Research has identified an association between malnutrition and functional deficits in patients with cancer, regardless of age, and other studies confirm that malnutrition affects treatment tolerability, outcomes, and quality of life for patients with cancer. However, studies have also found that oncology clinicians do not consistently assess for malnutrition and functional deficits in clinical settings. 

ONS member Virginia Sun, PhD, RN
ONS member Virginia Sun, PhD, RN, is an associate professor in the division of nursing research and education at City of Hope in Duarte, CA, and member of the Greater Los Angeles and Inland Empire ONS chapters.

Bowel dysfunction is one of the most common and persistent long-term adverse events for patients with rectal cancer, affecting 92% of survivors who received low anterior resection surgery. Malnutrition-related factors like diabetes or postoperative diarrhea also increase risk for anastomotic leakage, the most common cause of death after colorectal surgery.

To address those concerns, my colleagues and I developed a diet intervention for patients with rectal cancer. Altering Intake, Managing Symptoms (AIMS) is a telephone-based modification designed to support bowel symptom self-management through diet adjustments. The intervention consists of 10 sessions conducted over four to five months to help participants modify their diet for bowel control. AIMS integrates multiple behavior changes and motivational strategies, including setting goals, identifying barriers to modifying diets, and establishing an action plan.

We encourage participants to use food diaries to document and understand the relationship between various foods and bowel symptoms. Food access, preference, and tolerance can vary tremendously, so diaries allow a personalized approach for each participant’s needs.

Our pilot feasibility study found high acceptability. We’re currently conducting a phase II preliminary efficacy trial, funded by the National Cancer Institute, through the Southwestern Oncology Group cancer research network, and will publish the findings on after the trial ends in about a year.

AIMS builds on our previous research where we surveyed quality of life for long-term survivors of rectal cancer and found that many were changing their diets to self-manage bowel symptoms, but they almost always lacked the proper guidance. We also found that fruits and vegetables can be both helpful and troublesome for bowel dysfunction, and some survivors were avoiding them because it was the easiest way to achieve bowel control.

Through our research, we realized that patients with cancer need guidance on diet modification, and our intervention helped them to reduce their bowel dysfunction and promote healthy eating.