Dietary counselling to increase soluble fibre in patients with gynaecological cancers undergoing pelvic radiotherapy: a feasibility study

There are some potential benefits recently demonstrated with a high fibre intervention in improving gastrointestinal symptoms in patients with gynaecological cancers secondary to pelvic radiation treatment. Before further investigation into fibre as a therapeutic agent is undertaken, it must first be determined if increasing fibre intake will adversely affect radiation treatment delivery, as it is anticipated there will be an increase in gas production, which may affect bowel positioning. Hence, this study will look at whether an increased dietary fibre intervention is feasible in this population group without significantly affecting treatment fields and administration. Nutrition counselling and education by the research dietitian will be provided weekly via 30-45 minute one-on-one telehealth appointments throughout their radiation treatment to ensure the target fibre intake is achieved/maintained during this period. The initial session will involve: - An assessment of their nutritional status (weight and PG-SGA) - 24-diet recall to assess their total current dietary fibre intake and soluble fibre intake at baseline. - Education of dietary fibre – overview of types of fibre (soluble and insoluble) and their function; common food sources; use of educational resources of which includes a ready reckoner, sourced from the Fibre Categories Database (Fuller et al., 2018), listing common foods and their fibre composition that participants can refer to when recording their soluble fibre intake in the food diaries provided. - Develop (in liaison with the dietitian) a personalized meal plan/suggestions and strategies to gradually increase or modify dietary fibre intake, depending on baseline intake of dietary fibre (to avoid intolerance issues) - Demonstration of how to accurately record intake using a 3-day food diary (template designed specifically for this study and provided to participants) - Provision of contact details of the treating dietitian should they require additional support. Participants will be made aware that they are permitted to access dietetic services as much as required. Total time with dietitian will be recorded and documented for each participant. Weekly review sessions will include: - Assessment of their adherence via completion of the 3-day diet diaries - Weekly weights - Nutrition counselling and education to ensure the target fibre intake is reached and maintained each week throughout treatment - Nutritional counselling to ensure maintenance of nutritional status and to manage any other nutrition-impact symptoms from treatment. The intervention will be individualised to account for variation in baseline dietary soluble fibre intake between individuals and to mitigate excess gas being produced as a result of significantly increasing fibre consumption in a short period of time. Once the baseline fibre intake is assessed for each individual upon commencement of the intervention, the study dietitian will assist in developing a meal plan in collaboration with the participant to increase their soluble fibre intake by 2-3g each week during radiation treatment. Preliminary data will also be collected to look at the effect of an increased dietary (soluble) fibre diet on radiation-induced diarrhoea, nutritional status and quality of life. This will be a single arm single centre intervention feasibility trial, recruiting 40 participants from the RBWH radiation oncology outpatient department. Results from this study will determine whether increasing dietary fibre is realistic and safe to achieve in this setting, precluding any adverse effect on radiation treatment delivery.