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Currently, limited evidence-based guidelines exist for the effective management of chemotherapy induced dysgeusia in cancer outpatients. In this pilot study, we used innovative insights from gastrological sciences such as selective taste management to improve the taste of bread for cancer outpatients. We investigated whether it is feasible for cancer outpatients and family caregivers to bake personalized bread themselves at home and whether such bread is considered tasty despite their burdensome taste disorder. Included patients (N=112) are randomly divided in a bread-baking group (N=54) and a control group (N=58). The individual taste thresholds profile of all bread baking patients is assessed using the innovative O-Box. Using an algorithm, these profiles are processed into a recipe for personalized bread. Structured questionnaires and anthropometrics are used to compare the effects of personalized bread after one month follow-up. Only 17% of the bread baking group required some telephone or online assistance in order to correctly apply their personalized recipe. In 60% of the cases, the bread was prepared by the family caregiver. Compliance was high and no side effects were observed. Over 80% of the bread baking patients perceived personalized bread as equally or more tasteful despite their stressful chemotherapy-induced dysgeusia. Compared to the control group loss of bodyweight and Body Mass Index in the bread baking group was not significant (p .968 and p .956 respectively). Baking personalized bread at home appeared to be feasible. Cancer patients with chemotherapyinduced dysgeusia enjoyed the taste of bread again by applying selective taste management. This innovative gastrological self-care intervention is very promising and should be studied more in depth using whole meals in a larger cancer outpatients population.

Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key ‘bottlenecks’: inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.

Cochrane Corner: Antwoord opde vraag: Wat is het effect van reminiscentietherapie (RT) op patiënten met dementie en hun mantelzorgers, aan de hand van een Cochrane Systematische Review

Cochrane Corner: Antwoord op de vraag Hebben educatieve interventies voor mondzorg gericht op personeel en bewoners van woon- en zorgcentra (wzc) een positieve invloed op de gezondheid van de mond van de bewoners, aan de hand van een Cochrane Systematische review

People in need of care, chronic or acute, often present problematic food intake and special nutritional needs. Integrated, person-centred and pro-active food and nutritional care delivery has been proven effective for people in health care. However, skills mismatches have been reported in different professions involved, which also applies to the role of chefs in healthcare. The EU funded project NECTAR aims at closing this gap by creating a new job profile, called Chef Gastro-Engineering (CGE). The current publication summarizes the status quo in hospitals and gives a perspective on the future role of chefs in integrated healthcare delivery.

Currently, limited evidence-based guidelines exist for the effective management of chemotherapy-induced taste alterations in adult cancer patients. In this PhD study, we discuss the effectiveness of individual tailored taste control to overcome such taste changes. Taste alterations have major consequences, not only on a physical level but also on psychosocial dimensions of life. Taste alterations lead to reduced food intake, which in turn leads to unplanned weight loss. In cancer treatment, unintentional weight loss can lead to a reduced likelihood of a positive recovery. In the healthcare system, health professionals, patients and their caregivers are involved in primary food care. Therefore, a primary-food-care intervention is complex and needs to be considered thoroughly. Effective taste control starts with an appropriate taste assessment. The Center for Gastrology in Leuven developed the O-box. With this box, a complete taste assessment can be carried out, allowing gastro-engineering chefs (GIC) to determine which ingredients and to what extent each patient perceives as tasty. A quasi-RCT shows that cancer patients who eat individually flavour-controlled bread for 4 weeks can maintain their weight whereas the patients in the control group lost a significant amount of weight. More than 80% of these patients found this bread tastier during their treatment than the bread they ate before their treatment. A qualitative study with semi-structured interviews with these patients also shows that this intervention gives the patients the feeling that they can step out of their patient role. It gives them something positive to do and gives them insight into their illness and their meals. The patients also feel that the offered intervention acknowledges their problem. Taste management, therefore, can be a useful complementary intervention in cancer treatment and is experienced positively. A validated screening instrument ensures that the right patients can be referred to the assessment. In this study, we created a cross-cultural translation and validation of a Japanese screening instrument for taste alteration (Chemotherapy-induced Taste alteration Scale: CiTAS). For this purpose, we translated the original instrument from Japanese into Dutch and then back into Japanese, and we compared the two Japanese scales. We presented the first Dutch version to a cancer patient in a cognitive interview in which we changed the translation of one item. An expert panel of chefs reviewed the scale content and added five items for factor analysis. The final instrument contains 22 items in four subscales: reduction in basic taste, discomfort, phantogeusia, parageusia and general taste change. In this way, we prepared the CiTAS-NL for use with Dutch-speaking patients. To determine the exact incidence and prevalence of taste alterations, we prepared a protocol for a thorough systematic review on this topic. Overall, it can be concluded that the approach to taste change described in this study is an evidence-based approach that is ready to be implemented in healthcare settings. Extension to other meals and to various degrees of participation will further substantiate the evidence. A multidisciplinary nutrition team with a GIC will add value to patients with taste alterations due to chemotherapy treatment.