The influence of Social Determinants of Health, Diet, and Symptom experiences in Patients with Colorectal cancer

Abstract

Background: Colorectal cancer (CRC) is the third most common cancer in the United States, and many colorectal cancer survivors often experience various symptoms significantly influenced by diet. Although it is known that social determinants of health can lead to notable inequities that affect lifestyle and quality of life, limited studies have examined the interplay of social determinants of health and diet on symptom experiences in this population. The purposes of this dissertation were to describe the relationship among social determinants of health, diet, and symptom experiences in patients with colorectal cancer. More specifically, this dissertation (a) described the SDOH of symptoms among patients with CRC, including the role that diet quality in influencing symptoms, and (b) identifies sub-populations and targets for the development of tailored dietary interventions to improve the symptom experience of patients with CRC. Methods: A scoping review, a qualitative study, and secondary, quantitative data analysis were conducted in this dissertation. The Joanna Briggs Institute (JBI) Scoping Review methodology served as a guide for the scoping review. Twenty-one studies were included and systematically evaluated in the review. Conventional qualitative content analysis was used to analyze the qualitative data of individuals with CRC (n=18). Latent class/profile analysis identified subgroups of patients with distinct symptom profiles among patients with CRC (n=256). Differences in social determinants of health, and diet quality characteristics among the subgroups were evaluated using parametric and non-parametric analyses, adjusting for clinical factors (stage of cancer, comorbidities, and cancer treatment,). Results: The findings from my dissertation highlight that cancer symptom experiences, including gastrointestinal, chemotherapy-related, physical, and psychological symptoms, are influenced by SDOH at both individual (e.g., age, gender, race/ethnicity, education) and relationship (e.g., social support) levels. Diet further impacts these symptoms, with healthier diets linked to better symptom management. The qualitative themes identified emphasize the multidimensional effects of treatment, strategies to overcome SDOH barriers, adaptation to dietary needs, proactive self-management, and the role of multifaceted support systems in fostering resilience and positivity. This synthesis underscores the complex interplay of SDOH, diet, and social support in shaping cancer symptom experiences. In quantitative research, there were three symptom subroups: high symptom severity (n=49), moderate symptom severity (n=123), and low symptom severity (n=84) were identified, with significant differences examined in SDOH factors, including age, ethnicity, income, and social support, as well as in diet quality, after adjusting for clinical factors. Conclusions and Implications: This dissertation is the first to examine the relationships among social determinants of health, diet quality, and symptom experiences in patients with colorectal cancer through various research methods. The findings suggest that individuals affected by certain SDOH, and dietary patterns are more likely to endure a higher symptom burden, and that managing diet emerges as a pivotal strategy for mitigation of symptoms in this population. This research also emphasizes the need for future studies that examine the influence of SDOH on not only individual but also relational, community, and societal levels. Additionally, it highlights the importance of diet quality and social support in influencing health outcomes for patients with colorectal cancer and important targets for interventions. These findings provide a better understanding of the complex symptom experiences of patients living with cancer, which can inform future research and practice related to symptom management for this population.