The Case of the Terrible Taste
Tanya is a 46-year-old woman with leukemia. She recently finished induction therapy, and her oncologist told her she is ready to receive a hematopoietic stem cell transplant (HSCT). You speak with Tanya about what to expect in the upcoming weeks before her transplant, but she interrupts you: “Nothing tastes good anymore. I am so scared because I thought I completed chemotherapy. The doctor just told me I have to get more before my transplant. Every time I get chemotherapy, I lose my appetite.”
What Would You Do?
A patient’s nutritional status affects their clinical outcomes (https://onlinelibrary.wiley.com/doi/full/10.1002/jcsm.12525), as well as muscle mass and overall dietary requirements, but chemotherapy changes patients’ taste (https://link.springer.com/article/10.1007/s00520-016-3263-6) perceptions and may make it difficult for them to maintain adequate intake. Studies show that dietary preferences change throughout chemotherapy treatments, but patients consistently preferred milk-based strawberry-flavored (https://link.springer.com/article/10.1007/s00520-016-3263-6) oral nutritional supplements. Vanilla milk-based supplements are the choice supplement at the start of chemotherapy (https://link.springer.com/article/10.1007/s00520-016-3263-6), but patients’ inclination for them decreased as their treatments progressed.
Nurses can use evidence-based practice to make recommendations that may help patients resume eating. Ask patients what their preferences are. Do they like sweet or sour? If they prefer sour tastes over sweet (https://link.springer.com/article/10.1007/s00520-016-3263-6), studies found they like orange juice-based supplements. When patients say nothing tastes good anymore, ask them to clarify. By helping patients explore their dietary needs and preferences, they can improve their oral intake to meet their caloric requirements.
When recommending nutritional supplements, consider nutrient content such as fat, protein, and sugar. Patients with cancer require 25–30 kcal/kg per day (https://link.springer.com/article/10.1007/s12094-017-1757-4) to meet their nutritional requirements, especially while undergoing treatment. Many supplements now are lactose free, kosher, and halal, so patients have options for many food intolerances and religious or cultural requirements. Plus, most supplements have all ingredients and nutritional information listed on their websites.
Nurses must stay current with their specialty’s dietary-related guidelines (https://link.springer.com/article/10.1007/s00520-019-04887-x). Patients undergoing HSCT should not consume parenteral glutamine (https://link.springer.com/article/10.1007/s00520-019-04887-x) to prevent oral mucositis because it increases their risk for relapse and mortality; however, patients with head and neck cancers undergoing chemotherapy and radiation may use oral glutamine (https://link.springer.com/article/10.1007/s00520-019-04887-x) to prevent oral mucositis. Always caution patients about using supplements without first consulting their oncologist.
Registered dietitians, advanced practice providers, and physicians are members of the interprofessional team available to help navigate nutritional requirements for patients with cancer. Their guidance is especially important when patients are asking about or reporting using supplements. For more information, use reputable sources (https://www.ons.org/learning-libraries/nutrition) to build your knowledge base.
You ask Tanya if she is using milk-based nutritional drinks and if so, what flavor. She tells you she uses vanilla because it has the most neutral taste and she typically liked it during her previous treatment. You advise her to try strawberry to see if it is more appealing with her lack of taste. When you call to check on her a few days after starting chemotherapy for HSCT, she reports being able to maintain her caloric intake with the strawberry drinks.