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Appetite 75 (2014) 135–140
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Appetite
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Research report
Taste and smell dysfunction in childhood cancer survivors q
0195-6663/$ - see front matter � 2014 Elsevier Ltd. All rights reserved.http://dx.doi.org/10.1016/j.appet.2014.01.001
q Acknowledgements: The authors would like to thank Sinead Malloy and LucyMudge from Children’s Hospital Westmead and Karen Jones from Sydney Children’sHospital for their help in recruiting the participants for this study.⇑ Corresponding author.
E-mail addresses: [email protected] (J. Cohen), [email protected] (D.G. Laing), [email protected] (F.J. Wilkes), [email protected] (A. Chan), [email protected] (M. Gabriel),[email protected] (R.J. Cohn).
Jennifer Cohen a,b,⇑, David G. Laing b, Fiona J. Wilkes c, Ada Chan b, Melissa Gabriel d, Richard J. Cohn a,b
a Kids Cancer Centre, Sydney Children’s Hospital, High Street, Randwick, NSW 2031, Australiab Discipline of Paediatrics, School of Women’s & Children’s Health, UNSW Medicine, The University of NSW 2031, Australiac School of Psychology, Murdoch University, 90 South Street, Murdoch, Western Australia 6150, Australiad Oncology Unit, Children’s Hospital at Westmead, Corner Hawkesbury Rd and Hainsworth Street, Westmead, NSW 2145, Australia
a r t i c l e i n f o a b s t r a c t
Article history:Received 25 February 2013Received in revised form 16 December 2013Accepted 1 January 2014Available online 8 January 2014
Keywords:Taste functionSmell functionPediatric oncologySurvivorshipFood preferencesQoL
Introduction: Reduced or altered taste and smell function may occur as a side-effect of cancer therapy.This can lead to altered nutrient and energy intake. Some studies have suggested that taste and smell dys-function can persist many years after treatment completion but this has not been previously assessed insurvivors of childhood cancer. The aim of this study is to determine if taste and smell dysfunction is pres-ent in childhood cancer survivors (CCS). Food preference and Quality of Life was also assessed. Methods:Fifty-one child cancer survivors (mean age: 19.69 ± 7.09 years), more than five years since treatmentcompletion, (mean: 12.4 years) were recruited from the long term follow-up clinics at two Sydney-basedchildren’s hospitals. Taste function was assessed using a 25 sample taste identification test comprisingfive concentrations each of sweet, salty, sour and bitter tastes and water. Smell function was assessedby determining the ability of participants to identify 16 common odorants. The participants’ Quality ofLife was assessed using the Functional Assessment of Anorexia Cachexia scale and food preferences wereassessed using a 94-item food liking tool. Results: Taste dysfunction was found in 27.5% of participants(n = 14), and smell dysfunction in 3.9% (n = 2) of participants. The prevalence of taste dysfunction washigher than that seen in the non-cancer population. The child cancer survivors’ appeared to ‘‘like’’ the lesshealthy food groups such as flavoured beverages, takeaway and snacks over healthier food groups such asvegetables and salad. No correlation was found between those with a taste dysfunction and their food‘‘likes’’. Conclusion: A high level of taste dysfunction was found in CCS though there did not appear tobe an issue with smell dysfunction. Further work is also needed to assess whether a taste dysfunctiondo play a role in the dietary habits of CCS.
� 2014 Elsevier Ltd. All rights reserved.
Introduction
One potential side-effect of cancer therapy is reduced or alteredtaste and smell function (Comeau, Epstein, & Migas, 2001). Bothtaste and smell receptor cells rapidly turn over and are producedfrom dividing basal cells (Graziadei, 1973; Roper, 1989). The divi-sion mechanism is sensitive to the effects of chemotherapy and/or radiotherapy (Wickham et al., 1999). The senses of taste andsmell are integral in motivating a person’s food preferences (Drew-nowski, 1997; Mattes et al., 1990) and both child and adult cancerpatients commonly attribute difficulties maintaining food intake tothe altered taste developed during treatment (Comeau et al., 2001;
Skolin et al., 2006; Wismer, 2008). Altered taste in cancer patientshas also been associated with decreased energy and nutrient intake(Sanchez-Lara et al., 2010), potentially leading to nutrient deficien-cies (Hong et al., 2009).
Although the taste and smell receptor cells are replaced regu-larly over several weeks and longer, cancer therapy can potentiallylead to long term taste and smell receptor damage. This occurs dueto an alteration in the structure of the receptors or a decrease inthe number of normal receptor cells (Hong et al., 2009). Long-termtaste and smell dysfunction has been documented in the adultoncology population (Boer, Correa, Miranda, & de Souza, 2010;Epstein, Myers, Raynor, & Saelens, 1998). Patients who havereceived radiation therapy for head and neck cancer and thosewho have undergone a Hematopoietic Stem Cell Transplant (HSCT)demonstrate taste dysfunction, after their cancer treatment, up toseven and three years respectively. (Boer et al., 2010; Epstein &Barasch, 2010).
Survivors of childhood cancer have been shown to have poordietary habits (Cohen et al., 2012; Demark-Wahnefried et al.,2005; Robien, Ness, Klesges, Baker, & Gurney, 2008) and
Table 1Demographics of childhood cancer survivors.
CharacteristicSex (male:female) 24:27
Age at assessment, Mean (SD)(range): Years 19.69 (7.09)(12–40)
Age at diagnosis, Mean (SD)(range): Years 5.27 (4.05)(0–17)
Time since treatment completion Mean (SD)(range):Years
12.40 (6.87)(5–38)
Cancer diagnosis (n)ALLa 18AMLb 1Neuroblastoma 4Wilms tumour 4Rhabdomyosarcma 3Lymphoma 4Medulloblastoma 2Ewing’s sarcoma 2Osteosarcoma 3Other 10
Treatment (n)Chemotherapy 27Chemotherapy + radiotherapy 17Cranial radiotherapy 6Abdominal radiotherapy 2Head and neck radiotherapy 1Other sites 8HCSTc 7Total body irradiation 4
a ALL: Acute lymphoblastic leukemia.b AML: Acute myeloid leukemia.c HSCT: Haematopoietic stem cell transplant (HSCT).
136 J. Cohen et al. / Appetite 75 (2014) 135–140
preferences for high fat foods (Arroyave et al., 2008). In the generalpopulation, those with a documented taste or smell dysfunctioncan alter their food intake, either by compensating for the lack offlavour in foods with an increase in intake, or decreasing their in-take due to a lack of enjoyment of the food (Hutton, Baracos, &Wismer, 2007; Sanchez-Lara et al., 2010). Taste dysfunction hasalso been associated with obesity in both adults and children (Don-aldson, Bennett, Baic, & Melichar, 2009; Overberg, Hummel, Krude,& Wiegand, 2012) in the general population. The taste and smellfunction of childhood cancer survivors (CCS) has not been previ-ously assessed. If CCS are found to have a taste or smell dysfunctionthis may be one factor influencing their food preferences and die-tary intake. The aim of this study was to assess smell and tastefunction in this population and to determine whether this influ-ences food preferences which could in turn influence their dietaryintake. To this end, it was hypothesised that the CCS level of tasteand smell functioning would be related to food liking scores.
Methods
Participants
Participants were CCS who were at least 5 years since cancertreatment completion and who attended the long-term follow-upclinics for a their yearly review, at Sydney Children’s Hospital,Randwick and the Children’s Hospital Westmead, Australia, be-tween July and September 2011. Participants were excluded fromparticipation if they were under the age of 12 years, did not speakEnglish or were pregnant. Participants were also excluded if theyhad known problems with swallowing as the testing required par-ticipants to swallow a small amount of the tasting solutions. Thestudy protocol was approved by The Royal Alexandra Hospital forChildren Ethics Committee (Approval No. 11/CHW/24) and in-formed consent was obtained from all participants.
Demographics
Demographic information (Table 1) collected from the medicalrecords of participants included, age, sex, cancer diagnosis, typeof treatment received, time since treatment completion and cur-rent medications.
Taste identification
Taste function was assessed by the ability to identify four differ-ent tastes – sweet, sour, salty and bitter across five different con-centrations, and five samples of water. Each participant wasfamiliarised with the test procedure by sipping a few millilitresof a moderate strength solution. Each child was familiarized withthe test by being asked to sip a solution (2–3 ml of a single sample)that was moderately sweet (sucrose, 0.36 M; Sigma, Sydney,Australia), salty (sodium chloride, 0.18 M; BDH, Sydney, Australia),sour (citric acid, 0.009 M; BDH) and bitter (quinine hydrochloride,0.0001 M; Aldrich, Sydney, Australia), respectively, and water (No-bles Ultra Pure Water, Sydney, Australia). Test tastant concentra-tions were prepared by dissolving analytical grade sucrose (0.05,0.08, 0.12, 0.20, 0.32 M, Sigma, Sydney, Australia) citric acid(0.0038, 0.0062, 0.0100, 0.0159, 0.0256 M BDH, Sydney, Australia),sodium chloride (0.07, 0.11, 0.18, 0.28, 0.46 BDH) and quininehydrochloride (0.00009, 0.00016, 0.00026, 0.00041, 0.00065 M, Al-drich, Sydney, Australia) in purified drinking water (Nobles UltraPure Water, Sydney). For each of the 25 samples, participants werepresented with a small amount of tastant solution and then askedto select one of three labelled photographs which best describedthe taste they had sampled. The photographs were a pictorialrepresentation of the tastant. The photographs also contained the
name of the three tastants represented e.g. sweet, sour, salty, bitteror water. The assessor read out all three names to the participant(Laing et al., 2008) before they made their choice. The 25 tastantswere presented to each participant in a random order with a 20–30 s break between the assessment of each tastant. Participantswere advised to rinse their mouth with pure water between eachsample.
For each tastant, participants who identified less than four outof the five concentrations for each individual tastant were consid-ered to have impairment in their ability to detect that taste (Lainget al., 2008). This criteria was established from normative data forchildren (n = 232) and adults (n = 56) older than five years, usingthe same test procedure (Laing et al., 2008). The same criteria fortaste impairment has been used with participants with cysticfibrosis (Laing et al., 2010), chronic kidney disease (Armstrong,Laing, Wilkes, & Kainer, 2010) and healthy school children(Armstrong, Laing, Wilkes, & Laing, 2008).
Smell identification
Smell function was assessed by determining the ability of par-ticipants to identify 16 common odorants including Dettol™(a common antiseptic product based on chloroxylenol), sour, babypowder, fishy, grassy, paint, flowers, strawberry, cheesy, petrol,spicy, onion, Vicks VapoRub™ (odour of mentholated topicalcream), minty, orange and chocolate. The 16 odorants were dilutedto a total volume of 20 ml with odourless dipropylene glycol (Fluka99% pure) and placed in individual opaque squeeze bottles whicheach participant was shown how to squeeze and sniff from the bot-tle (Laing et al., 2008). The participants were then presented withthree labelled photographs and asked to pick the one most repre-sentative of the smell they had just been presented. The photo-graphs were a pictorial representation of the odorant combinedwith the name of the odorant. The test was developed not onlyfor adults but for use with children from five years of age (Laing
J. Cohen et al. / Appetite 75 (2014) 135–140 137
et al., 2008). It was developed with children five to nine years old(n = 232) and adults (n = 56). Early data indicated that childrenfrom nine years of age performed similarly to adults (Laing, Wilkes,Underwood, & Tran, 2011). In addition, it has been shown to have atest–retest reliability of 0.98 (Armstrong et al., 2008) indicating ahigh level of reliability. A score of less than 13 out of a possible16 (e.g. more than four smells incorrectly identified) was definedas an olfactory impairment (Laing et al., 2008).
Quality of Life (QoL)
The Functional Assessment of Anorexia/Cachexia TreatmentQoL scale (FAACT) was used for participants greater than 18 yearsof age and the Pediatric Functional Assessment of Anorexia Ca-chexia (Peds-FAACT) used for participants less than 18 years ofage. These tools are validated in this population to measure healthrelated quality of life (Chang, Xia, & Kasimis, 2005; Lai, Cella, Peter-man, Barocas, & Goldman, 2005) and contain an additional itemssection on issues relating to anorexia/cachexia. This tool was usedas a subjective measure of the severity of food-related symptomssuch as taste change and poor appetite.
Food liking
A 94-item food liking questionnaire was used to elicit partici-pant’s food preferences (Nicklaus, Boggio, Chabanet, & Issanchou,2004; Wardle, Sanderson, Leigh Gibson, & Rapoport, 2001). Thequestionnaire required participants to rate their attitudes towardsa range of common foods on a scale of 0–5, with 0 = not having trieda food, 1 = hating a food, up to 5 = loving the food. The responseswere then sorted according to 10 food groups; meat/fish, vegetarianfoods other than vegetables, bakery goods, breakfast foods, conve-nience foods/takeaways, dairy foods, fruit, snacks, green vegeta-bles/salad and other vegetables. The mean liking scores for eachof the 10 categories were calculated. The higher the mean score,the more likely the food group was ‘‘liked’’. This data was thenanalysed to illustrate trends in participant’s food likes.
Statistical analysis
Statistical analyses were performed using IBM SPSS version 19(IBM Corp., Armonk, New York). Previous research in clinical andnon-clinical populations using the same taste and smell tests uti-lised here indicate that the majority of people score towards thehigh-functioning end of the scale on both of these tests (Armstronget al., 2008; Cohen, Laing, & Wilkes, 2012; Laing et al., 2010). Sincethe underlying distribution of these smell and taste tests are non-normal, and the comparisons between treatment groups involvedsmall and uneven group sizes, non-parametric statistics were con-sidered the most appropriate method of analyses for the currentdata (Sheskin, 2011). Differences and associations were consideredsignificant at p < .05 (2-tailed). Bonferroni corrections were appliedto alpha for all subsequent post hoc tests to reduce the chance oftype I error (Sheskin, 2011). The specific analyses used to examineeach of the variables are described in the respective results sec-tions. Where Bonferroni corrections have been applied, the rele-vant adjusted alpha level is indicated alongside the reportedresults and significance values.
Results
Demographics
Fifty-five childhood cancer survivors were approached to par-ticipate in the study of which 51 (93%) were recruited. The meanage of the participants was 19.69 (±7.09) years and a mean of
12.4 (±6.87) years had passed since completion of their treatment(Table 1).
Taste
Taste dysfunction was found in 14 of the 51 participants(27.5%). Of those with a taste dysfunction, five (9.8%), eight(15.7%), four (7.8%) and six (11.8%) had a sweet, sour, salty or bitterdysfunction, respectively. Seven participants had a dysfunctioninvolving one tastant only, five had a dysfunction involving two ta-stants and two had a dysfunction involving three tastants. No pa-tient had a dysfunction involving all four tastants. A Friedman’sANOVA test indicated the total scores for sweet (4.47 ± 0.67), sour(4.45 ± 0.86), salty (4.61 ± 0.70), bitter (4.47 ± 0.92) and water(4.45 ± 1.12) were not significantly different (p = 0.490).
A series of Spearman’s correlation tests found no significantrelationship between taste scores and the age at diagnosis(rho = �0.078; p = 0.585) or years since treatment completion(rho = �0.101; p = 0.481). When these variables were correlatedwith individual tastant scores there was a significant negative cor-relation between age and bitter score (rho = �.357; p = 0.01) sug-gesting that as age increased participants were less able toidentify a bitter taste. No other significant results were found.When the participants were separated into three treatment types(chemotherapy (n = 27), chemotherapy + radiotherapy (n = 17),HSCT (n = 7)) a Kruskall-Wallis test indicated that there were nosignificant differences in total taste scores between the treatmenttypes. It should be noted that the power to find differences be-tween treatment types was limited by small group sizes, for anal-yses between the three treatment types the power ranged between0.18 and 0.34.
Smell
Of the 51 participants, six participants (11.8%) were identifiedas having some degree of a smell dysfunction. Two (3.9%) identi-fied only nine of the 16 odors and were classified as hyposmic(i.e. significant loss of smell function). Four of the participants wereslightly hyposmic with scores of 11 and 12 out of 16 respectively.Sour and flower odorants were the least identified odorants whileVicks VapoRub™, minty and paint were identified by all the partic-ipants (Fig. 1).
A series of Spearman’s correlation tests found no significantrelationship between smell scores and age of participants(rho = �0.223; p = 0.116), time since treatment completion(rho = �0.178; p = 0.211), or age at diagnosis (rho = �0.165;p = 0.248). A comparison of the smell scores between the threetreatment groups (chemotherapy (n = 27), chemotherapy + radio-therapy (n = 17), HSCT (n = 7)) using a Kruskall-Wallis test founda significant difference (p = 0.013). Post-hoc Mann–Whitney testsindicated the odour identification scores for the chemotherapy-only group were significantly higher than for the HSCT group[p = 0.004; Bonferroni adjusted a = 0.0167]. Again, it should benoted that the small group sizes limited power to find significantdifferences between treatment types (power ranged 0.18–0.34).Of the six participants with hyposmia, four of these received aHSCT transplant of whom two received total body irradiation(TBI) as part of their treatment. No other significant differenceswere found when comparing the treatment groups.
Food liking
The final mean score for each food category was out of five withthe higher the score, the more likely the food was ‘‘liked’’ (Fig. 2).The data showed that the most ‘‘liked’’ foods were non-dairyliquids (4.0), followed by takeaway (3.84) and snacks (3.8). The
Fig. 1. Percentage of participants who correctly identified each odorant.
138 J. Cohen et al. / Appetite 75 (2014) 135–140
least ‘‘liked’’ food groups were the salads and greens (3) followedby breakfast cereal (3.03), vegetarian food (3.14) and then vegeta-bles (3.3).
Spearman’s correlations indicated a significant negative correla-tion between smell score and liking for snacks (rho = �0.294,p = 0.036). Thus, as the smell score decreased the liking for snacksincreased. In contrast, a significant positive correlation was foundbetween smell score and salad/greens, (rho = 0.404, p = 0.003), sug-gesting that as the smell score increased liking of salad/greens alsoincreased. Mann–Whitney tests comparing the food liking scoresbetween those with and without a smell dysfunction found
Mea
n Li
king
Sco
re
Food
Fig. 2. Mean liking scores for each food category (0 = not havin
significantly higher mean food liking scores (possible score out offive) for those without a smell dysfunction for dairy foods (2.90vs. 3.56; p = 0.027), fruit (2.14 vs. 3.92; p = 0.001) and salad/greens(1.61 vs. 3.19; p = 0.0001). No significant differences or correlationswere found between the food groupings and the taste scores. Thetreatment group numbers were small, therefore results should beinterpreted with caution. The results of this study indicate thatthe differences in food liking for those with and without a smelldysfunction along with the above significant correlations providepartial support for the hypothesis that smell function is relatedto CCS food liking.
Group
g tried a food, 1 = hating a food, up to 5 = loving the food).
Table 2Mean score for questions in additional concerns section of the Functional Assessmentof Anorexia/Cachexia Treatment QoL scale FAACT (possible values 0 = not at all; 1 = alittle bit; 2 = somewhat; 3 = quite a bit; 4 = very much).
FAACT question Mean ± SD Range
I have a good appetite 2.80 ± 1.34 0–4The amount I eat is sufficient to meet my needs 2.92 ± 1.13 0–4I am worried about my weight 1.33 ± 1.43 0–4Most food tastes unpleasant to me 0.35 ± 0.86 0–3I am concerned about how thin I look 0.37 ± 0.78 0–3My interest in food drops as soon as I try to eat 0.29 ± 0.74 0–4I have difficulty eating rich or ‘‘heavy’’ foods 0.35 ± 0.93 0–4My family or friends are pressuring me to eat 0.33 ± 0.83 0–4I have been vomiting 0.12 ± 0.39 0–2When I eat, I seem to get full quickly 0.80 ± 1.32 0–4I have pain in my stomach area 0.29 ± 0.65 0–2My general health is improving 2.80 ± 1.39 0–4
J. Cohen et al. / Appetite 75 (2014) 135–140 139
Quality of Life
Results from the additional concerns section of the QoL toolindicated that the participants had no significant food related con-cerns (Table 2). For example, the mean score for the section on‘‘food tasting bad’’ was rated low. Correlation tests showed therewere no significant relationships between smell and taste function(total scores) and any food-related QoL measure. Mann–Whitneytests comparing the individual QoL domains between those witha taste dysfunction and those who did not, found a significantlyhigher QoL score for those with a taste dysfunction in responseto ‘‘My general health is improving’’ (3.46 vs. 2.29 p = 0.016). Therewere no QoL associations found when comparing those with andwithout a smell dysfunction.
Discussion
The results of this study in CCS demonstrate that 27.5% (n = 14)had some degree of taste dysfunction and 4% (n = 2) had a signifi-cant smell dysfunction. There was an absence of relationships be-tween taste, food liking and QoL and the modest relationshipbetween smell dysfunction and liking for healthy foods.
The prevalence of a taste dysfunction in adult oncology patientsduring chemotherapy has been reported to be as high as 40%(Sanchez-Lara et al., 2010) using objective measures or 86% usingsubjective measures such as self-report (Hutton et al., 2007). Inthe paediatric oncology population, prevalence rates of a tastedysfunction do not exist though it has been reported to be anissue during cancer therapy (Barale, Aker, & Martinsen, 1982;Skolin et al., 2006). A taste dysfunction during the more intensivepediatric HSCT have been reported to be around 40% (Cohen et al.,2012).
The findings in this study show a high prevalence rate oftaste dysfunction in survivors of childhood cancer. Some studieshave suggested that taste dysfunction continues well after treat-ment completion (Boer et al., 2010; Epstein et al., 1998) but thisis the first study to assess this in a cohort of survivors of child-hood cancer. There are wide variations in the prevalence rates oftaste dysfunction in the general population. Taste disorders havebeen reported to range from 0.85% (Boltong & Keast, 2012) to20% (Skinner, CArruth, Bounds, & Ziegler, 2002). The prevalencerates have been found using a wide variety of methodology fortaste assessment and make it difficult to adequately comparefindings. A relevant comparison of our prevalence rate of a tastedysfunction of 27% (n = 14) in the CCS, is with a group ofhealthy, nine to 12 year old Australian children (n = 432). Thegroup of healthy Australian children exhibited a taste lossprevalence of 10% using the same taste test as used with the
CCS and with the same criterion for defining taste loss (Lainget al., 2011).
Accordingly, the prevalence of taste loss of CCS is higherthan the general population and is a potential undesirable out-come as a result of the cancer itself or the treatment received.The mechanism(s) for taste loss in the present group of cancerpatients is unknown. Possible explanations include a reductionin the number of taste and smell receptors as a result of thecytotoxic effects of treatment; changes in the rate of turnoverof receptor cells, changes induced in the structure of receptorsaffecting the delivery of taste and smell molecules to tasteand smell receptors, or abnormalities in the reestablishmentof synaptic connections at the end of cancer treatment (Matteset al., 1990).
The incidence of smell dysfunction in the present study (3.9%;(n = 2)) is slightly higher than the a 1.9% found using the present16-odour identification test with a cohort of nine to 12 year oldAustralian children (Laing et al., 2011). Although the numbers aresmall in this study there is the suggestion that the smell dysfunc-tion can be influenced by the type of treatment received. Four ofthe six participants who had a smell dysfunction underwent aHSCT of whom two received TBI. This may reflect greater and morelasting damage to the olfactory system with the more intensivetreatment. Further work investigating taste function may be war-ranted with this group.
The results from this study indicate childhood cancer survivorsappear to ‘‘like’’ less healthy food groups such as flavoured bever-ages, takeaway and snacks over healthier food groups such asvegetables and salad. These results are consistent with previousresearch findings with childhood cancer survivors who displayedunhealthy eating habits, such as a poor vegetable intake and ahigh fat and sugar intake (Cohen et al., 2012; Demark-Wahnefriedet al., 2005; Robien et al., 2008). Despite these findings there didnot appear to be any association with food likes and tastefunction. In partial support of the hypothesis, there did appearto be some association with a smell dysfunction and a reducedliking of dairy, fruit and salad/greens. Further work is needed toconfirm whether taste or smell dysfunction is affecting CCS’s foodchoices.
Whilst taste and smell function does not appear to have a keyrole in the long term food likes of CCS, research suggests that treat-ment for malignancies may still have an influence on food prefer-ences through the development of food aversions. It has beenreported that the likelihood of an individual selecting a food for asecond time is related to their prior experiences (De Graff et al.,2005). This may be relevant to the development of food aversionsin the setting of cancer treatment as taste and smell alterationsduring the period of the disease and subsequent treatments cou-pled with symptoms of nausea and vomiting may have resultedin negative experiences during feeding (Boltong & Keast, 2012;Hong et al., 2009). The effect of food aversions may be even morepronounced in those receiving treatment for cancer at very youngages as food preferences are thought to be largely establishedthrough experiences with food in the first 3 years of life (Skinneret al., 2002).
The results from the QoL tool indicate that this cohort have anacceptable QoL as demonstrated by the ratings of participantswhich corresponded to low levels of concern about weight andappetite. Participants did not report that ‘‘food tasted bad’’ despite27.5% (n = 14) of this cohort displaying some form of taste dysfunc-tion. Furthermore, there was no association found between QoLscores and taste and smell scores. Previous studies suggest thatQoL is influenced by perceived level of olfactory dysfunction ratherthan actual degree of dysfunction (Landis, Konnerth, & Hummel,2004; Lin, Chu, Yuan, & Shu, 2009). It may be that a similar phe-nomenon occurs with taste dysfunction.
140 J. Cohen et al. / Appetite 75 (2014) 135–140
Conclusion
It is concluded that taste dysfunction occurs in pediatric longterm cancer survivors although no relationships were found be-tween taste function and food likes, and taste function and QoL.It does not appear that a smell dysfunction were as prevalentthough the incidence may be slightly higher than the general pop-ulation. It is known that CCS have undesirable food habits thereforelarger prospective longitudinal studies are needed to furtherunderstand the reasons for these poor dietary habits. Further workis also needed to assess whether taste dysfunction plays a role inthese dietary habits.
Funding
There was no funding provided for this study and no financialdisclosures for each author.
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