Experiences and Needs regarding Nutrition Information and Nutritional Supplements among Oncology Healthcare Professionals: A Sequential Exploratory Mixed-methods Study 

Experiences and Needs regarding Nutrition Information and Nutritional Supplements among Oncology Healthcare Professionals: A Sequential Exploratory Mixed-methods 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 Experiences and Needs regarding Nutrition Information and Nutritional Supplements among Oncology Healthcare Professionals: A Sequential Exploratory Mixed-methods Study Iris EC Nagtegaal, Loes van Rijssen, Barbara S van der meij, Manon GA van den Berg, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8549682/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract Purpose This study aimed to acquire a comprehensive understanding of the experiences and needs of HCPs in a university medical center at the medical oncology department regarding the provision of uniform information on nutrition and nutritional supplements to adult patients with cancer. Methods This exploratory sequential mixed-methods study employed an online questionnaire that was sent to HCPs and included questions on indications for providing nutrition advice, knowledge about nutrition and nutritional supplements, and needs regarding providing uniform advice about these topics. This was followed by semi-structured interviews with HCPs to gain deeper insights into their experiences and needs. Results Thirty-two HCPs completed the questionnaire, and nine HCPs participated in semi-structured interviews. The results identified five themes: knowledge of nutrition and nutritional supplements, interdisciplinary care, patient-centered care, information sources, and (scientific) basis of nutrition information and research. Conclusion This study highlights the need to improve HCPs’ knowledge and consistency regarding nutritional care. Although general nutritional knowledge is well established, familiarity with nutritional supplements remains limited, and individuals tend to approach them with less confidence. Education, awareness of guidelines, evidence-based information, a clearer division of roles between HCPs, and interprofessional collaboration are key to improving confidence, quality, and delivering personalized nutritional support in oncology. Cancer experiences healthcare professionals nutrition information nutrition needs nutritional supplements INTRODUCTION Malnutrition affects up to 80% of patients with cancer and can lead to serious consequences, including impaired functional status, diminished quality of life, and poor survival[ 1 – 7 ]. This underscores the importance of adequate nutrition, nutritional information, and optimal nutritional guidance for patients with cancer throughout their cancer trajectory[ 2 , 5 , 8 ]. Cancer itself as well as its therapy frequently lead to appetite loss, nausea and vomiting, diarrhea or constipation, and fatigue, all of which reduce nutrient intake and contribute to weight loss[ 3 – 5 ]. Healthcare professionals (HCPs) play an important role in identifying and discussing nutritional problems during patients’ cancer trajectories. Adequate nutrition can help reduce treatment-related side effects in patients with cancer and enhance the strength and energy levels essential for tolerating and recovering from systemic cancer treatment, while also supporting the immune system[ 6 , 9 ]. Multiple studies have indicated that patients with cancer, their partners, and relatives report that they do not receive sufficient information regarding nutrition and nutritional supplements. As a result, they are frequently unaware of the available evidence-based information on nutrition and nutritional supplements[ 10 – 12 ]. Van Veen et al.[ 13 ] concluded that HCPs in the Netherlands considered themselves to be insufficiently informed and confident in providing nutritional advice. Similarly, previous research by Kruif et al.[ 14 ] showed that, while HCPs acknowledge the importance of nutritional issues, their knowledge, attitudes, and communication about nutrition vary considerably between professionals and settings. Furthermore, Murphy et al.[ 15 ] also noted that awareness of guidelines among HCPs varied, which impacted consistency in practice and patient care improvement. The lack of high-quality evidence regarding the benefits and risks of nutritional supplement use is one of the factors contributing to the inconsistency and absence of nutritional guidance from HCPs[ 16 ]. Zirpoli et al.[ 17 ] investigated the provision of nutritional supplement recommendations to patients with cancer and demonstrated that 51% of patients did not receive recommendations from HCPs regarding supplement use. These findings highlight the urgent need to further involve HCPs in providing guidance and information on nutrition to patients with cancer. To improve cancer care, it is important to investigate HCPs’ experiences and needs concerning the provision of nutrition information during cancer trajectory. This study aimed to acquire a comprehensive understanding of the experiences and needs of HCPs regarding the provision of uniform guidance on nutrition and nutritional supplements to adult patients with cancer. To gain a comprehensive understanding, a parallel qualitative study was conducted to examine patients with cancer perspectives, wishes and needs regarding this important topic (van der Meij et al., unpublished data, 2026). METHODS Design and study population This study used an exploratory sequential mixed-methods design, wherein a quantitative phase was followed by a qualitative study[ 18 ]. Qualitative research was applied to understand the results of the quantitative study. The study population consisted of HCPs from the medical oncology department of a university medical center, including (oncology) nurses, clinical nurse specialists, physician assistants, residents, and medical oncologists. Data collection Data collection took place between April 2022 and May 2023. Quantitative data A digital questionnaire was sent to the participating HCPs. The questionnaire consisted of five sections: 1) demographic data; 2) frequency and indication(s) for providing nutritional advice to patients; 3) experiences and knowledge regarding the current advice on nutrition and nutritional supplements; 4) needs; 5) the extent to which they perceived or experienced a standardized approach in providing recommendations on nutrition and nutritional supplements in their medical oncology department. The questionnaire included both closed and open-ended questions. Filtering questions allowed the HCPs to skip questions that were not applicable to them. Content validity was assessed by a panel of four experts (i.e., nursing scientists, clinical nurse specialist, and teachers from the [blinded for peer review]) in cancer care. They evaluated whether the instrument contained an appropriate set of relevant items that comprehensively represented the full content of the construct domain being measured[ 18 ]. Qualitative data The semi-structured interviews were based on an interview guide that incorporated topics derived from both literature and insights gained from the quantitative phase of the study (Appendix 1). Subsequently, the guide was reviewed, revised, and approved by a panel of three experts (FP, LR, IN). These topics included experiences related to providing nutritional advice, evidence-based practice, collaboration, and perceived needs. A pilot interview with a clinical nurse specialist was conducted to test the interview guide. The data collected from this pilot interview were not included in the results. Semi-structured interviews were conducted with HCPs who met the inclusion criteria. Participants were selected through purposive sampling. To ensure a diverse range of experiences and needs from distinct roles, the principle of differentiation was applied by intentionally selecting HCPs from various professional roles (oncology nurses, clinical nurse specialists, physician assistants, medical residents, and medical oncologists). The interviews, with a duration of 30–40 minutes, were facilitated by pairs of trained nursing students. Each interview was audio recorded using digital equipment. Data analyses Quantitative data Quantitative data were analyzed using IBM SPSS Statistics software, version 25.0 (IBM SPSS Statistics, Armonk, NY). Descriptive statistics were used to describe the demographic data. The results of the closed-ended questions were processed as numbers and percentages. Responses to the open-ended questions were used to complement the interpretation of the closed questions. The answers were compared and grouped into descriptive data. Qualitative data A thematic analysis was conducted as described by Braun and Clarke[ 19 ]. This analysis enabled researchers to explore and understand the complexity and nuances of qualitative data to gain profound insights into the experiences, perspectives, and behaviors of individuals[ 19 ]. Each interview was transcribed verbatim by four trained students and anonymized before being imported into a qualitative data management program (ATLAS.ti for Windows, V 8.0). All transcripts were reviewed by three researchers (FP, LR, IN) and concepts and ideas for coding were developed. Subsequently, the interviews were assigned to the three researchers. Each interview was coded by at least two researchers. After coding each interview, a consensus meeting was held to resolve discrepancies in coding through discussion until consensus was reached (FP, LR, IN). Themes and subthemes were generated through an iterative process, including discussions with the research team (FP, LR, IN, BM, MB). Data triangulation This study employed methodological triangulation using a quantitative method to initially assess HCPs’ experiences and needs regarding nutrition and nutritional supplements, followed by a qualitative method[ 20 ]. To integrate the qualitative and quantitative data, the research team merged the findings to obtain a profound understanding of HCPs’ experiences and needs regarding nutrition and nutritional supplements. Consistent with Moon’s[ 20 ] view of triangulation as a strategy to enhance validity, reliability, and legitimation, both datasets were compared to identify similarities, differences, and complementary perspectives. The qualitative phase offered a deeper understanding and contextualization of the quantitative patterns, further reinforcing the validity and applicability of the results. This integration process formed the basis for the overarching themes described in the results section. Ethical considerations Ethical committee approval was not required for this research, as the study involved no medical interventions or risks to HCPs and was not covered by the Dutch WMO (Medical Research Involving Human Subjects Act). The questionnaires were anonymous. The interview recordings were securely erased after transcription, and the transcriptions were anonymized. The HCPs agreed to participate in the study by signing an informed consent form. This study was conducted in accordance with the EU GDPR (General Data Protection Regulation)[ 21 , 22 ]. RESULTS Quantitative data The questionnaire was distributed to 96 HCPs who met the inclusion criteria, of whom 32 (33%) completed the questionnaire. The study population consisted of three males and 29 females, and most of them were (oncology) nurses (n = 21, 66%). The respondents’ demographic characteristics are reported in Table 1 . In total, 16 (50%) HCPs indicated that they provide information or guidance on nutrition, 2 (6%) focused on nutritional supplements, and 14 (44%) HCPs gave information on both to patients. Table 1 - Demographic Characteristics of HCPs (N=32) Characteristics n (%) Age, median (range), y 43 (25-65) Sex Male Female 3 (9) 29 (91) Profession (Oncology) nurse Clinical nurse specialist Resident Medical oncologist 21 (66) 3 (9) 2 (6) 6 (19) Department Nursing department Outpatient clinic Day care unit 12 (38) 16 (50) 4 (13) Years of experience 0-5 y 6-15 y 16-25 y >25 y 16 (50) 7 (22) 4 (13) 5 (16) HCPs, healthcare professionals; n, number; y, years Qualitative data Nine HCPs participated in qualitative interviews. Among them were one physician assistant, two medical oncologists, one medical resident, four oncology nurses, and one clinical nurse specialist. Findings integration quantitative and qualitative data Through the comprehensive merging and integration of quantitative and qualitative data, five themes were identified: knowledge of nutrition and nutritional supplements, interdisciplinary care, patient-centered care, information sources, and (scientific) basis of nutrition information and research. Knowledge of nutrition and nutritional supplements Twenty-five (78%) HCPs reported that they had sufficient knowledge to provide nutritional advice. A desire to expand knowledge was mentioned by 20 (63%) HCPs. The interviews showed that most HCPs reported having adequate (basic) knowledge about nutrition. "Well, I do have quite a bit of general knowledge about nutrition in cancer, particularly in terms of the advice we provide to patients with cancer." (Respondent 7) In the context of advising on nutritional supplements, 25 (78%) HCPs reported wanting to gain more knowledge, indicating a need to strengthen their general understanding. In addition, 27 (84%) HCPs expressed the need to expand their existing expertise, for example, through clinical training sessions or patient case discussions. One of the challenging factors identified by HCPs in providing advice about nutritional supplements was that the questions posed and the supplements used by patients were diverse. “For me it is more difficult when people use various supplements, and I am not exactly sure what is in them. I find that difficult sometimes, so sometimes I ask for the label of the product or request that people bring it with them so I can check it.” (Respondent 3) HCPs expressed the need to provide clear advice on whether a food product or nutritional supplement is permitted and whether it can be used safely. Several HCPs expressed a desire for a comprehensive overview of what is allowed in relation to specific types of systemic cancer medication. “So, a wish for perhaps an overview of nutritional supplements and a wish that you might receive information [regarding developments of nutrition and nutritional supplements] once a year.” (Respondent 6) Several HCPs indicated that they knew where to seek information and who to consult regarding nutrition and nutritional supplements when their knowledge was insufficient. Nonetheless, they were eager to expand their knowledge in several ways. “(…) inviting a dietitian would be nice, and we could then save up our questions about what they would advise in certain situations.” (Respondent 1) Interdisciplinary care Providing advice about nutrition and nutritional supplements was offered by all HCPs (n = 32, 100%), and they considered this part of their professional responsibility. Regarding nutrition information, 14 (44%) HCPs experienced a uniform working method within their department. They perceived this uniformity as clear in their internal communication as discussions among colleagues revealed no discrepancies in the advice provided to patients. HCPs who did not experience a uniform working method (56%, n = 18) reported that a wide range of varying and changing advice was provided to the patients. Regarding nutritional supplements, 25 HCPs (78%) reported that they did not experience a uniform working method. They experienced limited alignment on this topic among HCPs, which resulted in a lack of awareness of each other’s approaches and advice. Most of the HCPs interviewed indicated that they collaborated with other disciplines when providing advice about nutrition and nutritional supplements. For example, some HCPs reported referring patients to a dietitian when nutritional inquiries became specific, when a patient had complex nutritional issues, or when energy requirements needed to be calculated. “In general, I think I manage quite well. When things get more specific, I do need a bit more support.” (Respondent 7) The topics of nutrition and nutritional supplements were not routinely discussed among HCPs. Nutritional topics were occasionally addressed in case discussions, such as when initiating interventions like enteral feeding, or when a relevant study on nutrition is highlighted. "Well, not specifically about nutrition. But if there are questions, we can discuss it. We do have collaborative moments with colleagues, but not about nutrition. No, it is somewhat of a neglected topic." (Respondent 8) “(…) that I would prefer having more conversations about this with oncologists and dietitians. I would actually have a need for that.” (Respondent 6) The HCPs indicated that they were not always aware of which information about nutrition or nutritional supplements their colleagues had shared with their patients. “I think we assume that we are roughly saying the same thing and using the same approach.” (Respondent 6) Opinions varied regarding who is responsible for providing advice on nutrition and nutritional supplements. The HCPs expressed a need for clarity regarding who holds which responsibilities. Regarding the provision of nutritional advice, HCPs (including nurses) believe that this responsibility lies with nurses. When it came to nutritional supplements' advice, the situation became more complex. The responsibility of providing advice about nutritional supplements was perceived differently by the HCPs. Nurses indicated that they provide little or no advice about this and are not always sure who is responsible: “And that becomes a bit of a point of discussion: is this the responsibility of the physician, or perhaps of others?” (Respondent 6) “The oncologist prescribes chemotherapy, so they should also say whether it is allowed to use turmeric or CBD oil or whatever, yes.” (Respondent 5) Patient-centered care About half of the HCPs (n = 17, 53%) reported receiving patients’ inquiries about nutrition and nutritional supplements on a weekly basis. Most HCPs (n = 25, 78%) noted that they were usually able to answer these questions. The initiative to discuss nutrition and nutritional supplements with patients varied among HCPs. Specifically, nine HCPs (28%) never or rarely initiate such discussions; 14 (44%) sometimes do, and 9 (28%) usually or always do. Examples of patient inquiries about nutrition include raw food, alcohol, sugar-free products, protein, and healthy eating. Questions about nutritional supplements include herbs, vitamins, fish oil, turmeric, and cannabis oil. HCPs reported that patient-related factors, such as the type of cancer, stage of the disease, and emotional well-being, contribute to the process of providing information about nutrition and nutritional supplements. “(…) in a care pathway involving stomach, intestinal, and liver cancer, there are numerous issues in the stomach, intestinal, and liver areas, so it is indeed a very significant challenge.” (Respondent 5) The initiative for asking questions about nutrition and nutritional supplements primarily lay with the patients, according to the HCPs. Several HCPs reacted to patient questions. “The question often comes from the patient, especially from the younger generation.” (Respondent 9) Some HCPs have incorporated the provision and inquiry of information about nutrition and nutritional supplements into their care. “But I do ask as standard how things are with the taste and appetite and if they have dry mucous membranes. And if I get a signal that things are not going well or I see the weight slowly decreasing, those are the moments when you give such advice.” (Respondent 2) In addition, HCPs noticed that patients themselves wanted to do everything they could to combat cancer and maintain control, ensuring that they were aware of all developments related to nutritional supplements. “There are quite a few people who are looking for alternatives and are involved with supplements.” (Respondent 6) Information sources The information sources HCPs consulted to stay informed about the nutrition and nutritional supplements advice included (national) scientifically based websites about nutrition and nutritional supplements, and questioning colleagues. Training sessions, guidelines, and scientific literature were also mentioned. Additionally, during the interviews, they indicated that they also made use of each other’s knowledge by seeking advice from dietitians, pharmacists, a taste physiotherapist, interdisciplinary discussions, and scientific based articles. “I often find it on www.voedingenkankerinfo.nl [a Dutch scientific website about nutrition and cancer], where I can usually find the information.” (Respondent 4) “…and we have a mailbox where we [HCPs] can ask questions [about nutritional supplements] to the pharmacists.” (Respondent 1) "(...) because I literally learned it by occasionally attending a colleague's consultation to hear how he or she explained it." (Respondent 3) Scientific basis of information and research Scientific evidence was not highlighted in the questionnaire's responses; however, during the interviews, most professionals emphasized the importance of providing advice. Most HCPs expressed a need for scientific evidence that is particularly focused on nutritional supplements when providing advice to patients, to ensure that their recommendations are safe and effective. “I want to provide advice on things that are scientifically substantiated and have medical content.” (Respondent 1) Most HCPs indicated that they advise against using nutritional supplements when their effects and potentially harmful interactions with systemic cancer treatment had not been scientifically studied. “So, try to avoid as much as possible doing anything that is not evidence-based.” (Respondent 8) Due to changes and developments in cancer care and nutritional supplements, it is difficult to keep track of everything. In addition, according to some respondents, there is limited evidence either supporting or discouraging the use of nutritional supplements. “There is minimal regular advice about supplements.” (Respondent 1) HCPs would appreciate a general, substantiated, evidence-based overview of nutritional supplements that patients may or may not take during their systemic cancer treatment. “A general overview that I can easily look up. Sometimes, people use specific herbs like turmeric... and I have to check each herb individually to see if it can be safely combined with their chemotherapy. I find that challenging; it would be much easier if this information was more readily available.” (Respondent 4) DISCUSSION This study explored the experiences and needs of HCPs regarding the provision of uniform guidance and information on nutrition and nutritional supplements to adult patients with cancer. Five key themes were identified: knowledge of nutrition and nutritional supplements, interdisciplinary care, patient-centered care, information sources, and (scientific) basis of nutrition information and research. Overall, HCPs reported having sufficient knowledge about nutrition and expressed a desire to further expand their understanding in this area. In contrast, their knowledge about nutritional supplements was limited. This limited knowledge regarding nutritional supplements is due to the lack of scientific research on the effects of these supplements throughout life, especially during systemic cancer treatment. Although some knowledge gaps and needs regarding nutrition and nutritional supplements were identified among HCPs in this study, our parallel study (van der Meij et al., unpublished data, 2026) showed that patients generally expressed confidence in their HCPs nutritional expertise and relied on them for guidance and managing nutrition-related symptoms when needed. Despite the trust that patients place in their HCPs, challenges remain regarding the consistency of information provision on nutrition and nutritional supplements, partly because nutrition is not a standard topic of discussion for every HCP. Approximately half of the HCPs reported that there is no uniform approach to providing nutritional information during cancer care. Additionally, some patients indicated that they received conflicting advice regarding nutrition and nutritional supplements, which may contribute to feelings of uncertainty or doubt. At the same time, they expressed a clear need for consistency and clarity in the information provided (van der Meij et al., unpublished data, 2026). Murphy et al.[ 15 ] concluded that strengthening HCPs’ confidence in providing evidence-based advice on both nutrition and nutritional supplements is essential for promoting greater consistency in nutritional care practices. However, this raises the question of how HCPs can be supported to gain knowledge and become more consistent in providing nutritional information and advice? Several studies have concluded that education could increase HCPs’ knowledge of nutrition and nutritional supplements[ 2 , 13 , 15 ]. This includes training in areas such as nutritional advice for specific types and stages of cancer, nutritional status assessment, alternative dietary approaches, and nutritional supplements[ 15 ]. This will lead to improved knowledge and consistency, which is also essential for delivering patient-centered nutritional care desired by both HCPs and patients[ 7 , 18 ]. Besides, HCPs seek guidelines to support their care practices, as these provide a foundation for scientific evidence that enhances consistency and quality. Murphy et al.[ 15 ] found that the use of guidelines varied among HCPs, highlighting the need for more uniform adherence. Both education and guidelines were identified by the HCPs in our study to support the provision of consistent, evidence-based nutritional care. HCPs also stressed the demand for scientific evidence, particularly regarding the use of nutritional supplements during cancer treatment. In contrast, patients are aware of the importance of scientific evidence but clearly pose that they would like more attention to complementary and alternative medicine in the hospital (van der Meij et al., unpublished data, 2026). However, this is a complex and often controversial issue. While some supplements may offer benefits in specific contexts, such as zinc supplementation which reduces the severity of oral mucositis during chemoradiation[ 23 ], other studies have linked supplement use to adverse outcomes. For instance, Smith et al.[ 24 ] and Mathijssen et al.[ 25 ] have shown that the use of St. John’s Wort may reduce the efficacy of chemotherapy and strongly recommended avoiding St. John’s Wort during systemic cancer treatment. These findings highlight the inconsistent and context-dependent nature of the evidence, which complicates the development of clear clinical guidance and poses challenges for HCPs seeking to provide individualized nutritional advice. This complexity emphasizes the need for a comprehensive overview that accommodates varying clinical scenarios. To address the reported needs and experiences of HCPs, nutritional care during cancer treatment should be delivered through an interdisciplinary approach, as it requires the combined expertise of various HCPs in oncology practice. Previous studies have emphasized that nutritional support and the use of supplements are the most effective when integrated into multidisciplinary cancer care[ 2 , 6 , 8 , 10 ]. Although our findings support the value of a multidisciplinary approach, they also reveal a lack of clarity regarding which HCPs are responsible for providing guidance on nutrition and supplement use. To improve the quality and consistency of nutritional care, clear role delineation and proactive integrated support should be prioritized within multidisciplinary oncology teams. Study strengths and limitations A key strength of this study was the use of a mixed-methods design. This approach allowed us not only to identify experiences and needs but also to gain a deeper understanding of the underlying reasons behind them. Several limitations should be considered. This study was conducted with nursing students, who have little research experience and limited experience in conducting interviews. This may have influenced the responses obtained depending on how the questions were asked. However, this can also be seen as a strength: students often bring a fresh, unbiased perspective and have time to conduct their work thoroughly. The study was conducted at a single center, which may affect the generalizability of findings to diverse healthcare settings. Implications for practice A complex issue in addressing all of the above needs, lies in the shifting dynamics of contemporary healthcare. To complement our findings, patient perspectives were also explored in a parallel qualitative study among patients with cancer (van der Meij et al., unpublished data, 2026). As a result, a comprehensive understanding of both HCPs and patient perspectives was achieved. Patients increasingly wish to be actively involved in their care by sharing their perspectives and participating in decision making. However, their views are often shaped by online content such as influencers and personal beliefs. This presents a challenge for HCPs, who must balance patient expectations with their professional responsibility to provide safe, evidence-based care[ 26 ]. This challenge is further intensified by the rapid pace of developments in oncology treatment, such as new types of systemic cancer therapies and the increasing attention to the use of nutritional supplements, making it increasingly difficult for HCPs to remain fully up to date. This raises important questions about the extent of knowledge that can reasonably be expected from HCPs, and where their responsibilities begin and end when advising patients on nutrition and supplement use. Artificial intelligence (AI) may offer valuable support by synthesizing evidence, identifying potential risks, and facilitating personalized guidance[ 27 ]. However, it should be noted that the reliability of this information depends on the sources utilized by AI. Conclusion This study emphasizes the need to improve HCPs’ knowledge and consistency regarding nutritional care during cancer care. Although general nutritional knowledge is well understood, nutritional supplements remain less familiar and are addressed with less confidence. Education, guideline awareness, and access to scientific evidence are crucial for enhancing HCPs’ knowledge. This not only improves their understanding of nutritional care, but also enables more effective communication with patients, leading to better-informed and personalized nutritional guidance. Additionally, the findings highlight the importance of mutual knowledge exchange among HCPs to reduce uncertainty. A clearer division of roles between HCPs, supported by education and interprofessional collaboration, may enhance the quality and personalization of nutritional care for patients with cancer. Declarations Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing Interests The authors have no relevant financial or non-financial interests to disclose. Author contributions Iris Nagtegaal and Floor Ploos van Amstel conceived the project and study, were involved in planning, and supervised the work. Iris Nagtegaal, Loes van Rijssen, Floor Ploos van Amstel processed the data and performed the analyses. Iris Nagtegaal, Loes van Rijssen, Floor Ploos van Amstel, Barbara van der Meij, Manon van den Berg, Anja de Kruif drafted the manuscript and designed the figures and tables. Iris Nagtegaal and Floor Ploos van Amstel were actively involved in planning, study coordination and healthcare professionals' recruitment. Petronella Ottevanger was in charge of overall direction and contributed to the final version of the manuscript. All authors provided critical feedback and helped shape the research, analysis, and manuscript. All authors read and approved the final manuscript. Ethics approval Ethical committee approval was not required for this research, as the study involved no medical interventions or risks to HCPs and was not covered by the Dutch WMO (Medical Research Involving Human Subjects Act). This study was conducted in accordance with the EU GDPR (General Data Protection Regulation). Consent to participate Informed consent was obtained from all individual participants included in the study. References Bossi P, Delrio P, Mascheroni A, Zanetti M. The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review. Nutrients. 2021;13(6):1980. https://doi.org/10.3390/nu13061980 Bossi P, De Luca R, Ciani O, D'Angelo E, Caccialanza R. Malnutrition management in oncology: An expert view on controversial issues and future perspectives. Front Oncol. 2022;12:910770. https://doi.org/10.3389/fonc.2022.910770 Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr. 2021;40(5):2898-913. https://doi.org/10.1016/j.clnu.2021.02.005 Baracos V, Martin L, Korc M, Guttridge D, Fearon K. Cancer-associated cachexia. Nat Rev Dis Primers. 2018;4:17105. https://doi.org/10.1038/nrdp.2017.105 Aprile G, Basile D, Giaretta R, Schiavo G, La Verde N, Corradi E, et al. The Clinical Value of Nutritional Care before and during Active Cancer Treatment. Nutrients. 2021;13(4):1196. https://doi.org/10.3390/nu13041196 Prado CM, Laviano A, Gillis C, Sung AD, Gardner M, Yalcin S, et al. Examining guidelines and new evidence in oncology nutrition: a position paper on gaps and opportunities in multimodal approaches to improve patient care. Support Care Cancer. 2022;30(4):3073-83. https://doi.org/10.1007/s00520-021-06661-4 Erickson N, Sulosaari V, Sullivan ES, Laviano A, van Ginkel-Res A, Remijnse W, et al. Nutrition Care in Cancer: An Overlooked Part of Patient-Centered Care. Semin Oncol Nurs. 2025;41(1):151799. https://doi.org/10.1016/j.soncn.2024.151799 Virizuela JA, Camblor-Alvarez M, Luengo-Perez LM, Grande E, Alvarez-Hernandez J, Sendros-Madrono MJ, et al. Nutritional support and parenteral nutrition in cancer patients: an expert consensus report. Clin Transl Oncol. 2018;20(5):619-29. https://doi.org/10.1007/s12094-017-1757-4 Soares CH, Beuren AG, Friedrich HJ, Gabrielli CP, Stefani GP, Steemburgo T. The Importance of Nutrition in Cancer Care: A Narrative Review. Curr Nutr Rep. 2024;13(4):950-65. https://doi.org/10.1007/s13668-024-00578-0 Kwok A, Palermo C, Boltong A. Dietary experiences and support needs of women who gain weight following chemotherapy for breast cancer. Support Care Cancer. 2015;23(6):1561-8. https://doi.org/10.1007/s00520-014-2496-5 Keaver L, O'Callaghan N, LaVertu AE, Semple CJ, Hughes CM, Hanna JR, et al. Experiences of cancer patients in receiving dietary advice from healthcare professionals and of healthcare professionals in providing this advice-a systematic review. J Cancer Surviv. 2024;18(4):1211-32. https://doi.org/10.1007/s11764-023-01359-4 Frenkel M, Sapire KJ, Lacey J, Zollman C, Sierpina VS. "What Should I Eat?"-Addressing Questions and Challenges Related to Nutrition in the Integrative Oncology Setting. Curr Oncol Rep. 2022;24(11):1557-67. https://doi.org/10.1007/s11912-022-01308-x van Veen MR, Hoedjes M, Versteegen JJ, van de Meulengraaf-Wilhelm N, Kampman E, Beijer S. Improving Oncology Nurses' Knowledge About Nutrition and Physical Activity for Cancer Survivors. Oncol Nurs Forum. 2017;44(4):488-96. https://doi.org/10.1188/17.ONF.488-496 de Kruif JTCM, Scholtens MB, van der Rijt J, de Boer MR, van den Berg MMGA, de Vries YC, et al. Perceptions of Dutch health care professionals on weight gain during chemotherapy in women with breast cancer. Support Care Cancer. 2019;27(2):601-7. https://doi.org/10.1007/s00520-018-4347-2 Murphy JL, Munir F, Davey F, Miller L, Cutress R, White R, et al. The provision of nutritional advice and care for cancer patients: a UK national survey of healthcare professionals. Support Care Cancer. 2021;29(5):2435-42. https://doi.org/10.1007/s00520-020-05736-y Harvie M. Nutritional supplements and cancer: potential benefits and proven harms. American Society of Clinical Oncology Educational Book. 2014;34(1):478-86. https://doi.org/10.14694/EdBook_AM.2014.34.e478 Zirpoli GR, Brennan PM, Hong CC, McCann SE, Ciupak G, Davis W, et al. Supplement use during an intergroup clinical trial for breast cancer (S0221). Breast Cancer Res Treat. 2013;137(3):903-13. https://doi.org/10.1007/s10549-012-2400-2 Polit D, Tatano Beck C. Nursing research: Generating and Assessing Evidence for Nursing Practice. Philadelphia: Wolters Kluwer; 2021. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77-101. https://doi.org/10.1191/1478088706qp063oa Moon MD. Triangulation: A Method to Increase Validity, Reliability, and Legitimation in Clinical Research. J Emerg Nurs. 2019;45(1):103-5. https://doi.org/10.1016/j.jen.2018.11.004 World Medical Association. World Medical Association Declaration of Helsinki. JAMA. 2013;310(20):2191-4. https://doi.org/10.1001/jama.2013.281053 GDPR.EU. General Data Protection Regulation (GDPR) [Available from: https://gdpr.eu/tag/gdpr/. Liu X, Zhang W, Chen Y, Rastogi S, Choudhury R. Effectiveness of zinc supplementation on the incidence of oral mucositis during chemotherapy and radiation: A meta‑analysis. Exp Ther Med. 2023;26(1). https://doi.org/10.3892/etm.2023.12046 Smith P, Bullock JM, Booker BM, Haas CE, Berenson CS, Jusko WJ. The influence of St. John's wort on the pharmacokinetics and protein binding of imatinib mesylate. Pharmacotherapy. 2004;24(11):1508-14. https://doi.org/10.1592/phco.24.16.1508.50958 Mathijssen R, Verweij J, de Bruijn P, Loos W, Sparreboom A. Effects of St. John’s Wort on Irinotecan Metabolism. J Natl Cancer Inst. 2002;94(16):1247-9. https://doi.org/10.1093/jnci/94.16.1247 Mesko B, deBronkart D, Dhunnoo P, Arvai N, Katonai G, Riggare S. The Evolution of Patient Empowerment and Its Impact on Health Care's Future. J Med Internet Res. 2025;27:e60562. https://doi.org/10.2196/60562 Salinari A, Machi M, Armas Diaz Y, Cianciosi D, Qi Z, Yang B, et al. The Application of Digital Technologies and Artificial Intelligence in Healthcare: An Overview on Nutrition Assessment. Diseases. 2023;11(3):97. https://doi.org/10.3390/diseases11030097 Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile1Interviewguide.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 01 Mar, 2026 Reviews received at journal 28 Feb, 2026 Reviews received at journal 23 Feb, 2026 Reviewers agreed at journal 11 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviewers invited by journal 08 Feb, 2026 Editor assigned by journal 08 Feb, 2026 Submission checks completed at journal 14 Jan, 2026 First submitted to journal 08 Jan, 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-8549682","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":589544979,"identity":"0d3b8ea7-d0f0-4df5-89e8-daedc732e54b","order_by":0,"name":"Iris EC Nagtegaal","email":"data:image/png;base64,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","orcid":"","institution":"Radboud University Nijmegen Medical Centre","correspondingAuthor":true,"prefix":"","firstName":"Iris","middleName":"EC","lastName":"Nagtegaal","suffix":""},{"id":589544980,"identity":"238768c2-0553-4a49-bdba-b6e6900543f0","order_by":1,"name":"Loes van Rijssen","email":"","orcid":"","institution":"Radboud University Nijmegen Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Loes","middleName":"van","lastName":"Rijssen","suffix":""},{"id":589544981,"identity":"aa681ba2-d75a-45ff-ba1c-9a4ea1b1e90f","order_by":2,"name":"Barbara S van der meij","email":"","orcid":"","institution":"HAN University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Barbara","middleName":"S van der","lastName":"meij","suffix":""},{"id":589544982,"identity":"e4e0e9c2-6e23-4154-8c32-c9d65bfebb58","order_by":3,"name":"Manon GA van den Berg","email":"","orcid":"","institution":"Radboud University Nijmegen Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Manon","middleName":"GA van den","lastName":"Berg","suffix":""},{"id":589544983,"identity":"07d46467-1b09-48fd-a32d-df1f00be0ea6","order_by":4,"name":"Anja JThCM de Kruif","email":"","orcid":"","institution":"HAN University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Anja","middleName":"JThCM","lastName":"de Kruif","suffix":""},{"id":589544984,"identity":"efd7c57c-4e28-4e51-8a5c-77c47f1f0d54","order_by":5,"name":"Petronella B Ottevanger","email":"","orcid":"","institution":"Radboud University Nijmegen Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Petronella","middleName":"B","lastName":"Ottevanger","suffix":""},{"id":589544985,"identity":"ddcc9766-0642-43af-b64c-6cbf1d7c040a","order_by":6,"name":"Floortje K Ploos van Amstel","email":"","orcid":"","institution":"Radboud University Nijmegen Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Floortje","middleName":"K Ploos van","lastName":"Amstel","suffix":""}],"badges":[],"createdAt":"2026-01-08 09:38:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8549682/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8549682/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102746482,"identity":"e5912e70-0d37-45b0-a9f8-6e32d3322dc8","added_by":"auto","created_at":"2026-02-16 08:57:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":654202,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8549682/v1/40059554-9c0f-406f-9cd2-90325468dc51.pdf"},{"id":102503489,"identity":"977848da-2b65-4867-a12e-e5bdedb64f57","added_by":"auto","created_at":"2026-02-12 11:03:46","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":27382,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile1Interviewguide.docx","url":"https://assets-eu.researchsquare.com/files/rs-8549682/v1/e7408bab82940bff1ebed8cf.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Experiences and Needs regarding Nutrition Information and Nutritional Supplements among Oncology Healthcare Professionals: A Sequential Exploratory Mixed-methods Study ","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMalnutrition affects up to 80% of patients with cancer and can lead to serious consequences, including impaired functional status, diminished quality of life, and poor survival[\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This underscores the importance of adequate nutrition, nutritional information, and optimal nutritional guidance for patients with cancer throughout their cancer trajectory[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Cancer itself as well as its therapy frequently lead to appetite loss, nausea and vomiting, diarrhea or constipation, and fatigue, all of which reduce nutrient intake and contribute to weight loss[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHealthcare professionals (HCPs) play an important role in identifying and discussing nutritional problems during patients\u0026rsquo; cancer trajectories. Adequate nutrition can help reduce treatment-related side effects in patients with cancer and enhance the strength and energy levels essential for tolerating and recovering from systemic cancer treatment, while also supporting the immune system[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMultiple studies have indicated that patients with cancer, their partners, and relatives report that they do not receive sufficient information regarding nutrition and nutritional supplements. As a result, they are frequently unaware of the available evidence-based information on nutrition and nutritional supplements[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Van Veen et al.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] concluded that HCPs in the Netherlands considered themselves to be insufficiently informed and confident in providing nutritional advice. Similarly, previous research by Kruif et al.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] showed that, while HCPs acknowledge the importance of nutritional issues, their knowledge, attitudes, and communication about nutrition vary considerably between professionals and settings. Furthermore, Murphy et al.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] also noted that awareness of guidelines among HCPs varied, which impacted consistency in practice and patient care improvement.\u003c/p\u003e \u003cp\u003eThe lack of high-quality evidence regarding the benefits and risks of nutritional supplement use is one of the factors contributing to the inconsistency and absence of nutritional guidance from HCPs[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Zirpoli et al.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] investigated the provision of nutritional supplement recommendations to patients with cancer and demonstrated that 51% of patients did not receive recommendations from HCPs regarding supplement use.\u003c/p\u003e \u003cp\u003eThese findings highlight the urgent need to further involve HCPs in providing guidance and information on nutrition to patients with cancer. To improve cancer care, it is important to investigate HCPs\u0026rsquo; experiences and needs concerning the provision of nutrition information during cancer trajectory. This study aimed to acquire a comprehensive understanding of the experiences and needs of HCPs regarding the provision of uniform guidance on nutrition and nutritional supplements to adult patients with cancer. To gain a comprehensive understanding, a parallel qualitative study was conducted to examine patients with cancer perspectives, wishes and needs regarding this important topic (van der Meij et al., unpublished data, 2026).\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign and study population\u003c/h2\u003e \u003cp\u003eThis study used an exploratory sequential mixed-methods design, wherein a quantitative phase was followed by a qualitative study[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Qualitative research was applied to understand the results of the quantitative study.\u003c/p\u003e \u003cp\u003eThe study population consisted of HCPs from the medical oncology department of a university medical center, including (oncology) nurses, clinical nurse specialists, physician assistants, residents, and medical oncologists.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData collection took place between April 2022 and May 2023.\u003c/p\u003e\n\u003ch3\u003eQuantitative data\u003c/h3\u003e\n\u003cp\u003eA digital questionnaire was sent to the participating HCPs. The questionnaire consisted of five sections: 1) demographic data; 2) frequency and indication(s) for providing nutritional advice to patients; 3) experiences and knowledge regarding the current advice on nutrition and nutritional supplements; 4) needs; 5) the extent to which they perceived or experienced a standardized approach in providing recommendations on nutrition and nutritional supplements in their medical oncology department. The questionnaire included both closed and open-ended questions. Filtering questions allowed the HCPs to skip questions that were not applicable to them. Content validity was assessed by a panel of four experts (i.e., nursing scientists, clinical nurse specialist, and teachers from the [blinded for peer review]) in cancer care. They evaluated whether the instrument contained an appropriate set of relevant items that comprehensively represented the full content of the construct domain being measured[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eQualitative data\u003c/h3\u003e\n\u003cp\u003eThe semi-structured interviews were based on an interview guide that incorporated topics derived from both literature and insights gained from the quantitative phase of the study (Appendix 1). Subsequently, the guide was reviewed, revised, and approved by a panel of three experts (FP, LR, IN). These topics included experiences related to providing nutritional advice, evidence-based practice, collaboration, and perceived needs. A pilot interview with a clinical nurse specialist was conducted to test the interview guide. The data collected from this pilot interview were not included in the results.\u003c/p\u003e \u003cp\u003eSemi-structured interviews were conducted with HCPs who met the inclusion criteria. Participants were selected through purposive sampling. To ensure a diverse range of experiences and needs from distinct roles, the principle of differentiation was applied by intentionally selecting HCPs from various professional roles (oncology nurses, clinical nurse specialists, physician assistants, medical residents, and medical oncologists).\u003c/p\u003e \u003cp\u003eThe interviews, with a duration of 30\u0026ndash;40 minutes, were facilitated by pairs of trained nursing students. Each interview was audio recorded using digital equipment.\u003c/p\u003e\n\u003ch3\u003eData analyses\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative data\u003c/h2\u003e \u003cp\u003eQuantitative data were analyzed using IBM SPSS Statistics software, version 25.0 (IBM SPSS Statistics, Armonk, NY). Descriptive statistics were used to describe the demographic data. The results of the closed-ended questions were processed as numbers and percentages. Responses to the open-ended questions were used to complement the interpretation of the closed questions. The answers were compared and grouped into descriptive data.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQualitative data\u003c/h3\u003e\n\u003cp\u003eA thematic analysis was conducted as described by Braun and Clarke[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This analysis enabled researchers to explore and understand the complexity and nuances of qualitative data to gain profound insights into the experiences, perspectives, and behaviors of individuals[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEach interview was transcribed verbatim by four trained students and anonymized before being imported into a qualitative data management program (ATLAS.ti for Windows, V 8.0). All transcripts were reviewed by three researchers (FP, LR, IN) and concepts and ideas for coding were developed. Subsequently, the interviews were assigned to the three researchers. Each interview was coded by at least two researchers. After coding each interview, a consensus meeting was held to resolve discrepancies in coding through discussion until consensus was reached (FP, LR, IN). Themes and subthemes were generated through an iterative process, including discussions with the research team (FP, LR, IN, BM, MB).\u003c/p\u003e\n\u003ch3\u003eData triangulation\u003c/h3\u003e\n\u003cp\u003eThis study employed methodological triangulation using a quantitative method to initially assess HCPs\u0026rsquo; experiences and needs regarding nutrition and nutritional supplements, followed by a qualitative method[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. To integrate the qualitative and quantitative data, the research team merged the findings to obtain a profound understanding of HCPs\u0026rsquo; experiences and needs regarding nutrition and nutritional supplements. Consistent with Moon\u0026rsquo;s[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] view of triangulation as a strategy to enhance validity, reliability, and legitimation, both datasets were compared to identify similarities, differences, and complementary perspectives. The qualitative phase offered a deeper understanding and contextualization of the quantitative patterns, further reinforcing the validity and applicability of the results. This integration process formed the basis for the overarching themes described in the results section.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eEthical committee approval was not required for this research, as the study involved no medical interventions or risks to HCPs and was not covered by the Dutch WMO (Medical Research Involving Human Subjects Act). The questionnaires were anonymous. The interview recordings were securely erased after transcription, and the transcriptions were anonymized. The HCPs agreed to participate in the study by signing an informed consent form. This study was conducted in accordance with the EU GDPR (General Data Protection Regulation)[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative data\u003c/h2\u003e \u003cp\u003eThe questionnaire was distributed to 96 HCPs who met the inclusion criteria, of whom 32 (33%) completed the questionnaire. The study population consisted of three males and 29 females, and most of them were (oncology) nurses (n\u0026thinsp;=\u0026thinsp;21, 66%). The respondents\u0026rsquo; demographic characteristics are reported in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. In total, 16 (50%) HCPs indicated that they provide information or guidance on nutrition, 2 (6%) focused on nutritional supplements, and 14 (44%) HCPs gave information on both to patients.\u003c/p\u003e \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e - Demographic Characteristics of HCPs (N=32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAge, median (range), y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e43 (25-65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e3 (9)\u003c/p\u003e\n \u003cp\u003e29 (91)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eProfession\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; (Oncology) nurse\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Clinical nurse specialist\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Resident\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Medical oncologist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e21 (66)\u003c/p\u003e\n \u003cp\u003e3 (9)\u003c/p\u003e\n \u003cp\u003e2 (6)\u003c/p\u003e\n \u003cp\u003e6 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eDepartment\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Nursing department\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Outpatient clinic\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Day care unit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e12 (38)\u003c/p\u003e\n \u003cp\u003e16 (50)\u003c/p\u003e\n \u003cp\u003e4 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eYears of experience\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 0-5 y\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 6-15 y\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 16-25 y\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026gt;25 y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e16 (50)\u003c/p\u003e\n \u003cp\u003e7 (22)\u003c/p\u003e\n \u003cp\u003e4 (13)\u003c/p\u003e\n \u003cp\u003e5 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eHCPs, healthcare professionals; n, number; y, years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003c/br\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eQualitative data\u003c/h2\u003e \u003cp\u003eNine HCPs participated in qualitative interviews. Among them were one physician assistant, two medical oncologists, one medical resident, four oncology nurses, and one clinical nurse specialist.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFindings integration quantitative and qualitative data\u003c/h2\u003e \u003cp\u003eThrough the comprehensive merging and integration of quantitative and qualitative data, five themes were identified: knowledge of nutrition and nutritional supplements, interdisciplinary care, patient-centered care, information sources, and (scientific) basis of nutrition information and research.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge of nutrition and nutritional supplements\u003c/h2\u003e \u003cp\u003eTwenty-five (78%) HCPs reported that they had sufficient knowledge to provide nutritional advice. A desire to expand knowledge was mentioned by 20 (63%) HCPs. The interviews showed that most HCPs reported having adequate (basic) knowledge about nutrition.\u003c/p\u003e \u003cp\u003e\"Well, I do have quite a bit of general knowledge about nutrition in cancer, particularly in terms of the advice we provide to patients with cancer.\" (Respondent 7)\u003c/p\u003e \u003cp\u003eIn the context of advising on nutritional supplements, 25 (78%) HCPs reported wanting to gain more knowledge, indicating a need to strengthen their general understanding. In addition, 27 (84%) HCPs expressed the need to expand their existing expertise, for example, through clinical training sessions or patient case discussions.\u003c/p\u003e \u003cp\u003eOne of the challenging factors identified by HCPs in providing advice about nutritional supplements was that the questions posed and the supplements used by patients were diverse.\u003c/p\u003e \u003cp\u003e\u0026ldquo;For me it is more difficult when people use various supplements, and I am not exactly sure what is in them. I find that difficult sometimes, so sometimes I ask for the label of the product or request that people bring it with them so I can check it.\u0026rdquo; (Respondent 3)\u003c/p\u003e \u003cp\u003eHCPs expressed the need to provide clear advice on whether a food product or nutritional supplement is permitted and whether it can be used safely. Several HCPs expressed a desire for a comprehensive overview of what is allowed in relation to specific types of systemic cancer medication.\u003c/p\u003e \u003cp\u003e\u0026ldquo;So, a wish for perhaps an overview of nutritional supplements and a wish that you might receive information [regarding developments of nutrition and nutritional supplements] once a year.\u0026rdquo; (Respondent 6)\u003c/p\u003e \u003cp\u003eSeveral HCPs indicated that they knew where to seek information and who to consult regarding nutrition and nutritional supplements when their knowledge was insufficient. Nonetheless, they were eager to expand their knowledge in several ways.\u003c/p\u003e \u003cp\u003e\u0026ldquo;(\u0026hellip;) inviting a dietitian would be nice, and we could then save up our questions about what they would advise in certain situations.\u0026rdquo; (Respondent 1)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eInterdisciplinary care\u003c/h2\u003e \u003cp\u003eProviding advice about nutrition and nutritional supplements was offered by all HCPs (n\u0026thinsp;=\u0026thinsp;32, 100%), and they considered this part of their professional responsibility. Regarding nutrition information, 14 (44%) HCPs experienced a uniform working method within their department. They perceived this uniformity as clear in their internal communication as discussions among colleagues revealed no discrepancies in the advice provided to patients. HCPs who did not experience a uniform working method (56%, n\u0026thinsp;=\u0026thinsp;18) reported that a wide range of varying and changing advice was provided to the patients. Regarding nutritional supplements, 25 HCPs (78%) reported that they did not experience a uniform working method. They experienced limited alignment on this topic among HCPs, which resulted in a lack of awareness of each other\u0026rsquo;s approaches and advice.\u003c/p\u003e \u003cp\u003eMost of the HCPs interviewed indicated that they collaborated with other disciplines when providing advice about nutrition and nutritional supplements. For example, some HCPs reported referring patients to a dietitian when nutritional inquiries became specific, when a patient had complex nutritional issues, or when energy requirements needed to be calculated.\u003c/p\u003e \u003cp\u003e\u0026ldquo;In general, I think I manage quite well. When things get more specific, I do need a bit more support.\u0026rdquo; (Respondent 7)\u003c/p\u003e \u003cp\u003eThe topics of nutrition and nutritional supplements were not routinely discussed among HCPs. Nutritional topics were occasionally addressed in case discussions, such as when initiating interventions like enteral feeding, or when a relevant study on nutrition is highlighted.\u003c/p\u003e \u003cp\u003e\"Well, not specifically about nutrition. But if there are questions, we can discuss it. We do have collaborative moments with colleagues, but not about nutrition. No, it is somewhat of a neglected topic.\" (Respondent 8)\u003c/p\u003e \u003cp\u003e\u0026ldquo;(\u0026hellip;) that I would prefer having more conversations about this with oncologists and dietitians. I would actually have a need for that.\u0026rdquo; (Respondent 6)\u003c/p\u003e \u003cp\u003eThe HCPs indicated that they were not always aware of which information about nutrition or nutritional supplements their colleagues had shared with their patients.\u003c/p\u003e \u003cp\u003e\u0026ldquo;I think we assume that we are roughly saying the same thing and using the same approach.\u0026rdquo; (Respondent 6)\u003c/p\u003e \u003cp\u003eOpinions varied regarding who is responsible for providing advice on nutrition and nutritional supplements. The HCPs expressed a need for clarity regarding who holds which responsibilities. Regarding the provision of nutritional advice, HCPs (including nurses) believe that this responsibility lies with nurses.\u003c/p\u003e \u003cp\u003eWhen it came to nutritional supplements' advice, the situation became more complex. The responsibility of providing advice about nutritional supplements was perceived differently by the HCPs. Nurses indicated that they provide little or no advice about this and are not always sure who is responsible:\u003c/p\u003e \u003cp\u003e\u0026ldquo;And that becomes a bit of a point of discussion: is this the responsibility of the physician, or perhaps of others?\u0026rdquo; (Respondent 6)\u003c/p\u003e \u003cp\u003e\u0026ldquo;The oncologist prescribes chemotherapy, so they should also say whether it is allowed to use turmeric or CBD oil or whatever, yes.\u0026rdquo; (Respondent 5)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003ePatient-centered care\u003c/h2\u003e \u003cp\u003eAbout half of the HCPs (n\u0026thinsp;=\u0026thinsp;17, 53%) reported receiving patients\u0026rsquo; inquiries about nutrition and nutritional supplements on a weekly basis. Most HCPs (n\u0026thinsp;=\u0026thinsp;25, 78%) noted that they were usually able to answer these questions. The initiative to discuss nutrition and nutritional supplements with patients varied among HCPs. Specifically, nine HCPs (28%) never or rarely initiate such discussions; 14 (44%) sometimes do, and 9 (28%) usually or always do. Examples of patient inquiries about nutrition include raw food, alcohol, sugar-free products, protein, and healthy eating. Questions about nutritional supplements include herbs, vitamins, fish oil, turmeric, and cannabis oil.\u003c/p\u003e \u003cp\u003eHCPs reported that patient-related factors, such as the type of cancer, stage of the disease, and emotional well-being, contribute to the process of providing information about nutrition and nutritional supplements.\u003c/p\u003e \u003cp\u003e\u0026ldquo;(\u0026hellip;) in a care pathway involving stomach, intestinal, and liver cancer, there are numerous issues in the stomach, intestinal, and liver areas, so it is indeed a very significant challenge.\u0026rdquo; (Respondent 5)\u003c/p\u003e \u003cp\u003eThe initiative for asking questions about nutrition and nutritional supplements primarily lay with the patients, according to the HCPs. Several HCPs reacted to patient questions.\u003c/p\u003e \u003cp\u003e\u0026ldquo;The question often comes from the patient, especially from the younger generation.\u0026rdquo; (Respondent 9)\u003c/p\u003e \u003cp\u003eSome HCPs have incorporated the provision and inquiry of information about nutrition and nutritional supplements into their care.\u003c/p\u003e \u003cp\u003e\u0026ldquo;But I do ask as standard how things are with the taste and appetite and if they have dry mucous membranes. And if I get a signal that things are not going well or I see the weight slowly decreasing, those are the moments when you give such advice.\u0026rdquo; (Respondent 2)\u003c/p\u003e \u003cp\u003eIn addition, HCPs noticed that patients themselves wanted to do everything they could to combat cancer and maintain control, ensuring that they were aware of all developments related to nutritional supplements.\u003c/p\u003e \u003cp\u003e\u0026ldquo;There are quite a few people who are looking for alternatives and are involved with supplements.\u0026rdquo; (Respondent 6)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eInformation sources\u003c/h2\u003e \u003cp\u003eThe information sources HCPs consulted to stay informed about the nutrition and nutritional supplements advice included (national) scientifically based websites about nutrition and nutritional supplements, and questioning colleagues. Training sessions, guidelines, and scientific literature were also mentioned. Additionally, during the interviews, they indicated that they also made use of each other\u0026rsquo;s knowledge by seeking advice from dietitians, pharmacists, a taste physiotherapist, interdisciplinary discussions, and scientific based articles.\u003c/p\u003e \u003cp\u003e\u0026ldquo;I often find it on \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.voedingenkankerinfo.nl\u003c/span\u003e\u003cspan address=\"http://www.voedingenkankerinfo.nl\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [a Dutch scientific website about nutrition and cancer], where I can usually find the information.\u0026rdquo; (Respondent 4)\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u0026hellip;and we have a mailbox where we [HCPs] can ask questions [about nutritional supplements] to the pharmacists.\u0026rdquo; (Respondent 1)\u003c/p\u003e \u003cp\u003e\"(...) because I literally learned it by occasionally attending a colleague's consultation to hear how he or she explained it.\" (Respondent 3)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eScientific basis of information and research\u003c/h2\u003e \u003cp\u003eScientific evidence was not highlighted in the questionnaire's responses; however, during the interviews, most professionals emphasized the importance of providing advice. Most HCPs expressed a need for scientific evidence that is particularly focused on nutritional supplements when providing advice to patients, to ensure that their recommendations are safe and effective.\u003c/p\u003e \u003cp\u003e\u0026ldquo;I want to provide advice on things that are scientifically substantiated and have medical content.\u0026rdquo; (Respondent 1)\u003c/p\u003e \u003cp\u003eMost HCPs indicated that they advise against using nutritional supplements when their effects and potentially harmful interactions with systemic cancer treatment had not been scientifically studied.\u003c/p\u003e \u003cp\u003e\u0026ldquo;So, try to avoid as much as possible doing anything that is not evidence-based.\u0026rdquo; (Respondent 8)\u003c/p\u003e \u003cp\u003eDue to changes and developments in cancer care and nutritional supplements, it is difficult to keep track of everything. In addition, according to some respondents, there is limited evidence either supporting or discouraging the use of nutritional supplements.\u003c/p\u003e \u003cp\u003e\u0026ldquo;There is minimal regular advice about supplements.\u0026rdquo; (Respondent 1)\u003c/p\u003e \u003cp\u003eHCPs would appreciate a general, substantiated, evidence-based overview of nutritional supplements that patients may or may not take during their systemic cancer treatment.\u003c/p\u003e \u003cp\u003e\u0026ldquo;A general overview that I can easily look up. Sometimes, people use specific herbs like turmeric... and I have to check each herb individually to see if it can be safely combined with their chemotherapy. I find that challenging; it would be much easier if this information was more readily available.\u0026rdquo; (Respondent 4)\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study explored the experiences and needs of HCPs regarding the provision of uniform guidance and information on nutrition and nutritional supplements to adult patients with cancer. Five key themes were identified: knowledge of nutrition and nutritional supplements, interdisciplinary care, patient-centered care, information sources, and (scientific) basis of nutrition information and research.\u003c/p\u003e \u003cp\u003eOverall, HCPs reported having sufficient knowledge about nutrition and expressed a desire to further expand their understanding in this area. In contrast, their knowledge about nutritional supplements was limited. This limited knowledge regarding nutritional supplements is due to the lack of scientific research on the effects of these supplements throughout life, especially during systemic cancer treatment. Although some knowledge gaps and needs regarding nutrition and nutritional supplements were identified among HCPs in this study, our parallel study (van der Meij et al., unpublished data, 2026) showed that patients generally expressed confidence in their HCPs nutritional expertise and relied on them for guidance and managing nutrition-related symptoms when needed. Despite the trust that patients place in their HCPs, challenges remain regarding the consistency of information provision on nutrition and nutritional supplements, partly because nutrition is not a standard topic of discussion for every HCP. Approximately half of the HCPs reported that there is no uniform approach to providing nutritional information during cancer care. Additionally, some patients indicated that they received conflicting advice regarding nutrition and nutritional supplements, which may contribute to feelings of uncertainty or doubt. At the same time, they expressed a clear need for consistency and clarity in the information provided (van der Meij et al., unpublished data, 2026). Murphy et al.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] concluded that strengthening HCPs\u0026rsquo; confidence in providing evidence-based advice on both nutrition and nutritional supplements is essential for promoting greater consistency in nutritional care practices. However, this raises the question of how HCPs can be supported to gain knowledge and become more consistent in providing nutritional information and advice?\u003c/p\u003e \u003cp\u003eSeveral studies have concluded that education could increase HCPs\u0026rsquo; knowledge of nutrition and nutritional supplements[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This includes training in areas such as nutritional advice for specific types and stages of cancer, nutritional status assessment, alternative dietary approaches, and nutritional supplements[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This will lead to improved knowledge and consistency, which is also essential for delivering patient-centered nutritional care desired by both HCPs and patients[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Besides, HCPs seek guidelines to support their care practices, as these provide a foundation for scientific evidence that enhances consistency and quality. Murphy et al.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] found that the use of guidelines varied among HCPs, highlighting the need for more uniform adherence. Both education and guidelines were identified by the HCPs in our study to support the provision of consistent, evidence-based nutritional care.\u003c/p\u003e \u003cp\u003eHCPs also stressed the demand for scientific evidence, particularly regarding the use of nutritional supplements during cancer treatment. In contrast, patients are aware of the importance of scientific evidence but clearly pose that they would like more attention to complementary and alternative medicine in the hospital (van der Meij et al., unpublished data, 2026). However, this is a complex and often controversial issue. While some supplements may offer benefits in specific contexts, such as zinc supplementation which reduces the severity of oral mucositis during chemoradiation[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], other studies have linked supplement use to adverse outcomes. For instance, Smith et al.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and Mathijssen et al.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] have shown that the use of St. John\u0026rsquo;s Wort may reduce the efficacy of chemotherapy and strongly recommended avoiding St. John\u0026rsquo;s Wort during systemic cancer treatment. These findings highlight the inconsistent and context-dependent nature of the evidence, which complicates the development of clear clinical guidance and poses challenges for HCPs seeking to provide individualized nutritional advice. This complexity emphasizes the need for a comprehensive overview that accommodates varying clinical scenarios.\u003c/p\u003e \u003cp\u003eTo address the reported needs and experiences of HCPs, nutritional care during cancer treatment should be delivered through an interdisciplinary approach, as it requires the combined expertise of various HCPs in oncology practice. Previous studies have emphasized that nutritional support and the use of supplements are the most effective when integrated into multidisciplinary cancer care[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Although our findings support the value of a multidisciplinary approach, they also reveal a lack of clarity regarding which HCPs are responsible for providing guidance on nutrition and supplement use. To improve the quality and consistency of nutritional care, clear role delineation and proactive integrated support should be prioritized within multidisciplinary oncology teams.\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eStudy strengths and limitations\u003c/h2\u003e \u003cp\u003eA key strength of this study was the use of a mixed-methods design. This approach allowed us not only to identify experiences and needs but also to gain a deeper understanding of the underlying reasons behind them.\u003c/p\u003e \u003cp\u003eSeveral limitations should be considered. This study was conducted with nursing students, who have little research experience and limited experience in conducting interviews. This may have influenced the responses obtained depending on how the questions were asked. However, this can also be seen as a strength: students often bring a fresh, unbiased perspective and have time to conduct their work thoroughly. The study was conducted at a single center, which may affect the generalizability of findings to diverse healthcare settings.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eImplications for practice\u003c/h2\u003e \u003cp\u003eA complex issue in addressing all of the above needs, lies in the shifting dynamics of contemporary healthcare. To complement our findings, patient perspectives were also explored in a parallel qualitative study among patients with cancer (van der Meij et al., unpublished data, 2026). As a result, a comprehensive understanding of both HCPs and patient perspectives was achieved. Patients increasingly wish to be actively involved in their care by sharing their perspectives and participating in decision making. However, their views are often shaped by online content such as influencers and personal beliefs. This presents a challenge for HCPs, who must balance patient expectations with their professional responsibility to provide safe, evidence-based care[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This challenge is further intensified by the rapid pace of developments in oncology treatment, such as new types of systemic cancer therapies and the increasing attention to the use of nutritional supplements, making it increasingly difficult for HCPs to remain fully up to date. This raises important questions about the extent of knowledge that can reasonably be expected from HCPs, and where their responsibilities begin and end when advising patients on nutrition and supplement use. Artificial intelligence (AI) may offer valuable support by synthesizing evidence, identifying potential risks, and facilitating personalized guidance[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, it should be noted that the reliability of this information depends on the sources utilized by AI.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study emphasizes the need to improve HCPs\u0026rsquo; knowledge and consistency regarding nutritional care during cancer care. Although general nutritional knowledge is well understood, nutritional supplements remain less familiar and are addressed with less confidence. Education, guideline awareness, and access to scientific evidence are crucial for enhancing HCPs\u0026rsquo; knowledge. This not only improves their understanding of nutritional care, but also enables more effective communication with patients, leading to better-informed and personalized nutritional guidance. Additionally, the findings highlight the importance of mutual knowledge exchange among HCPs to reduce uncertainty. A clearer division of roles between HCPs, supported by education and interprofessional collaboration, may enhance the quality and personalization of nutritional care for patients with cancer.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003eCompeting Interests\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eIris Nagtegaal and Floor Ploos van Amstel conceived the project and study, were involved in planning, and supervised the work.\u003c/p\u003e\n\u003cp\u003eIris Nagtegaal, Loes van Rijssen, Floor Ploos van Amstel processed the data and performed the analyses.\u003c/p\u003e\n\u003cp\u003eIris Nagtegaal, Loes van Rijssen, Floor Ploos van Amstel, Barbara van der Meij, Manon van den Berg, Anja de Kruif drafted the manuscript and designed the figures and tables.\u003c/p\u003e\n\u003cp\u003eIris Nagtegaal and Floor Ploos van Amstel were actively involved in planning, study coordination and healthcare professionals\u0026apos; recruitment.\u003c/p\u003e\n\u003cp\u003ePetronella Ottevanger was in charge of overall direction and contributed to the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors provided critical feedback and helped shape the research, analysis, and manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthics approval\u003c/p\u003e\n\u003cp\u003eEthical committee approval was not required for this research, as the study involved no medical interventions or risks to HCPs and was not covered by the Dutch WMO (Medical Research Involving Human Subjects Act). This study was conducted in accordance with the EU GDPR (General Data Protection Regulation).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent to participate\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBossi P, Delrio P, Mascheroni A, Zanetti M. The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review. Nutrients. 2021;13(6):1980. https://doi.org/10.3390/nu13061980\u003c/li\u003e\n\u003cli\u003eBossi P, De Luca R, Ciani O, D\u0026apos;Angelo E, Caccialanza R. Malnutrition management in oncology: An expert view on controversial issues and future perspectives. Front Oncol. 2022;12:910770. https://doi.org/10.3389/fonc.2022.910770\u003c/li\u003e\n\u003cli\u003eMuscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr. 2021;40(5):2898-913. https://doi.org/10.1016/j.clnu.2021.02.005\u003c/li\u003e\n\u003cli\u003eBaracos V, Martin L, Korc M, Guttridge D, Fearon K. Cancer-associated cachexia. Nat Rev Dis Primers. 2018;4:17105. https://doi.org/10.1038/nrdp.2017.105\u003c/li\u003e\n\u003cli\u003eAprile G, Basile D, Giaretta R, Schiavo G, La Verde N, Corradi E, et al. The Clinical Value of Nutritional Care before and during Active Cancer Treatment. Nutrients. 2021;13(4):1196. https://doi.org/10.3390/nu13041196\u003c/li\u003e\n\u003cli\u003ePrado CM, Laviano A, Gillis C, Sung AD, Gardner M, Yalcin S, et al. Examining guidelines and new evidence in oncology nutrition: a position paper on gaps and opportunities in multimodal approaches to improve patient care. Support Care Cancer. 2022;30(4):3073-83. https://doi.org/10.1007/s00520-021-06661-4\u003c/li\u003e\n\u003cli\u003eErickson N, Sulosaari V, Sullivan ES, Laviano A, van Ginkel-Res A, Remijnse W, et al. Nutrition Care in Cancer: An Overlooked Part of Patient-Centered Care. Semin Oncol Nurs. 2025;41(1):151799. https://doi.org/10.1016/j.soncn.2024.151799\u003c/li\u003e\n\u003cli\u003eVirizuela JA, Camblor-Alvarez M, Luengo-Perez LM, Grande E, Alvarez-Hernandez J, Sendros-Madrono MJ, et al. Nutritional support and parenteral nutrition in cancer patients: an expert consensus report. Clin Transl Oncol. 2018;20(5):619-29. https://doi.org/10.1007/s12094-017-1757-4\u003c/li\u003e\n\u003cli\u003eSoares CH, Beuren AG, Friedrich HJ, Gabrielli CP, Stefani GP, Steemburgo T. The Importance of Nutrition in Cancer Care: A Narrative Review. Curr Nutr Rep. 2024;13(4):950-65. https://doi.org/10.1007/s13668-024-00578-0\u003c/li\u003e\n\u003cli\u003eKwok A, Palermo C, Boltong A. Dietary experiences and support needs of women who gain weight following chemotherapy for breast cancer. Support Care Cancer. 2015;23(6):1561-8. https://doi.org/10.1007/s00520-014-2496-5\u003c/li\u003e\n\u003cli\u003eKeaver L, O\u0026apos;Callaghan N, LaVertu AE, Semple CJ, Hughes CM, Hanna JR, et al. Experiences of cancer patients in receiving dietary advice from healthcare professionals and of healthcare professionals in providing this advice-a systematic review. J Cancer Surviv. 2024;18(4):1211-32. https://doi.org/10.1007/s11764-023-01359-4\u003c/li\u003e\n\u003cli\u003eFrenkel M, Sapire KJ, Lacey J, Zollman C, Sierpina VS. \u0026quot;What Should I Eat?\u0026quot;-Addressing Questions and Challenges Related to Nutrition in the Integrative Oncology Setting. Curr Oncol Rep. 2022;24(11):1557-67. https://doi.org/10.1007/s11912-022-01308-x\u003c/li\u003e\n\u003cli\u003evan Veen MR, Hoedjes M, Versteegen JJ, van de Meulengraaf-Wilhelm N, Kampman E, Beijer S. Improving Oncology Nurses\u0026apos; Knowledge About Nutrition and Physical Activity for Cancer Survivors. Oncol Nurs Forum. 2017;44(4):488-96. https://doi.org/10.1188/17.ONF.488-496\u003c/li\u003e\n\u003cli\u003ede Kruif JTCM, Scholtens MB, van der Rijt J, de Boer MR, van den Berg MMGA, de Vries YC, et al. Perceptions of Dutch health care professionals on weight gain during chemotherapy in women with breast cancer. Support Care Cancer. 2019;27(2):601-7. https://doi.org/10.1007/s00520-018-4347-2\u003c/li\u003e\n\u003cli\u003eMurphy JL, Munir F, Davey F, Miller L, Cutress R, White R, et al. The provision of nutritional advice and care for cancer patients: a UK national survey of healthcare professionals. Support Care Cancer. 2021;29(5):2435-42. https://doi.org/10.1007/s00520-020-05736-y\u003c/li\u003e\n\u003cli\u003eHarvie M. Nutritional supplements and cancer: potential benefits and proven harms. American Society of Clinical Oncology Educational Book. 2014;34(1):478-86. https://doi.org/10.14694/EdBook_AM.2014.34.e478\u003c/li\u003e\n\u003cli\u003eZirpoli GR, Brennan PM, Hong CC, McCann SE, Ciupak G, Davis W, et al. Supplement use during an intergroup clinical trial for breast cancer (S0221). Breast Cancer Res Treat. 2013;137(3):903-13. https://doi.org/10.1007/s10549-012-2400-2\u003c/li\u003e\n\u003cli\u003ePolit D, Tatano Beck C. Nursing research: Generating and Assessing Evidence for Nursing Practice. Philadelphia: Wolters Kluwer; 2021.\u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77-101. https://doi.org/10.1191/1478088706qp063oa\u003c/li\u003e\n\u003cli\u003eMoon MD. Triangulation: A Method to Increase Validity, Reliability, and Legitimation in Clinical Research. J Emerg Nurs. 2019;45(1):103-5. https://doi.org/10.1016/j.jen.2018.11.004\u003c/li\u003e\n\u003cli\u003eWorld Medical Association. World Medical Association Declaration of Helsinki. JAMA. 2013;310(20):2191-4. https://doi.org/10.1001/jama.2013.281053\u003c/li\u003e\n\u003cli\u003eGDPR.EU. General Data Protection Regulation (GDPR) [Available from: https://gdpr.eu/tag/gdpr/.\u003c/li\u003e\n\u003cli\u003eLiu X, Zhang W, Chen Y, Rastogi S, Choudhury R. Effectiveness of zinc supplementation on the incidence of oral mucositis during chemotherapy and radiation: A meta‑analysis. Exp Ther Med. 2023;26(1). https://doi.org/10.3892/etm.2023.12046\u003c/li\u003e\n\u003cli\u003eSmith P, Bullock JM, Booker BM, Haas CE, Berenson CS, Jusko WJ. The influence of St. John\u0026apos;s wort on the pharmacokinetics and protein binding of imatinib mesylate. Pharmacotherapy. 2004;24(11):1508-14. https://doi.org/10.1592/phco.24.16.1508.50958\u003c/li\u003e\n\u003cli\u003eMathijssen R, Verweij J, de Bruijn P, Loos W, Sparreboom A. Effects of St. John\u0026rsquo;s Wort on Irinotecan Metabolism. J Natl Cancer Inst. 2002;94(16):1247-9. https://doi.org/10.1093/jnci/94.16.1247\u003c/li\u003e\n\u003cli\u003eMesko B, deBronkart D, Dhunnoo P, Arvai N, Katonai G, Riggare S. The Evolution of Patient Empowerment and Its Impact on Health Care\u0026apos;s Future. J Med Internet Res. 2025;27:e60562. https://doi.org/10.2196/60562\u003c/li\u003e\n\u003cli\u003eSalinari A, Machi M, Armas Diaz Y, Cianciosi D, Qi Z, Yang B, et al. The Application of Digital Technologies and Artificial Intelligence in Healthcare: An Overview on Nutrition Assessment. Diseases. 2023;11(3):97. https://doi.org/10.3390/diseases11030097\u003c/li\u003e\n\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":"Cancer, experiences, healthcare professionals, nutrition information, nutrition needs, nutritional supplements","lastPublishedDoi":"10.21203/rs.3.rs-8549682/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8549682/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis study aimed to acquire a comprehensive understanding of the experiences and needs of HCPs in a university medical center at the medical oncology department regarding the provision of uniform information on nutrition and nutritional supplements to adult patients with cancer.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis exploratory sequential mixed-methods study employed an online questionnaire that was sent to HCPs and included questions on indications for providing nutrition advice, knowledge about nutrition and nutritional supplements, and needs regarding providing uniform advice about these topics. This was followed by semi-structured interviews with HCPs to gain deeper insights into their experiences and needs.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThirty-two HCPs completed the questionnaire, and nine HCPs participated in semi-structured interviews. The results identified five themes: knowledge of nutrition and nutritional supplements, interdisciplinary care, patient-centered care, information sources, and (scientific) basis of nutrition information and research.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study highlights the need to improve HCPs\u0026rsquo; knowledge and consistency regarding nutritional care. Although general nutritional knowledge is well established, familiarity with nutritional supplements remains limited, and individuals tend to approach them with less confidence. Education, awareness of guidelines, evidence-based information, a clearer division of roles between HCPs, and interprofessional collaboration are key to improving confidence, quality, and delivering personalized nutritional support in oncology.\u003c/p\u003e","manuscriptTitle":"Experiences and Needs regarding Nutrition Information and Nutritional Supplements among Oncology Healthcare Professionals: A Sequential Exploratory Mixed-methods Study ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-12 11:03:41","doi":"10.21203/rs.3.rs-8549682/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-01T09:20:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-01T01:53:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-24T01:19:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"188568511148947319051137217950454947061","date":"2026-02-11T05:49:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"313018021635122844485037656591823743157","date":"2026-02-10T23:28:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"218565151873397352082478982110212239861","date":"2026-02-10T22:34:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169217127673362395073714420892191879498","date":"2026-02-10T21:46:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201869936901119872809634547263300225716","date":"2026-02-09T21:25:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-08T19:29:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-08T18:01:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-14T09:30:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2026-01-08T09:21:17+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":"8ef231c7-3487-4e67-867e-5f78e8126794","owner":[],"postedDate":"February 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-03-01T09:23:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-12 11:03:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8549682","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8549682","identity":"rs-8549682","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}