Transcript 2 (10%) - BC Cancer Agency

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.