Q26. What is the impact of patient adherence with dietary advice to their outcomes?

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Q26. What is the impact of patient adherence with dietary advice to their outcomes?

Summary

The level II positive quality study [1] measured compliance with dietary recommendations on a weekly basis through a supplement consumption record kept daily by the patient and verified by a carer/relative to ensure compliance. Even at the three month follow up time point the nutrition intervention group had remained compliant with dietary recommendations, and this translated into positive patient outcomes.

One level IV neutral quality study [2] reported on the different clinical outcomes according to adherence and non adherence with dietary recommendations but did not report on the reasons why patients were non-adherent. 47% of patients were deemed non-adherent – either not accepting nutritional counselling or refusing nasogastric or gastrostomy tubes during treatment. Ninety percent of adherent patients maintained their weight (mean weight change 0%) and all of the non-adherent patients continued to lose weight (mean 11% weight loss) during treatment. This trend continued in the 30-day follow up period post treatment. One level IV neutral quality study [3] studied patients who developed food aversions during radiotherapy. This demonstrated 53% of patients developed an aversion to items in their usual diet. The impact of this on their nutritional status was not measured, but the anticipated outcome is likely to have an impact on a patients’ ability to follow dietary advice if they have aversions to the foods being recommended to them, and therefore counselling strategies are required. One level IV neutral quality study [4] demonstrated the impact that side effects of treatment (xerostomia, taste, mucositis) and the associated interventions (frequency of oral cares, analgesic use) have on appetite. A level IV negative quality study [5] describes the food characteristics required to enable a patient to maintain their appetite, such as “ease of foods that dissolve well in the mouth” and “ease of consuming foods with a mild taste”. One level IV neutral quality study demonstrates that as mucositis improves, dietary oral intake improves [6]. Therefore management of these side effects and identification of strategies is important to enable adherence to dietary advice.

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Recommendation Grade
Patient adherence with dietary advice and nutrition support recommendations are essential to achieve positive outcomes through nutrition intervention. Therefore, the role of the multidisciplinary team is essential to ensure management of treatment side effects (e.g. pain, dysphagia, and mucositis) and other psychosocial factors are addressed to enable patients to follow dietary advice.
B

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References

  1. Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 2005 Aug;27(8):659-68 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15920748.
  2. Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A, et al. Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy. Head Neck 2008 Apr;30(4):503-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18098310.
  3. Mattes RD, Curran WJ Jr, Powlis W, Whittington R. A descriptive study of learned food aversions in radiotherapy patients. Physiol Behav 1991 Dec;50(6):1103-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1798763.
  4. Ogama N, Suzuki S, Umeshita K, Kobayashi T, Kaneko S, Kato S, et al. Appetite and adverse effects associated with radiation therapy in patients with head and neck cancer. Eur J Oncol Nurs 2010 Feb;14(1):3-10 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19734089.
  5. Ogama N, Suzuki S, Yasui Y, Azenishi K, Shimizu Y. Analysis of causal models of diet for patients with head and neck cancer receiving radiation therapy. Eur J Oncol Nurs 2010 Sep;14(4):291-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20584624.
  6. Pauloski BR, Rademaker AW, Logemann JA, Lundy D, Bernstein M, McBreen C, et al. Relation of mucous membrane alterations to oral intake during the first year after treatment for head and neck cancer. Head Neck 2011 Jun;33(6):774-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20737496.

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