How does Fortimel Compact Protein address sensory changes?
Taste changes in patients with cancer vary in character and severity. To compensate for sensory alterations, some patients need more intense stimuli (e.g., by adding spices, salt, or ginger) while others need less intense flavors1,2.
Fortimel Compact Protein, a compact high-protein, high-energy oral nutritional supplement (ONS) (125 ml, 300 kcal, 18 g protein), includes a range of five sensory-adapted flavors tailored to support the sensory challenges faced by oncology patients. The flavors were validated with cancer patients to create an enjoyable and more comfortable experience, while needing ONS to address their nutritional needs. The flavors have been designed with a sensorial taste signature (cool, warm and neutral) to support patients with different taste alterations
The three cool flavors (Cool Red Fruit, Cool Coconut, and Cool Cucumber Lime) contain specific menthol derivatives, which can activate the trigeminal nerve3. The Cool sensational flavors are particularly well-suited to patients who have a bad taste in their mouth, as menthol derivatives give a “fresh” taste.
The warm flavor (Hot Tropical Ginger) contains derivatives of hot chili pepper, which can also activate the trigeminal nerve4. This flavor is particularly well-suited for patients who find that everything is bland or tasteless, as the hot pepper and ginger flavors add interest via a “warm” taste.
Finally, the Neutral flavor is designed without additional sensory stimuli. It is particularly well-suited for patients who are hypersensitive to taste or smell and for patients with a metallic taste in the mouth.
The trigeminal somatosensory system is believed to play a fundamental role in chemo-sensation and the overall flavor of foods. Temperature and touch introduce additional perceptual qualities to the sensory experience evoked by chemicals in contact with the trigeminal system5. Examples include the cooling flavor sensation of menthol in the mouth and the warming flavor sensation of chilies.
Have these flavors been tested in patients and what was the feedback?
As palatability and acceptability are key for patient compliance6,7 the Fortimel Compact Protein sensory-adapted flavors have been developed and validated with patients undergoing cancer treatments.
In 2018, the first five sensational prototype flavors of Fortimel Compact Protein (Cool Lemon, Cool Red Fruits, Hot Tropical Ginger, Hot Mango and Neutral) were evaluated in patients undergoing systemic anti-cancer treatment8. Overall, 50 patients were included in the study, of whom 30 (60%) reported taste alterations and 13 (26%) reported smell alterations8.
The study found that three sensory-adapted flavors (Cool Red Fruits, Neutral and Hot Tropical Ginger) were rated positively by patients, particularly in patients with taste alterations. Importantly, patients with taste alterations demonstrated a larger variation in the overall liking of ONS flavors compared with patients without such alterations. Click to read the full study report in Supportive Care in Cancer journal8.
More recently, in 2021, two additional cooling flavors have been developed to provide patients with more sensory-adapted flavors, as flavor variety has also been identified to support compliance with ONS9.
The two new flavors (Cool Coconut and Cool Cucumber Lime) combine a “fresh” flavor, due to specific menthol derivatives, which can activate the trigeminal system and which along with unconventional and interesting flavors, create a different experience.
These new flavors have been assessed by 51 patients, including 20 patients reporting sensory alterations (18% with both smell and taste alterations, 6% with only smell alterations, and 16% with only taste alterations).
All five Fortimel Compact Protein sensation flavors have been validated with cancer patients, and demonstrated to be appreciated/liked8,9.
What did patients say?
- “The hint of mint brings relief and makes it easy to drink” (patient with sensory alterations – Cool Coconut)
- “It is refreshing, it has a nice flavor and it’s pleasant” (patient with sensory alterations – Cool Red Fruits)
- “A very vibrant taste, it quickly gets into your nose and awakens your sense of smell” (patient with sensory alterations – Cool Cucumber Lime)
Where can I find more information about nutritional management of patients with cancer?
The European Society of Clinical Oncology (ESMO) provides recommendations on the prevention and management of cancer-related malnutrition and cancer cachexia10. Click on button below to read the ESMO clinical practice guidelines, which provide multidisciplinary advice on the screening, assessment, and multimodal management of cancer cachexia.
- Boltong A, et al. Support Care Cancer. 2012;20:2765-74.
- de Vries YC, et al. Support Care Cancer. 2016;24:3119-26.
- Liedtke WB, Heller S, editors. TRP Ion Channel Function in Sensory Transduction and Cellular Signaling Cascades. Boca Raton (FL): CRC Press/Taylor & Francis; 2007.
- Tominaga M. Chem Senses. 2005;30 Suppl 1:i191-2.
- Green BG: Introduction: what is chemesthesis?, in McDonald ST, Bolliet DA, Hayes JE (eds): Chemesthesis: Chemical Touch in Food and Eating, Wiley-Blackwell, 2016.
- Lidoriki I, et al. J Am Coll Nutr 2020;39:650-6.
- Hogan SE, et al. Support Care Cancer. 2019;27:1853-60.
- de Haan JJ, et al. Support Care Cancer. 2021;29:5691-9.
- Data on file
- Arends J, et al. ESMO Open. 2021;6:100092.
- Spotten LE, et al. Ann Oncol. 2017;28:969-84.
- Brisbois TD, et al. J Pain Symptom Manage. 2011;41:673-83.
- Boltong A, et al. Support Care Cancer. 2012;20:2765-74.
- McGreevy J, et al. Support Care Cancer. 2014;22:2635-44.
- Turcott JG, et al. Nutr Cancer. 2016;68:241-9.
- Belqaid K, et al. Acta Oncol 2014;53:1405-12.
- Andreyev HJ et al. Eur J Cancer. 1998;34(4)p.503-9.
- Prado CM, et al. Cancer Chemother Pharmacol, 2011; 67(1): p.93-101.
- Fearon KC. Eur J Cancer 2008;44(8): p.1124-32.