Journal of Human Nutrition and Dietetics

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.

Dealing with loss: food and eating in women with ovarian cancer on parenteral nutrition

AbstractBackgroundMalignant bowel obstruction is a common complication of ovarian cancer, resulting in limited oral intake. Home parenteral nutrition (HPN) may be offered to patients in this condition to meet nutritional requirements. However, it is not known how they experience being unable to eat. The present study reports how patients related to food when receiving HPN.MethodsThe investigation was a qualitative study underpinned by phenomenology with women with advanced ovarian cancer in bowel obstruction receiving parenteral nutrition. Interview transcripts were analysed thematically guided by the techniques of Van Manen.ResultsWe recruited 20 women to the study. Participants were interviewed a maximum of four times and a total of 39 in‐depth longitudinal interviews were conducted. Participants could tolerate minimal amounts of food, if they had a venting gastrostomy. Not being able to eat engendered a sense of sadness and loss, and most women found it challenging to be in the presence of others eating. They adopted strategies to cope, which included fantasising about food and watching cookery programmes. These approaches were not a long‐term solution; either participants came to terms with their loss or the strategies became less effective in providing relief.ConclusionsHome parenteral nutrition meets the nutritional requirements of patients with malignant bowel obstruction but cannot replace the non‐nutritive functions of food. Healthcare professionals can offer a patient‐centred approach by acknowledging the difficulties that patients may face and, wherever possible, encourage them to focus on the positive benefits of interacting with people rather than the loss of eating on social occasions.