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Diet and Gastrointestinal Symptoms in Patients with Prostate Cancer Treated with Radiotherapy
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objective The main objective of this thesis was to explore the effects of diet on gastrointestinal symptoms in prostate cancer patients treated with local curative radiotherapy, by evaluating dietary intake prior to treatment (Study I), the psychometric properties of a new questionnaire on patient-reported gastrointestinal side effects (Study II), and the effect of a dietary intervention on acute and long-term gastrointestinal symptoms up to 2 years after radiotherapy completion (Study III-IV).

Methods A total of 130 men with localized prostate cancer referred to dose-escalated radiotherapy (ED2 87-102 Gy, α/β=3 Gy) were recruited to a dietary intervention trial. Patients were randomized to receive either standard care plus the dietary intervention of a fibre- and lactose-restricted diet (intervention group, IG; n=64) or standard care alone (standard care group, SCG; n=66). Data on gastrointestinal symptoms and dietary intake were collected pre-treatment and at seven time points during a follow-up period of 26 months.

Results Prior to treatment, grain products and milk products were major sources of energy. Unbalanced fatty acid intake and low intake of selenium were observed (Study I). Validation of the Gastrointestinal Side Effects Questionnaire (GISEQ) revealed satisfactory internal consistency, moderate concurrent validity and adequate responsiveness (Study II). There were no significant effects of the intervention on acute or long-term gastrointestinal symptoms, but a tendency towards lower prevalence and severity of bloating and diarrhoea in the IG compared to the SCG during radiotherapy. Gastrointestinal symptoms were predominantly mild, and the frequency of clinically relevant symptoms was merely a few percent. Dietary adherence in the IG was initially good, but tended to decline beyond 12 months post-radiotherapy (Study III-IV).

Conclusions A fibre- and lactose-restricted diet was not superior to the habitual diet in reducing gastrointestinal symptoms in patients undergoing high-dose, small-volume radiotherapy for localized prostate cancer. The GISEQ enables assessment of patient-perceived change in symptoms, but further work is needed to strengthen its psychometric qualities. It is suggested that continued research in this area target patient categories referred to irradiation of larger pelvic volumes with a higher risk of gastrointestinal symptoms, and that dietary interventions incorporate established strategies to enhance adherence and effectiveness.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. , 93 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 969
Keyword [en]
Dietary intervention, gastrointestinal symptoms, prostate cancer, radiotherapy, randomized controlled trial, health-related quality of life, questionnaire design, nutritional assessment
National Category
Cancer and Oncology
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-215410ISBN: 978-91-554-8861-1 (print)OAI: oai:DiVA.org:uu-215410DiVA: diva2:689882
Public defence
2014-03-07, Enghoffsalen, Ing 50, Akademiska sjukhuset, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2014-02-13 Created: 2014-01-13 Last updated: 2014-04-29
List of papers
1. Dietary intake in men recently diagnosed with prostate cancer
Open this publication in new window or tab >>Dietary intake in men recently diagnosed with prostate cancer
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(English)Article in journal (Other academic) Submitted
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-215386 (URN)
Available from: 2014-01-13 Created: 2014-01-13 Last updated: 2014-04-29Bibliographically approved
2. Assessing patients’ perceived bother from the gastrointestinal side effects of radiotherapy for localized prostate cancer: initial questionnaire development and validation
Open this publication in new window or tab >>Assessing patients’ perceived bother from the gastrointestinal side effects of radiotherapy for localized prostate cancer: initial questionnaire development and validation
2014 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 53, no 3, 368-377 p.Article in journal (Refereed) Published
Abstract [en]

Background

The present study reports on the development and first steps of validation of the Gastrointestinal Side Effects Questionnaire (GISEQ), a measure of patient-reported gastrointestinal symptoms following local radiotherapy to the prostate. The questionnaire design provides a novel approach of assessment of side effects of prostate radiotherapy, by enabling measurement of patient-perceived change in symptoms.

Material and methods

The eight-item GISEQ was administered to 130 prostate cancer patients referred to radiotherapy. Patients completed the GISEQ at four, eight and 15 weeks after start of radiotherapy. The psychometric properties including validity, reliability, responsiveness and feasibility were evaluated. The EORTC QLQ-C30 and QLQ-PR25 were chosen as comparative measures.

Results

Expert opinion supported content validity. For concurrent validity, correlation between the GISEQ and matching items in the EORTC questionnaires was moderate but significant (r > 0.41, p < 0.001). The responsiveness was adequate, indicated by changes in GISEQ scores over time corresponding to the effects of radiation. Internal consistency was satisfactory (overall Cronbach's α> 0.70). Sensitivity and specificity for items diarrhea, constipation and blood in stools ranged from 50% to 100% and from 68% to 100%, respectively. All items had a floor effect above 15%. The response rates ranged from 85% to 92% and missing items was < 0.8%, indicating good feasibility.

Conclusions

The GISEQ showed satisfactory internal consistency and adequate content validity, concurrent validity and responsiveness. It is brief, easy to use and can be quickly evaluated, making it useful not only for research but possibly also for clinical settings. Modification of response scale and extension of items are potential improvements. Further work is needed to strengthen the psychometric qualities of the GISEQ and to evaluate its clinical use and potential effects of response shift and recall bias.

National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-188191 (URN)10.3109/0284186X.2013.819994 (DOI)000331804200011 ()
Available from: 2012-12-13 Created: 2012-12-13 Last updated: 2017-12-06Bibliographically approved
3. Effects of a dietary intervention on acute gastrointestinal side effects and other aspects of health-related quality of life: A randomized controlled trial in prostate cancer patients undergoing radiotherapy
Open this publication in new window or tab >>Effects of a dietary intervention on acute gastrointestinal side effects and other aspects of health-related quality of life: A randomized controlled trial in prostate cancer patients undergoing radiotherapy
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2012 (English)In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 103, no 3, 333-340 p.Article in journal (Refereed) Published
Abstract [en]

Purpose:

To study the effect of a dietary intervention on acute gastrointestinal side effects and other aspects of health-related quality of life (HRQOL) in prostate cancer patients referred to radiotherapy.

Materials and methods:

A total of 130 patients were randomly assigned to one of two groups: an intervention group (IG, n = 64), instructed to reduce their intake of insoluble dietary fibres and lactose, a standard care group (SC, n = 66), instructed to continue their normal diet. Gastrointestinal side effects and other aspects of HRQOL were evaluated from baseline up to 2 months after completed radiotherapy, using the EORTC QLQ-C30 and QLQ-PR25 and the study-specific Gastrointestinal Side Effects Questionnaire (GISEQ). A scale indicating adherence to dietary instructions was developed from a Food Frequency Questionnaire (FFQ), with lower scores representing better compliance. Descriptive and inferential statistical analyses were conducted.

Results:

There was an interaction effect between randomization and time in the FFQ Scores (p < 0.001), indicating that both groups followed their assigned dietary instructions. The dietary intervention had no effect on gastrointestinal side effects or other aspects of HRQOL. During radiotherapy, the percentage of patients with bowel symptoms and bloated abdomen was lower in IG compared to SC, but the between-group differences were not statistically significant. During radiotherapy, the percentage of patients with bowel symptoms, urinary symptoms, pain, fatigue and diminished physical and role functioning increased in both groups.

Conclusions:

The dietary intervention had no effect on gastrointestinal side effects or other aspects of HRQOL. The tendency towards lower prevalence of bowel symptoms in IG may indicate some positive effect of the dietary intervention, but methodological refinements, clearer results and longer follow-up are needed before the value of diet change can be established with certainty.

Keyword
Prostate cancer, Radiotherapy, Gastrointestinal side effects, Dietary intervention, Health-related quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-178138 (URN)10.1016/j.radonc.2012.04.006 (DOI)000305845000009 ()
Available from: 2012-07-30 Created: 2012-07-30 Last updated: 2017-12-07Bibliographically approved
4. Effects of a dietary intervention on gastrointestinal symptoms after prostate cancer radiotherapy: Long-term results from a randomized controlled trial
Open this publication in new window or tab >>Effects of a dietary intervention on gastrointestinal symptoms after prostate cancer radiotherapy: Long-term results from a randomized controlled trial
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2014 (English)In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 113, no 2, 240-247 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE:

To evaluate the long-term effects of dietary intervention on gastrointestinal symptoms after highly dose-escalated radiotherapy for localized prostate cancer, using boost with protons or high-dose-rate brachytherapy.

MATERIALS AND METHODS:

Patients were randomized to an intervention group (n=64) advised to reduce insoluble dietary fiber and lactose intake, or to a standard care group (n=66) advised to continue their usual diet. Gastrointestinal symptoms, other domains of health-related quality of life (HRQOL), and dietary intake were evaluated for ⩽24months post-radiotherapy with the European Organization for Research and Treatment of Cancer quality-of-life questionnaires QLQ-C30 and QLQ-PR25, Gastrointestinal Side Effects Questionnaire, and Food Frequency Questionnaire. The effect of the intervention on gastrointestinal symptoms was evaluated using generalized estimating equations.

RESULTS:

Dietary intervention had no obvious effect on long-term gastrointestinal symptoms or HRQOL. The intervention group markedly reduced their dietary fiber and lactose intake during radiotherapy, but adherence tended to decline over time. The vast majority of long-term gastrointestinal symptoms were reported as 'a little', with a noticeable difference from pre-treatment only for unintentional stool leakage, limitations on daily activities, and mucus discharge.

CONCLUSION:

Long-term gastrointestinal symptoms were predominantly mild, and dietary intervention was not superior to a usual diet in preventing these symptoms.

Keyword
Prostate cancer, radiotherapy, dietary intervention, long term gastrointestinal symptoms
National Category
Cancer and Oncology
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-215389 (URN)10.1016/j.radonc.2014.11.025 (DOI)000347657200015 ()25467005 (PubMedID)
Available from: 2014-01-13 Created: 2014-01-13 Last updated: 2017-12-06Bibliographically approved

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