1. 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, 4 BC Cancer Agency Fraser Valley Centre Reimer S, MSc (candidate), RD 1 ; Sekhon S, RD 2 ; Brockman R, RD 3 ; Haines S, RD 4 ; Levy-Milne R, PhD, RD 2 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 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. 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 InterestedVery Interested Vegetables and Fruit3 (14%)8 (36%)6 (27%)2 (9%) Whole Grains3 (14%)8 (36%)6 (27%)1 (5%) Milk and Milk Alternatives2 (9%)9 (41%)7 (32%)2 (9%) Meat and Meat Alternatives 2 (9%)8 (36%)7 (32%)2 (9%) Fat Content3 (14%)9 (41%)5 (23%)1 (5%) Sugar3 (14%)5 (23%)4 (18%)7 (32%) Nutritional Supplements0 (0%)3(14%)6 (29%)12 (57%) Food-Drug Interactions4 (18%) 9 (41%)1 (5%) Vegetarian Diets2 (10%)9 (43%)4(19%)1 (5%) Cooking Methods7 (32%)6 (27%)5 (23%)1 (5%) Meal Preparation2 (9%)6 (27%)12 (55%)2 (9%) Juicing6 (27%)5 (23%)8 (36%)1 (5%) Healthy Eating1 (5%)2(10%)13 (62%)5 (24%) Organic Foods0 (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 SupplementsNot Interested Slightly Interested InterestedVery Interested Multi-Vitamin and Mineral Supplements 0 (0%)5 (24%)9 (43%)6(29%) Vitamin A2 (10%)9 (43%)4 (19%)1 (58%) Beta-Carotene3 (14%)7 (33%)4 (19%)2 (10%) Vitamin E3 (15%)5 (25%)7 (35%)1 (5%) Vitamin C0 (0%)6 (32%)7 (37%)3 (16%) Vitamin B Complex1 (5%)9 (435%)6 (29%)1 (5%) Vitamin D2(10%)5 (24%)6 (29%)5 (24%) Fish Oil Complex1 (5%)7(33%)8 (38%)2 (10%) Flax3 (15%)6 (30%)4 (20%)2 (10%) Other Omega-3 Supplements 2 (10%)4(19%)7 (33%)3 (14%) Calcium2 (10%)7 (33%)6 (29%)2 (10%) Iron1 (5%)8 (38%)5 (24%) 2 (10%) Protein Powders2 (10%)4 (19%)7 (33%)6 (29%) Fibre Supplements3 (14%)5 (24%)6 (29%)3 (14%) Cancer-Related Symptoms Not Concerned Slightly Concerned ConcernedVery Concerned Nausea0 (0%)1 (5%)8 (36%)13 (59%) Shortness of Breath0 (0%)1 (5%)6 (27%)15 (68%) Fatigue0 (0%)1 (5%) 20(91%) Taste Changes0 (0%)2 (9%)10 (46%) Mouth and Swallowing Problems 0 (0%)2 (9%)8 (36%)12 (55%) Loss of Appetite0 (0%) 1 (5%)21 (96%) Weight Loss0 (0%) 16 (73%)11 (38%) Diarrhea4 (18%) 90 (41%)5 (23%) Constipation0 (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/0,327 8_437890_438338_langld-en.html, accessed April 2008. http://www.bc.cancer.ca/ccs/internet/mediareleaselist/0,327 8_437890_438338_langld-en.html 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.htmlhttp://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. CharacteristicsNumber (%) ProfessionNurse8 (31) Dietitian18 (69) Worked with lung patients (years) 0-59 (34.5) 6-108 (31)  11 9 (34.5) Province of employment British Columbia4 (15) Alberta2 (8) Manitoba1 (4) Ontario7 (27) Quebec3 (11.5) New Brunswick1 (4) Nova Scotia3 (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 Figure 1 Information Sources That Lung Cancer Patients Use According to Health Care Practitioners, expressed as percentage Figure 2 Mode of Delivery of Nutrition Information That Lung Cancer Patients Prefer According to Health Care Practitioners, expressed as percentage References