Presentations

Abstract

Introduction:

Food insecurity is defined as a lack of access to adequate and nutritious food options. Due to high medical costs, patients with cancer are at higher risk of experiencing food insecurity and undernutrition and may also be restricted to choosing lower-cost, lower-quality food options. Dietary management is particularly important for medically ill patients who are already vulnerable to reduced overall food intake due to disease and treatment-related effects. While dietary recommendations vary based on treatment status, patients undergoing active treatment should consume a diet with adequate protein intake to minimize the effects of metabolic disturbances and maintain skeletal muscle mass. Nutritional guidelines in oncology recommend a protein consumption of 1.2-2.0 g/kg/day. However, most patients do not meet even the average daily recommended serving for healthy adults (0.8 g/kg/day). Cancer patients are also encouraged to consume a diet rich in fruits and vegetables. The American Cancer Society and the World Cancer Research Fund/American Institute for Cancer Research recommend that patients consume at least 5 servings (400 g or 14 oz) of fruits/vegetables daily. To better understand the relationship between food insecurity and food intake, we sought to investigate the effects of food security interventions on changes in food consumption among food-insecure patients undergoing active cancer treatment.

Methods:

We are conducting a three-arm randomized controlled trial assessing the impact of food security interventions among food-insecure patients (USDA U.S. Household Food Security Module score ≥ 3) at 5 New York City safety net cancer centers (R01CA230446-06, PI: Gany). Patients with either breast or gynecologic cancer are randomized into one of three arms: $230 monthly food voucher (arm 1), weekly home grocery delivery (arm 2), or weekly hospital-based food pantry (arm 3). All patients are also provided with a one-hour, one-on-one Nutrition and Cancer Education presentation that is delivered by a trained staff member. Sessions focus on optimizing nutrition during cancer treatment, stretching food dollars, and preparing healthful foods on a budget. Surveys are administered at baseline, 3 months, and 6 months, with questions on protein intake (internally developed Protein Screener), and fruit/vegetable intake (CHIS Fruit & Vegetable Screener). We compared changes in fruit, vegetable, and protein consumption pre-post the 6-month intervention, using paired sample t- tests to detect significant differences (p<0.05) in mean food consumption across different food categories.

Results:

234 patients completed baseline and 6-month assessments. The mean USDA U.S. Household Food Security Module score at baseline was 6. Among all patients, fish intake increased (p=0.000) and full-fat dairy milk intake decreased (p=0.000) when comparing before and after the intervention. There was also a trend towards increased low-fat milk consumption. All three study arms saw significant increases in fish consumption (arm 1, p=0.049; arm 2, p=0.013; arm 3, p=0.011). Arm 3 also had a significant decrease in full-fat milk consumption (p=0.005). There were no significant decreases in consumption of other types of protein. For fruit/vegetables, there were significant decreases in the consumption of 100% fruit juice (p=0.017), fried potatoes (p=0.005), and sweetened juice (p=0.001) from pre- to post-intervention. A slight trend towards increased consumption of fruits, lettuce salads, and other vegetables was observed. In arm 1, there was a decrease in the consumption of fried potatoes (p=0.036) and sweetened juice (p=0.011). In arm 2, there was a decrease in consumption of 100% fruit juice (p=0.005). Patients in arm 3 had a decrease in the consumption of fried potatoes (p=0.009) and sweetened juice (p=0.003). For both protein and fruits/vegetables, there were no significant differences when comparing between arms.

Conclusion:

A nutrition and cancer educational module plus access to regular food vouchers, grocery deliveries, or food pantries impact, to some extent, the types of food consumed by food insecure patients. In our study, all three intervention arms showed a significant increase in fish intake and favorable decreases in the amount of 100% fruit juice and sweetened juice that patients consumed. These findings suggest that nutrition education combined with a medically tailored food security intervention can benefit food-insecure patients undergoing active cancer treatment. Further research is needed to determine more specific dietary changes that result from food security interventions.