Effects of Personalized Meals on Quality of Life in Adult Cancer Patients Who Experience Chemotherapy-Induced Taste Alterations

Effects of Personalized Meals on Quality of Life in Adult Cancer Patients Who Experience Chemotherapy-Induced Taste Alterations | 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 Effects of Personalized Meals on Quality of Life in Adult Cancer Patients Who Experience Chemotherapy-Induced Taste Alterations Bart Geurden, Lobke Van den Wijngaert, Peter Boeren, Edwig Goossens, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4668933/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: This study aimed to assess whether the application of selective taste steering (STS) to personalize bread and soup recipes had any effect on (1) quality of life, (2) the palatability of these meals, and (3) food intake in patients with chemotherapy-induced taste alterations (CiTA). Methods: This multicentre controlled before-and-after study included two groups of adult cancer outpatients who all experienced CiTA. Both groups received dietary advice as standard care. In one group, STS was applied to bread and soups at home for three months. Both groups were compared using validated scales and a structured questionnaire, at the start of the study and after 1 and 3 months of follow-up. Results: A total of 19.3% of all patients (N=160) had a normal nutritional status (MNA-SF score >11). Compared to that in the intervention group, the number of patients with undernutrition (MNA-SF score <8) in the control group increased after 1 month (p <0.001) and 3 months (p <0.001) of follow-up. Compared to those in the control group, the 'fatigue', 'nausea/vomiting' and ‘diarrhoea’ symptom scores in the intervantion group decreased significantly (p <0.001, <0.001 and 0.002, respectively). In the intervention group, the score for 'appetite loss' decreased after 1 month (p <0.001) and remained low after 3 months of follow-up (p <0.001). Conclusion: STS translates into a significant decrease in the loss of appetite and an increase in palatability and intake of personalized bread and soups. These findings are clinically relevant and support this innovative approach to malnutrition in cancer patients. Chemotherapy Taste Quality of life Loss of appetite Food intake Malnourishment Figures Figure 1 Figure 2 INTRODUCTION Today, 1 in 20 Europeans face a cancer diagnosis in their lifetime, and the number of people living with a cancer diagnosis in the European Union (EU) is increasing, partly due to the ageing population [ 1 ]. The number of new cancer cases in Europe increased by 2.3% in 2022 compared to that in 2020, reaching 2.74 million. Similarly, the number of cancer deaths increased by 2.4% in 2022 compared to 2020, according to the European Commission’s estimates published in the European Cancer Information System (ECIS) [ 2 ]. A large proportion of these patients are likely to benefit from chemotherapy. Between 2018 and 2040, the number of patients requiring at least one course of chemotherapy will increase annually from 9.8 million to 15.0 million, a relative increase of 53% [ 3 ]. Both cancer itself and various chemotherapy drugs cause intended and unintended metabolic and physiological changes that, when combined, have a detrimental effect on a patient's nutritional status [ 4 , 5 ]. Cancer patients have a high prevalence of undernutrition, fluctuating between 25% and 80% [ 6 – 8 ], which significantly reduces the effectiveness of treatment methods as well as the patients’ overall chances of survival. The most common patient-reported chemotherapy-induced side effects that have been shown to have a direct impact on food intake and nutritional status include taste alterations, fatigue, nausea and vomiting, dysgeusia, and loss of appetite [ 9 – 11 ]. Identifying these side effects in patients, even if they are mild, and treating them in a timely manner can improve nutritional and emotional states, quality of life and the ultimate effect of cancer treatment [ 12 ]. Therefore, an individualized food care plan is essential for the treatment of cancer patients. In addition, there is a growing consensus to individualize food care plans for cancer patients and to better integrate approaches to the nutritional problems experienced by cancer patients [ 13 ]. A promising example of such an innovative integrated approach is selective taste steering (STS) [ 7 , 14 , 15 ]. STS is an intervention in which a chef gastro-engineering performs a specific taste analysis in which they process all relevant food-related data obtained by oncologists and dietitians into personalized meal recipes that can easily be prepared by cancer patients or their family caregivers at home. The aims of this study were to (1) assess whether the application of STS to personalize bread and soup recipes had any effect on quality of life, including symptoms such as fatigue, nausea and vomiting, dysgeusia, and loss of appetite; (2) assess whether the application of STS improved the palatability of these meals despite the presence of chemotherapy-induced taste alterations; and (3) determine whether the application of STS had any influence on the amount of food intake of the participating adult cancer outpatients. PATIENTS AND METHODS Study design In this multicentre controlled before-and-after study, two groups of adult cancer outpatients identified based on common chemotherapy-induced taste alterations were included. For all patients in both groups, dietary advice from a dietician in the event of dysgeusia served as the gold standard for meal preparation and consumption at home. In one group, STS was also applied to personalize recipes for bread and soups prepared at home. Both groups were followed for three months, and the outcomes of interest were recorded. Patient population For both groups, adult (aged > 18 years) cancer outpatients were eligible if they reported taste alterations after receiving at least one intravenous chemotherapy session and if they provided written informed consent. The type of cancer or chemotherapy was not considered for inclusion or exclusion in either group. However, patients with head-neck cancer, grade 2 mucositis, and chewing or swallowing problems and patients receiving a combination of radiotherapy and chemotherapy were excluded to avoid bias in normal food intake. We included the group of control patients from another study that was carried out in two hospitals by final-year dietetics students under the supervision of a member of our research team. The same research protocol was used, but instead of applying STS the students validated an additional measurement scale (not applicable in the present study). Therefore, randomization depended on the hospital to which a patient was admitted and treated. All eight hospitals in this study are located in the same geographic region, which had 6,774,807 inhabitants in 2023. Objectives and outcomes The main objectives of this study were to assess whether the application of STS to bread and soup recipes had any effect on quality of life, including symptoms such as fatigue, nausea and vomiting, dysgeusia, and loss of appetite, which are all included in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30 version 3.0). Furthermore, we aimed to assess whether the application of STS improved the palatability of these meals despite the presence of chemotherapy-induced taste alterations. Finally, we aimed to determine whether the application of STS had any influence on the amount of food intake of the participating adult cancer outpatients. Palatability and intake were measured after applying STS for one month and for three months using an online survey scored on a 7-point Likert scale, where a score of 1 point corresponds to the least desirable outcome and a score of 7 points corresponds to the best outcome. Methods In both groups, all self-reported taste alterations were first assessed using the Chemotherapy Induced Taste Alteration Scale (CITAS). All patients in both groups then received usual care (the gold standard), which meant that they ate regular meals that they were used to at home and accounted for any dietary advice if needed. A chef gastro-engineering (CGE) [ 16 ] from the research team carried out an on-site taste assessment for each consecutive patient in the intervention group using an O-box [ 14 ] (Fig. 1 ). The O-box test is used to assess human gustatory and olfactory sensitivity together with somatosensory functions of taste. In a sense, it is comparable to the well-known Sniffin sticks test [ 17 ], but instead of smelling different scents, an individual has to taste different foods. To this end, the O-box contains 21 carefully selected natural foods: some foods are provided with a pasta and others are provided in a liquid form, all in well-defined and reproducible concentrations [ 14 ]. These food products can be used in a multitude of concentrations and combinations on a taste stick to determine an individual’s minimum and maximum threshold values within which each taste is experienced as tasty or not. To avoid interrater variations, all taste assessments in this study were executed by one CGE, a trained member of the research staff. The individual taste assessment results, together with data about documented food allergies and patient-reported food likes and dislikes as well as any prescriptions from the treating oncologist, dietician and/or speech therapist, are used in algorithms by the CGE to generate personalized recipes. In this case, STSwas used to personalize recipes for bread and soup meals that could easily be prepared at home by the patients or their family caregivers. All the recipes were provided to the included patients online within 48 hours. To address any practical difficulties in applying these recipes at home, a helpdesk was available to assist the patients or informal caregivers if needed. The data from both cohorts were collected from March 2022–December 2023 at three different times—at baseline (t0), after one month (t1) and after three months (t2) of follow-up by using validated tools, including the MNA-SF [ 18 ], the CITAS [ 19 ], and the EORTC QLQ-C30 (version 3.0) [ 20 ]. For the patients in the intervention group, an additional questionnaire was used to monitor the application of STS and to assess food intake at t1 and t2. The MNA-SF comprises six questions and simple measurements: anthropometric measurements (body mass index, weight loss); a global assessment (mobility); and a dietary questionnaire and subjective assessment (food intake, neuropsychological problems, acute disease). A total MNA-SF score 11 points indicates malnutrition, risk of malnutrition, and no malnutrition, respectively [ 21 , 22 ]. The CITAS enables valid, reliable measurement of specific symptoms of chemotherapy-induced taste alterations. The CITAS, which comprises 18 items and 4 subscales scored using a 5-point Likert-type scale, was first developed by Kano and Kanda [ 19 ]. The first subscale, ‘Decline in Basic Taste’, concerns the condition of sensing bitter, sweet, salty, sour, and umami. The second subscale, ‘Discomfort’, concerns the relationships among taste alterations and nausea and vomiting, alterations in the sense of smell, difficulty eating spicy/oily/meaty meals, and reduced appetite. The third subscale concerns individuals’ experiences of phantogeusia and parageusia, and the fourth subscale, ‘General taste alterations’, concerns individuals’ experiences of ageusia, cacogeusia, and hypogeusia. For assessments using the CITAS, the scores for each subscale are evaluated rather than the total scale score [ 19 ]. The subscale scores are obtained by dividing the number of items by the sum of the scores of those items. The maximum possible score is 5 points, whereas the minimum possible score is 1 point. An increase in the score indicates that the intensity of taste alterations and discomfort has also increased. The EORTC QLQ-C30 (version 3.0) [ 20 ] is composed of both multi-item scales and single-item measures, including five functional scales, three symptom scales, a global health status/quality of life scale, and six single items. Each of the multi-item scales includes a different set of items, and no item is present in more than one scale. The data are analysed using the scoring procedures in the EORTC QLQ-C30 Scoring Manual [ 23 ]. All of the scales and single-item measures have scores ranging from 0 to 100 points. A high score for a functional scale represents a high/healthy level of functioning. A high score for the global health status/quality of life scale represents a high quality of life. Finally, a high score for a symptom scale/item represents a high level of symptomatology/problems. The palatability and daily intake of soups and bread were assessed for all patients in the intervention group. Both factors were evaluated for seven days: during the week before t1 and during the week before t2. To this end, a Likert-type scale ranging from 1 to 7 was used. A palatability score of 1 corresponds to an 'extremely bad taste', and a score of 7 corresponds to an 'excellent taste'. A daily intake score of 1 corresponds to 'I ate much less than normal', and a score of 7 corresponds to 'I ate much more than normal'. The average scores for palatability and daily intake are used to measure the effect of STS on these two factors. Statistical analyses All the statistical analyses were performed using SPSS version 29 (IBM Corp, Armonk, New York). A p value less than 0.05 was considered to indicate statistical significance. Descriptive statistics are provided for sociodemographic and clinical factors, as well as the main study variables, and are reported as the means and standard deviations for continuous variables and as numbers and proportions for dichotomous variables. Finally, a hierarchical regression analysis, controlling for age, sex and nutritional status at baseline, was performed to identify multivariate relationships between the interventions and outcomes. RESULTS Patient characteristics A total of 160 patients were included, of whom 74 (46.2%) were in the intervention group and 86 (53.75%) were in the control group (Table 1 ). The majority of the patients (n = 160) at t0 were female (56.8%). A total of 51.1% (n = 44) of the patients in the intervention group and 51.3% (n = 38) of the patients in the control group were older than 65 years at t0. Table 1 General, taste-related and nutritional data at baseline and after 1 and 3 months of follow up Characteristics Control group Intervention group t 0 N = 74 t 1 N = 70 t 2 N = 52 t 0 N = 86 t 1 N = 59 t 2 N = 55 Mean (SD) Mean (SD) p Mean (SD) p Mean (SD) Mean (SD) p Mean (SD) p General characteristics Male: N (%) 33 (44.6) 31 (44.3) 21 (40.4) 36 (41.9) 23 (39.0) 21 (38.2) Female: N (%) 41 (55.4) 39 (55.7) 31 (59.6) 50 (58.1) 36 (61.0) 34 (61.8) Age (years) 64.8 (9.40) 64.8 (9.48) 64.8 (10.11) 63.6 (13.11) 62.7 (13.60) 63.2 (13.56) Height (m) 1.72 (.051) 1.72 (.063) Weight (kg) 69.2 (10.84) 67.8 (9.83) < .001 65.0 (9.15) < .001 70.0 (14.88) 68.9 (13.8) < .001 67.3 (13.49) < .001 Body Mass Index 23.41 (3.73) 22.89 (3.44) < .001 21.98 (3.32) < .001 23.70 (4.94) 23.16 (4.44) < .001 22.62 (4.28) < .001 CITAS Decline in basic taste 2.61 (.91) 2.57 (.82) .954 2.43 (.73) .042 2.56 (.80) 2.50 (.75) .084 2.45 (.68) .002 Discomfort 2.40 (.73) 2.60 (.64) .043 2.53 (.66) .289 2.61 (.70) 2.55 (.68) .571 2.54 (.73) .787 Phantogeusia and parageusia 1.68 (.52) 1.66 (.60) .838 1.71 (.65) .812 1.76 (.65) 1.77 (.64) .249 1.72 (.70) .215 General taste alterations 3.29 (.61) 3.21 (.66) .355 3.23 (.64) .175 3.03 (.71) 3.09 (.68) .386 2.99 (.66) .030 MNA-Short Form Total scores 9.08 (2.58) 9.14 (1.94) < .001 8.02 (2.24) < .001 8.27 (2.43) 8.85 (1.91) .027 8.31 (2.48) .884 N (%) N (%) N (%) N (%) N (%) N (%) Total score 11 (no malnutrition) 27 (36.5) 11 (14.9) 3 (4.1) 4 (4.7) 4 (4.7) 2 (2.3) t0: baseline; t1: 1-month follow-up; t2: 3-month follow-up; SD: standard deviation; CITAS: Chemotherapy-Induced Taste Alteration Scale MNA-Short Form: Mini Nutritional Assessment-Short Form At t2, 27 (16.8%) men and 26 (16.2%) women dropped out of the study. The dropout of 31 patients (36.0%) in the intervention group was mainly due to no longer being motivated or being too ill to complete the online survey at the designated times (23.2%). Patients in the intervention group who were hospitalized for a longer period (4.7%) could therefore no longer receive STS. During the study, 8.1% of the participants in the intervention group and 9.4% of the participants in the control group died. Furthermore, the dropout of 22 patients (29.7%) in the control group was due to the fact that they were no longer motivated and were too ill to participate in the online study at the indicated times (20.3%). Chemotherapy-induced taste alterations All reported taste alterations were confirmed, as all participants (N = 160) had a score > 1 point on the CITAS. This means that all participants experienced this particular side effect of chemotherapy to a greater or lesser extent and that they all could benefit from STS. In both groups, there were very few significant differences in the CITAS scores after 1 or 3 months of follow-up compared to the baseline scores. The control group showed a significant (p .042) improvement in the perception of basic flavours after 3 months of follow-up compared to the scores at baseline. This effect was even more pronounced in the intervention group (p .002). There also appeared to be a significant (p .043) decrease in discomfort due to taste alterations in the control group at t1. However, that effect was no longer significant at t2. Finally, we observed a significant (p .030) improvement in the intervention group in terms of "general taste alterations". In both groups, the CITAS scores fluctuated over time but nevertheless indicated persistent and measurable taste alterations. This means that STS remains a useful self-care intervention, at least during this period. Prevalence of (the risk of) malnutrition A total of 31 (19.37%) patients (N = 160) had a normal nutritional status (MNA-SF score > 11 points) at t0. The prevalence of being at increased risk for malnutrition at t0 (MNA-SF score of 8–11 points) was high in the intervention group (64%) and in the control group (55.4%). During follow-up, an increasing number of patients became malnourished (MNA-SF score < 8 points). Compared to the intervention group, in the control group, this increase was significantly greater at both t1 (p < 0.001) and t2 (p < 0.001). Quality of life According to EORTC QLQ-C30 scores, there was no significant difference in the reported perception of global health status or overall quality of life between the two groups at t1 or t2 (see Table 2 ) compared to t0. Regarding the functional scales, the physical functioning as well as the role and social functioning scores all decreased significantly at t1 in the control group (p .002; p .011 and p .003, respectively), while there were no significant differences in these functional scale scores at t1 and t2 in the intervention group. A high score for a functional scale represents a high or healthy level of functioning. Table 2 Quality of life at baseline (t0) and after 1 (t1) and 3 months (t2) of follow-up, according to the EORTC QLQ-C30 scale (version 3.0) EORTC QLQ-C30 scales Control group Intervention group t 0 N = 74 t 1 N = 70 t 2 N = 52 t 0 N = 86 t 1 N = 59 t 2 N = 46 Mean (SD) Mean (SD) p Mean (SD) p Mean (SD) Mean (SD) p Mean (SD) p Global Health Status Global health status/QOL 53.21 (15.68) 52.61 (15.25) .807 52.04 (17.36) .760 54.88 (15.99) 53.81 (15.88) .251 53.39 (16.37) .223 Functional scales Physical functioning 61.35 (21.39) 56.89 (18.62) .002 53.40 (17.51) .108 54.88 (24.58) 58.08 (22.21) .260 56.39 (19.07) .851 Role functioning 47.28 (26.74) 45.00 (23.17) .011 40.09 (21.97) .006 46.76 (26.66) 49.53 (28.04) .690 50.80 (25.39) .928 Emotional functioning 71.36 (19.44) 73.37 (16.97) .039 69.38 (18.17) .771 69.12 (20.99) 69.80 (22.62) .620 72.39 (23.34) .340 Cognitive functioning 77.76 (18.37) 78.63 (17.76) .182 79.26 (15.70) .272 66.24 (24.80) 66.42 (23.13) .120 67.76 (22.99) .207 Social functioning 65.89 (23.16) 60.89 (19.82) .003 63.32 (19.73) .138 62.01 (24.13) 61.08 (24.24) .362 61.24 (23.55) .535 Symptom scales Fatigue 59.01 (22.11) 69.03 (17.02) < .001 72.57 (16.84) < .001 59.87 (22.94) 58.61 (21.69) .373 57.70 (22.02) .278 Nausea and vomiting 20.15 (22.64) 24.60 (21.58) .002 27.26 (20.71) < .001 15.63 (20.94) 16.05 (18.34) .623 15.96 (18.37) .479 Pain 28.30 (24.07) 29.87 (23.09) .024 29.21 (23.02) .032 26.47 (25.34) 29.02 (23.36) .043 29.74 (25.15) .104 Dyspnoea 24.12 (29.67) 22.66 (26.75) .257 24.91 (24.13) .988 27.71 (32.93) 21.85 (27.91) .072 24.41 (27.39) .514 Insomnia 39.42 (37.60) 41.63 (33.34) .086 36.19 (30.69) .476 37.40 (38.10) 36.47 (34.71) .692 30.96 (32.42) .131 Appetite loss 72.68 (27.02) 71.06 (25.07) .810 77.72 (26.28) .269 73.78 (30.11) 25.19 (27.68) < .001 27.26 (27.21) < .001 Constipation 16.51 (25.22) 16.97 (21.57) .647 16.81 (21.09) .779 23.44 (29.97) 21.83 (26.48) .435 23.67 (27.53) .872 Diarrhoea 11.59 (23.45) 16.03 (23.66) .001 21.17 (23.41) .002 14.21 (26.11) 13.42 (24.60) .709 10.07 (23.02) .295 Financial difficulties 17.84 (22.64) 20.27 (21.97) .013 21.17 (23.41) .133 24.95 (25.81) 20.71 (25.24) .326 19.37 (22.62) .538 SD: standard deviation; EORTC QLQ-C30: European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 Regarding the symptom scales, some significant and clinically relevant differences were detected. Compared to those in the control group, the 'fatigue' and 'nausea/vomiting' symptom scores decreased significantly in the intervention group (p < 0.001), meaning a lower level of symptomatology in these participants The same was true for the diarrhoea symptom score (p .002). The most striking difference occurred for the 'appetite loss' symptom score. This symptom score was high in the control group (between 71 and 78 points) and did not significantly change at t1 (p .810) or t2 (p .296). In the intervention group, on the other hand, the score for 'appetite loss' decreased significantly at t1 (p < 0.001) and remained significantly lower at t2 (p < 0.001). This means that the appetite increased quickly after the application of STS and that this effect also continued over time. Furthermore, hierarchical regression analysis (Table 3 ) revealed that the use of STS for bread and meal recipes strongly decreased appetite loss. After controlling for age, sex and loss of appetite at t0, STS continued to have a strong positive influence (β= − .69, p < .001) on appetite even after 3 months and explained 47% of the variance in the outcome variable. Table 3 Evolution of the effect on “loss of appetite” over 3 months under the influence of STS EORTC QLQ-C30 Appetite loss at 3 months ∆R2 β Sign Block 1: Demographics 0.001 n.s. Sex -0.01 Age -0.03 Block 2 : Appetite loss at baseline 0.001 n.s. EORTC QLQ-C30 Symptom scale Appetite loss 0.01 Block 3 : Intervention 0.49*** STS: Control (1) versus Intervention (2) -0.69 *** R 2 0.49 Adj R2 model 0.47 *** Palatability and intake of bread and soups Figure 2 shows the average scores of palatability and the daily intake of soups and bread by patients for whom STS was applied at home. Both scores were determined at t0 (N = 86), during the week before T1 (N = 59) and during the week before T2 (N = 46). DISCUSSION This study investigated the effects of the application of STS to bread and soup recipes for adult cancer outpatients experiencing CiTA. We demonstrated significant positive effects of STS on factors that disturb normal food intake, such as fatigue, nausea/vomiting, dysgeusia, and loss of appetite. Palatability and daily food intake also increased significantly when STS was applied. These results are important in the context of the general well-being of these seriously ill patients. Moreover, these results are also clinically relevant since they concern the improvement of factors that are well-known serious risk factors for malnutrition and deterioration due to cancer cachexia. Taste and taste alterations vary greatly from person to person. The most common identification tests used to assess gustatory and olfactory function are the taste strip test and the scratch and sniff test [ 24 ]. These tests focus on gustatory and olfactory functions [ 25 – 28 ], as they are the principal chemosensory systems in humans. However, the trigeminal somatosensory system also plays a fundamental role in the overall flavour perception of food and beverages [ 29 – 31 ]. Most odourants also stimulate the trigeminal nerve [ 32 ]. Moreover, all chemosensory functions (orthonasal and retronasal olfactory, gustatory, and trigeminal functions) are correlated with each other [ 33 ]. Chemotherapy influences these sensory functions and their mutual connections. Regarding STS, the intention is not to cure any such CiTA; STS is not applied to a patient but to meals and is intended to achieve adequate food intake, despite any taste alterations. That is why CITAS scores will always remain > 1 points, regardless of whether STS is applied. However, correctly applied STS can improve the palatability of meals for cancer patients despite alterations in taste. It is known that taste alterations can differ depending on the type of tumour and associated chemotherapy [ 34 , 35 ]. We did not consider these possible differences to be important for the purpose of this study. Experiencing a taste alteration that led to an increased CITAS score (> 1 point) was regarded as a core criterion for participation in the present study. The current state of knowledge regarding taste alterations in supporting cancer patients describes a wide variety of treatment options [ 36 ]. However, the heterogeneity of the existing studies leads to difficulties in the interpretation and analysis of the available evidence and in formulating recommendations [ 36 ]. Therefore, treatment tools available for clinicians to manage taste alterations are limited and are often based on personal clinical experience [ 37 – 40 ]. Currently, the gold standard in the care of the cancer patients is advice from an oncologist or a dietitian about the use or avoidance of certain ingredients in meals at home. In addition, patients may also inform themselves about taste problems and meal preparations through the national or international websites of renowned cancer organizations. The CITAS score not only shows the presence of taste alterations but also differs among individuals. It is therefore logical to map taste alterations at an individual level to base the meals on a measured individual taste profile. In the current approach to chemotherapy-induced taste alterations, there is no structured use of taste assessments at the individual level. Professional care provision is therefore limited to general and 'one size fits all' nutritional advice. The effects may therefore be due to coincidence and are not guaranteed to be useful for individual patients. Such an approach to CiTA is assessed as poorly by cancer patients themselves [ 41 ] and can certainly be improved. STS aims to contribute to this need for improved practice. To implement and anchor STS in practice, however, numerous obstacles still have to be overcome. STS requires thorough multidisciplinary anamnesis, including the mapping of all residual sensory functions of an individual patient, by a well-trained health worker with professional gastrological knowledge, preferably a CGE [ 16 ]. CGEs are preferred because they are able to combine extensive knowledge of ingredients and cooking techniques with all data from multidisciplinary anamnesis and O-box assessments to shape appropriate and meaningful personalized meals. However, making patient nutrition-related data from oncologists, nurses, dietitians, or speech therapists available to CGEs is not easy in the current organization of health care. In particular, legislation on privacy and medical information makes the work of CGEs more difficult. An innovative and efficient approach to taste problems, or any altered food intake with a negative impact on personal health and well-being, increases the importance of a highly educated chef as an equal professional partner in a care team [ 42 ]. This provides a bigger picture of effective food and nutrition care delivery in health care, with chefs becoming a potential part of an integrated food and nutrition care delivery model. Finally, the use of STS is currently limited to home care. The application of STS to hospitalized cancer patients is not obvious since most hospitals employ external caterers. These companies lack the necessary knowledge, skills and means to provide meals tailored to the specific needs of individual patients. Moreover, there is no direct communication between these companies and local care staff. This situation will increasingly jeopardize the quality of institutional healthcare, including care for hospitalized cancer patients, as evidence-based research suggests that food and nutrition should become a cornerstone in future institutional healthcare delivery [ 43 ]. CONCLUSION This study demonstrated that STS strongly decreases the loss of appetite and increases the palatability and intake of bread and soups despite chemotherapy-induced taste alterations in adult cancer outpatients. Compared to those in the intervention group, the physical functioning, role and social functioning scores, as well as the 'fatigue', 'nausea/vomiting' and ’diarrhoea’ symptom scores, deteriorated significantly in the control group. The clinical relevance of these results can hardly be underestimated given the effect they may have on nutritional status and cancer treatment itself. Further research into the application of appropriate and relevant STS in larger populations is still needed to confirm these effects and to encourage structural implementation and upscaling. Declarations Funding This research received a grant from BMS (Bristol Myers Squibb), Boehringer, Eli Lilly Benelux, and Servier. The authors are very grateful for this generous support. Competing interests All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Ethical approval The ethics committee of the Antwerp University Hospital acted as the Central Ethical Committee and approved the study protocol in February 2022 (Belgian registration number: B3002021000271). The study was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Consent to participate All participants provided their written consent prior to participating in this study. Consent for publish Not applicable. Data availability The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Center for Research and Innovation in Gastrology and Primary Food Care. Code availability Not applicable. Authors’ contribution All authors contributed to the study conception and design. Bart Geurden, Pieter Vandecandelaere, Lobke Van den Wijngaert and Edwig Goossens prepared all material and questionnaires. Data collection were performed by Lobke Van den Wijngaert, Peter Boeren and Edwig Goossens. Formal analysis was performed by Jef Adriaenssens and Bart Geurden. Pieter Vandecandelaere and Edwig Goossens achieved funding acquisition The first draft of the manuscript was written by Bart Geurden and Jef Adriaenssens. All authors commented on previous versions of the manuscript, and all authors read and approved the final manuscript. References De Angelis R, Demuru E, Baili P et al (2024) Complete cancer prevalence in Europe in 2020 by disease duration and country (EUROCARE-6): A population-based study. Lancet Oncol 25:293–307. https://doi.org/10.1016/s1470-2045(23)00646-0 ECIS - European Cancer Information System. From https://ecis.jrc.ec.europa.eu, accessed on 11/03/2024 Wilson BE, Jacob S, Yap ML, Ferlay J, Bray F, Barton MB (2019) Estimates of global chemotherapy demands and corresponding physician workforce requirements for 2018 and 2040: A population-based study. Lancet Oncol 20:769–780. https://doi.org/10.1016/s1470-2045(19)30163-9 van Soom T, El Bakkali S, Gebruers N, Verbelen H, Tjalma W, van Breda E (2020) The effects of chemotherapy on energy metabolic aspects in cancer patients: A systematic review. Clin Nutr 39:1863–1877. https://doi.org/10.1016/j.clnu.2019.07.028 Anand U, Dey A, Chandel AKS et al (2023) Cancer chemotherapy and beyond: Current status, drug candidates, associated risks and progress in targeted therapeutics. Genes Dis 10:1367–1401. https://doi.org/10.1016/j.gendis.2022.02.007 Muscaritoli M, Lucia S, Farcomeni A et al (2017) Prevalence of malnutrition in patients at first medical oncology visit: The PreMiO study. Oncotarget 8:79884–79896. https://doi.org/10.18632/oncotarget.20168 Drareni K, Dougkas A, Lusson H, Vansteene D, Giboreau A, Bensafi M (2023) Flavor enhancement as a strategy to improve food liking in cancer patients with taste and smell alterations. Clin Nutr Open Sci 47:53–63. https://doi.org/10.1016/j.nutos.2022.11.009 Rasschaert M, Vandecandelaere P, Marechal S, D'Hondt R, Vulsteke C, Mailleux M, De Roock W, van Erps J, Himpe U, De Man M, Mertens G, Ysebaert D (2024) Malnutrition prevalence in cancer patients in Belgium: The ONCOCARE study. Support Care Cancer 32:135. https://doi.org/10.1007/s00520-024-08324-6 Altun İ, Sonkaya A (2018) The most common side effects experienced by patients were receiving first cycle of chemotherapy. Iran J Public Health 47:1218–1219 Katta B, Vijayakumar C, Dutta S, Dubashi B, Ramakrishnaiah VPN (2023) The incidence and severity of patient-reported side effects of chemotherapy in routine clinical care: A prospective observational study. Cureus 15:e38301. https://doi.org/10.7759/cureus.38301 Pellegrini M, Merlo FD, Agnello E, Monge T, Devecchi A, Casalone V, Montemurro F, Ghigo E, Sapino A, Bo S (2023) Dysgeusia in patients with breast cancer treated with chemotherapy-a narrative review. Nutrients 15:226. https://doi.org/10.3390/nu15010226 Adamczyk D, Maison D, Lignou S, Oloyede OO, Clegg M, Methven L, Fairfield C, Gosney M, Hernando MJ, Amézaga J, Caro M, Tueros I (2024) The role of food during oncology treatment: Perspectives of cancer patients, caregivers and healthcare professionals. Support Care Cancer 32:303. https://doi.org/10.1007/s00520-024-08469-4 Kiss N, Symons K, Hewitt J, Davis H, Ting C, Lee A, Boltong A, Tucker RM, Tan SY (2021) Taste function in adults undergoing cancer radiotherapy or chemotherapy, and implications for nutrition management: A systematic review. J Acad Nutr Diet 121:278–304. https://doi.org/10.1016/j.jand.2020.08.014 Corremans M, Verroeye A, Wijngaert L, Goossens E, Vlaemynck G (2021) Selective taste management: A selfcare intervention for cancer outpatients suffering chemotherapy-induced dysgeusia. Int J Cancer Treat 4:19–25. https://doi.org/10.21203/rs.3.rs-321953/v1 Corremans M, Goossens E, Adriaenssens J, Mortelmans D, Geurden B (2022) A qualitative study about cancer outpatients' experiences with selective taste control of bread as a self-care intervention. Nurs Open 9:2683–2689. https://doi.org/10.1002/nop2.967 Winters M, Wagner V, Patalano R et al (2022) Chefs in future integrated healthcare - current state and innovation needs: A first overview of the NECTAR project (aN Eu curriculum for chef gasTro-engineering in primary food care). Int J Integr Care 22:7. https://doi.org/10.5334/ijic.6436 Wolfensberger M, Schnieper I, Welge-Lüssen A (2000) Sniffin'sticks: A new olfactory test battery. Acta Otolaryngol 120:303–306. https://doi.org/10.1080/000164800750001134 Kaiser MJ, Bauer JM, Ramsch C et al (2009) Validation of the mini nutritional assessment short-form (MNA-SF): A practical tool for identification of nutritional status. J Nutr Health Aging 13:782–788. https://doi.org/10.1007/s12603-009-0214-7 Kano T, Kanda K (2013) Development and validation of a chemotherapy-induced taste alteration scale. Oncol Nurs Forum 40:E79–E85. https://doi.org/10.1188/13.onf.e79-e85 Aaronson NK, Ahmedzai S, Bergman B et al (1993) 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 85:365–376. https://doi.org/10.1093/jnci/85.5.365 Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL (1999) The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 15:116–122. https://doi.org/10.1016/s0899-9007(98)00171-3 Sarikaya D, Halil M, Kuyumcu ME, Kilic MK, Yesil Y, Kara O, Ozturk S, Gungor E, Karabulut E, Yavuz BB, Cankurtaran M, Ariogul S (2015) Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Arch Gerontol Geriatr 61:56–60. https://doi.org/10.1016/j.archger.2015.04.006 Fayers P, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A (2001) EORTC QLQ-C30 scoring manual. European Organisation for Research and Treatment of Cancer, Brussels, Belgium Walliczek U, Negoias S, Hähner A, Hummel T (2016) Assessment of chemosensory function using "sniffin' sticks", taste strips, taste sprays, and retronasal olfactory tests. Curr Pharm Des 22:2245–2252. https://doi.org/10.2174/1381612822666160216150625 Talavera K, Yasumatsu K, Yoshida R, Margolskee RF, Voets T, Ninomiya Y, Nilius B (2008) The taste transduction channel TRPM5 is a locus for bitter-sweet taste interactions. FASEB J 22:1343–1355. https://doi.org/10.1096/fj.07-9591com Foster SR, Roura E, Thomas WG (2014) Extrasensory perception: Odorant and taste receptors beyond the nose and mouth. Pharmacol Ther 142:41–61. https://doi.org/10.1016/j.pharmthera.2013.11.004 Roper SD (2015) The taste of table salt. Pflugers Arch 467:457–463. https://doi.org/10.1007/s00424-014-1683-z Simon SA, Gutierrez R. TRP Channels at the Periphery of the Taste and Trigeminal Systems. In: Emir TLR, editor. Neurobiology of TRP Channels. Boca Raton (FL): CRC Press/Taylor & Francis; 2017. Chapter 7. PMID: 29356478. Small DM, Prescott J (2005) Odor/taste integration and the perception of flavor. Exp Brain Res 166:345–357. https://doi.org/10.1007/s00221-005-2376-9 Viana F (2011) Chemosensory properties of the trigeminal system. ACS Chem Neurosci 2:38–50. https://doi.org/10.1021/cn100102c Carstens E (2016) Overview of chemesthesis with a look to the future. In: McDonald ST, Bolliet DA, Hayes JE (eds) Chemesthesis. Wiley, Hoboken, NJ, pp. 268–285 Frasnelli J, Schuster B, Hummel T (2007) Interactions between olfaction and the trigeminal system: What can be learned from olfactory loss. Cereb Cortex 17:2268–2275. https://doi.org/10.1093/cercor/bhl135 Hernandez AK, Walke A, Haehner A, Cuevas M, Hummel T (2023) Correlations between gustatory, trigeminal, and olfactory functions and nasal airflow. Eur Arch Otorhinolaryngol 280:4101–4109. https://doi.org/10.1007/s00405-023-07962-6 Hovan AJ, Williams PM, Stevenson-Moore P, Wahlin YB, Ohrn KE, Elting LS, Spijkervet FK, Brennan MT, Dysgeusia Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO) (2010) A systematic review of dysgeusia induced by cancer therapies. Support Care Cancer 18:1081–1087. https://doi.org/10.1007/s00520-010-0902-1 Webber TB, Marra D, Puntoni M et al (2021) Patient-versus physician-reported outcomes in a low-dose tamoxifen trial in noninvasive breast cancer. Breast J 27:817–823. https://doi.org/10.1111/tbj.14296 Sevryugin O, Kasvis P, Vigano M, Vigano A (2021) Taste and smell disturbances in cancer patients: A scoping review of available treatments. Support Care Cancer 29:49–66. https://doi.org/10.1007/s00520-020-05609-4 Thorne T, Olson K, Wismer W (2015) A state-of-the-art review of the management and treatment of taste and smell alterations in adult oncology patients. Support Care Cancer 23:2843–2851. https://doi.org/10.1007/s00520-015-2827-1 Doty RL (2019) Treatments for smell and taste disorders: A critical review. Handb Clin Neurol 164:455–479. https://doi.org/10.1016/b978-0-444-63855-7.00025-3 Spencer AS, da Silva Dias D, Capelas ML, Pimentel F, Santos T, Neves PM, Mäkitie A, Ravasco P (2021) Managing severe dysgeusia and dysosmia in lung cancer patients: A systematic scoping review. Front Oncol 11:774081. https://doi.org/10.3389/fonc.2021.774081 Galaniha LT, Nolden AA (2023) Taste loss in cancer patients: Clinicians' perceptions of educational materials and diagnostic tools. Support Care Cancer 31:349. https://doi.org/10.1007/s00520-023-07794-4 Geurden B, Adriaenssens J (2023) How do adult cancer patients rate the current multidisciplinaryapproach to their chemotherapy induced taste disorders? Int J Cancer Treat 6:1–8 Nichani S, Fitterman N, Lukela M, Crocker J (2017) The society of hospital medicine. 3.23 team approach and multidisciplinary care. J Hosp Med 12:S82. https://doi.org/10.12788/jhm.2998 World Health Organization (2019) Nutrition in universal health coverage. World Health Organization, Geneva Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-4668933","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":340416138,"identity":"fdd20646-1c05-4c6e-97d4-0db782fab345","order_by":0,"name":"Bart Geurden","email":"data:image/png;base64,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","orcid":"","institution":"University of Antwerp","correspondingAuthor":true,"prefix":"","firstName":"Bart","middleName":"","lastName":"Geurden","suffix":""},{"id":340416139,"identity":"cbc7a6fc-ba10-49ca-a188-934581d5b203","order_by":1,"name":"Lobke Van den Wijngaert","email":"","orcid":"","institution":"Center for Gastrology and Primary Food Care","correspondingAuthor":false,"prefix":"","firstName":"Lobke","middleName":"Van den","lastName":"Wijngaert","suffix":""},{"id":340416140,"identity":"ee903578-fdbe-45a5-9994-41b8dc51f068","order_by":2,"name":"Peter Boeren","email":"","orcid":"","institution":"Center for Gastrology and Primary Food Care","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"","lastName":"Boeren","suffix":""},{"id":340416141,"identity":"9269f335-5953-4773-8619-0acc88bcee32","order_by":3,"name":"Edwig Goossens","email":"","orcid":"","institution":"Center for Gastrology and Primary Food Care","correspondingAuthor":false,"prefix":"","firstName":"Edwig","middleName":"","lastName":"Goossens","suffix":""},{"id":340416142,"identity":"edf007a5-27e6-45d4-8458-a88501696505","order_by":4,"name":"Jef Adriaenssens","email":"","orcid":"","institution":"Belgian Healthcare Knowledge Center (KCE)","correspondingAuthor":false,"prefix":"","firstName":"Jef","middleName":"","lastName":"Adriaenssens","suffix":""},{"id":340416143,"identity":"1d860b2f-4a23-4a26-b278-f8de184b9528","order_by":5,"name":"Pieter Vandecandelaere","email":"","orcid":"","institution":"AZ Delta","correspondingAuthor":false,"prefix":"","firstName":"Pieter","middleName":"","lastName":"Vandecandelaere","suffix":""}],"badges":[],"createdAt":"2024-07-01 14:56:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4668933/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4668933/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62628110,"identity":"5871a323-6587-4db3-af1f-db83231d4088","added_by":"auto","created_at":"2024-08-16 15:38:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":644184,"visible":true,"origin":"","legend":"\u003cp\u003eThe O-box\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4668933/v1/f2488d634e8f2e6bd55544ee.png"},{"id":62628108,"identity":"65b08ca5-a2e7-416e-b8e2-d6efc7b47d3c","added_by":"auto","created_at":"2024-08-16 15:38:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":39354,"visible":true,"origin":"","legend":"\u003cp\u003ePalatability and intake of bread and soups at t0 and after initiating STS at t1 and t2\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4668933/v1/d02787c05ec1c0752b63b32f.png"},{"id":64965352,"identity":"df40e852-b3d6-4610-8012-19fc92f0a41d","added_by":"auto","created_at":"2024-09-21 04:16:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1763562,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4668933/v1/34f103cb-5d2e-4967-81d4-11b15192d9c8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of Personalized Meals on Quality of Life in Adult Cancer Patients Who Experience Chemotherapy-Induced Taste Alterations","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eToday, 1 in 20 Europeans face a cancer diagnosis in their lifetime, and the number of people living with a cancer diagnosis in the European Union (EU) is increasing, partly due to the ageing population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The number of new cancer cases in Europe increased by 2.3% in 2022 compared to that in 2020, reaching 2.74\u0026nbsp;million. Similarly, the number of cancer deaths increased by 2.4% in 2022 compared to 2020, according to the European Commission\u0026rsquo;s estimates published in the European Cancer Information System (ECIS) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A large proportion of these patients are likely to benefit from chemotherapy. Between 2018 and 2040, the number of patients requiring at least one course of chemotherapy will increase annually from 9.8\u0026nbsp;million to 15.0\u0026nbsp;million, a relative increase of 53% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBoth cancer itself and various chemotherapy drugs cause intended and unintended metabolic and physiological changes that, when combined, have a detrimental effect on a patient's nutritional status [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Cancer patients have a high prevalence of undernutrition, fluctuating between 25% and 80% [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], which significantly reduces the effectiveness of treatment methods as well as the patients\u0026rsquo; overall chances of survival. The most common patient-reported chemotherapy-induced side effects that have been shown to have a direct impact on food intake and nutritional status include taste alterations, fatigue, nausea and vomiting, dysgeusia, and loss of appetite [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Identifying these side effects in patients, even if they are mild, and treating them in a timely manner can improve nutritional and emotional states, quality of life and the ultimate effect of cancer treatment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, an individualized food care plan is essential for the treatment of cancer patients. In addition, there is a growing consensus to individualize food care plans for cancer patients and to better integrate approaches to the nutritional problems experienced by cancer patients [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA promising example of such an innovative integrated approach is selective taste steering (STS) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. STS is an intervention in which a chef gastro-engineering performs a specific taste analysis in which they process all relevant food-related data obtained by oncologists and dietitians into personalized meal recipes that can easily be prepared by cancer patients or their family caregivers at home.\u003c/p\u003e \u003cp\u003eThe aims of this study were to (1) assess whether the application of STS to personalize bread and soup recipes had any effect on quality of life, including symptoms such as fatigue, nausea and vomiting, dysgeusia, and loss of appetite; (2) assess whether the application of STS improved the palatability of these meals despite the presence of chemotherapy-induced taste alterations; and (3) determine whether the application of STS had any influence on the amount of food intake of the participating adult cancer outpatients.\u003c/p\u003e"},{"header":"PATIENTS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eIn this multicentre controlled before-and-after study, two groups of adult cancer outpatients identified based on common chemotherapy-induced taste alterations were included. For all patients in both groups, dietary advice from a dietician in the event of dysgeusia served as the gold standard for meal preparation and consumption at home. In one group, STS was also applied to personalize recipes for bread and soups prepared at home. Both groups were followed for three months, and the outcomes of interest were recorded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePatient population\u003c/h2\u003e \u003cp\u003eFor both groups, adult (aged\u0026thinsp;\u0026gt;\u0026thinsp;18 years) cancer outpatients were eligible if they reported taste alterations after receiving at least one intravenous chemotherapy session and if they provided written informed consent. The type of cancer or chemotherapy was not considered for inclusion or exclusion in either group. However, patients with head-neck cancer, grade 2 mucositis, and chewing or swallowing problems and patients receiving a combination of radiotherapy and chemotherapy were excluded to avoid bias in normal food intake.\u003c/p\u003e \u003cp\u003eWe included the group of control patients from another study that was carried out in two hospitals by final-year dietetics students under the supervision of a member of our research team. The same research protocol was used, but instead of applying STS the students validated an additional measurement scale (not applicable in the present study). Therefore, randomization depended on the hospital to which a patient was admitted and treated. All eight hospitals in this study are located in the same geographic region, which had 6,774,807 inhabitants in 2023.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eObjectives and outcomes\u003c/h3\u003e\n\u003cp\u003eThe main objectives of this study were to assess whether the application of STS to bread and soup recipes had any effect on quality of life, including symptoms such as fatigue, nausea and vomiting, dysgeusia, and loss of appetite, which are all included in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30 version 3.0). Furthermore, we aimed to assess whether the application of STS improved the palatability of these meals despite the presence of chemotherapy-induced taste alterations. Finally, we aimed to determine whether the application of STS had any influence on the amount of food intake of the participating adult cancer outpatients. Palatability and intake were measured after applying STS for one month and for three months using an online survey scored on a 7-point Likert scale, where a score of 1 point corresponds to the least desirable outcome and a score of 7 points corresponds to the best outcome.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn both groups, all self-reported taste alterations were first assessed using the Chemotherapy Induced Taste Alteration Scale (CITAS). All patients in both groups then received usual care (the gold standard), which meant that they ate regular meals that they were used to at home and accounted for any dietary advice if needed.\u003c/p\u003e \u003cp\u003eA chef gastro-engineering (CGE) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] from the research team carried out an on-site taste assessment for each consecutive patient in the intervention group using an O-box [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe O-box test is used to assess human gustatory and olfactory sensitivity together with somatosensory functions of taste. In a sense, it is comparable to the well-known Sniffin sticks test [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], but instead of smelling different scents, an individual has to taste different foods. To this end, the O-box contains 21 carefully selected natural foods: some foods are provided with a pasta and others are provided in a liquid form, all in well-defined and reproducible concentrations [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These food products can be used in a multitude of concentrations and combinations on a taste stick to determine an individual\u0026rsquo;s minimum and maximum threshold values within which each taste is experienced as tasty or not. To avoid interrater variations, all taste assessments in this study were executed by one CGE, a trained member of the research staff. The individual taste assessment results, together with data about documented food allergies and patient-reported food likes and dislikes as well as any prescriptions from the treating oncologist, dietician and/or speech therapist, are used in algorithms by the CGE to generate personalized recipes. In this case, STSwas used to personalize recipes for bread and soup meals that could easily be prepared at home by the patients or their family caregivers. All the recipes were provided to the included patients online within 48 hours. To address any practical difficulties in applying these recipes at home, a helpdesk was available to assist the patients or informal caregivers if needed.\u003c/p\u003e \u003cp\u003eThe data from both cohorts were collected from March 2022\u0026ndash;December 2023 at three different times\u0026mdash;at baseline (t0), after one month (t1) and after three months (t2) of follow-up by using validated tools, including the MNA-SF [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], the CITAS [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], and the EORTC QLQ-C30 (version 3.0) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. For the patients in the intervention group, an additional questionnaire was used to monitor the application of STS and to assess food intake at t1 and t2.\u003c/p\u003e \u003cp\u003eThe MNA-SF comprises six questions and simple measurements: anthropometric measurements (body mass index, weight loss); a global assessment (mobility); and a dietary questionnaire and subjective assessment (food intake, neuropsychological problems, acute disease). A total MNA-SF score\u0026thinsp;\u0026lt;\u0026thinsp;8, 8\u0026ndash;11, and \u0026gt;\u0026thinsp;11 points indicates malnutrition, risk of malnutrition, and no malnutrition, respectively [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe CITAS enables valid, reliable measurement of specific symptoms of chemotherapy-induced taste alterations. The CITAS, which comprises 18 items and 4 subscales scored using a 5-point Likert-type scale, was first developed by Kano and Kanda [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The first subscale, \u0026lsquo;Decline in Basic Taste\u0026rsquo;, concerns the condition of sensing bitter, sweet, salty, sour, and umami. The second subscale, \u0026lsquo;Discomfort\u0026rsquo;, concerns the relationships among taste alterations and nausea and vomiting, alterations in the sense of smell, difficulty eating spicy/oily/meaty meals, and reduced appetite. The third subscale concerns individuals\u0026rsquo; experiences of phantogeusia and parageusia, and the fourth subscale, \u0026lsquo;General taste alterations\u0026rsquo;, concerns individuals\u0026rsquo; experiences of ageusia, cacogeusia, and hypogeusia. For assessments using the CITAS, the scores for each subscale are evaluated rather than the total scale score [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The subscale scores are obtained by dividing the number of items by the sum of the scores of those items. The maximum possible score is 5 points, whereas the minimum possible score is 1 point. An increase in the score indicates that the intensity of taste alterations and discomfort has also increased.\u003c/p\u003e \u003cp\u003eThe EORTC QLQ-C30 (version 3.0) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] is composed of both multi-item scales and single-item measures, including five functional scales, three symptom scales, a global health status/quality of life scale, and six single items. Each of the multi-item scales includes a different set of items, and no item is present in more than one scale. The data are analysed using the scoring procedures in the EORTC QLQ-C30 Scoring Manual [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. All of the scales and single-item measures have scores ranging from 0 to 100 points. A high score for a functional scale represents a high/healthy level of functioning. A high score for the global health status/quality of life scale represents a high quality of life. Finally, a high score for a symptom scale/item represents a high level of symptomatology/problems.\u003c/p\u003e \u003cp\u003eThe palatability and daily intake of soups and bread were assessed for all patients in the intervention group. Both factors were evaluated for seven days: during the week before t1 and during the week before t2. To this end, a Likert-type scale ranging from 1 to 7 was used. A palatability score of 1 corresponds to an 'extremely bad taste', and a score of 7 corresponds to an 'excellent taste'. A daily intake score of 1 corresponds to 'I ate much less than normal', and a score of 7 corresponds to 'I ate much more than normal'. The average scores for palatability and daily intake are used to measure the effect of STS on these two factors.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eAll the statistical analyses were performed using SPSS version 29 (IBM Corp, Armonk, New York). A p value less than 0.05 was considered to indicate statistical significance. Descriptive statistics are provided for sociodemographic and clinical factors, as well as the main study variables, and are reported as the means and standard deviations for continuous variables and as numbers and proportions for dichotomous variables. Finally, a hierarchical regression analysis, controlling for age, sex and nutritional status at baseline, was performed to identify multivariate relationships between the interventions and outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003eA total of 160 patients were included, of whom 74 (46.2%) were in the intervention group and 86 (53.75%) were in the control group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The majority of the patients (n\u0026thinsp;=\u0026thinsp;160) at t0 were female (56.8%). A total of 51.1% (n\u0026thinsp;=\u0026thinsp;44) of the patients in the intervention group and 51.3% (n\u0026thinsp;=\u0026thinsp;38) of the patients in the control group were older than 65 years at t0.\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\u003eGeneral, taste-related and nutritional data at baseline and after 1 and 3 months of follow up\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\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=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c11\" namest=\"c7\"\u003e \u003cp\u003eIntervention group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003et 0\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;74\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003et 1\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;70\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et 2\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;52\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003et 0\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;86\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003et 1\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;59\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003et 2\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;55\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\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\u003e\u003cb\u003eGeneral characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale: N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (44.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36 (41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23 (39.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale: N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (55.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (55.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (59.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50 (58.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e36 (61.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e34 (61.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.8 (9.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.8 (9.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64.8 (10.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e63.6 (13.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62.7 (13.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e63.2 (13.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.72 (.051)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.72 (.063)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69.2 (10.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.8 (9.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65.0 (9.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e70.0 (14.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e68.9 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e67.3 (13.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.41 (3.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.89 (3.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.98 (3.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.70 (4.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.16 (4.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e22.62 (4.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCITAS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecline in basic taste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.61 (.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.57 (.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.43 (.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.56 (.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.50 (.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.45 (.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.40 (.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.60 (.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.53 (.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.61 (.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.55 (.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.54 (.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.787\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhantogeusia and parageusia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.68 (.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.66 (.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.71 (.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.76 (.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.77 (.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.72 (.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.215\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral taste alterations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.29 (.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.21 (.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.23 (.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.03 (.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.09 (.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.99 (.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMNA-Short Form\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.08 (2.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.14 (1.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.02 (2.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.27 (2.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.85 (1.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8.31 (2.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.884\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score\u0026thinsp;\u0026lt;\u0026thinsp;8 (malnourished)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18 (20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score of 8\u0026ndash;11 (at risk)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (55.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (63.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (29.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e55 (64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e39 (45.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e35 (40.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score\u0026thinsp;\u0026gt;\u0026thinsp;11 (no malnutrition)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003et0: baseline; t1: 1-month follow-up; t2: 3-month follow-up; SD: standard deviation; CITAS: Chemotherapy-Induced Taste Alteration Scale\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eMNA-Short Form: Mini Nutritional Assessment-Short Form\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAt t2, 27 (16.8%) men and 26 (16.2%) women dropped out of the study. The dropout of 31 patients (36.0%) in the intervention group was mainly due to no longer being motivated or being too ill to complete the online survey at the designated times (23.2%). Patients in the intervention group who were hospitalized for a longer period (4.7%) could therefore no longer receive STS. During the study, 8.1% of the participants in the intervention group and 9.4% of the participants in the control group died. Furthermore, the dropout of 22 patients (29.7%) in the control group was due to the fact that they were no longer motivated and were too ill to participate in the online study at the indicated times (20.3%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eChemotherapy-induced taste alterations\u003c/h2\u003e \u003cp\u003eAll reported taste alterations were confirmed, as all participants (N\u0026thinsp;=\u0026thinsp;160) had a score\u0026thinsp;\u0026gt;\u0026thinsp;1 point on the CITAS. This means that all participants experienced this particular side effect of chemotherapy to a greater or lesser extent and that they all could benefit from STS. In both groups, there were very few significant differences in the CITAS scores after 1 or 3 months of follow-up compared to the baseline scores. The control group showed a significant (p .042) improvement in the perception of basic flavours after 3 months of follow-up compared to the scores at baseline. This effect was even more pronounced in the intervention group (p .002). There also appeared to be a significant (p .043) decrease in discomfort due to taste alterations in the control group at t1. However, that effect was no longer significant at t2. Finally, we observed a significant (p .030) improvement in the intervention group in terms of \"general taste alterations\". In both groups, the CITAS scores fluctuated over time but nevertheless indicated persistent and measurable taste alterations. This means that STS remains a useful self-care intervention, at least during this period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of (the risk of) malnutrition\u003c/h2\u003e \u003cp\u003eA total of 31 (19.37%) patients (N\u0026thinsp;=\u0026thinsp;160) had a normal nutritional status (MNA-SF score\u0026thinsp;\u0026gt;\u0026thinsp;11 points) at t0. The prevalence of being at increased risk for malnutrition at t0 (MNA-SF score of 8\u0026ndash;11 points) was high in the intervention group (64%) and in the control group (55.4%). During follow-up, an increasing number of patients became malnourished (MNA-SF score\u0026thinsp;\u0026lt;\u0026thinsp;8 points). Compared to the intervention group, in the control group, this increase was significantly greater at both t1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and t2 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eQuality of life\u003c/h2\u003e \u003cp\u003eAccording to EORTC QLQ-C30 scores, there was no significant difference in the reported perception of global health status or overall quality of life between the two groups at t1 or t2 (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) compared to t0. Regarding the functional scales, the physical functioning as well as the role and social functioning scores all decreased significantly at t1 in the control group (p .002; p .011 and p .003, respectively), while there were no significant differences in these functional scale scores at t1 and t2 in the intervention group. A high score for a functional scale represents a high or healthy level of functioning.\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\u003eQuality of life at baseline (t0) and after 1 (t1) and 3 months (t2) of follow-up, according to the EORTC QLQ-C30 scale (version 3.0)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEORTC QLQ-C30 scales\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c11\" namest=\"c7\"\u003e \u003cp\u003eIntervention group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003et 0\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;74\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003et 1\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;70\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et 2\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;52\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003et 0\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;86\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003et 1\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;59\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003et 2\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;46\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\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\u003e\u003cb\u003eGlobal Health Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlobal health status/QOL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53.21 (15.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.61 (15.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e52.04 (17.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.760\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e54.88 (15.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e53.81 (15.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e53.39 (16.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.223\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFunctional scales\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61.35 (21.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56.89 (18.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e53.40 (17.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e54.88 (24.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e58.08 (22.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e56.39 (19.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.851\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRole functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47.28 (26.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.00 (23.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40.09 (21.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e46.76 (26.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e49.53 (28.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.690\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e50.80 (25.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.928\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71.36 (19.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.37 (16.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69.38 (18.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e69.12 (20.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e69.80 (22.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e72.39 (23.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.340\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77.76 (18.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78.63 (17.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e79.26 (15.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e66.24 (24.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e66.42 (23.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e67.76 (22.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.207\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65.89 (23.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.89 (19.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e63.32 (19.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e62.01 (24.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e61.08 (24.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e61.24 (23.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.535\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSymptom scales\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59.01 (22.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.03 (17.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e72.57 (16.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e59.87 (22.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e58.61 (21.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e57.70 (22.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.278\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea and vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20.15 (22.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.60 (21.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27.26 (20.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e15.63 (20.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e16.05 (18.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e15.96 (18.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.479\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28.30 (24.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.87 (23.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e29.21 (23.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e26.47 (25.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e29.02 (23.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e29.74 (25.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnoea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.12 (29.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.66 (26.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24.91 (24.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.988\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e27.71 (32.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e21.85 (27.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e24.41 (27.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.514\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsomnia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39.42 (37.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.63 (33.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e36.19 (30.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e37.40 (38.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e36.47 (34.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e30.96 (32.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppetite loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e72.68 (27.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.06 (25.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77.72 (26.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e73.78 (30.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e25.19 (27.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e27.26 (27.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.51 (25.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.97 (21.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.81 (21.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.779\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e23.44 (29.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e21.83 (26.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.435\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e23.67 (27.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.872\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiarrhoea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.59 (23.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.03 (23.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21.17 (23.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e14.21 (26.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e13.42 (24.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e10.07 (23.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.295\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinancial difficulties\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17.84 (22.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.27 (21.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21.17 (23.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e24.95 (25.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e20.71 (25.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e19.37 (22.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.538\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eSD: standard deviation; EORTC QLQ-C30: European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding the symptom scales, some significant and clinically relevant differences were detected. Compared to those in the control group, the 'fatigue' and 'nausea/vomiting' symptom scores decreased significantly in the intervention group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), meaning a lower level of symptomatology in these participants The same was true for the diarrhoea symptom score (p .002). The most striking difference occurred for the 'appetite loss' symptom score. This symptom score was high in the control group (between 71 and 78 points) and did not significantly change at t1 (p .810) or t2 (p .296). In the intervention group, on the other hand, the score for 'appetite loss' decreased significantly at t1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and remained significantly lower at t2 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This means that the appetite increased quickly after the application of STS and that this effect also continued over time.\u003c/p\u003e \u003cp\u003eFurthermore, hierarchical regression analysis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) revealed that the use of STS for bread and meal recipes strongly decreased appetite loss. After controlling for age, sex and loss of appetite at t0, STS continued to have a strong positive influence (β= \u0026minus;\u0026thinsp;.69, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) on appetite even after 3 months and explained 47% of the variance in the outcome variable.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvolution of the effect on \u0026ldquo;loss of appetite\u0026rdquo; over 3 months under the influence of STS\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\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eEORTC QLQ-C30 Appetite loss at 3 months\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e∆R2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSign\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlock 1: Demographics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlock 2 : Appetite loss at baseline\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEORTC QLQ-C30 Symptom scale Appetite loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlock 3\u0026nbsp;: Intervention\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.49***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSTS: Control (1) versus Intervention (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdj R2\u003c/p\u003e \u003cp\u003emodel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePalatability and intake of bread and soups\u003c/h2\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the average scores of palatability and the daily intake of soups and bread by patients for whom STS was applied at home. Both scores were determined at t0 (N\u0026thinsp;=\u0026thinsp;86), during the week before T1 (N\u0026thinsp;=\u0026thinsp;59) and during the week before T2 (N\u0026thinsp;=\u0026thinsp;46).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study investigated the effects of the application of STS to bread and soup recipes for adult cancer outpatients experiencing CiTA. We demonstrated significant positive effects of STS on factors that disturb normal food intake, such as fatigue, nausea/vomiting, dysgeusia, and loss of appetite. Palatability and daily food intake also increased significantly when STS was applied. These results are important in the context of the general well-being of these seriously ill patients. Moreover, these results are also clinically relevant since they concern the improvement of factors that are well-known serious risk factors for malnutrition and deterioration due to cancer cachexia.\u003c/p\u003e \u003cp\u003eTaste and taste alterations vary greatly from person to person. The most common identification tests used to assess gustatory and olfactory function are the taste strip test and the scratch and sniff test [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. These tests focus on gustatory and olfactory functions [\u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], as they are the principal chemosensory systems in humans. However, the trigeminal somatosensory system also plays a fundamental role in the overall flavour perception of food and beverages [\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Most odourants also stimulate the trigeminal nerve [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Moreover, all chemosensory functions (orthonasal and retronasal olfactory, gustatory, and trigeminal functions) are correlated with each other [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Chemotherapy influences these sensory functions and their mutual connections. Regarding STS, the intention is not to cure any such CiTA; STS is not applied to a patient but to meals and is intended to achieve adequate food intake, despite any taste alterations. That is why CITAS scores will always remain\u0026thinsp;\u0026gt;\u0026thinsp;1 points, regardless of whether STS is applied. However, correctly applied STS can improve the palatability of meals for cancer patients despite alterations in taste. It is known that taste alterations can differ depending on the type of tumour and associated chemotherapy [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. We did not consider these possible differences to be important for the purpose of this study. Experiencing a taste alteration that led to an increased CITAS score (\u0026gt;\u0026thinsp;1 point) was regarded as a core criterion for participation in the present study.\u003c/p\u003e \u003cp\u003eThe current state of knowledge regarding taste alterations in supporting cancer patients describes a wide variety of treatment options [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. However, the heterogeneity of the existing studies leads to difficulties in the interpretation and analysis of the available evidence and in formulating recommendations [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Therefore, treatment tools available for clinicians to manage taste alterations are limited and are often based on personal clinical experience [\u003cspan additionalcitationids=\"CR38 CR39\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Currently, the gold standard in the care of the cancer patients is advice from an oncologist or a dietitian about the use or avoidance of certain ingredients in meals at home. In addition, patients may also inform themselves about taste problems and meal preparations through the national or international websites of renowned cancer organizations.\u003c/p\u003e \u003cp\u003eThe CITAS score not only shows the presence of taste alterations but also differs among individuals. It is therefore logical to map taste alterations at an individual level to base the meals on a measured individual taste profile. In the current approach to chemotherapy-induced taste alterations, there is no structured use of taste assessments at the individual level. Professional care provision is therefore limited to general and 'one size fits all' nutritional advice. The effects may therefore be due to coincidence and are not guaranteed to be useful for individual patients. Such an approach to CiTA is assessed as poorly by cancer patients themselves [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] and can certainly be improved. STS aims to contribute to this need for improved practice. To implement and anchor STS in practice, however, numerous obstacles still have to be overcome.\u003c/p\u003e \u003cp\u003eSTS requires thorough multidisciplinary anamnesis, including the mapping of all residual sensory functions of an individual patient, by a well-trained health worker with professional gastrological knowledge, preferably a CGE [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. CGEs are preferred because they are able to combine extensive knowledge of ingredients and cooking techniques with all data from multidisciplinary anamnesis and O-box assessments to shape appropriate and meaningful personalized meals. However, making patient nutrition-related data from oncologists, nurses, dietitians, or speech therapists available to CGEs is not easy in the current organization of health care. In particular, legislation on privacy and medical information makes the work of CGEs more difficult. An innovative and efficient approach to taste problems, or any altered food intake with a negative impact on personal health and well-being, increases the importance of a highly educated chef as an equal professional partner in a care team [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. This provides a bigger picture of effective food and nutrition care delivery in health care, with chefs becoming a potential part of an integrated food and nutrition care delivery model.\u003c/p\u003e \u003cp\u003e Finally, the use of STS is currently limited to home care. The application of STS to hospitalized cancer patients is not obvious since most hospitals employ external caterers. These companies lack the necessary knowledge, skills and means to provide meals tailored to the specific needs of individual patients. Moreover, there is no direct communication between these companies and local care staff. This situation will increasingly jeopardize the quality of institutional healthcare, including care for hospitalized cancer patients, as evidence-based research suggests that food and nutrition should become a cornerstone in future institutional healthcare delivery [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study demonstrated that STS strongly decreases the loss of appetite and increases the palatability and intake of bread and soups despite chemotherapy-induced taste alterations in adult cancer outpatients. Compared to those in the intervention group, the physical functioning, role and social functioning scores, as well as the 'fatigue', 'nausea/vomiting' and \u0026rsquo;diarrhoea\u0026rsquo; symptom scores, deteriorated significantly in the control group. The clinical relevance of these results can hardly be underestimated given the effect they may have on nutritional status and cancer treatment itself. Further research into the application of appropriate and relevant STS in larger populations is still needed to confirm these effects and to encourage structural implementation and upscaling.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received a grant from BMS (Bristol Myers Squibb), Boehringer, Eli Lilly Benelux, and Servier. The authors are very grateful for this generous support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical approval\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethics committee of the Antwerp University Hospital acted as the Central Ethical Committee and approved the study protocol in February 2022 (Belgian registration number: B3002021000271). The study was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided their written consent prior to participating in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publish\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData availability\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Center for Research and Innovation in Gastrology and Primary Food Care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCode availability\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors’ contribution\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Bart Geurden, Pieter Vandecandelaere, Lobke Van den Wijngaert and Edwig Goossens prepared all material and questionnaires. Data collection were performed by Lobke Van den Wijngaert, Peter Boeren and Edwig Goossens. Formal analysis was performed by Jef Adriaenssens and Bart Geurden. Pieter Vandecandelaere and Edwig Goossens achieved funding acquisition The first draft of the manuscript was written by Bart Geurden and Jef Adriaenssens. All authors commented on previous versions of the manuscript, and all authors read and approved the final manuscript.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDe Angelis R, Demuru E, Baili P et al (2024) Complete cancer prevalence in Europe in 2020 by disease duration and country (EUROCARE-6): A population-based study. Lancet Oncol 25:293\u0026ndash;307. https://doi.org/10.1016/s1470-2045(23)00646-0\u003c/li\u003e\n\u003cli\u003eECIS - European Cancer Information System. From https://ecis.jrc.ec.europa.eu, accessed on 11/03/2024\u003c/li\u003e\n\u003cli\u003eWilson BE, Jacob S, Yap ML, Ferlay J, Bray F, Barton MB (2019) Estimates of global chemotherapy demands and corresponding physician workforce requirements for 2018 and 2040: A population-based study. 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Nurs Open 9:2683\u0026ndash;2689. https://doi.org/10.1002/nop2.967\u003c/li\u003e\n\u003cli\u003eWinters M, Wagner V, Patalano R et al (2022) Chefs in future integrated healthcare - current state and innovation needs: A first overview of the NECTAR project (aN Eu curriculum for chef gasTro-engineering in primary food care). Int J Integr Care 22:7. https://doi.org/10.5334/ijic.6436\u003c/li\u003e\n\u003cli\u003eWolfensberger M, Schnieper I, Welge-L\u0026uuml;ssen A (2000) Sniffin\u0026apos;sticks: A new olfactory test battery. Acta Otolaryngol 120:303\u0026ndash;306. https://doi.org/10.1080/000164800750001134\u003c/li\u003e\n\u003cli\u003eKaiser MJ, Bauer JM, Ramsch C et al (2009) Validation of the mini nutritional assessment short-form (MNA-SF): A practical tool for identification of nutritional status. J Nutr Health Aging 13:782\u0026ndash;788. https://doi.org/10.1007/s12603-009-0214-7\u003c/li\u003e\n\u003cli\u003eKano T, Kanda K (2013) Development and validation of a chemotherapy-induced taste alteration scale. Oncol Nurs Forum 40:E79\u0026ndash;E85. https://doi.org/10.1188/13.onf.e79-e85\u003c/li\u003e\n\u003cli\u003eAaronson NK, Ahmedzai S, Bergman B et al (1993) 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 85:365\u0026ndash;376. https://doi.org/10.1093/jnci/85.5.365\u003c/li\u003e\n\u003cli\u003eVellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL (1999) The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 15:116\u0026ndash;122. https://doi.org/10.1016/s0899-9007(98)00171-3\u003c/li\u003e\n\u003cli\u003eSarikaya D, Halil M, Kuyumcu ME, Kilic MK, Yesil Y, Kara O, Ozturk S, Gungor E, Karabulut E, Yavuz BB, Cankurtaran M, Ariogul S (2015) Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Arch Gerontol Geriatr 61:56\u0026ndash;60. https://doi.org/10.1016/j.archger.2015.04.006\u003c/li\u003e\n\u003cli\u003eFayers P, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A (2001) EORTC QLQ-C30 scoring manual. European Organisation for Research and Treatment of Cancer, Brussels, Belgium\u003c/li\u003e\n\u003cli\u003eWalliczek U, Negoias S, H\u0026auml;hner A, Hummel T (2016) Assessment of chemosensory function using \u0026quot;sniffin\u0026apos; sticks\u0026quot;, taste strips, taste sprays, and retronasal olfactory tests. Curr Pharm Des 22:2245\u0026ndash;2252. https://doi.org/10.2174/1381612822666160216150625\u003c/li\u003e\n\u003cli\u003eTalavera K, Yasumatsu K, Yoshida R, Margolskee RF, Voets T, Ninomiya Y, Nilius B (2008) The taste transduction channel TRPM5 is a locus for bitter-sweet taste interactions. FASEB J 22:1343\u0026ndash;1355. https://doi.org/10.1096/fj.07-9591com\u003c/li\u003e\n\u003cli\u003eFoster SR, Roura E, Thomas WG (2014) Extrasensory perception: Odorant and taste receptors beyond the nose and mouth. Pharmacol Ther 142:41\u0026ndash;61. https://doi.org/10.1016/j.pharmthera.2013.11.004\u003c/li\u003e\n\u003cli\u003eRoper SD (2015) The taste of table salt. Pflugers Arch 467:457\u0026ndash;463. https://doi.org/10.1007/s00424-014-1683-z\u003c/li\u003e\n\u003cli\u003eSimon SA, Gutierrez R. TRP Channels at the Periphery of the Taste and Trigeminal Systems. In: Emir TLR, editor. Neurobiology of TRP Channels. Boca Raton (FL): CRC Press/Taylor \u0026amp; Francis; 2017. Chapter 7. PMID: 29356478.\u003c/li\u003e\n\u003cli\u003eSmall DM, Prescott J (2005) Odor/taste integration and the perception of flavor. Exp Brain Res 166:345\u0026ndash;357. https://doi.org/10.1007/s00221-005-2376-9\u003c/li\u003e\n\u003cli\u003eViana F (2011) Chemosensory properties of the trigeminal system. ACS Chem Neurosci 2:38\u0026ndash;50. https://doi.org/10.1021/cn100102c\u003c/li\u003e\n\u003cli\u003eCarstens E (2016) Overview of chemesthesis with a look to the future. In: McDonald ST, Bolliet DA, Hayes JE (eds) Chemesthesis. Wiley, Hoboken, NJ, pp. 268\u0026ndash;285\u003c/li\u003e\n\u003cli\u003eFrasnelli J, Schuster B, Hummel T (2007) Interactions between olfaction and the trigeminal system: What can be learned from olfactory loss. Cereb Cortex 17:2268\u0026ndash;2275. https://doi.org/10.1093/cercor/bhl135\u003c/li\u003e\n\u003cli\u003eHernandez AK, Walke A, Haehner A, Cuevas M, Hummel T (2023) Correlations between gustatory, trigeminal, and olfactory functions and nasal airflow. Eur Arch Otorhinolaryngol 280:4101\u0026ndash;4109. https://doi.org/10.1007/s00405-023-07962-6\u003c/li\u003e\n\u003cli\u003eHovan AJ, Williams PM, Stevenson-Moore P, Wahlin YB, Ohrn KE, Elting LS, Spijkervet FK, Brennan MT, Dysgeusia Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO) (2010) A systematic review of dysgeusia induced by cancer therapies. Support Care Cancer 18:1081\u0026ndash;1087. https://doi.org/10.1007/s00520-010-0902-1\u003c/li\u003e\n\u003cli\u003eWebber TB, Marra D, Puntoni M et al (2021) Patient-versus physician-reported outcomes in a low-dose tamoxifen trial in noninvasive breast cancer. Breast J 27:817\u0026ndash;823. https://doi.org/10.1111/tbj.14296\u003c/li\u003e\n\u003cli\u003eSevryugin O, Kasvis P, Vigano M, Vigano A (2021) Taste and smell disturbances in cancer patients: A scoping review of available treatments. Support Care Cancer 29:49\u0026ndash;66. https://doi.org/10.1007/s00520-020-05609-4\u003c/li\u003e\n\u003cli\u003eThorne T, Olson K, Wismer W (2015) A state-of-the-art review of the management and treatment of taste and smell alterations in adult oncology patients. Support Care Cancer 23:2843\u0026ndash;2851. https://doi.org/10.1007/s00520-015-2827-1\u003c/li\u003e\n\u003cli\u003eDoty RL (2019) Treatments for smell and taste disorders: A critical review. Handb Clin Neurol 164:455\u0026ndash;479. https://doi.org/10.1016/b978-0-444-63855-7.00025-3\u003c/li\u003e\n\u003cli\u003eSpencer AS, da Silva Dias D, Capelas ML, Pimentel F, Santos T, Neves PM, M\u0026auml;kitie A, Ravasco P (2021) Managing severe dysgeusia and dysosmia in lung cancer patients: A systematic scoping review. Front Oncol 11:774081. https://doi.org/10.3389/fonc.2021.774081\u003c/li\u003e\n\u003cli\u003eGalaniha LT, Nolden AA (2023) Taste loss in cancer patients: Clinicians\u0026apos; perceptions of educational materials and diagnostic tools. Support Care Cancer 31:349. https://doi.org/10.1007/s00520-023-07794-4\u003c/li\u003e\n\u003cli\u003eGeurden B, Adriaenssens J (2023) How do adult cancer patients rate the current multidisciplinaryapproach to their chemotherapy induced taste disorders? Int J Cancer Treat 6:1\u0026ndash;8\u003c/li\u003e\n\u003cli\u003eNichani S, Fitterman N, Lukela M, Crocker J (2017) The society of hospital medicine. 3.23 team approach and multidisciplinary care. J Hosp Med 12:S82. https://doi.org/10.12788/jhm.2998\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (2019) Nutrition in universal health coverage. World Health Organization, Geneva\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chemotherapy, Taste, Quality of life, Loss of appetite, Food intake, Malnourishment","lastPublishedDoi":"10.21203/rs.3.rs-4668933/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4668933/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eThis study aimed to assess whether the application of selective taste steering (STS) to personalize bread and soup recipes had any effect on (1) quality of life, (2) the palatability of these meals, and (3) food intake in patients with chemotherapy-induced taste alterations (CiTA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis multicentre controlled before-and-after study included two groups of adult cancer outpatients who all experienced CiTA. Both groups received dietary advice as standard care. In one group, STS was applied to bread and soups at home for three months. Both groups were compared using validated scales and a structured questionnaire, at the start of the study and after 1 and 3 months of follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 19.3% of all patients (N=160) had a normal nutritional status (MNA-SF score \u0026gt;11). Compared to that in the intervention group, the number of patients with undernutrition (MNA-SF score \u0026lt;8) in the control group increased after 1 month (p \u0026lt;0.001) and 3 months (p \u0026lt;0.001) of follow-up. Compared to those in the control group, the 'fatigue', 'nausea/vomiting' and ‘diarrhoea’ symptom scores in the intervantion group decreased significantly (p \u0026lt;0.001, \u0026lt;0.001 and 0.002, respectively). In the intervention group, the score for 'appetite loss' decreased after 1 month (p \u0026lt;0.001) and remained low after 3 months of follow-up (p \u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eSTS translates into a significant decrease in the loss of appetite and an increase in palatability and intake of personalized bread and soups. These findings are clinically relevant and support this innovative approach to malnutrition in cancer patients.\u003c/p\u003e","manuscriptTitle":"Effects of Personalized Meals on Quality of Life in Adult Cancer Patients Who Experience Chemotherapy-Induced Taste Alterations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-16 15:38:12","doi":"10.21203/rs.3.rs-4668933/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5655804f-ec77-4ce1-9ed4-a92332908822","owner":[],"postedDate":"August 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-21T04:08:42+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-16 15:38:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4668933","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4668933","identity":"rs-4668933","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}