A pilot cross-sectional study of colorectal cancer survivors examining their nutritional beliefs, behaviours, and access to dietary care : a thesis presented in partial fulfilment of the requirement for the degree of Master of Science in Nutrition and Dietetics at Massey University, Auckland, New Zealand

Abstract

Background: In New Zealand, colorectal cancer (CRC) ranks as the second most common cancer. Over the past three decades, the survival rate of CRC patients in New Zealand has steadily increased. Diet and lifestyle advice affects cancer recovery and the prevention of cancer recurrence. Understanding CRC survivors’ current dietary and lifestyle beliefs, behaviours, and advice and support from health services and other sources will identify gaps in service provision. Aim: To gather preliminary evidence on the sources and quality of dietary and lifestyle advice delivered in community settings according to CRC survivors. Methods: This study is a pilot cross-sectional study. Participants were sought through convenience sampling. Survivors aged 18 years and older who had been diagnosed with colorectal cancer, received clinical treatment in New Zealand, completed treatment 6 months to 30 months before registration, and resided in the New Zealand community were invited to complete an online questionnaire. Data was collected using the online Qualtrics software. Descriptive statistics were used to examine quantitative data. Results: In total, six valid responses were received (83.3% female, mean age 50 years). CRC survivors believed in the important role diet and lifestyle changes played in aiding cancer recovery and preventing cancer recurrence. Five major findings were identified: 1) CRC survivors received insufficient dietary and lifestyle advice and ongoing support from healthcare professionals (HCPs), 2) CRC survivors prefer to receive individualised dietary information specific to their health status and symptoms, 3) current practice did not meet the National Institute for Health and Care Excellence (NICE) guidelines recommended for CRC by HCPs, 4) despite awareness of World Cancer Research Fund International/American Institute for Cancer Research (WCRF/AICR) dietary guidelines among CRC survivors, for some, this did not lead to change in dietary habits, 5) CRC survivors achieved the physical activity levels recommended in guidelines proposed by the U.S Physical Activity Guidelines Advisory Committee. Conclusion: A structured and systematic approach should be developed to provide dietary and lifestyle information for CRC survivors throughout their cancer trajectory so that they will have a better quality of life and a reduced CRC recurrence. Please note: Chapter 5 provides a separate stand-alone chapter on a sub-study. Aim: To gain preliminary insights into the role and resources of HCPs in dietary and lifestyle advice provision and support to CRC survivors in New Zealand. Method: This study design is a pilot descriptive cross-sectional survey. HCPs aged 18 and older with experience providing care to CRC survivors in the community or government funded health services were sampled through convenience sampling. Participants were invited to complete an online questionnaire, and data was collected using the online Qualtrics software. Descriptive statistics were used to examine quantitative data. Results: Six responses (100% female, nurse practitioners, and a cancer support worker) were included in this study. Five major findings were identified: 1) HCPs reported many CRC survivors suffered from complex nutritional problems, 2) all HCPs viewed diet as important for CRC recovery, though their attitudes towards the role of diet in CRC recurrence varied, 3) there is a lack of dietitian access for CRC survivors, 4) there is a variation in providing dietary advice to CRC survivors between HCPs, 5) barriers to information provision include limited access to dietitians, lack of funds, insufficient educational resources, time constraints, the cost to patients, limited knowledge or training, and absence of dietitian services within the organisations. Conclusion: The sub-study recognised a potential gap in CRC survivor care and accessibility to dietetic support. These findings highlight a gap in service provision for CRC survivors in advice, support and information on diet and lifestyle.