Alterations in taste sensation: a case presentation of a patient with end-stage pancreatic cancer

Alterations in taste can occur as a result of cancer, cancer treatment, and from a variety of other causes. Cancer patients frequently experience taste alterations, which often go undetected in the clinical setting. This case presentation depicts a 90-year-old client with end-stage pancreatic cancer undergoing chemotherapy treatment with gemcitabine. The symptomatology of taste changes is described. Etiology and rationale for taste changes is presented for the cancer patient population, and for the general population. Review of the cancer literature, research instruments, and goals/outcomes are discussed. The author determined that interventional studies are lacking, and research is needed.     

Robust functional imaging of taste sensation with a Bessel beam

Functional imaging of intact taste cells in response to various tastant solutions poses a technical challenge since the refractive index of the immersion medium dynamically changes during tastant delivery. Critically, the focal shift introduced by high-index tastant solutions has been the fundamental limit in experimental design. Here we seek to address this issue by introducing an axially elongated Bessel beam in two-photon microscopy. Compared to the conventional Gaussian beam, the Bessel beam provides superior robustness to the index-induced focal shift, allowing us to acquire near artifact-free imaging of taste cells in response to a physiological taste stimulus.     

Understanding taste dysfunction in patients with cancer

Taste dysfunction is a significant but underestimated issue for patients with cancer. Impaired taste results in changes in diet and appetite, early satiety, and impaired social interactions. Nurses can play a key role in educating patients and families on the pathophysiology of taste dysfunction by suggesting interventions to treat the consequences of taste dysfunction, when available, and offering psychosocial support as patients cope with this often devastating consequence of treatment. Taste recognition helps humans identify the nutritional quality of food and signals the digestive tract to begin secreting enzymes. Spoiled or tainted foods typically are recognized by their bad taste. Along with the other sensory systems, taste is crucial for helping patients treated for cancer feel normal. This article will review the anatomy and physiology of taste; define the different types of taste dysfunction, including the underlying pathophysiologic basis related to cancer treatment; and discuss potential nursing interventions to manage the consequences of taste dysfunction.     

Resveratrol and cancer: a review.

The various properties of the stilbene phytoalexin Resveratrol provide interesting new avenues of research in the field of chemoprevention and chemotherapy. A particular emphasis is given on xenobiotic-related carcinogenesis.     

Decreased taste sensitivity in cancer patients under chemotherapy

Goals of work The aim of the study was to measure taste thresholds among cancer patients under chemotherapy compared to controls.Patients and methods The study was performed with 110 cancer patients and 170 healthy subjects of similar age distribution were included in the study. The electrogustometric detection threshold was evaluated as the lowest current intensity perceived by the subject in three tongue sites independently with a constant current generator.Main results Taste thresholds for all cancer patients demonstrated significantly higher values compared to controls.Conclusions Cancer patients treated by chemotherapy demonstrated a temporary taste sensitivity deficit. Associated with the illness due to the treatment, this deficit explains the patients complaining of abnormal or bad tastes, which results in food aversion and has a negative impact on nutritional status and quality of life. In order to prevent the risk of anorexia and the enhanced morbidity related to this deficit, treatment should include relevant information to the subject for anticipating objective taste modifications and a psychological follow-up during the actual change of taste quality perceptions in everyday life.     

Assisting demented patients with feeding: problems in a ward environment. A review of the literature

A critical review of the literature on assisting demented patients with feeding difficulties identifies that care at mealtimes is often task-centred, causing stress in both patients and staff and inadequate patient care. Nurses may even be inducing dependency in this vulnerable patient group. The staff to whom this care is most often delegated do not receive sufficient education or training to enable them to achieve a sufficient degree of empathy with the patient although there is evidence in the literature to suggest that this is a necessary requirement. It is also apparent that nurses use inadequate assessment criteria, perhaps due to the fact that there is an element of commonality in the feeding behaviour of demented patients which nurses feel they have seen many times and are able to deal with. The introduction of primary nursing, increased education of nursing assistants and improved assessment procedures to combat these problems are recommended. The process of change is briefly outlined and in conclusion some areas for future research are stated.     

Methadone use in cancer patients with pain: a review

In recent years a better understanding of the pharmacologic and pharmacokinetic properties of methadone, including equianalgesic ratios has led to its increased use as a second line opioid for the treatment of pain in patients with cancer. Methadone may be an important alternative for those who have side effects related to the use of other opioids because it has no known active metabolites, is well absorbed by oral and rectal routes, and also has the advantage of very low cost. However, it has a long, unpredictable half-life, which can result in accumulation and toxicity in some patients. In addition, rotation to methadone as a second line agent is more complex than with other opioids because of its increased potency in those patients who are opioid tolerant, particularly those who have been on higher doses of other opioids. Future research should address the use of methadone as a first-line agent in the management of cancer pain, its use in patients with neuropathic pain, and in those who develop rapid tolerance to other opioids. In some patients with cancer the long half-life of methadone offers the advantage of extended dosing intervals to 12 and even 24 hours, further research is also needed in this area.     

结直肠癌患者术后早期经口进食时机的Meta分析

目的 分析术后早期进食对结直肠癌患者预后和并发症的影响,寻找术后早期进食的最佳时机。方法 计算机检索CNKI、Wan Fang Data、VIP、CBM、PubMed、Web of Science、Embase、The Cochrane Library数据库,检索从建库至2021-12之前发表的文献。采用RevMan5.4软件进行Meta分析。结果 共12篇文献纳入Meta分析。结果显示, 早期经口进食组术后首次排气时间较短(MD=-16.12h,95%CI：-19.32～-12.92h,P=0.00);亚组分析显示：6～12h进食组、12h～24h进食组术后首次排气时间均短于传统经口进食组(MD分别为-16.12h、-24.82)。在术后总并发症发生率方面, 早期经口进食组总并发症发生率低于传统经口进食组(OR=0.52,95%CI：0.35～0.78,P=0.002);亚组分析显示：6～12h进食组术后总并发症发生率低于传统经口进食组(OR=0.46)、12h～24h进食组与传统经口进食组术后总并发症发生率间差异无统计学意义(OR=0.61)。结论 结直肠癌术后患者早期进食的最佳时机可能为6h～12h,但尚需更多高质量的临床试验进一步研究。     

Aspergillus sinusitis in neutropenic patients with cancer: a review

Aspergillosis typically occurs in patients with reduced host defenses; such patients include renal and marrow recipients as well as patients with chemotherapy-induced myelosuppression. Pulmonary structures are most frequently involved; non-pulmonary involvement (including sinus) has not been frequently reported. In the present study, paranasal sinusitis occurred in 52 myelosuppressed cancer patients treated over 5 years at the UMCC with chemotherapy. Twenty-one patients had Aspergillus sinusitis; Aspergillus spp., including flavus and niger, were directly recovered from sinus in 19 of the 21 infections. Two other patients were considered clinically, although not microbiologically, documented. Multiple predisposing factors for Aspergillus sinusitis during the 60 days prior to infection diagnosis appear to exist; these include: 1) granulocyte count less than 500 mm3 (mean duration, 42 days versus 14 days for sinusitis of other etiology; P less than 0.001); 2) prolonged hospitalization (mean duration, 22 days versus 14 days for patients with non-fungal sinusitis; P less than 0.001); and 3) prolonged antibiotic therapy (mean duration, 22 days versus 9 days; P less than 0.001). The Aspergillus sinusitis resolved in 18 of 21 patients following treatment with amphotericin B; however, 11 of 18 patients had infection recurrence that always developed when tumor recurred and chemotherapy was reinstituted.     

Classification of patients with cold sensation by a review of systems database: A single-centre observational study

ObjectivesIn Kampo medicine, a traditional medicine pattern^(TM1) refers to the complete clinical presentation of the patient at a given moment in time. Candidate herbal formulas are chosen for a chief complaint, and an appropriate formula is determined on the basis of the pattern^(TM1) diagnosis. In this study, we demonstrated the importance of accompanying symptoms in diagnosing traditional medicine patterns^(TM1).DesignSingle centre observational study.SettingWe analysed data from 524 new patients with a hypersensitivity to cold sensation as their primary diagnosis (mean age 51.6 ± 17.8 years; female ratio 82.1%) who visited the Keio University Hospital Kampo Clinic between 2008 and 2013.Main outcome measuresAccompanying symptoms were recorded on the browser-based e-questionnaire system, which contained 128 items. The Japan Society for Oriental Medicine’s board certified Kampo specialists diagnosed the traditional medicine patterns^(TM1).ResultsWhen participants were classified according to the origin of their cold sensation, there were no differences in their traditional medicine patterns. In contrast, when patients were classified based on the number of accompanying symptoms, a significant difference in the patterns was identified. An increasing number of accompanying symptoms was associated with more frequent qi stagnation and blood stasis pattern^(TM1). Patients with a qi stagnation pattern had higher rates of depression and insomnia. In contrast, patients with a blood stasis pattern^(TM1), had higher rates of acne, body stiffness, and menstrual abnormality.ConclusionsQi stagnation and blood stasis patterns^(TM1) are related to a number of different accompanying symptoms in the patients with hypersensitivity to cold sensation.     

Self-management programme for cancer patients: a literature review

GAO W.J. & YUAN C.R. (2011) Self‐management programme for cancer patients: a literature review. International Nursing Review 58 , 288–295 Background: With increased cancer survivorship, cancer, in its chronic form, self‐management among cancer patients has become an international research focus. Self‐management programmes are used to guide the self‐care process. Over the past 10 years, six self‐management programmes for cancer patients (Taking CHARGE, Expert Patients Programme, Living with Cancer Education Program, Focus Program, PRO‐SELF Program and Oncologist‐referred exercise self‐management programme) were used in a variety of self‐management studies for cancer patients. Aim: The aims of this paper are to describe, compare and critique these six self‐management programmes that are commonly used to guide self‐management for cancer patients, and propose directions for new self‐management programme development among cancer patients. Methods: Medline, Pubmed and Embase, Springer, Elsevier, EBSCO and ProQuest were searched for literatures on self‐management programmes for cancer patients from 2000 to November 2010. Search terms such as ‘self‐management’ or ‘self‐care’ or ‘patient education’ or ‘self‐management’ or ‘self‐care’ or ‘self‐efficacy’, ‘intervention’ or ‘program*’‘cancer’ or ‘carcinoma’ or ‘neoplasms’ were used. Results: Comparison and critique of these programmes revealed important limitations of cancer self‐management programmes including lack of the facilitators' training process, failure to assess the cultural differences and failure to cover all of the outcome measures. Conclusion: Researchers and clinicians need to build more individualized and dynamic self‐management programmes that parallel advances in clinical research and practice for cancer patients.     

Determinants of the sensation of thirst in terminally ill cancer patients

While a sensation of thirst causes severe distress for a certain proportion of cancer patients in the terminal stage, the factors contributing to this symptom have not been established. To clarify the association between sensation of thirst and medical factors, especially dehydration, a cross-sectional observational study was performed on terminally ill cancer patients receiving inpatient hospice care. On admission to a palliative care unit, 88 consecutive patients underwent blood sampling and were requested to rate the intensity of thirst on a visual analogue scale (VAS). Physicians prospectively evaluated factors that might potentially be contributing to the symptom. The mean VAS score for thirst was 5.0+/-2.8, and 18% of the patients complained of severe thirst with a VAS score of > or = 8. No significant correlations were observed between the VAS score for thirst and the values of total protein, blood urea nitrogen (BUN), creatinine, sodium, osmolality, hematocrit, atrial natriuretic peptide (ANP), and biochemical dehydration defined by the levels of BUN, creatinine, sodium and osmolality. On the other hand, dehydration defined by ANP level (< or = 15 pg/ml), hyperosmolality (> or = 300 mosmol/kg), gastrointestinal cancer, survival, performance status, oral intake, vomiting, and stomatitis were significantly associated with the severity of thirst. In addition, mouth breathing and opioids were determined to be a potential clinical cause of severe thirst when a retrospective chart review was carried out. In conclusion, sensation of thirst is a frequent symptom in terminally ill cancer patients and is associated with dehydration, hyperosmolality, poor general conditions, stomatitis, oral breathing, and opioids. Careful assessments and treatment of underlying causes is important to alleviate patients' distress.     

The management of dyspnea in cancer patients: a systematic review

Goals of work The goal of the study is to evaluate the effectiveness of four drug classes (opioids, phenothiazines, benzodiazepines, and systemic corticosteroids) for relieving dyspnea experienced by advanced cancer patients. Materials and methods A systematic literature review was conducted to July 2006. Search sources included MEDLINE, EMBASE, HealthSTAR, CINAHL, and the Cochrane Library. Four reviewers selected evidence using predefined criteria: controlled trials not limited to cancer and involving the specified drug classes for dyspnea treatment. Main results Three systematic reviews, one with meta-analysis, two practice guidelines, and 28 controlled trials were identified. Most examined the effect of opioids, generally morphine, on dyspnea. Although the results of individual trials were mixed, the systematic review with meta-analysis detected a significant benefit for dyspnea with systemic opioids; two small placebo-controlled trials in cancer patients found systemic morphine reduced dyspnea, and dihydrocodeine also significantly reduced dyspnea in four placebo-controlled trials. Nebulized morphine was not effective in controlling dyspnea in any study or the meta-analysis. No controlled trials examined systemic corticosteroids in the treatment of cancer patients, and of the other non-opioid drugs examined, only oral promethazine, a phenothiazine, showed some benefit in the relief of dyspnea. Studies varied in methodological quality. Conclusions Systemic opioids, administered orally or parenterally, can be used to manage dyspnea in cancer patients. Oral promethazine may also be used, as a second-line agent if systemic opioids cannot be used or in addition to systemic opioids. Nebulized morphine, prochlorperazine, and benzodiazepines are not recommended for the treatment of dyspnea, and promethazine must not be used parenterally. A complete list of Supportive Care Guidelines Group members is available at: .     

The treatment of depression in cancer patients: a systematic review

Goals of the work: To evaluate the efficacy of pharmacological and nonpharmacological treatments for depression in cancer populations. Materials and methods: The Supportive Care Guidelines Group conducted a systematic review of the published literature through June 2005. Search sources includes MEDLINE, EMBASE, CINAHL, PsycInfo, and the Cochrane Library. Comparative studies of treatments for depression in cancer patients were selected for review by two group members based on predefined criteria. Main results: Seven trials of pharmacological agents and four of nonpharmacological interventions were identified. Two trials detected a significant reduction in depressive symptoms for mianserin compared with placebo, and one trial found alprazolam to be superior to progressive muscle relaxation. Four drug trials found no significant difference between groups on depression measures although posttreatment reduction of symptoms was observed for all groups in two trials comparing active treatments (fluoxetine vs desipramine and paroxetine vs amitriptyline). Of the four trials involving nonpharmacological therapies for the management of depression, two detected a benefit for treatment (a multicomponent nurse delivered intervention and an orientation program) over usual care. Conclusion: There is limited evidence for the effectiveness of pharmacological and psychosocial interventions in the treatment of cancer patients with depressive disorders, and no evidence for the superiority of one treatment modality over another. Based on evidence from the general population and other medically ill populations, combined approaches to the treatment of depression may be the most effective. Further research is necessary in cancer patients to determine the relative effectiveness of psychosocial, pharmacological, and combined treatments. A paper presented as an invited lecture at the MASCC/ISOO 18th International Symposium of Supportive Care in Cancer in Toronto, Canada, June 2006, was based in part on this review. A complete list of Supportive Care Guidelines Group members is available at: .     

肿瘤患者压力性损伤患病率的系统评价

目的 系统评价肿瘤患者压力性损伤的患病率,为压力性损伤的防治决策提供依据.方法 计算机检索CNKI、WanFang Data、VIP、CBM、PubMed、EMbase、Cochrane Library、Web Of Science,收集有关肿瘤患者压力性损伤患病情况的相关研究.检索时限从建库至2019年9月,经逐层筛...     

Symptom prevalence in patients with incurable cancer: a systematic review

The suffering of patients with incurable cancer is determined to a large degree by the presence and intensity of the symptoms of their disease. Knowledge of symptom prevalence is important for clinical practice. The main aim of this study was to obtain a reliable estimation of symptom prevalence in patients with incurable cancer by performing a systematic review of studies assessing this topic. We included 44 studies (including 25,074 patients) on overall symptom prevalence (Group 1) and six studies (including 2,219 patients) on symptom prevalence during the last one to two weeks of life (Group 2). In these studies, symptom prevalence was assessed by a questionnaire, a standardized interview, or the medical record. We identified 37 symptoms assessed in at least five studies. Almost all symptoms occurred in more than 10% of the patients. Five symptoms (fatigue, pain, lack of energy, weakness, and appetite loss) occurred in more than 50% of the patients of Group 1. Weight loss occurred significantly more often in Group 2 compared to Group 1, and pain, nausea, and urinary symptoms occurred significantly less often. Generally, symptom prevalence was highest if assessed by a questionnaire. The results of this study should be used to guide doctors and nurses in symptom management. Proper attention to symptom burden and suffering should be the basis for individually tailored treatment aimed at improving or maintaining quality of life of patients in their last period of life.