The Nutritional Impact of Metallic Taste in Head and Neck Cancer Patients: Explorations and Clinical Implications

The Nutritional Impact of Metallic Taste in Head and Neck Cancer Patients: Explorations and Clinical Implications | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Nutritional Impact of Metallic Taste in Head and Neck Cancer Patients: Explorations and Clinical Implications Guillaume Buiret, Hélène Brignot, Chantal Septier, Thierry Thomas-Danguin, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4462168/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Sep, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted 17 You are reading this latest preprint version Abstract PURPOSE: Metallic taste (MT) is frequently observed during head and neck cancer treatments, but very little is known about its impact on nutritional status. The aim of this study was to explore the impact of MT on the quality of life and nutritional status in patients with head and neck cancer expressing MT disorder. METHODS: Questionnaires on quality of life, MT, weight, and food intake were filled out by 44 patients with head and neck cancer before, during, and up to one year after their treatment. Patients were divided into two groups based on the occurrence of MT. RESULTS: MT was commonly observed (27.2%), always during the treatment phase and mostly linked with radiotherapy or radiochemotherapy. MT intensity was moderate (40%) to high (26.7%). MT had a significant negative impact on QoL linked to dysgeusia (p=0.025). The negative impacts of MT on food intake and on weight were not significant, possibly due to a combination of sample size, dropouts, and duration of observation. Further research in this area could provide additional insights into how to better address the issue related to MT and enhance the quality of care provided to this patient population. CONCLUSION: Metallic taste, experienced by 27.2% of head and neck patients, contributes to dysgeusia and results in a significant decline in quality of life. ClinicalTrials.gov trial registration number: NCT03558789 metallic taste head and neck cancer quality of life dysgueusia impact Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION Head and Neck Cancers (HNC) are one of the most common forms of cancer worldwide, ranking as the fifth most prevalent cancer type in France ( 1 ). Apart from the medical challenges posed by this disease, patients with HNC face a unique set of symptoms and treatment-related complications, among which taste alterations hold significant importance. Their impact on nutritional status, food intake, and weight is important ( 2 – 7 ). Among these taste alterations, Metallic Taste (MT) proves to be one of the most disruptive symptoms, affecting patients' quality of life and their ability to maintain adequate nutrition. However little is reported on this symptom, including its incidence and impact. This taste alteration, characterized by a sensation of metal in the mouth and an unpleasant, persistent flavor, is frequently reported by HNC patients ( 2 ), slightly more than in the general cancerology population ( 8 ) despite there is no comparative study according to the type of cancer. The impact of MT extends beyond a mere sensory nuisance; it can have substantial consequences on food intake, oral hygiene, medication adherence, and, consequently, on disease progression and overall patient quality of life. Yet, despite its prevalence and clinical implications, MT remains relatively understudied and poorly understood in the context of HNC. This knowledge gap hinders the development of effective, targeted management strategies to alleviate this symptom, improve treatment compliance, and optimize the nutritional quality of patients. This study aims to address this gap by delving more deeply into the impact of MT in HNC patients, offering a comprehensive analysis and understanding of its implications and clinical significance. METHODS Study population: The prospective study involved a cohort of 44 patients diagnosed with HNC. These patients were included at the onset of their cancer, before the occurrence of MT, and were followed up for one year, unless a recurrence or another cancer occurred. At the end of the study, patients were categorized into two distinct groups based on the presence or absence of MT as reported by the patients. Testing: The population’s characteristics were assessed at the beginning of the study. Several questionnaires were administered to each patient at regular intervals: before any treatment; after surgery if any; midway and upon completion of radio(chemo)therapy if any; at 3-6-9 and 12 months. These assessments encompassed the EORTC QLQ30 ( 9 ) and HN35 ( 10 ) questionnaires to evaluate Quality of Life (QoL), a specific questionnaire to assess MT impact ( 11 ) in patients complaining about MT, measurement of weight, a Visual Analog Scale (VAS) to quantify food intake ( 12 ) (ranging from 0 for total eating abstention to 10 for normal eating). Data Analysis: The threshold for statistical significance in this study was set at a p-value of < 0.05 for all conducted tests. Population characteristics differences based on MT status were assessed using chi-squared tests for qualitative data and t-tests for continuous data. According to Neyman and Pearson ( 13 ), non-crossing confidence intervals were indicative of statistical significance. Linear and non-linear regressions were conducted on weight, the VAS data for food intake, and question #44 of the EORTC HN35 (“During the last week, did you have trouble with taste?”) concerning MT status. The statistical tests were performed using R software ( www.therproject.com ) v4.3.1. The packages prettyR, nlme, gplots, ggplot2, and patchwork were used. Ethical Considerations: This study was performed in line with the principles of the Declaration of Helsinki and adhered strictly to the French ethical guidelines and principles, with all participating patients providing informed consent prior to their involvement. Approval for the study was granted by the CPP Est I, Dijon, France (#2017-A03641-52). Additionally, the study is registered on ClinicalTrials.gov (NCT03558789). RESULTS 44 patients were included and followed up for one year. The flowchart of the study is presented in Fig. 1 . Table 1 displays the demographic characteristics of the study population at inclusion according to the MT status. Patients were predominantly male, of middle age, and with advanced Tumor and Node stage. The treatment modalities were predominantly multimodal. Table 1 studied population characteristics at inclusion according to metallic taste status. MT: metallic taste MT No MT p Sex: males n(%) ; females n(%) 9 (75%), 3 (25%) 25 (78.1%), 7 (21.9%) 1 Mean age at diagnosis ± SD (year) 61.7 ± 10.2 63.6 ± 9.8 0.58 Location n (%): Hypopharynx Larynx Oropharynx Oral Cavity Unknown primary 0 (0%) 1 (8.3%) 4 (33.3%) 5 (41.7%) 2 (16.7%) 3 (9.4%) 7 (21.9%) 10 (31.2%) 9 (28.1%) 3 (9.4%) 0.57 T stage n (%): 1 2 3 4 x 3 (25%) 6 (50%) 1 (8.3%) 0 (0%) 2 (16.7%) 6 (18.7%) 12 (37.5%) 7 (21.9%) 4 (12.5%) 3 (8.8%) 0.69 N stage n (%): 0 1 2a 2b 2c 3a 4 (33.3%) 4 (33.3%) 1 (8.3%) 2 (16.7%) 0 (0%) 1 (8.3%) 16 (50%) 6 (18.7%) 3 (9.4%) 3 (9.4%) 2 (6.2%) 2 (6.2%) 0.77 Smoking at inclusion n (%): Yes No Quit 3 (25%) 3 (25%) 6 (50%) 17 (50%) 2 (6.2%) 13 (40.6%) 0.11 Treatment Withdrawal of consent before treatment Chemotherapy, surgery, radiotherapy Surgery Surgery, radiotherapy Surgery, radiochemotherapy 0 (0%) 0 (0%) 2 (16.7%) 7 (58.3%) 3 (25%) 5 (15.6%) 1 (3.1%) 12 (37.5%) 5 (15.6%) 9 (28.1%) 0.54 Among the included patients, 12 complained of MT (27.2%), always during the treatment phase (periods 2 to 5, with one patient still complaining at period 6). There were no significant demographic characteristics differences at inclusion, between MT and no MT status. Table 2 reports the most intense responses to the metallic taste-specific questionnaire, exclusively among patients who reported experiencing metallic taste (n = 12). Figure 2 presents the evolution of MT intensity according to the patients who experienced it. Table 2 Impact of Metallic Test as assessed by the specific metallic taste questionnaire The MT is intense n (%) Not at all A little Moderately A lot I don't know 2 (13.3%) 3 (20%) 4 (26.7%) 6 (40%) 0 The MT bothers me with food in general n (%) Not at all A little Moderately A lot I don't know 4 (26.7%) 0 (0%) 4 (26.7%) 7 (46.7%) 0 (0%) The MT bothers me with only a few foods n (%) Not at all A little Moderately A lot I don't know 4 (28.6%) 3 (21.4%) 2 (14.3%) 4 (28.6%) 1 (7.1%) The MT gets stronger when I eat n (%) Not at all A little Moderately A lot I don't know 8 (53.3%) 0 (0%) 3 (20%) 4 (26.7%) 0 (0%) The MT is present all day long n (%) Not at all A little Moderately A lot I don't know 5 (33.3%) 4 (26.7%) 0 (0%) 6 (40%) 0 (0%) Do you consider this MT to be the most negative aspect of your taste changes? n (%) No Yes Don't know 4 (28.6%) 8 (57.1%) 2 (14.3%) How long have you had this metallic taste in your mouth? n (%) Less than a week Between one week and one month Between one and three months More than three months I can't answer this question 2 (13.3%) 5 (33.3%) 6 (40%) 1 (6.7%) 1 (6.7%) MT: metallic taste Figure 3 illustrates the evolution of weight over time according to MT status. On average, weight decreased by 0.68kg per Period (p < 10 − 5 ). However, The MT status did not significantly influence the evolution of weight (p = 0.54). In the the EORTC questionnaire, the questions 29 (“How would you rate your overall health during the past week?”) and 30 (“How would you rate your overall quality of life during the past week?”) were assessed with a VAS from 0 to 7. The mean evaluations of question 29 were 4.21/7 ± 0.71 in patients with MT and 4.78/7 ± 1.16 in patients without MT (p = 0.0045). The mean evaluations of question 30 were 4.47/7 ± 0.96 in patients with MT and 4.93/7 ± 1.3 in patients without MT (p = 0.0066). The Fig. 4 represents the evolution of Visual Analog Scale scores for food intake over time, according to MT status. Linear regression analysis revealed a non-significant decrease in mean VAS scores of 0.13 per Period (p = 0.08). The impact of MT status on VAS scores was also not significant (p = 0.41). However, employing a non-linear regression model with a second-degree polynomial highlighted a significant effect of the time period on food intake (p < 10 − 4 ), but the MT status remained not significant (p = 0.26). Figure 5 displays the evolution of responses to question#44 of the EORTC HN35 (“During the last week, did you have trouble with taste?”) over time according to MT status. Linear regression analysis revealed a significant increase in dysgeusia as a function of time period (0.05/Period, p = 0.046). Furthermore, the impact of MT status on dysgeusia was significant (p = 0.025). Using a non-linear regression model with a second-degree polynomial revealed a reinforced statistical significance of the impact of time period on dysgeusia (p < 10 − 4 ), with a maximum observed at Period 4 (i.e. the end of radiotherapy or radiochemotherapy), thereby further enhancing the significance of the regression (p < 10 − 4 ). DISCUSSION The incidence of metallic taste (MT) in our study, at 27.2%, closely aligns with the findings of McLaughlin’s series ( 2 ), which reported a 24% incidence, and our systematic literature review in the general population with cancer ( 8 ). Our study showed that HNC and their treatments have a general impact on nutritional status, evident through weight loss and worsened VAS scores for food intake. These findings are consistent with previous reports ( 2 – 7 ) and highlight the detrimental effect of HNC and its treatments on dysgeusia and quality of life (QoL). Interestingly, there was a discrepancy between the perception of MT and its impact. The perception of MT, assessed by intensity rating (Fig. 2 ) and in the EORTC HN35 question #44 (“During the last week, did you have trouble with taste?”, Fig. 4 ), was significantly more important in the MT group while there were no significant differences in VAS scores for food intake (Fig. 3 ) or weight. On the contrary, VAS recovered significantly more rapidly in the MT group. However, although it had no significant effect on nutritional indicators (food intake (VAS), weight), MT significantly affected overall health as indicated by question #29 of EORTC QLQ30 questionnaire. This emphasizes the specific and pronounced impact of MT on the sensory experience of taste, distinct from its effects on other aspects of nutritional status. This can be attributed to a contrast effect, where a higher intensity and earlier onset of metallic taste (MT) were associated with a quicker recovery, and/or to coping strategies in patients with MT. Our study also highlighted a temporal evolution of side effects, with a peak during the irradiation phase followed by a gradual recovery, a pattern commonly reported in the literature for various parameters including taste intensity tests ( 2 , 14 – 16 ), salivary flows ( 17 ), and QoL ( 18 ). Lilja et al. found a statistically significant correlation between taste disorders and QoL only at 3 months ( 19 ), i.e. at the end of the treatments, corresponding with the Period 5 of our study. The impact of HNC and their treatments on dysgeusia, and especially MT, is frequently underestimated in clinical practice, despite its strong and long-term effects ( 20 ). Nevertheless, patients often perceive these effects as "acceptable". In a qualitative study by Ganzer et al. ( 21 ), patients reported that they enjoyed eating, with eating becoming easier over time, despite minimizing the impact on their overall QoL as "the price to pay". Similarly, in an observational study examining the priorities and regrets of patients with HNC (30), caregivers (30), and carers (25) and their concordance, Gill et al. ( 22 ) reported that the top four priorities for all three groups were to be cured of cancer, to live as long as possible, to be pain-free, and to swallow normally. Notably, normal taste and smell ranked lowest among the concerns for the three groups. These findings are in line with the report of Lis et al. ( 23 ). It is important to acknowledge the limitations of our study, primarily stemming from the small population sample size. Indeed, motivating patients for extensive and repeated long testing sessions was challenging, resulting in a high attrition rate. This limitation underscores the need for larger-scale studies to further elucidate the complex interplay between MT, treatment outcomes, and patient-reported QoL in HNC populations. CONCLUSION Our study highlights the prevalence of metallic taste (MT) in head and neck cancer (HNC) patients, with an incidence of 27.2%, always observed during the treatment phase : (Periods 2 to 5 i.e. after surgery to after radiotherapy or radiochemotherapy; one patient still at Period 6, i.e. 3 months after the radiotherapy or radiochemotherapy). Importantly, MT significantly impacted the quality of life (QoL) associated with dysgeusia. While the impact of MT on food intake and weight loss was not statistically significant, this may be attributed to the small size of the population followed to one year after treatment. Future research efforts in this area are warranted to further investigate these findings and elucidate optimal strategies for addressing the challenges posed by MT in HNC patients. Such insights are crucial for enhancing the quality of care provided to this patient population. Declarations All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Guillaume Buiret, Chantal Septier and Hélène Brignot. The first draft of the manuscript was written by Guillaume Buiret and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Financial interests : The authors have no relevant financial or non-financial interests to disclose. Funding to report to this submission : This wok was supported by the Comités de la Drôme et de l’Ardèche de lutte contre le Cancer. Aknowledgements: to C.T. Molta, MD, for the English translation. References Defossez G, Le Guyader–Peyrou S, Uhry Z, Grosclaude P, Colonna M, Dantony E, et al. Estimations nationales de l’incidence et de la mortalité par cancer en France métropolitaine entre 1990 et 2018. Étude à partir des registres des cancers du réseau Francim 2019 [Available from: https://www.e-cancer.fr/content/download/266450/3759432/file/Synthese_Estimations%20nationales%20incidence%20et%20mortalite%20par%20cancer_juillet_2019.pdf . McLaughlin L. Taste dysfunction in head and neck cancer survivors. Oncology nursing forum. 2013;40(1):E4-13. McLaughlin L. Taste dysfunction and eating behaviors in survivors of head and neck cancer treatment. 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Treatment-related dysgeusia in head and neck cancer patients. Cancer Treat Rev. 2014;40(9):1106–17. Buiret G, Thomas-Danguin T, Feron G. Metallic taste prevalence in patients treated for cancer: a systematic literature review and meta-analysis. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. 2022;30(7):5691–702. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–76. Bjordal K, Hammerlid E, Ahlner-Elmqvist M, de Graeff A, Boysen M, Evensen JF, et al. Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. J Clin Oncol. 1999;17(3):1008–19. I I, Timmermans ER, Renken RJ, Ter Horst GJ, Reyners AK. 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Radiation-induced changes in taste acuity in cancer patients. Int J Radiat Oncol Biol Phys. 1978;4(7–8):663–70. Sapir E, Tao Y, Feng F, Samuels S, El Naqa I, Murdoch-Kinch CA, et al. Predictors of Dysgeusia in Patients With Oropharyngeal Cancer Treated With Chemotherapy and Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys. 2016;96(2):354–61. O'Neill M, Heron DE, Flickinger JC, Smith R, Ferris RL, Gibson M. Posttreatment quality-of-life assessment in patients with head and neck cancer treated with intensity-modulated radiation therapy. Am J Clin Oncol. 2011;34(5):478–82. Lilja M, Markkanen-Leppanen M, Viitasalo S, Saarilahti K, Lindford A, Lassus P, Makitie A. Olfactory and gustatory functions after free flap reconstruction and radiotherapy for oral and pharyngeal cancer: a prospective follow-up study. Eur Arch Otorhinolaryngol. 2018;275(4):959–66. Cohen J, Wakefield CE, Laing DG. Smell and Taste Disorders Resulting from Cancer and Chemotherapy. Current pharmaceutical design. 2016;22(15):2253–63. Ganzer H, Rothpletz-Puglia P, Byham-Gray L, Murphy BA, Touger-Decker R. The eating experience in long-term survivors of head and neck cancer: a mixed-methods study. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. 2015;23(11):3257–68. Gill SS, Frew J, Fry A, Adam J, Paleri V, Dobrowsky W, et al. Priorities for the head and neck cancer patient, their companion and members of the multidisciplinary team and decision regret. Clin Oncol (R Coll Radiol). 2011;23(8):518–24. List MA, Rutherford JL, Stracks J, Pauloski BR, Logemann JA, Lundy D, et al. Prioritizing treatment outcomes: head and neck cancer patients versus nonpatients. Head Neck. 2004;26(2):163–70. Additional Declarations No competing interests reported. Supplementary Files Annexes.pdf Cite Share Download PDF Status: Published Journal Publication published 11 Sep, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 16 Jul, 2024 Reviews received at journal 16 Jul, 2024 Reviews received at journal 12 Jul, 2024 Reviewers agreed at journal 07 Jul, 2024 Reviewers agreed at journal 06 Jul, 2024 Reviewers agreed at journal 06 Jul, 2024 Reviewers agreed at journal 04 Jul, 2024 Reviewers agreed at journal 04 Jul, 2024 Reviewers agreed at journal 04 Jul, 2024 Reviewers agreed at journal 04 Jul, 2024 Reviewers agreed at journal 03 Jul, 2024 Reviewers agreed at journal 02 Jul, 2024 Reviewers agreed at journal 01 Jul, 2024 Reviewers invited by journal 01 Jul, 2024 Editor assigned by journal 01 Jul, 2024 Submission checks completed at journal 23 May, 2024 First submitted to journal 22 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4462168","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":306157283,"identity":"2b5f6991-d5ac-4302-b803-65f4729fdf38","order_by":0,"name":"Guillaume Buiret","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYDACCQaGA0BKDsRgYCiACH4gQouBMUSLAViMcQYhLSCliQ1Ea5GP7jE8XFHxJ71/dgObxA8Dmzz+9gbG5go8WgzvnDE4eOaMQe6MOwfYJHsM0oolzhxgbDyDT8uMHIODjW0GuRsk8j8b8BgcTtwgkcD+sIGgln8G6QYSCcyGfwz+J26Qf8DYiE+LvARIS4NBAlAL42MegwNAWxjwazGQOVZwsOGYseGMG0AtMgbJiTPOJDbit2V28+aPDTVy8vwzEhgOvqmwS+xvP3wQvy0HMMUY8WkA2oJfehSMglEwCkYBEAAAA0FRMN3tZDUAAAAASUVORK5CYII=","orcid":"","institution":"Centre Hospitalier de Valence","correspondingAuthor":true,"prefix":"","firstName":"Guillaume","middleName":"","lastName":"Buiret","suffix":""},{"id":306157284,"identity":"a5111ede-a131-411d-92f8-de804bfe4265","order_by":1,"name":"Hélène Brignot","email":"","orcid":"","institution":"Centre des Sciences du Goût et de l'Alimentation","correspondingAuthor":false,"prefix":"","firstName":"Hélène","middleName":"","lastName":"Brignot","suffix":""},{"id":306157285,"identity":"2e2e4acd-f126-4334-8cd0-835b9a3db4dc","order_by":2,"name":"Chantal Septier","email":"","orcid":"","institution":"Centre des Sciences du Goût et de l'Alimentation","correspondingAuthor":false,"prefix":"","firstName":"Chantal","middleName":"","lastName":"Septier","suffix":""},{"id":306157286,"identity":"8762af11-9190-45ba-8bae-a8e8c34b2bb6","order_by":3,"name":"Thierry Thomas-Danguin","email":"","orcid":"","institution":"Centre des Sciences du Goût et de l'Alimentation","correspondingAuthor":false,"prefix":"","firstName":"Thierry","middleName":"","lastName":"Thomas-Danguin","suffix":""},{"id":306157287,"identity":"770318e3-61a4-4c18-874a-5ea99e625613","order_by":4,"name":"Gilles Féron","email":"","orcid":"","institution":"Centre des Sciences du Goût et de l'Alimentation","correspondingAuthor":false,"prefix":"","firstName":"Gilles","middleName":"","lastName":"Féron","suffix":""}],"badges":[],"createdAt":"2024-05-22 16:10:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4462168/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4462168/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00520-024-08854-z","type":"published","date":"2024-09-11T15:57:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58077164,"identity":"d67f95a1-3e86-481d-bb0a-f3df70fd8cb9","added_by":"auto","created_at":"2024-06-10 22:29:20","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":84978,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flowchart\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4462168/v1/e910668e2ec6bfcff0932e5c.jpg"},{"id":58076626,"identity":"e6e01786-4384-48f0-abaf-3ad69ba2ec4b","added_by":"auto","created_at":"2024-06-10 22:21:20","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46322,"visible":true,"origin":"","legend":"\u003cp\u003eevolution of MT intensity according to the patients who experienced it.\u003c/p\u003e\n\u003cp\u003ePeriods: 1: before any treatment; 2: after surgery if any; 3: in the middle of radiotherapy (if any);4: after radiotherapy (if any); 5: 3 months after treatment completion; 6: 6 months after treatment completion; 7: 9 months after treatment completion; 8: 12 months after treatment completion. No MT was reported after Period 6.\u003c/p\u003e","description":"","filename":"figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4462168/v1/2f44f53cc5a4cfc7219e8a6b.jpg"},{"id":58076627,"identity":"ff5424b2-58d3-4786-9d45-ef8c2ecdc42c","added_by":"auto","created_at":"2024-06-10 22:21:20","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":49247,"visible":true,"origin":"","legend":"\u003cp\u003eweight evolution according to Metallic Taste status\u003c/p\u003e\n\u003cp\u003eBlue = metallic taste, black = no metallic taste.\u003c/p\u003e\n\u003cp\u003ePeriods: 1: before any treatment; 2: after surgery if any; 3: in the middle of radiotherapy (if any);4: after radiotherapy (if any); 5: 3 months after treatment completion; 6: 6 months after treatment completion; 7: 9 months after treatment completion; 8: 12 months after treatment completion.\u003c/p\u003e","description":"","filename":"figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4462168/v1/ad83546827d7eb9f5f53a36d.jpg"},{"id":58076625,"identity":"1c5cd430-85d3-441f-891a-27004fcd889a","added_by":"auto","created_at":"2024-06-10 22:21:20","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":48476,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in Visual Analog Scale scores for food intake according to Metallic Taste status and Period.\u003c/p\u003e\n\u003cp\u003eBlue = metallic taste, black = no metallic taste\u003c/p\u003e\n\u003cp\u003ePeriods: 1: before any treatment; 2: after surgery if any; 3: in the middle of radiotherapy (if any);4: after radiotherapy (if any); 5: 3 months after treatment completion; 6: 6 months after treatment completion; 7: 9 months after treatment completion; 8: 12 months after treatment completion.\u003c/p\u003e","description":"","filename":"figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4462168/v1/7a49f1f17252683b4f97b580.jpg"},{"id":58076629,"identity":"1645095f-fc60-4a3b-bce9-853306354820","added_by":"auto","created_at":"2024-06-10 22:21:20","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":49638,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in EORTC HN35 question #44 (“During the last week, did you have trouble with taste?”) according to Metallic Taste status and time point.\u003c/p\u003e\n\u003cp\u003eBlue = metallic taste, black = no metallic taste.\u003c/p\u003e\n\u003cp\u003ePeriods: 1: before any treatment; 2: after surgery if any; 3: in the middle of radiotherapy (if any);4: after radiotherapy (if any); 5: 3 months after treatment completion; 6: 6 months after treatment completion; 7: 9 months after treatment completion; 8: 12 months after treatment completion.\u003c/p\u003e","description":"","filename":"figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4462168/v1/4b46a6bd54b90f87e7bd7807.jpg"},{"id":64619229,"identity":"23cd2be0-ab32-479f-85a4-c1fc56b3a48e","added_by":"auto","created_at":"2024-09-16 16:13:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":617907,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4462168/v1/8eaa83d6-e483-48f5-9301-6a48b9b0ddca.pdf"},{"id":58076630,"identity":"17ed5ee2-18a7-4e8c-a6ec-02dbaee25b13","added_by":"auto","created_at":"2024-06-10 22:21:21","extension":"pdf","order_by":9,"title":"","display":"","copyAsset":false,"role":"supplement","size":118321,"visible":true,"origin":"","legend":"","description":"","filename":"Annexes.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4462168/v1/a34fa3a05636883b0d93c8a1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Nutritional Impact of Metallic Taste in Head and Neck Cancer Patients: Explorations and Clinical Implications","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eHead and Neck Cancers (HNC) are one of the most common forms of cancer worldwide, ranking as the fifth most prevalent cancer type in France (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Apart from the medical challenges posed by this disease, patients with HNC face a unique set of symptoms and treatment-related complications, among which taste alterations hold significant importance. Their impact on nutritional status, food intake, and weight is important (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAmong these taste alterations, Metallic Taste (MT) proves to be one of the most disruptive symptoms, affecting patients' quality of life and their ability to maintain adequate nutrition. However little is reported on this symptom, including its incidence and impact.\u003c/p\u003e \u003cp\u003eThis taste alteration, characterized by a sensation of metal in the mouth and an unpleasant, persistent flavor, is frequently reported by HNC patients (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), slightly more than in the general cancerology population (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) despite there is no comparative study according to the type of cancer. The impact of MT extends beyond a mere sensory nuisance; it can have substantial consequences on food intake, oral hygiene, medication adherence, and, consequently, on disease progression and overall patient quality of life. Yet, despite its prevalence and clinical implications, MT remains relatively understudied and poorly understood in the context of HNC. This knowledge gap hinders the development of effective, targeted management strategies to alleviate this symptom, improve treatment compliance, and optimize the nutritional quality of patients.\u003c/p\u003e \u003cp\u003eThis study aims to address this gap by delving more deeply into the impact of MT in HNC patients, offering a comprehensive analysis and understanding of its implications and clinical significance.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eStudy population:\u003c/p\u003e \u003cp\u003eThe prospective study involved a cohort of 44 patients diagnosed with HNC. These patients were included at the onset of their cancer, before the occurrence of MT, and were followed up for one year, unless a recurrence or another cancer occurred. At the end of the study, patients were categorized into two distinct groups based on the presence or absence of MT as reported by the patients.\u003c/p\u003e \u003cp\u003eTesting:\u003c/p\u003e \u003cp\u003eThe population\u0026rsquo;s characteristics were assessed at the beginning of the study. Several questionnaires were administered to each patient at regular intervals: before any treatment; after surgery if any; midway and upon completion of radio(chemo)therapy if any; at 3-6-9 and 12 months. These assessments encompassed the EORTC QLQ30 (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and HN35 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) questionnaires to evaluate Quality of Life (QoL), a specific questionnaire to assess MT impact (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) in patients complaining about MT, measurement of weight, a Visual Analog Scale (VAS) to quantify food intake (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) (ranging from 0 for total eating abstention to 10 for normal eating).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis:\u003c/h2\u003e \u003cp\u003eThe threshold for statistical significance in this study was set at a p-value of \u0026lt;\u0026thinsp;0.05 for all conducted tests.\u003c/p\u003e \u003cp\u003ePopulation characteristics differences based on MT status were assessed using chi-squared tests for qualitative data and t-tests for continuous data.\u003c/p\u003e \u003cp\u003eAccording to Neyman and Pearson (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), non-crossing confidence intervals were indicative of statistical significance.\u003c/p\u003e \u003cp\u003eLinear and non-linear regressions were conducted on weight, the VAS data for food intake, and question #44 of the EORTC HN35 (\u0026ldquo;During the last week, did you have trouble with taste?\u0026rdquo;) concerning MT status.\u003c/p\u003e \u003cp\u003eThe statistical tests were performed using R software (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"http://www.therproject.com\" target=\"_blank\"\u003ewww.therproject.com\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.therproject.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e)\u003c/span\u003e v4.3.1. The packages prettyR, nlme, gplots, ggplot2, and patchwork were used.\u003c/p\u003e \u003cp\u003eEthical Considerations:\u003c/p\u003e \u003cp\u003e This study was performed in line with the principles of the Declaration of Helsinki and adhered strictly to the French ethical guidelines and principles, with all participating patients providing informed consent prior to their involvement. Approval for the study was granted by the CPP Est I, Dijon, France (#2017-A03641-52). Additionally, the study is registered on ClinicalTrials.gov (NCT03558789).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e44 patients were included and followed up for one year. The flowchart of the study is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e displays the demographic characteristics of the study population at inclusion according to the MT status. Patients were predominantly male, of middle age, and with advanced Tumor and Node stage. The treatment modalities were predominantly multimodal.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003estudied population characteristics at inclusion according to metallic taste status. MT: metallic taste\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo MT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex: males n(%)\u0026nbsp;; females n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (75%), 3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (78.1%), 7 (21.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age at diagnosis\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation n (%):\u003c/p\u003e \u003cp\u003eHypopharynx\u003c/p\u003e \u003cp\u003eLarynx\u003c/p\u003e \u003cp\u003eOropharynx\u003c/p\u003e \u003cp\u003eOral Cavity\u003c/p\u003e \u003cp\u003eUnknown primary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e1 (8.3%)\u003c/p\u003e \u003cp\u003e4 (33.3%)\u003c/p\u003e \u003cp\u003e5 (41.7%)\u003c/p\u003e \u003cp\u003e2 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (9.4%)\u003c/p\u003e \u003cp\u003e7 (21.9%)\u003c/p\u003e \u003cp\u003e10 (31.2%)\u003c/p\u003e \u003cp\u003e9 (28.1%)\u003c/p\u003e \u003cp\u003e3 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT stage n (%):\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003cp\u003e6 (50%)\u003c/p\u003e \u003cp\u003e1 (8.3%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e2 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (18.7%)\u003c/p\u003e \u003cp\u003e12 (37.5%)\u003c/p\u003e \u003cp\u003e7 (21.9%)\u003c/p\u003e \u003cp\u003e4 (12.5%)\u003c/p\u003e \u003cp\u003e3 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN stage n (%):\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e2a\u003c/p\u003e \u003cp\u003e2b\u003c/p\u003e \u003cp\u003e2c\u003c/p\u003e \u003cp\u003e3a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (33.3%)\u003c/p\u003e \u003cp\u003e4 (33.3%)\u003c/p\u003e \u003cp\u003e1 (8.3%)\u003c/p\u003e \u003cp\u003e2 (16.7%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e1 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (50%)\u003c/p\u003e \u003cp\u003e6 (18.7%)\u003c/p\u003e \u003cp\u003e3 (9.4%)\u003c/p\u003e \u003cp\u003e3 (9.4%)\u003c/p\u003e \u003cp\u003e2 (6.2%)\u003c/p\u003e \u003cp\u003e2 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking at inclusion n (%):\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eQuit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003cp\u003e6 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (50%)\u003c/p\u003e \u003cp\u003e2 (6.2%)\u003c/p\u003e \u003cp\u003e13 (40.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003cp\u003eWithdrawal of consent before treatment\u003c/p\u003e \u003cp\u003eChemotherapy, surgery, radiotherapy\u003c/p\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003cp\u003eSurgery, radiotherapy\u003c/p\u003e \u003cp\u003eSurgery, radiochemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e2 (16.7%)\u003c/p\u003e \u003cp\u003e7 (58.3%)\u003c/p\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (15.6%)\u003c/p\u003e \u003cp\u003e1 (3.1%)\u003c/p\u003e \u003cp\u003e12 (37.5%)\u003c/p\u003e \u003cp\u003e5 (15.6%)\u003c/p\u003e \u003cp\u003e9 (28.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the included patients, 12 complained of MT (27.2%), always during the treatment phase (periods 2 to 5, with one patient still complaining at period 6). There were no significant demographic characteristics differences at inclusion, between MT and no MT status.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e reports the most intense responses to the metallic taste-specific questionnaire, exclusively among patients who reported experiencing metallic taste (n\u0026thinsp;=\u0026thinsp;12). Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the evolution of MT intensity according to the patients who experienced it.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eImpact of Metallic Test as assessed by the specific metallic taste questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe MT is intense n (%)\u003c/p\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003cp\u003eA little\u003c/p\u003e \u003cp\u003eModerately\u003c/p\u003e \u003cp\u003eA lot\u003c/p\u003e \u003cp\u003eI don't know\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3%)\u003c/p\u003e \u003cp\u003e3 (20%)\u003c/p\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003cp\u003e6 (40%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe MT bothers me with food in general n (%)\u003c/p\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003cp\u003eA little\u003c/p\u003e \u003cp\u003eModerately\u003c/p\u003e \u003cp\u003eA lot\u003c/p\u003e \u003cp\u003eI don't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003cp\u003e7 (46.7%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe MT bothers me with only a few foods n (%)\u003c/p\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003cp\u003eA little\u003c/p\u003e \u003cp\u003eModerately\u003c/p\u003e \u003cp\u003eA lot\u003c/p\u003e \u003cp\u003eI don't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (28.6%)\u003c/p\u003e \u003cp\u003e3 (21.4%)\u003c/p\u003e \u003cp\u003e2 (14.3%)\u003c/p\u003e \u003cp\u003e4 (28.6%)\u003c/p\u003e \u003cp\u003e1 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe MT gets stronger when I eat n (%)\u003c/p\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003cp\u003eA little\u003c/p\u003e \u003cp\u003eModerately\u003c/p\u003e \u003cp\u003eA lot\u003c/p\u003e \u003cp\u003eI don't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (53.3%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e3 (20%)\u003c/p\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe MT is present all day long n (%)\u003c/p\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003cp\u003eA little\u003c/p\u003e \u003cp\u003eModerately\u003c/p\u003e \u003cp\u003eA lot\u003c/p\u003e \u003cp\u003eI don't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (33.3%)\u003c/p\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003cp\u003e6 (40%)\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you consider this MT to be the most negative aspect of your taste changes? n (%)\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eDon't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (28.6%)\u003c/p\u003e \u003cp\u003e8 (57.1%)\u003c/p\u003e \u003cp\u003e2 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow long have you had this metallic taste in your mouth? n (%)\u003c/p\u003e \u003cp\u003eLess than a week\u003c/p\u003e \u003cp\u003eBetween one week and one month\u003c/p\u003e \u003cp\u003eBetween one and three months\u003c/p\u003e \u003cp\u003eMore than three months\u003c/p\u003e \u003cp\u003eI can't answer this question\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3%)\u003c/p\u003e \u003cp\u003e5 (33.3%)\u003c/p\u003e \u003cp\u003e6 (40%)\u003c/p\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eMT: metallic taste\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e illustrates the evolution of weight over time according to MT status. On average, weight decreased by 0.68kg per Period (p\u0026thinsp;\u0026lt;\u0026thinsp;10\u003csup\u003e\u0026minus;\u0026thinsp;5\u003c/sup\u003e). However, The MT status did not significantly influence the evolution of weight (p\u0026thinsp;=\u0026thinsp;0.54).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn the the EORTC questionnaire, the questions 29 (\u0026ldquo;How would you rate your overall health during the past week?\u0026rdquo;) and 30 (\u0026ldquo;How would you rate your overall quality of life during the past week?\u0026rdquo;) were assessed with a VAS from 0 to 7. The mean evaluations of question 29 were 4.21/7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71 in patients with MT and 4.78/7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16 in patients without MT (p\u0026thinsp;=\u0026thinsp;0.0045). The mean evaluations of question 30 were 4.47/7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96 in patients with MT and 4.93/7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 in patients without MT (p\u0026thinsp;=\u0026thinsp;0.0066).\u003c/p\u003e \u003cp\u003eThe Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e represents the evolution of Visual Analog Scale scores for food intake over time, according to MT status. Linear regression analysis revealed a non-significant decrease in mean VAS scores of 0.13 per Period (p\u0026thinsp;=\u0026thinsp;0.08). The impact of MT status on VAS scores was also not significant (p\u0026thinsp;=\u0026thinsp;0.41). However, employing a non-linear regression model with a second-degree polynomial highlighted a significant effect of the time period on food intake (p\u0026thinsp;\u0026lt;\u0026thinsp;10\u003csup\u003e\u0026minus;\u0026thinsp;4\u003c/sup\u003e), but the MT status remained not significant (p\u0026thinsp;=\u0026thinsp;0.26).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e displays the evolution of responses to question#44 of the EORTC HN35 (\u0026ldquo;During the last week, did you have trouble with taste?\u0026rdquo;) over time according to MT status. Linear regression analysis revealed a significant increase in dysgeusia as a function of time period (0.05/Period, p\u0026thinsp;=\u0026thinsp;0.046). Furthermore, the impact of MT status on dysgeusia was significant (p\u0026thinsp;=\u0026thinsp;0.025). Using a non-linear regression model with a second-degree polynomial revealed a reinforced statistical significance of the impact of time period on dysgeusia (p\u0026thinsp;\u0026lt;\u0026thinsp;10\u003csup\u003e\u0026minus;\u0026thinsp;4\u003c/sup\u003e), with a maximum observed at Period 4 (i.e. the end of radiotherapy or radiochemotherapy), thereby further enhancing the significance of the regression (p\u0026thinsp;\u0026lt;\u0026thinsp;10\u003csup\u003e\u0026minus;\u0026thinsp;4\u003c/sup\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe incidence of metallic taste (MT) in our study, at 27.2%, closely aligns with the findings of McLaughlin\u0026rsquo;s series (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), which reported a 24% incidence, and our systematic literature review in the general population with cancer (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Our study showed that HNC and their treatments have a general impact on nutritional status, evident through weight loss and worsened VAS scores for food intake. These findings are consistent with previous reports (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and highlight the detrimental effect of HNC and its treatments on dysgeusia and quality of life (QoL). Interestingly, there was a discrepancy between the perception of MT and its impact. The perception of MT, assessed by intensity rating (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) and in the EORTC HN35 question #44 (\u0026ldquo;During the last week, did you have trouble with taste?\u0026rdquo;, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), was significantly more important in the MT group while there were no significant differences in VAS scores for food intake (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) or weight. On the contrary, VAS recovered significantly more rapidly in the MT group. However, although it had no significant effect on nutritional indicators (food intake (VAS), weight), MT significantly affected overall health as indicated by question #29 of EORTC QLQ30 questionnaire. This emphasizes the specific and pronounced impact of MT on the sensory experience of taste, distinct from its effects on other aspects of nutritional status. This can be attributed to a contrast effect, where a higher intensity and earlier onset of metallic taste (MT) were associated with a quicker recovery, and/or to coping strategies in patients with MT.\u003c/p\u003e \u003cp\u003eOur study also highlighted a temporal evolution of side effects, with a peak during the irradiation phase followed by a gradual recovery, a pattern commonly reported in the literature for various parameters including taste intensity tests (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), salivary flows (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and QoL (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Lilja et al. found a statistically significant correlation between taste disorders and QoL only at 3 months (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), i.e. at the end of the treatments, corresponding with the Period 5 of our study.\u003c/p\u003e \u003cp\u003eThe impact of HNC and their treatments on dysgeusia, and especially MT, is frequently underestimated in clinical practice, despite its strong and long-term effects (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Nevertheless, patients often perceive these effects as \"acceptable\". In a qualitative study by Ganzer et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), patients reported that they enjoyed eating, with eating becoming easier over time, despite minimizing the impact on their overall QoL as \"the price to pay\". Similarly, in an observational study examining the priorities and regrets of patients with HNC (30), caregivers (30), and carers (25) and their concordance, Gill et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) reported that the top four priorities for all three groups were to be cured of cancer, to live as long as possible, to be pain-free, and to swallow normally. Notably, normal taste and smell ranked lowest among the concerns for the three groups. These findings are in line with the report of Lis et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt is important to acknowledge the limitations of our study, primarily stemming from the small population sample size. Indeed, motivating patients for extensive and repeated long testing sessions was challenging, resulting in a high attrition rate. This limitation underscores the need for larger-scale studies to further elucidate the complex interplay between MT, treatment outcomes, and patient-reported QoL in HNC populations.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eOur study highlights the prevalence of metallic taste (MT) in head and neck cancer (HNC) patients, with an incidence of 27.2%, always observed during the treatment phase : (Periods 2 to 5 i.e. after surgery to after radiotherapy or radiochemotherapy; one patient still at Period 6, i.e. 3 months after the radiotherapy or radiochemotherapy). Importantly, MT significantly impacted the quality of life (QoL) associated with dysgeusia. While the impact of MT on food intake and weight loss was not statistically significant, this may be attributed to the small size of the population followed to one year after treatment. Future research efforts in this area are warranted to further investigate these findings and elucidate optimal strategies for addressing the challenges posed by MT in HNC patients. Such insights are crucial for enhancing the quality of care provided to this patient population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Guillaume Buiret, Chantal Septier and H\u0026eacute;l\u0026egrave;ne Brignot. The first draft of the manuscript was written by Guillaume Buiret and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFinancial interests\u003cem\u003e: \u003cem\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/em\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFunding to report to this submission : This wok was supported by the Comit\u0026eacute;s de la Dr\u0026ocirc;me et de l\u0026rsquo;Ard\u0026egrave;che de lutte contre le Cancer.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAknowledgements: to C.T. Molta, MD, for the English translation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDefossez G, Le Guyader\u0026ndash;Peyrou S, Uhry Z, Grosclaude P, Colonna M, Dantony E, et al. 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Oncology nursing forum. 2013;40(1):E4-13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcLaughlin L. Taste dysfunction and eating behaviors in survivors of head and neck cancer treatment. Medsurg nursing: official journal of the Academy of Medical-Surgical Nurses. 2014;23(3):165\u0026ndash;70, 84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRavasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck. 2005;27(8):659\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanchez-Lara K, Sosa-Sanchez R, Green-Renner D, Rodriguez C, Laviano A, Motola-Kuba D, Arrieta O. Influence of taste disorders on dietary behaviors in cancer patients under chemotherapy. Nutr J. 2010;9:15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShi Q, Mendoza TR, Gunn GB, Wang XS, Rosenthal DI, Cleeland CS. Using group-based trajectory modeling to examine heterogeneity of symptom burden in patients with head and neck cancer undergoing aggressive non-surgical therapy. Quality of life research: an international journal of quality of life aspects of treatment, care and rehabilitation. 2013;22(9):2331\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrune E, Dwivedi RC, Nutting CM, Harrington KJ. Treatment-related dysgeusia in head and neck cancer patients. Cancer Treat Rev. 2014;40(9):1106\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuiret G, Thomas-Danguin T, Feron G. Metallic taste prevalence in patients treated for cancer: a systematic literature review and meta-analysis. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. 2022;30(7):5691\u0026ndash;702.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBjordal K, Hammerlid E, Ahlner-Elmqvist M, de Graeff A, Boysen M, Evensen JF, et al. Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H\u0026amp;N35. J Clin Oncol. 1999;17(3):1008\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eI I, Timmermans ER, Renken RJ, Ter Horst GJ, Reyners AK. Metallic Taste in Cancer Patients Treated with Systemic Therapy: A Questionnaire-based Study. Nutrition and cancer. 2017;69(1):140\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuerdoux-Ninot E, Flori N, Janiszewski C, Vaille A, de Forges H, Raynard B, et al. Assessing dietary intake in accordance with guidelines: Useful correlations with an ingesta-Verbal/Visual Analogue Scale in medical oncology patients. Clin Nutr. 2019;38(4):1927\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeyman J, Pearson ES. On the problems of the most efficient tests of statistical hypotheses. Philosophical Transactions of the Royal Society of London. 1933;231A:289\u0026ndash;338.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsif M, Moore A, Yarom N, Popovtzer A. The effect of radiotherapy on taste sensation in head and neck cancer patients - a prospective study. Radiat Oncol. 2020;15(1):144.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaes A, Huygh I, Weltens C, Vandevelde G, Delaere P, Evers G, Van den Bogaert W. De Gustibus: time scale of loss and recovery of tastes caused by radiotherapy. Radiother Oncol. 2002;63(2):195\u0026ndash;201.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMossman KL, Henkin RI. Radiation-induced changes in taste acuity in cancer patients. Int J Radiat Oncol Biol Phys. 1978;4(7\u0026ndash;8):663\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSapir E, Tao Y, Feng F, Samuels S, El Naqa I, Murdoch-Kinch CA, et al. Predictors of Dysgeusia in Patients With Oropharyngeal Cancer Treated With Chemotherapy and Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys. 2016;96(2):354\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Neill M, Heron DE, Flickinger JC, Smith R, Ferris RL, Gibson M. Posttreatment quality-of-life assessment in patients with head and neck cancer treated with intensity-modulated radiation therapy. Am J Clin Oncol. 2011;34(5):478\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLilja M, Markkanen-Leppanen M, Viitasalo S, Saarilahti K, Lindford A, Lassus P, Makitie A. Olfactory and gustatory functions after free flap reconstruction and radiotherapy for oral and pharyngeal cancer: a prospective follow-up study. Eur Arch Otorhinolaryngol. 2018;275(4):959\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCohen J, Wakefield CE, Laing DG. Smell and Taste Disorders Resulting from Cancer and Chemotherapy. Current pharmaceutical design. 2016;22(15):2253\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGanzer H, Rothpletz-Puglia P, Byham-Gray L, Murphy BA, Touger-Decker R. The eating experience in long-term survivors of head and neck cancer: a mixed-methods study. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. 2015;23(11):3257\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGill SS, Frew J, Fry A, Adam J, Paleri V, Dobrowsky W, et al. Priorities for the head and neck cancer patient, their companion and members of the multidisciplinary team and decision regret. Clin Oncol (R Coll Radiol). 2011;23(8):518\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eList MA, Rutherford JL, Stracks J, Pauloski BR, Logemann JA, Lundy D, et al. Prioritizing treatment outcomes: head and neck cancer patients versus nonpatients. Head Neck. 2004;26(2):163\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"metallic taste, head and neck cancer, quality of life, dysgueusia, impact","lastPublishedDoi":"10.21203/rs.3.rs-4462168/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4462168/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePURPOSE: Metallic taste (MT) is frequently observed during head and neck cancer treatments, but very little is known about its impact on nutritional status. The aim of this study was to explore the impact of MT on the quality of life and nutritional status in patients with head and neck cancer expressing MT disorder.\u003c/p\u003e\n\u003cp\u003eMETHODS: Questionnaires on quality of life, MT, weight, and food intake were filled out by 44 patients with head and neck cancer before, during, and up to one year after their treatment. Patients were divided into two groups based on the occurrence of MT.\u003c/p\u003e\n\u003cp\u003eRESULTS: MT was commonly observed (27.2%), always during the treatment phase and mostly linked with radiotherapy or radiochemotherapy. MT intensity was moderate (40%) to high (26.7%). MT had a significant negative impact on QoL linked to dysgeusia (p=0.025). The negative impacts of MT on food intake and on weight were not significant, possibly due to a combination of sample size, dropouts, and duration of observation. Further research in this area could provide additional insights into how to better address the issue related to MT and enhance the quality of care provided to this patient population.\u003c/p\u003e\n\u003cp\u003eCONCLUSION: Metallic taste, experienced by 27.2% of head and neck patients, contributes to dysgeusia and results in a significant decline in quality of life.\u003c/p\u003e\n\u003cp\u003eClinicalTrials.gov trial registration number: NCT03558789\u003c/p\u003e","manuscriptTitle":"The Nutritional Impact of Metallic Taste in Head and Neck Cancer Patients: Explorations and Clinical Implications","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-10 22:21:15","doi":"10.21203/rs.3.rs-4462168/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-16T11:49:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-16T11:39:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-12T13:03:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"144146830621353951346000500438581064562","date":"2024-07-07T11:26:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318279967787828702522181456217287737022","date":"2024-07-06T17:27:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109287073195101891730674873724222545880","date":"2024-07-06T09:02:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"170319429047717556110936906158852242353","date":"2024-07-05T00:31:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50026912900341800160693377279054413398","date":"2024-07-04T11:35:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"228057206182891127650239467676975889772","date":"2024-07-04T10:29:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"101004047240583650357455196214538035907","date":"2024-07-04T05:04:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"23764967381541441997391827688543692596","date":"2024-07-03T15:20:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33100231287091999075953171308187878459","date":"2024-07-02T11:58:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164981645094943135428192165871404873441","date":"2024-07-01T14:28:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-01T14:21:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-01T14:07:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-24T02:50:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2024-05-22T16:09:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"8daf6c88-cdd5-402a-8168-a75710d08845","owner":[],"postedDate":"June 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-16T16:04:07+00:00","versionOfRecord":{"articleIdentity":"rs-4462168","link":"https://doi.org/10.1007/s00520-024-08854-z","journal":{"identity":"supportive-care-in-cancer","isVorOnly":false,"title":"Supportive Care in Cancer"},"publishedOn":"2024-09-11 15:57:58","publishedOnDateReadable":"September 11th, 2024"},"versionCreatedAt":"2024-06-10 22:21:15","video":"","vorDoi":"10.1007/s00520-024-08854-z","vorDoiUrl":"https://doi.org/10.1007/s00520-024-08854-z","workflowStages":[]},"version":"v1","identity":"rs-4462168","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4462168","identity":"rs-4462168","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}