Cancer survivors urgently need better nutritional support

More than two-thirds (69 percent) of the colorectal cancer patients who took part in the national survey said they did not receive any nutritional advice or support from their healthcare team throughout diagnosis, treatment and post-treatment, including those with a stoma.

A large proportion of those surveyed reported facing a number of nutritional difficulties including; being unsure about what to eat, diarrhea, appetite loss and changes to taste and smell.

Many cancer survivors said they had sought nutritional advice online from a variety of sources—mainly charity websites such as Bowel Cancer UK and Macmillan Cancer Support.

The research, published today (Monday 21st September 2020) in the Journal of Human Nutrition and Dietetics also highlighted cancer patients' desire for individualized advice relating to their specific nutritional problems.

Dr. Bernard Corfe, lead author of the study from the University of Sheffield, said: "Patients with bowel, colon and rectal cancer do not feel that they are getting the nutritional support and advice they need. Many colorectal cancer survivors have to adapt to a new way of life after their treatment—especially those who are fitted with a stoma bag. It is so important that they receive nutritional guidance from their health care team, both during and after treatment, rather than having to search for the information online which may lead to patients accessing unverified or even unreputable sources. It is vital that patients feel supported to overcome their specific nutritional difficulties and the advice is personalized for them and their lifestyle. For example a young patient living with a stoma is going to have very different questions and support needs to an older patient being treated for advanced bowel cancer."

In the UK, the National Institute for Clinical Excellence (NICE) guidelines recommend that after colorectal cancer treatment patients should be offered comprehensive advice on managing the effects of treatment on their bowel function, including information on diet, as their treatment may include partial resection or temporary or permanent stoma.

Furthermore, nutritional advice and education can be effective in improving the overall
survival, quality of life and nutrition of colorectal cancer survivors during and after treatment.

Pete Wheatstone, from Selby, was diagnosed with stage three bowel cancer aged 58 years old. "As a bowel cancer patient, the patient feedback in this research certainly resonated with me," he said.

"Generic advice during chemotherapy, such as 'eat whatever you like,' although well intended, could be more helpful and I agree that ideally individualized advice should be made available for all three stages—pre-treatment, during treatment and aftertreatment. Signposting to cancer charities such as Bowel Cancer UK and Macmillan Cancer Support is vital but has to be more effective than simply providing a list of information sources or multiple booklets at the time of diagnosis. We need the right advice at the right time. There should also be greater coordination with dieticians but also with GPs who are more likely to see the patient post-treatment."

Dr. Lisa Wilde, Director of Research and External Affairs at Bowel Cancer UK, said: "Many people with bowel cancer will find they can't eat the same foods as before their diagnosis, so getting valuable information from trusted healthcare professionals every step of the way can make a big difference to their lives. Around 268,000 people in the UK are living with bowel cancer, and it's really important that they are given advice about the best ways to eat a healthy, balanced diet to suit their individual needs. The Bowel Cancer UK website has lots of information about different foods and diet for people with bowel cancer, and we're pleased patients are using it for nutritional advice. However, it should be used as a starting point for conversations with a clinical team, rather than a substitute for a tailored package of information."

Researchers now hope to work with health care professionals in order to help better support patients to overcome nutritional difficulties. The Sheffield team have begun collaborating on an app which could help to give patients individual and approved nutritional advice without the need for extra resources and reducing pressure on health care professionals.