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Dietary advice provided to those undergoing pelvic radiotherapy

Published online by Cambridge University Press:  22 February 2017

Nickola Pallin*
Affiliation:
Institute of Health and Society, University of Worcester, Henwick Grove, Worcester, UK
Jane Richardson
Affiliation:
Institute of Health and Society, University of Worcester, Henwick Grove, Worcester, UK
*
Correspondence to: Nickola Pallin, Institute of Health and Society, University of Worcester, Henwick Grove, Worcester, UK. Tel: 020 7935 8544. E-mail: [email protected]

Abstract

Background

In those receiving radiotherapy for pelvic cancers, up to 80% develop gastrointestinal symptoms, with dietary interventions recommended to reduce these symptoms. However, research outlining the current dietary support provided to patients undergoing radiotherapy for pelvic cancer is lacking.

Aim

To identify the gastrointestinal symptoms experienced by those undergoing pelvic radiotherapy and to identify the dietary support provided to these patients.

Methods and materials

A service evaluation was undertaken in one NHS Trust hospital whereby patients undergoing radical pelvic radiotherapy during a 15-week recruitment period were invited to complete an anonymous questionnaire. Participants were recruited using purposive sampling and the data were analysed descriptively using SPSS.

Results

In total, 31 patients responded achieving a response rate of 48%. The most frequent reported gastrointestinal symptoms were gas and flatulence followed by diarrhoea, nausea and abdominal pain. The main dietary changes implemented by the respondents and recommended by health care professionals included reducing fibre intake, reducing certain vegetables, reducing caffeine and increasing water.

Findings

The results illustrate the impact of gastrointestinal side effects on patients’ dietary intake. The results highlight that nutritional guidance need to be standardised, especially for the management of diarrhoea and gas and flatulence as these were the most common occurring side effects. With radiographers most frequently giving nutritional advice they must be provided with guidance to support those undergoing pelvic radiotherapy.

Type
Original Articles
Copyright
© Cambridge University Press 2017 

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References

1.National Health Service. NHS standard contract for radiotherapy (all ages). London: NHS Commissioning Board, 2013. http://www.england.nhs.uk/wp-content/uploads/2013/06/b01-radiotherapy.pdf. Accessed on 21st August 2016.Google Scholar
2. Birgisson, H, Pahlman, L, Gunnarsson, U, Glimelius, B. Late adverse effects of radiation therapy for rectal cancer-a systematic overview. Acta Oncol 2007; 46 (4): 504516.CrossRefGoogle ScholarPubMed
3. Henson, C C, Burden, S, Davidson, S E, Lal, S. Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy. Cochrane Database Syst Rev 2013: 147.CrossRefGoogle Scholar
4. Andreyev, J. Gastrointestinal complications of pelvic radiotherapy: are they of any importance? Gut 2005; 54 (8): 10511054.CrossRefGoogle ScholarPubMed
5. Gami, B, Harrington, K, Blake, P et al. How patients manage gastrointestinal symptoms after pelvic radiotherapy. Aliment Pharmacol Ther 2003; 18 (10): 987994.CrossRefGoogle ScholarPubMed
6. McGough, C, Baldwin, C, Frost, G, Andreyev, H J N. Role of nutritional intervention in patients treated with radiotherapy for pelvic malignancy. Br J Cancer 2004; 90 (12): 22782287.CrossRefGoogle ScholarPubMed
7.National Cancer Institute. Cancer Therapy Evaluation Program. USA: National Cancer Institute, 2009. http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm. Accessed on 2nd February 2016.Google Scholar
8. Bentzen, S M, Baumann, M. Clinical manifestations of normal-tissue damage. In: Steel, G G (ed.) Basic Clinical Radiobiology. London: Hodder Arnold, 2002: 5667.Google Scholar
9. Wouters, B G. Irradiation-induced damage and the DNA damage response. In: Steel, G G (ed.) Basic Clinical Radiobiology. London: Hodder Arnold, 2002: 2740.Google Scholar
10. Del Fabbro, E, Demark-wahnefried, W, Baracos, V. Nutrition and the Cancer Patient. New York: Oxford University Press, 2010.CrossRefGoogle Scholar
11. Beck, P L, Wong, J F, Li, Y et al. Chemotherapy and radiotherapy-induced intestinal damage is regulated by intestinal trefoil factor. Gastroenterology 2004; 126 (3): 796808.CrossRefGoogle ScholarPubMed
12. Yeoh, E, Horowitz, M, Russo, A et al. Effect of pelvic irradiation on gastrointestinal function: a prospective longitudinal study. Am J Med 1993; 95 (4): 397406.CrossRefGoogle ScholarPubMed
13. Packey, C D, Ciorba, M A. Microbial influences on the small intestinal response to radiation injury. Curr Opin Gastroenterol 2010; 26: 8894.CrossRefGoogle ScholarPubMed
14. DeWitt, T, Hegazi, R. Nutrition in pelvic radiation disease and inflammatory bowel disease: similarities and differences. Biomed Res Int 2014: 16.CrossRefGoogle Scholar
15.Macmillan Cancer Support. Cured but at what cost? Long-term consequences of cancer and its treatment. UK: Macmillan Cancer Support, 2013. http://www.macmillan.org.uk/Documents/AboutUs/Newsroom/Consequences_of_Treatment_June2013.pdf. Accessed on 22nd July 2016.Google Scholar
16. Henson, C C, Andreyev, H J N, Symonds, R P, Peel, D, Swindell, R, Davidson, S E. Late-onset bowel dysfunction after pelvic radiotherapy: a national survey of current practice and opinions of clinical oncologists. Clin Oncol 2011; 23 (8): 552557.CrossRefGoogle ScholarPubMed
17. Webb, G J, Brooke, R, De Silva, A N. Chronic radiation enteritis and malnutrition. J Dig Dis 2013; 14 (7): 350357.CrossRefGoogle ScholarPubMed
18. Wedlake, L J, Shaw, C, Whelan, K, Andreyev, H J N. Systematic review: the efficacy of nutritional interventions to counteract acute gastrointestinal toxicity during therapeutic pelvic radiotherapy. Aliment Pharmacol Ther 2013; 37 (11): 10461056.CrossRefGoogle ScholarPubMed
19.Department of Health. Governance arrangements for research ethics committees: a harmonised edition. Leeds: Department of Health, 2012. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213753/dh_133993.pdf. Accessed on 9th May 2015.Google Scholar
20.Great Britain. Data Protection Act. London: Stationery Office, 1998.Google Scholar
21.General Medical Council. Good medical practice. Manchester: General Medical Council, 2013.Google Scholar
22. Denscombe, M. The Good Research Guide for Small Scale Social Research Projects, 4th edition. Berkshire: Idea, 2010.Google Scholar
23. Henson, C. Optimising the management of gastrointestinal symptoms following pelvic radiotherapy. PhD, the University of Manchester, Manchester, 2014.Google Scholar
24. Jenkinson, C, Coulter, A, Bruster, S. The Picker Patient Experience Questionnaire: development and validation using data from in-patient surveys in five countries. Int J Qual Health Care 2002; 14 (5): 353358.CrossRefGoogle ScholarPubMed
25. Steine, S, Finset, A, Laerum, E. A new, brief questionnaire (PEQ) developed in primary health care for measuring patients’ experience of interaction, emotion and consultation outcome. Fam Pract 2001; 18 (4): 410418.CrossRefGoogle ScholarPubMed
26. Andreyev, H J N. Gastrointestinal symptoms after pelvic radiotherapy: a new understanding to improve management of symptomatic patients. Lancet Oncol 2007; 8 (11): 10071017.CrossRefGoogle ScholarPubMed
27. Mitchell, E P. Gastrointestinal toxicity of chemotherapeutic agents. Semin Oncol 2006; 33 (1): 106120.CrossRefGoogle ScholarPubMed
28. Dunberger, G, Lind, H, Steineck, G, Waldenström, A C, Onelöv, E, Avall-Lundqvist, E. Loose stools lead to fecal incontinence among gynecological cancer survivors. Acta Oncol 2011; 50 (2): 233242.CrossRefGoogle ScholarPubMed
29. Jakobsson, S, Ekman, T, Ahlberg, K. Living through pelvic radiotherapy: a mixed method study of self-care activities and distressful symptoms. Eur J Oncol Nurs 2014; 19 (3): 301309.CrossRefGoogle ScholarPubMed
30. Doyle, C, Kushi, L H, Byers, T et al. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin 2006; 56 (6): 323353.CrossRefGoogle ScholarPubMed
31. Roberfroid, M. Dietary fiber, inulin, and oligofructose: a review comparing their physiological effects. Crit Rev Food Sci Nutr 1993; 33 (2): 103148.CrossRefGoogle ScholarPubMed
32. Murphy, J, Stacey, D, Crook, J, Thompson, B, Panetta, D. Testing control of radiation-induced diarrhea with a psyllium bulking agent: a pilot study. Can Oncol Nurs J 2000; 10 (3): 96100.CrossRefGoogle ScholarPubMed
33.Macmillan Cancer Support. Bowel problems after pelvic radiotherapy. UK: Macmillan Cancer Support, 2010. http://www.nhs.uk/ipgmedia/national/Macmillan%20Cancer%20Support/Assets/Pelvicradiotherapyinmen-bowelproblems(CB).pdf. Accessed on 20th January 2016.Google Scholar
34. Singh, B. Psyllium as therapeutic and drug delivery agent. Int J Pharm 2007; 334 (1): 114.CrossRefGoogle ScholarPubMed
35.National Cancer Institute. Managing chemotherapy side effects. National Cancer Institute, 2012. http://www.cancer.gov/publications/patient-education/diarrhea.pdf. Accessed on 19th January 2016.Google Scholar
36. Hamer, H M, Jonkers, D M A E, Venema, K, Vanhoutvin, S A L W, Troost, F J, Brummer, R J. Review article: the role of butyrate on colonic function. Aliment Pharmacol Ther 2008; 27 (2): 104119.CrossRefGoogle ScholarPubMed
37. Cook, S I, Selin, J H. Review article: short chain fatty acids in health and disease. Aliment Pharmacol Ther 1998; 12: 449507.CrossRefGoogle ScholarPubMed
39. Wedlake, L, Thomas, K, McGough, C, Andreyev, H J N. Small bowel bacterial overgrowth and lactose intolerance during radical pelvic radiotherapy: an observational study. Eur J Cancer 2008; 44 (15): 22122217.CrossRefGoogle ScholarPubMed
40. Shaw, C, Taylor, L. Treatment-related diarrhea in patients with cancer. Clin J Oncol Nurs 2012; 16 (4): 413417.CrossRefGoogle ScholarPubMed
41. Österlund, P, Ruotsalainen, T, Peuhkuri, K et al. Lactose intolerance associated with adjuvant 5-fluorouracil-based chemotherapy for colorectal cancer. Clin Gastroenterol Hepatol 2004; 2 (8): 696703.CrossRefGoogle ScholarPubMed
42.Macmillan Cancer Support. Pelvic radiotherapy in women – side effects during treatment. Macmillan Cancer Support, 2013. http://www.nhs.uk/ipgmedia/National/Macmillan%20Cancer%20Support/assets/Pelvicradiotherapyinwomen-possiblesideeffects%28CB%29.pdf. Accessed on 22nd July 2016.Google Scholar
43. Oates, R W, Schneider, M E, Lim Joon, M et al. A randomised study of a diet intervention to maintain consistent rectal volume for patients receiving radical radiotherapy to the prostate. Acta Oncol 2014; 53 (4): 569571.CrossRefGoogle ScholarPubMed
44. Stubbe, C E, Valero, M. Complementary strategies for the management of radiation therapy side effects. J Adv Pract Oncol 2013; 4 (4): 219231.Google ScholarPubMed
45.National Institute for Health and Care Excellence. Prostate cancer: diagnosis and management. NICE, 2014. http://www.nice.org.uk/guidance/cg175. Accessed on 2nd February 2016.Google Scholar
46. Andreyev, H J N. Gastrointestinal problems after pelvic radiotherapy: the past, the present and the future. Clin Oncol 2007; 19 (10): 790799.CrossRefGoogle ScholarPubMed