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Smith S, Fisher A, Lally PJ, Croker HA, Roberts A, Conway RE, Beeken RJ. Perceiving a need for dietary change in adults living with and beyond cancer: A cross-sectional study. Cancer Med 2024; 13:e7073. [PMID: 38457197 PMCID: PMC10922024 DOI: 10.1002/cam4.7073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Many people living with and beyond cancer (LWBC) do not meet dietary recommendations. To implement a healthier diet, people LWBC must perceive a need to improve their diet. METHODS Participants included people diagnosed with breast, prostate or colorectal cancer in the UK. Two binary logistic regression models were conducted with perceived need for dietary change as the outcome (need to improve vs. no need). Predictor variables included demographic and clinical characteristics, receipt of dietary advice, and either body mass index (BMI) or adherence to seven relevant World Cancer Research Fund (WCRF) dietary recommendations. RESULTS The sample included 5835 responses. Only 31% perceived a need to improve their diet. Being younger (odds ratio [OR] 0.95, 95% confidence interval [CI] = 94-0.95), female (OR = 1.33, 95% CI = 1.15-1.53), not of white ethnicity (OR = 1.8, 95% CI = 1.48-2.27), not married/cohabiting (OR = 1.32, 95% CI = 1.16-1.52) and having received dietary advice (OR = 1.36, 95% CI = 1.43-1.86) was associated with an increased odds of perceiving a need to improve diet. This association was also seen for participants with two or more comorbidities (OR = 1.31, 95% CI = 1.09-1.57), those not meeting the recommendations for fruit and vegetables (OR = 0.47, 95% CI = 0.41-0.55), fat (OR = 0.67, 95% CI = 0.58-0.77), and sugar (OR = 0.86, 95% CI = 0.75-0.98) in the dietary components model and those who had a higher BMI (OR = 1.53, 95% CI = 1.32-1.77) in the BMI model. CONCLUSIONS Most of this sample of people LWBC did not perceive a need to improve their diet. More research is needed to understand the reasons for this and to target these reasons in dietary interventions.
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Affiliation(s)
- Susan Smith
- Department of Behavioural Science and Health, University College London, London, UK
| | - Abi Fisher
- Department of Behavioural Science and Health, University College London, London, UK
| | - Phillippa J Lally
- Department of Behavioural Science and Health, University College London, London, UK
- Department of Psychology, University of Surrey, Surrey, UK
| | - Helen A Croker
- Department of Behavioural Science and Health, University College London, London, UK
| | - Anna Roberts
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rana E Conway
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Nelson V, Cross AJ, Powell J, Shaw C. Can people living with and beyond colorectal cancer make lifestyle changes with the support of health technology: A feasibility study. J Hum Nutr Diet 2023; 36:554-565. [PMID: 35320595 DOI: 10.1111/jhn.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rates of cancer survival are increasing, with more people living with and beyond cancer. Lifestyle recommendations for cancer survivors are based largely on extrapolation from cancer prevention recommendations. This feasibility study was designed to investigate diet and physical activity variables linked to primary prevention and digital behaviour change interventions in cancer survivors and delivered by an oncology dietitian to plan for future research. METHODS In this 2-month feasibility study, participants who had completed treatment for colorectal cancer were invited to complete online food diaries, underwent physical activity assessment, attended fortnightly telephone consultations with an oncology dietitian and completed an evaluation form. The baseline food diaries were used to help participants pick two lifestyle changes to focus on throughout the intervention. Demographic and clinical data were analysed using descriptive statistics. RESULTS In total, 996 patients were screened for eligibility; of these, 78 were eligible to approach and 69 were approached, resulting in 20 participants consenting to take part. Overall, the intervention was acceptable with 65% of participants completing an online food diary and 70% engaging with the dietitian over the telephone. The intervention received good feedback, with 100% of those completing the evaluation form reporting they felt supported and found it helpful. CONCLUSIONS The present study offers preliminary evidence that a lifestyle intervention delivered by an oncology dietitian using digital behaviour change interventions (DBCIs) to cancer survivors is feasible and accepted by participants and providers.
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Affiliation(s)
- Victoria Nelson
- Department of Nutrition and Dietetics, The Royal Marsden NHS Foundation Trust, London, UK
- The Royal Marsden School, The Royal Marsden NHS Foundation Trust, London, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Surgery & Cancer, Cancer Screening & Prevention Research Group, Imperial College London, London, UK
| | | | - Clare Shaw
- Department of Nutrition and Dietetics, The Royal Marsden NHS Foundation Trust, London, UK
- Biomedical Research Centre, The Royal Marsden and Institute of Cancer Research, London, UK
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Keaver L, O'Callaghan N, LaVertu AE, Semple CJ, Hughes CM, Hanna JR, Ryan L. Experiences of cancer patients in receiving dietary advice from healthcare professionals and of healthcare professionals in providing this advice-a systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01359-4. [PMID: 36964295 DOI: 10.1007/s11764-023-01359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/06/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE This systematic review investigated qualitative and quantitative studies exploring patients and healthcare professionals' (HCP) experience of nutrition care throughout the cancer journey. METHODS Five databases were systematically searched for studies reporting on patient and healthcare professionals' experience of nutrition advice. RESULTS Fifteen studies including 374 patients and 471 healthcare professionals were included. Findings indicate that patients desire more specific nutrition advice supported by members of the multidisciplinary team and delivered in appropriate and understandable language. Healthcare professionals have highlighted a lack of time, funding, dietetic roles, and knowledge as barriers to integrating nutrition as a standard part of cancer care. Five themes were identified (current provision of nutrition advice, optimal provision of nutrition advice, tension between patient values and nutritional or HCP priorities, providing evidence-based nutrition care, and practical barriers to nutrition advice provision). CONCLUSIONS Further work is essential to better understand and address identified barriers and improve the provision of nutrition advice to this population. IMPLICATIONS FOR CANCER SURVIVORS Findings from this review will guide the delivery of nutrition advice for cancer survivors.
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Affiliation(s)
- Laura Keaver
- Atlantic Technological University, Sligo, Ireland.
| | | | - Amy E LaVertu
- Hirsh Health Sciences Library, Tufts University, Boston, MA, USA
| | | | | | | | - Lisa Ryan
- Atlantic Technological University, Sligo, Ireland
- Atlantic Technological University, Galway, Ireland
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Ford KL, Trottier CF, Wismer WV, Sawyer MB, Siervo M, Deutz NEP, Prado CM, Vallianatos H. Drivers of Dietary Choice After a Diagnosis of Colorectal Cancer: A Qualitative Study. J Acad Nutr Diet 2023; 123:407-16. [PMID: 36002111 DOI: 10.1016/j.jand.2022.08.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dietary changes often accompany management of a cancer diagnosis, but how and why patients with colorectal cancer (CRC) make dietary decisions requires further investigation. OBJECTIVE To learn about patients' food-related beliefs and understand whether and why dietary changes were made by patients starting chemotherapy after a CRC diagnosis. DESIGN A qualitative semi-structured interview study was conducted as a secondary analysis among a subset of patients with stages II-IV CRC enrolled at baseline in a randomized controlled trial. PARTICIPANTS/SETTING Twenty-nine patients participated in the interview. Data were collected at the University of Alberta (Edmonton, Alberta, Canada) from 2016-2019 before any trial intervention. QUALITATIVE DATA ANALYSIS Audio-recorded interviews were transcribed verbatim then coded inductively by two research team members. Qualitative content analysis was applied to capture emergent themes. RESULTS Patients reported varied degrees of dietary change that stemmed from internal and external influences. Four main themes emerged to describe patients' dietary decisions after a CRC diagnosis: 1) Medical Influences: eating to live; 2) Health Beliefs: connecting lived experiences with new realities; 3) Static Diets: no changes postdiagnosis; and 4) Navigating External Influences: confluence of personal agency and social constraints. CONCLUSION The extent to which patients altered their dietary choices depended on perspectives and beliefs. These included the degree to which dietary decisions provided some agency (ie, feeling of control) for dealing with physical ramifications of cancer treatment, individuals' personal understandings of healthy foods, and the role of diet in managing their new physical reality postdiagnosis. This information provides registered dietitian nutritionists and health care providers with insight into dietary intentions of select patients being treated for CRC. These findings can guide future research focused on effective strategies for streamlined nutritional support that aligns with patient needs.
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Chen J, Jia L, Li Y, Shi Y, Dong X, Yao J, Zhu M, Zhang X, Yuan H. Factors influencing adherence to healthy eating behaviors among adult colorectal cancer survivors: a systematic mixed method review. Support Care Cancer 2022; 31:88. [PMID: 36574042 DOI: 10.1007/s00520-022-07475-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/17/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Under the umbrella of social cognitive theory, we examined the influences of personal, environmental, and behavioral factors on adherence to healthy eating behaviors among colorectal cancer survivors. METHODS Based on Pluye and Hong's framework, a systematic mixed studies review was conducted. An extensive search strategy was applied in PubMed, Web of Science, Embase, CINAHL, and PsycINFO (from date of record to 2022 January 22). The pillar integration process was employed to integrate the extracted data. The Mixed Methods Appraisal Tool was used to appraise the quality of all retained studies. RESULTS Twenty-eight studies with a total sample size of 5106 were included in the analysis, with 15 quantitative studies, 12 qualitative studies, and 1 mixed method study. The critical appraisal showed that 22 of the 28 studies (79%) were rated with five stars, while 6 (21%) were rated with four stars. The personal factors influencing adherence to healthy eating behaviors among colorectal cancer survivors included outcome expectancies, self-efficacy, psychological factors, knowledge about healthy eating, demographic and disease characteristics, environmental factors incorporated outside information on healthy eating, power of surrounding people, social activities, cultural milieus, socioeconomic status, and education. The behavioral factors included self-regulation of diet, goals, and other behaviors closely related to healthy eating behaviors. CONCLUSIONS Adherence to healthy eating behaviors among colorectal cancer survivors was influenced collectively by personal factors, environmental factors and behavioral factors.
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Keaver L, O'Callaghan N, Douglas P. Nutrition Support & Intervention Preferences of Cancer Survivors. J Hum Nutr Diet 2022; 36:526-539. [PMID: 35778782 DOI: 10.1111/jhn.13058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/03/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Ascertaining cancer survivors' specific needs and preferences regarding nutrition information delivery is important in developing and designing future health interventions in oncology. This study aimed to explore the nutrition information needs of cancer survivors and their preferences regarding intervention delivery. METHODS The present study is a mixed-methods study comprising a cross-sectional survey and focus groups. Participants were eligible for inclusion if they were 18+years, living in Ireland with a cancer diagnosis and had completed treatment at least six months previous. Cancer support centres promoted the online survey on social media. Focus groups were conducted with twenty individuals. RESULTS The cohort (n=56) were predominantly female (n=50, 89.3%), breast cancer survivors (n=42, 75%). Seven (12.5%) had received nutrition advice from a dietitian. Most are interested in receiving nutrition advice (n=52, 92.9%), with variability in delivery mode. There was interest in improving sleep quality (n=35, 62.5%), making positive lifestyle changes (n=28, 50%) and accessing cancer-specific physical activity classes (n=27, 48.2%). The best time to deliver information was throughout the cancer journey (n=31, 55.4%). Time and motivation (n=15, 26.8%) were the main barriers. Facilitators were keeping healthy (n=42, 75%), and weight maintenance (n=31, 55.4%). Four themes emerged from thematic analysis; lack of nutrition guidance, an abundance of misinformation, one size does not fit all and dietitians as the preferred source of advice. CONCLUSION There is a desire for evidence-based nutrition advice and for dietitians to be integrated into cancer clinics and cancer survivorship care. This research guides future interventional work on the efficacy of nutrition interventions to improve cancer survivorship outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Laura Keaver
- Department of Health and Nutritional Science, Atlantic Technological University, Sligo Campus, Ash Lane, Sligo, F91 YW50
| | - Niamh O'Callaghan
- Department of Health and Nutritional Science, Atlantic Technological University, Sligo Campus, Ash Lane, Sligo, F91 YW50
| | - Pauline Douglas
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, UK
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Whelan K. Group education by dietitians in patients with gastrointestinal disorders: Potentially clinically effective and time for randomised trials. J Hum Nutr Diet 2022; 35:417-420. [PMID: 35578390 DOI: 10.1111/jhn.13010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK
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Abstract
BACKGROUND Improvements in lifestyle such as diet and exercise can minimise the risk of a new cancer diagnosis or cancer recurrence. We investigated dietary changes and supplement use by survivors attending Sydney Cancer Survivorship Centre (SCSC) clinic to plan future interventions to help survivors improve their diet. METHODS Eligible survivors were SCSC cancer patients who had completed anticancer treatment with curative intent and attended their initial clinic between September 2013 and July 2019. Attendees completed questionnaires investigating dietary change and a 3-day food diary before attending clinic. RESULTS Overall, 520 (91%) survivors completed questionnaires and 310 (54%) a 3-day food diary. Mean age was 57 (range 18-90 years), and 68% were female. The main cancer types were breast (41%), colorectal (31%), and haematological (17%). In total, 318/520 (55%) reported making dietary change after their cancer diagnosis. Most common changes were increased fruit and vegetable intake (36%), reduced or avoidance of red meat (25%), sugar or sweets (20%) and fat (12%), while some (7%) specifically avoided dairy products. Overall, 269/439 (61%) reported taking dietary supplements, with a median of 2 supplements (range 0-8). Based on their 3-day food diary assessed by a dietitian, only 53/270 (20%) and 110/276 (40%) met the recommended serves of vegetables and fruit respectively. CONCLUSION The majority of survivors modified their diet after their cancer diagnosis; some modifications appeared to be beneficial, while others were not evidence-based. More than half of survivors reported taking dietary supplements. There is a need for providing appropriate dietary education in a timely manner to improve cancer survivors' diet.
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Affiliation(s)
- Sim Yee Tan
- Sydney Medical School, University of Sydney, Sydney, Australia.,Concord Cancer Centre, Concord Hospital, Concord West, NSW, Australia.,Nutrition and Dietetics Department, Concord Hospital, NSW, Concord, Australia
| | - Hoi Yu Wong
- Nutrition and Dietetics Department, Concord Hospital, NSW, Concord, Australia
| | - Janette L Vardy
- Sydney Medical School, University of Sydney, Sydney, Australia. .,Concord Cancer Centre, Concord Hospital, Concord West, NSW, Australia. .,Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, Sydney, Australia.
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