When older women with breast cancer go through chemotherapy, stomach problems often make it hard to eat healthy foods. Researchers studied 868 older breast cancer patients to understand what helps them make better food choices during treatment. They found that family support, believing treatment will help, and having confidence in self-care were the biggest factors that helped patients eat better. The study shows that nurses and doctors should give personalized help to patients, especially those living in rural areas or with advanced cancer, to improve their nutrition and quality of life during treatment.

The Quick Take

  • What they studied: What helps older breast cancer patients eat healthier foods when chemotherapy causes stomach problems and loss of appetite
  • Who participated: 868 older women with breast cancer who were receiving chemotherapy at three major hospitals in China. The study included women at different cancer stages and from both city and rural areas.
  • Key finding: Ten key factors—including family support, believing treatment will work, and confidence in taking care of yourself—explained about half of why some patients eat better than others during chemotherapy. Patients living in cities and those with earlier-stage cancer tended to manage their diet better.
  • What it means for you: If you or a loved one is an older woman with breast cancer undergoing chemotherapy, getting family support and working with healthcare providers on nutrition strategies may help you maintain better eating habits during treatment. However, this study shows there’s room for improvement in how well patients manage their diet overall.

The Research Details

Researchers conducted a cross-sectional study, which is like taking a snapshot at one moment in time rather than following people over months or years. They collected information from 868 older breast cancer patients at three major hospitals in two Chinese provinces using questionnaires. The patients answered questions about their eating habits during chemotherapy, how motivated they were to change their diet, whether they believed healthy eating would help them, how confident they felt managing their own care, and how much support they received from family and friends.

The researchers used a statistical method called multiple stepwise regression analysis to figure out which factors were most important in predicting whether patients would manage their diet well. This method helps identify the strongest connections between different factors and eating behavior, while accounting for how these factors might influence each other.

This approach was chosen because understanding the psychological and social reasons behind eating behavior during cancer treatment is just as important as understanding the physical side effects. The researchers wanted to see how patients’ thoughts, feelings, motivation, and relationships affected their ability to eat well when facing difficult treatment side effects.

This research matters because chemotherapy often causes serious stomach problems that make eating difficult, and poor nutrition during cancer treatment can slow recovery and reduce quality of life. By understanding what psychological and social factors help patients eat better, healthcare providers can design better support programs. Rather than giving all patients the same advice, doctors and nurses can focus on the specific factors that matter most—like strengthening family involvement or building patient confidence—to help each person succeed.

This study has several strengths: it included a large number of patients (868), used multiple hospitals to get diverse participants, and measured several important factors at once. However, there are some limitations to keep in mind. Because it’s a cross-sectional study, it shows what factors are connected to better eating but doesn’t prove that one thing causes another. The study was conducted in China, so results may not apply exactly the same way in other countries with different healthcare systems and cultures. The study relied on patients’ self-reported answers about their eating habits, which might not be completely accurate. Additionally, the study explains about 48% of why patients eat better or worse—meaning other important factors weren’t measured.

What the Results Show

The study found that older breast cancer patients scored an average of 68.4 out of a possible higher score on dietary self-management, suggesting their eating habits during chemotherapy need improvement. Ten specific factors were identified as the strongest predictors of whether patients would manage their diet well.

These ten factors included: living in an urban area (city patients did better than rural patients), having earlier-stage cancer (stage II patients did better than those with more advanced cancer), feeling motivated by their treatment, considering both immediate and future health consequences of their food choices, having a positive attitude about eating well, being able to make decisions about their diet, and receiving support from family members.

Together, these ten factors explained about 48% of the differences in how well patients managed their diet. This means that while these factors are important, there are other things we don’t yet understand that also influence eating behavior during chemotherapy. The research suggests that family support was particularly powerful—patients with strong family involvement in their care did significantly better at maintaining healthy eating habits.

The study revealed important differences between patient groups. Patients living in cities had better dietary self-management than those in rural areas, possibly because urban patients have better access to nutritional information and healthcare resources. Patients with stage II cancer (earlier stage) managed their diet better than those with more advanced cancer, which might be because advanced cancer causes more severe side effects. The research also showed that patients who felt confident in their ability to care for themselves were more likely to eat well, and those who believed their treatment would help them were more motivated to maintain good nutrition. Interestingly, patients who felt their treatment was imposed on them (rather than chosen) had worse dietary habits, suggesting that feeling some control over treatment decisions matters for overall self-care.

This research builds on previous studies showing that psychological factors—like motivation, confidence, and attitude—are just as important as physical factors in helping cancer patients manage their health. The finding that family support is crucial aligns with many other cancer studies showing that social connections improve treatment outcomes. However, this study is unique because it specifically focuses on older patients and dietary management during chemotherapy, and it uses a specific theory (Integrated Theory of Health Behavior Change) to organize the factors being studied. The results suggest that previous approaches focusing only on providing nutritional information may not be enough—patients also need psychological support and family involvement.

Several important limitations should be considered when interpreting these results. First, because this is a cross-sectional study (snapshot in time), we cannot determine whether these factors actually cause better eating or are simply associated with it. Second, the study only included patients from hospitals in two Chinese provinces, so results may not apply to older breast cancer patients in other countries or healthcare systems. Third, all information came from patients’ own reports about their eating habits, which can be inaccurate due to memory problems or social desirability bias (wanting to appear healthier than they actually are). Fourth, the study explains less than half of why patients eat better or worse, meaning important factors were not measured. Finally, the study doesn’t tell us whether improving these psychological and social factors would actually lead to better eating habits—only that they’re connected.

The Bottom Line

Based on this research, healthcare providers should: (1) Involve family members in nutrition planning and support for older breast cancer patients undergoing chemotherapy—this appears to be one of the most important factors; (2) Help patients understand how good nutrition will help them recover and feel better during treatment; (3) Build patients’ confidence in their ability to manage their diet despite side effects; (4) Give patients choices and involve them in decision-making about their nutrition plan; (5) Provide extra support to patients living in rural areas or with advanced cancer, as these groups showed lower dietary self-management. These recommendations have moderate confidence because the study shows these factors are connected to better eating, but doesn’t prove they cause improvement.

This research is most relevant for: older women (typically 65+) with breast cancer undergoing chemotherapy; family members and caregivers of these patients; nurses and doctors who work with cancer patients; and healthcare administrators planning supportive care programs. The findings are especially important for those in rural areas or with advanced cancer, who the study identified as needing extra help. This research is less directly applicable to younger cancer patients or those receiving other types of cancer treatment, though some principles may still apply.

Realistic expectations depend on the specific changes made. If family members increase their involvement in meal planning and preparation, patients might see improvements in eating habits within 1-2 weeks. If healthcare providers help build patient confidence through education and support, changes may take 2-4 weeks to become noticeable. Significant improvements in overall nutritional status typically take 4-8 weeks of consistent better eating habits. However, because chemotherapy side effects vary greatly, some patients may see faster improvements than others.

Want to Apply This Research?

  • Track daily food intake and stomach symptoms together. Users should log: (1) meals and snacks eaten each day, (2) portion sizes, (3) any nausea or stomach discomfort experienced, and (4) energy level. This helps identify which foods are tolerated best and shows progress over time. A simple 1-10 scale for stomach comfort can help users and their healthcare team spot patterns.
  • Use the app to set up a family accountability system: (1) Invite one family member to view your food log and send you encouragement messages; (2) Set one small, achievable nutrition goal each week (like eating one extra serving of vegetables or drinking more water); (3) Use app reminders to eat meals at consistent times, which can help with appetite; (4) Share your progress with your healthcare team during appointments. Start with one change rather than trying to overhaul your entire diet at once.
  • Create a long-term tracking dashboard that shows: (1) Weekly average of meals completed (aim for consistency); (2) Symptom patterns (which foods cause problems); (3) Confidence level in managing diet (1-10 scale, weekly); (4) Family support engagement (number of supportive messages received); (5) Progress toward nutrition goals. Review this dashboard monthly with your healthcare provider to adjust the plan as needed. The app should allow easy sharing of this data with doctors and nurses.

This research describes factors associated with better eating habits in older breast cancer patients during chemotherapy, but does not provide medical advice. If you or a loved one is an older woman with breast cancer undergoing chemotherapy, please consult with your oncologist, registered dietitian, or healthcare team before making any changes to your diet or nutrition plan. The findings from this study should not replace professional medical guidance. Individual responses to chemotherapy and nutritional needs vary greatly, and personalized medical advice from your healthcare team is essential. This study was conducted in China and may not apply equally to all populations or healthcare systems.