Quantifying Diet Quality Across Critical Periods of Cancer Survivorship: A Longitudinal Study

​The uncovering the long-term impact of oropharyngeal cancer and dysphagia on dietary quality and nutrition among cancer survivors (U-DINE) Study is a multisite longitudinal investigation of diet quality and nutritional risk across the oropharyngeal cancer (OPC) care continuum. U-DINE integrates dietary, clinical, and swallowing assessments from two clinical cohorts. Adults with primary, non-recurrent OPC are assessed at diagnosis, 3-6 months post-treatment, and 18-24 months post-treatment using standardized 24-hour dietary recalls and measures of food and nutrition security, barriers to healthy eating, and malnutrition risk. Among 333 participants, poor diet quality was pervasive. Very low (HEI-2020 51-70) or critically low (HEI-2020 ≤50) diet quality was observed in 130 of 132 participants (98.5%) at diagnosis, 35 of 36 (97.2%) post-treatment, and 158 of 165 (95.8%) during long-term survivorship; none had adequate diet quality. Critically low diet quality was observed in 35 of 58 non-White versus 154 of 275 White participants (60.3% vs. 56.0%), 18 of 27 females versus 171 of 306 males (66.7% vs. 55.9%), and 163 of 283 participants with HPV-positive versus 16 of 29 with HPV-negative tumors (57.6% vs. 55.2%). Among post-treatment and long-term survivors, critically low diet quality was observed in 8 of 10 participants treated with surgery alone (80.0%), 72 of 125 receiving radiation and chemotherapy (57.6%), 17 of 33 receiving radiation only (51.5%), and 15 of 30 receiving surgery plus radiation with or without chemotherapy (50.0%). Overall, 14 participants (4.2%) were lost to follow-up or withdrew. U-DINE findings demonstrate pervasive poor diet quality across OPC survivorship and support the feasibility of comprehensive dietary assessment. Its longitudinal design provides a framework for identifying dietary risk and barriers to healthy eating and informing targeted interventions across the cancer care continuum.