Study Reveals Disproportionate Burden of Poor Diet Quality Among Cancer Survivors, with Potential Impact on Cancer Treatment, Disease Progression, Survivorship

By Marcia Otto, PhD, FAHA, and Wes Gibson, MPH

A new study led by Associate Professor Marcia Otto, PhD, FAHA, reveals the disproportionate burden of poor diet quality among cancer survivors. Findings revealed that individuals with oropharyngeal cancer, a form of head and neck cancer that manifests in the oropharynx, overwhelmingly have poor diet quality ⁽¹⁾ both at the time of cancer diagnosis and long after their treatment ended, with diet quality 50% below U.S. Dietary Recommendations and 20% lower than those of similarly aged adults.

Funded by the U.S. Department of Defense, this study has recruited 300 patients diagnosed with oropharyngeal cancer from diverse socioeconomic backgrounds, races, ethnicities, and lifestyles, with a wide range of cancer-related comorbidities at two large cancer centers.

Conducted in collaboration with The University of Texas MD Anderson Cancer Center and the Michael E. DeBakey Department of Veterans Affairs Medical Center, researchers examined diet impact on cancer survivorship through the “Uncovering the long-term impact of Oropharyngeal Cancer and dysphagia on dietary quality and nutrition among cancer survivors (U-DINE) Study.”

“Our goal is to generate evidence that supports integrating food-based nutrition into cancer care, helping shift clinical practice to recognize the vital role diet plays in treatment success and survivorship,” said Otto, with the Department of Epidemiology and Center for Health Equity. This is pertinent in patients with oropharyngeal cancer, who often experience severe complications during treatment, affecting their ability to swallow and eat. “We hope these initial insights can extend beyond oropharyngeal cancer to benefit patients with other cancers, driving the development of multidisciplinary approaches that incorporate dietary support into care and improve outcomes for all cancer patients.”

The U-DINE is the first a unique study examining the prevalence and patterns of poor diet quality in cancer patients following them from diagnosis through treatment completion and into long-term survivorship. The ongoing study also investigates how swallowing difficulties may impact diet quality throughout different stages of survivorship. 

Healthy eating patterns play a pivotal role in cancer patients’ health across survivorship where deficiencies in essential nutrients during treatment can impair treatment response, worsen side effects, and prolong both treatment time and hospitalization. After treatment, supporting a high-quality diet is essential to reduce the risk of secondary cancers and other chronic conditions, such as heart disease.

At the time of cancer diagnosis, four in every five individuals had inadequate intake of fruits, vegetables, dairy, healthy fats, sodium, and saturated fats. Findings show a similar pattern of poor diet quality for individuals assessed during late-stage survivorship, suggesting that poor eating behavior persists after acute toxicities from cancer treatment have subsided. Left unabated, these dietary insufficiencies could substantially increase the risk of cardiovascular disease, diabetes, second malignancies, and functional decline in late survivorship.

Researchers are working to develop evidence-based programs to assist in this area where a gap in research currently exists in aiding individuals diagnosed with oropharyngeal cancer with developing and maintaining a high-quality diet recommendation that is tailored to their individual needs. Without this knowledge, clinicians cannot properly guide patients in adjusting their diet to improve health outcomes.

Otto and collaborators anticipate that future results from the U-DINE study will provide a crucial evidence base to advance policies and programs including Food is Medicine strategies to effectively address suboptimal diet during treatment and survivorship phases in this population.

Expansion of U-DINE includes broadening the cohort to assess survivors of different cancers, conducting a detailed examination of barriers to healthy eating during cancer care, and the testing, development, and implementation of ‘Food is Medicine’ strategies to address poor diet quality at the point of care, are expected to accelerate this overall effort.

Additional leads on the study include Kate Hutcheson, PhD, professor in the Department of Head and Neck Surgery at MD Anderson Cancer Center, and Vlad Sandulache, MD, PhD, associate professor and vice-chair of research at Baylor College of Medicine and chief of service at Michael E. DeBakey VA Medical Center (MEDVAMC). Co-Investigators on this study include Shreela V Sharma, PhD, RDN, LD, professor and vice chair in the Department of Epidemiology and Director of the Center for Health Equity and Ruosha Li, PhD, associate professor in the Department of Biostatistics and Data Science.

(1) Poor diet quality is characterized by low consumption of healthy, nutrient-dense foods such as fruits, vegetables, and whole grains, and excessive intake of unhealthy foods and food components (e.g., processed foods, salty snacks, sodium, refined sugars). Low-quality diet is a leading risk factor for illness, death, and disability in adult populations. In U-DINE, diet quality is estimated using two diet quality scores reflecting adherence to the 2020-2025 Dietary Guidelines for Americans (Healthy Eating Index 2020) and the World Cancer Research Fund and American Institute for Cancer Research Recommendations for Cancer Prevention (WCRF/AICR Score).

References:

U. S. Department of Agriculture and U.S. Department of Health and Human Services. 2020-2025 Dietary Guidelines for Americans. 2020. December 2020. DietaryGuidelines.gov.

National Cancer Institute. Standardized Scoring System to Assess Adherence to WCRF/AICR Cancer Prevention Recommendations. Updated June 2, 2022. Accessed June 20, 2023, 2023. https://epi.grants.cancer.gov/wcrf-aicr-score/