Elizabeth A. Johnston

Mental health and diet quality after primary treatment for ovarian cancer

AbstractAimsTo investigate anxiety and depression after primary treatment for ovarian cancer in relation to diet quality and intake.MethodsIn a cohort of women with ovarian cancer in Australia, levels of anxiety and depression (normal, subclinical, and clinical) were assessed using the Hospital Anxiety and Depression Scale at 9 months post‐diagnosis. Dietary intake was assessed using a validated food frequency questionnaire at 12 months post‐diagnosis and scored using the Healthy Eating Index 2015. Multinomial logistic regression and bivariate analyses were used to investigate relationships between levels of anxiety and depression and subsequent diet quality and intake of food groups.ResultsOf 595 women, anxiety and depression were identified among 128 (21%) and 80 (13%) women, respectively. Compared to women without anxiety or depression, women with subclinical anxiety (odds ratio = 0.49, 95% confidence interval: 0.25–0.98) and those with clinical depression (odds ratio = 0.25, 95% confidence interval: 0.07–0.93) were less likely to score in the highest quartile for diet quality. Separate adjustment for age, education, employment, disease stage, body mass index, and smoking status did not attenuate these associations. In bivariate analyses, women with subclinical anxiety were more likely to report higher intakes of sweet foods. Those with clinical depression were more likely to report lower intakes of orange vegetables and wholegrains, higher intakes of sweetened beverages, and not consume alcohol or soya foods.ConclusionsAnxiety or depression after primary treatment for ovarian cancer may be associated with poorer diet quality. Efforts to improve diet quality post‐treatment should consider support for mental health.

Association of Protein Intake with Recurrence and Survival Following Primary Treatment of Ovarian Cancer

Malnutrition is common during treatment of ovarian cancer, and 1 in 3 patients report multiple symptoms affecting food intake after primary treatment. Little is known about diet posttreatment in relation to ovarian cancer survival; however, general recommendations for cancer survivors are to maintain a higher level of protein intake to support recovery and minimize nutritional deficits. To investigate whether intake of protein and protein food sources following primary treatment of ovarian cancer is associated with recurrence and survival. Intake levels of protein and protein food groups were calculated from dietary data collected ∼12 mo postdiagnosis using a validated FFQ in an Australian cohort of women with invasive epithelial ovarian cancer. Disease recurrence and survival status were abstracted from medical records (median 4.9 y follow-up). Cox proportional hazards regression was used to calculate adjusted HRs and 95% CIs for protein intake and progression-free and overall survival. Among 591 women who were progression-free at 12 mo follow-up, 329 (56%) subsequently experienced cancer recurrence and 231 (39%) died. A higher level of protein intake was associated with better progression-free survival (>1-1.5 compared with ≤1 g/kg body weight, HR After primary treatment of ovarian cancer, a higher level of protein intake may benefit progression-free survival. Ovarian cancer survivors should avoid dietary practices that limit intake of protein-rich foods.

Dietitian encounters after treatment for ovarian cancer

AbstractBackgroundAfter ovarian cancer treatment, women report health issues that may be amenable to change with dietary support. The present study investigated how many women encounter a dietitian post‐treatment and the factors associated with dietitian service use.MethodsWe used data from a cohort of women with invasive epithelial ovarian cancer to identify socio‐economic, clinical and personal factors associated with dietitian encounter after treatment completion. Data were collected at regular intervals using validated questionnaires up to 4 years post‐treatment completion. Logistic regression (LR) and generalised linear mixed models (GLMM) were used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) to assess factors associated with dietitian encounter at any time‐point post‐treatment (LR), as well as in the 3 months prior to a follow‐up questionnaire (GLMM) to assess time‐varying factors.ResultsOf 819 women, 97 (12%) reported seeing a dietitian post‐treatment. Factors associated with dietitian encounter were being overweight (ORLR = 1.7, CI = 1.1–2.8), having poorer self‐rated health (ORLR = 2.5, CI = 1.2–5.2; ORGLMM = 2.3, CI = 1.2–4.4) or poorer diet quality (ORLR = 0.5, CI = 0.2–1.0) pre‐diagnosis, treatment within the public health system (ORGLMM = 1.8, CI = 1.2–2.7), previous support from dietetic (ORLR = 3.1, CI = 1.8–5.4; ORGLMM = 2.8, CI = 1.8–4.2) or other allied health services (ORLR = 2.0, CI = 1.2–3.2; ORGLMM = 3.7, CI = 2.4–5.5), and having progressive disease at follow‐up (ORGLMM = 2.2, CI = 1.4–3.3). Most women (86%) with ≥ 3 moderate‐to‐severe nutrition impact symptoms did not report a dietitian encounter post‐treatment.ConclusionsFew women encounter a dietitian post‐treatment for ovarian cancer, including those with multiple nutrition impact symptoms. Further work is needed to engage those likely to benefit from dietitian support but less likely to seek or receive it.

Dietary Practices After Primary Treatment for Ovarian Cancer: A Qualitative Analysis From the OPAL Study

Little is known about the dietary practices of women who have completed primary treatment for ovarian cancer, many of whom will go on to have cancer recurrence and further treatment. Knowledge of dietary practices is needed to optimize care. Our aim was to identify dietary practices after primary treatment for ovarian cancer and evaluate how these practices differ by disease recurrence and treatment status. Women with invasive epithelial ovarian cancer were provided with the following open-ended question after completing a food frequency questionnaire: "Is there anything we haven't asked you about your diet in the last 1 to 2 months that you feel is important?" Participants were from the OPAL (Ovarian Cancer Prognosis and Lifestyle) Study in Australia. The main outcomes were dietary practices after primary treatment for ovarian cancer and factors affecting these practices. Participants' responses were analyzed using content analysis. Individual content codes were categorized and reported by recurrence and treatment status at questionnaire completion. Two hundred eighty-six women provided responses on 363 questionnaires. Those undergoing further treatment for recurrence commonly reported dietary regimens with clinical indications (eg, low fiber to avoid bowel obstructions, high energy/protein to minimize nutritional deficits). Those not undergoing further treatment frequently reported "popular" diets (eg, organic, plant-based, and alkaline). For women with cancer recurrence, dietary practices were affected by poor appetite and late effects of treatment. For women without recurrence, other comorbidities, geographical location, family, and friends appeared to influence dietary practices. In both groups, nutrition information sources and personal beliefs informed dietary practices. Participant responses that referenced media or online sources often included misinformation. After primary treatment for ovarian cancer, women report dietary practices that may not be captured in standard food frequency questionnaires. Dietary practices and factors affecting these practices likely differ by treatment and recurrence status. Improved access to evidence-based dietary information and support is needed.