4. Discussion
gastrointestinal symptoms, NPS, nutritional behavior, upper gastrointestinal cancer, gastric cancer
RECRUITMENT, GASTRIC CANCER
This randomized-controlled pilot trial assessed the feasibility and preliminary effects of the iNutrition intervention for post-discharged gastric cancer patients following gastrectomy. Despite being affected by the COVID-19 pandemic, recruitment to the trial was in line with pre-study expectations as described in the clinical trial registration (ChiCTR2200064807). A high retention rate was attained, indicating that online intervention and surveys were feasible methods. Adherence and acceptability of the iNutrition intervention were also high, with most participants completing the intervention components and receiving high average scores across acceptability measures (NPS and SUS), echoed by our qualitative findings. Evidence from this study suggests that the iNutrition intervention is a feasible approach that is highly acceptable to post-discharged gastric cancer patients following gastrectomy. The trial was not structured to evaluate the effects on nutritional status, nutritional risk, weight, BMI, protein intake, symptoms, and quality of life, but encouraging changes in nutritional behavior, energy intake, and compliance with energy and protein requirements were observed. There is a strong belief that the iNutrition intervention should be an optional therapy for post-discharged gastric cancer patients following gastrectomy. Overall, the positive findings provide support for further development and evaluation of the iNutrition intervention.The current study successfully recruited 24 post-discharged gastric cancer patients following gastrectomy over a four-week period. The recruitment rate of 33% was similar with other mHealth interventions [The retention rate achieved in the current study was good, with 87.5% reporting complete data during the 12-week follow-up. In comparation, similar studies providing nutrition interventions through a combination of phone calls and apps have similar retention rates of between 75–90.7% after the 12-week intervention [In general, patients were highly involved with the iNutrition intervention, in terms of attendance and high acceptability scores of the NPS and SUS, echoed by the qualitative findings. In this study, participants completed 88.89% ± 12.98% planned nutrition consultations and used the iNutrition applet a median of 89 (range: 37–1975) times of during the 12 weeks of the intervention, suggesting a high adherence among participants. Biweekly telephone-delivered nutrition consultations implemented to improve adherence may have had a role in prompting participation, as suggested by interviews. Although adherence with the mHealth intervention is difficult to quantify [Furthermore, preliminary evidence of outcome improvements associated with the iNutrition intervention suggests that further testing in a sufficiently powered study is warranted. In the ITT analysis, including all randomized participants who started the trial, there was a significant between-group improvement in nutritional behavior, energy intake, and compliance with energy and protein requirements in the intervention participants compared with the control participants. Changes in protein intake, weight, BMI, nutritional status, nutritional risk, gastrointestinal symptoms, and quality of life were non-significant, however much they moved in the desired direction. Comparatively, in a nutrition intervention among perioperative upper gastrointestinal cancer patients, there was no significant effect on weight, nutritional status, and quality of life following 18 weeks of telephone or electronic nutrition counselling [