{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:07:14Z","timestamp":1788890834250,"version":"build-2803163510"},"reference-count":64,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":71,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014804","name":"Dutch Cancer Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014804","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low fruit and vegetable consumption among gynecological cancer survivors is associated with worse health outcomes, but this association could be bidirectional.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To investigate the association between physical and psychological symptoms and fruit and vegetable consumption, alongside a potential mediation by behavioral constructs of the theory of planned behavior (TPB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Self-reported data from a Dutch cohort of endometrial and ovarian cancer survivors (n = 227) was used. Physical and psychological symptoms were assessed at 12 months, TPB constructs, fruit and vegetable consumption at 18 months posttreatment. Associations of these symptoms with daily fruit (pieces) and vegetable (grams) consumption, and the role of intention as TPB construct were evaluated using mediation analyses. If mediation was present, successive regression analyses assessed possible involvements of distal TPB constructs (attitude, subjective norm, perceived behavioral control (PBC)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>About 53% and 32% of the survivors met the fruit or vegetable guidelines, respectively. Higher anxiety and depressive symptoms were directly associated with lower fruit consumption (P = .02). There were direct associations between higher fatigue or depressive symptoms and lower vegetable consumption (P &amp;lt; .05), partly mediated by intention (P = .01, P &amp;lt; .05, respectively). Of all distal TPB constructs, PBC was a possible mediator. More gastrointestinal symptoms showed a total association with lower vegetable consumption (P = .02).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Gynecological cancer survivors with more physical and psychological symptoms consumed less fruits and\/or vegetables. For vegetables, this was partly mediated by decreased intention and PBC. Dietary advice focusing on increasing intention and diminishing perceived barriers may empower survivors to integrate fruits and vegetables in their diet.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/abm\/kaaf008","type":"journal-article","created":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T07:19:14Z","timestamp":1737703154000},"source":"Crossref","is-referenced-by-count":0,"title":["Gynecological cancer survivors with higher levels of physical and psychological symptoms consume less fruits and vegetables"],"prefix":"10.1093","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3318-7495","authenticated-orcid":false,"given":"Joann","family":"Kiebach","sequence":"first","affiliation":[{"name":"Netherlands Comprehensive Cancer Organisation (IKNL) Department of Research and Development, , Boven Clarenburg 2, 3511CV, Utrecht, The Netherlands"},{"name":"Radboud University Medical Center Department of Health Evidence, , Houtlaan 4, 6525XZ,","place":["Nijmegen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0781-232X","authenticated-orcid":false,"given":"Sandra","family":"Beijer","sequence":"additional","affiliation":[{"name":"Netherlands Comprehensive Cancer Organisation (IKNL) Department of Research and Development, , Boven Clarenburg 2, 3511CV, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9589-3129","authenticated-orcid":false,"given":"Belle H","family":"de Rooij","sequence":"additional","affiliation":[{"name":"Netherlands Comprehensive Cancer Organisation (IKNL) Department of Research and Development, , Boven Clarenburg 2, 3511CV, Utrecht, The Netherlands"},{"name":"Tilburg University Department of Medical and Clinical Psychology, , Warandelaan 2, 5037AB,","place":["Tilburg, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5287-375X","authenticated-orcid":false,"given":"Johanna M A","family":"Pijnenborg","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center Department of Obstetrics and Gynecology, , Houtlaan 4, 6525XZ,","place":["Nijmegen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4004-7818","authenticated-orcid":false,"given":"M Caroline","family":"Vos","sequence":"additional","affiliation":[{"name":"Elisabeth-TweeSteden Hospital Department of Obstetrics and Gynecology, , Dr. Deelenlaan 5, 5042AD,","place":["Tilburg, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0592-1777","authenticated-orcid":false,"given":"Dorry","family":"Boll","sequence":"additional","affiliation":[{"name":"Catharina Hospital Department of Gynecology, , Michelangelolaan 2, 5623EJ,","place":["Eindhoven, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2409-6735","authenticated-orcid":false,"given":"Roy F P M","family":"Kruitwagen","sequence":"additional","affiliation":[{"name":"School for Oncology and Reproduction, Maastricht University Medical Center Department of Obstetrics and Gynecology, , P. 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