Purpose <p>Taste and smell alterations (TSAs) in nasopharyngeal cancer patients negatively impact their quality of life. This study is aimed at assessing the prevalence of TSAs in patients with nasopharyngeal carcinoma undergoing radiotherapy and at exploring the correlation between TSAs and quality of life.</p> Methods <p>The research was a cross-sectional survey conducted from June 2023 to March 2024 in which the Taste and Smell Survey (TSS) questionnaires were administered to 135 patients receiving radiotherapy for nasopharyngeal cancer.</p> Results <p>The mean total score on the TSS scale was 9.37 ± 4.595. A higher TSS score indicates more alterations. We enrolled 135 patients, 91.1% of whom reported alterations in taste and smell. The severity of alterations was classified as mild (6.7%), moderate (33.3%), and severe (51.1%). The occurrence of changes in taste sensitivity to salty, sweet, sour, and bitter flavors were 66.7%, 52.6%, 52.6%, and 53.3%, respectively, while olfactory sensitivity changes were found in 48.9% of the patients. Notably, a statistically significant correlation was found between cumulative dose of radiotherapy and the TSS score (<i>p</i> &lt; 0.05). TSAs were significantly correlated with anxiety and overall quality of life (<i>p</i> &lt; 0.05).</p> Conclusion <p>TSAs are prevalent among patients undergoing radiotherapy for nasopharyngeal carcinoma, with the majority experiencing moderate to severe alterations. The findings underscore the importance of implementing targeted interventions to address the sensory alterations and improve the patients’ psychological well-being and life quality.</p>