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Accessible nutrition resources tailored to patients with cancer, caregivers of cancer survivors, and people interested in cancer prevention are limited. Cook for Your Life is a bilingual (ie, English and Spanish) website providing science-based, nutrition information for people affected by cancer.
The aim of this study was to describe the characteristics of Cook for Your Life website users.
In December 2020, Cook for Your Life website visitors at least 18 years old were invited to participate in an online English-language survey. A Spanish version was offered in April 2021. Demographic, health, and cooking characteristics were collected. Persons with a cancer history were asked about treatment and side effects. Data were analyzed through December 2021 on those completing over half of the survey. Three groups were compared: people with a history of cancer diagnosis, caregivers of cancer survivors, and the general public (ie, people without a cancer history). Website use data were also compared.
Among English-language respondents, 3346 initiated the survey and 2665 (79.65%) completed over half of the questions. Of these, 54.82% (n=1461) had a cancer diagnosis, 8.26% (n=220) were caregivers, and 36.92% (n=984) were from the general public. English-language respondents were US residents (n=2054, 77.07%), with some from Europe (n=285, 10.69%) and Canada (n=170, 6.38%). Cancer survivors were most likely 55 years of age or older, female, non-Hispanic White, with incomes over US $100,000, and college educated. Caregivers and the general public were younger and more racially and geographically diverse. The most common cancer malignancies among English-language cancer survivors were breast (629/1394, 45.12%) and gastrointestinal (209/1394, 14.99%). For Spanish-language respondents, 942 initiated the survey; of these, 681 (72.3%) were analyzed. Of the 681 analyzed, 13.5% (n=92) were cancer survivors, 6.8% (n=46) were caregivers, and 79.7% (n=543) were from the general public. Spanish-language respondents were also more likely to be female and highly educated, but were younger, were from South or Latin America, and had incomes less than US $30,000. Among Spanish-language cancer survivors, breast cancer (27/81, 33%) and gastrointestinal cancer (15/81, 19%) were the most common diagnoses. Website use data on over 2.2 million users from December 2020 to December 2021 showed that 52.29% of traffic was in English and 43.44% was in Spanish. Compared to survey respondents, a higher proportion of website users were male, younger, and from South or Central America and Europe.
Cook for Your Life website users were demographically, socioeconomically, and geographically diverse, especially English-language respondents without a cancer history and all Spanish-language respondents. Improvements on website user diversity and reach for all patients with cancer and research on effective strategies for using this digital platform to support cancer prevention, treatment, and survivorship will continue.
ClinicalTrials.gov NCT04200482; https://www.clinicaltrials.gov/ct2/show/NCT04200482
Access to science-based nutrition information is vital for all persons affected by cancer, which includes those with a cancer diagnosis, caregivers of patients with cancer and survivors, and those interested in improving their diets for cancer prevention. For patients with cancer who are undergoing treatment, healthy nutrition is an important factor for maintaining energy, improving treatment tolerance and response, reducing cancer symptoms, and addressing the side effects of cancer treatments [
However, accessible, evidence-based dietary and nutrition resources tailored to the needs of people affected by cancer are limited [
Cook for Your Life [
When the website was relaunched in December 2020, a survey on the English language site was offered to visitors of the website. In April 2021, a Spanish version of the survey was added. The objective of this paper is to describe overall website use and findings from the English and Spanish online user surveys. Improving our knowledge about Cook for Your Life website users is key to understanding how and who uses the website and to determine how effectively we are reaching patients with cancer and survivors, caregivers, and the general population interested in cancer nutrition. With this information, we will be better able to adapt the website content to meet users’ needs and appropriately use the website as a resource and tool in the development of new health interventions to improve cancer prevention, treatment, and survivorship.
Cook for Your Life was a nonprofit organization founded in New York City in 2007 by AOG, a three-time cancer survivor. Recognizing that her culinary knowledge helped her better manage the side effects of her chemotherapy treatment, AOG began sharing cooking tips and recipes with other patients with cancer undergoing treatment. These efforts ultimately resulted in free, in-person cooking classes focused on healthy nutrition for patients with cancer and survivors, which were offered through New York City–based cancer centers and community organizations. One of the classes, “Cocinando Saludable, Viviendo Saludable: Promoviendo las compras, el concinar y comer saludable en los que han sobrevivido el cáncer de seno (Healthy Cooking, Healthy Life: Promoting ways to shop, cook and eat healthy foods among breast cancer survivors),” was tailored for Latina breast cancer survivors.
In 2009, AOG met HG, a cancer epidemiologist and cancer prevention scientist, when she was a faculty member at Columbia University’s Mailman School of Public Health. With funding from the National Cancer Institute (NCI), they developed AOG’s program into a formal curriculum and tested it in the Cocinar Para Su Salud (Cook for Your Health) study (ClinicalTrials.gov NCT01414062) [
In 2017, HG moved her research program to the Fred Hutchinson Cancer Center (formerly, the Fred Hutchinson Cancer Research Center) in Seattle, and upon AOG’s retirement in 2019, the Cook for Your Life website was acquired by the Fred Hutchinson Cancer Center. The website has subsequently been used as a nutrition tool and resource for new trials testing digital mobile health interventions to improve lifestyle behaviors among cancer survivors and individuals at risk of developing cancer, with a focus on underserved communities (ClinicalTrials.gov NCT04081298; ClinicalTrials.gov NCT04200482).
The Cook for Your Life website was built on a WordPress platform and is hosted on Amazon Web Services servers. Web traffic and use data are available from Google Analytics. Traffic data includes the number of new and returning users and number of page views. Web use data on all users includes metrics such as demographic characteristics, behavior on the site, country of residence, and type of device used (eg, mobile or desktop). Web analytics data can be viewed in real time or over specified date ranges.
An online survey with questions about demographic characteristics, health and cooking behaviors, and cancer history was created. Usability testing by study staff was conducted to check the survey branching logic and gauge length of time to complete. The English-language version of the survey was released on December 10, 2020, the same day the Cook for Your Life website was relaunched by Fred Hutch. The survey was released in Spanish on April 15, 2021. As an incentive, survey respondents received a customized, downloadable nutrition e-book upon survey completion, either in English or Spanish. Respondents were required to self-report being at least 18 years of age to participate. The Spanish version of the survey was identical to the English version in content and recruitment for participation.
Public-facing visitors to the website were invited to complete the survey through three routes. The first was via a “Volunteer to participate in a research study” link on the home page, the second was a “Get Involved” link in the global navigation at the top, and the third was through a pop-up window appearing to new visitors after 45 seconds on the website. The pop-up window invited users to click a link to participate in a short survey. In addition, the online survey and the request for volunteers was promoted weekly in the website’s digital newsletter, which has a mailing list of approximately 15,000 individuals.
A waiver of consent was submitted and approved (IRB file number 10567) by the Fred Hutch Institutional Review Board. The survey is administered using the Qualtrics Health Insurance Portability and Accountability Act–secure platform. The survey was completely voluntary. Although lengthy, respondents always had the option to stop answering survey questions at any time by closing the online window. This study was registered at ClinicalTrials.gov (NCT04200482).
Web traffic information over time was measured using number of page views per month. Website use data included number of users to the site and users’ gender, age range, and country of residence.
The online survey included questions about demographics, health status and behaviors, diet preferences, and cooking behaviors. Demographic characteristics included age group, gender, country of residence, race and ethnicity, education, household income, number of people living in their household, and whether they live in an urban, suburban, or rural area. Health status and behaviors included presence of noncancer medical conditions, smoking and drinking behavior, height and weight, frequency of fruit and vegetable consumption, and frequency of physical activity. Cooking questions included dietary preference, self-evaluation of cooking ability, frequency of cooking and eating out, and challenges of cooking. Survey respondents with a history of cancer were asked a subset of cancer-related questions, including cancer type, age at diagnosis, treatments received, and side effects of treatment.
Website data from Google Analytics were reviewed for the period from December 10, 2020, to December 13, 2021, to align with the same window of time that the English-language survey data were analyzed. The Spanish-language survey data were analyzed from users who participated in the survey from April 15 to December 13, 2021. Frequencies by gender, age range, and country of residence from the web use data were compared to the survey respondents.
Respondents completing at least 50% of the survey were included in the analysis. Three mutually exclusive groups were created: (1) cancer survivors, including patients undergoing active treatment; (2) primary caregivers of a patient with cancer or a survivor; and (3) members of the general public interested in cancer prevention. Frequency distributions in the characteristics were calculated across these three groups for the total sample and were stratified by gender. Statistically significant differences comparing cancer survivors to primary caregivers and the general public were tested using the Pearson chi-square test. Distributions of cancer-related characteristics among cancer survivor survey respondents stratified by gender were also estimated.
From December 10, 2020, to December 13, 2021, a total of 2.08 million unique users visited the Cook for Your Life website (
Screenshot of the Cook for Your Life website.
Cook for Your Life website total page views, and page views by English- and Spanish-language website users from December 2020 to December 2021.
After 1 year of data collection, 3346 website visitors initiated the English-language survey and, of these, 2665 (79.65%) completed at least 50% the survey. For the Spanish-language survey, 942 visitors initiated the survey, of whom 681 (72.3%) completed at least 50% of the survey. Among all 3346 respondents in either language, 82.79% (n=2770) reported being female, 78.48% (n=2626) were college educated, 78.75% (n=2635) were omnivores, 70.56% (n=2361) rated their cooking skills as intermediate, 62.67% (n=2097) cooked five or more times per week, and 69.04% (n=2310) ate out zero times or one time per week. English-language compared to Spanish-language respondents were more likely to report being a US resident (77.1% vs 11.9%), over 65 years of age (38.3% vs 18.5%), White (80.9% vs 38.0%), non-Hispanic (83.4% vs 5.7%), a nonsmoker (95.7% vs 89.3%), in a household with income over US $60,000 (45.0% vs 13.5%), and engaging in moderate-to-vigorous physical activity (84.9% vs 73.7%). English-language respondents from outside the United States were mainly from Europe (46.6%) or Canada (27.8%), while Spanish-language respondents were more likely to report living in South or Latin America (79.4%).
Characteristics comparing cancer survivors, primary caregivers, and the general public are provided in
Of the 681 Spanish-language respondents analyzed, 92 (13.5%) were cancer survivors, 46 (6.8%) were primary caregivers, and 543 (79.7%) were members of the general public. For Spanish-language respondents overall, cancer survivors were more likely to be over 65 years of age and nondrinkers relative to caregivers and members of the general public, but they were generally similar in all other characteristics. By gender, demographic and health characteristics for males across all three groups were similar in distribution to the overall sample of Spanish-language respondents (Tables S1 and S3 in
Clinical characteristics of cancer survivors by gender are shown in
Frequency of demographic characteristics of Cook for Your Life English- and Spanish-language respondents who completed at least 50% of the online survey.
Characteristic | English respondents (n=2665), n (%) | Spanish respondents (n=681), n (%) | ||||||||||||
Cancer survivors | Primary caregivers | General public | Cancer survivors | Primary caregivers | General public | |||||||||
Respondents by group | 1461 (54.8) | 220 (8.3) | 984 (36.9) | 92 (13.5) | 46 (6.8) | 543 (79.7) | ||||||||
|
Male | 214 (14.7) | 18 (8.2) | 175 (17.8) | 15 (16.3) | 11 (23.9) | 100 (18.4) | |||||||
|
Female | 1230 (84.2) | 200 (90.9) | 795 (80.8) | 76 (82.6) | 34 (73.9) | 435 (80.1) | |||||||
|
||||||||||||||
|
United States | 1206 (82.7) | 159 (72.3) | 689 (70.2) | 15 (16.5) | 5 (10.9) | 61 (11.3) | |||||||
|
Africa | 13 (0.9) | 1 (0.5) | 12 (1.2) | 0 (0) | 0 (0) | 0 (0) | |||||||
|
Asia or Pacific Islands | 42 (2.9) | 11 (5.0) | 30 (3.1) | 1 (1.1) | 0 (0) | 0 (0) | |||||||
|
Europe | 95 (6.5) | 23 (10.5) | 167 (17.0) | 13 (14.3) | 5 (10.9) | 35 (6.5) | |||||||
|
Middle East | 2 (0.1) | 1 (0.5) | 3 (0.3) | 0 (0) | 0 (0) | 0 (0) | |||||||
|
Canada | 84 (5.8) | 15 (6.8) | 71 (7.2) | 0 (0) | 0 (0) | 3 (0.6) | |||||||
|
South or Latin America | 17 (1.2) | 10 (4.6) | 10 (1.0) | 62 (68.1) | 36 (78.3) | 443 (81.9) | |||||||
|
18-35 | 30 (2.1) | 19 (8.6) | 105 (10.7) | 6 (6.5) | 8 (17.4) | 99 (18.2) | |||||||
|
36-55 | 391 (26.8) | 79 (35.9) | 276 (28.1) | 35 (38.0) | 20 (43.5) | 223 (41.1) | |||||||
|
56-65 | 407 (27.9) | 64 (29.1) | 273 (27.7) | 25 (27.2) | 9 (19.6) | 130 (23.9) | |||||||
|
66-75 | 436 (29.8) | 49 (22.3) | 242 (24.6) | 22 (23.9) | 7 (15.2) | 71 (13.1) | |||||||
|
≥76 | 197 (13.5) | 9 (4.1) | 88 (8.9) | 4 (4.4) | 2 (4.4) | 20 (3.7) | |||||||
|
American Indian | 9 (0.6) | 3 (1.4) | 6 (0.6) | 2 (2.2) | 2 (4.4) | 2 (0.4) | |||||||
|
Asian, Native Hawaiian, or Pacific Islander | 46 (3.2) | 15 (6.8) | 37 (3.8) | 1 (1.1) | 0 (0) | 3 (0.6) | |||||||
|
Black or African American | 49 (3.4) | 10 (4.6) | 48 (4.9) | 2 (2.2) | 0 (0) | 5 (0.9) | |||||||
|
White | 1216 (83.2) | 164 (74.6) | 775 (78.8) | 37 (40.2) | 21 (45.7) | 201 (37.0) | |||||||
|
Mixed race | 85 (5.8) | 17 (7.7) | 71 (7.2) | 31 (33.7) | 17 (37.0) | 234 (43.1) | |||||||
|
Other | 18 (1.2) | 4 (1.8) | 14 (1.4) | 8 (8.7) | 2 (4.4) | 45 (8.3) | |||||||
|
Prefer not to say | 38 (2.6) | 7 (3.2) | 33 (3.4) | 11 (12.0) | 4 (8.7) | 53 (9.8) | |||||||
|
Hispanic | 81 (5.5) | 21 (9.6) | 60 (6.1) | 73 (79.4) | 40 (87.0) | 480 (88.4) | |||||||
|
Non-Hispanic | 1258 (86.1) | 177 (80.5) | 787 (80.0) | 11 (12.0) | 2 (4.4) | 26 (4.4) | |||||||
|
Prefer not to say | 122 (8.4) | 22 (10.0) | 137 (13.9) | 8 (8.7) | 4 (8.7) | 37 (8.7) | |||||||
|
Less than high school | 22 (1.5) | 6 (2.7) | 35 (3.6) | 6 (6.5) | 5 (10.9) | 40 (7.4) | |||||||
|
High school graduate or GEDd | 111 (7.6) | 13 (5.9) | 80 (8.1) | 13 (14.1) | 3 (6.5) | 51 (9.4) | |||||||
|
Trade school or associate’s degree | 127 (8.7) | 21 (9.6) | 105 (10.7) | 11 (12.0) | 5 (10.9) | 51 (9.4) | |||||||
|
Some college but not a graduate | 211 (14.4) | 32 (14.6) | 150 (15.2) | 14 (15.2) | 10 (21.7) | 102 (18.8) | |||||||
|
College degree or more | 985 (67.4) | 147 (66.8) | 610 (62.0) | 48 (52.2) | 23 (50.0) | 294 (54.1) | |||||||
|
Other | 5 (0.3) | 1 (0.5) | 4 (0.4) | 0 (0) | 0 (0) | 5 (0.9) | |||||||
|
0-30,000 | 183 (12.5) | 38 (17.3) | 169 (17.2) | 38 (41.3) | 21 (45.7) | 208 (38.3) | |||||||
|
30,001-60,000 | 227 (15.5) | 38 (17.3) | 171 (17.4) | 16 (17.4) | 5 (10.9) | 48 (8.8) | |||||||
|
60,001-100,000 | 294 (20.1) | 44 (20.0) | 189 (19.2) | 4 (4.4) | 3 (6.5) | 37 (6.8) | |||||||
|
>$100,000 | 399 (27.3) | 47 (21.4) | 225 (22.9) | 5 (5.4) | 3 (6.5) | 40 (7.4) | |||||||
|
Prefer not to say | 358 (24.5) | 53 (24.1) | 230 (23.4) | 29 (31.5) | 14 (30.4) | 210 (38.7) | |||||||
|
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|
1 | 297 (20.3) | 23 (10.5) | 232 (23.6) | 9 (9.8) | 7 (15.2) | 60 (11.1) | |||||||
|
2 | 762 (52.2) | 108 (49.1) | 428 (43.5) | 29 (31.5) | 9 (19.6) | 155 (28.6) | |||||||
|
3 | 183 (12.5) | 42 (19.1) | 125 (12.7) | 19 (20.7) | 11 (23.9) | 124 (22.8) | |||||||
|
≥4 | 219 (15.0) | 47 (21.4) | 199 (20.2) | 35 (38.0) | 19 (41.3) | 204 (37.6) | |||||||
|
Urban | 455 (31.1) | 78 (35.5) | 351 (35.7) | 64 (69.6) | 34 (73.9) | 425 (78.3) | |||||||
|
Suburban | 691 (47.3) | 100 (45.5) | 429 (43.6) | 22 (23.9) | 7 (15.2) | 78 (14.4) | |||||||
|
Rural | 315 (21.6) | 42 (19.1) | 204 (20.7) | 6 (6.5) | 5 (10.9) | 40 (7.4) |
a
b
c
dGED: General Education Diploma.
Frequency of health characteristics of Cook for Your Life English- and Spanish-language respondents who completed at least 50% of the online survey.
Characteristic | English respondents (n=2665), n (%) | Spanish respondents (n=681), n (%) | ||||||
Cancer survivors | Primary caregivers | General public | Cancer survivors | Primary caregivers | General public | |||
|
Chest pain | 30 (2.4) | 7 (3.4) | 23 (2.4) | 2 (2.3) | 1 (2.4) | 20 (3.8) | |
|
Diabetes or prediabetes | 200 (14.3) | 29 (13.9) | 153 (16.0) | 16 (18.2) | 7 (16.7) | 78 (14.8) | |
|
Hypertension | 338 (24.2) | 55 (26.4) | 250 (26.2) | 26 (29.6) | 9 (21.4) | 116 (22.1) | |
|
High cholesterol | 290 (20.7) | 45 (21.6) | 215 (22.5) | 18 (20.5) | 14 (33.3) | 90 (17.1) | |
|
Heart disease | 66 (4.7) | 10 (4.8) | 45 (4.7) | 2 (2.3) | 3 (7.1) | 19 (3.6) | |
|
Vascular disease | 37 (2.6) | 7 (3.4) | 27 (2.8) | 2 (2.3) | 1 (2.4) | 6 (1.1) | |
Current smokera,b | 35 (2.5) | 11 (5.3) | 64 (6.7) | 8 (9.1) | 7 (16.7) | 55 (10.5) | ||
Drinks alcoholb,c,d | 625 (45.5) | 88 (45.4) | 540 (59.0) | 22 (25.3) | 20 (48.8) | 199 (39.2) | ||
|
||||||||
|
Total | 619 (100) | 86 (100) | 535 (100) | 22 (100) | 20 (100) | 195 (100) | |
|
1-2 per week | 320 (51.7) | 43 (50.0) | 204 (38.1) | 14 (63.6) | 12 (60.0) | 133 (68.2) | |
|
3-6 per week | 191 (30.9) | 23 (26.7) | 187 (35.0) | 6 (27.3) | 6 (30.0) | 43 (22.1) | |
|
Every day | 57 (9.2) | 4 (4.7) | 56 (10.5) | 1 (4.6) | 1 (5.0) | 9 (4.6) | |
|
≥2 per day | 51 (8.2) | 16 (18.6) | 88 (16.5) | 1 (4.6) | 1 (5.0) | 10 (5.1) | |
|
None | 36 (2.7) | 6 (3.1) | 37 (4.1) | 3 (3.5) | 1 (2.4) | 16 (3.2) | |
|
1-3 days | 255 (18.7) | 53 (27.8) | 234 (25.8) | 24 (27.6) | 10 (24.4) | 169 (33.6) | |
|
4-6 days | 417 (30.6) | 64 (33.5) | 276 (30.4) | 31 (35.6) | 17 (41.5) | 149 (29.6) | |
|
Every day | 653 (48.0) | 68 (35.6) | 360 (39.7) | 29 (33.3) | 13 (31.7) | 169 (33.6) | |
|
||||||||
|
Total | 1318 (100) | 184 (100) | 860 (100) | 83 (100) | 40 (100) | 483 (100) | |
|
<1 cup | 853 (64.7) | 116 (63.0) | 548 (63.7) | 50 (60.2) | 18 (45.0) | 234 (48.5) | |
|
1-2 cups | 355 (26.9) | 50 (27.2) | 235 (27.3) | 23 (27.7) | 15 (37.5) | 176 (36.4) | |
|
>2 cups | 110 (8.4) | 18 (9.8) | 77 (9.0) | 10 (12.1) | 7 (17.5) | 73 (15.1) | |
|
||||||||
|
None | 12 (0.9) | 0 (0) | 9 (1.0) | 2 (2.3) | 0 (0) | 5 (1.0) | |
|
1-3 days | 138 (10.2) | 20 (10.5) | 103 (11.5) | 22 (25.6) | 10 (24.4) | 123 (24.7) | |
|
4-6 days | 420 (31.0) | 70 (36.8) | 288 (32.1) | 32 (37.2) | 15 (36.6) | 190 (38.1) | |
|
Every day | 784 (57.9) | 100 (52.6) | 497 (55.4) | 30 (34.9) | 16 (39.0) | 181 (36.3) | |
|
||||||||
|
Total | 1321 (100) | 184 (100) | 849 (100) | 84 (100) | 41 (100) | 473 (100) | |
|
<1 cup | 775 (58.7) | 95 (51.6) | 442 (52.1) | 48 (57.1) | 23 (56.1) | 225 (47.6) | |
|
1-2 cups | 437 (33.1) | 65 (35.3) | 308 (36.3) | 27 (32.1) | 14 (34.2) | 173 (36.6) | |
|
>2 cups | 109 (8.3) | 24 (13.0) | 99 (11.7) | 9 (10.7) | 4 (9.8) | 75 (15.9) | |
|
None | 208 (15.6) | 28 (15.2) | 123 (14.4) | 25 (29.4) | 7 (17.1) | 127 (26.6) | |
|
1-3 days | 475 (35.7) | 74 (40.2) | 319 (37.3) | 35 (41.2) | 22 (53.7) | 208 (43.5) | |
|
4-6 days | 487 (36.6) | 62 (33.7) | 302 (35.3) | 18 (21.2) | 11 (26.8) | 109 (22.8) | |
|
Every day | 162 (12.2) | 20 (10.9) | 112 (13.1) | 7 (8.2) | 1 (2.4) | 34 (7.1) | |
|
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|
0 to <10 | 220 (16.5) | 31 (16.9) | 134 (15.7) | 24 (28.2) | 6 (14.6) | 134 (28.0) | |
|
10 to <30 | 352 (26.4) | 56 (30.4) | 214 (25.0) | 25 (29.4) | 17 (41.5) | 110 (23.0) | |
|
30 to <40 | 296 (22.2) | 37 (20.1) | 185 (21.6) | 17 (20.0) | 6 (14.6) | 77 (16.1) | |
|
40 to <60 | 321 (24.1) | 41 (22.3) | 208 (24.3) | 14 (16.5) | 9 (22.0) | 101 (21.1) | |
|
≥60 | 143 (10.7) | 19 (10.3) | 115 (13.4) | 5 (5.9) | 3 (7.3) | 56 (11.7) |
a
b
c
d
eMVPA: moderate-to-vigorous physical activity.
Frequency of cancer-related characteristics of English- and Spanish-language patients with cancer and survivors responding to at least 50% of the Cook for Your Life website survey stratified by gender.
Characteristic | English respondents (n=1394), n (%) | Spanish respondents (n=81), n (%) | ||||||||
Male (n=201) | Female (n=1177) | Male (n=13) | Female (n=67) | |||||||
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Breast | 0 (0) | 624 (53.0) | 0 (0) | 27 (40.3) |
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Gastrointestinal region | 64 (31.8) | 142 (12.1) | 4 (30.8) | 11 (16.4) |
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Gynecologic region | N/Aa | 124 (10.5) | N/Aa | 10 (14.9) |
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Hematologic region | 24 (11.9) | 102 (8.7) | 0 (0) | 1 (1.5) |
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Genitourinary region | 57 (28.4) | 26 (2.2) | 4 (30.8) | 3 (4.5) |
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Respiratory region (lung) | 10 (5.0) | 29 (2.5) | 1 (7.7) | 3 (4.5) |
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Skin | 6 (3.0) | 24 (2.0) | 1 (7.7) | 2 (3.0) |
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Endocrine region (thyroid) | 1 (0.5) | 20 (1.7) | 3 (23.1) | 3 (4.5) |
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Other | 39 (19.4) | 86 (7.3) | 0 (0) | 7 (10.5) |
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18-35 | 8 (4.0) | 62 (5.3) | 1 (7.7) | 10 (14.9) |
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|
36-55 | 38 (18.9) | 477 (40.5) | 6 (46.2) | 32 (47.8) |
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|
56-65 | 50 (24.9) | 355 (30.2) | 2 (15.4) | 16 (23.9) |
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||||
|
>65 | 105 (52.2) | 283 (24.0) | 4 (30.8) | 9 (13.4) |
|
||||
Undergoing treatment | 111 (55.2) | 581 (49.4) | 11 (84.6) | 26 (38.8) | ||||||
|
||||||||||
|
Total | 111 (100) | 581 (100) | 11 (100) | 26 (100) |
|
||||
|
Chemotherapy | 78 (70.3) | 274 (47.2) | 4 (36.4) | 13 (50.0) |
|
||||
|
Radiation therapy | 24 (21.6) | 102 (17.6) | 3 (27.3) | 5 (19.2) |
|
||||
|
Endocrine therapy | 9 (8.1) | 183 (31.5) | 4 (36.4) | 7 (26.9) |
|
||||
|
Targeted therapy or immunotherapy | 18 (16.2) | 125 (21.5) | 0 (0) | 2 (7.7) |
|
||||
|
Surgery | 64 (57.7) | 467 (80.4) | 11 (100) | 12 (46.2) |
|
||||
|
||||||||||
|
Total | 111 (100) | 581 (100) | 11 (100) | 26 (100) |
|
||||
|
Fatigue | 72 (64.9) | 373 (64.2) | 3 (27.3) | 13 (50.0) |
|
||||
|
Anxiety | 27 (24.3) | 201 (34.6) | 4 (36.4) | 10 (38.5) |
|
||||
|
Insomnia | 20 (18.0) | 190 (32.7) | 2 (18.2) | 12 (46.2) |
|
||||
|
Sad feelings | 35 (31.5) | 169 (29.1) | 4 (36.4) | 11 (42.3) |
|
||||
|
Nausea | 33 (29.7) | 159 (27.4) | 3 (27.3) | 12 (46.2) |
|
||||
|
Dry mouth | 24 (21.6) | 165 (28.4) | 1 (9.1) | 9 (34.6) |
|
||||
|
Hot flashes | 7 (6.3) | 181 (31.2) | 2 (18.2) | 11 (42.3) |
|
||||
|
Decreased appetite | 39 (35.1) | 146 (25.1) | 3 (27.3) | 9 (34.6) |
|
||||
|
General pain | 22 (19.8) | 151 (26.0) | 4 (36.4) | 7 (26.9) |
|
||||
|
Taste changes | 30 (27.0) | 142 (24.4) | 1 (9.1) | 8 (30.8) |
|
||||
|
Constipation | 23 (20.7) | 143 (24.6) | 2 (18.2) | 8 (30.8) |
|
||||
|
Diarrhea | 23 (20.7) | 130 (22.4) | 2 (18.2) | 2 (7.7) |
|
||||
|
Mouth sores | 6 (5.4) | 62 (10.7) | 1 (9.1) | 3 (11.5) |
|
||||
|
Difficulty swallowing | 16 (14.4) | 40 (6.9) | 1 (9.1) | 5 (19.2) |
|
||||
|
Vomiting | 9 (8.1) | 34 (5.9) | 0 (0) | 4 (15.4) |
|
aN/A: not applicable for men.
bMultiple responses possible.
The Cook for Your Life website is a bilingual science-based culinary and nutrition resource for persons affected by cancer, broadly defined as cancer survivors, caregivers of patients with cancer, and people interested in cancer prevention. An important goal of the website is to provide accessible diet and nutrition information to a wide and diverse range of people, including those from underserved populations. To improve our understanding of the website’s reach, we administered a volunteer-based, nonprobability survey on the site. Analysis of these survey data indicated that survey respondents, cancer survivors in particular, were primarily living in the United States and were primarily White, non-Hispanic females who were about 55 years of age or older, highly educated, and of high socioeconomic status. This finding suggests the need to improve the reach and diversity of the Cook for Your Life website user base, especially among patients with cancer and survivors.
Further evaluation of the survey respondents showed that characteristics differed according to whether the survey was taken in English or Spanish. English-language respondents were mainly White, non-Hispanic females with high household incomes and living in the United States. English-language cancer survivors were most likely to fit this description, and most reported having breast cancer. In the United States, breast cancer is the most common malignancy among women, and incidence rates are highest among non-Hispanic White people over 60 years of age [
Although cancer survivors were less diverse, English-language respondents without a history of cancer showed more gender, international, racial, and socioeconomic diversity. Spanish-language respondents were also more demographically diverse, including among those reporting a history of cancer. Website use data indicated that Cook for Your Life visitors, in general, included higher proportions of men, were younger (ie, 18-44 years old), and were more globally represented than those who responded to the survey. Furthermore, examination of the cooking questions indicated that many survey respondents cooked for themselves often and regarded their cooking skills to be intermediate, indicating that the Cook for Your Life website is attracting people with already-strong culinary interests. These findings suggest that the content and topic areas of the Cook for Your Life website are appealing to a wide range of people without a history of cancer, and the focus on reach and diversity should be concentrated mainly among patients with cancer and survivors.
While our analysis indicated acceptable demographic, socioeconomic, and geographic diversity and reach among our general users without a history of cancer, the Cook for Your Life website also aims to support nutrition needs of patients with cancer and survivors as well as cancer caregivers. Previous studies have reported that both patients with cancer and their caregivers do not receive adequate nutrition education despite expressing a desire and need for more nutrition support and information [
We acknowledge that the survey data represented only those who were agreeable to participating in an online survey and then, among those, who completed at least half of the survey. Web surveys are prone to increased error associated with coverage, sampling, and nonresponse, and those limitations apply to this analysis as well [
There have been a handful of science-based websites also focused on providing nutrition education and support to patients with cancer and led by cancer research or academic institutions. A publication from a research team in the Netherlands described their process of developing a website titled “Voeding en kanker info” (Nutrition and cancer info) [
Analysis of users who visited the Cook for Your Life website indicated acceptable demographic, socioeconomic, and geographic reach and diversity for users without a history of cancer in particular. Research to improve our knowledge about the website’s user base, including understanding how people learn and apply knowledge from the website, use of specific website content, and information about website functionality, access, and application, more broadly, will continue. Work focused on improving diversity and reach among patients with cancer and survivors is needed and should include targeting patients with cancer with a clear sampling frame and through various modes of data collection.
Supplementary tables.
Fred Hutchinson Cancer Center.
This work was supported by funding from the Fred Hutchinson Cancer Center and the National Cancer Institute (grant R01CA186080).
None declared.