Diet, nutrition and pelvic cancers: A mixed-methods study to explore dietary habits, nutritional awareness and experiences of nutritional care
Background: Nutrition is an important aspect of cancer survivorship care that is not routinely addressed. Patients may benefit from dietary modifications to improve quality of life and future health outcomes. This PhD aimed to explore dietary habits, awareness of nutritional recommendations and experiences of nutritional support in patients who have received radiotherapy to the pelvic area following a cancer diagnosis. Methods: First, a systematic review regarding diet and nutrition information and support needs after a pelvic cancer diagnosis was conducted (Phase 1). In Phase two, people diagnosed with a pelvic cancer (anal, bladder, rectal and cancers of the reproductive organs), either undergoing [on-treatment (OT): n=266] or having completed pelvic radiotherapy 6-24 months previously [post-treatment (PT): n=405], were invited to participate in a survey, followed by telephone interviews with a sub-sample of 28 respondents. In Phase three, the availability and quality of online nutrition information for pelvic cancer patients in the UK was assessed. Results: The survey was completed by 254 (38%) cancer survivors. High overweight and obesity rates (39% and 24% respectively) and presence of treatment side effects (e.g. bowel changes, appetite issues, fatigue) (82%) were observed. Two-thirds of respondents (n=170) reported at least one dietary change since diagnosis; most notable changes were reduction of sugary foods (48%) and alcohol (41%). Forty-three percent (n=108) had received dietary support from the healthcare team, of which 67% (n=72) felt their needs were well met. Receipt of support from the healthcare team was significantly associated with dietary change (OR 3.63, 95% CI: 1.82-7.23). The majority of respondents (68%, n=171) would like to receive additional dietary support. Qualitative analysis identified seven themes: “Impact of diagnosis and treatments on dietary choices”, “Personal resources”, “Social resources”, “Comorbidities and disabilities”, “Influence of work”, “Regaining normality” and “Barriers to dietary changes”.. Finally, most online materials about diet and nutrition had comprehensive content and good quality, but they were not widely available. Conclusion: This thesis identified a lack of routine provision of nutritional care to patients following a cancer diagnosis and highlighted the need for reliable information to support patients in managing diet-related problems and leading a healthy future lifestyle. Contribution to knowledge: This thesis has developed a detailed understanding of diet and nutrition information and support needs in an under-researched cancer population, with the use of a mixed-methods design. This knowledge will inform the design of future dietary / lifestyle interventions.
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