When you get treatment for epidermal growth factor receptor (EGFR)-positive non-small-cell lung cancer (NSCLC), food and drinks may suddenly taste or smell different. Water can taste metallic. Coffee might smell like sewage. Meat or animal proteins could smell or taste like dirt.
Foods that you once loved may become too sweet, too salty, bland, bitter, or just “off.” These changes commonly happen during cancer treatment and may be caused by:
- Chemotherapy
- Radiation therapy
- Immunotherapy
- Targeted therapy
- Dry mouth
- Mouth sores
- Inflammation related to your cancer
With cancer, you can get changes to your senses of smell and taste. A change in taste is known as dysgeusia, and a change in smell is called parosmia.
These differences in taste and smell can kill your appetite. But it’s important to keep getting your vitamins and minerals (nutrition) during your treatment. With some trial and error, a few simple steps can help make these changes more manageable.
How Lung Cancer and Its Treatment Affect Taste and Smell
About 70% of people who undergo chemotherapy get changes to their senses of smell and taste. The differences can alter the way you experience food, drink, or odor, but you don’t completely lose these senses.
“This is the rule, not the exception,” says Eric Singhi, MD, a medical oncologist at UT MD Anderson Cancer Center in Houston.
Smell changes
Chemotherapy targets rapidly dividing cancer cells, but it can also affect healthy cells that quickly divide. That may include your taste buds and cells inside your nose (also called olfactory receptors) that take in smells.
“If chemotherapy is eliminating some of those cells, then the perception of taste and smell could be off,” says Stephanie Canty, a certified nurse practitioner (CNP) at Dana-Farber Cancer Institute in Boston.
Dry mouth and taste
Chemotherapy can also cause mouth sores, known as mucositis, that can affect the way things taste. Dry mouth is often a side effect of several cancer treatments and may interfere with taste perception.
In fact, dry mouth is strongly linked to radiation therapy to the head and neck because it can damage your salivary glands. Some chemotherapy, immunotherapy, and targeted therapy can also lead to:
- Dry mouth
- Mouth irritation
- Taste changes
Saliva, which is too low in case of dry mouth, protects your teeth and mouth from bacteria. Saliva also supports normal chewing, swallowing, and taste. Both the lack of saliva and the presence of bacteria can change the way things taste.
Treatment can change taste
Targeted therapies and newer immune-based treatments may also cause taste changes, though the reasons can vary by drug. For example, Canty says, “Some EGFR inhibitors can make you more prone to mouth sores.”
Some people with lung cancer report changes in their sense of taste or smell before they ever begin treatment, Singhi says, but its cause is not well understood.
Can You Prevent or Stop This Attack on Your Senses?
There’s no proven way to keep dysgeusia or parosmia from happening during lung cancer treatment. Even though you can’t stop changes in your sense of taste or smell from happening, a few things may help, depending on the cause.
Hydration
Hydration may sound too easy to make a difference, but it can. Drinking fluids can help counter the dry mouth that comes with many cancer treatments. Good hydration can change the way things taste. “Ample hydration, like 64 ounces of hydrating fluid a day, is our general recommendation,” Canty says.
Oral hygiene
Taking care of your teeth and mouth is another simple way to make a difference. “Brushing your teeth and using an alcohol-free mouthwash several times a day can help,” Canty says. “It can reduce the bacteria and buildup on and around your teeth, gums, and tongue to help with taste perception.”
Zinc supplementation
The mineral zinc may help ease the mouth sores you get from chemo and radiation treatments. Zinc may also help counter any changes in your sense of taste. If you want to try zinc, ask your doctor for guidance. This is because the studies using zinc carefully measured out oral or IV solutions, not the vitamin tablets found at your local drug store.
Oral cryotherapy
Oral cryotherapy means holding ice chips or something cold in your mouth during your lung cancer chemotherapy infusions. The ice chips can narrow the blood vessels in your mouth and help lower the amount of chemo medicine that reaches the tissues inside your mouth. This can help prevent mouth sores and possibly any impact on your sense of taste.
Saliva substitutes
Over-the-counter rinses, sprays, and gels for dry mouth can help keep your mouth moist. These remedies can help, especially when your treatment has sapped your natural saliva production.
You can also try sugar-free candy or sugar-free chewing gum to stimulate saliva. If your lips get dry, try keeping lip balm handy to moisten your lips.
Taste and smell training
Research shows that a structured program using unknown tastes and smells can retrain your taste buds and olfactory nerves to work as they did before. This testing is also called a blind taste or blind smell test. You can’t see what you’re smelling or tasting — think of it as physical therapy for your senses. The training is typically run by a dietitian. Ask your doctor for a referral.
Dealing With Changes in Taste and Smell
“We don’t have a guaranteed way to fully bring taste and smell back,” Singhi says. “If it happens, it can take months — even 6-12 months — after completing treatment.” In the meantime, here are some tips to deal with the changes in taste and smell. Because quite literally, smell and taste can sometimes put you off your dinner — and breakfast and lunch.
Eating helps you stay strong while living with cancer. These hacks can help you get past any changes in your sense of taste or smell so you can get the nutrients you need.
Be patient
“It takes trial and error,” Canty says. “What tastes unpleasant one week may improve the next as treatment cycles change.” There’s no secret ingredient or magic recipe that works. In fact, the same food that tastes strange today may taste normal tomorrow. Start with foods that look and smell appetizing to you. Keep a running list of what works and what doesn’t. But stay open-minded, and be willing to try foods again.
If food seems tasteless
Wake up your taste buds. Try adding stronger, bolder flavors such as:
- Cinnamon
- Citrus
- Cumin
- Ginger
- Herbs
- Lemon
- Marinades, especially lemon or fruit-based
- Mint
- Pickled foods
- Vinegar sauces
“Tart and citrus flavors can help stimulate any taste receptors that may still be there or that may not be affected,” Singhi says. Stronger flavors can cover up bitter or metallic tastes. Bolder spices can cut extra sweetness. But skip sour or acidic flavors if you have mouth sores.
Flavors and textures. Try different flavors of the same food. You can experiment with yogurt or ice cream; don’t give up after just one try. The same goes for textures. If you can’t taste baked potatoes, try mashed potatoes. Sometimes, changing the flavor or texture of a food can make the taste or smell different, and that can make it more appetizing.
Alternate your bites. You might have done this when you were a kid. If you’ve got two items on the table — grilled cheese and tomato soup — take one bite of one, then the other, and continue till you finish the meal.
If your mouth tastes like metal
Don’t add extra metal. Try to use plastic, bamboo, or wooden utensils instead. This can cut down on any extra metallic taste. Also, avoid canned foods, and try fresh or frozen foods instead.
Rinse your mouth with water. Do this before and after every meal to clean your mouth.
Chew sugar-free gum. It can help reset your taste buds. Or you may use breath mints.
If meat tastes like dirt
Try these proteins instead:
- Cold egg salad
- Cold roast beef
- Dairy protein, such as Greek yogurt
- Tofu, seitan (made from wheat gluten), or other plant-based meat substitutes
If you can’t bear the smell
Try cooler foods. Choose foods that can be served cold or at room temperature. Cooler foods give off less aroma, which may make them easier to tolerate and eat.
Open the windows. When you cook, try to keep the windows open. Let the smell drift out rather than build up around you.
Lower odor foods. Avoid foods with strong odors, such as beef and fish. Go for poultry and eggs instead.
If you just can’t manage to eat much at all
Try small, frequent meals. You don’t have to eat three square meals a day. It might be easier to tolerate smaller portions throughout the day.
Take small frequent sips. Throughout your meal, take small sips of your drink. This helps rinse out the taste more quickly.
Go for liquids. If it’s easier than a full meal that is sometimes impossible, try a liquid meal. You can opt for smoothies, yogurt, or nutrition shakes.
Communicate with Your Care Team
During your lung cancer treatment, you’ll want to eat meals and maintain your weight. “Your body’s in recovery mode,” Singhi says. “You want to make sure that your nutrition, your weight, and your quality of life are all satisfactory.”
So, let your cancer care team know about any changes in your senses of taste and smell. They can help you keep eating and stay nourished. Your care team can also help you:
- Figure out why the change is happening
- Know whether it’s a typical treatment side effect
- Decide to see another specialist
Get support
They can also connect you with nutrition counseling to psychosocial support if eating has become emotionally distressing. If you’re eating less, avoiding fluids, or losing weight, it’s time to speak up. Learning about how lung cancer treatment affects taste and smell can help you prepare to talk to your cancer care team.
Speaking up also helps you know what to expect. When you talk to your doctor about your treatment’s impact on taste and smell, Canty says, “you do better, have less anxiety, and [stick] to treatment better because you’re well prepared with reasonable expectations.”
