Nutrition Care Needs and Multidisciplinary Rehabilitation in Upper GI Cancer Survivors

Abstract

During the last decades, the number of people diagnosed with upper gastrointestinal (UGI) cancers, such as oesophageal (gullet) and stomach cancer, increased in Ireland. Fortunately, with early diagnosis and advances in treatment, more people are surviving these cancers. However, survivors often experience different side effects after cancer treatment, which can impact their ability to eat and absorb food and impair their quality of life. Nevertheless, little is known about the challenges that survivors face beyond treatment in Ireland and which type of care is required to meet their needs. In this thesis, five studies were completed to answer these questions. In the first two studies, a survey and 1:1 interviews, people diagnosed with UGI cancer were asked about their symptoms, quality of life, psychological status, and need for additional nutritioncare. The findings of this study suggested that malnutrition and gastrointestinal discomfort remain an issue in survivors of UGI cancer.Impaired quality of life and psychological distress were also observed in this group of cancer survivors. Furthermore, survivors spoke of the need for clear, practical, and timely nutritional information, extensive input during the acute phase of recovery, increased follow-up throughout survivorship, support groups, and resources for caregivers. In the third study, nutritional status, muscle mass and dietary intake of disease-free UGI cancer survivors participating in a rehabilitation study were evaluated. Results of this study showed that one in three of those UGI cancer survivors was malnourished, and one in eight had low muscle mass and strength. It was also observed that they had a poor-quality diet that did not comply with recommendations for cancer prevention. In the fourth study, available scientific evidence was reviewed to see if care programmes with core components of nutrition and exercise can improve food intake, physical function, and quality of life in UGI cancer survivors. The results of this study showed that little information is available about the effectiveness of nutrition and exercise in improving these factors in UGI cancer survivors, and further studies are required to answer this question. In the fifth study, the practicality of remote delivery of a nutrition intervention to UGI cancer survivors was investigated. The findings demonstrated that this approach is practical and acceptable for participants. Further studies are needed to see if this approach can be as effective as in-person nutrition interventions. Overall, studies completed in this thesis demonstrated that UGI cancer survivors are not returning to their normal lives after treatment. The findings of the present thesis highlighted the urgent need for tailored survivorship care programmes to address these survivors' unique needs. Additionally, further research is essential to determine the most effective survivorship care plans to meet the long-term needs of UGI cancer survivors.