Purpose <p>Taste alterations (TAs) are a common and distressing side effect experienced by patients with cancer. They significantly impact patients' nutritional intake, quality of life (QoL), and treatment outcomes. This narrative review explores the prevalence, mechanisms, and clinical implications of TAs in patients with cancer.</p> Methods <p>An online bibliographic search was performed across multiple electronic databases, including Medline via PubMed, Embase, Scopus, and Web of Science.</p> Results <p>TAs were across all treatment modalities and in treatment-naïve cancer patients. It is hypothesized that the mechanisms contributing to the development of TAs are multifactorial and may be associated with cancer itself or its therapies. The mechanisms include direct cytotoxic effects of cancer treatments, disruption of regenerative pathways, salivary gland dysfunction, and systemic inflammation. However, the exact mechanisms remain poorly understood. The management of TAs requires a multifaceted approach, including counselling and pharmacological interventions. Tailored nutritional strategies, such as oral nutritional supplements with patient-preferred flavors, can help address some sensory challenges and improve adherence to nutritional intervention and nutritional status. However, depending on the affected sensory modality and its severity, many sensory-adapted flavors showed limited effectiveness. Taste enhancers targeting specific taste receptors offer promising solutions to restore palatability.</p> Conclusion <p>TAs are an underrecognized challenge in cancer patients despite their impact on nutritional status and QoL. Addressing TAs should be an integral component of supportive care in oncology to optimize nutritional and treatment outcomes, as well as improve QoL and prognosis.</p>