Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Nutrition Learning Interests of Lung Cancer Patients According to Health Care Providers Reimer S, MSc (candidate), RD1; Sekhon S, RD2; Brockman R, RD3; Haines S, RD4; Levy-Milne R, PhD, RD2 1 Human Nutrition Graduate Program, University of British Columbia, 2 BC Cancer Agency-Vancouver Centre, 3 BC Cancer Agency- Centre of the Southern Interior, 4BC Cancer Agency Fraser Valley Centre Introduction Table 3. Lung Cancer Patients’ Levels of Interest in Dietary Supplements According to Health Care Practitioners Table 1. Demographic Data Characteristics Number (%) Dietary Supplements Lung cancer is one of the most prevalent types of cancer and is associated with the greatest cancer mortality for both men and women. In British Columbia, 1400 women and 1400 men are expected to be diagnosed with lung cancer in 2008. Survival rates are poor with a 5-year relative survival rate of 12% for men and 15% for women. About 1150 and 1250 women and men, respectively, are expected to die from this type of cancer in the same year. Lung cancer is associated with a high incidence of malnutrition (about 45-60% of patients), characterized by factors such as weight loss and anorexia. Malnutrition is associated with reduced quality of life, a decrease in response to treatment and increased risk of treatment-induced toxicity. Due to the complexity and poor survival rate of this population, dietitians are challenged to develop information resources and/or provide interventions that meet the needs of lung cancer patients. Project Purpose Profession Nurse Dietitian Worked with 0-5 lung patients 6-10 (years) 11 Province of British Columbia employment Alberta Manitoba Ontario Quebec New Brunswick 2 (8) 1 (4) 7 (27) 3 (11.5) 1 (4) Nova Scotia 3 (11.5) Prince Edward Island Newfoundland and Labrador 1 (4) 4 (15) Nutrition-Related Topics Not Interested Slightly Interested Interested Very Interested Vegetables and Fruit 3 (14%) 8 (36%) 6 (27%) 3 (14%) Milk and Milk Alternatives 2 (9%) 8 (36%) 6 (27%) 1 (5%) 9 (41%) 7 (32%) 2 (9%) 8 (36%) 7 (32%) 2 (9%) Fat Content 3 (14%) 9 (41%) 5 (23%) 1 (5%) Sugar 3 (14%) 5 (23%) 4 (18%) 7 (32%) Nutritional Supplements 0 (0%) 3(14%) 6 (29%) 12 (57%) Food-Drug Interactions 4 (18%) 4 (18%) 9 (41%) 1 (5%) Vegetarian Diets 2 (10%) 9 (43%) 4(19%) 1 (5%) Methods Cooking Methods 7 (32%) 6 (27%) 5 (23%) 1 (5%) Ethical approval was obtained from the UBC BCCA Behavioural Research Ethics Board. Meal Preparation 2 (9%) 6 (27%) 12 (55%) 2 (9%) Juicing 6 (27%) 5 (23%) 8 (36%) 1 (5%) Healthy Eating 1 (5%) 2(10%) 13 (62%) 5 (24%) Organic Foods 0 (0%) 10 (46%) 7 (32%) 3 (14%) Boosting Immune System 0 (0%) 5 (23%) 7 (32%) 9 (41%) High Calorie, High Protein Foods 1 (5%) 0 (0%) 7 (32%) 14 (64%) The questionnaire gathered data on demographics and patients’ nutrition-related interests (ranging from not interested to very interested) on topics such as general nutrition, dietary supplements, diet-related symptoms and information seeking behaviors of lung cancer patients from the perspectives of health professionals. Multi-Vitamin and Mineral 0 (0%) Supplements 5 (24%) 9 (43%) 6(29%) Vitamin A 2 (10%) 9 (43%) 4 (19%) 1 (58%) Beta-Carotene 3 (14%) 7 (33%) 4 (19%) 2 (10%) Vitamin E 3 (15%) 5 (25%) 7 (35%) 1 (5%) Vitamin C 0 (0%) 6 (32%) 7 (37%) 3 (16%) Vitamin B Complex 1 (5%) 9 (435%) 6 (29%) 1 (5%) Vitamin D 2(10%) 5 (24%) 6 (29%) 5 (24%) Fish Oil Complex 1 (5%) 7(33%) 8 (38%) 2 (10%) Flax 3 (15%) 6 (30%) 4 (20%) 2 (10%) Other Omega-3 Supplements 2 (10%) 4(19%) 7 (33%) 3 (14%) Calcium 2 (10%) 7 (33%) 6 (29%) 2 (10%) Iron 1 (5%) 8 (38%) 5 (24%) 2 (10%) Protein Powders 2 (10%) 4 (19%) 7 (33%) 6 (29%) Fibre Supplements 3 (14%) 5 (24%) 6 (29%) 3 (14%) Cancer-Related Symptoms Not Concerned Slightly Concerned Concerned Very Concerned Nausea 0 (0%) 1 (5%) 8 (36%) 13 (59%) Shortness of Breath 0 (0%) 1 (5%) 6 (27%) 15 (68%) Fatigue 0 (0%) 1 (5%) 1 (5%) 20(91%) Taste Changes 0 (0%) 2 (9%) 10 (46%) 10 (46%) Mouth and Swallowing Problems 0 (0%) 2 (9%) 8 (36%) 12 (55%) Loss of Appetite 0 (0%) 0 (0%) 1 (5%) 21 (96%) Weight Loss 0 (0%) 0 (0%) 16 (73%) 11 (38%) Diarrhea 4 (18%) 4 (18%) 90 (41%) 5 (23%) Constipation 0 (0%) 2 (9%) 9 (41%) 11 (50%) Note: Out of a possible 22 responses Fact Sheet: Canadian Cancer Statistics 2008- Cancer Trends across Canada and in British Columbia., 2008. http://www.bc.cancer.ca/ccs/internet/mediareleaselist/0,327 8_437890_438338_langld-en.html, accessed April 2008. National Cancer Institute Canada, Five-year relative cancer survival in Canada, 1992. http://www.ncic.cancer.ca/ncic/internet/standard/0,3621,846 58243_85787780_91035796_langId-en,00.html, accessed April 2008. Yeung T, Sekhon S, Levy-Milne R. The nutrition information needs of lung cancer patients. BC Cancer Agency Annual Cancer Conference, 2008. According to dietitians and nurses, lung cancer patients are interested in high calorie, high protein foods, nutritional supplements, healthy eating, boosting the immune system, meal preparation and sugar (Table 2). They also perceive multi-vitamin and mineral supplements, vitamin D, and protein powders are the dietary supplements that lung cancer patients are interested in (Table 3). As shown in Table 4, the health care practitioners identified lung cancer patients being concerned about all of the diet and cancer-related symptoms. Dietitians perceived themselves as a primary source for nutrition information for lung cancer patients followed by family members and friends and the internet (Figure 1). Lung cancer patients prefer to receive nutrition information mainly from pamphlets, through phone contacts and office visits according to health care practitioners (Figure 2). The nurses reported that they refer lung cancer patients primarily to the dietitian for nutrition-related education. Dietitians use in-house written materials and handouts from the Canadian Cancer Society and the BC Cancer Agency. Figure 2 Mode of Delivery of Nutrition Information That Lung Cancer Patients Prefer According to Health Care Practitioners, expressed as percentage 100 100 80 80 60 60 40 40 20 20 0 Doctor Diet and Nutrition When asked what would be the greatest diet and nutritionrelated concerns for their lung cancer patients, almost all of the dietitians and nurses stated lack of appetite and/or weight loss. Figure 1 Information Sources That Lung Cancer Patients Use According to Health Care Practitioners, expressed as percentage The data are expressed as frequencies calculated from the web-based survey program. References Twenty-seven percent of the respondents were from Western provinces, 38.5% from Ontario and Quebec and 34.5% from Atlantic Canada. Note: Out of a possible 22 responses; responses indicating unsure are not included The questionnaire was sent to a convenience sample of registered dietitians and nurses across Canada who were identified as health care providers working with lung cancer patients. Demographics The majority of participants (n=26) were dietitians (69%) and about two-thirds worked with lung cancer patients for 6 years or more (Table 1). Table 4. Lung Cancer Patients’ Levels of Concern in Diet and Cancer-Related Symptoms According to Health Care Practitioners 2 (9%) 2 (9%) A 12-item questionnaire was adapted from a lung cancer patient survey (Refer to Yeung et al, 2008). This questionaire was generated using web-based software (SurveyMonkey). It was tested for content and face validity by a team of registered dietitians who work with lung cancer patients at the BC Cancer Agency. Interested Very Interested Note: Out of a possible 21 responses; responses indicating unsure are not included Meat and Meat Alternatives To assist health care practitioners in the development of nutrition resources for lung cancer patients. Slightly Interested Table 2. Lung Cancer Patients’ Levels of Interest in Diet and Nutrition Topics According to Health Care Practitioners Whole Grains To Identify the nutrition related issues and information needs of lung cancer patients from the perspective of dietitians and nurses who work with lung cancer patients. 8 (31) 18 (69) 9 (34.5) 8 (31) 9 (34.5) 4 (15) Not Interested Summary of Findings 0 Registered Dietitian Pamphlets Conclusions The present study along with the study that was conducted with lung cancer patients (Yeung et al, 2008) are intended to help dietetic practitioners develop effective educational strategies for this population. From the findings of this study, it appears that the lung cancer patients seen by the dietitians and nurses were already nutritionally compromised and many of these patients required palliative care, with more emphasis on symptom management. Internet Other Health Professionals Naturopath/Hom eopath Support Groups Fam ily Mem bers/Friends Email/Mailed Information Videolinked Sessions Media Books/Journals Group Sessions Phone Contact Pam phlets Internet Home Visit Office Visit These results differ from a pilot study addressing nutritionrelated information needs of lung cancer patients. Of note, the patients in the pilot study appeared ‘healthier’ and were interested in whole foods, healthy eating, organic foods and the fat content in the diet.