Barriers and Facilitators to Adherence to a Mediterranean Diet Intervention during Chemotherapy Treatment: A Qualitative Analysis

Abstract

Patients undergoing chemotherapy are at risk for malnutrition and a high symptom burden, and nutritional interventions can address clinical and supportive care outcomes. Herein, we identified barriers and facilitators to adhering to a Mediterranean Diet (MedDiet) intervention during chemotherapy. Patients with cancer (any type) who were undergoing chemotherapy were enrolled into a clinical trial testing the effects of an 8-week MedDiet intervention on cancer-related fatigue. Participants were randomized 2:1, MedDiet:control. The intervention entailed food provision, education, a cookbook, a session with a nutritionist, and weekly check-ins. Post-intervention, all participants completed semi-structured exit interviews. The interviews were transcribed and open coding was conducted to describe the facilitators and barriers to MedDiet adherence. Participants (n = 29, n = 21 in the intervention group) were 51.0 ± 15.1 years old and 93.1% had breast cancer. Educational materials and convenient food delivery were the highest reported facilitators. Many patients offered that changing their diet gave a sense of control and empowerment. Barriers to adherence were that the frozen food was unappetizing, participants’ (or their spouse/children’s) food preferences did not align with the MedDiet, and chemotherapy-induced side effects that prevented food consumption (eg, mouth sores, lack of appetite). This project helps understand the patient experience within nutritional interventions to optimize dietary programs during chemotherapy treatment.

Acknowledgments

We would like to thank Lisadine Cherubin for assisting with the transcription of the exit interviews and helpful discussions. We are also grateful for helpful discussions with Cheryl Knott regarding qualitative research methodology. We would like to thank the Summer Program in Obesity, Diabetes, and Nutrition Research Training (SPORT) at the University of Maryland School of Medicine for opportunities, resources, and mentorship for B.I.H.

Disclosure statement

The authors report no conflict of interest.

Data availability statement

Raw data are available from Dr. Amber Kleckner upon reasonable request.

Additional information

Funding

This work was supported by the National Institutes of Health (NIH) National Cancer Institute (NCI) under grant UG1CA189961 to Drs. Karen Mustian and Gary Morrow and T32CA102618 to Drs. Michelle Janelsins and Gary Morrow as well as the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) under grant T35DK095737 to Dr. Nanette Steinle. This publication was supported by funds through the Maryland Department of Health’s Cigarette Restitution Fund Program (CH-649-CRF).