Effects of a nutrition intervention on acute and late bowel symptoms and health-related quality of life up to 24 months post radiotherapy in patients with prostate cancer: a multicentre randomised controlled trial

Abstract

Purpose: Radiotherapy to the prostate gland and pelvic lymph nodes may cause acute and late bowel symptoms and diminish quality of life. The aim was to study the effects of a nutrition intervention on bowel symptoms and health-related quality of life, compared with standard care.

Methods: Patients were randomised to a nutrition intervention (n = 92) aiming to replace insoluble fibres with soluble and reduce intake of lactose, or a standard care group (n = 88) who were recommended to maintain their habitual diet. Bowel symptoms, health-related quality of life and intake of fibre and lactose-containing foods were assessed up to 24 months after radiotherapy completion. Multiple linear regression was used to analyse the effects of the nutrition intervention on bowel symptoms during the acute (up to 2 months post radiotherapy) and the late (7 to 24 months post radiotherapy) phase.

Results: Most symptoms and functioning worsened during the acute phase, and improved during the late phase in both the intervention and standard care groups. The nutrition intervention was associated with less blood in stools (p = 0.047), flatulence (p = 0.014) and increased loss of appetite (p = 0.018) during the acute phase, and more bloated abdomen in the late phase (p = 0.029). However, these associations were clinically trivial or small.

Conclusions: The effect of the nutrition intervention related to dietary fibre and lactose on bowel symptoms from pelvic RT was small and inconclusive, although some minor and transient improvements were observed. The results do not support routine nutrition intervention of this type to reduce adverse effects from pelvic radiotherapy.

Keywords: Bowel symptoms; Nutrition intervention; Prostate cancer; Radiotherapy.

Fig. 1

Flow chart. Note: ‘Did not complete questionnaires’: the number of patients who did not complete the specific assessment point but did not withdraw from the study. First appointment with the dietitian: the start of radiotherapy, 4 and 8 weeks: after the start of radiotherapy, 2, 7, 12, 18 and 24 months: after radiotherapy completion

Fig. 2

Mean scores for bowel symptoms at baseline, 4 weeks, 8 weeks, 2 months, 7 months, 12 months, 18 months and 24 months. Variables from the QLQ-C30, QLQ-PR25 and GISEQ assessing bowel symptoms among patients with prostate cancer undergoing radiotherapy, who received the nutrition intervention (NIG) and those who received standard care (SCG). Abbreviations: Bloating, bloated abdomen; Bowel symptoms, aggregated scale bowel symptoms; Limitations, limitations of daily activities due to bowel symptoms; Leakage, unintentional leakage of stools. Note: Scores ranges from 0 to 100 in EORTC QLQ-C30 and QLQ-PR25, and from 0 to 10 in GISEQ

Fig. 2

Mean scores for bowel symptoms at baseline, 4 weeks, 8 weeks, 2 months, 7 months, 12 months, 18 months and 24 months. Variables from the QLQ-C30, QLQ-PR25 and GISEQ assessing bowel symptoms among patients with prostate cancer undergoing radiotherapy, who received the nutrition intervention (NIG) and those who received standard care (SCG). Abbreviations: Bloating, bloated abdomen; Bowel symptoms, aggregated scale bowel symptoms; Limitations, limitations of daily activities due to bowel symptoms; Leakage, unintentional leakage of stools. Note: Scores ranges from 0 to 100 in EORTC QLQ-C30 and QLQ-PR25, and from 0 to 10 in GISEQ