Background
Survivors of gastric cancer who undergo total gastrectomy experience long-term nutritional challenges, including impaired body composition, reduced functional recovery, and lower quality of life. Our previous systematic review on the effect of nutritional interventions on body composition in individuals with gastrectomy supports the use of dietary and nutritional interventions in this population. Its translation into structured, context-specific survivorship care remains limited in India and other low- and middle-income countries. Bridging this evidence-to-practice gap is critical for strengthening post-treatment cancer care.
Objectives
Building on the evidence from the review, our objective was to describe the evidence-to-action pathway used to develop a culturally informed and individualised dietary intervention for total gastrectomy survivors, integrating global research evidence, clinical guidelines, patient involvement, and tool development within the WCRF-funded EASE-IN feasibility study.
Methods
A multi-stage evidence-based approach was adopted to design a personalised nutritional intervention. First, global evidence on nutritional interventions following gastrectomy was synthesised to identify effective components influencing body composition and Quality of Life (QoL). Second, existing clinical nutritional guidelines relevant to post-gastrectomy care were reviewed to assess their scope, content, and applicability. Third, a structured Patient and Public Involvement and Engagement (PPIE) activity was conducted with stomach cancer survivors. Building on the combined evidence of review, international guidelines, and PPIE, a draft set of nutritional guidelines was designed and refined later based on another PPIE workshop. The guidelines were then translated into local languages, i.e. Hindi and Marathi, to ensure cultural relevance and accessibility. In addition, the interventions are personalised depending on the patient’s body composition, dietary preferences, and medical symptoms, and are currently being implemented as part of our feasibility study.
Results / Current Status
The evidence synthesis highlighted the importance of structured nutritional counselling, tailored dietary guidance, and longitudinal monitoring of body composition and recovery following total gastrectomy. A review of existing guidelines revealed gaps in addressing the nutritional and survivorship needs specific to post-gastrectomy patients in India. Through integration of global evidence and patient-derived insights, the EASE-IN intervention and associated tools were finalised and operationalised. Implementation has commenced at the Tata Memorial Hospital (TMH), a tertiary cancer centre, with participant recruitment underway.
Conclusions and Implications
This study outlines a systematic approach for translating research evidence into actionable nutritional survivorship care for patients with gastric cancer who have undergone total gastrectomy. By integrating evidence synthesis, guideline review, patient engagement, and tool development, this approach provides a scalable model for strengthening post-cancer dietary care and informing policy-relevant survivorship strategies in settings with limited resources.