Table 9

Investigation and management of change in taste

InvestigationsPotential resultsClinical management plan
Actions from history, medication and dietary assessment
History findingsSmokingSmoking cessation advice.
Medication findings (see p. 80)Chemotherapy/radiotherapy induced
  1. Reassure patient.

  2. Refer for dietetic advice around appropriate foods.

  3. Inform patient about the charity Fifth Sense.2

Medication inducedDiscuss alternative options available.See ‘Medications that may induce mucositis or change in sense of taste’ (p. 27).
Dietary findingsNutritional compromiseRefer for dietetic advice.
First line
Visual inspection of mouthOral candidiasisAntifungal therapy.
Dental problems/poor oral hygieneRefer to dentist/oral hygienist.
Blood test for vitamin B12, zinc and seleniumDeficientArrange replacement.
Second line
OGDGORDStart PPI or H2 antagonist. If following oesophagectomy, consider promotility agents (see p. 26).
CandidiasisAntifungal therapy.
If rapid/progressive unexplained changes, then CT/MRI head/PETBase of skull diseaseRefer to the appropriate MDT requesting an appointment within 2 weeks.
Third line
If normal investigations/no response to interventionReassure.
  • CT, computerised tomography; GORD, gastro-oesophageal reflux disease; H2, histamine receptor 2; MDT, multidisciplinary team; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); PET, positron emission tomography; PPI, proton pump inhibitor.