Ravasco, P., Monteiro-Grillo, I., Marques-Vidal, P., & Camilo, M. (2005). Dietary counseling improves patient outcomes: A prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. Journal of Clinical Oncology, 23, 1431–1438.

To investigate the impact of dietary counseling or nutritional supplements on morbidity and quality-of-life outcomes in patients with cancer during and three months after radiotherapy (RT)

Group 1 patients received individualized dietary counseling based on regular food groups. Group 2 patients consumed two cans of a high-protein liquid supplement per day in addition to their usual diet. Group 3 patients (control) were instructed to maintain their ad lib intake.

This prospective study design allowed for comparison of the effects of the interventions across the study arms over time. Evaluation took place at three points: baseline, at the end of RT, and three months later. Several types of outcome variables were measured, including nutritional status indicators.

• The study evaluated 111 patients with colorectal cancer referred for preoperative radiotherapy plus 5-fluorouracil//folinic acid administered on the first and last five days.
• The sample included 66 males and 45 females.
• Patient age range was 32–88 years.
• Patients were stratified by cancer stage and then randomized (n = 37 in groups 1, 2, and 3).
• All patients completed the study.

• Single radiation oncology department
• Lisbon, Portugal

The study was a prospective, randomized, controlled trial.

• Nutritional assessment
• Patient-Generated Subjective Global Assessment: to assess symptoms, weight change, alterations in food intake, functional capacity, components of metabolic stress, and physical examination findings
• Anthropometrics: height and weight
• Nutritional requirements and dietary assessment
• World Health Organization formulas
• Diet history: 24-hour food questionnaire
• European Organization for Research and Treatment Cancer Quality of Life questionnaire (EORTC QLQ-C30)

Protein 3 energy intake: at three-month time point, group 1 maintained nutritional intake and groups 2 and 3 returned to baseline. After RT and at three months, rates of anorexia, nausea and vomiting, and diarrhea were higher in group 3. At RT completion, 211 QOL function scores improved in group 1, 3 out of 6 function scores improved in group 2, and all scores worsened in group 3.

Researchers concluded that both interventions positively influenced outcomes. Three months after RT, dietary counseling was the only intervention to sustain a significant impact on patient outcomes.

• The study was limited to patients with colorectal cancer.
• The sample was of mixed disease stage (45 were stage I/II, 66 were stage III/IV), although patients were stratified for this.
• Measurement of outcomes was complicated by the fact that patients were receiving active treatments with RT.
• This type of dietary intervention is available to patients by referral to a registered dietitian. Expertise is required, which may be cost-prohibitive or not available at various settings.

This study examined the effects of individualized dietary counseling in a high-risk group. Whether individualized dietary counseling in other cancer groups will produce the desired outcome of increased appetite needs to be examined.