Project Purpose

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.

To assist health care practitioners in the development of nutrition resources for lung cancer patients.

Nutrition Learning Interests of Lung Cancer Patients According to Health Care Providers

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

Reimer S, MSc (candidate), RD1; Sekhon S, RD2; Brockman R, RD3; Haines S, RD4; Levy-Milne R, PhD, RD2

Introduction

Methods

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.

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).

Twenty-seven percent of the respondents were from Western provinces, 38.5% from Ontario and Quebec and 34.5% from Atlantic Canada.  

Diet and Nutrition  

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).

When asked what would be the greatest diet and nutrition-related concerns for their lung cancer patients, almost all of the dietitians and nurses stated lack of appetite and/or weight loss.

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.

Conclusions

The present study along with the study that was conductedwith 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.

These results differ from a pilot study addressing nutrition-related 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.

Summary of Findings

Ethical approval was obtained from the UBC BCCA Behavioural Research Ethics Board.

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.

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.

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.

The data are expressed as frequencies calculated from the web-based survey program.

Table 1. Demographic Data

Nutrition-Related Topics

Not Interested

Slightly Interested

Interested Very Interested

Vegetables and Fruit 3 (14%) 8 (36%) 6 (27%) 2 (9%)

Whole Grains 3 (14%) 8 (36%) 6 (27%) 1 (5%)

Milk and Milk Alternatives 2 (9%) 9 (41%) 7 (32%) 2 (9%)

Meat and Meat Alternatives

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%)

Cooking Methods 7 (32%) 6 (27%) 5 (23%) 1 (5%)

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%)

Table 2. Lung Cancer Patients’ Levels of Interest in Diet and Nutrition Topics According to Health Care Practitioners

Dietary Supplements Not Interested

Slightly Interested

Interested Very Interested

Multi-Vitamin and Mineral Supplements

0 (0%) 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%)

Table 4. Lung Cancer Patients’ Levels of Concern in Diet and Cancer-Related Symptoms According to Health Care Practitioners

Table 3. Lung Cancer Patients’ Levels of Interest in Dietary Supplements According to Health Care Practitioners

Fact Sheet: Canadian Cancer Statistics 2008- Cancer Trends across Canada and in British Columbia., 2008. http://www.bc.cancer.ca/ccs/internet/mediareleaselist/0,3278_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/0,3621,84658243_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.

Characteristics Number (%)

Profession Nurse 8 (31)

Dietitian 18 (69)

Worked with lung patients (years)

0-5 9 (34.5)

6-10 8 (31)

11 9 (34.5)

Province of employment

British Columbia 4 (15)

Alberta 2 (8)

Manitoba 1 (4)

Ontario 7 (27)

Quebec 3 (11.5)

New Brunswick 1 (4)

Nova Scotia 3 (11.5)

Prince Edward Island

1 (4)

Newfoundland and Labrador

4 (15)

Note: Out of a possible 22 responses; responses indicating unsure are not included

Note: Out of a possible 21 responses; responses indicating unsure are not included

Note: Out of a possible 22 responses

0

20

40

60

80

100

Doctor Registered Dietitian

Other Health Professionals Naturopath/Homeopath

Support Groups Family Members/Friends

Media Books/Journals

Pamphlets Internet

Figure 1 Information Sources That Lung Cancer Patients Use According to Health Care Practitioners, expressed as percentage

0

20

40

60

80

100

Pamphlets Internet

Email/Mailed Information Videolinked Sessions

Group Sessions Phone Contact

Home Visit Office Visit

Figure 2 Mode of Delivery of Nutrition Information That Lung Cancer Patients Prefer According to Health Care Practitioners, expressed as percentage

References