Introduction

Nutrition is an important aspect of care in the management of cancer at all stages from diagnosis to survivorship [1, 2]. Adequate nutrition is an important part of treatment and enables an individual to better tolerate treatment, cope with the side effects of treatment and improve their overall quality of life [3]. The weight loss that can often accompany cancer can disproportionately affect muscle mass and adequate energy and protein intake is imperative to combat this [4, 5]. As individuals complete treatment, there can be a persistence of some of the side effects of treatment such as fatigue and taste and smell changes which can all negatively impact ability or desire to consume food [6]. At this point, the role of nutrition in maintaining health, preventing occurrence of cardiovascular disease and weight management is important [2]. The importance of nutrition for those with cancer is becoming more recognised with the recent European Society for Parenteral and Enteral Nutrition 2020 congress calling to improve the nutritional care of cancer patients [7]. The National Cancer Control Programme has highlighted survivorship as a research gap which requires addressing, with the ‘National Cancer Survivorship Needs Assessment’ work placing significant importance on the wellbeing of survivors [8]. In addition, the Irish Cancer Society’s strategy for 2020–2025 includes ‘Living Well After Treatment’ as one of its five priorities [9]. To date, the views of those with cancer in relation to the importance of nutrition have been sparse. This brief paper aimed to identify the views of those with cancer regarding the importance of nutrition as it relates to ten different situations or stages in the cancer journey.

Methods

A questionnaire containing demographic information and one question utilising a 5-point Likert scale around the importance of nutrition in relation to ten different cancer stages or patient types (Table 1) was developed by a dietitian and an oncology researcher and was piloted with an oncology team and three cancer patients, resulting in some minor grammatical edits. The questionnaire was then distributed through the oncology day wards and outpatient departments of two hospitals in the Northwest of Ireland, along with an information sheet indicating that completion of the questionnaire implied consent. The questionnaire was completed by those undergoing treatment, by those who had completed treatment (cancer survivors) and excluded those who were at end of life or the advanced stages of cancer. Ethical approval was granted by the ethics boards in both hospitals. Data collection took place between September 2018 and May 2019. Data was analysed using SPSS Version 26 and statistical significance was taken as p < 0.05. Descriptive data is presented using frequencies and percentages. The Likert scale was collapsed such that strongly agree and agree were combined, disagree and strongly disagree were combined and those who indicated they did not know or did not answer were combined.

Results

One hundred ninety-seven individuals responded to the questionnaire. They were mainly female (n = 124, 62.9%), aged 60+ (n = 123, 62.5%), diagnosed with cancer in the last 3 years (n = 109, 55.3%) and the most common cancer types were breast (n = 63, 32%) and colorectal (n = 41, 20.8%) (Table 1).

Table 1 Demographic characteristics of those recruited (n = 197)
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Individuals strongly agreed or agreed that good nutritional care is important for everyone independent of their weight or cancer treatment (n = 194, 98.5%); when you are receiving any form of active treatment for cancer (n = 192, 97%); when you require surgery for cancer (n = 186, 94.4%); when you require chemotherapy for cancer (n = 190, 96.5%); when you require radiotherapy for cancer (n = 175, 88.8%); when you are in the advanced stages of cancer (n = 180, 91.4%); when you are a cancer survivor (n = 192, 97.5%); when you have a low body weight (n = 179, 90.9%); when you have a normal body weight (n = 185, 93.9%); and when you are overweight (n = 179, 90.9%) (Table 2).

Table 2 Views around the role of nutritional care in cancer
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There were nineteen individuals (9.6%) unsure/did not state if nutrition was important for those undergoing radiation therapy, eighteen (9.1%) unsure/did not state if good nutritional care is important when you have a low body weight, thirteen (6.6%) unsure/did not state if good nutritional care is important when you are overweight and the same proportion if nutrition was important for those with advanced cancer.

Discussion

This paper reported on the views of cancer patients and survivors’ regarding nutrition and its importance during specific stages of cancer, treatment type or weight status. It is clear from the findings that nutritional care was viewed positively for all statements with 88.8 to 98.5% agreeing or strongly agreeing with each statement.

These findings support recent work which indicated that patients and survivors would be willing to drive anywhere in the country in order to receive nutritional care [10]. Cancer may provide a teachable moment where individuals recognise the importance of nutrition and are more willing to change their lifestyle [11]. Ideally, this advice is desired from the healthcare team [12]. Unfortunately, at the moment in Ireland, cancer patients are not typically being referred for dietetic support due to a lack of resources [10, 13]. There is currently only one oncology dietitian for every 4,500 cancer patients [10, 14]. This figure does not take into account cancer survivors, who have distinct nutritional needs and also require dietetic support.

Those with cancer then turn elsewhere for nutrition support. These alternative sources of information tend to revolve around internet searches [15]. Currently in Ireland, there is a lack of nutrition guidance from the websites of the HSE, national cancer centres and support groups [16]. This can leave those with cancer vulnerable to misinformation and alternative non-evidence-based therapies [17]. As the numbers of those experiencing cancer continues to increase [18], the need for evidence-based nutrition support will only expand. Those with this diagnosis recognise the importance of nutrition in all stages of the cancer journey. It is imperative that this be recognised by the health service and nutrition becomes a more integrated aspect of cancer care.

Conclusion

Irish cancer patients and survivors have a positive view of the role of nutritional care in cancer from diagnosis through cancer survivorship. It is important that services are put in place to provide this nutritional care at all stages of cancer.