Thursday, May 7, 2009
The Journal of Supportive Oncology (my favorite free journal with excellent practical palliative care articles) published a fantastic review of taste and odor dysfunction in cancer patients. If you read this article you could become a local expert because so few clinicians appreciate the implications or understand the treatment options for these significant quality of life markers. Obviously with this kind of endorsement it qualifies as a teaching file article.
Some of you will remember when I claimed xerostomia as my 'favorite symptom.' Well taste alteration is probably in my top 5 favorite symptoms. (If you must know the others, they would be opioid neurotoxicity, delirium, and intractable vomiting. In no particular order. And yes, pain is not on there, but I know my stuff. OK back to the article, thanks for tagging along on my sidebar.) There are small things you can do to make a difference including: avoiding metal in silverware, serving cool foods, and my number one recommendation adding a sialogogue and/or saliva substitute.
I do not know why nurses and doctors can do so many other 'gross' things in medicine, but there is a severe and general aversion to writing for or administering saliva substitutes. It is more than just lack of knowledge, because even when informed, I have had nurses basically say, "I'm not giving that to them, That's disgusting!" Yet when I go in the room and have the patient try it, the patient exclaims (with a smile and a much louder voice) "My mouth feels alive again. Thank you so much."
Those mouth care kits that have the swabs and moisturizer really need to have the saliva substitutes in them as well. There is no reason artificial saliva needs to be a physician's order. And yes I know some patients really do not care for it, but try the different forms: spray vs. gel, or maybe add sugar-free gum (which contains some of the same ingredients as artificial saliva.)
Anyway, if I have not given you enough reasons to read this article, you should at least read it so you can say the following fun medical words: Ageusia, dysgeusia, hypogeusia, phantogeusia, agnosia, hyposmia, electrogustometer, umami, xerostomia, sialogogue, circumvallate papillae. But it really is not that dense of an article. It is very accessible lest these words scare you away.
And quick shout out to my oncology attending from residency at Wake Forest, Glenn Lesser with the senior author credit.
JH Hong, P Omur-Ozbek, BT Stanek, AM Dietrich, SE Duncan, YW Lee, & G Lesser (2009). Taste and Odor Abnormalities in Cancer Patients Journal of Supportive Oncology, 7, 58-65