Head and neck cancer (HNC) caregivers are especially vulnerable to poor outcomes because the HNC patients are at high risk for physical and functional impairments. This study examines contextual and stress process variables potentially associated with HNC caregivers' physical and psychological well-being. Patient-caregiver variables included socio-demographics, primary stressors (caregiving, patient clinical characteristics, HNC-related symptoms/dysfunction), secondary stressors (caregiver employment, childcare responsibilities and sleep duration <7 hr), appraisal, and response (physical activity). General linear models modeled caregiver well-being, along with depression and anxiety. A total of 33 patient-caregiver dyads were included. Most caregivers were female (81.8%) and patient spouses/partners (72.7%). Factors significantly associated with better caregiver physical well-being included caregiver older age, <2 comorbidities, ≥7 hr of sleep, ≥3 days/week physical activity, and patient swallowing and speech dysfunction. Factors significantly associated with better caregiver mental health functioning were less patient social dysfunction and less perceived caregiving burden. Short nighttime sleep, higher caregiver burden, and <3 days/week physical activity were also significantly related to caregivers' depression and anxiety. Results suggested caregiver behaviors and perceived burden, along with patient HNC concerns are linked with caregiver well-being. These behavioral, cognitive, and patient factors should be incorporated into caregiver screening tools or targeted with behavioral interventions to improve caregiver well-being.

In addition to expediting patient recovery, community gardens that are associated with medical facilities can provide fresh produce to patients and their families, serve as a platform for clinic-based nutrition education, and help patients develop new skills and insights that can lead to positive health behavior change. While community gardening is undergoing resurgence, there is a strong need for evaluation studies that employ valid and reliable measures. The objective of this study was to conduct a process evaluation of a community garden program at an urban medical clinic to estimate the prevalence of patient awareness and participation, food security, barriers to participation, and personal characteristics; garden volunteer satisfaction; and clinic staff perspectives in using the garden for patient education/treatment. Clinic patients (n=411) completed a community garden participation screener and a random sample completed a longer evaluation survey (n=152); garden volunteers and medical staff completed additional surveys. Among patients, 39% had heard of and 18% had received vegetables from the garden; the greatest barrier for participation was lack of awareness. Volunteers reported learning about gardening, feeling more involved in the neighborhood, and environmental concern; and medical staff endorsed the garden for patient education/treatment. Comprehensive process evaluations can be utilized to quantify benefits of community gardens in medical centers as well as to point out areas for further development, such as increasing patient awareness. As garden programming at medical centers is formalized, future research should include systematic evaluations to determine whether this unique component of the healthcare environment helps improve patient outcomes.

Purpose Head and neck cancer (HNC) caregivers have poorer psychological health compared to patients and the general population, but have not yet been targeted for wellness programs to reduce adverse psychosocial or physical health outcomes. To inform development of such programs, we identified potential vulnerabilities to poor outcomes and examined wellness program preferences among HNC caregivers. We also examined whether interest in wellness programs varied by potential vulnerabilities among HNC caregivers. Methods Surveys were administered to caregivers (N = 33) of HNC patients undergoing major surgery. Sociodemographic factors, caregiving characteristics, psychosocial functioning, and health behavior data were collected. Fisher's exact tests and t-tests were used to examine characteristics associated with interest in the different types of wellness programs. Results Many caregivers reported a heavy caregiving load (88% live with patient; 73% provide daily care), a smoking history (42%), and compromised psychosocial functioning (45% with depressive symptoms; 33% with anxiety above population norms). Most caregivers were interested in wellness programs focused on diet/exercise (71.9%), cancer education (66.7%), stress reduction (63.6%), and finances, caregiving, and well-being (57.6%). Caregivers endorsed highest interest in programs offered during the patient's medical treatment (63.6%) and mail was the preferred program format (50.0%). Those with more depressive symptoms reported more interest in programs focused on cancer education (p = .03), stress reduction (p = .05), and educational classes on finances, caregiving and well-being (p = .01). Conclusions Wellness programs offering a menu of options should be developed for HNC caregivers.

Participants expressed an interest in learning more about food, nutrition, and health through community-based programming.

Dietary intake is a modifiable behavior that may reduce the risk of recurrence and death among breast cancer survivors. Cancer survivors are encouraged to consume a diet rich in fruit, vegetables, and whole grains; and limit red meat, processed meat, and alcohol intake. Using the National Health and Nutrition Examination Survey (2003–2006), this study examined whether breast cancer survivors and women with no history of cancer differed in the distribution of usual intake of foods included in the dietary recommendations for preventing cancer and recurrences. Participants completed one or two 24 hour dietary recalls. The food groups included in this analysis were whole fruit, total vegetables, dark green and orange vegetables, whole grains, red meat, processed meat, alcohol, and calories from solid fat, alcohol and added sugar. The National Cancer Institute Method was used to estimate the distribution of usual intake and to compare breast cancer survivors (n=102) to non-cancer respondents (n=2,684). Using age and cancer survivor as covariates, subgroup estimates of usual intake were constructed. No significant group differences were found, except that survivors reported a greater intake of whole grains. Over 90% of both groups did not meet recommendations for fruits, vegetables, and whole grains; 75.4% and 70.2% consumed less than the red meat recommendation; and less than 10% of either group met the recommendation for percent calories from solid fat, alcohol and added sugar. The diet of breast cancer survivors was not significantly different from women with no history of cancer.