Assessment of and Interventions for Women at High Risk for Breast or Ovarian Cancer: A Survey of Primary Care Physicians.

As clinical guidelines for cancer prevention refer individuals to primary care physicians (PCP) for risk assessment and clinical management, PCPs may be expected to play an increasing role in cancer prevention. It is crucial that PCPs are adequately supported to assess an individual's cancer risk and make appropriate recommendations. The objective of this study is to assess use, familiarity, attitude, and behaviors of PCPs regarding breast and ovarian cancer risk and prevention, to better understand the factors that influence their prescribing behaviors. We conducted a cross-sectional, web-based survey of PCPs in the United States, recruited from an opt-in healthcare provider panel. Invitations were sent in batches until the target sample size of 750 respondents (250 each for obstetrics/gynecology, internal medicine, and family medicine) was met. Self-reported use of breast/ovarian cancer risk assessments was low (34.7%-59.2%) compared with discussion of cancer family history (96.9%), breast exams (87.1%), and mammograms (92.8%). Although most respondents (48.0%-66.8%) were familiar with cancer prevention interventions, respondents who reported to be less familiar were more likely to report cautious attitudes. When presented with hypothetical cases depicting patients at different breast/ovarian cancer risks, up to 34.0% of respondents did not select any of the clinically recommended course(s) of action. This survey suggests that PCP use of breast/ovarian cancer risk assessment tools and ability to translate the perceived risks to clinical actions is variable. Improving implementation of cancer risk assessment and clinical management guidelines within primary care may be necessary to improve the appropriate prescribing of cancer prevention interventions.Prevention Relevance: Primary care physicians are becoming more involved in cancer prevention management, so it is important that cancer risk assessment and medical society guideline recommendations for cancer prevention are better integrated into primary care to improve appropriate prescribing of cancer prevention interventions and help reduce cancer risk.

Cancer Prevention in Primary Care: Perception of Importance, Recognition of Risk Factors and Prescribing Behaviors.

PURPOSE: Acceptability and uptake of cancer preventive interventions is associated with physician recommendation, which is dependent on physician familiarity with available preventive options. The goal of this study is to evaluate cancer prevention perceptions, understanding of breast and ovarian cancer risk factors, and prescribing behaviors of primary care physicians. METHODS: We conducted cross-sectional. Web-based survey of 750 primary care physicians (250 each for obstetrics/gynecology, internal medicine, and family medicine) in the United States. Survey respondents were recruited from an opt-in health care provider panel. RESULTS: Perception of importance and the practice of recommending general and cancer-specific preventive screenings and interventions significantly differed by provider type. These perceptions and behaviors reflected the demographics of the population that the primary care physicians see within their respective practices. The majority of respondents recognized genetic/hereditary risk factors for breast or ovarian cancer, while epidemiologic or clinical risk factors were less frequently recognized. Prescribing behaviors were related to familiarity with the interventions, with physicians indicating that they more frequently reinforced a specialist's recommendation rather than prescribed a preventive intervention. CONCLUSIONS: Cancer prevention perceptions, recognition of cancer risk factors, and prescribing behaviors differ among practice types and were related to familiarity with preventive options. Cancer prevention education and risk assessment resources should be more widely available to primary care physicians.

Predictors of Retention in an Adult Text Messaging Smoking Cessation Intervention Program: Cohort Study.

BACKGROUND: Mobile health tools such as text messaging programs can support smoking cessation. However, high rates of disengagement from these tools decrease their effectiveness. OBJECTIVE: The purpose of this study was to identify user characteristics associated with retention in an adult text messaging smoking cessation intervention. METHODS: Adults initiating a quit attempt using the publicly available program SmokefreeTXT between March 6 and June 21, 2016 (n=6215), were included. Data were collected to assess nicotine dependence, frequency of being around other smokers, time of the day for cigarette cravings, extrinsic and intrinsic motivation to quit smoking, confidence in quitting, and long-term intention to be smoke free. Multivariable survival analysis modeling for time to opt out was conducted to identify characteristics associated with opting out over the course of the intervention, adjusting for age, sex, and smoking frequency, reset of the quit date by the user, and the number of days enrolled before initiating the quit attempt. Among those who opted out, multivariable multinomial logistic regression analysis was used to identify predictors of opting out early (within 3 days and between 4 and 7 days into the quit attempt) compared to opting out late (more than 7 days into the quit attempt), adjusting for the same confounders. RESULTS: Survival analyses indicated that younger age, female sex, higher levels of nicotine dependence, lower intention to be smoke free, and enrolling in SmokefreeTXT ≤1 week before initiating the quit attempt were associated with an increased risk of opting out. For example, users who smoked within 5 minutes of waking up were 1.17 times more likely to opt out than those who smoked more than 5 minutes after waking up (95% CI 1.01-1.35). Among users who opted out from SmokefreeTXT, logistic regression modeling indicated that compared to users who were never or rarely around other smokers, those who were sometimes around other smokers had 1.96 times more likely to opt out within the first 3 days of the quit attempt (95% CI 1.18-3.25). In addition, compared to users with high levels of long-term quit intention, users with lower levels of intention had 1.80 times the odds of opting out between 4 and 7 days into the quit attempt (95% CI 1.02-3.18). Users who reset their quit date after initiating a quit attempt were less likely to opt out at either time point compared with those who did not reset their quit date. CONCLUSIONS: Several user characteristics are associated with retention in an adult text messaging smoking cessation program. These results provide guidance on potential characteristics that should be addressed in future text messaging smoking cessation programs. Providing additional support to users with these characteristics may increase retention in text messaging programs and ultimately lead to smoking cessation.

Acceptability of Localized Cancer Risk Reduction Interventions Among Individuals at Average or High Risk for Cancer.

Individuals at high risk for cancer, including those already diagnosed with premalignant lesions, can potentially benefit from chemopreventive interventions to reduce cancer risk. However, uptake and acceptability have been hindered due to the risk of systemic toxicity and other adverse effects. Locally delivered chemopreventive agents, where direct action on the primary organ may limit systemic toxicity, are emerging as an option for high-risk individuals. While a number of clinical trials support the development of chemopreventive agents, it is crucial to understand the factors and barriers that influence their acceptability and use. We conducted 36 focus groups with 198 individuals at average and high risk of breast/ovarian, gynecologic, and head/neck/oral and lung cancers to examine the perceptions and acceptability of chemopreventive agents. Participants' willingness to use chemopreventive agents was influenced by several factors, including perceived risk of cancer, skepticism around prevention, previous knowledge of chemopreventive agents, support from trusted sources of health information, participation in other cancer-related risk-reduction activities, previous experience with similar modalities, cost, regimen, side effects, and perceived effectiveness of the preventive intervention. Our findings indicate that individuals may be more receptive to locally delivered chemopreventive agents if they perceive themselves to be at high risk for cancer and are given the necessary information regarding regimen and side effects to make an informed decision. Clinical trials that collect additional patient-centered data including side effects and how these interventions fit into an individual's lifestyle are imperative to improve uptake of chemopreventive agents.

Associations Between Engagement and Outcomes in the SmokefreeTXT Program: A Growth Mixture Modeling Analysis.

INTRODUCTION: Smoking continues to be a leading cause of preventable death. Mobile health (mHealth) can extend the reach of smoking cessation programs; however, user dropout, especially in real-world implementations of these programs, limit their potential effectiveness. Research is needed to understand patterns of engagement in mHealth cessation programs. METHODS: SmokefreeTXT (SFTXT) is the National Cancer Institute's 6-8 week smoking cessation text-messaging intervention. Latent growth mixture modeling was used to identify unique classes of engagement among SFTXT users using real-world program data from 7090 SFTXT users. Survival analysis was conducted to model program dropout over time by class, and multilevel modeling was used to explore differences in abstinence over time. RESULTS: We identified four unique patterns of engagement groups. The largest percentage of users (61.6%) were in the low-engagers declining group; these users started off with low level of engagement and their engagement decreased over time. Users in this group were more likely to drop out from the program and less likely to be abstinent than users in the other groups. Users in the high engagers-maintaining group (ie, the smallest but most engaged group) were less likely to be daily smokers at baseline and were slightly older than those in the other groups. They were most likely to complete the program and report being abstinent. CONCLUSIONS: Our findings show the importance of maintaining active engagement in text-based cessation programs. Future research is needed to elucidate predictors of the various levels of engagement, and to assess whether strategies aimed at increasing engagement result in higher abstinence rates. IMPLICATIONS: The current study enabled us to investigate differing engagement patterns in non-incentivized program participants, which can help inform program modifications in real-world settings. Lack of engagement and dropout continue to impede the potential effectiveness of mHealth interventions, and understanding patterns and predictors of engagement can enhance the impact of these programs.

Electronic Health Information Exchange Opportunities for Self-management of Care: Responses from Older Adults With and Without Cancer History in the United States.

PURPOSE OF STUDY: Of 15.5 million US cancer survivors, 80% are ≥ 55 years. Supporting older patients in care self-management through electronic health information (EHI) exchange may enhance recovery. We assessed: (1) perceived importance of EHI access to adults ≥ 55 years (incl survivors) and (2) age-related preferences for EHI exchange. RECENT FINDINGS: Older adults are one of the fastest-growing user groups for internet/technologies. Most older adults 55-64 years are active internet users, and use among adults ≥ 65 years is growing quickly as baby boomers mature. Understanding EHI patient-provider exchange preferences may provide opportunities for older patients but also begin to address the future needs of other patient populations, including cancer survivors. We observed a "digital divide" for perceived importance of EHI access and EHI exchange interests. Engaging older adults (i.e., ≥ 75 years) to improve comfort/experience with technologies may support EHI use in self-management. Survivors may have distinct EHI needs/preferences than older adults without cancer history.

Processing of fallopian tube, ovary, and endometrial surgical pathology specimens: A survey of U.S. laboratory practices.

OBJECTIVE: Many high-grade serous carcinomas initiate in fallopian tubes as serous tubal intraepithelial carcinoma (STIC), a microscopic lesion identified with specimen processing according to the Sectioning and Extensive Examination of the Fimbria protocol (SEE-Fim). Given that the tubal origin of these cancers was recently recognized, we conducted a survey of pathology practices to assess processing protocols that are applied to gynecologic surgical pathology specimens in clinical contexts in which finding STIC might have different implications. METHODS: We distributed a survey electronically to the American Society for Clinical Pathology list-serve to determine practice patterns and compared results between practice types by chi-square (χ2) tests for categorical variables. Free text comments were qualitatively reviewed. RESULTS: Survey responses were received from 159 laboratories (72 academic, 87 non-academic), which reported diverse specimen volumes and percentage of gynecologic samples. Overall, 74.1% of laboratories reported performing SEE-Fim for risk-reducing surgical specimens (82.5% academic versus 65.7% non-academic, p < 0.05). In specimens from surgery for benign indications in which initial microscopic sections showed an unanticipated suspicious finding, 75.9% of laboratories reported using SEE-Fim to process the remainder of the specimen (94.8% academic versus 76.4% non-academic, p < 0.01), and 84.6% submitted the entire fimbriae. CONCLUSIONS: Changes in the theories of pathogenesis of high-grade serous carcinoma have led to implementation of pathology specimen processing protocols that include detailed analysis of the fallopian tubes. These results have implications for interpreting trends in cancer incidence data and considering the feasibility of developing a bank of gynecologic tissues containing STIC or early cancer precursors.

The Impact of Weight and Weight-Related Perceptions on Smoking Status Among Young Adults in a Text-Messaging Cessation Program.

Introduction: Weight gain and concerns about weight can influence a smoker's ability to successfully quit, and young adults are a subgroup of smokers who are particularly concerned about the impact of quitting on their body weight. This study explored the associations between body mass index, weight perceptions, and smoking status among young adults. Methods: The sample consisted of 4027 young adults between the ages of 18 and 29 who participated in a randomized control trial of the National Cancer Institute's SmokefreeTXT program. Multivariable logistic regression models were used to examine the associations between weight related variables and smoking status. Results: Obese participants had a 0.72 lower odds (95% CI: 0.62, 0.85) of reporting smoking at the end of the program than participants of normal weight, and this difference persisted over time. Weight perceptions were also associated with smoking status. Those who perceived themselves to be slightly underweight/underweight were more likely to report smoking than those who reported being just about the right weight (OR: 1.53, 95% CI: 1.20, 1.95), and those who strongly disagreed that smoking cigarettes helps people keep their weight down were less likely to report smoking at the end of treatment than those who neither agreed nor disagreed with this statement (OR: 0.69, 95% CI: 0.54, 0.87). Conclusions: Weight related factors assessed at baseline predicted smoking status at the end of treatment and through long term follow-up. Smoking cessation programs that tailor content to addresses the specific needs of weight concerned smokers may enhance effectiveness. Implications: This study explores the association between weight related factors and smoking status among young adults, a priority population for smoking cessation efforts. This study demonstrates that both actual weight and weight perceptions (eg, perception of body weight, perception of associations between smoking and weight) are associated with smoking outcomes, and thus need to be a considered in the development of smoking cessation programs.

"We're Just Not Prepared for Eating Over Our Whole Life": A Mixed Methods Approach to Understanding Dietary Behaviors Among Longer Term Cancer Survivors.

BACKGROUND: In many countries, there are growing numbers of persons living with a prior diagnosis of cancer, due to the aging population and more successful strategies for treatment. There is also growing evidence of the importance of healthful diet and weight management for survivorship, yet many long-term cancer survivors are not successfully following recommendations. METHODS: We explored this issue in a mixed methods study with 53 adult survivors of 3 cancers (breast, prostate, and non-Hodgkin's lymphoma), living in Maryland. Participants provided three 24-hour dietary recalls, and results were used to classify respondents on 2 metrics of healthful eating (the Healthy Eating Index 2010, and a 9-item index based on current dietary recommendations). Recalls were also used to guide in-depth qualitative discussions with participants regarding self-assessment of dietary behaviors, healthful eating, and diet's importance in cancer prevention and survivorship. RESULTS: Survivors following a more healthful diet were more likely to be female, have greater socioeconomic resources, more years since diagnosis, normal weight, and no smoking history. Qualitative discussions revealed a more nuanced understanding of dietary strategies among healthful eaters, as well as the importance of household members in dietary decision making. DISCUSSION: Most survivors had received little nutrition counseling as part of their cancer care, highlighting the importance of holistic, household-oriented nutrition education for maintaining health among long-term cancer survivors.

Implicit theories of smoking and association with current smoking status.

Implicit theories of smoking refer to people's beliefs about whether smoking behavior is something that is changeable (incremental belief) or fixed (entity belief). This study examines implicit theories of smoking and its association with smoking behavior in a nationally representative sample of US adults using data from the Health Information National Trends Survey. The current results show that implicit theories of smoking are associated with smoking. Among former smokers, 90 percent endorsed an incremental belief about smoking compared to 70 percent of current smokers. Our study provides initial evidence for the role of implicit theories of smoking as a psychological factor associated with smoking behavior.

Characterizing user engagement with health app data: a data mining approach.

The use of mobile health applications (apps) especially in the area of lifestyle behaviors has increased, thus providing unprecedented opportunities to develop health programs that can engage people in real-time and in the real-world. Yet, relatively little is known about which factors relate to the engagement of commercially available apps for health behaviors. This exploratory study examined behavioral engagement with a weight loss app, Lose It! and characterized higher versus lower engaged groups. Cross-sectional, anonymized data from Lose It! were analyzed (n = 12,427,196). This dataset was randomly split into 24 subsamples and three were used for this study (total n = 1,011,008). Classification and regression tree methods were used to identify subgroups of user engagement with one subsample, and descriptive analyses were conducted to examine other group characteristics associated with engagement. Data mining validation methods were conducted with two separate subsamples. On average, users engaged with the app for 29 days. Six unique subgroups were identified, and engagement for each subgroup varied, ranging from 3.5 to 172 days. Highly engaged subgroups were primarily distinguished by the customization of diet and exercise. Those less engaged were distinguished by weigh-ins and the customization of diet. Results were replicated in further analyses. Commercially-developed apps can reach large segments of the population, and data from these apps can provide insights into important app features that may aid in user engagement. Getting users to engage with a mobile health app is critical to the success of apps and interventions that are focused on health behavior change.

Cigarette smoking risk-reducing beliefs: Findings from the United States Health Information National Trends Survey.

Cigarette smoking risk-reducing beliefs are ideas that certain health promoting behaviors (e.g., exercise) may mitigate the risks associated with smoking. The objective of this study was to describe smoking risk-reducing beliefs and the belief that quitting can reduce the harmful effects of smoking among the U.S. adult population and the associations between these beliefs, current smoking status, and sociodemographics. Data were from the Health Information National Trends Survey 4 (HINTS 4) Cycles 3 and 4 (2013-2014; N=6862). Descriptive analyses were conducted to examine bivariate associations among the quit smoking belief, smoking risk-reducing beliefs, and covariates. Weighted ordinal logistic regression models examined the adjusted associations between smoking status and sociodemographics, with quit smoking belief and risk-reducing beliefs. Eighty-two percent of the population reported that quitting cigarette smoking can help reduce the harmful effects of smoking a lot: former smokers and individuals with higher educational attainment were more likely to endorse this belief than never smokers and those with lower educational attainment. Many people endorsed smoking risk-reducing beliefs about exercise (79.3%), fruits and vegetables (71.8%), vitamins (67.2%), and sleep (68.5%). Former smokers were less likely to subscribe to these beliefs than never smokers. Vulnerable populations who may be most at risk of smoking attributable morbidity and mortality were more likely to endorse risk-reducing beliefs. Future studies are needed to better understand how risk-reducing beliefs are formed and if modifying these beliefs may help to reduce cigarette smoking in the U.S.

A qualitative study of dietary discussions as an emerging task for cancer clinicians.

OBJECTIVES: Improvements in cancer detection and treatment create a need for care that prioritizes acute treatment and ongoing needs. There have been calls to include health promotion in cancer care, but little empirical consideration of the work involved in such an expansion of services. In this article, we adopt a constructionist position to explore clinicians' perspectives on capacity for health promotion, specifically dietary counseling. METHODS: Our data result from 33 semi-structured qualitative interviews with members of cancer care teams. All interviewees were affiliated with one of two contrasting medical systems located in Baltimore, MD, USA. Interviews focused on professional roles and responsibilities around health promotion for cancer survivors. We employed both purposive and snowball sampling. We conducted a thematic analysis informed by the sociology of professions literature of discussions of dietary change by provider type. RESULTS: We discuss four emergent themes that relate to the work of providing dietary counseling: (1) prioritization of behavior change in survivorship care, (2) evidence base for dietary messaging, (3) available time and clinical priorities and (4) clinical expertise. Interviewees generally expressed support for the importance of diet for healthy cancer survivorship. However, while there was broad support for dietary change and health promotion, we found little evidence of an emerging consensus on how this work should be accomplished, nor an indication of any occupational group expanding their professional remit to prioritize health promotion tasks. CONCLUSIONS: Health promotion is the key to any efficient and effective model of cancer care. Careful attention to the impact of the task on key patient outcomes as well as system capacity for the provision of dietary counseling and its fit with a specific professional remit will be critical for successful integration of health promotion into routine cancer care.

Implications of social media use on health information technology engagement: Data from HINTS 4 cycle 3.

Little is known about the association between Internet/social media use and health information technology (HIT) engagement. This study examines patterns of social media use and HIT engagement in the U.S.A. using data from the 2013 Health Information National Trends Survey (N = 3,164). Specifically, predictors of two HIT activities (i.e., communicating with a healthcare provider using the Internet or email and tracking personal health information electronically) are examined. Persons who were females, higher education, non-Hispanic others, having a regular healthcare provider, and ages 35-44 were more likely to participate in HIT activities. After controlling for sociodemographics and health correlates, social media use was significantly associated with HIT engagement. To our knowledge, this is one of the first studies to systematically examine the use and relationships across multiple types of health-related online media.

Mining Health App Data to Find More and Less Successful Weight Loss Subgroups.

BACKGROUND: More than half of all smartphone app downloads involve weight, diet, and exercise. If successful, these lifestyle apps may have far-reaching effects for disease prevention and health cost-savings, but few researchers have analyzed data from these apps. OBJECTIVE: The purposes of this study were to analyze data from a commercial health app (Lose It!) in order to identify successful weight loss subgroups via exploratory analyses and to verify the stability of the results. METHODS: Cross-sectional, de-identified data from Lose It! were analyzed. This dataset (n=12,427,196) was randomly split into 24 subsamples, and this study used 3 subsamples (combined n=972,687). Classification and regression tree methods were used to explore groupings of weight loss with one subsample, with descriptive analyses to examine other group characteristics. Data mining validation methods were conducted with 2 additional subsamples. RESULTS: In subsample 1, 14.96% of users lost 5% or more of their starting body weight. Classification and regression tree analysis identified 3 distinct subgroups: "the occasional users" had the lowest proportion (4.87%) of individuals who successfully lost weight; "the basic users" had 37.61% weight loss success; and "the power users" achieved the highest percentage of weight loss success at 72.70%. Behavioral factors delineated the subgroups, though app-related behavioral characteristics further distinguished them. Results were replicated in further analyses with separate subsamples. CONCLUSIONS: This study demonstrates that distinct subgroups can be identified in "messy" commercial app data and the identified subgroups can be replicated in independent samples. Behavioral factors and use of custom app features characterized the subgroups. Targeting and tailoring information to particular subgroups could enhance weight loss success. Future studies should replicate data mining analyses to increase methodology rigor.

The salience of cancer and the "survivor" identity for people who have completed acute cancer treatment: a qualitative study.

PURPOSE: Globally, there are nearly 33 million persons who have survived 5 or more years after a diagnosis of cancer [1]. We explore the salience of cancer in such people's self-concept as an important element for creating patient-centered care for those living with a cancer history. METHODS: Our data are responses to a free-listing exercise and subsequent qualitative interviews with 53 individuals aged between 45 and 74 who were diagnosed with non-Hodgkin's lymphoma or breast or prostate cancer at least 3 years prior and had completed acute treatment. Participants lived in the Baltimore-Washington region of the USA. RESULTS: Cancer was not necessarily salient to participants' current self-concept, and espousal of a "survivor" identity is complex. We construct a typology of seven contrasting meanings of "survivor" based upon participants' narratives (factual, beaten, functional, temporary, adversity, passage of time, and lucky or blessed) and present interviewees' rationales as to why they did or did not adopt a survivorship identity. CONCLUSIONS: We examine the complexity of "survivorship" as an identity and people's affiliation with it, as well as how this relates to other salient and fluid elements of people's sense of self within a life course perspective. IMPLICATIONS FOR CANCER SURVIVORS: Understanding how cancer factors into people's self-concept throughout the life course is important for designing effective, patient-centered programs that acknowledge diverse experiences and expectations and possible changes with the passage of time.

Exploring important influences on the healthfulness of prostate cancer survivors' diets.

A cancer diagnosis is often conceptualized as a teachable moment when individuals might be motivated to make lifestyle changes. Many prostate cancer survivors, however, do not adhere to dietary guidelines. In this article, we explore how cancer affected prostate cancer survivors' diets and identify important influences on diet. Twenty prostate cancer survivors completed three 24-hour dietary recalls and an in-depth dietary interview. We analyzed interviews using a constant comparison approach, and dietary recall data quantitatively to assess quality and qualitatively to identify food choice patterns. Most men reported not making dietary changes following their cancer diagnosis but did express an interest in healthy eating, primarily to facilitate weight loss. Men portrayed barriers to healthy eating that often outweighed their motivation to eat healthy. Public health programs should consider alternative ways of framing healthy eating programs for prostate cancer survivors that might be more effective than a cancer-specific focus.

Clinical care providers' perspectives on body size and weight management among long-term cancer survivors.

OBJECTIVE: To examine clinical care providers' perspectives on cancer survivors' body size and weight management. STUDY DESIGN: In-depth, semi-structured, qualitative interviews. METHODS: Interviews were conducted with 33 providers (eg. oncologists, surgeons, primary care providers, nurses, dietitians) across academic and community clinical settings. They were transcribed, coded, and analyzed thematically using constant comparative analysis. RESULTS: Providers conceptualized weight in relation to acute treatment, cancer outcomes, or overall health/comorbidities. These patterns were reflected in their reported framing of weight discussions, although providers indicated that they counsel patients on weight to varying extents. Perspectives differed based on professional roles and patient populations. Providers reported that survivors are motivated to lose weight, particularly due to comorbidity concerns, but face numerous barriers to doing so. CONCLUSION: Providers described survivor-level and capacity-level factors influencing survivors' weight management. Differences by provider type highlighted the role of provider knowledge, attitudes, and beliefs in clinical encounters. Opportunities for research and intervention include developing and disseminating evidence-based clinical resources for weight management among cancer survivors, addressing capacity barriers, and exploring communication strategies at interpersonal and population levels.

The impact of cancer treatment on the diets and food preferences of patients receiving outpatient treatment.

Patients undergoing cancer treatment experience a multitude of symptoms that can influence their ability to complete treatment as well as their quality of life during and after treatment. This cross-sectional study sought to describe the dietary changes experienced by cancer patients and to identify associations between these changes and common treatment symptoms. A convenience sample of 1199 cancer patients aged 18 yr and older undergoing active treatment were recruited from 7 cancer centers to complete a self-administered paper-and-pencil survey. Descriptive analyses were conducted to estimate prevalence of dietary changes and chi-squared tests were used to examine associations between dietary changes and health outcomes. Approximately 40% of patients reported a decreased appetite since beginning treatment, and 67.2% of patients reported at least 1 chemosensory alteration. Increased taste sensitivities were more common than decreased taste sensitivities, with increased sensitivity to metallic being the most common taste sensitivity (18.6%). Patients also had increased sensitivities to certain smells including cleaning solutions (23.4%), perfume (22.4%), and food cooking (11.4%). Patients reported a wide range of food preferences and aversions. Patients who had less energy or lost weight since beginning treatment were more likely than others to report treatment-related dietary changes.