Abstract 1356: Promoting dietary change in the care of long term cancer survivors: Perspectives of the clinical care team.
Authors: Smith Katherine C. , Coa Kisha , Klassen Ann C. , Caulfield Laura , Shockney Lillie , Helzlsouer Kathy J. 
Published: August 2014

Abstract
Improvements in the prognosis of cancer patients attributable to advances in early detection and treatment have resulted in a large number of cancer survivors who are living longer lives. There are approximately 11.7 million cancer survivors in the United States, of whom 64% survive five or more years post-diagnosis. Cancer survivors are at increased risk of cancer recurrence, a second incidence of cancer, development of other chronic diseases, and report poorer health than adults who have not had cancer. Interventions seeking to promote behavior change, such as a healthy diet or regular physical activity, have been proposed as one strategy for improving the health outcomes and quality of life of long-term cancer survivors. Although a physician recommendation has consistently been found to be an important predictor of behavior change, there is limited research exploring current practices for addressing behavior change in the care of post-treatment cancer survivors or on the clinical perceptions of the importance of promoting behavior change.
We conducted in-depth, semi-structured interviews with 32 clinicians (e.g., oncologists, primary care providers, nurses, dieticians, social workers) from two clinical settings (one academic and one community) who care for prostate, breast, and/or non-Hodgkin lymphoma cancer survivors. Interview questions focused on how diet is currently addressed in care of cancer survivors and perceptions of the importance of promoting dietary change among cancer survivors. Interviews were audio recorded, transcribed verbatim and analyzed using a constant comparison approach.
Varying perspectives were elicited on the relevance of behavior change in caring for cancer survivors by clinician type (e.g., primary care providers compared to oncologists) and cancer type. Among clinicians who believed that promoting a healthy diet was an important component of caring for cancer survivors, some recommended dietary change as a strategy for reducing risk of recurrence, while others recommended it to promote overall health. The majority of clinicians who thought it was important to recommend dietary changes to their patients identified someone else as a more appropriate person to provide details about healthy diet or effective intervention strategies. Oncologists presented both lack of time and lack of expertise as barriers to addressing diet with their patients. Primary care providers (PCPs) were often mentioned as appropriate clinicians to handle dietary concerns, although they too cited similar barriers to care provision.
These findings suggest that while many clinicians perceive value in promoting behavior change in cancer survivors, it does not fall neatly within the remit of any core member of the current cancer care team, nor are resources for nutrition expertise easily identified. Intervention strategies should address this gap.
Citation Format: Katherine C. Smith, Kisha Coa, Ann C. Klassen, Laura Caulfield, Lillie Shockney, Kathy J. Helzlsouer. Promoting dietary change in the care of long term cancer survivors: Perspectives of the clinical care team. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1356. doi:10.1158/1538-7445.AM2013-1356