Subjective and Objective Assessment of Taste and Smell Sensation in Advanced Cancer

Context: Taste and smell abnormalities (TSA) occur throughout the cancer trajectory regardless of cancer primary site and contribute to cancer-associated malnutrition. TSA etiology is poorly understood. Tumor-related inflammation is a possible cause. Objective: This study examined the prevalence, characteristics, and severity of TSA in advanced cancer and explored the relationship between TSA and nutritional status. No previous study combined subjective and objective measures for both taste and smell assessment in this population. Method: Consecutive advanced cancer hospice patients were recruited. A modified version of the “Taste and Smell Survey” assessed subjective TSA. Validated taste strips and “Sniffin’ Sticks” were the objective measures. The abridged patient-generated subjective global assessment evaluated nutritional status. Results: A 93% prevalence of TSA in 30 patients with advanced cancer was identified. When subjective and objective evaluations were combined, 28 had taste abnormalities, 24 smell abnormalities, and 24 both. Taste changes included “persistent bad taste” (n ¼ 18) and changes in how basic tastes were perceived. Half reported smell was not “as strong” as prediagnosis, while more than half (n ¼ 16) had an objective smell abnormality. Most (97%) were at risk of malnutrition. Fatigue, dry mouth, early satiety, and anorexia were common nutrition-impact symptoms. No statistically significant relationship was found between TSA and malnutrition scores. Conclusions: TSA were highly prevalent. Subjective taste and smell changes did not always accord with objective TSA, suggesting both assessments are valuable. TSA characteristics varied, and particular foods tasted and smelled different and were not enjoyed as before. TSA are common, high-impact problems in advanced cancer

The World Health Organisation analgesic ladder: its place in modern Irish medical practice.

Pain is the single most common reason why patients seek medical care. Worldwide, there are 10 million new cases of cancer each year, with 6 million deaths annually. The World Health Organisation (WHO) first published Cancer Pain Relief in 1986, designed to be a simple, intuitive and accessible guide to the management of cancer pain that would be applicable and useful whatever the language, culture, economy, country and clinical setting. In Ireland today, we have ready access to many different opioids, and the WHO guidelines may seem inadequate and outdated. This article describes the evolution and use of the WHO guidelines, as viewed from the global perspective of its 193 member nations. The WHO ladder still remains valid today in Ireland, even as we await the imminent publication of new evidence-based national cancer pain guidelines this year

Description of sampled groups, ADMIXTURE clustering and <i>F</i>_<i>ST</i> values.

<p>(a) Geographic locations of sampled populations analysed, with the 12 Pagani populations [<a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.1005397#pgen.1005397.ref002" target="_blank">2</a>] in larger font. The remaining 10 populations include the MKK and those from the 1000 Genomes Project (see <a href="http://www.1000genomes.org" target="_blank">www.1000genomes.org</a> for details; CHI = CHB/CHS); locations on map for these 10 populations are indicative. All populations are colored by the group that many of their individuals were assigned to using fineSTRUCTURE; these 17 groups are referred to throughout using the label of one of the majority populations (see <a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.1005397#pgen.1005397.s003" target="_blank">S3 Table</a>). (b) Pairwise <i>F</i>_<i>ST</i> comparing all groups (see <a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.1005397#pgen.1005397.s003" target="_blank">S3 Table</a>). (c) ADMIXTURE assuming 8 clusters applied to Pagani, 1KGP and MKK individuals, as labeled by the fineSTRUCTURE groups. In (b)-(c), the two Ari groups (ARIb, ARIc) are highlighted with the blue rectangle.</p

Differences in inferred ancestry under analyses (A)-(C) using <i>F</i>_<i>XY</i>.

<p>Differences in inferred ancestry under analyses (A)-(C) (using <i>F</i>_<i>XY</i>; see <a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.1005397#sec010" target="_blank">Methods</a>) between all pairings of ARIb individuals (pink), all pairings of ARIc individuals (green), and all pairings of one ARIb and one ARIc individual (cyan). In each plot the black vertical line gives the mean difference across the pairings of one ARIb and one ARIc, with <i>P</i>(ARIb), <i>P</i>(ARIc) giving the proportion of ARIb and ARIc pairings, respectively, with a difference greater than or equal to this mean.</p

Inferred ancestry composition of groups under each analysis.

<p>(top) Inferred ancestry composition of recipient groups when forming each group as mixtures of (a) all sampled groups, (b) all sampled groups except the Ari, and (c) all non-Pagani groups only. The colour of each group’s label provides the key for each pie, with Pagani groups geographically located on the map (roughly) according to the label most represented in the given group. All 1KGP groups and MKK are placed on the map loosely according to their relative geographic positions. (bottom) <i>TVD</i>_<i>XY</i> values comparing the painting profiles for all pairwise comparisons of groups <i>X</i>, <i>Y</i> under each analysis, with scale at far right. Ari groups (ARIb/ARIc) are highlighted with black outlines in each plot.</p