A high proportion of patients with gynaecological cancers experience gastrointestinal toxicity symptoms such as diarrhoea during and post pelvic radiation treatment. Nutrition status and absorptive functions of these patients may be severely compromised, leading to increased risk of interrupted treatments and hence poorer treatment outcomes and quality of life. Previous studies have provided little clarity regarding the best dietary intervention for symptom management; however low fibre/residue diets historically recommended are no longer deemed best practice. Our systematic review (n=4 studies) shows that increased dietary fibre modification during radiation therapy may have some potential benefits with improving gastrointestinal symptoms, however the evidence is of low quality and there is ambiguity regarding the optimal type, amount and timing of fibre to prescribe.1
A retrospective chart review of patients (n=104) attending a tertiary public hospital from 2017-2018 demonstrated the need for specialized dietetic involvement; reflected by the high prevalence of nutrition impact symptoms (diarrhoea, fatigue, nausea, pain) and the large proportion of malnourished and at-risk patients presenting before and during treatment. There is currently no uniform evidenced-based model of care for dietary management for this patient cohort.
Semi-structured interviews with dietitians across Australia were conducted (n=17 cancer centres) and these demonstrated variation in service provision and dietary prescriptions, including multiple variations of a ‘low’ or ‘modified-fibre’ diet with differing ratios of soluble and insoluble fibre. The majority of clinics lacked automatic referral (94%) or post-treatment pathways (88%), suggesting that current dietetic services may not be adequately meeting the needs of these patients, especially given the knowledge gap in effective symptom management. Hence soluble fibre as a therapeutic agent is to be further explored in a single centre study, in terms of its feasibility, safety and efficacy via dietary counselling during radiation treatment.