Knowledge, attitudes and behaviors toward healthy eating among Chinese cancer patients treated with chemotherapy: A systematic review

Side effects from chemotherapy may disturb healthy eating. There are many food taboos among Chinese patients with cancer treated with chemotherapy; they may be conservative in food intake and seek help from traditional Chinese medicine to adjust to healthy eating. Differences in eating cultures may lead Chinese patients with cancer to generate different knowledge, attitudes, and behaviors toward healthy eating. This systematic review explored the knowledge, attitudes, and behaviors toward healthy eating and summarized influencing factors among Chinese patients with cancer treated with chemotherapy. Two English and three Chinese databases were searched since 2007. The eligibility criteria were quantitative descriptive studies, participants who were adult Chinese patients with cancer who received chemotherapy, and primary outcomes that included knowledge, attitudes, or behaviors toward healthy eating. A total of 12 studies were identified. The 11-item tool from the Agency for Healthcare Research and Quality was used to assess quality. All studies were of moderate quality. Narrative qualitative analysis was considered to summarize the findings, and the results were reported by scores or percentages. Four studies measured knowledge, and the information about what to eat and how much to eat was contradictory and confused patients, with little known about Chinese food therapy. Ten studies involved attitudes, and patients were aware of the importance and willingness for eating guidance before, during, and after chemotherapy. Strategies to relieve vomiting and nausea, engage in healthy food choices, and seek food therapy were the main behaviors. The influencing factors were found only in behaviors, including demographic and psychological factors. Knowledge, attitudes, and behaviors toward healthy eating are not satisfactory and need to be improved. More high-quality studies should regard health behavior as a distal outcome and explore the influences of knowledge and attitudes on behaviors.