Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

    Full text documents are added when available. The database is updated daily and currently holds about 240,000 items, of which 72,000 in open access.

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‘Voedingsvoorlichting bij kanker moet meer prioriteit krijgen’
Veen, Merel van - \ 2019
Improving information provision on nutrition and cancer : For cancer survivors and health professionals
Veen, Merel R. van - \ 2019
Wageningen University. Promotor(en): E. Kampman, co-promotor(en): S. Beijer. - Wageningen : Wageningen University - ISBN 9789463439817 - 173

Numerous guidelines are available for the prevention of cancer. Optimal nutrition after a cancer diagnosis may increase survival, reduce the risk of recurrence, limit side-effects and improve recovery and quality of life. However, cancer survivors often do not receive nutritional information, and health professionals are often not trained to provide such advice (chapter 1). This thesis aims to improve nutritional information provision for cancer survivors, the general public and health professionals by investigating whether adherence to dietary recommendations is associated with improved quality of life; investigating the importance of information provision on nutrition and cancer by assessing nutritional beliefs, assessing information needs of cancer survivors and whether survivors change their dietary behaviour when they receive information on nutrition and cancer, by assessing the ideas of oncology nurses and by developing a website.

In chapter 2, the association between adherence to the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) recommendations and health related quality of life (HRQL) among colorectal cancer (CRC) survivors was investigated. All CRC survivors stage I-IV, diagnosed between January 2000 and June 2009 in the southern area of the Netherlands were sampled via the Netherlands Cancer Registry (NCR). Questionnaires about dietary intake, body height/weight, physical activity and HRQL were sent out. WCRF/AICR adherence scores (range 0-8, with a higher score for better adherence) were calculated using the questionnaires on dietary intake, physical activity, and body mass index (BMI). 1,096 CRC survivors with a mean WCRF/AICR adherence score of 4.81 ± 1.04 were included (response rate 67%). Higher WCRF/AICR scores were associated with better global health status, physical, role, cognitive and social functioning, and with less fatigue. Physical activity seemed to be the main contributor.

In chapter 3, the association between nutritional information provision and beliefs on nutrition and cancer was investigated. Questionnaires were filled out by 326 CRC survivors one month after surgery on general characteristics, nutritional information provision by health care professionals, nutritional information needs, satisfaction with nutritional information and patients’ beliefs on nutrition and cancer. Most respondents who received information strongly believe nutrition influences feelings of well-being (59%) and recovery after cancer (62%). 62% of respondents received information from one or more health professionals. Respondents who received information from three health professionals, had stronger beliefs on the influence of nutrition on cancer outcomes than those who did not receive information about nutritional complaints after treatment (PR 3.2; 95% CI 1.5-6.9), recovery after cancer (PR 1.8; 95% CI 1.2-2.9) and about recurrence of cancer (PR 2.9; 95% CI 1.3-6.4).

In chapter 4, it was investigated whether obtaining nutritional information influences reported changes in dietary behaviour in 239 cancer survivors and their relatives and how this association is. It was then investigated whether nutritional information needs influenced this association. This panel completed a survey about their experiences with nutritional information provision by healthcare professionals in the period after diagnosis, their information needs regarding nutrition and cancer, and whether they changed their dietary behaviour since diagnosis. The survey showed that 56% of respondents obtained nutritional information, mostly during treatment. Respondents who obtained nutritional information more often reported to have altered their dietary behaviour after diagnosis in a positive way (less products that promote weight gain, increased intake of plant foods, decreased meat and alcohol use), regardless whether they had nutritional information needs or not.

Chapter 5 investigated if oncology nurses perceived themselves as having insufficient knowledge to provide advice on nutrition and/or physical activity, and which characteristics were associated with this perception. 355 oncology nurses provided advice on nutrition and of these, 327 provided advice on physical activity. Of these oncology nurses, 43% perceived themselves as having insufficient knowledge to provide advice on nutrition, and 46% perceived insufficient knowledge to provide advice on physical activity. In particular, younger oncology nurses and oncology nurses with an intermediate vocational education more often perceived themselves as having insufficient knowledge to give these advices.

In Chapter 6, the development of a website to make scientific information available for cancer survivors was described. Initially, the website was filled with answers to frequently asked questions provided by cancer organizations and the Dutch Dietetic Oncology Group, and by responding to various fiction and facts published in the media. Furthermore, an opportunity for visitors to submit specific questions regarding nutrition and cancer was included. The answers to these visitors’ questions were consequently published on the website.

Chapter 7 discusses that healthy lifestyle screening should be implemented in all phases of cancer care; that dieticians are responsible for nutritional support and information provision for all cancer patients; that a cancer diagnosis is not the window of opportunity for sustained lifestyle changes and that physicians are the ones to stress the importance of a healthy diet to cancer survivors, but should refer to experts for the actual advice. Future research should focus on the need for cancer survivors to better adhere to the recommendations for a healthy lifestyle, with better information provision by health professionals. For public health and clinical practice, available information sources should be promoted and implemented in health care.

Based on the results of this thesis as well as existing literature, it can be concluded that evidence based nutritional information should be provided to cancer survivors. To be able to do so, health professionals should receive more nutritional training to emphasize the important role of nutrition in cancer and to properly refer and advice cancer survivors about nutrition and cancer. The dietician must have the lead in this process. This is important, since correct nutritional information might positively influence cancer survivors’ beliefs about the role of nutrition in cancer and stimulate cancer survivors to positively alter their dietary behaviour. The newly developed website voedingenkankerinfo.nl on diet and cancer fills a gap in the provision of information about nutrition and cancer for both patients, the general public and health professionals.

Colorectal cancer survivors’ beliefs on nutrition and cancer; correlates with nutritional information provision
Veen, Merel R. van; Mols, Floortje ; Smeets, Lian ; Kampman, Ellen ; Beijer, Sandra - \ 2019
Supportive Care in Cancer (2019). - ISSN 0941-4355 - 9 p.
Colorectal cancer survivor - Health professionals - Information provision - Nutrition

Purpose: To investigate CRC survivors’ beliefs on nutrition and cancer and the association with nutritional information provision by (kind and number) of health professionals and to inquire about foods that CRC survivors believed either had a positive or negative influence on their cancer. Methods: A total of 326 CRC survivors of an ongoing prospective cohort study filled out questionnaires 1 month after surgery on whether they had received nutritional information from health professionals. Also, their beliefs that nutrition influences (1) feelings of well-being, (2) complaints after treatment, (3) recovery and (4) cancer recurrence were investigated. Prevalence ratios were calculated (using Cox proportional hazard regression analysis) to study associations between information provision and the four beliefs adjusted for age, gender and cancer stage. Results: Sixty-two percent of respondents received information about nutrition from one or more health professionals. Most respondents who received information strongly believe nutrition influences feelings of well-being (59%) and recovery after cancer (62%). Compared with those who did not receive information, respondents who received information from three professionals showed the strongest beliefs on the influence of nutrition on complaints after treatment (PR 3.4; 95% CI 1.6–7.4), recovery after treatment (PR 2.0; 95% CI 1.2–3.3) and recurrence (PR 2.8; 95% CI 1.3–6.2). Conclusion: Nutritional information provision by health professionals positively influences the beliefs of CRC survivors on the influence of nutrition on cancer outcomes: stronger beliefs occur when respondents received information from three health professionals.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations for cancer prevention is associated with better health–related quality of life among long-term colorectal cancer survivors : results of the PROFILES registry
Veen, Merel R. van; Mols, Floortje ; Bours, Martijn J.L. ; Weijenberg, Matty P. ; Kampman, Ellen ; Beijer, Sandra - \ 2019
Supportive Care in Cancer 27 (2019)12. - ISSN 0941-4355 - p. 4565 - 4574.
Body composition - Colorectal cancer survivors - Dietary guidelines - Health-related quality of life - Physical activity - WCRF guidelines

Since colorectal cancer (CRC) survivors often suffer from long-term adverse health effects of the cancer and its treatment, having a negative impact on their health-related quality of life (HRQL), this study focuses on the association between adherence to WCRF/AICR recommendations and HRQL among CRC survivors. In a cross-sectional PROFILES registry study in 1096 CRC survivors (mean time since diagnosis 8.1 years), WCRF/AICR adherence scores (range 0–8, with a higher score for better adherence) were calculated, and HRQL was assessed using the EORTC QLQ-C30. Associations between adherence scores and HRQL scores were investigated using linear regression analyses. Additionally, associations with adherence to guidelines for body mass index (BMI) (normal weight, overweight and obese), physical activity (PA) (score 0/1) and diet (score < 3, 3– < 4 and > 4) were evaluated separately. Mean adherence score was 4.81 ± 1.04. Higher WCRF/AICR scores were associated with better global health status (β 1.64; 95%CI 0.69/2.59), physical functioning (β 2.71; 95%CI 1.73/3.68), role functioning (β 2.87; 95%CI 1.53/4.21), cognitive functioning (β 1.25; 95%CI 0.19/2.32), social functioning (β 2.01; 95%CI 0.85/3.16) and fatigue (β − 2.81; 95%CI − 4.02/− 1.60). Adherence versus non-adherence PA was significantly associated with better physical, role, emotional and social functioning, global health status and less fatigue. Except for the association between being obese and physical functioning (β − 4.15; 95%CI − 47.16/− 1.15), no statistically significant associations with physical functioning were observed comparing adherence to non-adherence to BMI and dietary recommendations. Better adherence to the WCRF/AICR recommendations was positively associated with global health status, most functioning scales and less fatigue among CRC survivors. PA seemed to be the main contributor.

Nutritional Information Provision to Cancer Patients and Their Relatives Can Promote Dietary Behavior Changes Independent of Nutritional Information Needs
Veen, Merel R. van; Winkels, Renate M. ; Janssen, Silvie H.M. ; Kampman, Ellen ; Beijer, Sandra - \ 2018
Nutrition and Cancer 70 (2018)3. - ISSN 0163-5581 - p. 483 - 489.
We investigated whether obtaining nutritional information influences reported changes in dietary behavior in cancer survivors and their relatives and whether nutritional information needs influence this association. We included 239 cancer survivors and their relatives, recruited from an online panel of cancer survivors and relatives. This panel completed a survey about their experiences with nutritional information provision by healthcare professionals and the media in the period after diagnosis, their information needs regarding nutrition and cancer, and whether they changed their dietary behavior since diagnosis. The survey showed that 56% of respondents obtained nutritional information, mostly during treatment. Respondents who obtained nutritional information more often reported to have altered their dietary behavior after diagnosis. This association was not altered by having information needs. The reported changes in dietary behavior were coherent with the recommendations of the World Cancer Research Fund: respondents reported to choose less products that promote weight gain, increased intake of plant foods, and decreased meat and alcohol use. Respondents who obtained nutritional information more often changed their dietary behavior, regardless whether they had nutritional information needs. This might be an indication that healthcare professionals should provide nutritional information not only to those expressing a need for nutritional information.
Improving oncology nurses' knowledge about nutrition and physical activity for cancer survivors
Veen, Merel R. van; Hoedjes, Meeke ; Versteegen, Joline J. ; Meulengraaf-Wilhelm, Nienke van de; Kampman, Ellen ; Beijer, Sandra - \ 2017
Oncology Nursing Forum 44 (2017)4. - ISSN 0190-535X - p. 488 - 496.
Healthpromotion behavior - Nutrition - Patient education - Physical activity

Purpose/Objectives: To assess what percentage of oncology nurses perceived themselves as having insuffcient knowledge to provide advice on nutrition and/or physical activity (PA), which characteristics were associated with nurses' perception, and whether the content and information sources differed among those nurses. Design: A cross-sectional study. Setting: A web-based survey among oncology nurses in the Netherlands. Sample: 355 oncology nurses provided advice on nutrition; of these, 327 provided advice on PA. Methods: From May to July 2013, oncology nurses were invited to complete an online questionnaire. Pearson's chi-squared tests and uni-and multivariate logistic regression analyses were conducted. Main Research Variables: Oncology nurses' perception of having suffcient or insuffcient knowledge to be able to provide advice on nutrition and PA, the content of the advice, and the information sources on which the advice was based. Findings: 43% of oncology nurses perceived themselves as having insuffcient knowledge to provide advice on nutrition, and 46% perceived insuffcient knowledge to provide advice on PA. Factors associated with perceiving insuffcient knowledge on nutrition were being aged younger, having lower education, and providing counseling during treatment only. Those nurses were more likely to suggest taking oral nutritional supplements or visiting a dietitian and were less likely to provide information on fluid intake. Nurses perceiving insuffcient knowledge about PA used oncology guidelines less often. Conclusions: Almost half of the oncology nurses providing advice on nutrition and PA perceived themselves as having insuffcient knowledge to be able to provide such advice. In particular, younger oncology nurses and oncology nurses with an intermediate vocational education may beneft most from education about these topics. Implications for Nursing: Educational training for oncology nurses should include nutrition and PA. Oncology nurses should collaborate with dietitians to discuss what information should be provided to patients by whom, and specifc PA advice should be provided by a physical therapist.

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