Weight and muscle loss in head and neck cancer (HNC) patients are common. While adequate calorie and protein intake may support maintenance, macronutrient composition remains understudied. The primary aim of this pilot randomized controlled trial was to assess the feasibility and acceptability of home-delivered, medically-tailored meals (MTMs) of a carbohydrate-restricted, high-fat (CRHF) diet versus a standard diet (SD) in newly diagnosed HNC patients undergoing radiotherapy (RT). Thirteen patients were randomized to CRHF (n = 6) or SD (n = 7). Participants received isocaloric MTMs daily for two weeks pre-RT and during RT. CRHF meals contained ∼30%-carbohydrate, 45%-fat, and 25%-protein, compared with ∼50/30/20% in SD meals. Feasibility outcomes were recruitment, retention, adherence, acceptability, and adverse events. Exploratory outcomes included descriptive changes in weight and body composition to inform future trial design. Recruitment and retention rates were 65% and 69%, respectively. MTM adherence averaged 92% in CRHF and 96% in SD. Participants reported high MTM satisfaction. CRHF participants exhibited descriptive patterns suggesting greater muscle preservation and fat loss. Higher adherence to either diet was observed with less weight loss during RT. Feasibility data suggest that a "Food is Medicine" approach may warrant further investigation in a larger trial design to assess efficacy.

Survivors of head and neck cancer have complex nutritional and supportive care needs. These needs result from the tumour's proximity to organs essential for normal eating function and the intensive treatment targeting those organs. Despite the crucial role of nutrition and supportive care in head and neck cancer, research and funding are lacking compared with other cancer types. This Review was compiled and written by a team of multidisciplinary medical professionals. Topics include poor access to medical nutrition therapy (MNT), MNT reimbursement policies, long-term survivorship care needs, percutaneous endoscopic gastrostomy tube placement, nutrition literacy, psychological services, speech-language pathology care, and concomitant physical activity. The goal of this work is to define current issues in research and practice, advocate for the expansion of head and neck cancer funding opportunities, and raise awareness of head and neck cancer supportive care needs and challenges. This work provides a roadmap for health-care professionals, researchers, policy makers, and funding agencies to prioritise nutrition in head and neck cancer care, with the overarching goal of improving treatment outcomes and quality of life.

Background:Existing studies on breast cancer survivors (BCS) have primarily focused on individual aspects of either diet or exercise preferences and barriers. Our study aims to examine BCS' perceptions toward diet and exercise combined. Given the transformative impact of COVID-19, there is a crucial need for insights in the post-pandemic era to address the distinct challenges faced by BCS in maintaining their health and well-being. Objectives:This exploratory study aims to understand BCS' preferences for and barriers to diet and exercise to inform future intervention development. Methods:A cross-sectional survey was administered to adults diagnosed with ductal carcinoma in situ or stage I-IV breast cancer (BC) from 2019 to 2021 regarding interest, preferences, and barriers to participating in diet and exercise interventions. Descriptive analysis compared pre-COVID-19 (pre-C) and during-COVID-19 pandemic (during-C) subsets. Results:There were 224 participants. Over half expressed interest in a BC research study related to diet and exercise. Most preferred receiving consultations in-person with relevant specialists, education or counseling in one-on-one sections, and information from written materials, in-person, or via technology. Barriers were fatigue, family, and work. One hundred and thirty participants completed the survey pre-C, and 94 during-C. Compared with pre-C, during-C participants preferred visual communication tools for information on nutrition and exercise over in-person methods (P < 0.05). In most categories, the percentage of barriers noted during-C was greater than pre-C. Conclusions:Participants indicated preference for dual-modal diet and exercise interventions. The pandemic impacted participation preferences and barriers, with shifts toward favoring visual communication tools over in-person services and increasing psychosocial and COVID-related barriers. Hybrid care, combining in-person with technology-based delivery, shows promise in enhancing flexibility and accessibility in nutrition and exercise interventions amid the pandemic.

Radiation-induced fibrosis (RIF) refers to the aberrant and continuous induction of myofibroblast-mediated wound healing in response to radiation therapy (RT) and occurs in up to 50% of head and neck squamous cell carcinoma (HNSCC) patients post-RT. Frontline treatment consists of an anti-inflammatory agent, pentoxifylline, in combination with an antioxidant, Vitamin E, (PENTOX) along with palliative care agents such as corticosteroids, non-steroidal anti-inflammatory agents, muscle relaxants (i.e., botulinum toxin A), or physical therapy for alleviation of symptoms such as pain, inflammation, and lymphedema. However, while efficacious in stabilization and palliation of disease, PENTOX is one of the only established agents with confirmed anti-fibrotic effects in HNSCC. Alternative therapies such as hyperbaric oxygen therapy or superoxide dismutase show efficacy in alleviating acute radiation toxicities but lack a substantial reduction in fibrotic burden. Furthermore, experimental investigations into natural antioxidants, anti-fibrotic agents approved for idiopathic pulmonary fibrosis, mesenchymal stem cell therapy, and general nutritional support, indicate anti-RIF potential, but studies in HNSCC specifically are lacking. This review aims to characterize the pathogenesis of RIF development in the HNSCC disease setting and summarize promising anti-fibrotic agents under investigation for radiation-induced toxicities.

Abstract Background: ASCO has reaffirmed critical role of early phase (EP) clinical trials (CT) in cancer research and treatment that patients (pts) may achieve improvement in quality of life, experience psychological and direct medical benefits. Disparities in access and participation to CT exist and are more profoundly seen in EP CT with challenge of engaging underrepresented populations (UP) in EP CT which are often complex and only available at larger cancer centers in metropolitan areas. NCI’s Create Access to Targeted Cancer Therapy for Underserved Populations (CATCH-UP.2020) helped bring EP CT to UP. To determine the impact of financial toxicity (FT) as a barrier specific to EP CT participation of UP, the validated COST-FACIT tool was used to survey cancer pts undergoing treatment at the University of Kansas Cancer Center. Methods: This study was approved by our Institutional Review Board (Study 00150640). During routine scheduled visits, pts completed COST-FACIT survey on touch screen tablet. A list of validated questions on EP CT awareness, access, and willingness to participate were included in the survey. Pts responded to 12-item COST-FACIT questionnaire describing the relationship between financial stress and treatments (scale 0 to 4). The score was computed using responses captured from COST-FACIT. Based on literature, scores <26 were determined to be higher FT. Two-sided Fisher's Exact Tests were used to test for a significant association at an alpha level of 0.05. UP included racial and ethnic minorities, low socioeconomic status, low education, and rural. Results: Of 108 pts, 101 completed surveys. 45% identified as female and 55% as male. 11.2% 18–35 years (yrs) of age, 13.9% 36 –50 yrs, 24% 51–65 yrs and 54% >65 yrs. 62.4% were white, 17.8% black, and 19.8% others (Asian or Native American). 8.9% completed <12th grade, 23.8% completed high school, 29.7% have some college experience, 22% completed college and 16% have master’s/doctoral degree. COST-FACIT mean score was 25.7 (SD 10.4, r^2 of 0.48) showing significant financial stress. 46% of pts had scores <26. Pts 18-35 yrs (p=0.02), 36–65 yrs (p=0.00), had yearly incomes of >150,000 (p=0.02) or unaware of their yearly income (p=0.05) were more likely to have significant FT. Pts with < 12th grade (14.89%) or some college experiences (34.09%) were likely to have significant FT. Pts identifying as Asian or Native American were more likely to experience FT than white or black. Conclusion: Almost half of our pts suffer from significant FT creating disparities in EP CT access and participation. Data suggest ages 35-65 yrs, low levels of education, and races other than white and black experience higher levels of FT that is a barrier to EP CT participation. These data support our ongoing efforts to bring innovative EP CT to everyone including the VA and our other outreach partners with higher concentrations of UP. Data on rural and health professional shortage areas will be reported during the meeting. This project was supported in part by The University of Kansas Cancer Center P30CA168524. Citation Format: Kamiyah Hicks, Anusha Chidharla, Dinesh Pal Mudaranthakam, Hope Krebil, Issa Espinoza, Asuka Suzuki, Sam Pepper, Angelica Allen, Jill Hamilton - Reeves, Debra Sullivan, Anna Arthur, Saqib Abbasi, Anup Kasi, Rahul Parikh, Elizabeth Wulff - Burchfield, Al - Ola Abdallah, Lori Barbosa, Erin Carroll, Jennifer Heins, Tara Lin, Gary Doolittle, Weijing Sun, Joaquina Baranda. The impact of financial toxicity as a barrier to access and participation in early phase clinical trials for underrepresented populations using the COST–FACIT tool [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B142.

Purpose Food insecurity—the lack of unabated access to nutritious foods—is a consequence many cancer survivors face. Food insecurity is associated with adverse health outcomes and lower diet quality in the general public. The goal of this analysis was to extract major and prevailing dietary patterns among food insecure cancer survivors from observed 24-h recall data and evaluate their relationship to survival after a cancer diagnosis. Methods We implemented two dietary patterns analysis approaches: penalized logistic regression and principal components analysis. Using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) study, we extracted three dietary patterns. Additionally, we evaluated the HEI-2015 for comparison. Cox proportional hazards models assessed the relationship between the diet quality indices and survival after a cancer diagnosis. Results There were 981 deaths from all causes and 343 cancer-related deaths. After multivariable adjustment, we found higher risks of all-cause mortality associated with higher adherence to Pattern #1 (HR 1.25; 95% CI 1.09–1.43) and Pattern #2 (HR 1.15; 95% CI 1.01–1.31) among cancer survivors. Conclusion Among all cancer survivors, higher adherence to major and prevailing dietary patterns from the U.S. food insecure cancer survivor population may lead to worse survival outcomes.

The objective of our study was to evaluate the relationship between county-level food insecurity (FI) and the risk of Coronavirus-2019 (COVID-19) mortality in the United States during the early pandemic (March 25, 2020-December 25, 2021), while accounting for geographic contributions to that risk. Bayesian Intrinsic Conditional Autoregressive negative binomial regression models with spatially-structured and unstructured random effects were used to model the posited relationship between FI and COVID-19 mortality and to account for geographic heterogeneity and residual sources of variance. The model parameters' posterior distributions, means, and credible intervals (CrIs) were approximated with Laplace's approximation via the R-INLA package. Using data from the Johns Hopkins Coronavirus Resource Center, we found that a standard deviation increase in county-level FI prevalence (4%) was associated with a 1.11-fold increased risk of county-level COVID-19 mortality (95% CrI, 1.02-1.20), but only in sensitivity analyses. We found no significant association when the analysis was performed with COVID-19 mortality data from the Centers for Disease Control and Prevention. County-level FI was positively and modestly associated with COVID-19 mortality within the first 2 years of the pandemic. Data sources and quality impacted the results.

Abstract Introduction: Despite advancements in cancer therapy, health disparities persist among underrepresented populations, including racial and ethnic minorities, people of low socioeconomic status, and people in geographically isolated areas. Representation in Early-Phase Clinical Trials (EPCT) is important, as limited representation exacerbates said inequities. Underrepresentation in clinical trials (CTs) impacts the true understanding of cancer biology and its role in treatment development. We aim to identify barriers and promoting factors influencing patients’ decisions to enroll in EPCTs and identify interventions to increase minority enrollment in clinical trials using a survey-based questionnaire. Methods: Following the extensive literature review, a list of validated questions were collected to populate a questionnaire to evaluate common themes faced by patients in participation in EPCT. This survey was offered to patients with cancer seen at the University of Kansas Cancer Center. This study is IRB-approved (STUDY00150640). Descriptive analysis was performed with Chi-Square and Fisher’s Exact Tests to determine significant associations between the qualitative variables to evaluate the most pressing barriers that were perceived in access to EPCT. Results: A total of 108 responses were collected. Over 58% of patients were over 65 years old. 62.4% were white, 17.8% African American, and 19.8% others (Asian or Native American). 40% of pts did not know about EPCTs before the survey. Only 26% of responders expressed participating in EPCTs in the past. Most people believe EPCTs are accessible to the public (75%) and would benefit from disease improvement (42%). Personal reasons for participating in EPCTs include obtaining a sense of hope (62%) and expressing no other treatment options available (49%). Encouragement to join EPCTs centered around wishing to help future cancer patients (67%) and trusting the center conducting the trial (52%). Pts emphasized the greatest benefit of participation in trials was the support of family and friends (69%). The top three perceived factors impacting EPCT accessibility from the pts perspective included understanding the value of the trial (76%), poor understanding of CTs process (40%), and lack of information of CTs (39%). Significant associations were observed with previous participation of EPCTs and increased age (p-value 0.031). An association was found with the responder’s self-identified race and perceived accessibility of EPCTs for the public(p-value 0.007). Conclusion: Most responders believed that EPCTs are readily available to others though the most noted barriers included individual perspectives about attributed trial value and purpose. Many pts noted a belief that EPCT involvement would increase hope regarding therapy and a personal desire to help future cancer patients. This will provide a foundational landmark for creating initiatives and interventions that will enhance diversity and access of EPCTs to the community. This project is supported by the University of Kansas Cancer Center P30CA168524. Citation Format: Issa Jimenez Espinoza, Anusha Chidharla, Kamiyah Hicks, Dinesh Pal Mudaranthakam, Sam Pepper, Angelica Allen, Asuka Suzuki, Debra Sullivan, Jill Hamilton-Reeves, Anup Kasi, Rahul Parikh, Saqib Abbasi, Al-Ola Abdallah, Elizabeth Wulff- Burchfield, Anna Arthur, Lori Barbosa, Erin Carroll, Jennifer Heins, Hope Krebiill, Tara Lin, Gary Doolittle, Weijing Sun, Joaquina Baranda. Understanding Barriers to Equity in Early Phase Clinical Trials Participation for the – Underrepresented Populations (uBEEP-UP Project)- A single-center survey-based study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B122.

Background: Head and neck squamous cell carcinoma (HNSCC) is a class of heterogenous cancers involving the upper aerodigestive tract. We previously demonstrated the utility of a priori diet quality indices for predicting survival after an HNSCC diagnosis. The aim of this analysis was to evaluate the role of those a priori diet quality indices and proinflammatory cytokines in newly diagnosed HNSCC survivors. Methods: We analyzed cross-sectional data from a sample (n 1/4 146; mean age 59.6 y; 79.3% male) from the University of Michigan Head and Neck Specialized Program of Research Excellence prospective longitudinal cohort study. Dietary intake was measured at pretreatment using a food frequency questionnaire. Serum samples were also collected at pretreatment. Covariate-adjusted proportional odds and logistic regression models were used to assess the relationship between 6 diet quality indices (Alternative Healthy Eating Index [AHEI]-2010, Alternate Mediterranean Diet, Dietary Approaches to Stop Hypertension [DASH], and 3 low-carbohydrate indices) and serum measures of a panel of 10 inflammatory cytokines and a cytokine summary composite score. Results: Higher scores on the AHEI-2010 and DASH diet quality indices were associated with higher odds of lower cytokine value scores for several cytokines and for the cytokine summary composite score (AHEI-2010-odds ratio [OR]: 1.55; 95% confidence interval [CI]: 1.10, 2.20; DASH-OR: 1.65; 95% CI 1.15, 2.36). Conclusions: Higher scores on the AHEI-2010 and DASH diet quality indices may be associated with lower proinflammatory cytokine levels in HNSCC survivors.

Background Several prospective studies report improved outcomes with pretreatment nutrition interventions prior to radiation therapy for head and neck cancer (HNC), but none have assessed similar interventions before surgery for HNC. Methods POINT, a pilot randomized controlled trial, was conducted to evaluate a multimodal nutrition intervention. Patients undergoing primary surgery with free flap reconstruction for HNC were randomly assigned to the control arm or a preoperative multimodal nutrition intervention. Results POINT included 49 patients. Nutrition risk scores did not change significantly for either the intervention or control group. Control patients had a significant decrease in body weight in the preoperative period ( p < 0.001). Conversely, weight among intervention patients did not significantly decrease ( p = 0.680). The intervention mitigated weight loss in patients with dysphagia ( p = 0.001). Conclusions Preoperative nutrition optimization shows potential to reduce weight loss normally experienced by patients with head and neck cancer prior to surgical extirpation, especially among those with subjective dysphagia.

Abstract This cross-sectional study assessed the nutrition and physical activity (PA) needs, practices, and programming preferences of adults ages 40+ years from seven states (n = 1,250). Respondents were mostly educated, White, food-secure, adults ages 60+ years. Many were married, suburban-residing, and interested in health programming. By self-report most respondents were “at nutritional risk” (59.3%), in “somewhat good health” (32.3%), and sedentary (49.2%). One-third reported PA intention in the next two months. Desired programs were less than four weeks and under 4 h weekly. Respondents preferred to attend self-directed online lessons (41.2%). Program format preference varied by age (P < 0.05). More respondents aged 40–49 years and 70+ years reported a preference for online group sessions compared to those aged 50 to 69 years. Respondents ages 60 to 69 years reported the highest preference for interactive apps. More older respondents (60 years and older) preferred asynchronous online lessons compared to the younger respondents (age 59 years and younger). There were significant program participation interest differences by age, race, and location (P< 0.05). These results revealed a need and preference for self-directed, online health programming for middle-aged and older adults.

Head and neck cancer (HNC) is associated with high rates of malnutrition. We conducted a systematic review and descriptive analysis to determine the effects of nutrition interventions on the nutrition status, quality of life (QOL), and treatment tolerance of HNC patients. PubMed, Web of Science, and Embase were searched to include all potentially relevant studies published between 2006–2022. Meta-analysis was not conducted due to heterogeneity of study designs and outcomes reported. Studies were categorized as nutrition interventions: (1) with oral nutrition supplements (ONS) and medical nutrition therapy (MNT) delivered by an RD; (2) with enteral nutrition (EN) support and MNT delivered by an RD; (3) with motivational interviewing and no ONS or EN; and (4) with ONS and no RD. Seven articles met inclusion criteria. Studies measured outcomes from immediately following treatment to 12 months post-treatment. Interventions resulted in benefits to lean mass/weight maintenance (three studies), QOL (two studies), nutrient intake adequacy (one study) and treatment tolerance (two studies). Nutrition counseling by a registered dietitian leads to improved nutrition status and QOL. Further research is needed to determine best practices related to timing of initiation, duration of nutrition intervention, as well as frequency of dietitian follow-up.

Aging is a natural process but may lead to aging anxiety due to physical and mental health changes. Aging anxiety is more prevalent among African Americans compared to Whites. This study aimed to investigate the correlation between aging anxiety, its four constructs including fear of older adults (contact with older adults), psychological concerns (personal/internal issues), physical appearance (physical changes), and fear of loss (loss of autonomy and social relationships), with the different types of physical activity (PA), as well as the attitudes toward PA. A total of 178 African American adults aged 40 years and older completed an online Qualtrics survey. The Lasher and Faulkender survey was utilized for the purposes of obtaining data on aging anxiety. PA was measured using questions derived from the National Health Interview Survey questionnaire and miscellaneous Questions for PA attitudes. The results revealed that fear of loss was the most anxiety-inducing factor among the participants. Females were more fearful of older adults and more anxious about aging than males. Possessing an enjoyable attitude toward PA was associated with less fear of older adults, fewer psychological concerns, and a lower total score of aging anxiety. Physical appearance constructs were correlated with age and strengthening exercises. Younger participants were more worried about their appearance than older participants. Fear of loss was higher among single and lower-income participants. Interventions and mental health programs should consider addressing the fear of loss and promoting a positive attitude toward PA to alleviate aging anxiety among middle-aged and older African Americans.

Enriched GO terms for genes differentially expressed between HPV-KRT and HPV-IMU subgroups in the UM cohort.

Background: Most head and neck cancer (HNC) patients undergoing aggressive treatments with chemoradiotherapy and surgical resection of tumors suffer from symptoms long after treatment is completed that hinder adequate oral food intake, collectively known as Nutrition Impact Symptoms (NIS). Our aim was to examine the correlations between NIS and HNC survivors’ vegetable intake and use of seasoning. Methods: We conducted a 29-item telephone administrated survey to collect vegetable intake and seasoning habits among HNC survivors (n=22, age 61.4 ± 9.8 years, mean ± standard deviation) who received radiation therapy between 6 months and 10 years before recruitment identified through the cancer registry at Carle Foundation Hospital. Treatment-related side-effects (11 items) including difficulty swallowing, dry mouth, and mouth sores reflected NIS. A mean composite score was created for all the symptoms where higher scores indicated greater NIS. Spearman correlations examined the relationships between NIS, vegetable intake, and seasoning. Results: Half (50%) of the participants reported no change in their vegetable intake since diagnosis of cancer, and on average, ate 1 cup/day of total vegetables. Higher NIS scores associated with higher pumpkin and sweet potatoes intake (r (20) = .43, p<0.05), and there was a trend for higher scores of difficulties swallowing to be associated with lower corn and peas intake (r (20) =-.37, p=0.08). Participants with higher scores of problems with teeth and gums were less likely to use seasoning (r (20) = -.42, p<0.05). Conclusion: The findings support that HNC treatment can affect vegetable intake long after completion of radiotherapy. However, it would be premature for any recommendations to be derived from the present study for health professionals. A larger, observational study with a longer follow-up is therefore needed to examine these correlations.

BACKGROUND:Understanding the knowledge, attitudes, and practices pertaining to food insecurity among oncology registered dietitian nutritionists (RDNs) is critical to ensuring that cancer survivors have adequate nutrition-a fundamental component of successful treatment and recovery.OBJECTIVE:To qualitatively assess oncology RDNs' knowledge, attitudes, and practices regarding the food access needs of their patients using a qualitative semantic approach to thematic analysis.DESIGN:The qualitative cross-sectional study was conducted from September 2018 to January 2019.PARTICIPANTS AND SETTING:Forty-one oncology RDNs working with cancer survivors in various clinical settings across the United States participated.MAIN OUTCOME MEASURES:Participants completed a semistructured, in-depth interview via telephone, lasting an average of 49 minutes.STATISTICAL ANALYSES PERFORMED:Two coders (primary and secondary) trained in qualitative thematic data analysis methods used a semantic approach to thematic analysis to analyze transcripts. A qualitative and mixed methods online coding program Dedoose was used to organize and analyze the data.RESULTS:Participants defined food insecurity (FI) as a lack of access to nutritious foods and a lack of resources to purchase nutritious foods. RDNs stated they believe FI is a serious problem in the United Staes, has a greater influence on cancer survivors than healthy individuals and they have specific concerns about FI among their own patients. Despite their concerns, most expressed that they do not use a validated tool to identify FI, nor were they aware that any exists. Only a small proportion of the RDNs stated that they regularly ask patients about their food access needs.CONCLUSIONS:Although Oncology RDNs have heard of FI, they do not routinely assess patients' food security status with a validated tool, nor do they consistently ask patients directly about their food access needs. These findings suggest there is a need for developing education and training opportunities for oncology RDNs to enhance their ability to screen for and address FI with their patients.

No evidence-based prevention strategies currently exist for cancer-related cognitive decline (CRCD). Although patients are often advised to engage in healthy lifestyle activities (e.g., nutritious diet), little is known about the impact of diet on preventing CRCD. This secondary analysis evaluated the association of pre-treatment diet quality indices on change in self-reported cognition during chemotherapy. Study participants (n = 96) completed the Block Brief Food Frequency Questionnaire (FFQ) before receiving their first infusion and the PROMIS cognitive function and cognitive abilities questionnaires before infusion and again 5 days later (i.e., when symptoms were expected to be their worst). Diet quality indices included the Dietary Approaches to Stop Hypertension (DASH), Alternate Mediterranean Diet (aMED), and a low carbohydrate diet index and their components. Descriptive statistics were generated for demographic and clinical variables and diet indices. Residualized change models were computed to examine whether diet was associated with change in cognitive function and cognitive abilities, controlling for age, sex, cancer type, treatment type, depression, and fatigue. Study participants had a mean age of 59 ± 10.8 years and 69

While there is an association between Western diets and the incidence of colorectal cancer (CRC), this dietary association has remained unexplored in Palestine. The aim of this study was to examine how fiber and fruit and vegetable (FV) intakes are associated with CRC risk among Palestinian adults. We recruited 528 Palestinians between 2014 and 2016. We identified 118 patients who received CRC treatment at Augusta Victoria Hospital, East Jerusalem. We additionally identified 410 controls who consisted of community-based Palestinians without cancer. All participants completed a survey on demographics and a validated dietary intake food screener. Multivariable logistic regression models tested associations between fiber and FV intakes (categorized into quartiles) with CRC risk. After adjusting for significant covariates (age, sex, education, physical activity, smoking status, BMI, IBD, and family history of CRC), as fibers increased across increasing quartiles, the CRC risk significantly decreased (OR = 0.36, 95% CI: 0.15–0.86, p-trend = 0.02). After adjusting for age and sex, as FV intake increased, the CRC risk significantly decreased (OR = 0.34, 95% CI: 0.15–0.75, p-trend = 0.009). Consumption of fiber-rich foods was inversely associated with CRC risk. Understanding this relationship among Palestinians is essential in order to develop targeted, culturally relevant strategies that may potentially alleviate the burden of CRC.

Aim:This cross-sectional study examined how the COVID-19 pandemic impacted the food practices, physical activity (PA) levels, and stress levels of aging adults ages 40 years and older from seven states. It also explored to what extent the COVID-19 outcomes were affected by the social determinants of health (SDH). Subject and methods:Respondents (n = 1250) completed an online survey. Descriptive statistics were used to analyze the sociodemographic attributes and COVID-19 responses while the multiple llinear regression (MLR) test evaluated to what extent the SDH variables measured were associated with the reported COVID-19 impacts food practices, PA levels, and stress levels. Results:Respondents were mostly White (75.9%), married (58.7%), age 60 years and older (61.8%), with a high school education or higher (97.4%). Most of the respondents (85.8%) live in areas that respondents perceived as supportive of health and well-being opportunities for older adults. Nearly one-half of the respondents reported maintaining their pre-pandemic grocery shopping/food buying frequency (44.7%) and PA levels (48.1%). However, 48.6% reported being "somewhat or very stressed" due to the pandemic. Findings revealed that the COVID-19 impacts on food-buying, PA levels, and stress levels were significantly influenced by age, gender, race, education, location, community, nutritional risk, quality of life, food security, and income (p < 0.05). Conclusion:These findings provide valuable information as we continue to confront the impact the COVID-19 pandemic has had on the health and well-being of aging adults. We can use this information to inform future public health programming interventions and opportunities.

(1) Background: Food insecurity (FI) is a public health and sociodemographic phenomenon that besets many cancer survivors in the United States. FI in cancer survivors may arise as a consequence of financial toxicity stemming from treatment costs, physical impairment, labor force egress, or a combination of those factors. To our knowledge, an understanding of the dietary intake practices of this population has not been delineated but is imperative for addressing the needs of this vulnerable population; (2) Methods: Using data from NHANES, 1999–2018, we characterized major dietary patterns in the food insecure cancer survivor population using: i. penalized logistic regression (logit) and ii. principal components analysis (PCA). We validated these patterns by examining the association of those patterns with food insecurity in the cancer population; (3) Results: Four dietary patterns were extracted with penalized logit and two with PCA. In the pattern validation phase, we found several patterns exhibited strong associations with FI. The FI, SNAP, and Household Size patterns (all extracted with penalized logit) harbored the strongest associations and there was evidence of stronger associations in those moderately removed from a cancer diagnosis (≥2 and <6 years since diagnosis); (4) Conclusions: FI may play an influential role on the dietary intake patterns of cancer survivors in the U.S. The results highlight the relevance of FI screening and monitoring for cancer survivors.