Effects of a nutrition intervention on acute and late bowel symptoms and health-related quality of life up to 24 months post radiotherapy in patients with prostate cancer: a multicentre randomised controlled trial

Abstract

Purpose Radiotherapy to the prostate gland and pelvic lymph nodes may cause acute and late bowel symptoms and diminish quality of life. The aim was to study the effects of a nutrition intervention on bowel symptoms and health-related quality of life, compared with standard care. Methods Patients were randomised to a nutrition intervention (n = 92) aiming to replace insoluble fibres with soluble and reduce intake of lactose, or a standard care group (n = 88) who were recommended to maintain their habitual diet. Bowel symptoms, health-related quality of life and intake of fibre and lactose-containing foods were assessed up to 24 months after radiotherapy completion. Multiple linear regression was used to analyse the effects of the nutrition intervention on bowel symptoms during the acute (up to 2 months post radiotherapy) and the late (7 to 24 months post radiotherapy) phase. Results Most symptoms and functioning worsened during the acute phase, and improved during the late phase in both the intervention and standard care groups. The nutrition intervention was associated with less blood in stools (p = 0.047), flatulence (p = 0.014) and increased loss of appetite (p = 0.018) during the acute phase, and more bloated abdomen in the late phase (p = 0.029). However, these associations were clinically trivial or small. Conclusions The effect of the nutrition intervention related to dietary fibre and lactose on bowel symptoms from pelvic RT was small and inconclusive, although some minor and transient improvements were observed. The results do not support routine nutrition intervention of this type to reduce adverse effects from pelvic radiotherapy.

The effect of nutritional interventions involving dietary counselling on gastrointestinal toxicities in adults receiving pelvic radiotherapy – A systematic review

“…Constipation as an outcome was reported in six articles. 26,27,29,31,34,36 Nil significant differences in outcomes were found in any of these studies.…”

“…The EORTC QLQ-C30 and the site-specific modules PR25, CX24 and EN-24 were used in seven articles (six studies) to assess individual GI toxicities and overall QOL scores. 5,26,27,29,31,34,36 Ravasco et al reported a significant improvement in median QOL function scores within the individual DC group at RT completion (P < 0.002). 27 These improvements were proportional to increases in intake of energy and protein, and nutritional status improvement (P < 0.05).…”

“…Pain and/or camping was reported in 9 articles. 5,26,27,29,31,32,[34][35][36] Linn et al reported a reduction in Grade 2 abdominal pain incidence in the probiotic group (3.8%) compared with the placebo group (57.1%, P = 0.000). This was also reflected in a reduction in the number of reported days of abdominal pain occurrence.…”

“…In five articles, outcomes were also recorded as combined symptom scores, in which individual toxicities were grouped together to provide an overall score. 26,28,29,33,36 Diarrhoea Diarrhoea was assessed as an outcome in 11 articles 5,26,27,29,[31][32][33][34][35][36][37] and included in an overall grouped symptom score in one article. 28 Three studies found a reduction of diarrhoea incidence.…”

“…RCT, randomised control trial; DC, dietary counselling; F, female; IG, intervention group; LCT, long-chain triglycerides. 1 Demers et al5 ; 2 Forslund et al31 ; 3 Garcia-Peris et al34 ;4 Linn et al32 ; 5 Mansouri-Tehrani et al35 ;6 Pettersson et al26 ;7 Pettersson et al29 ; 8 Ravasco et al27 ; 9 Soto-Lugo et al36 ;10 Wedlake et al33 ;11 Wedlake et al28 ;12 Weston et al 37 ª 2021 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology…”