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A nutrition intervention in men with prostate cancer: Exploring effects on bowel symptoms from radiotherapy, patient experience, and nutrient intake
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology. (Birgitta Johansson)
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
Abstract [en]

Objective The main objective of this thesis was to explore the effects of a nutrition intervention on acute and late bowel symptoms in men with localised prostate cancer treated with pelvic radiotherapy (study I), participants’ experiences from receiving the nutrition intervention (study II), and associations with nutrient intakes (study III).

Methods A total of 180 men with localised prostate cancer referred to curative radiotherapy targeting the prostate gland and pelvic lymph nodes were recruited to the trial. The participants were randomised to standard care plus a nutrition intervention aiming to modify fibre and lactose intakes (NIG; n=92) or standard care alone (SCG; n=88). Data on bowel symptoms and dietary intake were collected pre-treatment and at seven time points during a 26-month study period. Analyses of the effects of the nutrition intervention on bowel symptoms were conducted for the acute phase (up to 2 months post radiotherapy), and the late phase (7 to 24 months post radiotherapy). Semi-structured interviews were conducted with 15 participants from the NIG to explore experiences of the nutrition intervention.

Results The nutrition intervention was associated with statistically significantly, but not clinically significantly, less bother from blood in stools and flatulence during the acute phase. The nutrition intervention was also associated with more bloated abdomen during the late phase (Study I). Social support, contributing to the greater good, prior knowledge, dietary information, and a small need for change facilitated adherence. While feeling limited, wanting to decide for themselves, the timing of the intervention, unmet expectations, and loss of motivation were described as barriers for adherence (Study II). A greater reduction of lactose was associated with decreased intake of calcium at the end of the radiotherapy period. A more modified fibre intake during the radiotherapy period was associated with increased vitamin C, but decreased selenium intake (Study III).

Conclusions The effects from the nutrition intervention were small and inconclusive and do not support routine dietary advice aiming to modify fibre and lactose intakes as a mean to substantially reduce adverse effects from pelvic radiotherapy. Tailored nutritional interventions based on individual preferences, prior knowledge, and context, could enhance adherence. There were few associations between modified fibre and lactose intakes and nutrient intakes, thus, no recommendations can be made on whether such dietary advice should continue to be provided to men with prostate cancer undergoing pelvic radiotherapy.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. , p. 83
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1666
Keywords [en]
Nutrition intervention, bowel symptoms, radiotherapy, prostate cancer
National Category
Nursing Nutrition and Dietetics
Research subject
Caring Sciences; Nutrition
Identifiers
URN: urn:nbn:se:uu:diva-408823ISBN: 978-91-513-0945-3 (print)OAI: oai:DiVA.org:uu-408823DiVA, id: diva2:1423576
Public defence
2020-06-05, H:son Holmdahl-salen, Akademiska sjukhuset ingång 100/101, 2 trappor, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2020-05-13 Created: 2020-04-15 Last updated: 2020-05-13
List of papers
1. Effects of a nutrition intervention on acute and late bowel symptoms and health-related quality of life up to 24 months post radiotherapy in patients with prostate cancer: a multicentre randomised controlled trial.
Open this publication in new window or tab >>Effects of a nutrition intervention on acute and late bowel symptoms and health-related quality of life up to 24 months post radiotherapy in patients with prostate cancer: a multicentre randomised controlled trial.
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2019 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: Radiotherapy to the prostate gland and pelvic lymph nodes may cause acute and late bowel symptoms and diminish quality of life. The aim was to study the effects of a nutrition intervention on bowel symptoms and health-related quality of life, compared with standard care.

METHODS: Patients were randomised to a nutrition intervention (n = 92) aiming to replace insoluble fibres with soluble and reduce intake of lactose, or a standard care group (n = 88) who were recommended to maintain their habitual diet. Bowel symptoms, health-related quality of life and intake of fibre and lactose-containing foods were assessed up to 24 months after radiotherapy completion. Multiple linear regression was used to analyse the effects of the nutrition intervention on bowel symptoms during the acute (up to 2 months post radiotherapy) and the late (7 to 24 months post radiotherapy) phase.

RESULTS: Most symptoms and functioning worsened during the acute phase, and improved during the late phase in both the intervention and standard care groups. The nutrition intervention was associated with less blood in stools (p = 0.047), flatulence (p = 0.014) and increased loss of appetite (p = 0.018) during the acute phase, and more bloated abdomen in the late phase (p = 0.029). However, these associations were clinically trivial or small.

CONCLUSIONS: The effect of the nutrition intervention related to dietary fibre and lactose on bowel symptoms from pelvic RT was small and inconclusive, although some minor and transient improvements were observed. The results do not support routine nutrition intervention of this type to reduce adverse effects from pelvic radiotherapy.

Keywords
Bowel symptoms, Nutrition intervention, Prostate cancer, Radiotherapy
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-399824 (URN)10.1007/s00520-019-05182-5 (DOI)31758324 (PubMedID)
Funder
Swedish Cancer Society
Available from: 2019-12-16 Created: 2019-12-16 Last updated: 2020-04-15Bibliographically approved
2. Experiences of a nutrition intervention: A qualitative study within a randomised controlled trial in men undergoing radiotherapy for prostate cancer
Open this publication in new window or tab >>Experiences of a nutrition intervention: A qualitative study within a randomised controlled trial in men undergoing radiotherapy for prostate cancer
2020 (English)In: Nutrition & Dietetics, ISSN 1446-6368, E-ISSN 1747-0080, Vol. 77, no 2, p. 223-230Article in journal (Refereed) Published
Abstract [en]

AIM: Men with prostate cancer undergoing radiotherapy may experience acute and late bowel symptoms. Nutrition interventions have shown some benefits, however, adherence tends to decline over time. Qualitative studies, carried out after an intervention, are important to help explain trial results. The aim of the present study was to explore patient experience of participating in a nutrition intervention in a randomised controlled trial, with a focus on facilitators and barriers to adherence.

METHODS: Semistructured interviews were conducted with 15 men with prostate cancer recruited from a randomised controlled trial on a nutrition intervention during radiotherapy. Interviews were analysed with content analysis with an inductive approach.

RESULTS: The informants were motivated to make dietary changes to avoid bowel symptoms. Social support, a feeling of contributing to the greater good, prior knowledge, dietary information and a small need for behaviour change facilitated adherence. Feeling limited, wanting to decide for themselves, the timing of the intervention, unmet expectations of dietary advice and loss of motivation, were described as barriers for adherence.

CONCLUSIONS: Future nutrition intervention trials may benefit from involving significant others to a greater degree, as well as offering pre-set recipes and strategies to manage social events, and more sessions with the dietitian for patients in need of more support. Tailored interventions based on the individual's preferences, context and prior knowledge about food may further facilitate adherence.

Keywords
experiences, interview, nutrition intervention, prostate cancer, radiotherapy
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-399826 (URN)10.1111/1747-0080.12564 (DOI)000522619200007 ()31243870 (PubMedID)
Available from: 2019-12-16 Created: 2019-12-16 Last updated: 2020-05-07Bibliographically approved
3. Associations between modified fiber and lactose intakes and nutrient intakes in men with prostate cancer undergoing radiotherapy
Open this publication in new window or tab >>Associations between modified fiber and lactose intakes and nutrient intakes in men with prostate cancer undergoing radiotherapy
Show others...
(English)Manuscript (preprint) (Other academic)
Keywords
Nutrient intake, fiber, lactose, prostate cancer, radiotherapy
National Category
Nursing
Research subject
Caring Sciences; Caring Sciences
Identifiers
urn:nbn:se:uu:diva-408820 (URN)
Available from: 2020-04-15 Created: 2020-04-15 Last updated: 2020-04-15

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