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Lactoferrin supplementation for taste and smell abnormalities among patients receiving cancer chemotherapy

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Abstract

Purpose

Taste and smell abnormalities (TSA) are common in patients receiving chemotherapy and may lead to altered nutritional intake, treatment withdrawal, and impaired quality of life. Lipid peroxidation in the oral cavity is one cause of TSA. Lactoferrin (LFN), an iron-binding salivary protein, reduces production of lipid oxidation byproducts and has been shown to reduce perception of unpleasant flavors. To assess the feasibility of LFN as a treatment for TSA, we conducted pilot investigations among patients with cancer who self-reported TSA following onset of chemotherapy. The primary objective was to assess change in subjective taste and smell perception from baseline to completion of 30 days of LFN supplementation.

Methods

Patients were treated with 750 mg LFN daily for 30 days and followed for an additional 30 days without LFN. TSA was measured via the taste and smell questionnaire (TSQ) including taste (score 0–10), smell (score 0–6), and composite scores (0–16) (0 = no TSA) at baseline, day 30, and day 60.

Results

A total of 26 patients enrolled; 19 remained on study at day 30 and 17 at day 60. Baseline mean TSQ scores were 6.5 (taste), 3.1 (smell), and 9.6 (composite). By day 30, mean composite TSQ score improved by 1.7 (p = 0.018); taste and smell improved by 0.6 (p = 0.062) and 1.1 (p = 0.042), respectively. From baseline to day 60, mean composite TSQ score improved by 3.8 (p < 0.0001); taste and smell improved by 1.9 (p = 0.001) and 1.8 (p = 0.003).

Conclusions

Further evaluation of LFN is warranted to determine its value for improving self-reported TSA among patients receiving chemotherapy.

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Data availability

Our research team has full control over all primary data and we agree to allow the journal to review the data if requested.

Code availability

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Acknowledgements

We are sincerely grateful to the patients who graciously volunteered to participate in this study; to Michele Harmon, RN, who served as the research nurse for these pilot investigations, and to Donald B. Penzien, PhD, for his time and attention as a preliminary reviewer of this manuscript.

Funding

This work was made possible through funding from the Louise McMichael Miracle Cancer Research Fund. The Virginia Tech Water INTERface Interdisciplinary Graduate Education Program provided support for Dr. Aili Wang during her PhD studies. A training grant awarded by the National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) Initiative and the National Cancer Institute (NCI) provided support for Dr. Megan Irby during the period of time in which this manuscript was drafted (grant number 3UG1CA189824-06S2).

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Section On Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Glenn J. Lesser

  2. Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Megan B. Irby

  3. Department of Oncology, Mayo Clinic, Jacksonville, FL, USA

    Richard C. Taylor & Anna Snavely

  4. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Douglas Case

  5. Key Laboratory of Coarse Cereal Processing, School of Food and Biological Engineering, Chengdu University, Chengdu, China

    Aili Wang

  6. Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA

    Andrea Dietrich

  7. Department of Food Science and Technology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA

    Susan Duncan

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  1. Glenn J. Lesser
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  2. Megan B. Irby
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  8. Susan Duncan
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Contributions

Dr. Glenn Lesser, Dr. Douglas Case, Dr. Aili Wang, Dr. Andrea Dietrich, and Dr. Susan Duncan contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Dr. Douglas Case, Dr. Anna Snavely, and Dr. Megan Irby. Background information was compiled and summarized by Dr. Richard Taylor and Dr. Megan Irby. The first draft of the manuscript was prepared by Dr. Megan Irby and Dr. Glenn Lesser, and all authors reviewed, revised, commented on, and drafted content for the final version of the manuscript. All authors read and approved the manuscript.

Corresponding author

Correspondence to Glenn J. Lesser.

Ethics declarations

Ethics approval

All procedures involving human participants were in accordance with the ethical standards of the Institutional Review Boards of Wake Forest Baptist Medical Center (CCCWFU#98112) and Virginia Tech (IRB#14–880) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The studies described in this manuscript are registered with www.clinicaltrials.gov (NCT01596634; NCT01941810).

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Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing of data derived from the studies described within this manuscript.

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The authors declare no competing interests.

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Lesser, G.J., Irby, M.B., Taylor, R.C. et al. Lactoferrin supplementation for taste and smell abnormalities among patients receiving cancer chemotherapy. Support Care Cancer 30, 2017–2025 (2022). https://doi.org/10.1007/s00520-021-06609-8

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  • DOI: https://doi.org/10.1007/s00520-021-06609-8

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