Cancer-related fatigue is a common side effect of cancer and its treatments. Between 80 and 100 percent of people with cancer report this side effect at some point, according to the American Cancer Society, and it can affect cancer survivors for years after treatment. In the line of addressing and treating this fatigue, researchers at the Ohio State University Comprehensive Cancer Center recently published data on a dietary intervention for survivors of non-Hodgkin lymphoma designed to reduce their cancer-related fatigue (Nutr Cancer 2023; https://doi.org/10.1080/01635581.2023.2173259).
"Cancer-related fatigue is the most commonly reported persistent symptom affecting non-Hodgkin lymphoma survivors," noted Tonya Sue Orchard, PhD, a member of the Cancer Control Program at Ohio State. It's associated with depression, anxiety, and reduced quality of life, and has been shown to affect survivors as long as 5-10 years post-treatment.
"We are interested in developing dietary strategies to combat this condition and thus improve quality of life for cancer survivors," she said. Their data did indeed show that the dietary intervention was followed by the survivors who were part of the study and did help lessen their cancer-related fatigue and improve quality-of-life measures. Orchard explained more about the intervention and its implications.
1 Can you walk through what the intervention involved?
"This study used a single-arm, pre-post test design. Participants were non-Hodgkin lymphoma survivors who had been in remission for at least 2 years. This was a 12-week intervention in which participants met virtually via Zoom with a registered dietitian nutritionist or dietetic intern weekly for the first 4 weeks, then biweekly for the remaining 8 weeks of the study. The nutrition counseling was based on the Fatigue Reduction Diet (FRD) pattern, developed by Suzanna M. Zick, ND, MPH.
"Previous research by our collaborator, Dr. Zick, has shown that this diet pattern was effective in reducing fatigue in breast cancer survivors. She tested the Fatigue Reduction Diet intervention using a hybrid format with some nutrition counseling offered in person and some by phone. Our research has shown preliminary efficacy in lymphoma survivors using a totally remote method to deliver the intervention.
"The FRD is high in specific vegetables, fruits, whole grains and omega-3 fats-all of which have been associated with reduced fatigue in cancer survivors. Changes in diet quality and fatigue were measured with validated instruments before and after the 12-week intervention. Delivered virtually in a telehealth format, [it] was feasible and well-accepted by lymphoma survivors in our study. We saw significant improvements in diet quality and fatigue at the end of the intervention, compared to baseline."
2 What are the implications of the work? Could the intervention be scaled up and used in more cancer survivor populations?
"This is promising preliminary data, but it needs to be validated in a larger randomized controlled trial. This remotely delivered intervention is very scalable and we are working to test a similar intervention in other groups of cancer survivors.
"Some limitations are that this was a small, single-arm feasibility study. Dietary intake and fatigue were self-reported using validated questionnaires. Weight loss was not targeted in this study, but some participants did report weight loss. Anthropometric data (such as height and weight) were self-reported at baseline, but were not assessed post-intervention. It is possible that weight loss could have contributed to preliminary evidence for reduction in fatigue reported by participants in this study. A larger randomized controlled trial will address many of these limitations."
3 Is there anything else that practicing oncologists and cancer care providers should know about this work?
"Improving diet quality through a pattern such as the Fatigue Reduction Diet is a promising strategy for lessening persistent cancer-related fatigue. Registered dietitian nutritionists can assist individuals in implementing changes that have the potential to improve negative side effects of cancer and thus improve quality of life."