Patient-Initiated Non-Pharmacological Management Strategies for Chemotherapy-Induced Diarrhoea and Constipation: A cross-sectional study

Patient-Initiated Non-Pharmacological Management Strategies for Chemotherapy-Induced Diarrhoea and Constipation: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patient-Initiated Non-Pharmacological Management Strategies for Chemotherapy-Induced Diarrhoea and Constipation: A cross-sectional study Thi Hanh Phung, Natalie Bradford, Erin Pitt, Kimberly Alexander This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9218238/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Purpose Chemotherapy-induced diarrhoea (CID) and constipation (CIC) are common and distressing side effects that impair quality of life in patients with cancer. Although non-pharmacological strategies may help manage these symptoms, their use in Vietnam is poorly understood. This study examines the prevalence, types, and perceived effectiveness of non-pharmacological strategies for CID and CIC management. Method A cross-sectional survey of 193 participants with cancer at Hanoi Medical University Hospital (Vietnam) collected data on demographics, clinical characteristics, use of non-pharmacological strategies, perceived effectiveness, and information sources. Binary logistic regression identified factors associated with strategy use. Results Among participants with CID (n = 106), 30.2% used non-pharmacological strategies, compared with 75.0% of those with CIC (n = 120). Dietary modification was the predominant approach (CID: 92.3%; CIC: 85.8%), including vegetables, natural laxatives, and herbal teas for CIC, and soft diets, food avoidance, and guava buds for CID. Most participants (70%-84%) reported substantial relief. Information sources were largely informal (81.6%), with only 4.8% receiving professional advice. Higher education (OR = 2.09, p = 0.03), being a freelancer/homemaker (OR = 6.77, p = 0.02), or employed (OR = 3.15, p = 0.02) were associated with greater use. Participants with CIC alone were statistically significantly more likely to use non-pharmacological strategies than those with CID alone (OR = 6.03; p < 0.001). No adverse effects were reported. Conclusion Non-pharmacological self-management of CID and CIC is widely used and perceived as effective among Vietnamese patients with cancer, but is largely unguided and based on informal advice. diarrhoea constipation complementary therapy self-management oncology nursing symptom management 1. Introduction Chemotherapy-induced diarrhoea (CID) and constipation (CIC) are among the most common and distressing gastrointestinal complications experienced by patients with cancer receiving chemotherapy. Reported prevalence varies widely, ranging from 30% to 90%, reflecting differences in cancer type, treatment regimen, and assessment methods [ 1 – 3 ]. When underreported or poorly managed, CID and/or CIC can lead to dehydration, malnutrition, treatment delays, and reduced quality of life, [ 4 , 5 ]. Despite their frequency and impact, CID and CIC often receive less attention than other chemotherapy side effects such as nausea, vomiting, or pain. This relative under-prioritisation may be partly attributable to patient underreporting, inconsistent symptom assessment, and limited supportive care resources, particularly in low- and middle-income country settings [ 6 ]. Effective management of CID and CIC requires a combination of pharmacological and non-pharmacological approaches. However, pharmacological treatments are often initiated reactively after symptom onset and may be associated with adverse effects that limit their tolerability or sustained use [ 5 ]. In response, many patients adopt non-pharmacological strategies, including dietary modification, adequate hydration, physical activity, abdominal massage, herbal or traditional remedies to alleviate symptoms and maintain daily functioning. Evidence for the widespread use of these strategies comes mainly from interviews with health professionals [ 7 ], offering only indirect insight into patients’ actual behaviours. Such data offer limited understanding of how patients themselves select, apply, and evaluate non-pharmacological strategies over time, or how these practices contribute to safe and effective self-management. These evidence limitations are particularly important in low- and middle-income country contexts, where economic constraints, cultural beliefs, and limited access to healthcare drive patients toward self-care and complementary methods of management [ 8 ]. A recent scoping review highlighted several patient-initiated non-pharmacological strategies, including dietary modifications and complementary and alternative medicine practices, used to support CID and CIC management [ 9 ]. However, the review identified that most existing evidence originates from high-income countries, with limited representation from low- and middle-income settings, and no studies conducted in Vietnam. Moreover, while the review catalogued types of strategies used, it provided limited insight into patients’ perceived benefits and limitations, potential risks, or the individual, health-related, and environmental factors that shape their use in everyday practice. Consequently, there remains insufficient empirical guidance to support nurses and other healthcare professionals in assisting patients to use these strategies in a consistent, safe, and effective manner. To address these gaps, this study aimed to: (1) investigate the prevalence of non-pharmacological strategy use for CID and CIC management among Vietnamese patients with cancer; (2) describe the self-reported benefits and limitations of these strategies; and (3) identify individual, health-related, and environmental factors associated with their use. 2. Method 2.1 Study design and participants This cross-sectional study included patients at Hanoi Medical University, Vietnam. The data collection period for this study was from August 1 to September 30, 2024. The hospital has eight diagnostic and support departments and 14 clinical departments, including an Oncology and Palliative Care Centre that provides treatment and care for patients with cancer in Hanoi and the surrounding provinces. The centre operates as a high-volume oncology service, managing approximately 9500 inpatient admissions and over 1600 outpatient consultations within a six-month period. The inclusion criteria were patients who were receiving chemotherapy as outpatients and who (1) aged 18 years or older; (2) diagnosed with any type or stage of cancer; (3) had completed at least two chemotherapy cycles; (4) reported experience of CID and/or CIC during previous treatment cycles; (5) had an Eastern Cooperative Oncology Group (ECOG) performance status < 2, indicating that they could perform self-care activities; (6) had an expected prognosis of at least 12 months as determined by the referring oncologist; (7) were able to communicate in Vietnamese; and (8) provided written informed consent. Exclusion criteria included: (1) inability to complete the questionnaire due to low literacy level or communication impairment; (2) chronic constipation or diarrhoea not related to chemotherapy; (3) pre-existing digestive disorders within three months before the cancer diagnosis; (4) emesis-inducing conditions such as severe hypertension, hepatic or renal failure; (5) concurrent participation in other clinical trials; or (6) unsuitability for participation as determined by the clinical treatment team (e.g., patients considered too unwell or distressed to take part). A convenience sample size was used. The sample size was calculated based on the formula for estimating a proportion in a population [ 10 ]: $$\:n=\frac{{Z}^{2}\times\:P\left(1-P\right)}{{d}^{2}}$$ where Z = 1.96 for a 95% confidence level, \(\:P=0.5\) (maximum variability), and \(\:d=0.07\) (margin of error of ± 7%), the required sample size was approximately 196 participants. 2.2 Theoretical framework This study was informed by the Revised Self- and Family Management Framework [ 11 ], which provided a conceptual basis for examining how contextual factors influence patients’ self-management of CID/CIC. The Revised Self- and Family Management Framework outlines how individual, health-related, and environmental factors interact to shape self-management processes and outcomes. In this study, the framework guided the identification and organisation of variables into these domains. 2.3 Instruments 2.3.1 Demographics and clinical data Demographic and clinical characteristics were collected in the first section of the survey. Individual factors included age, gender, marital status, educational level, living status, current employment status, monthly household income, insurance status and place of residence (urban or rural). Health-related variables included cancer type, treatment modality (chemotherapy only or in combination with other treatments), treatment duration, and previous experience of CID and/or CIC. The Distress Thermometer, a validated single-item screening tool recommended by the National Comprehensive Cancer Network (NCCN), was used to assess the participants’ distress level [ 12 ]. Scores range from 0 (“no distress”) to 10 (“extreme distress”), with a cut-off score of ≥ 4 indicating moderate to severe distress among Vietnamese patients [ 13 ]. 2.3.2 Non-pharmacological strategies for CID and CIC management The second section of the survey examined participants’ self-reported use of non-pharmacological strategies for managing or preventing CID and CIC since the commencement of chemotherapy. This section was developed based on findings from a previously published scoping review [ 9 ] and prior research exploring self-care strategies among patients with chemotherapy-related symptoms [ 14 – 16 ]. Participants were asked to report: The non-pharmacological strategies they had used for CID and/or CIC management. To reduce recall bias, this question included recall-aid prompts with examples of common practices (e.g., dietary adjustments, physical activity, supplements, abdominal massage, hydration, or traditional remedies); The perceived usefulness of each strategy, rated on a 3-point Likert scale from 0 (“did not help”) to 2 (“helped a lot”); Any side effects or difficulties encountered while using these strategies; and The sources of information they relied upon to select or apply these strategies (e.g., healthcare professionals, family/friends, internet or social media, and personal experience). Open-ended questions were included to allow participants to describe additional strategies not listed in the questionnaire. Responses were later categorised into common groups identified in the literature [ 7 ], including dietary modification, physical activity, and complementary approaches. The full questionnaire is available in Supplementary Appendix 1. 2.4 Data collection and analysis Participants were invited to complete the self-administered survey either in paper form or electronically via the REDCap platform. The estimated completion time was 10–15 minutes. Those preferring the online format received a secure survey link via Zalo (a messenger app). There were no missing data for any variable included in the analysis; therefore, complete-case analysis was equivalent to the full sample, and no imputation was required. Data were analysed using IBM SPSS Statistics version 27.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics (frequencies, percentages, means, and standard deviations) summarised participant characteristics and use of non-pharmacological strategies. Binary logistic regression identified factors associated with the use of these strategies. Independent variables included individual (e.g., age, gender, education, income), health-related (e.g., cancer type, treatment duration, previous CID/CIC experience), and environmental factors (e.g., health insurance, residence). Results were reported as odds ratios (OR) with 95% confidence intervals (CI). Statistical significance was set at p < 0.05. Responses to open-ended questions about non-pharmacological strategies were coded and grouped thematically to identify common types and perceived usefulness. 2.5 Ethical considerations This study was approved by the Human Research Ethics Committee of Queensland University of Technology, Australia (Approval No. 8272), and received institutional support from the Board of Directors of Hanoi Medical University Hospital, Vietnam. All participants received written and verbal information about the study and provided written informed consent before participation. Participation was voluntary, and participants could withdraw at any time. Participation or non-participation did not affect their care. 3. Results 3.1 The characteristics of participants Of the 225 patients approached, 193 consented to participate, resulting in a response rate of 86%. The remaining 32 patients declined, mainly due to feeling unwell, time constraints, or lack of interest. Detailed descriptions of participants’ sociodemographic and clinical characteristics are presented in Table 1 . Table 1 Sociodeomographic and clinical characteristics of participants (n = 193) Variables n % Sociodemographic characteristics Age ≤ 65 years 122 63.2 > 65 years 71 36.8 Gender Male 96 49.7 Female 97 50.3 Marital status Married/Partnered 186 96.4 Widowed/Divorced/Single 7 3.6 Living status Living alone 5 2.6 Living with partner/spouse/family/friends 188 97.4 Highest educational level ≤ 12 years 139 72.0 > 12 years 54 28.0 Employment Farmer 58 30.0 Self-employed 9 4.7 Employed by organisation 32 16.6 Retired 81 42.0 Housewives/ Freelancer 13 6.7 Current household incomes compared to expenses Lower than expenses 152 78.8 Equal to/higher than expenses 41 21.2 Health insurance Yes 191 99.0 No 2 1.0 Place of residence Rural 113 58.5 Regional 30 15.6 Urban 50 25.9 Clinical Characteristics Cancer diagnosis Gastrointestinal cancer 124 64.2 Breast/ gynaecological cancer 38 19.7 Lung cancer 21 10.9 Prostate cancer 7 3.6 Other cancers types 3 1.6 Months since commencing chemotherapy treatment ≤ 6 months 85 44.0 7–12 months 48 24.9 > 12 months 60 31.1 Type of treatment recieved Chemotherapy only 79 40.9 Combination of chemotherapy with surgery/ radiology 114 59.1 Distress level* < 4 115 59.6 ≥ 4 78 40.4 Experienced with CID only 73 37.8 CIC only 87 45.1 Both CID and CIC 33 17.1 Self-reported bother/ distress related to CID and/or CIC Not at all 5 2.6 A little bit 88 45.6 Somewhat 53 27.5 Quite a bit 39 20.2 Very much 8 4.1 * measured using NCCN Distress thermometer 3.2. The use of non-pharmacological strategies to manage CID and CIC and perceived effectiveness Table 2 summarises participants' self-initiated actions taken to manage CID and CIC. Among participants with CID, 30.2% reported using non-pharmacological strategies, while 75.0% of participants with CIC reported doing so. In addition, 23.6% of participants with CID and 5.8% of those with CIC reported choosing to wait for symptoms to resolve without taking specific action. Table 2 Self-initiated actions taken by participants to manage CID and CIC Self-Initiated Action Taken CID (n = 106), n (%) CIC (n = 120), n (%) Notified physicians and received advice/prescriptions 36 (34.0) 27 (22.5) Did not notify physicians and self-medicated 28 (26.4) 18 (15.0) Used non-pharmacological strategies to relieve symptoms 32 (30.2) 90 (75.0) Did nothing and waited for symptoms to resolve 25 (23.6) 7 (5.8) Note : Participants could report more than one self-initiated management action for CID and/or CIC; therefore, categories are not mutually exclusive. Participants who reported “doing nothing and waiting for symptoms to resolve” did not report other management actions. Some participants experienced both CID and CIC. Participants commonly used dietary and lifestyle strategies to manage CID and CIC (Table 3 ). For CID, guava buds, soft diets, and avoiding trigger foods provided the greatest relief. For CIC, increasing vegetables, natural laxative foods, and herbal drinks were most frequent and perceived as highly effective. No additional non-pharmacological strategies emerged from the free-text responses. No adverse effects from non-pharmacological strategy use were reported by any participants. Most participants (81.6%) relied on family or friends for advice, with minimal professional input (4.8%). Table 3 Non-pharmacological strategies to manage CID and CIC Total users, n (%) Perceived effectiveness Did not help n (%) Helped a little n (%) Helped a lot n (%) Non-pharmacological strategies to manage CID (n = 52 responses from 106 participants) Dietary adjustment Total of 48 (92.3%) responses Soften foods 13 (25.0) 1 (7.7) 5 (38.5) 7 (53.8) Avoid certain foods 15 (28.9) 1 (6.7) 6 (40.0) 8 (53.3) Consume guava buds 7 (13.5) 0 (0.0) 0 (0.0) 7 (100) Probiotics and yogurt 13 (25.0) 2 (15.4) 4 (30.8) 7 (53.8) Physical activities Total of 2 (3.8%) responses Exercise 2 (3.8) 1 (50.0) 0 (0.0) 1 (50.0) Supplement (vitamin, mineral, herb) Total of 2 (3.8%) responses 2 (3.8) 0 (0.0) 0 (0.0) 2 (100) Non-pharmacological strategies to manage CIC (n = 239 responses from 120 participants) Dietary adjustment Total of 205 (85.8%) responses Increase vegetable intake 69 (28.9) 2 (2.9) 9 (13.0) 58 (84.1) Probiotics and yogurt 30 (12.6) 2 (6.7) 10 (33.3) 18 (60.0) Consume natural laxative foods 63 (26.3) 5 (7.9) 14 (22.2) 44 (69.9) Consume different kinds of drinks 43 (18.0) 1 (2.3) 12 (27.9) 30 (69.8) Physical activities Total of 28 (11.7%) responses Exercise 21 (8.8) 1 (4.7) 3 (14.3) 17 (81.0) Belly massage 7 (2.9) 0 (0.0) 1 (14.3) 6 (85.7) Supplement (fiber, herb) Total of 6 (2.5%) responses 6 (2.5) 1 (16.7) 0 (0.0) 5 (83.3) Sources of information for non-pharmacological strategies Medical staff 6 (4.8) Internet/ magazines 9 (7.2) Friends/relatives/family 102 (81.6) Other patients 8 (6.4) Note : Participants could use more than one non-pharmacological strategy. 3.3 The association of non-pharmacological strategy use with participant characteristics Binary logistic regression identified key factors associated with non-pharmacological strategy use (Table 4). Most personal characteristics (age, gender, marital status, living arrangements) were not statistically significant. However, participants with > 12 years of education were twice as likely to use non-pharmacological strategies (OR = 2.09; p = 0.03) than those with less years of education. Employment also influenced use among freelancers/homemakers (OR = 6.77; p = 0.02) and employees of an organisation (OR = 3.15; p = 0.02), who reported higher use of non-pharmacological strategies than farmers. Participants with only CIC being more likely to use non-pharmacological strategies than those with CID (OR = 6.03; p < 0.001). Other clinical and social factors, including income, cancer type, treatment duration, and residence, were not statistically significant. Table 4: The asociation of non-pharmacological strategy use with sociodemographic and clinical characteristics Use of NPS, n (%) OR ( 95 % CI ) P-value Sociodemographic characteristics Age ≤ 65 years 70 (57.4) Ref > 65 years 46 (64.8) 1.37 (0.75 – 2.50) 0.31 Gender Male 53 (55.2) Ref Female 63 (64.9) 1.50 (0.84 -2.68) 0.17 Marital status Widowed/Divorced/Single 2 (28.6) Ref Married/Partnered 114 (61.3) 3.96 (0.75 – 20.95) 0.12 Living status I live alone 2 (40.0) Ref I live with my partner/spouse/family/friend 114 (60.1) 0.43 (0.07 -2.65) 0.37 Highest educational level ≤ 12 years 77 (55.4) Ref > 12 years 39 (72.2) 2.09 (1.06 -4.15) 0.03 Employment Farmer 26 (44.8) Ref Self-employed 7 (77.8) 4.31 (0.82 – 22.53) 0.08 Employed by an organisation 23 (71.9) 3.15 (1.24 – 7.96) 0.02 Retired 49 (60.5) 1.88 (0.95 – 3.73) 0.07 Freelancers/Housewives 11 (84.6) 6.77 (1.37 – 33.29) 0.02 Household incomes Lower than expenses 87 (57.2) Ref Equal to/higher than expenses 29 (70.7) 1.81 (0.86 – 3.81) 0.12 Health insurance No 2 (100) - - Yes 114 (59.7) - - Place of residence Rural 71 (62.8) Ref Regional 16 (53.3) 0.68 (0.30 – 1.52) 0.35 Urban 29 (58) 0.82 (0.41 – 1.61) 0.56 Clinical characteristics Cancer d iagnosis Gastrointestinal cancer 74 (59.7) Ref Breast/ gynaecological cancer 23 (60.5) 1.04 (0.49 – 2.18) 0.93 Lung cancer 11 (52.4) 0.74 (0.29 – 1.88) 0.53 Prostate cancer 5 (71.4) 1.69 (0.32 – 9.03) 0.54 Others 3 (100) - - Months since started to receive chemotherapy treatment ≤ 6 months 52 (61.2) Ref 7 – 12 months 27 (56.3) 0.82 (0.39 – 1.67) 0.58 > 12 months 37 (61.7) 1.02 (0.52 – 2.01) 0.95 Distress level * < 4 36 (54.5) Ref ≥ 4 51 (65.4) 1.57 (0.80 – 3.08) 0.23 Type of treatment recieved Chemotherapy only 43 (54.4) Ref Chemotherapy with surgery/ radiology 73 (64) 1.57 (0.80 – 3.08) 0.19 Experienced with CID only 24 (32.9) Ref CIC only 65 (74.7) 6.03 (3.03 – 11.99) <0.001 Both CID and CIC 27 (81.8) - - How CID and/or CIC bothered/distressed you? Not at all 4 (80.0) Ref A little bit 52 (59.1) 0.36 (0.04 – 3.37) 0.37 Somewhat 29 (54.7) 0.30 (0.03 - 2.88) 0.29 Quite a bit 24 (61.5) 0.40 (0.04 - 3.92) 0.43 Very much 7 (87.5) 1.75 (0.08 – 36.29) 0.72 Abbreviations: NPS, non-pharmacological strategies; OR, odds ratio; CI, confidence interval; *: NCCN Distress thermometer ; Ref, reference category used in logistic regression for calculating odds ratios. 4. Discussion This study is the first in Vietnam to explore how patients with cancer use non-pharmacological strategies to manage CID and CIC. As reported in the descriptive results (Table 2), 26.4% of participants with CID and 15.0% with CIC reported not notifying physicians and self-medicating. This behaviour is consistent with observations in other Asian and Western contexts. For example, in their UK-based practice guidance, Andreyev, Ross [4] reported that many patients considered bowel symptoms too minor or personal to discuss with clinicians, while Dulal, Paudel [17] found that nearly 90% of patients with gastrointestinal cancers in Nepal self-medicated before consulting healthcare providers. In Vietnam and similar cultures, bowel-related issues may be perceived as private or even taboo, discouraging open communication with clinicians and contributing to underreporting and delayed treatment. Moreover, the outpatient status of all participants likely reinforced this reliance on self-management, as these patients often have limited access to continuous professional support between chemotherapy sessions [18] . As shown in Table 2, 23.6% of participants with CID and 5.8% with CIC chose to do nothing, waiting for symptoms to resolve. Passive coping has been observed elsewhere [7] and may reflect fatigue, low awareness, or normalisation of side effects. These behaviours can lead to dehydration, malnutrition, and inconsistent symptom control, emphasising the need for proactive patient education and supportive follow-up. Non-pharmacological strategies were far more common among participants with CIC (75.0%) than those with CID (30.2%). This findings is consistent with a previous systematic review that analysed 33 studies and found that non-pharmacological interventions, such as increased fluid intake, dietary fiber, and physical activity were more commonly applied to CIC than CID [9]. However, unlike the studies included in that review, which primarily examined healthcare professional–delivered interventions in high-income settings, the present study provides novel evidence from Vietnam on patient-initiated, self-managed strategies embedded in everyday dietary and cultural practices. In the current study, dietary changes were the most common and effective approaches, especially for CIC, confirming the importance of fibre, hydration, and moderate activity in symptom relief as noted in earlier research [19, 20]. Physical interventions, such as exercise and abdominal massage were also reported to be highly effective, with over 80% of users indicating benefit. Their high effectiveness suggests they should be more strongly emphasised in patient education and care planning [21]. In contrast, participants with CID reported fewer non-pharmacological practices, reflecting uncertainty about effective self-management. For instance, all participants who used guava buds reported them to be helpful underscoring the value of traditional medicine in Vietnam. Guava (Psidium guajava L.) has a long history of use in Asia for treating diarrhea, supported by pharmacological studies demonstrating its anti-diarrheal, antimicrobial, and anti-inflammatory effects [22-26]. However, its unsupervised use reflects broader self-management trends and potential safety risks related to inconsistent dosing, unrecognised drug interactions, food safety, and delayed clinical assessment. Further clinical research is needed to evaluate its efficacy and guide the integration of evidence-based traditional remedies into supportive cancer care. Another important finding was the source of information about non-pharmacological strategies. Over 80% of participants learned about self-management strategies from family or friends, while very few received advice from healthcare professionals. This dependence on non-expert networks, particularly among rural patients, reflects a significant communication gap and limited access to evidence-based guidance [27]. Individual factors such as education level and employment status were statistically significant predictors of non-pharmacological strategy use. Participants with higher education were twice as likely to use such strategies, and those who were employed, freelancers, or homemakers had higher odds compared with farmers. These patterns may reflect differences in daily routines, access to health-related information, and opportunities to engage with self-care practices. While freelancers and homemakers may have greater flexibility to incorporate non-pharmacological strategies into daily life, employed participants may also benefit from greater exposure to health information or structured routines that encourage proactive health management, rather than flexibility alone. These findings are consistent with previous studies linking education, health literacy, and occupational context to greater engagement in self-care behaviours [28-30]. Participants with CIC only were more likely to adopt non-pharmacological strategies than those with CID alone, with a statistically significant association (OR = 6.03; p < 0.001). This may reflect differences in clinical prioritisation, as diarrhoea is often managed more urgently due to its potential impact on treatment continuity [31], which may lead patients to rely more readily on pharmacological management. In contrast, constipation may be viewed as less acute and more manageable through dietary or lifestyle modification, thereby encouraging greater use of self-initiated, non-pharmacological approaches. 4.1 Clinical implications These findings highlight the crucial role of health professionals in guiding patients’ self-management of CID and CIC. Their role should include assessing bowel symptoms, providing clear and evidence-based information on general dietary and lifestyle measures, and address cultural barrier by normalising discussions about bowel symptoms and engaging respectfully with patients’ beliefs and self-care practices. Educational interventions should prioritise patients with less years of education or those primarily affected by diarrhoea, using clear language, visuals, and practical demonstrations. Given the frequent use of guava among participants and its evidence-based anti-diarrhoeal properties, health professionals could safely incorporate information about Psidium guajava L. into structured education programs. Integrating such culturally familiar yet evidence-supported remedies may improve patient trust, adherence, and overall effectiveness of symptom management. 4.2 Strengths and limitations This study offers new evidence on non-pharmacological symptom management among Vietnamese patients undergoing chemotherapy, addressing an important evidence gap in an under-researched population. It also contributes to the emerging understanding of how Asian patients adopt self-management strategies, highlighting that many participants relied on self-initiated methods used without professional guidance or individualised assessment such as dietary avoidance or restriction based on personal beliefs or use of herbal or traditional remedies. These findings underscore the need for structured, health professional-led guidance to ensure that non-pharmacological advice is safe and evidence-based, in line with existing clinical practice recommendations for the management of chemotherapy-related gastrointestinal symptoms [32, 33]. Importantly, the sample included all eligible patients who were invited, reducing the risk of sampling bias and strengthening the representativeness of the cohort. However, several limitations should be noted. The cross-sectional design precludes causal inference, and reliance on self-reported data introduces potential recall bias. The single-site sample limits generalisability. In addition, the study may not have captured all relevant contextual or system-level factors that influence patients’ use of non-pharmacological strategies, such as access to supportive care, culturally appropriate resources, and family or social support. The lack of observed associations with environmental factors should therefore be interpreted cautiously, as more subtle or unmeasured influences may still be important. Future studies should employ longitudinal designs with larger, more diverse samples to enhance reliability and applicability. 5. Conclusion This study is the first in Vietnam to examine the use of non-pharmacological strategies for CID and CIC among participants with cancer. Despite high symptom prevalence, many participants underreported problems and relied on informal or traditional remedies. Non-pharmacological strategy use was far lower for CID than CIC. Among those, dietary and physical strategies were commonly applied and perceived as effective. Higher education and type of employment were associated with a greater use of non-pharmacological strategies. The findings reflect the influence of health literacy and lifestyle factors. Most participants obtained information from family or community sources rather than healthcare providers, underscoring the need for structured, health professional-led education. Strengthening culturally tailored guidance and communication can enhance safe, evidence-based self-management of CID and CIC among participants with cancer. Declarations Competing Interests The authors have no relevant financial or non-financial interests to disclose. Ethical considerations This study was approved by the Human Research Ethics Committee of Queensland University of Technology, Australia (Approval No. 8272) on 29 July 2024, and received institutional support from the Board of Directors of Hanoi Medical University Hospital, Vietnam. Consent to Participate Informed consent was obtained from all participants. Consent to Publish Not applicable. Funding This study is funded by a Queensland University of Technology (QUT) Postgraduate Research Award (International) Scholarship. Author Contribution THP: Conceptualization, Methodology, Formal analysis, Investigation, Validation, Data curation, Project administration, Writing – Original Draft, Writing – Review and editing;NB, EP, KA: Conceptualization, Methodology, Investigation, Supervision, Writing – Review and editing. 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Cancer Chemother Pharmacol 74(4):675–680. https://doi.org/10.1007/s00280-014-2526-5 Pehlivan Z, Nural N (2022) Prevalence of constipation in patients undergoing chemotherapy and the effect of constipation on quality of life. Support Care Cancer 30(10):8019–8028. https://doi.org/10.1007/s00520-022-07244-7 Andreyev J, Ross P, Donnellan C, Lennan E, Leonard P, Waters C, Wedlake L, Bridgewater J, Glynne-Jones R, Allum W, Chau I, Wilson R, Ferry D (2014) Guidance on the management of diarrhoea during cancer chemotherapy. Lancet Oncol 15(10):e447–e460. https://doi.org/10.1016/S1470-2045(14)70006-3 McQuade RM, Stojanovska V, Abalo R, Bornstein JC, Nurgali K (2016) Chemotherapy-induced constipation and diarrhea: Pathophysiology, current and emerging treatments. Front Pharmacol 7:414. https://doi.org/10.3389/fphar.2016.00414 Kapoor M, Sehrawat A, Philips AO, Panda SS, Cyriac SL, Rathnam K, Saju SV, Moharana L, Mohanty SS, Sundriyal D, Mishra M, N S, Sikri V, Toi PC, Manju R, Biswajit D, Ganesan P, Paul D, G GC (2024) Unveiling the challenges of small cell lung cancer in resource-limited settings: A multicenter collaboration analysis of demographics, treatment modalities, and prognosis. J Clin Oncol 42(16 Suppl):e20103–e20103. https://doi.org/10.1200/JCO.2024.42.16_suppl.e20103 Van Dongen SI, Stoevelaar R, Kranenburg LW, Noorlandt HW, Witkamp FE, van der Rijt CCD, van der Heide A, Rietjens JAC (2022) The views of healthcare professionals on self-management of patients with advanced cancer: An interview study. Patient Educ Couns 105(1):136–144. https://doi.org/10.1016/j.pec.2021.05.021 Shi JJ, Maldonado JA, Wu CF, Peterson SK, Chen YS, Diao K, Volk RJ, Giordano SH, Shih YT, Kaiser K, Smith GL (2023) Financial toxicity in cancer patients and subsequent risk of repeat acute care utilization. Front Psychol 14:1209526. https://doi.org/10.3389/fpsyg.2023.1209526 Phung TH, Pitt E, Alexander K, Bradford N (2024) Non-pharmacological interventions for chemotherapy-induced diarrhoea and constipation management: A scoping review. Eur J Oncol Nurs 68:102485. https://doi.org/10.1016/j.ejon.2023.102485 Lwanga SK, Lemeshow S (1991) Sample size determination in health studies: A practical manual. World Health Organization. https://doi.org/10.2307/2290547 Grey M, Schulman-Green D, Knafl K, Reynolds NR (2015) A revised self- and family management framework. Nurs Outlook 63(2):162–170. https://doi.org/10.1016/j.outlook.2014.10.003 Ownby KK (2019) Use of the distress thermometer in clinical practice. J Adv Pract Oncol 10(2):175–179. https://doi.org/10.6004/jadpro.2019.10.2.7 Nguyen TQ, Do TM, Pham TA (2021) Screening for psychological distress in Vietnamese cancer patients: An evaluation of the distress thermometer. Cancer Med 10(21):7793–7803. https://doi.org/10.1002/cam4.4298 Rehwaldt M, Wickham R, Purl S, Tariman J, Blendowski C, Shott S, Lappe M (2009) Self-care strategies to cope with taste changes after chemotherapy. Oncol Nurs Forum 36(2):E47–E56. https://doi.org/10.1188/09.ONF.E47-E56 Toygar İ, Yeşilbalkan ÖU, Kürkütlü M, Aslan A (2020) Complementary and alternative medicines used by cancer patients to cope with chemotherapy-induced constipation. Complement Ther Clin Pract 39:101108. https://doi.org/10.1016/j.ctcp.2020.101108 Wickham RS, Rehwaldt M, Kefer C, Shott S, Abbas K, Glynn-Tucker E, Potter C, Blendowski C (1999) Taste changes experienced by patients receiving chemotherapy. Oncol Nurs Forum 26(4):697–706 Dulal S, Paudel BD, Wood LA, Neupane P, Shah A, Acharya B, Shilpakar R, Acharya SC, Karn A, Poudel B, Thapa RR, Acharya A, Martin MG (2020) Reliance on self-medication increases delays in diagnosis and management of GI cancers: Results from Nepal. JCO Glob Oncol 6:1258–1263. https://doi.org/10.1200/go.20.00202 Howell D, Mayer DK, Fielding R, Eicher M, Verdonck-de Leeuw IM, Johansen C, Soto-Perez-de-Celis E, Foster C, Chan R, Alfano CM, Hudson SV, Jefford M, Lam WWT, Loerzel V, Pravettoni G, Rammant E, Schapira L, Stein KD, Koczwara B (2021) Management of cancer and health after the clinic visit: A call to action for self-management in cancer care. J Natl Cancer Inst 113(5):523–531. https://doi.org/10.1093/jnci/djaa083 Williams AR, Mowlazadeh B, Sisler L, Williams PD (2015) Self-reported assessment of symptoms and self-care within a cohort of US veterans during outpatient care for cancer. Clin J Oncol Nurs 19(5):595–602. https://doi.org/10.1188/15.CJON.595-602 Williams PD, Lantican LS, Bader JO, Lerma D (2014) Symptom monitoring, alleviation, and self-care among Mexican Americans during cancer treatment. Clin J Oncol Nurs 18(5):547–554. https://doi.org/10.1188/14.CJON.547-554 Hanai A, Ishiguro H, Sozu T, Tsuda M, Arai H, Mitani A, Tsuboyama T (2016) Effects of a self-management program on antiemetic-induced constipation during chemotherapy among breast cancer patients: A randomized controlled clinical trial. Breast Cancer Res Treat 155(1):99–107. https://doi.org/10.1007/s10549-015-3652-4 Birdi T, Krishnan GG, Kataria S, Gholkar M, Daswani P (2020) A randomized open label efficacy clinical trial of oral guava leaf decoction in patients with acute infectious diarrhoea. J Ayurveda Integr Med 11(2):163–172. https://doi.org/10.1016/j.jaim.2020.04.001 Chandra KA, Wanda D (2017) Traditional method of initial diarrhea treatment in children. Compr Child Adolesc Nurs 40:128–136. https://doi.org/10.1080/24694193.2017.1386980 Hirudkar JR, Parmar KM, Prasad RS, Sinha SK, Lomte AD, Itankar PR, Prasad SK (2020) The antidiarrhoeal evaluation of Psidium guajava L. against enteropathogenic Escherichia coli induced infectious diarrhoea. J Ethnopharmacol 251:112561. https://doi.org/10.1016/j.jep.2020.112561 Li DL, Xing FW (2016) Ethnobotanical study on medicinal plants used by local Hoklos people on Hainan Island, China. J Ethnopharmacol 194:358–368. https://doi.org/10.1016/j.jep.2016.07.050 Ong HG, Kim YD (2020) Medicinal plants for gastrointestinal diseases among the Kuki-Chin ethnolinguistic groups across Bangladesh, India, and Myanmar: A comparative and network analysis study. J Ethnopharmacol 251:112415. https://doi.org/10.1016/j.jep.2019.112415 Dai Minh L, Quang BV, Ngoc Le Mai D, Quyen LL, Gia NH, Hang NT, Giang KB (2022) Health literacy of newly-admitted cancer patients in Vietnam: Difficulties understanding treatment options and processing health-related information. Health Serv Insights 15:11786329211067325. https://doi.org/10.1177/11786329211067325 Loquai C, Dechent D, Garzarolli M, Kaatz M, Kaehler KC, Kurschat P, Meiss F, Micke O, Muecke R, Muenstedt K, Stein A, Nashan D, Stoll C, Schmidtmann I, Huebner J (2017) Use of complementary and alternative medicine: A multicenter cross-sectional study in 1089 melanoma patients. Eur J Cancer 71:70–79. https://doi.org/10.1016/j.ejca.2016.10.029 Keene MR, Heslop IM, Sabesan SS, Glass BD (2019) Complementary and alternative medicine use in cancer: A systematic review. Complement Ther Clin Pract 35:33–47. https://doi.org/10.1016/j.ctcp.2019.01.004 Johnson SB, Park HS, Gross CP, Yu JB (2017) Use of alternative medicine for cancer and its impact on survival. J Natl Cancer Inst 110(1):121–124. https://doi.org/10.1093/jnci/djx145 Okhuysen PC, Schwartzberg LS, Roeland E, Anupindi R, Hull M, Yeaw J, Lee YC, Sun L, Franklin G, Chaturvedi P, Tam IM (2021) The impact of cancer-related diarrhea on changes in cancer therapy patterns [Conference abstract]. J Clin Oncol 39(15 Suppl). https://doi.org/10.1200/JCO.2021.39.15_suppl.12111 Bossi P, Antonuzzo A, Cherny NI, Rosengarten O, Pernot S, Trippa F, Schuler U, Snegovoy A, Jordan K, Ripamonti CI (2018) Diarrhoea in adult cancer patients: ESMO clinical practice guidelines. Ann Oncol 29:iv126–iv142. https://doi.org/10.1093/annonc/mdy145 Larkin PJ, Cherny NI, La Carpia D, Guglielmo M, Ostgathe C, Scotté F, Ripamonti CI (2018) Diagnosis, assessment and management of constipation in advanced cancer: ESMO clinical practice guidelines. Ann Oncol 29(Suppl 4):iv111–iv125. https://doi.org/10.1093/annonc/mdy148 Additional Declarations No competing interests reported. Supplementary Files SupplementaryAppendix.NPSforCIDCID.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 19 May, 2026 Reviews received at journal 16 May, 2026 Reviewers agreed at journal 07 May, 2026 Reviewers invited by journal 07 May, 2026 Editor assigned by journal 07 May, 2026 Submission checks completed at journal 05 Apr, 2026 First submitted to journal 25 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9218238","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":641373182,"identity":"b6602334-dadf-4822-9c12-869f046e8815","order_by":0,"name":"Thi Hanh Phung","email":"data:image/png;base64,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","orcid":"","institution":"School of Nursing, Faculty of Health, Queensland University of Technology","correspondingAuthor":true,"prefix":"","firstName":"Thi","middleName":"Hanh","lastName":"Phung","suffix":""},{"id":641373195,"identity":"6bed39db-d269-44f3-ad17-39b8209e272e","order_by":1,"name":"Natalie Bradford","email":"","orcid":"","institution":"Cancer and Palliative Care Outcomes Centre at Centre for Children’s Health Research, Queensland University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Natalie","middleName":"","lastName":"Bradford","suffix":""},{"id":641373200,"identity":"42796827-0325-4a64-912d-099f02f226dd","order_by":2,"name":"Erin Pitt","email":"","orcid":"","institution":"Child Health Research Centre, The University of Queensland","correspondingAuthor":false,"prefix":"","firstName":"Erin","middleName":"","lastName":"Pitt","suffix":""},{"id":641373204,"identity":"53a523bf-9c4d-4051-bdf1-cacdee9f4a28","order_by":3,"name":"Kimberly Alexander","email":"","orcid":"","institution":"Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Kimberly","middleName":"","lastName":"Alexander","suffix":""}],"badges":[],"createdAt":"2026-03-25 05:08:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9218238/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9218238/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109759910,"identity":"b48c159e-e266-4bef-86ab-7c27afe037f3","added_by":"auto","created_at":"2026-05-22 07:27:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":403388,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9218238/v1/256361fe-56de-4e5d-8428-0c92c044345b.pdf"},{"id":109481713,"identity":"91af20d9-8acf-4125-af90-3fdde0655814","added_by":"auto","created_at":"2026-05-18 15:16:25","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":50642,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryAppendix.NPSforCIDCID.docx","url":"https://assets-eu.researchsquare.com/files/rs-9218238/v1/016762c2fd9ca0457049424a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Patient-Initiated Non-Pharmacological Management Strategies for Chemotherapy-Induced Diarrhoea and Constipation: A cross-sectional study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eChemotherapy-induced diarrhoea (CID) and constipation (CIC) are among the most common and distressing gastrointestinal complications experienced by patients with cancer receiving chemotherapy. Reported prevalence varies widely, ranging from 30% to 90%, reflecting differences in cancer type, treatment regimen, and assessment methods [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. When underreported or poorly managed, CID and/or CIC can lead to dehydration, malnutrition, treatment delays, and reduced quality of life, [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Despite their frequency and impact, CID and CIC often receive less attention than other chemotherapy side effects such as nausea, vomiting, or pain. This relative under-prioritisation may be partly attributable to patient underreporting, inconsistent symptom assessment, and limited supportive care resources, particularly in low- and middle-income country settings [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEffective management of CID and CIC requires a combination of pharmacological and non-pharmacological approaches. However, pharmacological treatments are often initiated reactively after symptom onset and may be associated with adverse effects that limit their tolerability or sustained use [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In response, many patients adopt non-pharmacological strategies, including dietary modification, adequate hydration, physical activity, abdominal massage, herbal or traditional remedies to alleviate symptoms and maintain daily functioning. Evidence for the widespread use of these strategies comes mainly from interviews with health professionals [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], offering only indirect insight into patients\u0026rsquo; actual behaviours. Such data offer limited understanding of how patients themselves select, apply, and evaluate non-pharmacological strategies over time, or how these practices contribute to safe and effective self-management.\u003c/p\u003e \u003cp\u003eThese evidence limitations are particularly important in low- and middle-income country contexts, where economic constraints, cultural beliefs, and limited access to healthcare drive patients toward self-care and complementary methods of management [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. A recent scoping review highlighted several patient-initiated non-pharmacological strategies, including dietary modifications and complementary and alternative medicine practices, used to support CID and CIC management [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, the review identified that most existing evidence originates from high-income countries, with limited representation from low- and middle-income settings, and no studies conducted in Vietnam. Moreover, while the review catalogued types of strategies used, it provided limited insight into patients\u0026rsquo; perceived benefits and limitations, potential risks, or the individual, health-related, and environmental factors that shape their use in everyday practice. Consequently, there remains insufficient empirical guidance to support nurses and other healthcare professionals in assisting patients to use these strategies in a consistent, safe, and effective manner.\u003c/p\u003e \u003cp\u003eTo address these gaps, this study aimed to: (1) investigate the prevalence of non-pharmacological strategy use for CID and CIC management among Vietnamese patients with cancer; (2) describe the self-reported benefits and limitations of these strategies; and (3) identify individual, health-related, and environmental factors associated with their use.\u003c/p\u003e"},{"header":"2. Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design and participants\u003c/h2\u003e \u003cp\u003eThis cross-sectional study included patients at Hanoi Medical University, Vietnam. The data collection period for this study was from August 1 to September 30, 2024. The hospital has eight diagnostic and support departments and 14 clinical departments, including an Oncology and Palliative Care Centre that provides treatment and care for patients with cancer in Hanoi and the surrounding provinces. The centre operates as a high-volume oncology service, managing approximately 9500 inpatient admissions and over 1600 outpatient consultations within a six-month period. The inclusion criteria were patients who were receiving chemotherapy as outpatients and who (1) aged 18 years or older; (2) diagnosed with any type or stage of cancer; (3) had completed at least two chemotherapy cycles; (4) reported experience of CID and/or CIC during previous treatment cycles; (5) had an Eastern Cooperative Oncology Group (ECOG) performance status\u0026thinsp;\u0026lt;\u0026thinsp;2, indicating that they could perform self-care activities; (6) had an expected prognosis of at least 12 months as determined by the referring oncologist; (7) were able to communicate in Vietnamese; and (8) provided written informed consent.\u003c/p\u003e \u003cp\u003eExclusion criteria included: (1) inability to complete the questionnaire due to low literacy level or communication impairment; (2) chronic constipation or diarrhoea not related to chemotherapy; (3) pre-existing digestive disorders within three months before the cancer diagnosis; (4) emesis-inducing conditions such as severe hypertension, hepatic or renal failure; (5) concurrent participation in other clinical trials; or (6) unsuitability for participation as determined by the clinical treatment team (e.g., patients considered too unwell or distressed to take part).\u003c/p\u003e \u003cp\u003eA convenience sample size was used. The sample size was calculated based on the formula for estimating a proportion in a population [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:n=\\frac{{Z}^{2}\\times\\:P\\left(1-P\\right)}{{d}^{2}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ewhere Z\u0026thinsp;=\u0026thinsp;1.96 for a 95% confidence level, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:P=0.5\\)\u003c/span\u003e\u003c/span\u003e (maximum variability), and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:d=0.07\\)\u003c/span\u003e\u003c/span\u003e (margin of error of \u0026plusmn;\u0026thinsp;7%), the required sample size was approximately 196 participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Theoretical framework\u003c/h2\u003e \u003cp\u003eThis study was informed by the Revised Self- and Family Management Framework [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], which provided a conceptual basis for examining how contextual factors influence patients\u0026rsquo; self-management of CID/CIC. The Revised Self- and Family Management Framework outlines how individual, health-related, and environmental factors interact to shape self-management processes and outcomes. In this study, the framework guided the identification and organisation of variables into these domains.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Instruments\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Demographics and clinical data\u003c/h2\u003e \u003cp\u003eDemographic and clinical characteristics were collected in the first section of the survey. Individual factors included age, gender, marital status, educational level, living status, current employment status, monthly household income, insurance status and place of residence (urban or rural). Health-related variables included cancer type, treatment modality (chemotherapy only or in combination with other treatments), treatment duration, and previous experience of CID and/or CIC. The Distress Thermometer, a validated single-item screening tool recommended by the National Comprehensive Cancer Network (NCCN), was used to assess the participants\u0026rsquo; distress level [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Scores range from 0 (\u0026ldquo;no distress\u0026rdquo;) to 10 (\u0026ldquo;extreme distress\u0026rdquo;), with a cut-off score of \u0026ge;\u0026thinsp;4 indicating moderate to severe distress among Vietnamese patients [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Non-pharmacological strategies for CID and CIC management\u003c/h2\u003e \u003cp\u003eThe second section of the survey examined participants\u0026rsquo; self-reported use of non-pharmacological strategies for managing or preventing CID and CIC since the commencement of chemotherapy. This section was developed based on findings from a previously published scoping review [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and prior research exploring self-care strategies among patients with chemotherapy-related symptoms [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Participants were asked to report:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe non-pharmacological strategies they had used for CID and/or CIC management. To reduce recall bias, this question included recall-aid prompts with examples of common practices (e.g., dietary adjustments, physical activity, supplements, abdominal massage, hydration, or traditional remedies);\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe perceived usefulness of each strategy, rated on a 3-point Likert scale from 0 (\u0026ldquo;did not help\u0026rdquo;) to 2 (\u0026ldquo;helped a lot\u0026rdquo;);\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAny side effects or difficulties encountered while using these strategies; and\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe sources of information they relied upon to select or apply these strategies (e.g., healthcare professionals, family/friends, internet or social media, and personal experience).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eOpen-ended questions were included to allow participants to describe additional strategies not listed in the questionnaire. Responses were later categorised into common groups identified in the literature [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], including dietary modification, physical activity, and complementary approaches. The full questionnaire is available in Supplementary Appendix 1.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data collection and analysis\u003c/h2\u003e \u003cp\u003eParticipants were invited to complete the self-administered survey either in paper form or electronically via the REDCap platform. The estimated completion time was 10\u0026ndash;15 minutes. Those preferring the online format received a secure survey link via Zalo (a messenger app). There were no missing data for any variable included in the analysis; therefore, complete-case analysis was equivalent to the full sample, and no imputation was required.\u003c/p\u003e \u003cp\u003eData were analysed using IBM SPSS Statistics version 27.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics (frequencies, percentages, means, and standard deviations) summarised participant characteristics and use of non-pharmacological strategies.\u003c/p\u003e \u003cp\u003eBinary logistic regression identified factors associated with the use of these strategies. Independent variables included individual (e.g., age, gender, education, income), health-related (e.g., cancer type, treatment duration, previous CID/CIC experience), and environmental factors (e.g., health insurance, residence). Results were reported as odds ratios (OR) with 95% confidence intervals (CI). Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eResponses to open-ended questions about non-pharmacological strategies were coded and grouped thematically to identify common types and perceived usefulness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Ethical considerations\u003c/h2\u003e \u003cp\u003eThis study was approved by the Human Research Ethics Committee of Queensland University of Technology, Australia (Approval No. 8272), and received institutional support from the Board of Directors of Hanoi Medical University Hospital, Vietnam. All participants received written and verbal information about the study and provided written informed consent before participation. Participation was voluntary, and participants could withdraw at any time. Participation or non-participation did not affect their care.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1 The characteristics of participants\u003c/h2\u003e \u003cp\u003eOf the 225 patients approached, 193 consented to participate, resulting in a response rate of 86%. The remaining 32 patients declined, mainly due to feeling unwell, time constraints, or lack of interest. Detailed descriptions of participants\u0026rsquo; sociodemographic and clinical characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodeomographic and clinical characteristics of participants (n\u0026thinsp;=\u0026thinsp;193) \u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eSociodemographic characteristics\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;65 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;65 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried/Partnered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed/Divorced/Single\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eLiving status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiving alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiving with partner/spouse/family/friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHighest educational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;12 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;12 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eEmployment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed by organisation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousewives/ Freelancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCurrent household incomes compared to expenses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower than expenses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual to/higher than expenses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHealth insurance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical Characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eCancer diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGastrointestinal cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreast/ gynaecological cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProstate cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther cancers types\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eMonths since commencing chemotherapy treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u0026ndash;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of treatment recieved\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChemotherapy only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCombination of chemotherapy with surgery/ radiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDistress level*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eExperienced with\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCID only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCIC only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoth CID and CIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eSelf-reported bother/ distress related to CID and/or CIC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA little bit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSomewhat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuite a bit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery much\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003e* measured using NCCN Distress thermometer\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2. The use of non-pharmacological strategies to manage CID and CIC and perceived effectiveness\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarises participants' self-initiated actions taken to manage CID and CIC. Among participants with CID, 30.2% reported using non-pharmacological strategies, while 75.0% of participants with CIC reported doing so. In addition, 23.6% of participants with CID and 5.8% of those with CIC reported choosing to wait for symptoms to resolve without taking specific action.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSelf-initiated actions taken by participants to manage CID and CIC\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-Initiated Action Taken\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCID (n\u0026thinsp;=\u0026thinsp;106),\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCIC (n\u0026thinsp;=\u0026thinsp;120),\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNotified physicians and received advice/prescriptions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (34.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (22.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDid not notify physicians and self-medicated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (15.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsed non-pharmacological strategies to relieve symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (30.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90 (75.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDid nothing and waited for symptoms to resolve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (5.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eNote\u003c/em\u003e: \u003cem\u003eParticipants could report more than one self-initiated management action for CID and/or CIC; therefore, categories are not mutually exclusive. Participants who reported \u0026ldquo;doing nothing and waiting for symptoms to resolve\u0026rdquo; did not report other management actions. Some participants experienced both CID and CIC.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eParticipants commonly used dietary and lifestyle strategies to manage CID and CIC (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). For CID, guava buds, soft diets, and avoiding trigger foods provided the greatest relief. For CIC, increasing vegetables, natural laxative foods, and herbal drinks were most frequent and perceived as highly effective. No additional non-pharmacological strategies emerged from the free-text responses. No adverse effects from non-pharmacological strategy use were reported by any participants. Most participants (81.6%) relied on family or friends for advice, with minimal professional input (4.8%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNon-pharmacological strategies to manage CID and CIC \u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal users, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003ePerceived effectiveness\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDid not help\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHelped a little\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHelped a lot\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eNon-pharmacological strategies to manage CID (n\u0026thinsp;=\u0026thinsp;52 responses from 106 participants)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eDietary adjustment\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eTotal of 48 (92.3%) responses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSoften foods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (53.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvoid certain foods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (53.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsume guava buds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProbiotics and yogurt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (53.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activities\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eTotal of 2 (3.8%) responses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSupplement (vitamin, mineral, herb)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eTotal of 2 (3.8%) responses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-pharmacological strategies to manage CIC (n\u0026thinsp;=\u0026thinsp;239 responses from 120 participants)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eDietary adjustment\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eTotal of 205 (85.8%) responses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncrease vegetable intake\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9 (13.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e58 (84.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProbiotics and yogurt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (60.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsume natural laxative foods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 (7.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44 (69.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsume different kinds of drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 (69.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePhysical activities\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eTotal of 28 (11.7%) responses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17 (81.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelly massage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (85.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSupplement (fiber, herb)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eTotal of 6 (2.5%) responses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (83.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eSources of information for non-pharmacological strategies\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"3\" nameend=\"c6\" namest=\"c4\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternet/ magazines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFriends/relatives/family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (81.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (6.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNote\u003c/b\u003e: \u003cem\u003eParticipants could use more than one non-pharmacological strategy.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3 The association of non-pharmacological strategy use with participant characteristics\u003c/h2\u003e \u003cp\u003eBinary logistic regression identified key factors associated with non-pharmacological strategy use (Table\u0026nbsp;4). Most personal characteristics (age, gender, marital status, living arrangements) were not statistically significant. However, participants with \u0026gt;\u0026thinsp;12 years of education were twice as likely to use non-pharmacological strategies (OR\u0026thinsp;=\u0026thinsp;2.09; p\u0026thinsp;=\u0026thinsp;0.03) than those with less years of education. Employment also influenced use among freelancers/homemakers (OR\u0026thinsp;=\u0026thinsp;6.77; p\u0026thinsp;=\u0026thinsp;0.02) and employees of an organisation (OR\u0026thinsp;=\u0026thinsp;3.15; p\u0026thinsp;=\u0026thinsp;0.02), who reported higher use of non-pharmacological strategies than farmers. Participants with only CIC being more likely to use non-pharmacological strategies than those with CID (OR\u0026thinsp;=\u0026thinsp;6.03; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Other clinical and social factors, including income, cancer type, treatment duration, and residence, were not statistically significant.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;4: The asociation of non-pharmacological strategy use with sociodemographic and clinical characteristics \u003c/b\u003e \u003c/p\u003e \u003c/div\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"945\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 567px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of NPS,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003e\u003cstrong\u003e95 % CI\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 945px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSociodemographic\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u0026le; 65 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e70 (57.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u0026gt; 65 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e46 (64.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e1.37 (0.75 \u0026ndash; 2.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e53 (55.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e63 (64.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e1.50 (0.84 -2.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eWidowed/Divorced/Single\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eMarried/Partnered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e114 (61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e3.96 (0.75 \u0026ndash; 20.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiving status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eI live alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eI live with my partner/spouse/family/friend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e114 (60.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.43 (0.07 -2.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest educational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u0026le; 12 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e77 (55.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u0026gt; 12 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e39 (72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e2.09 (1.06 -4.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e26 (44.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eSelf-employed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e7 (77.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e4.31 (0.82 \u0026ndash; 22.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eEmployed by an organisation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e23 (71.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e3.15 (1.24 \u0026ndash; 7.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e49 (60.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e1.88 (0.95 \u0026ndash; 3.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eFreelancers/Housewives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e11 (84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e6.77 (1.37 \u0026ndash; 33.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold incomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eLower than expenses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e87 (57.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eEqual to/higher than expenses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e29 (70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e1.81 (0.86 \u0026ndash; 3.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth insurance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e114 (59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e71 (62.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eRegional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e16 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.68 (0.30 \u0026ndash; 1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e29 (58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.82 \u0026nbsp;(0.41 \u0026ndash; 1.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 945px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer d\u003c/strong\u003e\u003cstrong\u003eiagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eGastrointestinal cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e74 (59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eBreast/ gynaecological cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e23 (60.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e1.04 (0.49 \u0026ndash; 2.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eLung cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e11 (52.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.74 (0.29 \u0026ndash; 1.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eProstate cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e5 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e1.69 (0.32 \u0026ndash; 9.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e3 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonths since started to receive chemotherapy treatment\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u0026le; 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e52 (61.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e7 \u0026ndash; 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e27 (56.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.82 (0.39 \u0026ndash; 1.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u0026gt; 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e37 (61.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e1.02 (0.52 \u0026ndash; 2.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistress\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;level\u003c/strong\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u0026lt; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e36 (54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003e\u0026ge; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e51 (65.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e1.57 (0.80 \u0026ndash; 3.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of treatment\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;recieved\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eChemotherapy only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e43 (54.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eChemotherapy with surgery/ radiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e73 (64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e1.57 (0.80 \u0026ndash; 3.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperienced\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;with\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eCID only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e24 (32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eCIC only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e65 (74.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e6.03 (3.03 \u0026ndash; 11.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eBoth CID and CIC\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e27 (81.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHow\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;CID and/or CIC bothered/distressed you?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eNot at all\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e4 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eA little bit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e52 (59.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.36 (0.04 \u0026ndash; 3.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eSomewhat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e29 (54.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.30 (0.03 - 2.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eQuite a bit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e24 (61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.40 (0.04 - 3.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 350px;\"\u003e\n \u003cp\u003eVery much\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e7 (87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e1.75 (0.08 \u0026ndash; 36.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations: NPS, non-pharmacological strategies; OR, odds ratio; CI, confidence interval;\u0026nbsp;\u003c/em\u003e\u003cem\u003e*:\u0026nbsp;\u003c/em\u003e\u003cem\u003eNCCN Distress thermometer\u003c/em\u003e\u003cem\u003e;\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u0026nbsp;Ref, reference category used in logistic regression for calculating odds ratios.\u003c/em\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study is the first in Vietnam to explore how patients with cancer use non-pharmacological strategies to manage CID and CIC. As reported in the descriptive results (Table 2), 26.4% of participants with CID and 15.0% with CIC reported not notifying physicians and self-medicating. This behaviour is consistent with observations in other Asian and Western contexts. For example, in their UK-based practice guidance, Andreyev, Ross [4] reported that many patients considered bowel symptoms too minor or personal to discuss with clinicians, while Dulal, Paudel [17] found that nearly 90% of patients with gastrointestinal cancers in Nepal self-medicated before consulting healthcare providers. In Vietnam and similar cultures, bowel-related issues may be perceived as private or even taboo, discouraging open communication with clinicians and contributing to underreporting and delayed treatment. Moreover, the outpatient status of all participants likely reinforced this reliance on self-management, as these patients often have limited access to continuous professional support between chemotherapy sessions [18] .\u003c/p\u003e\n\u003cp\u003eAs shown in Table 2, 23.6% of participants with CID and 5.8% with CIC chose to do nothing, waiting for symptoms to resolve. Passive coping has been observed elsewhere [7] and may reflect fatigue, low awareness, or normalisation of side effects. These behaviours can lead to dehydration, malnutrition, and inconsistent symptom control, emphasising the need for proactive patient education and supportive follow-up.\u003c/p\u003e\n\u003cp\u003eNon-pharmacological strategies were far more common among participants with CIC (75.0%) than those with CID (30.2%). This findings is consistent with a previous systematic review that analysed 33 studies and found that non-pharmacological interventions, such as increased fluid intake, dietary fiber, and physical activity were more commonly applied to CIC than CID [9]. However, unlike the studies included in that review, which primarily examined healthcare professional\u0026ndash;delivered interventions in high-income settings, the present study provides novel evidence from Vietnam on patient-initiated, self-managed strategies embedded in everyday dietary and cultural practices.\u003c/p\u003e\n\u003cp\u003eIn the current study, dietary changes were the most common and effective approaches, especially for CIC, confirming the importance of fibre, hydration, and moderate activity in symptom relief \u0026nbsp;as noted in earlier research [19, 20]. Physical interventions, such as exercise and abdominal massage were also reported to be highly effective, with over 80% of users indicating benefit. Their high effectiveness suggests they should be more strongly emphasised in patient education and care planning [21].\u003c/p\u003e\n\u003cp\u003eIn contrast, participants with CID reported fewer non-pharmacological practices, reflecting uncertainty about effective self-management. For instance, all participants who used guava buds reported them to be helpful underscoring the value of traditional medicine in Vietnam. Guava (Psidium guajava L.) has a long history of use in Asia for treating diarrhea, supported by pharmacological studies demonstrating its anti-diarrheal, antimicrobial, and anti-inflammatory effects [22-26]. However, its unsupervised use reflects broader self-management trends and potential safety risks related to inconsistent dosing, unrecognised drug interactions, food safety, and delayed clinical assessment. Further clinical research is needed to evaluate its efficacy and guide the integration of evidence-based traditional remedies into supportive cancer care.\u003c/p\u003e\n\u003cp\u003eAnother important finding was the source of information about non-pharmacological strategies. Over 80% of participants learned about self-management strategies from family or friends, while very few received advice from healthcare professionals. This dependence on non-expert networks, particularly among rural patients, reflects a significant communication gap and limited access to evidence-based guidance [27].\u003c/p\u003e\n\u003cp\u003eIndividual factors such as education level and employment status were statistically significant predictors of non-pharmacological strategy use. Participants with higher education were twice as likely to use such strategies, and those who were employed, freelancers, or homemakers had higher odds compared with farmers. These patterns may reflect differences in daily routines, access to health-related information, and opportunities to engage with self-care practices. While freelancers and homemakers may have greater flexibility to incorporate non-pharmacological strategies into daily life, employed participants may also benefit from greater exposure to health information or structured routines that encourage proactive health management, rather than flexibility alone. These findings are consistent with previous studies linking education, health literacy, and occupational context to greater engagement in self-care behaviours [28-30].\u003c/p\u003e\n\u003cp\u003eParticipants with CIC only were more likely to adopt non-pharmacological strategies than those with CID alone, with a statistically significant association (OR = 6.03; p \u0026lt; 0.001). This may reflect differences in clinical prioritisation, as diarrhoea is often managed more urgently due to its potential impact on treatment continuity [31], which may lead patients to rely more readily on pharmacological management. In contrast, constipation may be viewed as less acute and more manageable through dietary or lifestyle modification, thereby encouraging greater use of self-initiated, non-pharmacological approaches.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eClinical implications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThese findings highlight the crucial role of health professionals in guiding patients\u0026rsquo; self-management of CID and CIC. Their role should include assessing bowel symptoms, providing clear and evidence-based information on general dietary and lifestyle measures, and address cultural barrier by normalising discussions about bowel symptoms and engaging respectfully with patients\u0026rsquo; beliefs and self-care practices. Educational interventions should prioritise patients with less years of education or those primarily affected by diarrhoea, using clear language, visuals, and practical demonstrations. Given the frequent use of guava among participants and its evidence-based anti-diarrhoeal properties, health professionals could safely incorporate information about Psidium guajava L. into structured education programs. Integrating such culturally familiar yet evidence-supported remedies may improve patient trust, adherence, and overall effectiveness of symptom management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2 Strengths and limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study offers new evidence on non-pharmacological symptom management among Vietnamese patients undergoing chemotherapy, addressing an important evidence gap in an under-researched population. It also contributes to the emerging understanding of how Asian patients adopt self-management strategies, highlighting that many participants relied on self-initiated methods used without professional guidance or individualised assessment such as dietary avoidance or restriction based on personal beliefs or use of herbal or traditional remedies. These findings underscore the need for structured, health professional-led guidance to ensure that non-pharmacological advice is safe and evidence-based, in line with existing clinical practice recommendations for the management of chemotherapy-related gastrointestinal symptoms [32, 33]. Importantly, the sample included all eligible patients who were invited, reducing the risk of sampling bias and strengthening the representativeness of the cohort. However, several limitations should be noted. The cross-sectional design precludes causal inference, and reliance on self-reported data introduces potential recall bias. The single-site sample limits generalisability. In addition, the study may not have captured all relevant contextual or system-level factors that influence patients\u0026rsquo; use of non-pharmacological strategies, such as access to supportive care, culturally appropriate resources, and family or social support. The lack of observed associations with environmental factors should therefore be interpreted cautiously, as more subtle or unmeasured influences may still be important. Future studies should employ longitudinal designs with larger, more diverse samples to enhance reliability and applicability.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study is the first in Vietnam to examine the use of non-pharmacological strategies for CID and CIC among participants with cancer. Despite high symptom prevalence, many participants underreported problems and relied on informal or traditional remedies. Non-pharmacological strategy use was far lower for CID than CIC. Among those, dietary and physical strategies were commonly applied and perceived as effective. Higher education and type of employment were associated with a greater use of non-pharmacological strategies. The findings reflect the influence of health literacy and lifestyle factors. Most participants obtained information from family or community sources rather than healthcare providers, underscoring the need for structured, health professional-led education. Strengthening culturally tailored guidance and communication can enhance safe, evidence-based self-management of CID and CIC among participants with cancer.\u003c/p\u003e"},{"header":"Declarations","content":"\n\u003ch2\u003eCompeting Interests\u003c/h2\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003ch2\u003eEthical considerations\u003c/h2\u003e\n\u003cp\u003eThis study was approved by the Human Research Ethics Committee of Queensland University of Technology, Australia (Approval No. 8272) on 29 July 2024, and received institutional support from the Board of Directors of Hanoi Medical University Hospital, Vietnam.\u003c/p\u003e\n\u003ch2\u003eConsent to Participate\u003c/h2\u003e\n\u003cp\u003eInformed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study is funded by a Queensland University of Technology (QUT) Postgraduate Research Award (International) Scholarship.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eTHP: Conceptualization, Methodology, Formal analysis, Investigation, Validation, Data curation, Project administration, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review and editing;NB, EP, KA: Conceptualization, Methodology, Investigation, Supervision, Writing \u0026ndash; Review and editing.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to ethical and privacy considerations but are available from the corresponding author on reasonable request. All shared data will be non-identifiable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHuamao C, Xixi G, Yan Z, Jian F, Yan G, Chen H, Gu X, Zhang Y, Feng J, Gu Y (2021) Associated factors with constipation and health-related quality of life in lung cancer patients with platinum-based chemotherapy: A cross-sectional study. Medicine 100(30):1\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/MD.0000000000026547\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000026547\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeefe DM, Elting LS, Nguyen HT, Grunberg SM, Aprile G, Bonaventura A, Selva-Nayagam S, Barsevick A, Koczwara B, Sonis ST (2014) Risk and outcomes of chemotherapy-induced diarrhea (CID) among patients with colorectal cancer receiving multi-cycle chemotherapy. 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Ann Oncol 29(Suppl 4):iv111\u0026ndash;iv125. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/annonc/mdy148\u003c/span\u003e\u003cspan address=\"10.1093/annonc/mdy148\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"diarrhoea, constipation, complementary therapy, self-management, oncology nursing, symptom management","lastPublishedDoi":"10.21203/rs.3.rs-9218238/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9218238/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eChemotherapy-induced diarrhoea (CID) and constipation (CIC) are common and distressing side effects that impair quality of life in patients with cancer. Although non-pharmacological strategies may help manage these symptoms, their use in Vietnam is poorly understood. This study examines the prevalence, types, and perceived effectiveness of non-pharmacological strategies for CID and CIC management.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA cross-sectional survey of 193 participants with cancer at Hanoi Medical University Hospital (Vietnam) collected data on demographics, clinical characteristics, use of non-pharmacological strategies, perceived effectiveness, and information sources. Binary logistic regression identified factors associated with strategy use.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong participants with CID (n\u0026thinsp;=\u0026thinsp;106), 30.2% used non-pharmacological strategies, compared with 75.0% of those with CIC (n\u0026thinsp;=\u0026thinsp;120). Dietary modification was the predominant approach (CID: 92.3%; CIC: 85.8%), including vegetables, natural laxatives, and herbal teas for CIC, and soft diets, food avoidance, and guava buds for CID. Most participants (70%-84%) reported substantial relief. Information sources were largely informal (81.6%), with only 4.8% receiving professional advice. Higher education (OR\u0026thinsp;=\u0026thinsp;2.09, p\u0026thinsp;=\u0026thinsp;0.03), being a freelancer/homemaker (OR\u0026thinsp;=\u0026thinsp;6.77, p\u0026thinsp;=\u0026thinsp;0.02), or employed (OR\u0026thinsp;=\u0026thinsp;3.15, p\u0026thinsp;=\u0026thinsp;0.02) were associated with greater use. Participants with CIC alone were statistically significantly more likely to use non-pharmacological strategies than those with CID alone (OR\u0026thinsp;=\u0026thinsp;6.03; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No adverse effects were reported.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eNon-pharmacological self-management of CID and CIC is widely used and perceived as effective among Vietnamese patients with cancer, but is largely unguided and based on informal advice.\u003c/p\u003e","manuscriptTitle":"Patient-Initiated Non-Pharmacological Management Strategies for Chemotherapy-Induced Diarrhoea and Constipation: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-18 15:16:21","doi":"10.21203/rs.3.rs-9218238/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"97747639831769785483936535847047190486","date":"2026-05-19T09:00:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-16T21:38:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"216226261791906566318992598354282888183","date":"2026-05-07T19:50:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-07T14:24:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-07T14:20:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-05T22:48:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2026-03-25T04:53:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9aaf2221-9655-487f-9e53-7bfc622ee8b0","owner":[],"postedDate":"May 18th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"97747639831769785483936535847047190486","date":"2026-05-19T09:00:24+00:00","index":17,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-16T21:38:34+00:00","index":16,"fulltext":""},{"type":"reviewerAgreed","content":"216226261791906566318992598354282888183","date":"2026-05-07T19:50:19+00:00","index":12,"fulltext":""},{"type":"reviewersInvited","content":"4","date":"2026-05-07T14:24:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-07T14:20:10+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T15:16:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-18 15:16:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9218238","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9218238","identity":"rs-9218238","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}