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Case study: Your Path to Research: Lindsey Allan is using research to help improve the nutritional health of cancer patients

In Your Path to Research – a series that uncovers the research community across the National Institute of Health Research Kent, Surrey and Sussex region – we speak with oncology dietitian Lindsey Allan about her motivations, inspirations and the ups and downs of her first time as a principal investigator.

Lindsey works at Royal Surrey NHS Foundation Trust as a Macmillan Oncology Dietitian and Dietetic Team Lead for the Oncology Team. She dabbled in research during her undergraduate degree in 2006 and became more and more interested in how research can advance patient care as her career progressed. In 2019, she was awarded NIHR Clinical Research Network Kent, Surrey and Sussex Greenshoots funding – dedicated funds to support healthcare professionals to become principal investigators – for her first project as a principal investigator.

Tell us a bit about your role as an oncology dietitian?

Day to day I am involved in a lot of clinical work looking after patients who have nutritional problems during their cancer treatment. The dietetic team and I support patients with a broad spectrum of cancers, but predominantly colorectal, lung, gynaecological, ovarian, pancreatic and renal. As well as Royal Surrey’s St Luke’s Cancer Centre, we also provide a dietetic service to cancer patients at local private hospitals.

As part of my role I write patient information leaflets, train dietetic students during practical placements and act as clinical supervisor for dietetic undergraduate and Master’s level dissertations. I also provide education sessions for patients and staff at Royal Surrey, speak at conferences and have team leader responsibilities such as annual appraisals and sitting on job interview panels.

You’ve received NIHR funding for a Greenshoots project. What is this project about and why is it important to you?

My research will assess the efficacy of a four-stage diet I have developed for people diagnosed with an inoperable partial bowel obstruction. I have already been recommending this diet to my patients but we haven’t done any studies to prove it helps.

We know that if we improve patients’ nutritional health we can better equip them for, often aggressive, chemotherapy and therefore improve their chance of survival. Good nutrition is also important for terminal patients as the wrong diet can aggravate symptoms such as vomiting, diarrhoea and chronic pain. If we can help these patients get their diet right, then we can improve their quality of life and even potentially extend it.

I began developing the idea for the four-stage diet in 2013, after I had been working as an oncology dietitian for about three years. We didn’t see many inoperable subacute (partial) bowel obstructions at that time. But, when we did, one of our consultants, Dr Agniezska Michael, and I felt that we should do better for our patients. Some people are well enough to continue with treatment and can be given parenteral nutrition – which means they are fed through a vein – but this is not always possible.

Around this time, one particular patient asked me to produce a booklet so that she knew how to increase her nutritional intake as her symptoms improved, but also told her what to do if things took a turn for the worse. This inspired me to develop a diet that could improve the situation for patients, like her, who might not be able to eat normally but who might be able to eat something.

This resulted in the four-stage diet, which I based on the evidence and recommendations for Crohn’s disease as the problems suffered by people with these two conditions are similar. Depending on the degree of obstruction, patients follow one of the four stages – clear fluids, all liquids, puree and soft sloppy foods – all of which are low in fibre. Patients can move up and down the stages depending on how they feel on the day, for example, if someone is having abdominal pain, they are advised to step back to clear fluids.

For the study, I’ll be recruiting 30 patients with an inoperable gynae-oncology or colorectal cancer who are diagnosed with partial bowel obstruction either caused by disease spread to the peritoneum or who have a primary tumour causing a blockage. Participants will be recruited over a maximum of two years from Royal Surrey and Frimley Hospital.

What inspired you to become a researcher?

My patients inspired me to become a researcher. They cope with so much pain, discomfort and stress. We should always strive to make their situation better and research is the best way to do this.

Also, the Royal Surrey oncology department is an inspiring place to work. There’s a strong commitment to patients and delivering them the best care, which goes hand in hand with the strong research culture that is instilled within the department. I’ve been particularly inspired by some of my fellow clinical research colleagues.

What do you enjoy most about research?

It’s fundamental purpose. It takes clinical practice a stage further as findings from my projects have the potential to help patients in my Trust and beyond.

What have you found the biggest research-related challenge?

The speed! There’s no straightforward algorithm to follow from the start when setting up a clinical trial and unexpected actions arise as you progress, which can really slow things down.

COVID-19 has also been a huge challenge for this project. I received the sponsorship for the study early 2019 and was really keen to get stuck in, but it was, understandably, delayed. I was finally able to start recruiting patients in March 2021.

What are your career ambitions?

I’m planning to apply for a clinical research fellowship to do a doctorate with the next stage of the research. This will hopefully mean that I can continue to develop my research career as well as my clinical role. Beyond that, it is to develop national guidelines for managing inoperable malignant bowel obstruction and for these to be taught at undergraduate level. If I can do that before I retire, I will be happy knowing that my career has made a lasting difference to improvements in patient care.

What are your interests outside of work?

Being outside as much as I possibly can! Walking or running, either way, I find it has a huge psychological benefit and I get to spend time with two of my favourite companions, my dogs.

I am a member of the Royal Surrey Choir, an avid reader and love to travel. I have ambitions to go to Canada next, to visit my daughter who is at university there.

And, as you would hope with a dietitian, I love to eat!

What advice would you give to others considering a career in research?

Don’t be put off by all of the work that’s involved. Get help and put the time in because it is so worth it when you get there! If you have a question that could improve patient care, and it hasn’t been asked before, then that question needs answering.