A systematic review of nurse-led dietary interventions for cancer patients and survivors

Trajectories of aerobic physical activity and fruit and vegetable intake in adults with cancer: Predictors and outcomes of class membership

PURPOSE

Advances in cancer treatment have led to increased survival rates, but cancer survivors often face challenges such as physical and psychosocial impairments, accelerated aging, and reduced quality of life. While regular physical activity (PA) and a heathy diet, particularly fruit and vegetable (F&V) intake, are known to benefit recovery, many survivors do not meet recommended health behavior guidelines.

METHODS

Latent class linear mixed modeling was used to analyze YUCAN study data, identifying distinct trajectories of aerobic PA and F&V intake in adults with breast, prostate, or colorectal cancer, during the transition from treatment to early survivorship. We examined trajectory patterns, identified socio-demographic, clinical, and psychosocial predictors of trajectory groups, and explored associations with physical health and distress. Participant (n = 501) surveys were analyzed at baseline (~ 3 months from treatment completion) and at 3-month intervals for 12 months.

RESULTS

Three PA trajectories were identified: "consistently low," "low and increasing," and "high and decreasing." Two F&V intake trajectories were found: "moderate and increasing," and "consistently low." Socio-demographic factors, such as older age and racial-ethnic minority status, as well as psychosocial factors, including resilience and perceived controllability of the illness, were significant predictors of PA trajectory membership. Higher F&V intake was also associated with better physical health at T5.

CONCLUSION

These findings highlight the intragroup variability in health behavior trajectories, predictors and health outcomes.

IMPLICATIONS FOR CANCER SURVIVORS

This variability indicates that survivors may require individualized support to adopt healthier behaviors during the transition to early survivorship.

The effect of consultations performed by specialised nurses or advanced nurse practitioners on patient and organisational outcomes in patients with complex health conditions: An umbrella review

BACKGROUND

Policymakers and researchers often suggest that nurses may play a crucial role in addressing the evolving needs of patients with complex conditions, by taking on advanced roles and providing nursing consultations. Nursing consultations vary widely across settings and countries, and their activities range from complementing to substituting traditional physician-led consultations or usual care.

OBJECTIVE

This study was aimed at describing the effects of nursing consultations with patients with complex conditions in any setting on patient outcomes (quality of life, physical status, psychosocial health, health behaviour, medication adherence, mortality, anthropometric and physiological outcomes, and patient satisfaction) and organisational outcomes (health resource use and costs).

DESIGN

Umbrella review.

METHODS

We followed the Joanna Briggs Institute method for umbrella reviews. We searched PubMed, Embase, Cochrane Database of Systematic Reviews and CINAHL to identify relevant articles published in English, Dutch, French, Spanish or German between January 2013 and February 2023. We included systematic literature reviews, with or without meta-analyses, that included randomised controlled trials conducted in high-income countries. Reviews were eligible if they pertained to consultations led by specialised nurses or advanced nurse practitioners. Article selection, data extraction and quality appraisal were performed independently by at least two reviewers.

RESULTS

We included 50 systematic reviews based on 473 unique trials. For all patient outcomes, nursing consultations achieved effects at least equivalent to those of physician-led consultations or usual care (i.e., non-inferiority). For quality of life, health behaviour, medication adherence, mortality and patient satisfaction, more than half the meta-analyses found statistically significant effects in favour of nursing consultations (i.e., superiority). Cost results must be interpreted with caution, because very few and heterogeneous cost-related data were extracted, and the methodological quality of the cost analyses was questionable. Narrative syntheses confirmed the overall conclusions of the meta-analyses.

CONCLUSIONS

The effects of nursing consultations on patients with complex health conditions across healthcare settings appear to be at least similar to physician-led consultations or usual care. Nursing consultations appear to be more effective than physician-led consultations or usual care in terms of quality of life, health behaviour, mortality, patient satisfaction and medication adherence. Further analysis of the primary data is necessary to determine the patient populations and settings in which nursing consultations are most effective. Moderate study quality, diversity amongst and within systematic reviews, and quality of reporting hamper the strength of the findings.

The Interplay of Psycho-Social Determinants on Quality of Life and Health Behaviors Among Hispanic, Non-Hispanic Black Cancer Survivors

OBJECTIVES

This study aimed to explore psycho-social factors (i.e., socio-demographics, health insurance, stress) associated with Quality of life (QOL) and the degree to which self-reported access to healthcare and health behaviors (i.e., fruit and vegetable consumption, physical activity) mediate the effects of psycho-social factors on QOL among Hispanic, non-Hispanic Black (NHB), and other non-White cancer survivors.

METHODS

The descriptive cross-sectional study enrolled a total of 74 Hispanic (n = 26), NHB (n = 42), and other non-White (n = 6) people affected by cancer. QOL, physical activity, diet, stress, and survivorship care data were collected prospectively between June 2022-September 2023.

RESULTS

The mean scores of QOL were moderate for global health (59.4 ± 21.4) and functional status (64.8 ± 22.2) and low for symptom experience (33.6 ± 19.4). Of the participants, 35.1% (n = 24) reported at least one challenge in accessing healthcare. The average daily consumption of fruits and vegetables was 2.44 ± 0.61 cup equivalents. Most participants had insufficient (37.8%) or minimal (47.3%) engagement in physical activity. Men and those with higher stress levels reported lower global health status. Higher stress level was associated with an increased likelihood of lower physical activity. Private insurance and some college education were associated with an increased likelihood of consuming more fruit and vegetables. Self-reported access to healthcare did not mediate the association between any of the variables and the global health score of QOL.

CONCLUSIONS

Hispanic, NHB and other non-White cancer survivors had moderate global health and functional status with lower symptom burden. Further research with a large sample is needed to explore the associations between health behaviors, access to care challenges, and other factors that may better explain determinants of QOL among non-White cancer survivors.

IMPLICATIONS FOR NURSING PRACTICE

Findings suggest that tailored interventions should consider the interplay of psychosocial determinants to optimize health behaviors and QOL.

Non-pharmacological interventions for chemotherapy-induced diarrhoea and constipation management: A scoping review

PURPOSE

Chemotherapy-induced diarrhoea (CID) and constipation (CIC) are among the most common and severe gastrointestinal symptoms related to chemotherapy. This review aimed to identify and describe the evidence for non-pharmacological interventions for the management of CID and CIC.

METHODS

The scoping review was based on the Joanna Briggs Institute methodology and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Evidence from five databases were included: CINAHL, MEDLINE, Embase, PubMed, and APA PsycInfo. Data were systematically identified, screened, extracted and synthesised narratively to describe the evidence for non-pharmacological interventions and their effects on CID and CIC.

RESULTS

We included 33 studies, of which 18 investigated non-pharmacological interventions for CID management, six for CIC management, and nine for both CID and CIC management. Interventions were categorized into five groups, including (1) digital health interventions, (2) physical therapies, (3) diet and nutrition therapies, (4) education, and (5) multimodal. Diet and nutrition therapies were the most common to report potential effectiveness for CID and CIC outcomes. Most of the interventions were implemented in hospitals under the supervision of healthcare professionals and were investigated in randomised control trials.

CONCLUSIONS

The characteristics of non-pharmacological interventions were diverse, and the outcomes were inconsistent among the same type of interventions. Diet and nutritional interventions show promise but further research is needed to better understand their role and to contribute to the evidence base. Nurses are well placed to assess and monitor for CIC and CID, and also deliver effective non-pharmacological interventions.

A Systematic Review of Dietary Interventions for Cancer Survivors and Their Families or Caregivers

Family or caregiver engagement has the potential to support healthy dietary changes among cancer survivors. However, little is known about these family- or caregiver-involved dietary interventions and their effects. This systematic review aimed to identify the behavior change techniques (BCTs) used in dietary interventions for cancer survivors and their families or caregivers and to synthesize intervention effects on dietary and health outcomes. Following the PRISMA guidelines, we conducted systematic searches in three databases and identified 12 trials (16 peer-reviewed manuscripts) for inclusion in this review. Data were extracted from these manuscripts and the BCT taxonomy was used to identify the BCTs. A total of 38 BCTs were identified from 12 trials, 13 of which were used in at least half of the 12 trials. Ten studies reported significant intervention effects on health outcomes (e.g., adiposity) and six suggested significant improvements in dietary behaviors (e.g., fruit and vegetable intake). Overall, this review found that family- or caregiver-involved interventions for cancer survivors significantly improved dietary and health outcomes. Future research should identify BCTs particularly for dietary changes and develop effective dyadic strategies to facilitate diet-related interactions between survivors and their families or caregivers to enhance their engagement in healthy diets.

The effect of nurse-led empowering education on nutrition impact side effects in patients with colorectal cancer undergoing chemotherapy: A randomised trial

OBJECTIVE

This study assessed the effect of empowering education on patient-reported outcomes and morbidity.

METHODS

A randomised controlled trial was conducted on adults with colorectal cancer (43 + 40). The intervention consisted of one-hour empowering patient education on nutrition impact side effects. The effect was compared with standard care. The difference between the groups was analysed pre and post intervention.

RESULTS

The change in malnutrition-related knowledge level was higher in the intervention group compared to control group (median 0.0, IQR 1.00 vs median 0.0, IQR 0.0, p = 0.028). Additional contacts with outpatient clinic were fewer in intervention group (median 0.00, IQR 0.00) compared to control group (median 1.00, IQR 2.00, p < 0.001). We did not find a statistically significant difference in the change in activation level, risk of malnutrition and quality of life between the groups.

CONCLUSION

Empowering education may affect positively on patients' knowledge level related to malnutrition and reduce the number of additional contacts with health care thus reduce health care costs.

PRACTICE IMPLICATIONS

Empowering education may be used in patients with colorectal cancer to improve knowledge and reduce additional contacts with health care. Further research is needed on the effect of empowering education in self-care.