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

Abstract

Gastrointestinal (GI) toxicities are common in patients receiving radiotherapy (RT) to the pelvis. This systematic review aims to evaluate the effectiveness of nutritional interventions involving dietary counselling (DC) on GI toxicities in patients receiving pelvic RT. The search method entailed two phases to retrieve studies. Articles from a previous Cochrane review by Lawrie et al. 2018 were assessed for inclusion. An updated systematic search was then conducted to retrieve articles published between 2013 and 2020 from five electronic databases (MEDLINE, EMBASE, CINAHL, CENTRAL and Scopus). The inclusion criteria entailed randomised controlled trials involving adults ≥18 years, undergoing curative pelvic RT, receiving a nutritional intervention involving DC with or without supplements. DC was defined as written or face-to-face dietary advice provided before or during RT. Outcomes included GI toxicities reported by validated assessment tools. The Academy of Nutrition and Dietetics Quality Criteria Checklist was utilised to assess quality and risk of bias. Of 1922 studies retrieved, 12 articles encompassing 11 individual RCTs were included. Seven studies included a supplement in addition to DC. Supplements included probiotics, prebiotics, probiotic + soluble fibre, high protein liquid supplement and fat emulsion. Of the 11 studies, one involved individualised DC, and the remaining studies prescribed consumption or avoidance of fats, fibre, lactose, protein and FODMAP. The most common toxicities reported were diarrhoea (n = 11), pain/cramping (n = 9) and bloating/flatulence (n = 5). Three studies stated an improvement in diarrhoea incidence. Results varied between studies. Further quality studies are required to assess the effectiveness of DC, in particular individualised DC on GI toxicities in patients receiving pelvic RT.

Life style and interaction with microbiota in prostate cancer patients undergoing radiotherapy: study protocol for a randomized controlled trial

“…Few clinical trials have investigated the effect of diet and physical activity counselling on PCa patients undergoing different types of treatments (RT, androgen deprivation therapy, surgery). A recent review evaluating the effectiveness of nutritional interventions involving dietary counselling on GI toxicities in patients receiving pelvic RT [ 17 ] demonstrated a lack of published RCTs. According to the authors, it is still unclear which is the best nutritional approach for the management of GI toxicity, because the proposed nutritional approach differed among studies and results varied.…”

“…Several studies suggest that nutritional intervention can have a positive effect on toxicities, weight control and QoL in PCa patients [ 14 – 16 ]. No firm conclusion has been drawn on the efficacy of dietary modifications [ 17 , 18 ], but individualized approach based on appropriate professional counselling to manipulate dietary intake based on emerging symptoms throughout treatment is desirable [ 19 ].…”

“…The number of studies to evaluate the effect of dietary and/or exercise in PCa patients have increased in recent years [ 17 , 28 – 31 ]. However, these studies are not designed to evaluate the combined effect of dietary changes combined with exercise in PCa patients undergoing RT, nor to elucidate their effects on gut microbiota and RT-toxicity.…”