Increasingly, clinicians and healthcare systems are recognizing how the patients’ social situation impacts their ability to fully focus on their cancer treatment and recovery. Addressing these conditions – frequently called “social determinants of health” – is becoming an increasing focus of cancer clinics and researchers. One key social determinant of health is food insecurity, or patients’ access to nutritious foods. If patients do not have easy, reliable ways of finding healthy foods and can afford to pay for those foods, they are physically limited in their response to treatment and, overall, well-being – experiencing more delays in their treatment, non-adherence to treatment, or change their treatment. Now, researchers are trying to find effective ways to support patients experiencing food insecurity.
A recently published article in the Journal of Clinical Oncology reported the results of a clinical trial to address food insecurity in patients with cancer. Led by Francesca Gany, MD, MS at the Immigrant Health and Cancer Disparities Service at Memorial Sloan Kettering Cancer Center, this team analyzed the impact of three different food insecurity programs at improving patients’ health and well-being.
Patients were randomly put into one of three treatment groups which received the following intervention for 6 months:
- Pantry only: Weekly food pantry bags filled with nutrient dense foods (estimated to cost $35/bag).
- Voucher plus pantry: Weekly food pantry bags plus a $230 debit card (amount selected based on Supplemental Nutrition Assistance Program benefits) to be used for food and transportation to get food (estimated weekly cost: $102).
- Delivery plus pantry: Weekly food pantry bags plus weekly grocery delivery of five lunches and five dinners for one person (estimated weekly cost: $95).
The cancer center has a food pantry located inside their cancer clinics, and patients can go there once per week based on self-reported need. Food selections for the pantry and delivery were purposefully selected based on patient food preferences and input from a nutritionist to meet the needs of patients with cancer.
In the trial, 117 patients were included. To be eligible, they had to be close to starting chemotherapy or radiation therapy, already enrolled in the cancer center’s service for underserved patients, and meet the criteria for food insecurity. Treatment completion at six months was the primary outcome, along with appointment attendance (both extracted from patients’ medical records), food security status (measured with the USDA Household Food Security Survey Module), depression symptoms (measured with the PHQ-9), and quality of life (measured with the FACT-G).
In total, about half of the patients were Black, 38% were Hispanic, and only 26% were from the US. Seventy percent were employed at enrollment, and 86% had health insurance.
At the end of the study, 85% of patients completed treatment. The treatment group who received the voucher plus the pantry had the highest rate of treatment completion (95%) followed by delivery plus pantry (83%) and pantry only (78%). These differences in treatment completion rates were statistically significant. The three groups had about 62% treatment attendance; this did not differ between groups. About half (47%) of patients had become food secure at the end of six months, especially the groups receiving delivery plus pantry and pantry only.
Across all groups, patients’ depression symptoms and quality of life improved at six months. These improvements were statistically significant in the groups receiving delivery plus pantry and pantry only.
The researchers conclude that the voucher plus pantry arm had the greatest impact on treatment completion, which could be attributed to the additional visits patients had to make to receive the voucher, and the agency they had in selecting how to use the voucher. With the basic need of food security improved, this could reduce patients’ concerns about providing for their family and therefore, improve depression and quality of life.
Interventions to improve patients’ social determinants of health can have broad-reaching impacts. Not only does a food intervention assist with patients’ nutritional status, but helped them attend appointments, complete treatment, and improve their well-being. While such programs are not widely available since not all cancer clinics have embedded food pantries or resources to provide assistance, this is an opportunity for local collaborations and policy solutions.
While this was a small-scale study at one institution, providing evidence-based clinical trials that demonstrate the efficacy of such interventions could help pave the way for clinicians, policymakers, and healthcare systems as a way of improving cancer inequities and improving outcomes for underserved patients with cancer.