Nutrition in cancer care: Expert views on taste modulation to elevate palatability and compliance

Summary 

• Nutrition is one modifiable factor in cancer treatment plans and plays an important role in patient care. But taste and smell alterations (TSAs)—commonly caused by the disease or its treatment—can make maintaining nutritional plans unpleasant and difficult.
• We believe that nutritional support should never feel like a burden for people living with cancer.
• In this article, we interviewed dsm-firmenich Taste and Medical Nutrition experts to explore how advanced flavors and taste modulation solutions can help elevate medical nutrition products to improve patient experiences, maximize compliance—and ultimately support better cancer care.

According to the World Health Organization (WHO), around 1 in 5 people develop cancer in their lifetime.¹ And that figure could be as high as 1 in 2 in some places, like the UK.² Therefore, elevating the treatment and care of people living with cancer is an ever-present priority for science and society.

Nutrition is an integral and modifiable factor in cancer care—replacing crucial calories and nutrients commandeered by cancer cells to fuel their growth and providing people with the energy and strength needed both to fight the disease itself and to tolerate treatments. But adhering to nutritional care plans during cancer therapy can be a challenge for patients due to common side effects experienced as a result of the disease or its treatments. A prime barrier is taste and smell alterations (TSAs), which affect up to 86% of people living with cancer.³ TSAs can have huge detrimental effects on adherence to nutritional care, which in turn impacts treatment effectiveness, quality of life, and health outcomes.

We sat down with dsm-firmenich experts, Alessia Delbrück, Global Senior Innovation Manager Medical Nutrition, and Lyzandra Passarella-Dutour, Director Global Technical Taste, to explore the impact of TSAs on people living with cancer, and how forward-thinking flavors and taste modulation strategies in medical nutrition for cancer care has the potential to transform the patient experience and product efficacy. 

1. Why do many people living with cancer experience taste and smell alterations?

Alessia Delbrück: “TSAs are incredibly common in patients with cancer. Research indicates that between 20-86% experience changes in taste and 5-60% encounter smell alterations.² But despite the high prevalence, the underlying cause (or causes) of TSAs in cancer are not fully understood. Multiple factors have been suggested to contribute: damage to tastebuds caused by radio- or chemotherapy, oral symptoms such as inflammation or dry mouth, and changes in macronutrient metabolism, to name a few.^2,4,5,6

Lyzandra Passarella-Dutour: “The way these TSAs manifests can also differ from person to person, depending on cancer type and therapy, and can even change over the course of the treatment. Some patients may complain about food not having much taste—like eating cardboard—while others may experience an increased sensitivity to smells, food tasting too salty or too sweet, or even a bitter, metallic taste in the mouth.^2,3,7

“To date, there is no gold standard assessment tool to identify and monitor TSAs in clinical settings, so subjective tests such as questionnaires remain the most useful measure.⁸ This makes it difficult to develop and test interventions for the prevention and treatment of TSAs.”

2. What is the impact of TSAs on patients and their treatments?

Alessia Delbrück: “TSAs have a significant impact on patients’ food consumption behavior, with research showing that these alterations are strongly associated with reduced energy and nutrient intake.^4,5 Which makes sense—no one wants to eat food that has no flavor or that comes with unpleasant sensory experiences. That considered, getting essential nutrition becomes too much of a burden for many people with cancer.

“The main challenge is that this burden can result in discontinuation of nutritional care products—like oral nutritional supplements (ONS)—contributing to malnutrition,⁵ which is estimated to affect up to 80% of cancer patients.⁹ Malnutrition can have devastating consequences for patients’ health and treatment outcomes—including impairing tolerance and response to cancer therapies, delaying wound healing, increasing the risk of infections, and ultimately reducing survival rates.⁶  Up to 20% of deaths in cancer patients can be related to malnutrition,^6,10,11 among other factors, underlining the importance of nutritional care that addresses TSAs and improves therapy compliance.”

Lyzandra Passarella-Dutour: “Beyond the nutritional impact, TSAs can be hugely detrimental to people’s mental health and emotional wellbeing too. Nutrition is not just about sustenance. Food is so often a focal point of social gatherings, family traditions, and culture. Not to mention the private joy and indulgence we get from consuming our favorite foods. Cancer-associated sensory changes can take away the ability to enjoy the experience of eating. It’s no wonder then that clinical research shows TSAs are significantly correlated with reduced quality of life,¹² diminished social-emotional function,¹³ and increased anxiety.¹⁴”

Alessia Delbrück: “This was really brought into focus for me when an oncologist colleague shared that he tells his patients not to eat their absolute favorite food while undergoing therapy. The reason? TSAs can cause them to associate that beloved food with unpleasant tastes and experiences. To protect their long-term enjoyment, he recommends saving those favorites for after recovery, when they can truly savor them again.”

3. How can developers of medical nutrition products address TSAs?

Lyzandra Passarella-Dutour: “The sensory profile of medical nutrition products is often a key determining factor in patient compliance—and ultimately clinical outcomes. Therefore, careful design and engineering of this experience is indispensable. The strategy we use at dsm-firmenich approaches sensory experience from two angles:

Tackling the unpleasant and undesirable tastes

“The amount of nutrients needed in a medical nutrition formulation often results in off-notes, however this can be further exacerbated by cancer-associated TSAs which heighten certain aspects of taste and smell. With our advanced taste receptor science expertise and molecular masking technologies, we can address sensory challenges linked to bitterness, metallic taste, astringency, and fish notes. This last one is particularly key for people living with cancer.

“Omega-3 fatty acids are known to be incredibly important in cancer care, helping to manage cancer-induced inflammation and cancer cachexia (wasting syndrome),^15,16,17 and may even support the efficacy of chemotherapy and reduce side effects.^18,19 However, these ingredients can come with challenging off-notes and unpleasant fishy tastes. So, we are on a mission to make omega-3 solutions as palatable as possible in medical nutrition products.”

Enhancing the desirability of products by creating patient-centric taste profiles

“This means sometimes going beyond traditional vanilla, strawberry, and chocolate flavors (although these certainly still have their purpose) to deliver flavors that patients desire, and often miss. For example, we recently performed a series of interviews with ONS users that highlighted how coffee and tea flavors can help people feel more ‘normal’. The people we spoke to talked about how these flavors featured in their morning rituals and reminded them of better times when they could go out for coffee with friends.

“We also offer a wide range of flavor options that can help to avoid taste fatigue and work to develop innovative solutions for flavor customization that empower patients to adapt flavors according to their daily preferences. This can help people regain some small sense of control and normalcy in a tumultuous time.”

4. How else can dsm-firmenich support formulators in meeting the sensory needs of people with cancer?

Alessia Delbrück: "Sensorial design in medical nutrition requires a solid understanding of patient needs and pain points. TSAs can cause different sensory challenges for different people, and preferences can vary greatly based on factors such as age, culture, and other medical conditions. At dsm-firmenich we cultivate these crucial insights through collaborations with hospitals and researchers and by working with cancer patients directly , which helps to give us a full picture of patient pain points and potential approaches to tackle TSAs. We also invest significantly in research testing flavors and taste modulation solutions within cancer care settings (i.e., in actual patients rather than healthy sensory panels). This means we can be sure our solutions work well in people who need them most.”

Lyzandra Passarella-Dutour: “Designing medical nutrition products that overcome the sensory challenges experienced by people living with cancer requires a targeted and collaborative approach. With the combination of world-leading taste and sensory expertise, innovative technologies, and unique insights into the pain points of people living with cancer, we help our customers make this a reality.”