Limitations
The dietary data should be interpreted with caution as dietary intake
information was collected cross-sectionally using a 1-day 24-hour diet
recall and may not be indicative of the larger picture of the changing
dietary quality during treatment. Future studies should consider the use
of the 24-hour diet recall assess over a three-day period to assess
dietary intake 47 with dietary intake assessed
longitudinally throughout cancer treatment. This study had a small
sample size which resulted in an uneven sample distribution across age
groups. Therefore, identification of groups most at risk of poor dietary
quality could not be concluded. Additionally, the sample was
heterogeneous across cancer diagnosis and treatment, making it difficult
to draw conclusions regarding dietary quality across treatment
intensity. The study did not adjust for multiple comparisons with the
possibility of an inflated Type I error. Due to this, the results need
to be interpreted with caution. Nutrition information needs will vary
for different cancer and treatment types; for example, steroid use will
drive up hunger 21 whereas other treatments can cause
nausea, vomiting and other symptoms that impact intake. The study
excluded patients who were receiving enteral nutrition during the study
period. Although childhood cancer patients receiving enteral nutrition
rely on supplementary feeding for their nutritional intake, some
patients may also be consuming some oral intake. Excluding these
patients may have introduced some sampling bias and future studies
should aim to assess the dietary intake of all patients during active
treatment. High levels of health literacy and socio-economic status
among study participants may have influenced the results of this study.
The results from this study may not be transferrable to other oncology
populations, especially those from developing countries where treatment
and dietary advice may vary.