesta-VVAS) [17]. Higher ingesta-VVAS scores indicated better dietary intake. Cachexia-related QOL was assessed using the Functional Assessment of Anorexia/Cachexia Therapy (FAACT), with higher scores indicating better QOL. The FAACT is a patient-reported outcome measure originally designed to assess specific symptoms and concerns [18, 19]. The 12 items of the FAACT Anorexia Cachexia Subscale (ACS) specifically measure cachexia-related symptoms and concerns and may be scored alone to yield a domain score [20]. In addition, the five-item anorexia symptoms and four-item anorexia concerns subscales derived from the 12-item FAACT ACS were demonstrated to be useful for assessing these parameters in patients with lung cancer [21]. These subscales have also been applied to evaluate the effects of treatment on cachexia in patients with advanced cancer [5, 21].

Demographic And Clinical Characteristics

Demographic and clinical characteristics (i.e., sex, age, primary cancer site, Eastern Cooperative Oncology Group Performance Status [ECOG PS] [22], and anticancer treatment status [pre-chemotherapy, chemotherapy, and never treated/previous treatment]) were obtained through the self-report questionnaires. Physical measurements (i.e., height, current body weight, and previous body weight) were reported by patients to calculate body mass index (BMI) and percentage of weight loss (%WL) over the previous 6 months. BMI was calculated by dividing current body weight (kg) by the square of height (m²). The %WL was calculated as follows: (current body weight [kg] - previous body weight [kg]) / previous body weight (kg) × 100.

Statistical analyses

The primary endpoints were taste and smell disturbances, dietary intake, and the 12-item FAACT ACS. We excluded patients with missing data related to the primary endpoint from the analysis. Patient demographics and clinical characteristics were presented as numbers (%) for categorical variables or means (standard deviation [SD]) for continuous variables, where appropriate. Cachexia was defined as a %WL over the previous 6 months ≥ 5% or as a BMI < 20 kg/m² + a %WL over the previous six months ≥ 2%, based on international consensus criteria [9].

To examine the impact of disturbances in taste (NRS ≥ 1) and smell (NRS ≥ 1), we used independent-samples t-tests and analyses of variance (ANOVAs) to explore potential confounding variables such as sex, age, primary cancer site, ECOG PS, anticancer treatment status (pre-chemotherapy, chemotherapy, and never treated/previous treatment), and cachexia (non-cachexia and cachexia).

We classified taste and smell disturbances into three levels for analysis: NRS = 0, NRS = 1–3, and NRS ≥ 4. Independent-samples t-tests and ANOVAs were used to investigate the relationships among dysgeusia (three groups), olfactory disorders (three groups), dietary intake, 12-item FAACT ACS, five-item anorexia symptoms scores, and four-item anorexia concerns scores.

To assess the effects of dietary intake and 12-item FAACT ACS on taste and smell disturbances, we developed a robust linear model with crude estimation. A multivariate model adjusted for sex, age (two groups: <69 years and ≥ 70 years), primary cancer site, ECOG PS (two groups: PS: 0–2 and PS: 3–4), treatment status (pre-chemotherapy, chemotherapy, and never treated/previous treatment), and cachexia (non-cachexia and cachexia) was generated. Significance was set at P < .05. All analyses were performed using SPSS version 28.0.1 (IBM Corp., Armonk, NY, USA) and EZR (Saitama Medical Center, Jichi Medical University) [23].

A total of 495 patients were asked to participate in the survey, and 378 responded (response rate: 76.4%). Among these, no patients refused to participate. Thirty-five patients were excluded owing to missing data related to the primary endpoint. Therefore, the data from 343 patients were analyzed.

Table 1 summarizes the demographic and clinical characteristics of the included patients. The proportion of male patients was 51.9%, and the mean age was 61.9 ± 12.2 years. The proportions of patients with the primary cancer site in the upper/lower gastrointestinal tract, liver/biliary system/pancreas, and lung were 13.7%, 16.6%, and 22.4%, respectively. The proportions of patients with ECOG PS of 0–2 and 3–4 were 71.7% and 27.1%, respectively. The proportion of patients receiving chemotherapy was 65.6%, and the proportion of patients treated with a previous anticancer treatment was 26.2%. The proportion of patients with cachexia was 45.5%.

Table 1

Patient characteristics (n = 343)
Sex [no. (%)]
Male	178 (51.9)
Female	165 (48.1)
Age in years (mean ± standard deviation)	61.9 ± 12.2
Age in years [no. (%)]
<69	243 (70.8)
≥70	100 (29.2)
Primary cancer site [no. (%)]
Upper and lower gastrointestinal tract	47 (13.7)
Liver, biliary system, and pancreas	57 (16.6)
Lungs	77 (22.4)
Breast	25 (7.3)
Gynecology	19 (5.5)
Urology	20 (5.8)
Otolaryngology	14 (4.1)
Hematology	11 (3.2)
Other	68 (19.8)
ECOG performance status [no. (%)]
0–2	246 (71.7)
3–4	93 (27.1)
Anticancer treatment status [no. (%)]
Pre-chemotherapy	22 (6.4)
Chemotherapy	225 (65.6)
Never treated/previous treatment	90 (26.2)
Cachexia [no. (%)]
None	164 (47.8)
Cachexia	156 (45.5)
The sums of some percentages were not 100% owing to missing values. ECOG, Eastern Cooperative Oncology Group.

Factors associated with taste and smell disturbances in patients with advanced cancer

The prevalence of taste and smell disturbances is shown in Table 2. Among patients with advanced cancer receiving palliative care, 35.6% and 20.9% of patients had taste disturbances (NRS ≥ 1) and smell disturbances (NRS ≥ 1), respectively. Sex (male), ECOG PS (3–4), and cachexia were associated with taste (NRS ≥ 1) and smell (NRS ≥ 1) disturbances.

Table 2

Prevalence of taste and smell disturbances
	Taste disturbance (NRS ≥ 1)				Smell disturbance (NRS ≥ 1)
	n	%	95% CI	P	n	%	95% CI	P
Total (n = 343)	122/343	35.6	0.28 to 0.38		72/343	20.9	0.17 to 0.25
Sex				.047				.02
Male (n = 178)	67	37.6	0.31 to 0.45		49	27.5	0.21 to 0.34
Female (n = 165)	55	33.3	0.26 to 0.41		23	13.9	0.09 to 0.19
Age (years)				.30				.67
<69 (n = 243)	82	33.7	0.28 to 0.40		45	18.5	0.14 to 0.23
≥70 (n = 100)	40	40.0	0.30 to 0.50		27	27	0.18 to 0.36
Primary cancer site				.36				.13
Upper and lower gastrointestinal tract (n = 47)	18	38.3	0.24 to 0.52		9	19.1	0.08 to 0.30
Liver, biliary system, and pancreas (n = 57)	20	35.1	0.23 to 0.47		12	21.1	0.10 to 0.32
Lungs (n = 77)	33	42.9	0.32 to 0.54		20	26.0	0.16 to 0.36
Breast (n = 25)	10	40.0	0.21 to 0.59		3	12.0	-0.01 to 0.25
Gynecology (n = 19)	2	10.5	-0.03 to 0.24		1	5.3	-0.05 to 0.15
Urology (n = 20)	5	25	0.06 to 0.44		2	10.0	-0.03 to 0.23
Otolaryngology (n = 14)	4	28.6	0.05 to 0.52		3	21.4	0.00 to 0.43
Hematology (n = 11)	3	27.3	0.01 to 0.54		3	27.3	0.01 to 0.54
Other (n = 68)	24	35.3	0.24 to 0.47		18	26.5	0.16 to 0.37
ECOG performance status				< .001				.01
0–2 (n = 246)	73	29.7	0.24 to 0.35		43	17.5	0.13 to 0.22
3–4 (n = 93)	46	49.5	0.39 to 0.60		29	31.2	0.22 to 0.41
Anticancer treatment status				.56				.37
Pre-chemotherapy (n = 22)	4	18.2	0.02- to 0.34		1	4.5	-0.04 to 0.13
Chemotherapy (n = 225)	85	37.8	0.31 to 0.44		46	20.4	0.15 to 0.26
Never treated/previous treatment (n = 90)	29	32.2	0.23 to 0.42		23	25.6	0.17 to 0.35
Cachexia status				< .001				.01
None (n = 164)	44	26.8	0.20 to 0.34		23	14.0	0.09 to 0.19
Cachexia (n = 156)	69	44.2	0.36 to 0.52		45	28.8	0.22 to 0.36
ECOG, Eastern Cooperative Oncology Group. NRS, Numerical Rating Scale. CI, confidence interval.

Associations of taste and smell disturbances with dietary intake and cachexia-related QOL

The relationships among taste and smell disturbances, dietary intake, 12-item FAACT ACS scores, five-item anorexia symptoms scores, and four-item anorexia concerns scores are shown in Fig. 1 and the e-Table. More severe taste and smell disturbances were significantly associated with worse dietary intake and deteriorating cachexia-related QOL scores (P-values all ≤ .001). Multiple analyses revealed that the presence of taste and smell disturbances, sex, ECOG PS (0–2), and cachexia were associated with dietary intake and the 12-item FAACT ACS (Table 3, 4).

Table 3

Taste disturbance: multivariate analyses (dietary intake, 12-item FAACT ACS)
	Dietary intake			12-item FAACT ACS
	Coefficient	95% CI	P	Coefficient	95% CI	P
Taste disturbance
None (NRS: 0)	Ref.			Ref.
Mild (NRS: 1–3)	-0.85	-1.52 to -0.19	.012	-3.27	-5.36 to -1.18	.002
Moderate–severe (NRS: ≥4)	-1.11	-1.87 to -0.35	.004	-6.42	-8.79 to -4.05	< .001
Sex
Male (n = 178)	Ref.			Ref.
Female (n = 165)	0.19	-0.36 to 0.76	.49	-0.13	-1.91 to 1.64	.88
Age (years)
<69	Ref.			Ref.
≥70	0.26	-0.32 to 0.85	.37	0.53	-1.31 to 2.37	.57
Primary cancer site
Upper and lower gastrointestinal tracts	Ref.			Ref.
Liver, biliary system, and pancreas	0.0049	-0.89 to 0.90	.99	-1.95	-4.77 to 0.86	.17
Lungs	0.65	-0.19 to 1.51	.13	-0.97	-3.65 to 1.70	.47
Breast	0.16	-1.02 to 1.35	.78	1.07	-2.64 to 4.80	.56
Gynecology	0.48	-0.81 to 1.78	.46	-2.74	-6.82 to 1.33	.18
Urology	0.81	-0.48 to 2.11	.21	-0.56	-4.63 to 3.49	.78
Otolaryngology	-0.058	-1.57 to 1.46	.94	0.090	-4.67 to 4.85	.97
Hematology	1.05	-0.46 to 2.57	.17	4.02	-0.74 to 8.79	.10
Other	0.84	-0.037 to 1.73	.06	0.66	-2.10 to 3.43	.63
ECOG performance status
0–2	Ref.
3–4	-2.24	-2.83 to -1.65	< .001	-5.55	-7.40 to -3.70	< .001
Anticancer treatment status
Pre-chemotherapy	Ref.			Ref.
Chemotherapy	-0.19	-1.20 to 0.81	.71	2.19	-0.96 to 5.36	.17
Never treated/previous treatment	-0.51	-1.58 to 0.55	.34	0.42	-2.92 to 3.77	.80
Cachexia
None	Ref.			Ref.
Cachexia	-0.94	-1.47 to -0.41	< .001	-1.72	-3.37 to -0.075	.04
FAACT ACS, Functional Assessment of Anorexia/Cachexia Therapy Anorexia Cachexia Subscale. ECOG, Eastern Cooperative Oncology Group. NRS, Numerical Rating Scale. CI, confidence interval. Ref., reference group

Table 4

Smell disturbance: multivariate analyses (dietary intake, 12-item FAACT ACS)
	Dietary intake			12-item FAACT ACS
	Coefficient	95% CI	P	Coefficient	95% CI	P
Smell disturbance
None (NRS: 0)	Ref.			Ref.
Mild (NRS: 1–3)	-1.03	-1.83 to -0.23	.011	-4.79	-7.31 to -2.28	< .001
Moderate–severe (NRS: ≥4)	-1.29	-2.22 to -0.37	.006	-7.06	-9.96 to -4.16	< .001
Sex
Male	Ref.			Ref.
Female	0.12	-0.44 to 0.69	.66	-0.41	-2.20 to 1.36	.64
Age (years)
<69	Ref.			Ref.
≥70	0.30	-0.27 to 0.89	.30	0.76	-1.08 to 2.60	.41
Primary cancer site
Upper and lower gastrointestinal tract	Ref.			Ref.
Liver, biliary system, and pancreas	0.054	-0.84 to 0.95	.90	-1.77	-4.59 to 1.05	.21
Lungs	0.70	-0.15 to 1.55	.10	-0.71	-3.39 to 1.96	.59
Breast	0.11	-1.07 to 1.29	.85	0.86	-2.86 to 4.58	.64
Gynecology	0.62	-0.66 to 1.92	.33	-2.15	-6.21 to 1.90	.29
Urology	0.84	-0.45 to 2.13	.20	-0.44	-4.50 to 3.61	.82
Otolaryngology	0.0018	-1.51 to 1.51	.99	0.23	-4.52 to 4.98	.92
Hematology	1.24	-0.27 to 2.76	.10	5.04	0.27 to 9.80	.038
Other	1.00	0.11 to 1.88	.026	1.33	-1.43 to 4.11	.34
ECOG performance status
0–2
3–4	-2.25	-2.84 to -1.66	< .001	-5.67	-7.52 to -3.82	< .001
Anticancer treatment status
Pre-chemotherapy	Ref.			Ref.
Chemotherapy	-0.17	-1.19 to 0.83	.72	2.27	-0.90 to 5.44	.15
Never treated/previous treatment	-0.39	-1.47 to 0.67	.46	1.01	-2.35 to 4.38	.55
Cachexia
None	Ref.			Ref.
Cachexia	-0.97	-1.50 to -0.45	< .001	-1.92	-3.56 to -0.27	.022
FAACT ACS, Functional Assessment of Anorexia/Cachexia Therapy Anorexia Cachexia Subscale. ECOG, Eastern Cooperative Oncology Group. NRS, Numerical Rating Scale. CI, confidence interval. Ref., reference group

This large multicenter study examined the association of taste and smell disturbances with dietary intake and cachexia-related QOL in patients with advanced cancer. Our findings highlight two main areas to be addressed: (1) the frequency of and the factors associated with taste and smell disturbances in patients with advanced cancer and (2) the association of taste and smell disturbances with reduced dietary intake and cachexia-related QOL, independent of performance status and cachexia.

Taste and smell disturbances were observed in 35.6% and 20.9% of patients, respectively. In previous studies, the frequency of taste and smell disturbances varied from 16–86% and depended on the stage of disease and treatment regimens [24, 25]. In this study, there was a trend toward worse taste and smell disturbances during and after chemotherapy, but there were no significant differences according to anticancer treatment status (pre-chemotherapy, chemotherapy, and never treated/previous treatment). This suggests that taste alterations, independent of tumor therapy [26, 27], can be experienced at any stage of cancer [28, 29]. Therefore, it is necessary to consider the possibility that patients with advanced cancer exhibiting poor ECOG PS may experience taste and smell disturbances.

Additionally, dietary intake and cachexia-related QOL became poorer as taste and smell disturbances worsened, independent of performance status and cachexia. This indicates that patients may benefit from treatment for taste and smell disorders regardless of performance status and cachexia. Thus, healthcare providers should focus on symptoms indicative of such disorders. Furthermore, to improve cachexia-related QOL, taste and smell disturbances must be appropriately diagnosed, and the treatment plan should be carefully selected based on patient characteristics (e.g., oral candida, zinc deficiency, etc.) [29]. Moreover, if the available treatments for taste and smell disturbances are limited [30], efforts should be made to further explore foods that the patient enjoys. Because all five senses are used to enjoy meals, it is important to enhance patients’ senses, including taste and smell [3, 30].

The strengths of the present study included the high participant response rate, its multicenter design, and the use of validated measurement tools. However, this study also had some limitations. First, as this was a cross-sectional analysis, the casual relationship of each factor related to taste and smell disturbances could not be confirmed. Second, because non-responding participants were excluded from the analysis, the results of this study cannot be generalized to all patients with cancer treated at the participating institutions. Finally, as patients that were prohibited to eat by the primary physician for medical reasons were excluded, the findings of this study may be underestimated.

Dietary intake and cachexia-related QOL worsened as disturbances in taste and smell became more severe, independent of performance status and cachexia. This indicates that patients may experience improvements in cachexia-related QOL following treatment for taste and smell disorders. Thus, healthcare providers should pay attention to symptoms indicative of such disturbances. Furthermore, future studies should investigate ways in which to enhance patients’ enjoyment of food (e.g., strengthening of other senses) when available treatments for these conditions are limited.

Funding:

This study was funded by SASAKAWA Health Foundation (Grant Number 2020A-001) and JSPS KAKENHI (Grant Number 21K10319).

Conflicts of interest:

The authors have read and understood the journal’s policy on the declaration of interest and declare that there are no conflicts of interest.

Compliance with Ethical Standards:

This study was conducted in accordance with the ethical standards of the Helsinki Declaration and the ethical guidelines for medical and health research involving human participants presented by the Ministry of Health, Labor, and Welfare in Japan. The study was approved by the local Institutional Review Boards of all participating institutions. Japanese law does not require individual informed consent from participants in a non-invasive observational trial such as this study. If patients did not want to participate, we requested they return the questionnaire with “no participation” indicated. The completion and return of the questionnaire were regarded as the consent to participate.

Data sharing and data accessibility:

Data are available upon reasonable request.

Author contributions:

Conceptualization: Hiroyuki Otani, Koji Amano, Tatsuya Morita, Tomofumi Miura, Naoharu Mori, Ryohei Tatara, Takaomi Kessoku, Yoshinobu Matsuda, Keita Tagami, Masanori Mori, Tomohiko Taniyama, Nobuhisa Nakajima, Erika Nakanishi, Jun Kako, Akemi Naito Shirado, Naosuke Yokomichi, Mitsunori Miyashita; Data curation: Hiroyuki Otani, Koji Amano, Tatsuya Morita, Tomofumi Miura, Naoharu Mori, Ryohei Tatara, Takaomi Kessoku, Yoshinobu Matsuda, Keita Tagami, Masanori Mori, Tomohiko Taniyama, Nobuhisa Nakajima, Erika Nakanishi, Jun Kako, Akemi Naito Shirado, Naosuke Yokomichi, Mitsunori Miyashita; Formal analysis: Hiroyuki Otani, Koji Amano, Tatsuya Morita, Tomofumi Miura, Naoharu Mori, Ryohei Tatara, Takaomi Kessoku, Yoshinobu Matsuda, Keita Tagami, Masanori Mori, Tomohiko Taniyama, Nobuhisa Nakajima, Erika Nakanishi, Jun Kako, Akemi Naito Shirado, Naosuke Yokomichi, Mitsunori Miyashita; Funding acquisition: Koji Amano; Investigation: Hiroyuki Otani, Koji Amano, Tatsuya Morita, Tomofumi Miura, Naoharu Mori, Ryohei Tatara, Takaomi Kessoku, Yoshinobu Matsuda, Keita Tagami, Masanori Mori, Tomohiko Taniyama, Nobuhisa Nakajima, Erika Nakanishi, Jun Kako, Akemi Naito Shirado, Naosuke Yokomichi, Mitsunori Miyashita; Methodology: Hiroyuki Otani, Koji Amano, Tatsuya Morita, Tomofumi Miura, Naoharu Mori, Ryohei Tatara, Takaomi Kessoku, Yoshinobu Matsuda, Keita Tagami, Masanori Mori, Tomohiko Taniyama, Nobuhisa Nakajima, Erika Nakanishi, Jun Kako, Akemi Naito Shirado, Naosuke Yokomichi, Mitsunori Miyashita; Project administration: Koji Amano, Tatsuya Morita; Resources: Hiroyuki Otani, Koji Amano, Tatsuya Morita, Naoharu Mori, Ryohei Tatara, Takaomi Kessoku, Yoshinobu Matsuda, Keita Tagami, Masanori Mori, Tomohiko Taniyama, Nobuhisa Nakajima, Erika Nakanishi, Jun Kako, Akemi Naito Shirado, Naosuke Yokomichi, Mitsunori Miyashita; Software: Hiroyuki Otani, Koji Amano, Tatsuya Morita, Tomofumi Miura, Naoharu Mori, Ryohei Tatara, Takaomi Kessoku, Yoshinobu Matsuda, Keita Tagami, Masanori Mori, Tomohiko Taniyama, Nobuhisa Nakajima, Erika Nakanishi, Jun Kako, Akemi Naito Shirado, Naosuke Yokomichi, Mitsunori Miyashita; Supervision: Hiroyuki Otani, Koji Amano, Tatsuya Morita, Tomofumi Miura, Naoharu Mori, Ryohei Tatara, Takaomi Kessoku, Yoshinobu Matsuda, Keita Tagami, Masanori Mori, Tomohiko Taniyama, Nobuhisa Nakajima, Erika Nakanishi, Jun Kako, Akemi Naito Shirado, Naosuke Yokomichi, Mitsunori Miyashita; Validation: Hiroyuki Otani, Koji Amano, Tatsuya Morita, Tomofumi Miura, Naoharu Mori, Ryohei Tatara, Takaomi Kessoku, Yoshinobu Matsuda, Keita Tagami, Masanori Mori, Tomohiko Taniyama, Nobuhisa Nakajima, Erika Nakanishi, Jun Kako, Akemi Naito Shirado, Naosuke Yokomichi, Mitsunori Miyashita; Visualization: Hiroyuki Otani, Koji Amano, Tatsuya Morita, Tomofumi Miura, Naoharu Mori, Ryohei Tatara, Takaomi Kessoku, Yoshinobu Matsuda, Keita Tagami, Masanori Mori, Tomohiko Taniyama, Nobuhisa Nakajima, Erika Nakanishi, Jun Kako, Akemi Naito Shirado, Naosuke Yokomichi, Mitsunori Miyashita; Writing – original draft: Hiroyuki Otani, Koji Amano, Tatsuya Morita, Tomofumi Miura, Naoharu Mori, Ryohei Tatara, Takaomi Kessoku, Yoshinobu Matsuda, Keita Tagami, Masanori Mori, Tomohiko Taniyama, Nobuhisa Nakajima, Erika Nakanishi, Jun Kako, Akemi Naito Shirado, Naosuke Yokomichi, Mitsunori Miyashita; and Writing – review and editing: Hiroyuki Otani, Koji Amano, Tatsuya Morita, Tomofumi Miura, Naoharu Mori, Ryohei Tatara, Takaomi Kessoku, Yoshinobu Matsuda, Keita Tagami, Masanori Mori, Tomohiko Taniyama, Nobuhisa Nakajima, Erika Nakanishi, Jun Kako, Akemi Naito Shirado, Naosuke Yokomichi, Mitsunori Miyashita.

Acknowledgments:

We thank all patients who completed the questionnaire.

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Impact of taste/smell disturbances on dietary intake and cachexia-related quality of life in patients with advanced cancer

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Taste And Smell

Dietary Intake And Cachexia-related Qol

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Factors associated with taste and smell disturbances in patients with advanced cancer

Associations of taste and smell disturbances with dietary intake and cachexia-related QOL

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