SUMMARY & CONCLUSIONS

The purpose of this study was to determine the taste function of post-laryngectomy head and neck cancer survivors and examine associations with dietary intake and malnutrition status. In this randomized, double-blinded, controlled trial, participants were tested in their ability to identify solutions of the five basic tastes of bitter, salty, sour, sweet, and umami. A 24-hour dietary recall was conducted to determine dietary intake and participants were screened for positive markers of malnutrition. At low concentration, 33.3% of participants were able to identify bitter, 16.7% salty, 16.7% sour, 0% sweet, and 0% umami. There were no reported positive features of malnutrition though a majority of participants’ 24-hour dietary recall showed energy intake below recommendation. Positive correlations were found between energy intake and correct identification scores for sour at medium (r = 0.956, p = 0.003) and low (r = 0.912, p = 0.011) concentrations and umami at low concentration (r = 0.854, p = 0.031). Findings suggest that taste impairment is a long-term post-treatment effect in post-laryngectomy head and neck cancer survivors though adaptation seems to occur. These findings promote the need for preventative or rehabilitative interventions for taste impairment to prevent subsequent alterations in dietary intake and maximize quality of life.

ABSTRACT

BACKGROUND

MATERIALS & METHODS

RESULTS

Taste Detection in Post-laryngectomy Head and Neck Cancer Survivors and Its Effect on Dietary Intake and Malnutrition Status

Kariann Akiyama, RDN1, Long Wang, PhD, MD, RDN, FAND1, Betty McMicken, PhD2, James Buenaventura, DPT3, Kristin Mahood, MS, RDN1

1 Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, CA 908402 Department of Communication Sciences and Disorders, Chapman University, Irvine, CA 92618

3 Department of Physical Therapy, California State University, Long Beach, Long Beach, CA 90840

RESULTS

ACKNOWLEDGEMENTS

• Head and neck cancer (HNC) is a cumulative term describing several varieties of malignant tumors that form in or around the areas of the throat, nose, sinuses, mouth, or larynx. The main treatments for HNC include surgery, radiation therapy, and chemotherapy. A laryngectomy, the partial or total removal of the larynx, is a common surgical procedure when the cancer is in or has spread to the larynx, hypopharynx, oral cavity, or oropharynx. These treatments or a combination of these treatments result in various physical and functional challenges including taste impairment.

• Though several qualitative studies have shown a prevalence of taste alterations in post-laryngectomy HNC survivors,1, 2, 3, 4 there are few quantitative analyses.5, 6 Of the few quantitative studies conducted within the last 5 years exploring taste function, none determined the ability to detect all five taste stimulants. These studies were conducted in the general HNC population and did not specifically study those post-laryngectomy. More quantitative research determining taste function and its associations with dietary intake will contribute further knowledge and understanding to this issue in this specific subgroup population.

• It was hypothesized that there were no significant associations between taste function and energy intake in post-laryngectomy HNC survivors. It was also hypothesized that there were no significant associations between taste function and malnutrition status in post-laryngectomy HNC survivors.

• Taste impairment was shown to be an enduring adverse effect of treatment in post-laryngectomy HNC survivors though adaptation to these alterations in taste seems to occur.

• Findings of this study promotes the need for interventions for taste impairment, possibly through the means of stimulating saliva production, to prevent possible subsequent alterations in dietary intake and maximize quality of life.

• In this randomized, double-blinded, controlled trial, participants were tested in their ability to correctly identify solutions of the five basic tastes of bitter, salty, sour, sweet, and umami at three different concentrations in triplicate (Figure 1). Concentrations were based on the normal detection threshold for each taste stimuli according to literature.7 A 24-hour dietary recall was conducted to determine dietary intake and participants were screened for positive markers of malnutrition.

• Statistical analysis was performed using IBM Statistical Package for the Social Sciences (SPSS) version 24. Descriptive statistics were run to determine frequencies of correct identification of taste stimuli in total and correct identification of each individual taste stimuli of bitter, salty, sour, sweet, and umami at high, medium, and low concentrations. A Pearson’s correlation was used to determine the association between the correct identification of taste stimuli and energy intake. Significance was set at p < 0.05.

I would like to thank Dr. Wang, Dr. McMicken, Dr. Buenaventura, and Kristin Mahood for their guidance and support during this research.

•A total of 6 participants were included in the analysis. Table 1

•Participants most successfully identified the taste stimuli of salty, followed by bitter, sour, umami, and sweet. Figure 2

•At the lowest concentration, 2 participants were able to identify bitter, 1 salty, 1 sour, and 0 for sweet and umami. Figure 3

•No participants reported positive features of malnutrition though 5 out of 6 (83.3%) participants’ 24-hour dietary recall showed energy intake below recommendation (610 ± 358 calories below recommendation).

•Based on participants’ stated height and weight, no participants were categorized as underweight (body mass index [BMI] < 18.5). Mean BMI was 26.6 ± 2.6 with participants in weight status categories of normal (BMI 18.5-24.9; n = 1, 16.7%), overweight (BMI 25-29.9; n = 4, 66.7%), and obese (BMI ≥ 30, n = 1, 16.7%).

•Positive correlations were found between energy intake and correct identification scores for sour at medium and low concentrations and for umami at low concentration. Table 2

Figure 1. A breakdown of the taste test sample solutions

RESULTS

Figure 2. Total frequency of correct identification of taste stimuli amongst participants.

Figure 3. Percentage of participants (n = 6) able to detect taste stimuli. Ability to taste a taste stimuli determined by a threshold accuracy of ≥ 66.6% (correct identification of 2 out of 3 samples).

REFERENCES1. Dooks P, McQuestion M, Goldstein D, Molassiotis A. Experiences of patients with laryngectomies as they reintegrate into their community. Supp Care Cancer 2012;20:489-98.2. Metreau A, Louvel G, Godey B, Le Clech G, Jegoux F. Long-term functional and quality of life evaluation after treatment for advanced pharyngolaryngeal carcinoma. Head Neck 2014;36(11):1604-10.3. Ozturk A, Mollaoglu M. Determination of problems in patients with post-laryngectomy. Scand J Psychol 2013;54(2):107-11.4. Mumovic G, Hocevar-Boltezar I. Olfaction and gustation abilities after a total laryngectomy. Radiol Oncol 2014;48(3):301-6.5. Baharvand M, ShoalehSaadi N, Barakian R, Jalali Moghaddam E. Taste alteration and impact on quality of life after head and neck radiotherapy. J Oral Pathol Med 2012;42(1):106-12.6. McLaughlin L. Taste dysfunction in head and neck cancer survivors. Oncol Nurs Soc 2013;40(1):E4-13.7. Breslin P. Human gustation and flavour. Flavour Frag J 2001;16(6):439-56.

TABLE 1. Participant Characteristics (n = 6)Age (yr) – Mean ± SD 71.8 ± 5.0Sex – n (%)

Male 5 (83.3%)Female 1 (16.7%)

Tumor Site – n (%)Larynx 4 (66.7%)Pharynx 2 (33.3%)

Treatment in Addition to Laryngectomy – n (%)Radiation 4 (66.7%)Radiation and Chemotherapy 1 (16.7%)None 1 (16.7%)

Time Since Treatment (yr) – Mean ± SD 17 ± 10.8

a. Cannot be computed because at least one of the variables is constant.* Correlation is significant at the 0.05 level (2-tailed). ** Correlation is significant at the 0.01 level (2-tailed).

TABLE 2. Correlations Between Correct Identification Scores and Energy Intake

Correct Identification Scores r p

Total 0.532 0.28

Bitter

High 0.358 0.49

Medium 0.577 0.23

Low -0.015 0.98

Salty

High 0.208 0.69

Medium -0.227 0.67

Low 0.034 0.95

Sour

High -0.260 0.62

Medium 0.956** 0.003

Low 0.912* 0.011

Sweet

High -0.354 0.49

Medium -0.131 0.81

Low a. a.

Umami

High 0.061 0.91

Medium -0.111 0.83

Low 0.854* 0.031