The following article is part of a series highlighting the effects of social determinants of health on cancer care. The other articles in this series address housing insecurity and transportation insecurity.
Estimates suggest that anywhere from 17% to 55% of patients with cancer are affected by food insecurity, which is defined as the lack of continuous access to nutritious and safe foods in the amounts needed for a healthy and active life.1
One recent study revealed higher rates of cancer and cancer death in US counties with greater food insecurity.2 Another study showed that US counties with food deserts or food swamps tend to have higher rates of death from obesity-related cancers.3
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For food-insecure patients, a diagnosis of cancer poses special challenges.1 Food-insecure patients lack the flexibility in food purchasing and preparation that can mitigate common cancer-related symptoms like anorexia, parosmia, dysgeusia, nausea, diarrhea, and dysphagia.
Food-insecure cancer patients may also have trouble adhering to therapy.1,4 A study from 2020 showed that cancer patients who were persistently and newly food-insecure were significantly more likely to skip, delay, or change prescription medications.4
Addressing Food Insecurity
Experts have said that food insecurity is an underrecognized social determinant of health, and there is a lack of screening for food insecurity among cancer patients.1,5
Inadequate screening may undermine potential mitigation efforts like early referrals to social workers and food depositories and enrollment in federal benefit programs.1
Isolated programs for food insecurity screening in cancer patients and survivors, direct food assistance, and partnerships with community organizations have been developed through nonprofit, community, and hospital initiatives.1 However, these programs are predominantly funded by donations and short-term grants that demand periodic reapplication. As funding priorities shift, logistical elements may prove difficult for health care partners to navigate, utilize, and maintain as part of their usual workflow.
One method of addressing food insecurity is the “food is medicine” initiative, which advocates for viewing interactions between patients and health care providers as opportunities for nutrition-based interventions.6
The “food is medicine” concept supports interventions such as medically-tailored meals, co-location of food pantries in health centers, and close coordination with local food banks.6 Through government, institutional, or philanthropic funding sources, medically-tailored groceries and meals are provided to patients at low or no cost at participating centers.
However, peer reviewed research on the impact of the “food is medicine” initiative is lacking.6 Evidence gaps include the comparative efficacy of different interventions on physical, social, and mental health outcomes and health care use, treatment effects in different medical circumstances and/or phases of treatment, and the optimal intensity and duration of support needed.
Cooperation and Research
Cancer centers have some of the resources needed to address food insecurity in patients and their families.1 By partnering with government and nongovernment organizations, health care organizations can offer integrated and equitable care and potentially improve cancer care outcomes.
Experts suggest that more research is needed to define when food insecurity is most likely to occur and the extent to which food insecurity influences the conventional outcomes of cancer therapy.1 Research is also needed to identify the long-term impact of mitigation efforts, key issues for clinical programs to address, and best practices.
References
1. Raber M, Jackson A, Basen-Engquist K, et al. Food insecurity among people with cancer: Nutritional needs as an essential component of care. J Natl Cancer Inst. 2022;114(12):1577-1583. doi:10.1093/jnci/djac135
2. Chen KY, Blackford AL, Hussaini SMQ. County-level food insecurity to predict cancer incidence and mortality in the United States, 2015-2020. J Clin Oncol. 2023;41:16_suppl, 10539-10539. doi:10.1200/JCO.2023.41.16_suppl.10539
3. Bevel MS, Tsai M-H, Parham A, et al. Association of food deserts and food swamps with obesity-related cancer mortality in the US. JAMA Oncol. Published online May 4, 2023. doi:10.1001/jamaoncol.2023.0634
4. McDougall JA, Anderson J, Jaffe SA, et al. Food insecurity and forgone medical care among cancer survivors. J Oncol Pract. 2022;16(9); e922-e932. doi:10.1200/JOP.19.00736
5. Patel KG, Borno HT, Seligman HK. Food insecurity screening: A missing piece in cancer management. Cancer. 2019;125(20):3494-3501. doi:10.1002/cncr.32291
6. Downer S, Berkowitz SA, Harlan TS, et al. Food is medicine: Actions to integrate food and nutrition into healthcare. BMJ. 2020;369:m2482. doi:10.1136/bmj.m2482
This article originally appeared on Cancer Therapy Advisor
