Management of Metallic Taste During Chemotherapy
The most effective strategies to decrease metallic taste from chemotherapy include using plastic utensils instead of metal, eating cold or frozen foods, adding strong herbs/spices/sweeteners/acids to foods, consuming sweet and sour foods together, and rinsing with chelating agents before meals. 1
Understanding the Problem
Metallic taste is a highly prevalent side effect affecting 9.7% to 78% of cancer patients receiving chemotherapy, with women experiencing it more frequently than men. 1, 2 This taste alteration occurs across multiple treatment modalities including chemotherapy, targeted therapy, and concomitant radiotherapy. 2 Patients experiencing metallic taste also commonly report that everything tastes bitter and are bothered by sour foods. 2
Evidence-Based Management Strategies
Dietary Modifications (First-Line Approach)
- Use plastic utensils instead of metal silverware when eating, as metal contact can intensify the metallic sensation 1
- Eat cold or frozen foods rather than hot foods, which reduces the intensity of taste alterations 1, 3
- Add strong flavoring agents including herbs, spices, sweeteners, or acidic ingredients to mask the metallic taste 1, 3
- Consume sweet and sour foods together, as this combination helps counteract metallic sensations 1
- Eat blander foods when strong flavors become intolerable 3
- Take smaller, more frequent meals rather than large meals, which improves tolerance 3
Oral Care Interventions
- Perform oral care before eating to cleanse the palate and reduce metallic taste intensity 3
- Rinse with chelating agents before meals to bind metallic ions in the oral cavity 1
- Drink more water with foods to dilute taste sensations and improve swallowing 3
Specialized Supplements
- Consider 'miracle fruit' supplements (Synsepalum dulcificum), which contain miraculin that temporarily modifies taste perception by making sour foods taste sweet 1
Avoiding Common Pitfalls
Do not recommend zinc supplementation for chemotherapy-induced metallic taste, as the evidence shows zinc is only effective for radiation-induced taste changes (not chemotherapy-induced), and a recent RCT in 58 cancer patients receiving chemotherapy found no benefit from zinc supplementation. 4
Avoid strong-smelling or strong-tasting foods when patients report they worsen symptoms, as this varies by individual and chemotherapy regimen. 3
Pharmacological Considerations
While guidelines address appetite stimulation and nausea management, there are insufficient consistent clinical data to recommend cannabinoids specifically for taste disorders in cancer patients. 4 The focus should remain on dietary modifications and oral care strategies rather than pharmacological interventions for metallic taste specifically.
Patient Education Timing
Provide prechemotherapy teaching about taste change management strategies to at-risk patients, particularly those receiving cisplatin, carboplatin, or cyclophosphamide, as early intervention promotes better self-care and coping. 3 Women should receive particular attention as they experience metallic taste more frequently than men. 2
Clinical Monitoring
Taste sensitivity testing can identify specific taste alterations (salty, sweet, sour, bitter, fat, water), with females typically showing better taste perception than males even during chemotherapy. 5 However, the subjective experience of metallic taste is highly variable among patients, and not all patients find it bothersome despite its presence. 2