The Influence Of Dietary Restriction On Quality Of Life In The Patients With Hematological Malignancies Who Received Chemotherapy: A Single-Institution Study

In decades past, patients with chemotherapy were treated with severed sterile or low-bacteria diets, and after chemotherapy, diet control was sometimes continued for some months. Sterile diets do not have a place in diet management today because of improved antimicrobial therapies, lack of evidence to demonstrate efficacy. Nonetheless, some form of diet restriction to minimize acquisition of organisms from food sources and food handlers is common. We investigated the influence of teaching for diet restrictions on quality of life (QOL) during and after chemotherapy in patients with hematological malignancies.

From September 2007 to May 2013 at Yonago Medical Center, all patients with chemotherapy received the education about dietary restriction using the diet and food safety guideline for the hematopoietic stem cell transplantation (HSCT) patients of The Japan Society for Hematopoietic Cell Transplantation. And those patients are advised to follow diet precautions for 6 months after chemotherapy and allogeneic graft patients with HSCT for 6 months after termination of immunosuppressive drugs. Patients and caregivers require education on food safety practices before chemotherapy were started. 95 patients were investigated in this study. We performed the questionnaire to the patients twice (initial and follow-up surveys) at intervals of one year in May, 2013 from April, 2012. 21 patients were in the period of dietary restriction (initial), and one year afterward (follow-up) (phase 1), and 74 patients were in the time of dietary restriction being canceled (initial), and one year afterward (follow-up) (phase 2). We divide the dietary feeling over dietary restriction into observance, pain, illusion, and uneasiness and evaluated four scores of each. To assess QOL, the Medical Outcomes Study Form-36 was used. We analyzed changes in dietary feeling scores, QOL scores, and body mass index (BMI) between initial and follow-up, and between phase 1 and phase 2. We confirmed that scores of the dietary feeling showed significantly correlation to QOL scores, carrying out the questionnaire to 90 outpatients with hematological disorders who did not received chemotherapy.

The patients included 10 patients with acute myeloid leukemia, 7 with myelodysplastic syndrome, 3 with acute lymphoblastic leukemia, 3 with chronic lymphoid leukemia, 10 with multiple myeloma, 60 with malignant lymphoma, and 2 with others. 29 patients underwent HSCT. In phase 1, the Role-Physical (RP), Bodily Pain (BP), and Social Functioning (SF) scores increased significantly (all, P<0.05) from initial to follow-up. We could not find any differences in phase 2. We analyzed the changes in scores from the initial to follow-up surveys. Among phase 1 and phase 2 patients, BMI, Physical Functioning (PF), RP, BP, General Health (GH), Vitality (VT), SF, Role-Emotional (RE), Mental Health (MH), and Role-Social component (RCS) reported worsening in changes (all, P<0.05). In phase 1, the change of BP scores from initial to follow-up significantly correlate with the dietary feeling scores (p=0.0118, r=564). Other QOL scores did not show significant correlation with dietary feeling scores. The changes on dietary feeling scores from the initial to follow-up at phase1 were seemed to be higher than those at phase 2, however, the changes in phase 1 and phase 2 were 1.3 and 0.3 (respectively, not significance).

From the period of dietary restriction to one year afterward of dietary restriction being canceled, QOL scores and the pain by dietary restriction has improved. After that time, in one year observation, an improvement of those scores was not found. The correlation between the changes of QOL and those of dietary feeling was not found except only BP. On the other hand, scores of the dietary feeling showed significantly correlation to QOL scores of the patients without chemotherapy. By diet and food safety education by nurses, the patients who receives chemotherapy understood the necessity for diet restriction. Our results suggest that dietary restriction has not directly influenced lowering QOL of patients with chemotherapy. If diet and food safety education is required for a chemotherapy, we may perform dietary restriction positively, although, it cannot predict from this study what restriction can prevent infection. In the future, the dietary restriction should make it clear at what kind of it is required.

No relevant conflicts of interest to declare.