EFTA01192170

Cancer Nutrition Study Sponsored by Delaware North Companies March 2013 WHP Research, Inc. 6710 Glenbrook Road Chevy Chase, MD 20815 Providing Marketing Research with www.whpresearch.com Wisdom, Honesty, and Precision 301.986.1824 EFTA01192170 Table of Contents ■ Executive Summary ■ Detailed Findings J Participant Profile J Type of Cancer J Treatment J Medication, Supplements and Vitamins J Demographics J Symptoms J Behavior Changes J Weight Changes J Exercise, Energy and Work Food Shopping and Preparation - Experience with Food and Beverages since beginning Treatment J Eating and Drinking Behaviors J Dietary Changes J Taste Sensitivity J Foods and Beverages Avoiding J Foods and Beverages Preferring J Appeal of other Products and Services Appendix 9 EFTA01192171 Executive Summary Research Background and Objectives Methodology Considerations and Suggestions Summary of Findings EFTA01192172 Research Background and Objectives Cancer patients struggle with nutrition during treatment, and the symptoms related to eating during treatment might include decreased or increased appetite, altered taste and smell, early satiety, mouth sores, nausea, extreme fatigue, constipation/diarrhea and other symptoms. This survey will explore the impact of taste and smell on nutritional intake and quality of life, and will ask questions about consumption of food, intake of fluids, food preparation and barriers to cooking and shopping for food during cancer treatment. Specifically, the research: ■ Provides a profile of patients on active cancer treatment Type of cancer, when diagnosed, type of treatments Eating drinking preferences, usage of supplements, activity levels Symptoms experiencing and what precludes them from having healthy diets Demographic information ■ Assesses the appeal of different foods and beverages (ones avoiding and preferring) ■ Assesses appeal of products and services al Generates a list of recipes or food dishes that appeal to them during treatment El Identifies differences, if any, by type of traveler or demographic information Results will be shared with the Culinary Institute of America master chefs to identify products, develop recipes or tips, products or services that will appeal to cancer patients. Further research is then recommended to gain reactions to the food products, recipes and preparation of in- home meals via in-home or in-patient taste tests or placements. 4 EFTA01192173 Methodology ■ This research is a joint effort between Delaware North Companies, the Culinary Institute of America, WHP Research and seven medical centers. The survey was developed in partnership to bring together medical and marketing research expertise. Once the centers received IRB approval, surveys were collected from cancer patients who were actively undergoing treatment. Paper surveys were distributed and collected by nurses, therapists or nutritionists in waiting areas or other clinical areas. Surveys were completed anonymously, with the option for patients to answer any or all questions. All participants are 18 years of age or older. ■ A total of 1,203 surveys were collected and analyzed from seven medical centers: ▪ Roswell Park Cancer Institute (302) ▪ New York University Clinical Cancer Center (298) ▪ Dana Farber/Brigham and Women's Cancer Center (199•) ▪ Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (118) University of Chicago Comprehensive Cancer Center (109) Mayo Clinic Cancer Center (100) • Cedars-Sinai / Samuel Oschin Comprehensive Cancer Institute (77) • Surveys were collected between April and December, 2012. See Appendix for questionnaire. • A survey completed by a participant <18 years old was not included. EFTA01192174 Considerations and Suggestions Based on this research study, the following suggestions are offered or the following factors ought to be considered when designing menus and recipes to best serve cancer patients. Most patients feel it would be extremely or very helpful to have recipes to better manage their symptoms. Most of them also feel it would be helpful to have written information on how to eat better during cancer treatment. In addition, having pre-packaged or prepared meals available for sale would be helpful, especially when the meals are designed and promoted specifically for cancer patients. Given that different cancer patients might have different symptoms related to food, the Team might want to design some menu items geared to specific types of patients (e.g., avoiding constipation-causing menu items with lung cancer patients or diarrhea-causing menu items with gastrointestinal cancer patients). In addition, menus also need to take into account patients' other health problems, such as diabetes and/or heart disease. ■ The majority of patients have less energy. Patients who have less energy or have lost weight unintentionally since beginning treatment are the most likely to have symptoms and are the most likely to have decreased appetites and lower food consumption. These patients are most in need of nutrients to help them feel better and to help increase energy levels. Those with low energy levels especially desire recipes that will help them manage their symptoms. However, these recipes must be easy to prepare, not requiring a lot of energy. In addition, liquid nutrition that tastes good might entice those with unintentional weight loss to consumer more calories, especially breast and hematological patients who are the most likely to have an increased desire for beverages. Most patients have increased taste sensitivities; decreased taste sensitivities is less of an issue. Patients preferring food served at room temperature are the most likely to have increased taste sensitivities. The most often increased taste sensitivities are metallic, salty and sweet. Since greasy and fried foods are being avoided by about one-half of the patients, menus should not feature too many of these types of foods. Although spicy foods are also being avoided by a sizeable number of patients, other patients seek spicy foods. Thus, labeling on a menu is critical, identifying if its a "spicy" or "bland" recipe/dish. 6 EFTA01192175 Considerations and Suggestions, Cont'd. ■ Some ethnic differences are noted. Most Caucasians are not avoiding meat. African Americans are the most likely to be avoiding salty foods. Once again, labeling and identifying foods are critical, such as if low salt, low sugar, low fat, all natural (not processed), easy to digest and organic. When designing menus for patients, the aromas/smells that might arise when cooking ought to be considered. In particular, six out of ten breast patients find aromas/smells annoying. These patients also are the least likely to find food appetizing when prepared at home. ■ Creating hot food items will have the most appeal since hot foods are most desired, among those with a food temperature preference. Foods with the greatest appeal are fruits and vegetables, soups, poultry, pasta and fish. Those eating less food since beginning treatment are the least likely to prefer fish and meat. Based on analysis of all the recipes and food preferences provided, recipes ought to be designed taking into consideration the following categories and the recipes suggested by cancer patients (see verbatim comments): ▪ Carb-heavy foods (e.g., pastas, casseroles, rice, breads, potatoes) _J Comfort foods (e.g., soups, stews, eggs, pastas) _J Soft, smooth and creamy foods (e.g., smoothies, ice cream, pudding, yogurts, eggs) _J Sweets (e.g., fruit pies, cakes, cookies, ice cream) _J Spicy or flavorful (e.g., Asian, Mexican, Indian, Thai, Chinese, Italian) • Salty (e.g., popcorn, chips, nuts, crackers, pretzels) ▪ Bland (e.g., mashed potatoes, rice, toast, bananas, eggs, soup, oatmeal) • Meats/seafood (e.g., steak, chicken, fish) • Fruits/vegetables (e.g., bananas, apples, oranges, potatoes, green vegetables) EFTA01192176 Summary of Findings Participant Profile Survey participants represent a mix of patients with different types of cancer, primarily: solid (29%), hematologic malignancies (21%), breast (19%), gastrointestinal (15%) and lung (14%). ▪ Solid tumors are most often gynecological (42%), prostate, kidney or bladder (22%), head or neck (17%) or brain or spinal (13%). ▪ Hematologic malignancies are most often lymphoma (40%), multiple myeloma (35%) or leukemia (27%). ■ On average, they were first diagnosed about nine months ago, with almost one-half of them (47%) diagnosed more than one year ago. About 10% were diagnosed within the past two months. ■ Nine out of ten survey participants are undergoing chemotherapy. About one-third of those with solid or lung cancer are receiving a mix of chemotherapy, hormone therapy and/or radiation. ■ Most participants do not have other health problems (61%). Among those with other conditions, diabetes and heart disease are most prevalent. ■ A mix of men (39%) and women (61%) participated, with about one-half between 45 to 64 years (48%), and most Caucasian (80%). ■ Survey participants are likely to be taking prescriptions, with anti-nausea (45%), pain medication (33%) and steroids (26%) being most common. About one-third of the participants are taking nutritional supplements, with one-fifth taking Ensure/Boost. About seven out of ten participants are taking vitamins or minerals, with vitamin D (30%), calcium (23%), and multi-vitamins (22%) having the highest usage. ■ Only about three out of ten participants are taking dietary supplements or herbs. Fish oil (12%) and herbal tea (9%) are mentioned most often. 8 EFTA01192177 Summary of Findings, Cont'd. Symptoms Symptoms vary somewhat based on the type of cancer a participant has. Symptoms most prevalent are: ▪ GI: significant fatigue, poor appetite, diarrhea, nausea and/or vomiting, dry mouth, gas/bloating ▪ Lung: significant fatigue, poor appetite, constipation, shortness of breath/no oxygen, dry mouth ▪ Solid: significant fatigue, constipation, poor appetite, nausea and/or vomiting, dry mouth ▪ Breast: significant fatigue, constipation, dry mouth, reflux/indigestion ▪ Hema: significant fatigue, constipation, dry mouth, poor appetite ■ Symptoms are most likely to occur among those ... ▪ Experiencing less energy since beginning treatment ▪ Losing weight unintentionally ▪ Consuming less food and beverages since beginning treatment Changes ■ In terms of weight changes, more patients have lost weight (45%) than gained weight (24%). ▪ However, breast patients are about equal, with 32% losing weight and 29% gaining weight. ▪ Weight change tends to be unintentional (88%) versus intentional (12%). However, for 19% of GI patients their weight change has been intentional. ▪ About one-half of those with less energy have lost weight. More than three-fourths of the patients (78%) have less energy, two-thirds (67%) are working less often and three-fifths (60%) are exercising less often since beginning treatment. ■ Two-thirds of the patients (67%) are able to shop for food all or most of the time, 59% are able to prepare meals, and 53% consider themselves to be the primary food preparer. ▪ About one-fifth of those 75 years or older are not able to shop for food (17%) or prepare meals (19%). ▪ As would be expected, those with less energy and unintentional weight loss are the least likely to shop for food and/or prepare meals. 9 EFTA01192178 Summary of Findings, Cont'd. Food and Beverage Behavior Since beginning treatment, food appetites have lessened (39% vs. 15% increased) and food consumption is more likely to have waned (30% eating less often vs. 22% eating more often). ▪ Decreases in appetite are most prevalent among GI and lung patients. ▪ However, about the same number of GI (and also hema) patients are eating more often as are eating less often. ▪ Those with less energy and those with unintentional weight losses are the most likely to have decreased appetites and lower food consumption. ■ Since beginning treatment, increases are noted on the desire for beverages (31% vs. 16% decreased) and beverage consumption (49% more often vs. 11% less often). ▪ Increases in thirst are most realized among breast and hema patients. ▪ Although those with less energy and unintentional weight losses are more likely to have increases (versus decreases) in desire for beverages and beverage consumption, when compared to those with the same/more energy or the same/more weight gains, significantly more of the less energy/weight loss individuals have declines on these measures. Since beginning treatment, alcoholic beverage intake has dropped (78% drinking less often). About one-half of the patients (51%) are drinking/eating about the same as they were before treatment. _ Those with less energy and unintentional weight losses are the most likely to have had dietary changes. Almost 60% of the patients have increased taste sensitivities; 18% have decreased taste sensitivities. ▪ Increased sensitivities are most often metallic (19%), salty (15%), and sweet (14%). ▪ Those 75 years or older are most likely to have increased taste sensitivities (75%). ▪ Those with less energy and unintentional weight losses are the most likely to have increased and/or decreased taste sensitivities. About one-half of them have increased taste sensitivities; one-fifth have decreased taste sensitivities. ▪ Those with reduced food and beverage consumption are the most likely to have increased taste sensitivities. ▪ Patients preferring food served at room temperature are also most likely to have increased taste sensitivities. 10 EFTA01192179 Summary of Findings, Cont'd. Foods Avoiding • Most patients (80%) are avoiding some types of foods, especially greasy/fried foods (52%) and spicy foods (42%). About 47% of patients avoid foods that they used to eat due to medical advice; 57% due to intolerance; 70% for other reasons. ▪ Those with less energy and those with unintentional weight losses tend to avoid more foods than others, especially greasy, spicy, acidic, Indian and Mexican foods. ▪ Those 75 years or older are less likely to avoid foods than younger patients. ▪ Caucasians are the least likely to avoid meat (only 20% avoiding). ▪ African Americans are the most likely to avoid salty foods (42%). ■ When asked open-ended, other foods avoiding (not already listed) include foods that are high fat/rich, processed, hard to digest, high sugar content, cold temperatures, raw fish, shellfish and non-organic fruits/vegetables. Beverages Avoiding • Alcoholic beverages (50%+), soda/pop/tonic (39%) and coffee (28%) are the beverages most often avoided. Lung patients are the least likely to avoid coffee (only 16% avoiding). ▪ Coffee is especially being avoided among those with low energy levels and weight losses. ▪ Those 75 years or older are the least likely to avoid specific beverages. ▪ Caucasians are the least likely to avoid soda/pop/tonic and coffee. Aromas/Smells Avoiding • About one-half (48%) of all patients are bothered by aromas/smells, with the most annoying aromas/smells being cleaning solutions and perfumes/colognes. ▪ Breast patients are the most likely to find aromas/smells annoying (60%). ▪ Those 75 years or older are the least likely to be bothered by aromas/smells. ▪ Other ethnicities (not White or Black) are most sensitive to the smell of fish and food cooking. ▪ Those with less energy, weight losses and dietary changes are most sensitive to aromas/smells. 11 EFTA01192180 Summary of Findings, Cont'd. Food Preference Most patients (65%) do not have a food temperature preference. Those with a preference, desire hot foods. African Americans are the most likely to prefer hot foods (43%), followed by those 75 years or older (30%). Those with less energy and those with weight losses are more likely than others to have a food temperature preference. ■ Food is more appetizing when prepared at home (43%) versus eating out (13%) or bringing in (5%). The reminder do not have a preference. ▪ Breast cancer patients are the least likely to find food more appetizing when prepared at home (only 35%). ▪ African Americans are the most likely to find food more appetizing when prepared at home (52%). ▪ One-fifth (19%) of those with weight gain are most likely to prefer eating out. ■ Fruits/vegetables (69%), soups (62%), poultry (61%), pasta (55%) and fish (53%) are most favored. ▪ Those 75 years and older prefer soups, poultry, pasta and meat, while others prefer more ethnic/spicy foods. ▪ African Americans have a strong preference for fish (70%). ▪ Those with more energy are more likely to find more foods appealing. ▪ Those eating less food since beginning treatment are less likely to prefer fish and meat versus those eating the same or more food. ■ When asked unaided, foods that are most appealing to patients can be grouped as: ▪ Carb-heavy foods (e.g., pastas, casseroles, rice, breads, potatoes) ▪ Comfort foods (e.g., soups, stews, eggs, pastas) ▪ Soft, smooth and creamy foods (e.g., smoothies, ice cream, pudding, yogurts, eggs) ▪ Sweets (e.g., fruit pies, cakes, cookies, ice cream) ▪ Spicy or flavorful (e.g., Asian, Mexican, Indian, Thai, Chinese, Italian) ▪ Salty (e.g., popcorn, chips, nuts, crackers, pretzels) ▪ Bland (e.g., mashed potatoes, rice, toast, bananas, eggs, soup, oatmeal) ▪ Meats/seafood (e.g., steak, chicken, fish) ▪ Fruits/vegetables (e.g., bananas, apples, oranges, potatoes, green vegetables) 12 EFTA01192181 Summary of Findings, Cont'd. Beverage Preference • Water is the most preferred beverage (74%), followed by fruit juice (48%), tea (44%) and coffee (40%). ▪ GI patients are the most likely to prefer fruit juice (58%). ▪ About one-half of breast patients (51%) prefer tea. ▪ African Americans also have a great desire for tea (54%). ▪ Coffee has the greatest appeal among those 75 years or older (54%). ▪ Those who have lost weight prefer sports drinks (25%) more than other patients. Appeal of Products and Services • When asked about specific products and services, interest in recipes and written information is the highest: • Recipes that help you manage your symptoms (59% would find it extremely or very helpful) • Written information on eating better during cancer treatment (59%) • Pre-packaged or prepared meals to purchase that are full of nutrients needed to help you feel better (46%) • Videos on creating easy, highly nutritional meals (32%) • Liquid nutrition that tastes like food instead of milk shakes (18%) Some differences are found by type of patients: ▪ Breast patients are the most likely to find these products and services helpful. ▪ Adults under 75 years are more likely to feel that these products and services would be helpful than those 75 years or older. ▪ Caucasians are less interested in these products and services than others. ▪ Recipes that would help manage symptoms would be most helpful to those with less energy and unintentional weight loss. ▪ Having pre-packaged or prepared meals would be most helpful to those lacking energy while having better tasting liquid nutrition might entice those with unintentional weight loss to consume more calories. ▪ Those with changes in food consumption are most likely to find recipes helpful. ▪ Those who are eating less food are also the most likely to find tasty liquid nutrition helpful versus others. 13 EFTA01192182 Detailed Findings Participant Profile Symptoms Behavior Changes Experience with Food and Beverages since beginning Treatment Foods and Beverages Avoiding Foods and Beverages Preferring Appeal of other Products and Services EFTA01192183 Participant Profile EFTA01192184 First Diagnosis On average, patients were first diagnosed with cancer 9.4 months ago. Survey participants represent a mix of different types of cancer. Those with hematologic malignancies were diagnosed on average 10.6 months ago, while those with gastrointestinal cancers were diagnosed on average 8.1 months ago. Type of Cancer Total GI Lune Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) Within past 2 months 11 15 11 11 7 12 Within past 4 months 16 17 14 16 20 12 Within past 6 months 12 15 12 12 13 10 Within past 9 months 6 12 8 6 6 2 Within past year 7 9 9 5 7 6 More than one year ago 47 32 46 49 47 58 Mean 9.4 mo. 8.1mo. 9.5 mo. 9.6 mo. 9.6 mo. 10.6 mo. =Significantly higher than all numbers =Significantly lower than all numbers = Significantly higher than lowest number Q4 - When were you first diagnosed with cancer? 16 EFTA01192185 Type of Cancer A mix of different types of cancer patients participated. Gynecological cancer represents the largest group among those having solid tumors. Type of Cancer Total GI Lung Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) Type of Cancer Solid tumors - Net 29 5 16 100 5 2 Gynecological 12 1 1 42 2 1 Prostate, kidney or bladder 6 1 5 22 1 1 Head or neck 5 1 2 17 0 0 Brain or spinal 4 2 8 13 2 0 Soft tissue sarcoma 2 1 1 6 0 0 Osteosarcoma 1 1 2 0 0 Hematologic malignacies - Net 22 1 2 2 1 100 Lymphoma 9 1 2 1 40 Multiple myeloma 8 o 1 1 0 35 Leukemia 6 o o 1 27 Breast cancer 19 1 2 3 100 1 GI cancers - Net 15 100 5 3 1 1 Gastrointestinal 9 61 2 1 * 1 Pancreatic, liver or gall bladder 7 44 S 2 * Lung cancer 14 5 100 8 2 2 Bone marrow transplant 2 1 0 0 5 Other malignancies 8 4 4 2 2 1 O5 - What type of cancer do you have? Multiple answers accepted. 17 EFTA01192186 Treatment Nine out of ten patients surveyed are undergoing chemotherapy. About one-third of those with solid or lung cancer are receiving a mix of chemotherapy, hormone therapy and/or radiation. Type of Cancer Total GI Luna Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) 21 % S ii ii ii Treatment Chemotherapy 90 99 97 90 85 89 Radiation 15 11 27 25 11 4 Surgery 8 7 8 14 9 4 Hormone Therapy 5 1 1 8 13 Transplant 2 1 0 * 0 5 None at this time or between treatments 4 1 2 2 4 9 Nets: Only chemotherapy 71 82 66 59 70 81 Only hormone therapy 2 0 0 3 7 0 Only radiation 2 0 1 3 3 0 Only chemo and radiation 2 1 1 4 3 0 Mix of chemo, hormone and/or radiation 21 17 31 34 17 9 =Significantly higher than all numbers =Significantly lower than all numbers = Significantly higher than lowest number Q6 - Which of the following treatments, if any, are you currently receiving? Multiple answers accepted. 18 EFTA01192187 Gender, Age and Ethnicity On average, the patients are 60 years old. Eight out of ten patients who participated in the survey are Caucasian. GI and Hema patients skew male. Breast cancer patients are the most ethnically diverse and youngest, on average. Type of Cancer Total GI aL g Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) 79 79 79 Gender Female 61 43 61 60 98 44 Male 39 57 39 40 2 56 Age 18 to 24 1 1 0 2 0 2 25 to 34 3 4 0 4 4 1 35 to 44 9 5 4 6 23 7 45 to 54 20 20 12 19 27 17 55 to 64 28 32 29 30 23 23 65 to 74 27 25 40 28 16 34 75+ 13 14 15 11 7 15 Average 60 yrs. 61yrs. 65 yrs. 60 yrs. 53 yrs. 65 yrs. Ethnicity Caucasian 80 84 83 82 76 81 African American 9 5 11 6 14 10 Hispanic 4 4 2 5 4 4 =Significantly higher than all numbers Asian 3 3 2 3 4 1 =Significantly higher than lowest number Other 4 5 2 5 3 4 =Significantly lower than all numbers 01 - Are you: Q2 - What is your age? 19 Q3 - What is your ethnicity? EFTA01192188 Other Health Problems About six out of ten patients do not have any other health problems. One in ten patients have diabetes and/or heart disease. About one-fifth of GI patients also have diabetes. Many lung cancer patients also have lung and/or heart disease. Type of Cancer Total GI Lung Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) Other Health Problems Diabetes 13 19 14 11 11 13 Heart disease 10 9 15 10 3 11 Lung disease 5 2 20 5 3 5 Kidney disease 2 0 4 2 1 3 Liver disease 2 6 1 2 3 2 HIV/AIDS 1 2 0 * 1 1 None of the above 61 58 56 61 66 62 Other 17 14 13 19 21 17 =Significantly higher than all numbers = Significantly lower than all numbers = Significantly higher than lowest number Q8 - Which of the following health problems, if any, do you have? Multiple answers accepted. 20 EFTA01192189 Medications and Nutritional Supplements Anti-nausea, pain medications and steroids are most prescribed. Three out of ten patients are not taking any medications. Two-thirds are not taking any nutritional supplements. Breast cancer patients are the least likely to be on prescription medications and/or nutritional supplements. Type of Cancer Total GI Lt l fi Solid Breast Hema Base sizes: (1198) (1821 (169) (343) (226) (255) 96 Prescription Medications Anti-nausea 45 58 48 SO 36 39 Pain medication 33 31 37 36 30 33 Steroids 26 20 29 26 21 34 Antibiotics 15 9 12 13 10 31 Sedatives 9 7 12 11 11 7 Appetite stimulants 3 7 2 2 3 2 Anticonvulsants 2 1 2 S 1 1 Neuroleptics 2 1 2 1 1 3 None of the above 29 26 27 24 41 25 Nutritional Supplements Ensure/Boost 20 28 31 21 11 18 Protein Shake 6 9 6 6 3 5 Carnation Instant Breakfast 5 5 6 7 3 5 Protein Powder 5 6 6 6 5 4 Glucerna 2 6 3 2 1 2 Muscle Milk 1 3 0 1 1 1 BeneCalorie 2 1 0 0 Nepro • 0 0 0 0 r Significantly higher than all numbers None of the above 65 52 57 64 76 70 r Significantly higher than lowest number Other 7 9 7 7 8 4 r Significantly lower than all numbers Q9 - Which of the following prescription medications, if any, are you taking? Multiple answers accepted. O10 - Which of the following nutritional supplements, if any, are you taking? Multiple answers accepted. 21 EFTA01192190 Vitamins/Minerals Vitamin D and Calcium are most often taken. Compared to other patients, those with Solid or Breast cancer are more likely to be taking calcium. Lung patients are most likely to take folic acid. Type of Cancer Total GI aL Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) Vitamins / Minerals Vitamin D 30 25 23 30 36 34 Calcium 23 14 16 26 31 20 Multi-vitamins (MVI) 22 26 23 19 19 29 Multi-vitamins with minerals 13 15 12 12 14 12 Vitamin 612 12 9 17 12 9 14 Folic Acid 10 6 28 7 4 12 Magnesium 10 5 6 15 7 10 Vitamin B - complex 10 7 7 10 11 14 Vitamin C 10 6 9 13 14 8 Potassium 8 7 6 7 9 9 Iron 7 12 5 5 6 5 Vitamin 66 6 5 6 9 8 3 Vitamin E 5 3 6 5 5 5 Zinc 3 2 3 2 4 3 Biotin 2 2 1 2 3 2 Vitamin A 1 1 1 2 1 1 None of the above 31 36 28 31 34 29 r Significantly higher than all numbers Other 6 3 5 7 7 6 r Significantly higher than lowest number r Significantly lower than all numbers Ctll - Which of the following vitamins/minerals, if any, are you taking? Multiple answers accepted. 97 EFTA01192191 Dietary Supplements/Herbs Most patients are not taking dietary supplements or herbs. Fish oil and herbal teas are the most often mentioned dietary supplements/herbs. Type of Cancer Total GI Lung Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) Dietary Supplements / Herbs Fish oil 12 7 13 13 11 14 Herbal tea 9 7 12 11 12 6 Flaxseed 6 5 4 6 5 7 Co Q10 enzyme 4 3 4 4 5 3 Fiber 4 5 5 5 3 4 L-Glutamine 3 4 2 5 1 2 Milk Thistle 2 2 1 2 3 1 Wheat Grass 2 3 2 2 4 Alpha Lipoic Acid 1 2 1 2 1 1 Chinese herbals 1 2 2 1 1 L-Carnitine 1 1 1 1 1 1 L-Lysine 1 1 1 1 1 Lutein 1 1 3 1 2 2 Saw Palmetto 2 0 0 0 Black Cohosh * 1 1 * 0 0 St. John's wort * 0 1 0 1 0 r Significantly higher than all numbers None of the above 71 76 72 68 71 71 r Significantly higher than lowest number = Significantly lower than all numbers O12 - Which of the following dietary supplements/herbs, if any, are you taking? Multiple answers accepted. 23 EFTA01192192 Symptoms EFTA01192193 Symptoms At least one-fourth of the cancer patients' are experiencing significant fatigue, constipation, poor appetite, dry mouth and/or nausea and/or vomiting. The top four symptoms by type of cancer are circled. Type of Cancer Total GI Luna Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) Symptoms Significant fatigue 41 Constipation 33 27 Poor appetite 31 Dry mouth 27 30 Nausea and/or vomiting 26 21 20 22 Gas/bloating 23 29 23 26 26 15 Quickly feeling full 21 24 20 24 16 Reflux/indigestion 21 21 22 23 13 Diarrhea 20 15 20 24 15 Increased sensitivity to smells 17 17 16 18 25 13 Shortness of breath, no oxygen 17 12 18 16 19 Mouth/tongue sores 12 13 10 14 15 9 Trouble swallowing 9 7 14 13 8 5 Sore throat 8 5 7 10 8 7 Severe pain (6+ out of 10) 7 5 10 9 8 6 Sore/bleeding gums 6 6 7 9 5 2 Decreased sense of smell 6 6 5 9 3 8 Trouble chewing 3 3 2 5 1 2 Loss of teeth 2 1 4 3 2 Shortness of breath, require oxygen 2 1 7 1 1 3 None of the above 16 14 14 14 19 18 Q7 - What symptoms, if any, do you have? Multiple answers accepted. = Top 4 symptoms by type of cancer 25 EFTA01192194 Those experiencing less energy since they began treatment and those who have lost weight, unintentionally, are the most likely to experience symptoms. Energy Level Weight Change (unintentional) Total More/Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (354) (456) Symptoms Significant fatigue 41 12 51 39 35 53 Constipation 33 22 36 35 32 34 Poor appetite 31 15 35 13 21 50 I Dry mouth 27 16 30 22 22 35 Nausea and/or vomiting 26 14 29 21 19 36 Gas/bloating 23 14 26 27 18 26 Quickly feeling full 21 10 24 13 16 33 Reflux/indigestion 21 13 24 22 20 23 Diarrhea 20 13 23 16 18 24 Increased sensitivity to smells 17 7 20 14 17 20 Shortness of breath, no oxygen 17 7 20 20 15 20 Mouth/tongue sores 12 6 14 12 10 13 Trouble swallowing 9 5 10 5 6 12 Sore throat 8 5 8 7 6 9 Severe pain (6+ out of 10) 7 3 9 8 4 11 Sore/bleeding gums 6 2 7 8 5 7 Decreased sense of smell 6 4 7 6 3 8 Trouble chewing 3 3 3 1 2 5 Loss of teeth 2 1 2 2 1 2 Shortness of breath, require oxygen 2 2 3 1 1 5 None of the above 16 36 10 21 22 8 Q7 -What symptoms, if any, do you have? Multiple answers accepted. =Significantly highest or higher than both numbers = Significantly lowest or lower than both numbers = Significantly higher than lowest number 26 EFTA01192195 Almost all of the patients who are consuming less food/beverages since beginning treatment are experiencing some symptoms. Eating Behavior Drinking Behavior Total More Same Less More Same Less Base sizes: (1198) (251) (565) (349) (570) (469) (126) Symptoms Significant fatigue 41 45 32 57 43 38 55 Constipation 33 36 It 28 39 36 26 II 44 Poor appetite 31 18 13 68 27 28 57 Dry mouth 27 33 • 17 41 31 19 41 Nausea and/or vomiting 26 25 17 41 27 20 46 Gas/bloating 23 29 it 19 26 24 22 25 MI Quickly feeling full 21 18 12 38 21 18 Reflux/indigestion 21 22 17 28 21 18 33 Diarrhea 20 20 17 27 21 18 30 Increased sensitivity to smells 17 24 II 9 24 19 11 29 Shortness of breath, no oxygen 17 17 14 23 21 14 17 Mouth/tongue sores 12 13 8 17 12 8 21 I Trouble swallowing 9 7 5 16 9 7 15 Sore throat 8 6 6 12 8 6 11 Severe pain (6+ out of 10) 7 6 3 15 8 6 13 Sore/bleeding gums 6 6 4 9 6 4 10 Decreased sense of smell 6 6 4 9 5 7 6 Trouble chewing 3 1 2 5 3 3 6 Loss of teeth 2 2 1 3 2 2 1 Shortness of breath, require oxygen 2 2 2 3 2 3 3 None of the above 16 14 23 4 13 20 6 Q7 - What symptoms, if any, do you have? Multiple answers accepted. =Significantly highest or higher than both numbers = Significantly lowest or lower than both numbers =Significantly higher than lowest number EFTA01192196 Behavior Changes EFTA01192197 Weight Changes More patients have lost weight, unintentionally, than have gained weight. When looking at gains versus losses, more patients have lost weight than gained weight, except for Breast patients who are divided. The weight change tends to be unintentional; however, for GI patients, one-fifth of their weight change is intentional. Type of Cancer Total GI Lung Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) % Gained 24 20 27 25 29 22 Gained more than 20 pounds 4 6 6 4 4 3 Gained 11to 20 pounds 6 2 4 7 10 5 Gained 5 to 10 pounds 14 12 17 14 15 14 Stayed about the same weight 31 30 24 32 39 29 Lost 45 51 50 43 32 49 Lost S to 10 pounds 19 16 17 17 18 22 Lost 11to 20 pounds 13 15 14 11 9 15 Lost more than 20 pounds 13 20 18 16 6 13 Weight Change Intentional 12 19 11 9 9 14 Unintentional 88 81 89 91 91 87 =Significantly higher than all numbers = Significantly lower than all numbers = Significantly higher than lowest number Q32 - Since you began treatment, have you: Q33 - Was this weight gain or loss: 29 EFTA01192198 One-half of the patients who have experiencing less energy since treatment began have lost weight. About nine out of ten said their weight change was unintentional. African Americans are the most likely to have gained weight, but most of them are still more likely to have lost weight (31% vs. 45%, respectively). Energy Level Ethnicity Total More Same Less White Black Others Base sizes: (1198) (253) (892) (954) (111) (132) % % % % % Gained 24 28 23 24 31 19 Gained more than 20 pounds 4 3 4 4 5 3 Gained 11to 20 pounds 6 7 6 6 4 7 Gained 5 to 10 pounds 14 17 13 13 22 10 Stayed about the same weight 31 42 28 31 25 33 Lost 45 31 49 45 45 48 Lost 5 to 10 pounds 19 16 20 18 21 25 Lost 11to 20 pounds 13 8 14 14 9 12 Lost more than 20 pounds 13 6 15 14 15 11 Weight Change _ Intentional 12 24 9 13 5 9 Unintentional 88 76 91 87 95 91 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q32 - Since you began treatment, have you: Q33 - Was this weight gain or loss: 30 EFTA01192199 Exercise, Energy and Work Six out of ten patients are exercising less often, not surprising since the majority (78%) have less energy. Most patients are also working less often. Two-thirds of the Lung patients are exercising less often; most of them (82%) have less energy. Type of Cancer Total GI Lunt Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) Exercising More often 7 8 7 6 9 6 About the same 33 35 28 31 36 36 Less often 60 57 66 62 56 58 Energy Level More 4 7 3 1 2 6 About the same 18 19 15 18 17 20 Less 78 74 82 81 80 74 Working More often 2 4 0 2 1 2 About the same 31 27 33 24 38 30 Less often 67 70 67 75 60 68 =Significantly higher than all numbers =Significantly lower than all numbers = Significantly higher than lowest number Q34 - Since you began treatment, are you exercising: Q35 - Since you began treatment, do you have: 31 Q36 - Since you began treatment, are you working: EFTA01192200 Among those with less energy, about seven out of ten are exercising less often and about three-fourths of them are working less often. About nine out of ten patients who have unintentionally lost weight have less energy. Energy Level Weight Change (unintentional) Total More Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (354) (456) Exercising More often 7 16 4 7 7 5 About the same 33 54 27 29 39 29 Less often 60 30 69 64 54 66 Energy Level More 4 17 0 3 3 2 About the same 18 83 0 19 26 11 Less 78 0 100 78 71 87 Working More often 2 7 1 2 1 1 About the same 31 57 24 28 44 22 Less often 67 36 76 70 56 77 Although the majority of patients (78%) have less energy, patients who are eating less often and drinking less often (90%+) have significantly less energy, are working less often (80%+), and exercising less often (72%+) vs. those eating/drinking the same or more since beginning treatment. =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q34 - Since you began treatment, are you exercising: Q35 - Since you began treatment, do you have: 32 Q36 - Since you began treatment, are you working: EFTA01192201 Food Shopping and Preparation Two-thirds of the patients indicate that they are able to shop for food. Only 10% said they are not able to prepare meals at all. However, only about one-half of them consider themselves to be the primary food preparer. About 12-16% of Lung, Solid and Hema patients indicate they are not able to shop for food and/or not able to prepare meals. Not surprisingly, the women Breast patients are more likely to be the primary food preparer and shop for food. Type of Cancer Total GI Luna Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) Ability to Shop for Food Yes 67 63 64 66 74 66 Sometimes 23 29 23 23 21 21 No 10 9 14 12 6 14 Ability to Prepare Meals Yes 59 57 54 56 63 60 Sometimes 31 36 30 32 35 26 No 10 7 16 12 3 15 Primary Food Preparer Self 53 46 49 52 72 49 Spouse/significant other 33 43 35 34 16 39 Family member(s) 10 8 14 9 9 10 Caregiver 1 2 0 2 1 1 Friend(s) 1 1 1 1 2 0 =Significantly higher than all numbers Central dining or delivery 1 1 2 2 1 1 Significantly higher than lowest number =Significantly lower than all numbers Q37 - Are you able to shop for food? Q38 - Are you able to prepare meals for yourself and/or your family? 3:3 Q39 - Who is the primary food preparer at home? EFTA01192202 Those 75+ years and "other" ethnicity are the least likely to shop for food or prepare meals. African Americans are the least likely to have a spouse or significant other helping with food preparation, but one-fifth of them have another family member serving as the primary food preparer. Age Ethnicity Total 18-74 75+ White Black Others Base sizes: (1198) (1043) (151) (954) (111) (132) 2i 2fa 2fa if if if Ability to Shop for Food Yes 67 67 66 69 64 55 Sometimes 23 24 17 21 32 26 No 10 9 17 10 4 19 Ability to Prepare Meals Yes 59 59 56 61 56 52 Sometimes 31 32 25 30 39 32 No 10 9 19 10 5 17 Primary Food Preparer Self 53 54 48 54 61 45 Spouse/significant other 33 33 39 36 17 30 Family member(s) 10 10 9 8 21 19 Friend(s) 1 1 1 1 0 1 Caregiver 1 1 1 1 0 4 Central dining or delivery 1 1 3 1 1 2 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q37 - Are you able to shop for food? Q38 - Are you able to prepare meals for yourself and/or your family? 34 Q39 - Who is the primary food preparer at home? EFTA01192203 Those with less energy and unintentional weight loss are the least likely to shop for food and prepare meals. Energy Level Weight Change (unintentional) Total More/Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (354) (456) Ability to Shop for Food Yes 67 83 63 70 74 59 _A Sometimes 23 12 26 22 20 26 No 10 6 12 8 7 is Ability to Prepare Meals Yes 59 80 53 66 66 1 18. 1 Sometimes 31 14 36 29 28 37 No 10 6 11 5 6 16 Primary Food Preparer Self 53 55 52 57 54 49 Spouse/significant other 33 34 34 30 34 36 Family member(s) 10 8 11 9 9 12 Friend(s) 1 1 1 1 1 0 Caregiver 1 1 2 1 1 2 Central dining or delivery 1 1 1 3 1 0 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q37 - Are you able to shop for food? Q38 - Are you able to prepare meals for yourself and/or your family? 35 Q39 - Who is the primary food preparer at home? EFTA01192204 Experience with Food and Beverages since beginning Treatment EFTA01192205 Appetite and Eating Habits Since beginning treatment, more patients have experienced a decreased appetite and are eating less often. Decreases in appetite are most prevalent among GI and Lung patients. However, about the same number of GI (and Hema) patients are eating more often as are eating less often. Type of Cancer Total GI Lung Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) N S N % S N Appetite Increased 15 13 16 15 19 16 Stayed about the same 45 41 36 43 45 55 Decreased 39 47 48 42 36 29 Eating More often 22 27 20 19 22 21 About the same 49 43 44 46 47 58 Less often 30 31 36 35 31 20 =Significantly higher than all numbers = Significantly lower than all numbers = Significantly higher than lowest number O13 - Since you began treatment, has your appetite most often: Q14 - Since you began treatment, are you eating: 37 EFTA01192206 Compared to others, patients experiencing less energy since they began treatment and those who have lost weight, unintentionally, are significantly more likely to have a decrease in appetite and are eating significantly less often. Energy Level Weight Change (unintentional) Total More/Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (354) (456) Appetite Increased 15 22 13 40 9 6 Stayed about the same 45 65 40 47 67 28 Decreased 39 13 47 13 24 67 Eating More often 22 28 20 36 20 14 About the same 49 64 45 54 64 34 Less often 30 8 36 10 16 52 =Significantly highest or higher than both numbers =Significantly higher than lowest number O13 - Since you began treatment, has your appetite most often: O14 - Since you began treatment, are you eating: 38 EFTA01192207 Desire for Beverages and Beverage Habits Since beginning treatment, their desire for fluids has increased and almost one-half of patients are drinking beverages more often. The desire for beverages and consumption has increased the most among Breast and Hema patients. Type of Cancer Total GI Lung Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) Desire for Beverages Increased 31 23 25 30 38 36 Stayed about the same 54 56 59 50 51 57 Decreased 16 22 17 20 11 8 Drinking Beverages / Fluids More often 49 41 45 45 57 58 About the same 40 45 43 42 36 36 Less often 11 15 12 13 7 6 =Significantly higher than all numbers = Significantly lower than all numbers = Significantly higher than lowest number C115 - Since you began treatment, has your desire for beverages (fluids): C116 - Since you began treatment, are you drinking beverages (fluids): 39 EFTA01192208 Although about three out of ten patients have an increased desire for fluids, a sizeable number of patients who have experienced less energy since they began treatment and patients who have lost weight, unintentionally, have a decreased desire for beverages than others. Energy Level Weight Change (unintentional) Total More/Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (354) (456) Desire for Beverages Increased 31 29 31 36 28 30 Stayed about the same 54 65 50 54 61 46 Decreased 16 6 19 10 11 24 Drinking Beverages / Fluids More often 49 45 50 58 51 45 About the same 40 50 37 36 44 38 Less often 11 4 13 7 6 17 = Significantly highest or higher than both numbers = Significantly higher than lowest number O15 - Since you began treatment, has your desire for beverages (fluids): O16 - Since you began treatment, are you drinking beverages (fluids): 40 EFTA01192209 Alcoholic Beverage Consumption Among those who consumed alcoholic beverages before treatment, the majority of them are now drinking alcoholic beverages less often since they began treatment. GI and Solid patients are most notably drinking alcoholic beverages less often. Type of Cancer Total GI Lune Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) Drinking Alcoholic Beverages More often 2 2 2 2 1 1 About the same 20 14 18 15 25 27 Less often 78 85 81 83 74 72 Patients experiencing less energy and losing weight are drinking alcoholic beverages less often (>80%). =Significantly higher than all numbers = Significantly lower than all numbers = Significantly higher than lowest number O17 - Since you began treatment, are you drinking alcoholic beverages: 11 EFTA01192210 Dietary Changes About one-half of the patients are drinking/eating similarly to how they were before treatment. Most of them have no preference in terms of food temperature. Breast and Hema patients are the most likely to be drinking/eating the same. Type of Cancer Total GI Lung Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) % % % % % Normal / no changes 51 46 49 47 57 55 Changes -Net 49 54 51 53 43 45 Solids 39 41 40 38 34 42 Liquids 36 41 37 39 33 33 Liquids Only 2 1 1 3 1 1 Soft solids 25 31 28 29 20 17 Soft solids and liquids only 5 8 7 7 6 2 Nutritional supplements 12 19 14 13 6 7 Tube feedings 2 3 3 6 1 =Significantly higher than all numbers =Significantly lower than all numbers = Significantly higher than lowest number O18 - Which types of foods/beverages are you drinking/eating? Multiple answers accepted. 42 EFTA01192211 Consistent to other results, patients experiencing less energy and those losing weight are the most likely to have had dietary changes. Energy Level Weight Change (unintentional) Total More/Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (354) (456) Normal / no changes 51 60 49 56 60 43 Changes- Net 49 40 51 44 40 57 Solids 39 35 40 39 34 42 Liquids 36 29 MI 38 31 31 42 Liquids Only 2 1 2 0 2 3 Soft solids 25 18 II27 17 19 31 Soft solids and liquids only 5 3 6 4 3 8 Nutritional supplements 12 8 12 7 8 17 Tube feedings 2 1 3 1 1 4 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q18 - Which types of foods/beverages are you drinking/eating? Multiple answers accepted. 43 EFTA01192212 Taste Sensitivity About four out of ten patients have increased taste sensitivities, most often to metallic, salty or sweet items. About eight out of ten patients do not have any decreased taste sensitivities. Hema patients are the least likely to have increased taste sensitivities. One-fourth of Solid patients have decreased taste sensitivities, most often to sweet and salty items. Type of Cancer Total GI Luna Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) 2fa Increased Taste Sensitivity Metallic 19 24 16 23 21 13 Salty 15 15 14 19 15 13 Sweet 14 14 12 15 16 14 Bitter 10 11 12 9 11 9 Sour 8 11 8 10 8 5 None of the above 59 53 61 54 58 64 Decreased Taste Sensitivity Sweet 10 6 8 14 7 10 Salty 9 8 8 10 11 9 Bitter S 3 4 8 6 4 Sour S 3 3 7 6 5 None of the above 82 87 80 76 81 83 =Significantly higher than all numbers =Significantly lower than all numbers = Significantly higher than lowest number Q20 - Which of the following, if any, are you having increased taste sensitivity to? Multiple answers accepted. Q21 - Which of the following, if any, are you having decreased taste sensitivity to? Multiple answers accepted. 44 EFTA01192213 Older patients are less likely than others to have increased taste sensitivities. Some differences are noted by ethnicity. Age Ethnicity Total 18-74 75+ White Black Others Base sizes: (1198) (1043) (151) (954) (111) (132) Increased Taste Sensitivity Bitter 10 10 6 10 7 7 Metallic 19 21 8 21 15 13 Salty 15 16 10 13 25 20 Sour 8 8 3 7 6 10 Sweet 14 15 8 13 22 14 None of the above 59 56 75 59 52 58 Decreased Taste Sensitivity Bitter 5 5 3 4 7 7 Salty 9 9 8 8 8 15 Sour 5 5 4 4 11 8 Sweet 10 11 4 9 12 18 None of the above 82 81 84 84 75 70 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q20 - Which of the following, if any, are you having increased taste sensitivity to? Multiple answers accepted. Q21 - Which of the following, if any, are you having decreased taste sensitivity to? Multiple answers accepted. 45 EFTA01192214 Patients experiencing less energy and those losing weight are the most likely to have increased and/or decreased taste sensitivities. About one-half of them have increased taste sensitivities; about one-fifth have decreased taste sensitivities. Energy Level Weight Change (unintentional) Total More/Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (354) (456) Increased Taste Sensitivity Metallic 19 13 21 20 16 23 Salty 15 8 17 14 12 18 Sweet 14 9 15 16 11 16 Bitter 10 5 11 9 9 11 Sour 8 4 9 7 7 8 None of the above 59 72 55 63 64 52 Decreased Taste Sensitivity Sweet 10 7 11 10 7 12 Salty 9 4 11 10 9 9 Bitter 5 2 6 5 4 6 Sour 5 2 6 4 3 7 None of the above 82 90 79 81 86 79 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q20 - Which of the following, if any, are you having increased taste sensitivity to? Multiple answers accepted. Q21 - Which of the following, if any, are you having decreased taste sensitivity to? Multiple answers accepted. 46 EFTA01192215 Patients who have eating and drinking habits that are the same as prior to treatment are the least likely to be experiencing taste sensitivities. Increased taste sensitivities are most prevalent among those with reduced consumption. Eating Behavior Drinking Behavior Total More Same Less More Same Less Base sizes: (1198) (251) (565) (349) (570) (469) (126) Increased Taste Sensitivity Metallic 19 24 13 26 21 • 15 30 Salty 15 17 10 22 16 11 24 Sweet 14 16 9 21 16 11a 18 Bitter 10 14 6 13 11 7 15 Sour 8 8 4 13 8 6 16 None of the above 59 55 70 44 56 66 44 Decreased Taste Sensitivity Sweet 10 13 6 14 11 7 14 Salty 9 9 7 13 11 6 12 Bitter 5 3 4 7 4 4 6 Sour 5 4 3 9 5 4 7 None of the above 82 79 88 72 80 86 75 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q20 - Which of the following, if any, are you having increased taste sensitivity to? Multiple answers accepted. Q21 - Which of the following, if any, are you having decreased taste sensitivity to? Multiple answers accepted. 47 EFTA01192216 Although few patients prefer food served cold,* those who have this preference are the most likely to have increased and/or decreased taste sensitivities. Patients who prefer food served at room temperature are more likely to have increased taste sensitivities versus those preferring food served hot or those with no preference. Temperature Preference for Food Total Hot Cold Room None Base sizes: (1198) (256) (35)* (123) (752) Increased Taste Sensitivity Metallic 19 23 40 39 15 Salty 15 21 29 22 11 Sweet 14 16 17 21 12 Bitter 10 10 23 18 7 Sour 8 8 11 18 6 None of the above 59 50 26 39 66 Decreased Taste Sensitivity Sweet 10 14 29 25 5 Salty 9 12 27 13 6 Bitter 5 6 27 11 2 Sour 5 8 12 9 3 None of the above 82 72 47 67 89 =Significantly highest or higher than both numbers = Significantly lowest or lower than both numbers = Significantly higher than lowest number * Use caution since sample size is extremely low (n=35). Q20 - Which of the following, if any, are you having increased taste sensitivity to? Multiple answers accepted. Q21 - Which of the following, if any, are you having decreased taste sensitivity to? Multiple answers accepted. 48 EFTA01192217 Foods and Beverages Avoiding EFTA01192218 Foods Avoiding Eight out of ten patients avoid some types of foods. Greasy/fried foods and spicy foods are most avoided. GI patients avoid significantly more foods than Hema patients. Type of Cancer Total GI Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) 72 % 2ft 2fi 26 If Foods Avoid (Net) 80 85 78 82 81 75 Greasy/fried foods 52 58 46 52 58 46 Spicy foods 44 54 40 48 43 33 Citric/acidic foods 31 35 28 33 33 26 Indian 30 36 27 35 34 24 Mexican 30 36 29 32 31 25 Salty foods 27 23 27 30 26 26 Sweets 23 24 20 23 23 24 Meat 22 25 16 27 26 16 Soy 22 26 20 23 24 19 Asian 21 29 18 21 22 16 Dairy 19 19 19 20 23 15 Some fruits and vegetables 18 25 11 18 15 19 Bland foods 18 18 20 17 16 19 Crunchy foods 15 16 17 20 13 9 Chewy foods 13 15 17 18 9 8 High fiber foods 12 20 12 16 8 7 Fish 12 13 8 12 14 12 Vegetarian 10 12 11 12 8 8 Pasta 9 9 5 12 9 8 Poultry 8 11 6 8 8 8 =Significantly higher than all numbers Soups 6 7 4 5 4 9 r Significantly higher than lowest number None of the above 20 15 22 18 19 25 =Significantly lower than all numbers Q22 - Since you began treatment, which of the following types of foods, if any, are you intolerant to? Q23 - Which of the following types of foods, if any, are you avoiding that you used to eat? 50 Q24 - Which of the following types of foods, if any, are you avoiding due to medical advice? Multiple answers accepted. EFTA01192219 Most patients (53%) are not avoiding specific foods due to medical advice. Some of them are intolerant to specific foods or are just avoiding them. Avoiding ... Since Due to For any intolerant But used medical reason to it to eat it advice Greasy/fried foods 52 25 37 19 Spicy foods 44 28 28 14 Citric/acidic foods 31 17 16 14 Indian 30 17 22 5 Mexican 30 16 21 6 Salty foods 27 11 17 12 Sweets 23 8 15 9 Meat 22 10 15 5 Soy 22 8 15 5 Asian 21 10 14 4 Dairy 19 9 11 6 Some fruits and vegetables 18 10 9 10 Bland foods 18 8 13 1 Crunchy foods 15 8 9 3 Chewy foods 13 6 9 2 Ai High fiber foods 12 7 7 5 Fish 12 6 7 a 1 Al Vegetarian 10 4 2 Pasta 9 4 2 Poultry 8 5 5 Mr' Soups 6 4 3 2 None of the above 20 43 30 53 1 = Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number 51 EFTA01192220 Patients having less energy and unintentional weight loss tend to avoid more foods than others, especially greasy, spicy, acidic, Indian and Mexican foods. Energy Level Weight Change (unintentional) Total More Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (354) (456) Foods Avoid (Net) 80 73 82 78 74 87 Greasy/fried foods 52 42 54 45 48 57 Spicy foods 44 37 46 37 40 52 Citric/acidic foods 31 25 33 30 29 35 Indian 30 22 33 29 27 35 Mexican 30 20 33 26 26 35 Salty foods 27 23 29 29 23 29 Sweets 23 23 23 18 22 25 Meat 22 20 22 19 19 26 Soy 22 13 24 24 17 25 Asian 21 14 23 19 16 25 Dairy 19 15 20 16 16 22 Some fruits and vegetables 18 11 19 14 14 24 Bland foods 18 15 19 17 17 19 Crunchy foods 15 10 16 10 15 18 Chewy foods 13 7 15 9 12 17 High fiber foods 12 7 13 12 9 16 Fish 12 8 12 10 9 14 Vegetarian 10 6 11 10 7 13 Pasta 9 7 10 9 6 11 Poultry 8 7 8 6 5 11 Soups 6 4 6 4 4 9 None of the above 20 27 18 22 26 13 = Significantly highest or higher than both numbers = Significantly lowest or lower than both numbers = Significantly higher than lowest number 52 EFTA01192221 Older patients are less likely to avoid foods than others. Caucasians are less likely to avoid meat than others. Four out of ten African American patients are avoiding salty foods. Age Ethnicity Total 18-74 75+ White Black Others Base sizes: (1198) (1043) (151) (954) (111) (132) Foods Avoid (Net) 80 81 73 80 82 82 Greasy/fried foods 52 52 45 50 59 58 Spicy foods 44 44 45 43 39 52 Citric/acidic foods 31 32 25 30 34 38 Indian 30 30 33 31 27 33 Mexican 30 29 38 30 25 29 Salty foods 27 27 33 25 42 33 Sweets 23 24 19 21 31 28 Meat 22 23 15 20 30 32 Soy 22 21 26 22 19 21 Asian 21 20 26 21 22 22 Dairy 19 19 15 17 30 22 Some fruits and vegetables 18 18 16 18 17 18 Bland foods 18 18 14 18 26 13 Crunchy foods 15 15 14 14 16 20 Chewy foods 13 12 18 12 14 16 High fiber foods 12 12 13 12 13 13 Fish 12 12 11 10 13 23 Vegetarian 10 10 10 9 11 13 Pasta 9 10 8 8 12 15 Poultry 8 9 4 7 11 13 Soups 6 6 6 5 8 10 None of the above 20 19 27 20 18 18 = Significantly highest or higher than both numbers = Significantly lowest or lower than both numbers = Significantly higher than lowest number EFTA01192222 Nine out of ten patients who are eating less food since beginning treatment are avoiding some type of food. Eating Behavior Total More Same Less Base sizes: (1198) (251) (565) (349) 96 Foods Avoid (Net) Greasy/fried foods 52 56 44 61 Spicy foods 44 50 34 55 Citric/acidic foods 31 36 23 40 Indian 30 30 24 40 Mexican 30 31 23 39 Salty foods 27 26 24 33 Sweets 23 25 19 28 Meat 22 20 16 34 Soy 22 21 17 29 Asian 21 20 14 32 Dairy 19 21 14 25 Some fruits and vegetables 18 20 11 27 Bland foods 18 15 15 23 Crunchy foods 15 14 9 24 Chewy foods 13 10 9 22 High fiber foods 12 11 7 20 Fish 12 8 7 22 Vegetarian 10 9 6 17 Pasta 9 8 7 14 Poultry 8 7 4 15 Soups 6 6 11 None of the above 20 17 10 =Significantly highest or higher than both numbers • Significa ntly lowest or lower than both numbers =Significantly higher than lowest number 54 EFTA01192223 Other Foods Avoided Patients mention explain the types of foods that they are avoiding ... • Acidic / spicy foods Spicy foods, Cajun, Creole Garlic, onions, hot peppers, hot sauces Pizza Spicy food because it makes my mouth sore Tomato sauce, salsa, chili Grapefruit ■ Fried / greasy / high fat or rich foods Any dishes that are too rich, oily or greasy, e.g. pastas with creams, chicken wings Fats, including cooking oil andfatty oils • Processed / salty foods Processed foods; preservatives; deli meats; white bread • Foods hard to digest or hard to chew Constipation issues: anything high in fiber, breads, dairy Hard to chew foods: chips, crackers, stringy vegetables, red meat, steak ■ Sweets and foods with high sugar content ■ Cold beverages or cold foods - Ice cream or frozen desserts; ice water or cold beverages Other foods and beverages include ... Raw fish/sushi, shellfish; avoiding fruits/veggies, salads unless organic; meats that are not grass-fed, anything with hormones; coffee, alcohol Q26 - Since you began treatment, what other foods, if any, are you avoiding? Sample of verbatim comments shown above. See Appendix for all verbatim comments. 55 EFTA01192224 Patients describe the foods that they are avoiding ... Anything that I really liked before treatment, I don't want to ruin my future experience, I know it's going to taste terrible so why eat it. If I can smell cooking (even good cooking) it kills my appetite. Fresh fruit and veggies due to bacteria Fruit and veggies that are difficult to clean by soap and water such as berries, grapes, grape tomatoes, salad Anything with seeds unless cut out - cucumbers, tomatoes etc. Foods with skin, seeds, pulp, whole grains Breads, though I love them. Too hard to swallow. Meats. Crunchy things. No taste. They hurt to swallow Can't have cold drink or ice after the chemo treatments for about four days. It burn my throat to drink them Chemo makes it painful to eat strongly spiced preparedfood. Dairy is difficult as well but not painful In patient and out patient facilities - too much sugar, salt and simple carbs Q26 - Since you began treatment, what other foods, if any, are you avoiding? Sample of verbatim comments shown above. See Appendix for all verbatim comments. 56 EFTA01192225 Beverages Avoiding Patients are most likely to avoid alcoholic beverages, followed by soda, pop or tonic. Lung patients are the least likely to avoid coffee. Type of Cancer Total GI Lunt Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) Beverages Avoid Other alcoholic drinks 54 61 51 57 51 50 Beer 51 61 47 55 46 48 Wine 50 57 41 55 47 49 Soda, pop or tonic 39 45 35 39 41 32 Coffee 28 31 16 28 33 28 Soy milk 24 19 28 26 25 23 Sports drinks 23 22 21 24 25 24 Milk 19 22 18 22 23 14 Vegetable juice 17 20 18 17 15 15 Flavored water 16 14 18 17 17 18 Fruit juice 15 13 15 14 14 14 Tea 12 12 11 14 10 16 Water 5 6 4 5 6 3 None of the above 18 12 23 17 18 21 =Significantly higher than all numbers =Significantly lower than all numbers = Significantly higher than lowest number Q28 - Since you began treatment, which beverages, if any, are you avoiding that you used to drink? Multiple answers accepted. 57 EFTA01192226 Patients 75+ years are less likely to avoid beverages than others. Caucasians are significantly less likely to avoid soda/pop/tonic and coffee than others. Age Ethnicity Total 18-74 75+ White Black Others Base sizes: (1198) (1043) (151) (954) (111) (132) 96 Beverages Avoid Other alcoholic drinks 54 54 50 54 58 50 Beer 51 53 42 50 57 54 Wine 50 51 44 50 54 51 Soda, pop or tonic 39 40 32 37-I P 47 49 Coffee 28 29 19 26 36 36 Soy milk 24 24 26 25 23 22 Sports drinks 23 23 25 23 23 24 Milk 19 20 18 18 24 22 Vegetable juice 17 16 21 17 15 16 Flavored water 16 16 17 15 18 23 Fruit juice 15 15 13 14 16 19 Tea 12 13 8 12 6 17 Water 5 5 5 4 2 8 None of the above 18 17 27 18 15 22 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q28 - Since you began treatment, which beverages, if any, are you avoiding that you used to drink? Multiple answers accepted. 58 EFTA01192227 Coffee is being avoided more among patients with low energy levels and weight loss versus others. Energy Level Weight Change (unintentional) Total More Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (354) (456) Beverages Avoid Other alcoholic drinks 54 42 57 54 49 56 Beer 51 42 54 50 47 54 Wine 50 39 53 46 46 54 Soda, pop or tonic 39 32 41 37 36 43 Coffee 28 17 31 19 23 35 Soy milk 24 15 26 26 21 23 Sports drinks 23 21 23 25 23 21 Milk 19 14 21 16 19 21 Vegetable juice 17 11 18 15 15 19 Flavored water 16 14 17 16 16 18 Fruit juice 15 11 16 13 13 17 Tea 12 5 14 11 10 15 Water 5 2 5 3 5 5 None of the above 18 34 ..i 14 20 25 13 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q28 - Since you began treatment, which beverages, if any, are you avoiding that you used to drink? Multiple answers accepted. 59 EFTA01192228 More than nine out of ten patients (92%) who are drinking less beverages since treatment began are avoiding some type of beverage, especially alcoholic and carbonated beverages. Drinking Behavior Total More Same Less Base sizes: (1198) (570) (469) (126) % N % N Beverages Avoid Other alcoholic drinks 54 56 50 60 Beer 51 53 47 61 Wine 50 53 45 56 Soda, pop or tonic 39 42 31 51 Coffee 28 29 25 37 Soy milk 24 23 23 32 Sports drinks 23 22 22 29 Milk 19 19 16 31 Vegetable juice 17 16 14 29 Flavored water 16 17 15 19 Fruit juice 15 15 12 23 Tea 12 13 8 21 Water 5 2 4 16 None of the above 18 15 25 8 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q28 - Since you began treatment, which beverages, if any, are you avoiding that you used to drink? Multiple answers accepted. 60 EFTA01192229 Bothersome Smells/Aromas The most annoying smells and aromas are cleaning solutions and perfume or cologne. Six out of ten Breast cancer patients try to avoid aromas, especially perfume/cologne and cleaning solutions. Type of Cancer Total GI Lune Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) N N % % N Cleaning solutions 25 23 24 27 32 22 Perfume/cologne 24 17 22 24 37 24 Fish 12 10 7 15 14 10 Food cooking 12 17 12 12 15 8 Hand sanitizers 9 7 6 8 12 11 Meat 6 10 5 6 7 4 Plastic 6 6 2 6 10 6 Poultry 4 8 2 5 6 3 Dairy 2 4 4 3 2 2 None of the above 52 53 56 50 40 . V 53 Other 9 9 9 11 7 9 Most often mentions are: Foods and Beverages: garlic, onions, coffee Other smells: cigarette/cigar smoke, gasoline, scented candles/incense • Significantly higher than all numbers • Significantly higher than lowest number See Appendix for all "Other" comments. III• Significantly lower than all numbers Q31 - Since you began treatment, which of the following aromas/smells bother you or do you try to avoid? Multiple answers accepted. 61 EFTA01192230 Only one-fourth of those 75+ years are bothered by aromas/smells. Other ethnicities (not White or Black) are most sensitive to the smell of fish and food cooking aromas. Age Ethnicity Total 18-74 75+ White Black Others Base sizes: (1198) (1043) (151) (954) (111) (132) Cleaning solutions 25 26 14 24 28 27 Perfume/cologne 24 26 10 25 18 20 Fish 12 12 7 11 9 20 Food cooking 12 13 5 11 13 20 Hand sanitizers 9 10 1 9 4 10 Meat 6 6 1 6 5 6 Plastic 6 6 3 6 6 7 Poultry 4 5 1 4 4 6 Dairy 2 3 1 2 1 5 None of the above 52 48 76 52 52 46 Other 9 9 6 9 4 12 = Significantly highest or higher than both numbers = Significantly higher than lowest number O31 - Since you began treatment, which of the following aromas/smells bother you or do you try to avoid? Multiple answers accepted. 6? EFTA01192231 Patients experiencing less energy since treatment began are the most sensitive to aromas and smells. More than one-half of them mention a specific type of aroma or smell that they try to avoid. Energy Level Weight Change (unintentional) Total More/Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (354) (456) Cleaning solutions 25 16 27 28 22 27 Perfume/cologne 24 19 25 23 22 26 Fish 12 5 13 11 9 14 Food cooking 12 4 14 8 8 18 Hand sanitizers 9 7 9 9 6 11 Meat 6 3 6 7 6 6 Plastic 6 2 7 9 4 7 Poultry 4 2 5 5 3 6 Dairy 2 2 2 2 2 3 None of the above 52 68 47 52 57 46 Other 9 7 9 7 8 10 = Significantly highest or higher than both numbers =Significantly higher than lowest number O31 - Since you began treatment, which of the following aromas/smells bother you or do you try to avoid? Multiple answers accepted. 63 EFTA01192232 Since beginning treatment, those who have had eating changes are the most likely to be bothered by aromas/smells. Eating Behavior Total More Same Less Base sizes: (1198) (251) (565) (349) % % % Cleaning solutions 25 29 18 33 Perfume/cologne 24 30 19 28 Fish 12 12 7 Food cooking 12 13 5 Hand sanitizers 9 9 7 11 Meat Plastic Poultry 6 6 4 6 6 3 31. 4 3 iii 10 Dairy 2 2 1 5 None of the above 52 46 63 37 Other 9 10 6 11 -I =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q31 - Since you began treatment, which of the following aromas/smells bother you or do you try to avoid? Multiple answers accepted. 64 EFTA01192233 Foods and Beverages Preferring EFTA01192234 Temperature of Food Preferred Among those having a preference for how foods are served, most of them prefer foods served hot. Type of Cancer Total GI aL Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) % % % Hot 22 32 29 17 14 23 Room temperature 11 12 11 17 9 5 Cold 3 3 1 4 3 3 No preference 65 53 59 62 74 69 =Significantly higher than all numbers =Significantly lower than all numbers = Significantly higher than lowest number 019 - Since you began treatment, do you prefer foods that are served: 66 EFTA01192235 Older patients and non-Caucasian patients have a strong preference for hot foods. Two-thirds of Caucasians do not have a preference for the temperature that food is served. Age Ethnicity Total 18-74 75+ White Black Others Base sizes: (1198) (1043) (151) (954) (111) (132) % % % % % Hot 22 21 30 19 43 27 Room temperature 11 11 5 10 14 15 Cold 3 3 2 3 2 3 No preference 65 65 63 68 41 55 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number O19 - Since you began treatment, do you prefer foods that are served: 67 EFTA01192236 Patients experiencing less energy and those losing weight are more likely than others to have a preference on food temperature. Energy Level Weight Change (unintentional) Total More/Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (354) (456) Hot 22 21 22 18 17 27 Room temperature 11 6 12 11 10 12 Cold 3 1 4 2 3 4 No preference 65 71 63 68 70 58 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number O19 - Since you began treatment, do you prefer foods that are served: 68 EFTA01192237 Appeal of Food Food is more appetizing when prepared at home versus eating out or bringing in (43% vs. 18%, respectively). Breast cancer patients are the least likely to indicate that food is most appetizing when prepared at home. Type of Cancer Total GI a Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) % % % Prepared at home 43 43 43 42 35 49 Eaten out 13 15 17 13 17 10 Brought in S 6 4 7 6 1 No preference 39 37 37 38 42 40 =Significantly higher than all numbers =Significantly lower than all numbers = Significantly higher than lowest number O40 - Is food more appetizing when prepared at home, brought in, or eaten out? 69 EFTA01192238 African Americans are significantly more likely than Caucasians to feel that food is more appetizing when it is prepared at home. Age Ethnicity Total 18-74 75+ White Black Others Base sizes: (1198) (1043) (151) (954) (111) (132) % % Prepared at home 43 42 49 41 52 48 Eaten out 13 13 16 13 18 13 Brought in 5 5 2 5 5 5 No preference 39 40 34 41 25 35 =Significantly highest or higher than both numbers =Significantly higher than lowest number Q40 - Is food more appetizing when prepared at home, brought in, or eaten out? 70 EFTA01192239 Those with unintentional weight gain are significantly more likely than others to find food more appetizing when it is eaten out. Energy Level Weight Change (unintentional) Total More/Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (354) (456) Prepared at home 43 41 44 36 42 47 Brought in 5 2 16 3 4 6 Eaten out 13 13 13 19 11 12 No preference 39 44 38 42 42 35 =Significantly highest or higher than both numbers =Significantly higher than lowest number O40 - Is food more appetizing when prepared at home, brought in, or eaten out? EFTA01192240 Food Preferences Fruits and vegetables, soups, poultry, pasta and fish are the most preferred types of foods. Type of Cancer Total GI Lung Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) Foods Prefer Some fruits and vegetables 69 72 63 69 70 73 Soups 62 65 69 64 58 62 Poultry 61 63 65 58 60 62 Pasta 55 62 61 53 53 56 Fish 53 54 57 52 52 55 Meat 46 49 49 44 42 51 Dairy 44 45 45 44 43 47 Sweets 41 47 43 41 41 39 High fiber foods 35 37 34 33 36 36 Crunchy foods 29 32 23 28 32 30 Asian 26 28 28 29 23 24 Salty foods 26 26 24 23 31 26 Vegetarian 24 25 22 25 33 19 Mexican 22 27 19 23 24 21 Spicy foods 22 20 22 23 22 23 Chewy foods 21. 24 17 19 24 23 Citric/acidic foods 19 18 19 20 19 20 Bland foods 14 15 14 16 16 12 Greasy/fried foods 13 13 21 13 10 12 Indian 10 11 10 13 10 8 =Significantly higher than all numbers Soy 9 12 11 10 10 5 =Significantly higher than lowest number None of the above 9 4 8 9 7 14 =Significantly lower than all numbers Q25 - Which of the following types of foods, if any, do you prefer? Multiple answers accepted. 77 EFTA01192241 Preferences vary by age and ethnicity. Those 75+ years have a greater preference for soups, poultry, pasta and meat while other adults have stronger preferences for more ethnical foods. Preference for fish is strong among African Americans. Age Ethnicity Total 18-74 75+ White Black Others Base sizes. 1198) (1043) (151) (954) (111) (132) Foods Prefer Some fruits and vegetables 69 69 71 70 73 62 Soups 62 61 72 63 55 62 Poultry 61 59 69 61 72 47 Pasta 55 54 64 58 47 40 -NI Fish 53 53 54 52 70 47 Meat 46 45 58 49 44 30 Dairy 44 43 49 47 35 29 Sweets 41 40 47 42 45 32 High fiber foods 35 35 36 34 39 35 Crunchy foods 29 29 32 31 24 22 Asian 26 27 17 27 23 24 Salty foods 26 26 19 27 14 23 Vegetarian 24 25 21 24 29 20 Mexican 22 24 6 23 20 12 Spicy foods 22 23 14 22 27 16 Chewy foods 21 21 20 22 22 12 Citric/acidic foods 19 19 24 20 17 17 Bland foods 14 14 13 15 4 13 Greasy/fried foods 13 14 11 14 16 9 Indian 10 11 3 11 5 4 Soy 9 9 7 9 5 9 None of the above 9 8 12 9 4 10 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers =Significantly higher than lowest number Q25 - Which of the following types of foods, if any, do you prefer? Multiple answers accepted. 73 EFTA01192242 Food preferences are similar, regardless of energy level and weight changes. However, food appeal is greater among those with more energy. Energy Level Weight Change (unintentional) Total More/Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (350) (456) Foods Prefer Some fruits and vegetables 69 75 68 70 72 67 Soups 62 60 64 60 58 66 Poultry 61 67 59 62 64 58 Pasta SS 58 SS 59 54 57 Fish 53 60 51 56 53 52 Meat 46 52 45 51 47 43 Dairy 44 49 42 41 46 43 Sweets 41 43 41 47 37 41 High fiber foods 35 36 34 33 38 33 Crunchy foods 29 32 28 33 30 25 Asian 26 26 26 27 27 23 Salty foods 26 31 24 29 26 23 Vegetarian 24 23 24 25 25 23 Mexican 22 21 22 20 25 20 Spicy foods 22 25 21 23 21 21 Chewy foods 21 27 19 20 21 20 Citric/acidic foods 19 22 19 20 20 18 Bland foods 14 11 15 15 10 16 Greasy/fried foods 13 17 12 14 15 12 Indian 10 11 9 11 11 8 Soy 9 10 8 11 10 6 None of the above 9 9 9 8 11 8 =Significantly highest or higher than both numbers =Significantly higher than lowest number Q25 - Which of the following types of foods, if any, do you prefer? Multiple answers accepted. EFTA01192243 Food preferences do not vary much by quantity of food being consumed. However, those eating less food are significantly less likely to prefer fish and meat than others. Eating Behavior Total More Same Less Base sizes: (1198) (251) (565) (349) Foods Prefer Some fruits and vegetables 69 74 69 66 Soups 62 66 59 66 Poultry 61. 66 61 55 Pasta 55 58 52 57 Fish 53 58 55 45 Meat 46 54 47 38 Dairy 44 45 43 44 Sweets 41 46 40 40 High fiber foods 35 40 33 33 Crunchy foods 29 34 28 27 Asian 26 27 26 25 Salty foods 26 28 23 27 Vegetarian 24 24 25 23 Mexican 22 23 22 20 Spicy foods 22 22 23 21 Chewy foods 21 22 21 21 Citric/acidic foods 19 20 19 19 Bland foods 14 14 11 20 Greasy/fried foods 13 15 12 15 Indian 10 11 11 8 Soy 9 8 10 8 None of the above 9 6 13 5 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers =Significantly higher than lowest number Q25 - Which of the following types of foods, if any, do you prefer? Multiple answers accepted. EFTA01192244 Most Appealing Foods Patients describe foods that are most appealing to them. Carb-heavy foods Pasta, noodles, macaroni, mac and cheese, linguine, spaghetti, fettuccini, lasagna, Casseroles, rice, risotto Cereal, breads, crackers, rolls, bagels, muffins Potatoes, mashed potatoes, sweet potatoes "Comfort" foods Soups, homemade soups, stews, chili, eggs, pastas/carb-heavy foods Warm, comforting, simple I love comfort foods right now ■ "Soft, Smooth and Creamy" foods Smoothies, shakes, frozen yogurt, ice cream, cottage cheese, pudding, baby food, apple sauce, yogurts, creamy soups, oatmeal, custards, rice pudding, fella, eggs, eggs soft cooked Foods which are easy to swallow, don't require lots of chewing Soft easily digested versions of old time favorites ■ Sweets Chocolate, cookies, candy, cakes, ice cream, frozen yogurt, sherbet, smoothies, fruit pies, pudding, cheesecake Always like sweets but 'grazing' with good nutrition important I seem to have much more of a sweet tooth since I've been on Chemo Maybe slight increase in sweets because I can get away with it more than I could before! Q27 - What foods have been most appealing to you? Sample of verbatim comments shown above. See Appendix for all verbatim comments. EFTA01192245 Most Appealing Foods, Cont'd. Although spicy foods are appealing to many patients, others prefer bland foods. Spicy or flavorful foods Asian, Mexican, Indian (curry), Thai, Chinese, Italian, Pizza Full flavor foods I like to add herbs to my food to keep them from being bland. I enjoy Mexican food because it is spicy. Strong craving for sweets or spicy foods, e.g., hot stuffed banana peppers, lots of pepper on food Salty Popcorn, potato chips, nuts, salty chips, crackers, pretzels Salty foods are appealing Bland foods During the first week I prefer blandfoods — mashed potatoes, rice, toast, bananas, eggs, chicken soup None!!! But I have been able to eat Campbell's creamy cup of chicken soup, oatmeal Bland — easily digestible Nutritional, bland, simple Bland with salty rather than spicy nature Q27 - What foods have been most appealing to you? Sample of verbatim comments shown above. See Appendix for all '7 verbatim comments. EFTA01192246 Most Appealing Foods, Cont'd. Specifically, meats, fish, fruits and vegetables have strong appeal. Meats / Seafood Steak, beef, chicken, poultry, fish, seafood Fresh fish, dark meat chicken, or turkey Baked chicken I was anemic for a while and craved red meat, spinach, any iron rich foods Tend to crave red meat, such as hamburger, more often Broiled, baked or grilled. Try to avoid greasy/fried foods ■ Fruits and vegetables Bananas, apples, oranges, watermelon, most melons, grapes Potatoes, sweet potatoes, squash, spinach, string beans, bok choi, cabbage, kale, carrots, green vegetables, avocados Fresh fruits and veggies, salads Canned, dried, frozen fruits Cold fruit that has been prepared bite size Q27 - What foods have been most appealing to you? Sample of verbatim comments shown above. See Appendix for all verbatim comments. 78 EFTA01192247 Appealing Recipes or Food Dishes Patients share some of their most appealing recipes or food dishes. Carb-heavy foods A pasta dish with tomato sauce, veggies, possibly meat, topped with cheese and a high fiber crusty topping l ate potatoes and corn for about a month; l was able to keep food down Love pasta. In summer it would be pasta salad with tuna or chicken. Also like pasta with shrimp/tuna, oil, some (not a lot) of garlic Paella — rice with green plantains, with ham, pork chops, chicken, seafood and condiments — tomato sauce, cilantro, onion, garlic, green peppers Pasta dish in butter or cream sauce with a large side of slightly cooked green veggies like peas, broccoli or corn; good bread with olive oil/vinegar Rice noodles with carrots, bell pepper, cucumber, avocado and lime in a peanut sauce. Rigatoni mixed with spinach, red peppers, chicken strips, olive oil, garlic, black olives and Romano/parmesan cheese. Sheppard's pie — mashed potatoes, cheese, ground beef peas Spaghetti with tomato sauce and meatballs Stir fry — brown rice, veggies, chicken, soy sauce Q30 - Please describe a recipe or food dish you would create that would really appeal to you during treatment. Sample of verbatim comments shown above. See Appendix for all verbatim comments. -9 EFTA01192248 Appealing Recipes or Food Dishes, Cont'd. ■ "Comfort" foods A fish soup or stew that has a variety of seafood along with healthy herbs or vegetables in a tasty stock Chicken and dumplings, food with lots of gravy (but not cheese). Soups and chowders. Scrambled eggs and grits. Chicken pot pie ("comfort food") — with potatoes, carrots, peas, onions with a flaky crust Comfort foods — mashed potatoes, spaghetti carbonara, BLT or club sandwiches, lasagna Crockpot — chicken, rice, vegetables French toast or pancakes and eggs over easy with sausage Homemade chicken noodle soup. I make andfreeze so as to have after chemo I like all, but first time after chemo — soft comfort foods like sweet potatoes I make a chicken stew at least once a month. I use potatoes, carrots, chicken, a lot of spices. Better over white rice. I make a special soup — it has broccoli, string beans, carrots, potatoes, kale, chicken and I eat it every day in a bowl full especially after chemo. It keeps me regulated and my blood healthy. Lentil soup, sautéed garlic, onion, leeks, carrots, celery in olive oil, add vegetable broth (preferably homemade), water, lentils, favorite vegetables — kale, spinach, etc. Mac and cheese homemade with butter, milk, sharp cheddar, Elbows mac, flour, salt and pepper Omelets, sometimes soups (such as creamy soups or tomato) Potato soup — sautéed onions, bacon, potatoes, cream, corn, celery, chicken stock, salt and pepper Scrambled eggs with green peppers, onion, cheese Q30 - Please describe a recipe or food dish you would create that would really appeal to you during treatment. Sample of verbatim comments shown above. See Appendix for all verbatim comments. 80 EFTA01192249 Appealing Recipes or Food Dishes, Cont'd. ■ "Soft, Smooth and Creamy" foods - Almost mash potatoes — it is a recipe from Davita website for renal patients who still want mashed potatoes but should not have them (potassium). Secret ingredient = cauliflower Cream of wheat with French vanilla creamer Cream sauce with lots of soft vegetables and rice I just began treatment so I don't know yet — perhaps rice pudding but the idea of eating is abhorrent to me I've become a fan of green smoothies. They don't look appealing but they taste great. Oatmeal with flaxseed oil and tablespoon of real maple syrup. Peach and ginger smoothie, pineapple and papaya smoothie Pudding, jello, cream soups, scrambled eggs, mashed potatoes Smoothie with vanilla ice cream, yogurt, strawberries, blueberries and protein powder Sweets Evening dessert: 30 gm protein powder, 4 oz. milk, 4 oz. Univa, cream, peanut butter, scoop of light ice cream in blender New York cheesecake, cherry pie Creamy desserts, like pudding Key lime yogurt for dessert and tea with cookie For dessert, a root beer float Melted chocolate chips and peanut butter chips mixed with something crunchy, such as chow mien noodles then cooled to make cookies Nothing really sounds good; ice cream is the only thing that tastes good Something that continued to have taste and that I really liked was putting vanilla ice cream on top of hot apple pies or apple crisp Q30 - Please describe a recipe or food dish you would create that would really appeal to you during treatment. Sample of verbatim comments shown above. See Appendix for all verbatim comments. 81 EFTA01192250 Appealing Recipes or Food Dishes, Cont'd. Spicy or flavorful foods A beef burrito with guacamole and hot sauce I make a chicken stew at least once a month. I use potatoes, carrots, chicken, a lot of spices. Better over white rice. I would enjoy anything that is a little bit spicy with salsa. Mexican food, like tacos, tastes good right now. Indian curries, Thai spicy noodles Mexican torte made by my wife with a lot of jalapenos Some sort of dish comprised of chicken or ground beef slightly salty and slightly spicy with cheese Spicy dish, popcorn with hot sauce Spicy fried rice with beef pork, shrimp Vegetable rice with BBQ lamb and onions or curry shrimp with crab and lobster meat over yellow rice with onions, green peppers • Salty Air popped popcorn with a small amount of oil to hold salt and light salt Diarrhea is my main problem so salty good broth dishes Bland foods Egg salad, ham salad — mostly blandfoods Non-spicy, low acid. Chili- somehow with lots offlavor but easy on the tummy Plain chicken and rice soup with celery, onion, salt and pepper. No oregano, parsley, carrots, etc. Plain grilled chicken with plain boiled potatoes or rice, with steamed veggies Right after chemo — something mild/bland, chicken a la king Q30 - Please describe a recipe or food dish you would create that would really appeal to you during treatment. Sample of verbatim comments shown above. See Appendix for all verbatim comments. 8? EFTA01192251 Appealing Recipes or Food Dishes, Cont'd. Meats / Seafood - Baked chicken breast, corn, mashed potatoes Baked fish with acceptable herbs (if any, that could be easily digested — lemon, parsley, thyme, ginger) Broiled salmon, vegetables steamed, boiled red potatoes Brown rice with sautéed vegetables (all kinds of vegetables). Since I am on a high protein diet, I add chicken or pork to this. Chicken breast sautéed with mushrooms, mashed potatoes, grilled veggie sautéed with water Chicken thighs with skin cooked in a pan with white peach, balsamic vinegar, honey and caramelized onions (on good days) when nauseous — wonton soup or Chef Boyardee mac and cheese Chicken, cooked with rice in chicken broth and onions Fish on the grill and green vegetables or salad Grilled chicken with spicy marinade and seasoned rice with feta cheese Grilled salmon with vegetables and rice Non chewy meats or seafood and non stringy veggies Orange ginger chicken or any recipe from the cookbook — The Cancer Fighting Kitchen Parmesan crusted fish, mashed potatoes, green vegetable. I really like spices and seasonings and fish. Sautéed ground beef with mushrooms and zucchini, can of Mexican stewed tomatoes, toped with melted cheese Q30 - Please describe a recipe or food dish you would create that would really appeal to you during treatment. Sample of verbatim comments shown above. See Appendix for all verbatim comments. 83 EFTA01192252 Appealing Recipes or Food Dishes, Cont'd. Meats / Seafood, Cont'd. Scallops pan fried in light flour over rice Simple meals — protein (lean), grilled vegetables, fruit Small steak, mashed potatoes Spaghetti and meatballs Steak and vegetables Steak with red wine and blackberry jam and onion and garlic sauce, with mashed potatoes and sautéed green beans Turkey sausage with green, red, orange and yellow peppers sautéed with onions and sun dried tomatoes and tomato sauce. Thai pork or beef slice cooked with ginger and soy sauce Very thin sliced turkey cutlet lightly browned in skillet with mushrooms, red onions or red pepper/demi-glaze with a red wine, add some butter to it; nice looking, yummy hot dish with a roasted red potato or rice Q30 - Please describe a recipe or food dish you would create that would really appeal to you during treatment. Sample of verbatim comments shown above. See Appendix for all verbatim comments. 84 EFTA01192253 Appealing Recipes or Food Dishes, Cont'd. Fruits and vegetables A large fruit salad with pears, cherries, sugar and apples A salad with lots of vegetables, eggs, beets, etc. Baked fresh beets — peeled and uniformly cut and tossed lightly in olive oil, salt and pepper — wrap in foil and bake one hour Baked potato with broccoli, shredded cheese Blended green vegetables with garlic and extra virgin olive oil Broccoli or zucchini with pasta and sun dried tomatoes with olive oil and garlic Brown rice with steamed veggies — broccoli, kale, peanuts, onions and a yummy sauce Cooked vegetables: carrots, broccoli, zucchini, peas in a light cheese sauce Cucumber, quinoa, tomato, cilantro, lime salad Salad with grains, tabouli, sesame noodle, beets with Italian dressing Fresh fruit plate — strawberries, grapes, cantaloupe, pineapple, kiwi Foods to address specific concerns Due to steroids, I tend to prefer "heavy" foods but only eat a small portion, i.e., small square of lasagna. Sounds good! Pasta because it is easy to swallow; it will not aggravate my mouth sores Anything a relatively toothless person can eat - stews, pastas, well cooked, bite size cereals, etc. I am mostly tube feeding. Maybe a clear broth soup with rice and tofu and for dessert a root beer float High calorie, tasty Smoothing warm soft and chewy! (tongue sores make eating difficult) Q30 - Please describe a recipe or food dish you would create that would really appeal to you during treatment. Sample of verbatim comments shown above. See Appendix for all verbatim comments. 85 EFTA01192254 Beverages Prefer Water is the most preferred beverage, followed by fruit juice, tea and/or coffee. About one- half of Breast patients prefer tea. More than one-half of GI patients prefer fruit juice. Type of Cancer Total GI Lung Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) Beverages Prefer Water 74 70 75 75 78 74 Fruit juice 48 58 47 as 45 as Tea 44 44 39 43 51 41 Coffee 40 43 45 40 34 40 Milk 36 32 40 36 32 41 Flavored water 26 25 25 28 26 23 Soda, pop or tonic 26 27 26 23 26 28 Vegetable juice 24 23 22 24 26 25 Sports drinks 19 26 21 18 12 19 Wine 11 9 11 10 16 10 Beer 7 5 5 5 5 10 Soy milk 5 8 3 5 8 5 Other alcoholic drinks 4 4 7 4 5 3 None of the above 7 5 6 7 5 8 =Significantly higher than all numbers =Significantly lower than all numbers = Significantly higher than lowest number Q29 — Since you began treatment, which beverages, if any, do you prefer? Multiple answers accepted. 86 EFTA01192255 Coffee is favored significantly more among adults 75+ than those younger. African Americans have the greatest desire for tea vs. others. Age Ethnicity Total 18-74 75+ White Black Others Base sizes: (1198) (1043) (151) (954) (111) (132) Beverages Prefer Water 74 74 74 73 80 78 Fruit juice 48 47 55 48 54 43 Tea 44 44 42 43 54 39 Coffee 40 38 54 41 35 38 Milk 36 36 37 37 38 28 Flavored water 26 27 21 27 30 17 Soda, pop or tonic 26 26 24 27 27 16 Vegetable juice 24 24 19 23 31 24 Sports drinks 19 20 9 18 23 19 Wine 11 11 10 11 19 4 Beer 7 6 11 7 8 3 Soy milk 5 6 2 5 9 8 Other alcoholic drinks 4 4 3 5 5 1 None of the above 7 7 9 7 5 10 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q29 — Since you began treatment, which beverages, if any, do you prefer? Multiple answers accepted. 87 EFTA01192256 Beverage preferences are similar, regardless of energy level and weight changes. However, sports drinks have greater appeal among those who have lost weight. Energy Level Weight Change (unintentional) Total More Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (354) (456) Beverages Prefer Water 74 74 74 79 72 70 Fruit juice 48 49 47 42 45 51 Tea 44 43 44 44 42 45 Coffee 40 44 39 45 39 37 Milk 36 39 36 34 33 39 Flavored water 26 21 27 25 24 27 Soda, pop or tonic 26 27 25 27 20 29 Vegetable juice 24 23 23 23 22 24 Sports drinks 19 16 20 15 14 25 Wine 11 12 10 10 10 10 Beer 7 8 6 6 8 7 Soy milk 5 8 5 7 6 5 Other alcoholic drinks 4 3 4 4 3 4 None of the above 7 9 6 8 10 5 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q29 — Since you began treatment, which beverages, if any, do you prefer? Multiple answers accepted. 88 EFTA01192257 Few differences are noted by drinking consumption. Those who are consuming more fluids are significantly more likely to prefer water than others. Drinking Behavior Total More Same Less Base sizes: (1198) (570) (469) (126) Beverages Prefer Water 74 79 69 62 Fruit juice 48 48 47 49 Tea 44 46 42 41 Coffee 40 40 42 34 Milk 36 38 35 35 Flavored water 26 28 23 28 Soda, pop or tonic 26 24 29 22 Vegetable juice 24 26 22 16 Sports drinks 19 22 15 20 Wine 11 10 12 10 Beer 7 7 6 3 Soy milk 5 6 5 4 Other alcoholic drinks 4 3 4 7 None of the above 7 5 10 6 =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q29 — Since you began treatment, which beverages, if any, do you prefer? Multiple answers accepted. 89 EFTA01192258 Appeal of other Products and Services EFTA01192259 Appeal of other Products and Services (Extremely/Very Helpful) About six out of ten patients would find it helpful to receive recipes that help them manage their symptoms and/or written information on eating better during cancer treatment. Appeal is greatest among those with Breast cancer. Type of Cancer Total GI aL Solid Breast Hema Base sizes: (1198) (182) (169) (343) (226) (255) Recipes that help you manage your 59 59 58 53 67 56 symptoms Written information on eating better 59 57 57 58 65 56 during cancer treatment Pre-packaged or prepared meals to purchase that are full of nutrients 46 44 42 44 57 40 needed to help you feel better Videos on creating easy, highly 32 29 29 30 42 34 nutritional meals Liquid nutrition that tastes like food 18 20 23 20 14 14 instead of milk shakes =Significantly higher than all numbers = Significantly lower than all numbers = Significantly higher than lowest number O41 - Please rate how helpful each of the following products and services would be to you. 91 EFTA01192260 Products and services are most appealing to adults under 75 years. Although some Caucasians find these ideas helpful, they are significantly less interested in them versus others. Age Ethnicity Total 18-74 75+ White Black Others Base sizes: (1198) (1043) (151) (954) (111) (132) Recipes that help you manage your symptoms 59 61 J 38 56 73 67 Written information on eating better 59 -= 6 47 56 76 66 during cancer treatment Prepackaged or prepared meals to purchase that are full of nutrients 46 7471 32 44 55 48 needed to help you feel better Videos on creating easy, highly 29 32 34 19 53 39 nutritional meals Liquid nutrition that tastes like food 18 18 22 16 28 27 instead of milk shakes = Significantly highest or higher than both numbers = Significantly lowest or lower than both numbers = Significantly higher than lowest number Q41 - Please rate how helpful each of the following products and services would be to you. 9? EFTA01192261 Receiving recipes that would help manage symptoms would be significantly more helpful to those with less energy and unintentional weight loss. Having pre- packaged or prepared meals also appeal more to those lacking energy while having better tasting liquid nutrition might entice those with unintentional weight loss to consume more calories. Energy Level Weight Change (unintentional) Total More/Same Less Gain Same Loss Base sizes: (1198) (253) (892) (215) (354) (456) Recipes that help you manage your 59 49 61 52 57 60 symptoms Written information on eating better 59 55 60 60 60 57 during cancer treatment Pre-packaged or prepared meals to purchase that are full of nutrients 46 38 47 42 44 49 needed to help you feel better Videos on creating easy, highly 32 33 32 32 33 30 nutritional meals Liquid nutrition that tastes like food 18 14 19 13 14 instead of milk shakes =Significantly highest or higher than both numbers =Significantly higher than lowest number Q41 - Please rate how helpful each of the following products and services would be to you. 93 EFTA01192262 Those with changes in food consumption are more interested in recipes that would help them manage their symptoms than those patients whose eating habits have not changed since beginning treatment. Those who are eating less food are also the most interested in tasty liquid nutrition versus others. Eating Behavior Total More Same Less Base sizes: (1198) (251) (565) (349) Recipes that help you manage your 59 61 53 65 symptoms Written information on eating better during cancer treatment 59 62 57 58 Pre-packaged or prepared meals to purchase that are full of nutrients 46 46 40 53 needed to help you feel better Videos on creating easy, highly 32 31 32 33 nutritional meals Liquid nutrition that tastes like food 18 13 17 24 instead of milk shakes =Significantly highest or higher than both numbers =Significantly lowest or lower than both numbers = Significantly higher than lowest number Q41 - Please rate how helpful each of the following products and services would be to you. 94 EFTA01192263 Appendix Questionnaire Verbatim Comments EFTA01192264 Patients share other comments ... Everything appeals to me. Nothing tastes good. And the smell offood makes me lose my appetite. My tastes have changed frequently during Rx; what appeals one day, does not on another day Educate the doctors! They don't provide any advice on eating or supplements (minimal advice). It should matter to them what they can do to manage a patients side effects and symptoms and it should matter to them what patients put into their bodies that inhibits treatment or better enhances treatment. It is negligent of the entire oncology field to not better educate and continually educate medical staff beyond western medicine. Nutritionists and dieticians are not sufficient. Taste buds seem affected - can't taste food like used to - dull; kind of like when you have a cold and can't taste - you know what it's supposed to taste like but can't taste it; 1st treatments were AC-lost 14 lbs.; 2nd to 4th treatments are Taxol-gaining weight back Sample of verbatim comments shown above. See Excel File for all verbatim comments. 96 EFTA01192265