The development and implementation of targeted dietetic interventions during cancer survivorship, with a focus on early-stage, hormone-receptor positive breast and gynaecologic cancers
| dc.contributor.advisor | Cushen, Samantha | |
| dc.contributor.advisor | Ryan, Aoife | |
| dc.contributor.author | Johnston, Katie | en |
| dc.contributor.funder | Irish Cancer Society | en |
| dc.contributor.funder | Breakthrough Cancer Research | en |
| dc.date.accessioned | 2026-09-22T15:28:07Z | |
| dc.date.available | 2026-09-22T15:28:07Z | |
| dc.date.issued | 2026-02-13 | |
| dc.date.submitted | 2026-02-13 | |
| dc.description.abstract | The global incidence of cancer has increased over the last decade, and due to advances in treatment and early detection, the number of survivors living with and beyond a cancer diagnosis is rising. Women surviving early-stage breast and gynaecologic cancers often experience complex supportive care needs, including alterations in body composition, increased risk of chronic disease, and long-term symptoms associated with medically induced (iatrogenic) menopause. Despite evidence suggesting that dietitian-led interventions are feasible and valued by survivors, structured survivorship services in this population remain limited. Contributing factors include resource constraints, fragmented care pathways, and insufficiently tailored nutritional screening and intervention strategies. In the absence of formal support, many survivors take control of their own health through complementary and alternative approaches, including dietary and herbal supplements, often without professional guidance. Emerging literature underscores both the potential benefits of patient-centred dietetic care and the substantial gaps in nutritional guidance, screening, and supplement management that persist for breast and gynaecologic cancer survivors. The primary aim of this thesis was to explore the feasibility and acceptability of a dietitian- and nurse-led survivorship clinic using electronic patient-reported outcomes and evaluate the impact of a dietitian-led intervention on nutrition-specific needs, body composition, dietary quality, weight gain concern, and psychosocial outcomes in women surviving early-stage breast and gynaecologic cancers. The thesis further aimed to investigate the prevalence, motivations, and information sources of dietary and herbal supplement use in female cancer survivors affected by iatrogenic menopause, identifying gaps in professional guidance. Finally, it sought to develop, co-design, and implement a multimodal, symptom-responsive dietary resource tailored to survivors’ nutritional and symptom-management needs, assessing its reach, engagement, and utility for both survivors and healthcare professionals. The Linking You to Support and Advice (LYSA) Randomised Controlled Trial and its complex intervention utilising ePROs proved to be feasible among 200 participants and highly acceptable to participants and healthcare professionals through its concurrent process evaluation. Findings suggested that a bi-monthly supportive care intervention can significantly improve fatigue, anxiety, depression and health-related quality of life scores, as well as significantly reducing patient-reported weight gain concern when compared to an active comparator. Importantly, despite improvements in psychosocial outcomes, the research highlighted that current nutritional screening tools and guidelines lack specificity, failing to capture the nutritional considerations and risks faced by this cohort, moving beyond traditional malnutrition concerns. This thesis also explored dietary and herbal supplement use among female cancer survivors affected by iatrogenic menopause. Supplement use was highly prevalent, including widespread poly-supplementation and frequent use of herbal products outside recommended guidelines. Motivations for supplement use were largely symptom-driven, yet healthcare professionals, including dietitians, were infrequently consulted, with survivors relying heavily on digital and social media sources for guidance. These findings revealed gaps in professional advice and emphasised the need for structured, evidence-based interventions to support safe and effective supplement use, particularly for managing fatigue, vasomotor symptoms, musculoskeletal pain, and cognitive changes. In response to these gaps, a co-designed, multimodal dietary resource was developed to address survivors’ nutritional and symptom-management needs. The Menopause Plate © dietary model through the Menopause, Diet and Cancer resources provided practical, evidence-informed guidance for managing common menopause-related symptoms while bridging self-directed behaviours with professional support. Engagement with the resource was substantial (n = >12,500), with wide dissemination through printed booklets, webinars, and online materials. Collectively, this thesis demonstrates that symptom-responsive, dietitian-led care is feasible, acceptable, and potentially impactful for women surviving breast and gynaecologic cancers. Structured interventions, combined with digital tools and co-designed dietary resources, offer a foundation for patient-centred survivorship care that improves psychosocial outcomes, supports informed nutritional decision-making, and enhances quality of life. The research presented in this thesis establishes a framework for future practice, highlighting the need for refined nutritional screening tools, structured guidance on supplement use, and strategies to ensure equitable, scalable implementation of dietetic interventions across survivorship pathways. | en |
| dc.description.status | Not peer reviewed | en |
| dc.description.version | Accepted Version | en |
| dc.format.mimetype | application/pdf | en |
| dc.identifier.citation | Johnston, K. E. 2026. The development and implementation of targeted dietetic interventions during cancer survivorship, with a focus on early-stage, hormone-receptor positive breast and gynaecologic cancers. PhD Thesis, University College Cork. | |
| dc.identifier.endpage | 491 | |
| dc.identifier.uri | https://hdl.handle.net/10468/19313 | |
| dc.language.iso | en | en |
| dc.publisher | University College Cork | en |
| dc.relation.project | Irish Cancer Society (Grant numbers WHI19CON, WHI21COHE, WHI22LOW, WHI22COHE) | |
| dc.relation.project | Breakthrough Cancer Research (Grant number BCR-2019-09-ICS-UCC ) | |
| dc.rights | © 2026, Katie E. Johnston. | |
| dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | |
| dc.subject | Cancer survivorship | |
| dc.subject | Electronic patient reported outcomes (ePROs) | |
| dc.subject | Supportive cancer care | |
| dc.subject | Dietetics | |
| dc.subject | Personalised nutrition | |
| dc.subject | Body composition | |
| dc.subject | Complementary and alternative medicine | |
| dc.subject | Symptom management | |
| dc.subject | Quality of life | |
| dc.subject | Implementation science | |
| dc.title | The development and implementation of targeted dietetic interventions during cancer survivorship, with a focus on early-stage, hormone-receptor positive breast and gynaecologic cancers | |
| dc.type | Doctoral thesis | en |
| dc.type.qualificationlevel | Doctoral | en |
| dc.type.qualificationname | PhD - Doctor of Philosophy | en |
