Clarke Emma, Pugh Gemma, van den Heuvel Eveline, Kavanagh Erin, Cheung Pamela, Wood Andrew, Winstanley Mark, Braakhuis Andrea, Lovell Amy L
Department of Nutrition and Dietetics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
National Child Cancer Network, Te Aho o Te Kahu Cancer Control Agency, Wellington, New Zealand.
Nutr Diet. 2023 Nov;80(5):494-510. doi: 10.1111/1747-0080.12803. Epub 2023 Mar 14.
Nutrition challenges are common during childhood cancer treatment and can persist into survivorship, increasing the risk of non-communicable diseases. Evidence-based practice and implementation of nutrition interventions/education for childhood cancer survivors has been poorly investigated and may influence their future health. This study aimed to explore the nutrition interventions/education needs of childhood cancer survivors and the barriers and facilitators to delivering follow-up services in New Zealand.
Semi structured interviews were conducted with childhood cancer survivors and/or their families (n=22) and health professionals (n=9) from a specialist paediatric oncology centre in New Zealand. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed inductively using thematic analysis. A multi-level consensus coding methodology was used where each theme and associated subthemes were discussed with the study team for confirmation to ensure accurate coding and analysis.
Three themes emerged from the analysis: (1) the current survivorship care pathway does not provide adequate interventions/education, (2) weight and dietary changes are common challenges and (3) requirements for interventions/education in survivorship are varied. Common nutrition-related concerns included fussy eating/limited dietary intake, poor diet quality, difficulties with tube weaning, and challenges with weight gain. Participants expressed a desire for education on healthy eating alongside information about cancer-related nutrition issues, such as learned food aversions. A preference for clear referral pathways and multifaceted interventions tailored to individual patient needs was identified.
The trifecta of treatment side effects, negative feeding practices and poor messaging from health professionals creates a challenging environment to optimise nutrition. A stepped care model matching the intervention intensity with the childhood cancer survivors is required. Education for healthcare professionals will improve the delivery of timely interventions/education and monitoring practices.
营养挑战在儿童癌症治疗期间很常见，并且可能持续到癌症存活期，增加了患非传染性疾病的风险。针对儿童癌症幸存者的营养干预措施/教育的循证实践及实施情况尚未得到充分研究，而这可能会影响他们未来的健康。本研究旨在探讨新西兰儿童癌症幸存者的营养干预措施/教育需求以及提供后续服务的障碍和促进因素。
对来自新西兰一家专业儿科肿瘤中心的儿童癌症幸存者和/或其家人（n = 22）以及健康专业人员（n = 9）进行了半结构化访谈。访谈进行了录音并逐字转录。使用主题分析法对转录本进行归纳分析。采用了多层次共识编码方法，每个主题及相关子主题都与研究团队进行了讨论以确认，以确保准确编码和分析。
分析得出三个主题：（1）当前的癌症存活期护理路径未提供充分的干预措施/教育；（2）体重和饮食变化是常见挑战；（3）癌症存活期对干预措施/教育的需求各不相同。常见的与营养相关的问题包括挑食/饮食摄入量有限、饮食质量差、脱管困难以及体重增加方面的挑战。参与者表示希望获得关于健康饮食的教育以及与癌症相关的营养问题的信息，例如习得性食物厌恶。研究确定了对明确转诊途径和针对个体患者需求量身定制的多方面干预措施的偏好。
治疗副作用、负面喂养习惯以及健康专业人员传达的信息不佳这三者共同构成了一个难以优化营养的挑战性环境。需要一种将干预强度与儿童癌症幸存者相匹配的分级护理模式。对医疗保健专业人员的教育将改善及时干预措施/教育的提供及监测实践。
