Limitations
The dietary data should be interpreted with caution as dietary intake information was collected cross-sectionally using a 1-day 24-hour diet recall and may not be indicative of the larger picture of the changing dietary quality during treatment. Future studies should consider the use of the 24-hour diet recall assess over a three-day period to assess dietary intake 47 with dietary intake assessed longitudinally throughout cancer treatment. This study had a small sample size which resulted in an uneven sample distribution across age groups. Therefore, identification of groups most at risk of poor dietary quality could not be concluded. Additionally, the sample was heterogeneous across cancer diagnosis and treatment, making it difficult to draw conclusions regarding dietary quality across treatment intensity. The study did not adjust for multiple comparisons with the possibility of an inflated Type I error. Due to this, the results need to be interpreted with caution. Nutrition information needs will vary for different cancer and treatment types; for example, steroid use will drive up hunger 21 whereas other treatments can cause nausea, vomiting and other symptoms that impact intake. The study excluded patients who were receiving enteral nutrition during the study period. Although childhood cancer patients receiving enteral nutrition rely on supplementary feeding for their nutritional intake, some patients may also be consuming some oral intake. Excluding these patients may have introduced some sampling bias and future studies should aim to assess the dietary intake of all patients during active treatment. High levels of health literacy and socio-economic status among study participants may have influenced the results of this study. The results from this study may not be transferrable to other oncology populations, especially those from developing countries where treatment and dietary advice may vary.