Availability and quality assessment of online nutrition information materials for pelvic cancer patients in the UK

Written information can be an essential source of support in the promotion of lifestyle changes after a cancer diagnosis. This study aimed to identify and assess the quality of available online Patient Information Materials (PIMs) in relation to diet and nutrition for pelvic cancer patients. The online sources of the National Health Service, cancer centres and charitable organisations throughout the UK were searched. Content was assessed using an evidence-based checklist, and readability with two validated formulas. Consumer feedback was sought through Patient and Public Involvement (PPI) groups. Forty PIMs were identified; four were designed specifically for pelvic cancers (bladder, bowel, prostate) and 36 were generic (relevant for all cancers). Most PIMs had a good content score, with PIMs from charities scoring higher overall than PIMs from cancer centres [32 (4) Vs 23 (11), P<0.001]. Seventy-three percent of PIMs had a readability score within acceptable levels (6th-8th grade; reading ability of 11-14 year-olds). PPI contributors found most PIMs useful and comprehensive but lacking specific information needed to meet individual needs. There is limited availability of online PIMs for cancer survivors and even fewer tailored to pelvic cancers. Most materials have comprehensive content and acceptable readability. Some PIMs may require improvemen

Diet and nutrition information and support needs in pelvic radiotherapy: A systematic, mixed-methods review

Introduction: This study aimed to review diet and nutrition information and support needs of cancer patients who receive pelvic radiotherapy to inform the development of interventions to improve this area of care. Methods: The systematic review followed the PRISMA guidelines. Six electronic databases were searched for peer-reviewed studies of any design that assessed diet and nutrition needs after a pelvic cancer diagnosis. Narrative synthesis was used to integrate findings. Results: Thirty studies (12 quantitative, 15 qualitative, 3 mixed-methods) were included. Four themes, “content of dietary information”; “sources of information”. “sustaining dietary change”; and “views on the role of diet post-treatment”, summarised evidence about provision of nutritional guidance following diagnosis, but also contrasting views about the role of diet post diagnosis. Qualitative studies contributed considerably more to the synthesis, compared to quantitative studies. Included studies were of moderate to good quality; selection bias in quantitative studies and poor evidence of credibility and dependability in qualitative studies were highlighted. Conclusion: There is some evidence of lack of nutrition support in pelvic cancer survivors, but methodological limitations of included studies may have had an impact on the findings. Future, prospective studies that focus on diet and nutrition needs post-diagnosis are warranted to improve care

Glycaemic Index, Glycaemic Load and dietary fibre characteristics of two commercially available fruit smoothies

In light of the updated Eatwell Guide and the corresponding change in the consumption of fruit smoothies, the aim of this study was to measure the glycaemic index and load of two commercial fruit smoothies and to investigate the retention of dietary fibre following production. In vitro analysis was performed to identify fibre material (cellulose and pectins) using calcofluor staining and immunocytochemical labelling. A repeated measures crossover study was conducted (n 10) to determine the Glycaemic Index (GI) and Glycaemic Load (GL) of the smoothies. Results showed that dietary fibre was still present in the smoothies after processing (16.9-17.5% cellular material by dry weight). The GI was low for both smoothies (39 and 36), whereas the GL was medium and borderline-low, respectively (11.4 and 9.7). The retention of fibre in these smoothies may have a potential positive effect on glycaemic response and may contribute to daily fibre requirements

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

Δίαιτα και καρκίνοι της περιοχής της λεκάνης: μια μελέτη μικτών μεθόδων για τη διερεύνηση διαιτητικών συνηθειών, διατροφικών γνώσεων και εμπειριών στη διατροφική φροντίδα

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.Εισαγωγή: Η δίαιτα / διατροφή αποτελεί έναν σημαντικό παράγοντα φροντίδας μετά τη διάγνωση καρκίνου που όμως συχνά δε διευθετείται. Οι ασθενείς μπορούν να ωφεληθούν από διαιτητικές αλλαγές με στόχο τη βελτίωση της ποιότητας ζωής τους και την πρόληψη άλλων νοσημάτων. Ο σκοπός του διδακτορικού ήταν η διερεύνηση διαιτητικών συνηθειών, γνώσεων περί διατροφής και συστάσεων, καθώς και εμπειριών διαιτητικής υποστήριξης ασθενών που έλαβαν ακτινοθεραπεία στην περιοχή της λεκάνης λόγω διάγνωσης καρκίνου. Μέθοδοι: Αρχικά, διενεργήθηκε συστηματική ανασκόπηση σχετικά με τις ανάγκες υποστήριξης και παροχής πληροφοριών για δίαιτα μετά τη διάγνωση καρκίνου της περιοχής της λεκάνης. Στη συνέχεια, άτομα με διάγνωση καρκίνου της περιοχής της λεκάνης (ορθοκολικού, ουροδόχου κύστης, αναπαραγωγικών οργάνων) που είτε υποβάλλονταν σε ακτινοθεραπεία (n=266) είτε είχαν ολοκληρώσει ακτινοθεραπεία στην περιοχή της λεκάνης (n=405), στρατολογήθηκαν για συμμετοχή σε έρευνα / ερωτηματολόγιο, και ένα δείγμα αυτών παρείχε επιπλέον τηλεφωνικές συνεντεύξεις (n=28). Το τρίτο μέρος της διδακτορικής διατριβής αποτέλεσε την διαθεσιμότητα και αξιολόγηση πληροφοριών διατροφής στο διαδίκτυο για ασθενείς με διάγνωση καρκίνου της περιοχής της λεκάνης. Αποτελέσματα: Το ερωτηματολόγιο συμπληρώθηκε από 254 (38%) άτομα. Παρατηρήθηκαν υψηλά ποσοστά υπερβαρότητας και παχυσαρκίας στο δείγμα (39% και 24% αντίστοιχα) και παρουσία παρενεργειών των θεραπειών (στο 82% τουλάχιστον ένα σύμπτωμα όπως αλλαγές στη γαστρεντερική λειτουργία, απώλεια όρεξης, κόπωση). Τα δύο τρίτα των ατόμων που συμμετείχαν (n=170) πραγματοποίησαν τουλάχιστον μία διαιτητική αλλαγή μετά τη διάγνωση, με κύριες αλλαγές τη μείωση των τροφίμων με ζάχαρη (48%) και του αλκοόλ (41%). Σαράντα τρία τοις εκατό (n=108) έλαβαν διαιτητική υποστήριξη από την ιατρική ομάδα, εκ των οποίων το 67% (n=72) ήταν ευχαριστημένοι. Η υποστήριξη από την ιατρική ομάδα σχετίστηκε σημαντικά με διαιτητική αλλαγή (OR 3.63, 95% CI: 1.82-7.23). Η πλειοψηφία των ατόμων που συμμετείχαν (68%, n=171) θα ήθελαν να λάβουν πρόσθετη στήριξη σχετικά με τη δίαιτά τους. Η ανάλυση της ποιοτικής έρευνας ανέδειξε επτά θεματικές ενότητες: "Η επίδραση της διάγνωσης και των θεραπειών στις διαιτητικές επιλογές", "Προσωπικές πηγές", "Κοινωνικές πηγές", "Συνοδά νοσήματα και αναπηρία", "Η επίδραση της εργασίας", "Ανακτώντας την κανονικότητα" και "Εμπόδια στη διαιτητική αλλαγή". Τέλος, τα περισσότερα ενημερωτικά φυλλάδια και μέσα σχετικά με δίαιτα και διατροφή είχαν καλό περιεχόμενο και καλή ποιότητα αλλά δεν ήταν διαθέσιμα στο ευρύ κοινό. Επίλογος: Η έρευνα ανέδειξε έλλειψη συστηματικής διαιτητικής στήριξης σε άτομα μετά τη διάγνωση καρκίνου στη λεκάνη και την ανάγκη για παροχή ποιοτικών, βασισμένων σε έρευνα, πληροφοριών σε ασθενείς για να αντιμετωπίσουν τις παρενέργειες των θεραπειών και να έχουν μια υγιή μελλοντική ζωή. Συνεισφορά στη γνώση: Η διατριβή αυτή βοήθησε στην κατανόηση των αναγκών σε στήριξη σχετικά με δίαιτα και διατροφή μιας ομάδας ασθενών που δεν έχει μελετηθεί επαρκώς, με ερευνητικό σχεδιασμό μικτών μεθόδων. Η γνώση αυτή μπορεί να συνεισφέρει στο σχεδιασμό αποτελεσματικών μελλοντικών παρεμβάσεων

Parental Lifestyle Changes and Correlations with Children’s Dietary Changes during the First COVID-19 Lockdown in Greece: The COV-EAT Study

The aim of this study was to investigate changes in the eating behaviour of parents during the first lockdown implemented in Greece due to COVID-19 and to explore possible associations with corresponding changes in the eating behaviour of their children. A quantitative cross-sectional study was performed using an online questionnaire. The study sample consisted of 397 parents with children aged 2–18 years, who were recruited from 63 municipalities in Greece. It was observed that the percentage of parents and children reporting consumption of breakfast during the lockdown period increased by 10.6% and 5%, respectively. Also, 75% of the parents increased their snack consumption and 61% their sweets consumption. Parents increased home-cooking during lockdown (6.4 times/week), compared to 5.6 times/week before (p p p < 0.05). More than half parents tried to lose weight during lockdown (58.4%). In conclusion, both favourable (home-cooking) and unfavourable (increased snacking) lifestyle changes during the first COVID-19 lockdown in Greece were reported for parents

Parental Lifestyle Changes and Correlations with Children&rsquo;s Dietary Changes during the First COVID-19 Lockdown in Greece: The COV-EAT Study

The aim of this study was to investigate changes in the eating behaviour of parents during the first lockdown implemented in Greece due to COVID-19 and to explore possible associations with corresponding changes in the eating behaviour of their children. A quantitative cross-sectional study was performed using an online questionnaire. The study sample consisted of 397 parents with children aged 2&ndash;18 years, who were recruited from 63 municipalities in Greece. It was observed that the percentage of parents and children reporting consumption of breakfast during the lockdown period increased by 10.6% and 5%, respectively. Also, 75% of the parents increased their snack consumption and 61% their sweets consumption. Parents increased home-cooking during lockdown (6.4 times/week), compared to 5.6 times/week before (p &lt; 0.001), which was associated with decreased consumption of fast foods for both parents and children (p &lt; 0.001 for all comparisons) and also correlated with increased consumption of fruit and vegetables for children (p &lt; 0.05). More than half parents tried to lose weight during lockdown (58.4%). In conclusion, both favourable (home-cooking) and unfavourable (increased snacking) lifestyle changes during the first COVID-19 lockdown in Greece were reported for parents

Barriers and facilitators of healthy lifestyle and perspectives towards the development of weight loss programmes. Focus groups with post-treatment breast cancer survivors in Greece

The present study aimed to identify the factors that prohibit or enable breast cancer survivors from adopting a healthy lifestyle, as well as to record patients’ suggestions towards developing a weight-loss lifestyle intervention. Twenty-three breast cancer survivors participated in four online, semi-structured focus groups in Greece. All discussions were video-recorded and transcribed verbatim. Participants were 50⋅5 ± 7⋅4 years old with a current mean BMI of 29⋅1 ± 3⋅4 kg/m2. Four main themes emerged from thematic analysis: (1) dietary and lifestyle practices, (2) the effects of cancer on body weight, (3) the impact of cancer on psychology, and (4) the effect of the environment on body weight. Lack of information from healthcare professionals and lack of time were the main barriers to body weight management, whereas the main facilitators were support from their social environment, along with a comfortable physical environment, and the facility of technology. Participants suggested that an effective weight-loss lifestyle intervention should include psychological and social support, guidance and education, collaboration, flexible recommendations, personalised goals, and a follow-up plan. The needs of breast cancer survivors need to be considered when designing weight-loss lifestyle interventions. A personalised approach may prove more effective in promoting a healthy lifestyle and improving patients’ care