Altered smell and taste in palliative care
Many patients with palliative care needs experience altered smell and taste. This may be associated with nausea, and can be managed by avoiding triggers of nausea. Many drugs can cause changes in taste and smell—some used by patients with palliative care needs (eg baclofen, chemotherapy)Boltong, 2012Schiffman, 2018.
Altered smell and taste is particularly common in patients with cancer, even before the cancer diagnosis; inflammation and changes to microbiota contribute to this phenomenonMurtaza, 2017. This may lead to a dramatic change in food preferences, which patients and families can find confusing and hard to accept. Preparing patients, families and carers early for these changes through explanation and counselling can diminish the impact. Encourage exploration of new foods, and support acceptance and indulgence in new food cravings.
Altered smell and taste may lead to poor outcomes if left untreated (eg low quality of life, poor nutrition, low energy). Conclusive evidence to guide management is lacking, but initial treatment should address causes or contributing factors (eg dry mouth), and may include oral care, salivary replacement, dietary counselling, patient education, nutritional supplementation (see the Gastrointestinal guidelines for advice). Other options include zincHoppe, 2021 or lactoferrin supplements, Synsepalum dulcificum (miracle fruit) and tetrahydrocannabinol (THC)Razmovski-Naumovski, 20221, but evidence supporting their use is weak, and the additional drug burden and potential adverse effects should be consideredBraud, 2020Sevryugin, 2021.
For management of anorexia, weight loss and cachexia in palliative care, see Anorexia, weight loss and cachexia in palliative care.