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Palliative cancer care - oral problems - Management
How should I treat someone who has alteration in taste?

  • Stress the importance of good oral hygiene. See Self care.
  • Treat dry mouth if present.
  • Treat oral candidiasis. See Oral Candida infection.
  • Withdraw treatment with drugs that may induce or increase symptoms (Table 1).
  • Refer to a dietitian where appropriate. Give general advice whilst awaiting an appointment.
  • If loss of taste follows radiotherapy, reassure the person that taste acuity is partially restored 20 to 60 days after radiotherapy and is usually fully restored within 2 to 4 months.
  • Some experts recommend a trial of an oral zinc salt.
Clarification / Additional information
  • Give general advice whilst the person is waiting to see the dietitian. The following may be tried [Twycross and Wilcock, 2001]:
    • Encourage eating tart foods (e.g. lemon juice, pickles, vinegar), if stomatitis or mouth ulcers are not present.
    • Recommend food that leaves its own taste (e.g. fresh fruit, hard sweets).
    • Add or reduce sugar as appropriate.
    • Reduce the urea content of the diet by eating white meats, eggs, and dairy products.
    • Mask the bitter taste of food containing urea:
      • Add wine or beer to soups and sauces.
      • Marinate chicken, meat, and fish.
      • Use more and stronger seasonings.
      • Eat food cold or at room temperature.
      • Drink more liquids.
    • Hot food with a strong smell may be helpful [Doyle et al, 2004].
    • With the advice of a specialist, a trial of an oral zinc salt e.g. zinc sulphate, may be used.
Basis for recommendation
  • The basis of this recommendation is expert advice [Twycross and Wilcock, 2001; Doyle et al, 2004].
  • The authors of a standard textbook on oral care in palliative disease recommend that it is appropriate to offer people with taste disturbance a trial of an oral zinc salt [Davies and Finlay, 2005]. However:
    • There is is limited and conflicting evidence from small trials of 30 or less people with radiotherapy-related taste problems that use of an oral zinc salt may be effective, but this may not be generalizable to people with other cancer-related taste problems.
    • No zinc salt is licensed for this use in the UK and the optimum dose of a zinc salt is unknown as the zinc regimen varied in the different trials.

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