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Nutrition Information Needs of Lung Cancer Patients Yeung T2, BSc candidate, (Dietetics); Sekhon S1, Bsc, RD; Levy-Milne R1,2, PhD, RD 1. B.C. Cancer Agency, Vancouver, B.C. 2. University of British Columbia, Vancouver, British Columbia Introduction • Lung cancer is one of the most common causes of cancer death for both men and women in North America. Lung cancer patients typically have a 5-year survival rate of 17% among women and 14% among men. • Upon diagnosis, cancer patients express motivation for changing dietary behaviour to increase well-being and prevent cancer recurrence. • Recent pilot studies conducted at the BC Cancer Agency demonstrated that nutrition is one of the main concerns among lung cancer patients and Chinese cancer support group participants. However, there are few reports in the literature that have examined the specific nutrition-related concerns of these patients. •Health care providers are challenged to develop information resources for the complex needs of these patients. Table 1. Patient Demographics Table 4. Levels of Interest in Cancer-Related Symptoms Patient Characteristics Number of Patients (n=35) Cancer-Related Symptoms Not Slightly Interested Interested Interested Very Interested Nausea 4 (15%) 6 (22%) 10 (37%) 7 (26%) Male 19 (54%) Shortness of Breath 2 (7%) 4 (13%) 10 (32%) 14 (45%) Female 16 (45%) Fatigue 1 (3%) 4 (14%) 10 (35%) 14 (48%) < 50 7 (20%) Taste Changes 2 (7%) 5 (18%) 7 (25%) 14 (50%) 50-64 16 (46%) 3 (10%) 6 (21%) 10 (25%) 10 (35%) 65 12 (34%) Mouth and Swallowing Problems Caucasian 22 (63%) Loss of Appetite 3 (11%) 3 (11%) 9 (32%) 13 (46%) Asian 13 (37%) Weight Loss 2 (7%) 5 (17%) 11 (38%) 11 (38%) < 18.5 1 (3%) Diarrhea 5 (18%) 2 (7%) 10 (36%) 11 (39%) 18.5-29.9 30 (88%) Constipation 0 (0% 4 (14%) 14 (50%) 10 (36%) > 29.9 3 (9%) < 2002 2 (6%) 2003-2005 5 (15%) > 2006 0 (0%) Received Past Treatment 24 (69%) Presently Receiving Treatment 10 (29%) Gender Age (years) Ethnicity BMI Year of Cancer Diagnosis Cancer Treatment Note: Out of a possible35 responses; responses indicating unsure are not included Figure 5. Top 3 Sources for Diet and Nutrition Information Doctor 20 19 17 18 • Identify nutrition and information needs of lung cancer patients and how they would like to receive this information. Nutrition-Related Topics Vegetables and Fruit Not Interested 0 (0%) Slightly Interested 2 (6%) Interested Very Interested 11 (32%) 15 16 Number of Respondents Project Purpose Table 2. Levels of Interest in Diet and Nutrition Topics Other Health Professionals Registered Dietitian Naturopathic/Homeopathi c Practitioner Support Group/Support Services Family Members and Friends Media 14 12 11 9 10 8 0 (0%) 6 (18%) 3 4 5 Pamphlets 3 2 Internet 15 (45%) 0 Telephone Hotlines 0 Milk and Milk Alternatives 2 (7%) Methods • Ethical approval was obtained from the UBC BCCA Research Ethics Board. 4 (13%) 5 (16%) 11 (37%) 13 (43%) Meat and Meat Alternatives 3 (10%) 14 (45%) Fat Content 3 (10%) 8 (28%) 8 (28%) 8 (28%) Sugar 3 (9%) 3 (9%) 9 (28%) 14 (44%) Nutritional Supplements 4 (13%) 6 (16%) 11 (36%) 14 (32%) Food-Drug Interactions 4 (13%) 3 (10%) 14 (45%) 9 (29%) Vegetarian Diets 7 (23%) 3 (10%) 8 (27%) 11 (37%) S e rie s 1 Health Care Organizations Sources of Information 9 (29%) Figure 6. Top 3 Methods of Receiving Diet and Nutrition Information 30 • Patients were also asked to select their top three sources of nutrition information and preferred methods of information modality. • The questionnaire was translated into Chinese and administered to participants including patients and caregivers that participated in the Chinese Support Group. However, not all patients in the Chinese Support group had lung cancer and therefore only those with lung cancer were included in the data analysis and results. Lessons Learned and Limitations •Demographic bias was expected as most of the respondents were educated and therefore more likely to participate in health studies. 9 (28%) 12 (38%) 6 (19%) Meal Preparation 6 (19%) 8 (26%) 8 (26%) 6 (19%) Juicing 5 (17%) 9 (30%) 9 (30%) 4 (13%) Healthy Eating 1 (3%) 6 (19%) 8 (25%) 15 (47%) Organic Foods 2 (6%) 7 (23%) 8 (26%) 11 (36%) Boosting Immune System 0 (0%) 2 (7%) 11 (37%) 14 (47%) High Calorie, High Protein Foods 2 (6%) 9 (29%) 6 (19%) 11 (36%) Internet/Web-based Electronic Format 20 Email or Mailed Information Video-linked Sessions 20 15 •Language posed a barrier to study participation. A greater number of Chinese-speaking patients from the lung clinic and Chinese support group consented to participate upon translation of the survey. •Participants identified taste changes, fatigue, loss of appetite, shortness of breath, diarrhea, weight loss, and mouth and swallowing problems as cancer-related topics of interest to them (Table 4). •Registered dietitians were not considered a primary source for nutrition information (Figure 5). Sources most often consulted were doctors, family members and friends and other health professionals. •Majority of respondents preferred to receive written nutrition information via pamphlet, mai or email (Figure 6). •Most participants felt that nutrition plays a role by helping with cancer recovery, improving quality of life and looking or feeling better (Figure 7). 14 Phone Contact 13 Home Visit Office Visit Note: Out of a possible35 responses; responses indicating unsure are not included Conclusions 7 •Lung cancer patients are interested in healthy eating, nutritional supplements and symptom management strategies through pamphlets, mail or emailed information. 5 5 4 3 2 0 Methods Dietary Supplements Not Interested Slightly Interested Interested Very Interested Multi-Vitamin and Mineral Supplements 1 (3%) 10 (29%) 12 (35%) 11 (32%) Vitamin A 5 (18%) 9 (32%) 6 (21%) 5 (18%) Beta-Carotene 4 (14%) 10 (36%) 8 (29%) 4 (14%) Vitamin E 2 (8%) 7 (27%) 10 (39%) 5 (19%) Vitamin C 2 (7%) 8 (29%) 9 (32%) 8 (29%) Vitamin B Complex 2 (8%) 4 (15%) 10 (39%) 6 (23%) Vitamin D 3 (10%) 6 (20%) 10 (33%) 10 (33%) Fish Oil Complex 5 (19%) 5 (19%) 7 (27%) 7 (27%) Flax 4 (14%) 3 (11%) 10 (36%) 10 (36%) Other Omega-3 Supplements 2 (7%) 3 (11%) 12 (44%) 8 (30%) Calcium 3 (10%) 4 (13%) 13 (43%) 9 (30%) Iron 3 (11%) 5 (19%) 9 (33%) 9 (33%) Protein Powders 6 (22%) 10 (37%) 7 (26%) 3 (11%) Fibre Supplements 7 (27%) 9 (35%) 8 (31%) 1 (4%) •Complementary and alternative therapies were not a topic of great interest for this group. Figure 7. Top 3 Roles Nutrition Plays in Relation to Diagnosis 30 Increased Control Over Life 25 25 Help with Cancer Recovery 20 Note: Out of a possible35 responses; responses indicating unsure are not included •Lung patients primarily turn to their doctors and other health care providers for nutritional counsel and guidance. Registered dietitians are not considered a primary source for nutrition information. Thus doctors could play a key role in the dissemination of nutrition information. •Addressing information needs of lung cancer patients is important to improve patient care and satisfaction. Improved Quality of Life To Look or Feel Better 15 15 To Prevent/Delay Recurrence 10 9 Achieve Another Health Goal I Do Not Feel Nutrition Plays a Role 5 5 3 •The survey was administered in-person while patients waited for their physician appointment. It was labour intensive to have someone available to approach patients and administer the survey. •Contrary to the literature, over 60% of respondents cited no interest in complementary and alternative therapies (data not shown). Group Sessions 7 •The short duration of the study resulted in a small sample size. •Multi-vitamin and mineral supplements, flax, iron, and vitamin D received greater interest (Table 3). 25 10 Table 3. Levels of Interest in Dietary Supplements Diet and Nutrition •Lung patients are very interested in healthy eating, and want more information on vegetables and fruit, organic foods, whole grains, nutritional supplements, sugar, boosting the immune system, and high calorie, high protein foods (Table 2). Pamphlets 25 Number of Respondents • The 22-item survey gathered data on demographics, medical history, nutritional concerns, complementary therapies, and information seeking behaviors. On a likert rating scale from ‘not interested’ to ‘very interested’, 35 patients rated the importance of the following: general nutrition, dietary supplements, complementary and alternative therapies, and cancer-related symptoms. 3 (9%) Number of Respondents • A questionnaire was administered to lung cancer patients attending the outpatient Lung Cancer Clinic and the Chinese Cancer Support Group at the BCCA Vancouver Centre. Cooking Methods Demographics • The majority of participants (n=35) were between 50 to 64 years of age with slightly more females than males (Table 1). • Most participants had at least a high school diploma and consisted mainly of cancer survivors. • More than half of the participants were currently not receiving treatment. Bookes and Journals 5 6 20 (59%) 11 (33%) • Out of 37 surveys that were collected, 35 surveys were used in the study. 8 2 Whole Grains Summary of Findings References National Cancer Institute Canada, Five-year relative cancer survival in Canada, 1992. http://www.ncic.cancer.ca/ncic/internet/standard/0,3621,84658243_8578 7780_91035796_langId-en,00.html, accessed March 2, 2008 2 0 2nd Qtr W. Demark-Wahnefried, N.M Aziz J.H. Rowland, and B.M. Pinto, Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer, J Clin Oncol. 23 (2005), pp. 5814-5830. C. Doyle, L.H. Kushi, T. Byers, K.S. Courneya, W. Demark-Wahnefried, B. Grant, A. McTiernan, C.L. Rock, C. Thompson, T. Gansler, and K.S. Andrews, Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices, CA Cancer J Clin. 56 (2006), pp. 323-353. M. Wells, L. Sarna, M.E. Cooley, J.K. Brown, C. Chernecky, R.D. Williams, G. Padilla, L.L. Danao, Use of Complementary and Alternative Medicine Therapies to Control Symptoms in Women Living with Lung Cancer. Cancer Nurs. 30 (2007), pp. 1 45-154