Abstract
Background
Pelvic radiotherapy is a common part of treatment used in gynecologic malignancies.
The side effects associated with treatment, such as gastrointestinal toxicity, can
be acute and chronic. Previous studies have provided little clarity in regard to the
best dietary intervention for management of symptoms.
Objective
The aim of this systematic review was to summarize the evidence on the efficacy of
nutrition interventions involving fiber modification in patients with gynecologic
cancers undergoing pelvic radiotherapy to prevent or alleviate gastrointestinal side
effects, in comparison to standard care, placebo, or no intervention.
Methods
Studies, inclusive of any language and date, up to December 1, 2019, were selected
from eight electronic databases: PubMed, Embase, the Cumulative Index to Nursing and
Allied Health Literature, Scopus, Science direct, Clinical Key, Web of Science, and
Cochrane. Key study outcomes included gastrointestinal toxicity such as diarrhea/bowel
changes, abdominal pain or bloating, and nausea; nutritional status; and quality of
life. All studies underwent a quality appraisal using the Academy of Nutrition and
Dietetics Quality Criteria Checklist and certainty of evidence was assessed via the
Grading of Recommendations Assessment, Development, and Evaluation criteria.
Results
Four studies were included (total number of participants = 89), with quality ratings
of neutral or negative. Due to the risk of bias, inconsistency, indirectness, and
imprecision, there was very low certainty of evidence that dietary fiber modifications
improved these outcomes. Some positive trends regarding improvements in incidence
and severity of diarrhea and bowel symptoms were reported; however, the body of evidence
was insufficient to form specific recommendations for clinical practice. This is reflected
in the Grading of Recommendations Assessment, Development, and Evaluation criteria
rating (very low level of certainty) for quality of life and gastrointestinal toxicity
outcomes.
Conclusions
This systematic review suggests that supplementary fiber modification during radiation
therapy may have some potential benefits with improving gastrointestinal symptoms;
however, more definitive evidence and further exploration of fiber in a therapeutic
role is required to inform dietary practice.
Keywords
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Biography
E. Croisier is a doctoral degree candidate, School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia; and Department of Nutrition and Dietetics, The Royal Brisbane Women’s Hospital, Herston, Queensland, Australia.
Biography
T. Brown is an Assistant Director of Nutrition and Dietetics at the Royal Brisbane and Women’s Hospital, Queensland Health, Queensland, Australia.
Biography
J. Bauer is an associate professor, School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia.
Article info
Publication history
Published online: October 28, 2020
Accepted:
August 14,
2020
Received:
December 10,
2019
Footnotes
Supplementary materials: Figure 1 is available at www.jandonline.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT Supported by the Australian Government Research Training Program.
PROSPERO registration of this systematic review was accepted in February 2019 (registration no: CRD42019121397).
AUTHOR CONTRIBUTIONS E. Croisier conducted the data synthesis and analysis, and drafted the initial manuscript. All authors reviewed, commented, and contributed to the revision of subsequent drafts of the manuscript.
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