People living beyond a cancer diagnosis face physical and psychological sequelae that impact their quality of life. Many are at greater risk of cardiovascular disease post-treatment, and while diet is central to its management, evidence on how diet influences cardiometabolic outcomes after treatment remains limited. Our systematic review of dietary interventions in men receiving androgen deprivation therapy (ADT, 12 studies) showed energy-restricted and plant-based dietary patterns hold promise for improving blood pressure and high-density lipoprotein cholesterol; effects on other cardiometabolic markers were largely null, likely reflecting small samples and methodological limitations.¹ We have since shown that higher adherence to the Australian Dietary Guidelines in men receiving ADT (n=61) is independently associated with lower total and low-density lipoprotein cholesterol.²
Translating this evidence is a further challenge, because diet quality after cancer is often poor. In people with prostate cancer we found diet quality ranged from low³ to moderate,² typically low in fruit, vegetables, and legumes but high in sodium and saturated fat.²ʼ³ Diet quality is shaped by interacting individual (motivation, mental wellbeing, knowledge, culinary skills, treatment side-effects), environmental (social support, food availability, built environment) and system (healthcare access, economic factors, marketing) factors.³ʼ⁴ Nutritional needs are therefore individualised, and support must be matched to it.
Supporting dietary change across survivorship demands efficient triage that prioritises nutrition needs and directs dietetic resources to those who will benefit most. Our scoping review highlights current needs-analysis tools cluster in active treatment and screen for malnutrition (82%), with few needs-analysis tools designed for after treatment.⁵ Furthermore, in the NEEDS study we found only 57% of Australian cancer services used a needs-analysis assessment and diet-based assessments led to referrals 38% of the time. Most clinicians (62%) wanted improved evidence-based needs-analysis tools.⁶ Brief, workflow-feasible tools using stepped-care scoring are needed to capture diet quality and cardiometabolic risk, shifting survivorship nutrition care beyond malnutrition treatment.⁵ʼ⁶