Brenton J. Baguley

Background/Objectives: In ovarian cancer, the association between low muscle mass and outcomes is unclear, despite well-established evidence in other cancer diagnoses. Overall body composition may have greater prognostic value. This study aimed to investigate associations between body composition and clinical outcomes. Methods: Retrospective study of women diagnosed with ovarian cancer between August 2020 and March 2024. Clinical characteristics were extracted from medical records. Body composition phenotypes (low skeletal muscle index [SMI], low skeletal muscle density [SMD], high subcutaneous [SATI], visceral [VATI] and total adipose tissue index [TATI]) were assessed from pre-treatment CT images. Logistic regression, chi-squared, Fisher’s exact tests, and Mann–Whitney U tests were used to assess associations between body composition phenotypes, patient characteristics and study outcomes. Cox proportional hazards models were fitted to examine associations with survival. Results: Ninety-nine patients [mean (SD) age 61 (12.7) years, 80% stage III/IV] were included. Overall, 67 (67%) women had low SMI, 57 (57%) low SMD, and 49 (49%) high TATI. Thirty-seven (37%) women had low SMI and low SMD, 23 (23%) low SMI with high TATI, and 33 (33%) low SMD with high TATI. Post-menopausal status was associated with higher VAT (p = 0.004). Low SMI or low SMD co-occurring with high adiposity was associated with a 1.91–2.03 and 2.15–2.49 higher hazard mortality. There was insufficient or weak evidence of an association between body composition and other treatment outcomes. Conclusion: These findings suggest additive effects when phenotypes co-occur. In ovarian cancer, singular assessments may be an oversimplification. Future studies should continue to consider co-occurring phenotypes to adequately capture risk.

Background Androgen deprivation therapy (ADT) improves survival in advanced prostate cancer but may lead to debilitating side effects, including sarcopenic obesity and a 10–45% increased risk of other comorbidities. Guidelines recommend exercise and nutrition interventions during ADT, but access to these services is often limited, and referral pathways are unclear. This study aims to evaluate the feasibility and preliminary efficacy of an online, home-based, multi-faceted, exercise, nutrition and education programme (ProHealth) for men with prostate cancer treated with ADT. ProHealth was co-designed with consumers and healthcare professionals to include (i) education on prostate cancer and treatment-related side effects and (ii) multimedia behaviour change resources to support individualised nutrition and exercise behaviour change. Methods and analysis This 12-week randomised controlled trial (target n=50) will include men treated with ADT for >3 months or who have completed ADT in the last 24 months, are overweight or obese and are not under the care of a dietitian or exercise professional. Participants will be randomised (1:1) to the ProHealth intervention or usual care. The intervention group will receive four consultations with an Accredited Practising Dietitian to promote a high protein and energy reduced diet, and five consultations with an Accredited Exercise Physiologist to follow a home-based progressive resistance training and aerobic exercise programme. The primary outcomes are feasibility (recruitment rate, retention, data completeness, reach, safety, consultation attendance and adherence, and usage of the ProHealth web platform), acceptability and satisfaction of the ProHealth intervention. Exploratory secondary outcomes will be assessed at baseline and 12 weeks and include changes in body weight and composition (total and appendicular fat-free mass, fat mass), quality of life (Functional Assessment of Cancer Therapy (FACT)—General, FACT-Prostate, FACT-Fatigue), physical function (30-second sit-to-stand), dietary intake (3-day food diary) and physical activity (7-day accelerometer). Linear regression models will estimate differences between the intervention and usual care group. Qualitative interviews on participant satisfaction will be transcribed verbatim for thematic analysis. Ethics and dissemination This study is approved by Deakin University Human Research Ethics Committee (DUHREC2024-038) and registered on Australian and New Zealand Clinical Trials Registry (ACTRN12624000874516). Findings will be disseminated through peer-reviewed journals, scientific meetings and other public forums. Trial registration number ACTRN12624000874516.

Background: Nut consumption has been associated with a reduced risk of functional decline, but evidence from randomised controlled trials to support functional benefit is lacking. Therefore, this study aimed to investigate whether daily supplementation of peanut butter over 6 months, relative to usual care, can improve physical function in community‐dwelling older adults. Methods: One hundred and twenty older adults (aged ≥ 65 years) at risk of falls were randomly assigned to receive peanut butter (43 g/day, n = 60) or maintain usual care (control, n = 60) for 6 months. Outcomes assessed at baseline and 6 months included physical function (4‐m gait speed [primary outcome], standing balance test, four‐square step test [FSST], five times sit‐to‐stand [5STS] test time and muscle power, 30‐s sit‐to‐stand (30‐s STS) and timed up and go [TUG] tests), muscle strength (handgrip [HGS] and isometric knee extensor strength tests [KES]) and anthropometry/body composition (weight, body mass index [BMI], total lean and fat mass and appendicular lean mass). Linear regression models, adjusting for age, sex, baseline value of the dependent variable, BMI, physical activity and diet quality, estimated intention‐to‐treat intervention effects. Results: A total of 108 (90%) participants completed the study. At baseline, 70% were female, and the mean ± SD age and BMI were 76.1 ± 4.6 years and 27.5 ± 4.2 kg/m ² , respectively. At 6 months, there were no significant treatment effects on the primary outcome of gait speed or other measures of physical function ( p > 0.05), with the exception that 5STS time and muscle power improved significantly more in the peanut butter compared to control group (estimated treatment effect: time, −1.23 s [95% CI, −2.09, −0.37], p = 0.006; absolute power, 22.0 W [95% CI: 7.1 to 36.9], p = 0.004; relative power, 0.27 W/kg [95% CI: 0.10 to 0.45], p = 0.002). Changes in HGS, KES, weight, BMI, total fat mass, total lean mass or appendicular lean mass did not differ between groups. In the peanut butter group, among those who completed the follow‐up, the mean (SD) adherence was 86.0 (13.8) %. Conclusion: In community‐dwelling older adults at risk for falls, daily peanut butter consumption for 6 months improved 5STS time and muscle power based on 5STS, but not gait speed, muscle strength or body composition. Trial Registration: Australian New Zealand Clinical Trials: ACTRN12622001291774

Background/Objectives: Gastric, oesophageal, and pancreatic cancers are common worldwide, with low but improving survival rates due to advances in curative treatments. However, these treatments often cause long-term nutrition impact symptoms that are frequently overlooked, leading to malnutrition and poorer health outcomes. This review explored the types of nutrition impact symptoms following curative-intent treatment for upper gastrointestinal (UGI) cancers and assessed their impact on nutrition status. Methods: A systematic search of four electronic databases identified studies involving adults treated with curative intent for UGI cancers. Included studies reported both nutrition impact symptoms and nutrition outcomes using validated tools. Study quality was assessed, and results were synthesised narratively. Results: Eleven studies (n = 953 participants), predominantly from the Asia–Pacific region, met the inclusion criteria. Participants were mostly male (68%), with surgery as the primary treatment (91%). Most studies (n = 10) used validated assessment tools to identify nutrition impact symptoms. Reflux was the most commonly reported symptom (n = eight studies), followed by abdominal pain and diarrhoea. Nutrition status was assessed using various validated tools: Patient-Generated Subjective Global Assessment (n = six studies, 55%), Mini Nutritional Assessment (n = two studies, 18%), and Global Leadership Initiative on Malnutrition as well as Subjective Global Assessment and Prognostic Nutritional Index (both n = one study, 9%). Malnutrition prevalence was up to 87% one year post-treatment. Conclusions: Nutrition impact symptoms are common and persistent after curative-intent treatment for UGI cancers. Future research should incorporate validated assessment tools and extend follow-up beyond 12 months. Integrating long-term, tailored dietetic support to identify and manage symptoms post-treatment is vital to improve outcomes for patients.

Purpose: Women with ovarian cancer are at high risk of malnutrition and muscle loss due to advanced-stage diagnosis and treatment toxicities. Evidence-based guidelines recommend screening for malnutrition and sarcopenia to prevent associated adverse consequences, including reduced survival. This study aimed to describe awareness and perceptions of nutrition-related issues and practices in ovarian cancer among Australian healthcare professionals. Methods: A national survey was completed between November 2023 and March 2024. The 24-item survey evaluated awareness and perceptions of nutrition-related issues, screening and referral practices for malnutrition and sarcopenia at specific timepoints (from diagnosis, during, and/or post-treatment) and barriers to nutrition care in ovarian cancer. Results: Professionals (n = 57) were predominantly nurses (39%), dietitians (23%), or surgeons (19%). The most reported nutrition-related issues at diagnosis were weight loss (67%), overweight/obesity (54%), and sarcopenia (44%). During treatment, weight loss (70%) and sarcopenia (65%) were prominent, while post-treatment, weight gain (46%) and sarcopenia (39%) were most reported. The perceived clinical importance of malnutrition and sarcopenia varied according to professional discipline. Professionals identified chemotherapy as the treatment with the highest nutrition risk (97%), and 75% reported observing self-initiated dietary changes during treatment, yet 18% indicated their health services did not screen for nutrition risk, and 58% did not screen for sarcopenia. Key barriers were lack of established processes for sarcopenia screening (75%), limited dietetic services (60%), and lack of specific referral pathways (58%). Conclusion: The perceived importance of malnutrition and sarcopenia in ovarian cancer varies according to professional discipline despite robust evidence of the importance to clinical outcomes.

Purpose: Survival after a cancer diagnosis is improving, increasing the importance of understanding and managing long-term treatment-related adverse effects. This study aimed to understand breast and prostate cancer survivors’ understanding of how cancer treatment may affect cardiovascular and musculoskeletal health. Methods: Australian breast and prostate cancer survivors treated with therapies with known cardiovascular adverse effects were recruited via a private cancer care provider. Participants completed an online background questionnaire, then participated in a focus group. Focus groups were recorded, transcribed, then analysed using reflexive thematic analysis. Results: In total, 26 cancer survivors (15 breast, 11 prostate; mean age 67 years) participated in one of seven focus groups. Three major themes were developed: 1) Focus is on the here and now, not the future—participants were infrequently told that their cancer treatment can have negative long-term effects; 2) Wanting individualised delivery of side-effect information—participants received varying types and amounts of information about side effects, but it was not delivered in a way that best suited them; and 3) Left wondering how to best manage side effects—few participants were provided with information about how to manage long term side effects, despite wanting this information. Conclusion: Important information about long-term side effects of cancer treatment, and how to manage them, was inconsistently provided to breast and prostate cancer survivors. Information about long-term treatment side effects should be delivered in a flexible, individualised way to better enable cancer survivors to understand the risk and engage in preventative health behaviours.

Dietary interventions during chemotherapy hold promise for clinical and supportive care outcomes. We systematically investigated the feasibility, safety, and efficacy of nutritional counseling conducted during chemotherapy. Studies prospectively implemented nutrition counseling during chemotherapy. Articles were identified from three databases—EMBASE, Cochrane Library, and SCOPUS—from inception to 1 October 2024. Feasibility, safety, and efficacy of outcome data were extracted. Among 44 publications, 39 studies recruited 98 ± 80 participants (range 15–360); 38/39 (97%) were randomized controlled trials. One-third (31%) were among patients with breast cancer. Interventions were divided into individualized nutritional counseling (n = 21), nutrition counseling plus exercise (n = 13), and nutrient-specific dietary patterns (n = 10). Many had goals to achieve established nutrition guidelines. Feasibility was high based on attendance at counseling sessions, retention, and/or food log analysis. Overall, there were minimal adverse events related to the interventions. Many studies showed between-group differences favoring the intervention group for body weight (8/24, gain or loss, according to goals), nutritional status (8/9), quality of life (3/10 without and 6/9 with exercise), cancer-related fatigue (7/10), chemotherapy tolerance (6/11), and treatment responses (3/13). In conclusion, nutritional interventions were feasible and safe for patients undergoing chemotherapy and demonstrated preliminary efficacy to improve nutritional status, fatigue, chemotherapy tolerance, and other outcomes.

Dietary interventions during chemotherapy hold promise for clinical and supportive care outcomes. We systematically investigated the feasibility, safety, and efficacy of nutritional counseling conducted during chemotherapy. Studies prospectively implemented nutrition counseling during chemotherapy. Articles were identified from three databases—EMBASE, Cochrane Library, and SCOPUS—from inception to October 1, 2024. Feasibility, safety, and efficacy of outcome data were extracted. Among 44 publications, 39 studies recruited 98±80 participants (range 15-360); 38/39 (97%) were randomized controlled trials. One-third (31%) were among patients with breast cancer. Interventions were divided into individualized nutritional counseling (n=21), nutrition counseling plus exercise (n=13), and nutrient-specific dietary patterns (n=10). Many had goals to achieve established nutrition guidelines. Feasibility was high based on attendance at counseling sessions, retention, and/or food log analysis. Overall, there were minimal adverse events related to the interventions. Many studies showed between-group differences favoring the intervention group for body weight (8/24, gain or loss, according to goals), nutritional status (8/9), quality of life (3/10 without and 6/9 with exercise), cancer-related fatigue (7/10), chemotherapy tolerance (6/11), and treatment responses (3/13). In conclusion, nutritional interventions were feasible and safe for patients undergoing chemotherapy and demonstrated preliminary efficacy to improve nutritional status, fatigue, chemotherapy tolerance, and other outcomes.