Alberta Cancer Foundation

Ask the Expert

Q: I recently started undergoing chemotherapy treatments and I’m finding that foods just don’t taste the same. How can I make food more enjoyable?

“Alterations in taste and smell perception can be a normal side effect of chemotherapy and radiation treatment,” explains Dr. Wendy Wismer, a sensory and consumer scientist and associate professor at the University of Alberta. “In some cases, a person’s sense of smell can become more acute, but in other cases it may become less so. Everyone seems to respond differently; some people don’t experience very much difference while other people are strongly affected.”

The exact cause of the alteration in taste and smell perception that some people experience during chemotherapy and radiation treatment is not understood. In most cases, those who notice that their perception of taste or smell is altered by chemotherapy find that it typically lasts for a while following treatment and begins to improve before the next treatment cycle.

Inadequate nutrition can have a significant impact on quality of life and a patient’s ability to tolerate and recover from therapeutic interventions like chemotherapy. “There are a number of things that people who experience changes in taste and smell perception can do to mitigate its overall effect on their health and quality of life,” Wismer says. “Those who experience unhealthy weight loss due to this problem should try to eat more when they are feeling better and choose foods that are particularly enjoyable to them. Don’t shy away from full calorie foods – this is the time to treat yourself.”

Wismer also suggests adding more herbs to improve the flavour of foods and snacking often on a variety of snacks. When dining out, some people find that buffet-style restaurants help them find more foods that are appetizing. Focusing on the visual aspect of the food can also be helpful when taste and smell perception is dulled and many people report that a nicely presented small portion can seem more appetizing to them.

“Don’t be discouraged if you experience changes in taste and smell perception during cancer treatment,” Wismer says. “Temporary changes in taste and smell perception can be a normal consequence of chemotherapy and radiation treatment. Sometimes it can help to participate in a support group and share advice and eating tips with others who are undergoing similar experiences.”

Q: “My doctor recently informed me that the recommendations for Pap testing in Alberta have changed and that I might not require a Pap test annually anymore. Why did the recommendations change? Is it really adequate for most women to get a Pap test every three years?

In October 2009, Alberta officially updated its Cervical Cancer Screening Guidelines. The new guidelines advise that women should have Pap tests annually for three years and if all three tests are normal, most women can begin having Pap tests every three years. It is also recommended that women start having Pap tests regularly at age 21 or three years after becoming sexually active, whichever is later. Women should have Pap tests regularly at least until age 70.

“The guidelines changed because there have been a lot of scientific advances that led to new understanding about the cause of cervical cancer and the natural history of how it develops,” explains Dr. Laura McDougall, medical lead of the Alberta breast and cervical cancer screening programs and co-chair of the committee responsible for developing the new guidelines. “We now know that most cervical cell changes are caused by infections with certain types of human papillomavirus (HPV). These types of HPV are spread by sexual contact and are so common that at least 70 per cent of people will get HPV during their lifetime. Many of the infections occur soon after women become sexually active. In most cases, the immune system will clear HPV within two years of infection, but when it doesn’t clear, the virus can cause cell changes that may lead to cervical cancer. These changes happen slowly. Delaying screening until women have been sexually active for three years allows most of the cervical changes to go away on their own. The few that persist can still be detected and treated before cancer develops.”

The new recommendations reduced the number of Pap tests performed annually in Alberta, but cost cutting was not on the agenda of the committee who established the new guidelines. “The committee that established the new recommendations spent many months reviewing scientific literature and was guided by what was in the best interest of women’s health,” McDougall says. “Although earlier Alberta guidelines recommended annual Pap tests for women, evidence from many research studies strongly suggests that annual screening offers very little extra protection and may result in over-diagnosis of cervical cell changes and unnecessary follow-up testing that can be very stressful for women. The exception is women whose immune systems are compromised or who have had high-grade cervical changes in the past – these women still benefit from annual screening.”

McDougall also points out that the new guidelines are in line with other provinces in Canada and with the new recommendations from the American College of Obstetricians and Gynecologists. “Pap testing is as important as it ever was even for women who have received the HPV vaccine,” she says. “Regular Pap testing can help prevent up to 90 per cent of cervical cancer.”

Ask the Expert is an opportunity to have your questions regarding cancer prevention and treatment answered by an expert at Alberta Health Services. We’ll answer different reader-submitted questions in each issue of Leap; please submit them via email to Remember, this advice is never a substitute for talking directly to your family doctor.