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Abstract

Food insecurity is common among low-income immigrants and minority cancer patients. To our knowledge, this randomized controlled trial is the first to prospectively examine the impact of food insecurity interventions on cancer outcomes with the aim of informing evidence-based interventions to address food insecurity in cancer patients.

A three-arm, randomized controlled trial was conducted in food insecure cancer patients (N = 117) (18 points USDA Household Food Security Survey Module ≥ 3) at four cancer clinics in New York City. The divisions included a food pantry at the hospital’s oncology clinic (Division 1), a meal voucher plus pantry (Division 2), and home delivery plus pantry (Division 3). Completion of treatment (primary outcome) and full physician visit were assessed at 6 months. Food safety status, symptoms of depression (Patient Health Questionnaire-9) and quality of life measures (Functional Evaluation of General Cancer Therapy) were assessed at baseline and 6 months later.

Voucher plus Pantry had the highest treatment completion rate (94.6%) followed by Grocery Delivery plus Pantry (82.5%) and Pantry (77.5%); P = 0.046). Food security scores improved significantly in all groups, and Patient Health Questionnaire-9 and Cancer Therapy Functional Evaluation-General scores improved significantly in the pantry and delivery plus pantry groups.

Our results from this preliminary study indicate that the voucher plus pantry was the most effective intervention for improving treatment completion and met our a priori criterion for a promising intervention (≥ 90%). All interventions have demonstrated the potential to improve food security among medically underserved, food insecure, cancer patients, at risk of poor nutritional status, reduced quality of life and lower survival. All cancer patients should be screened for food insecurity with evidence-based interventions for food insecurity.

© 2022 American Society of Clinical Oncology

CONTEXT

  • primary goal

  • To our knowledge, this randomized controlled trial is the first to prospectively compare cancer treatment completion and quality of life outcomes of food safety interventions in oncology clinics in medically underserved cancer patients: the food pantry (Group 1 ), food voucher plus pantry (arm 2) and home delivery plus pantry (arm 3).

  • Received knowledge

  • In this pilot study, voucher plus pantry was most effective in improving treatment completion (main outcome; 94.6% completion rate). Food security scores improved significantly in all groups, and depression and quality of life scores improved significantly in pantry and delivery plus pantry groups.

  • Relevance

  • Intervention effectiveness data can enable providers and health systems to deliver the interventions that best fit their resources and/or patient needs. All cancer patients should be screened for food insecurity, and evidence-based food insecurity interventions should be available to patients in need.

SUPPORT

Supported by the New York State Health Foundation; National Cancer Institute: Major Cancer Center Support Grant (P30 CA008748), R01 CA230446 01; CCNY/MSKCC Partnership for Cancer Research Education and Outreach (U54 CA137788); Lori Tisch Lighting Foundation; New York Community Foundation; and the Avon Foundation.

INFORMATION ABOUT CLINICAL STUDIES

NCT01603316

Concept and design: Francesca Ghani, Yuelin Li, Victoria Blinder, Jennifer Leng

Providing research materials or patients: Irina Melnik, Margaret Kemeny, Elizabeth Guevara, Caroline Hwang

Collection and collection of data: Irina Melnik, Julia Ramirez, Margaret Kemeny, Elizabeth Guevara, Caroline Hwang

Data analysis and interpretation: Francesca Ghani, Irina Melnik, Minglun Wu, Yuelin Li, Jackie Finick

Manuscript writing: All authors

Final approval of the manuscript: All authors

Responsible for all aspects of work: All authors

Eating to bridge outcome disparities: a randomized controlled trial of interventions to reduce food insecurity to improve cancer treatment outcomes

Below is the disclosure information provided by the authors of this manuscript. All relationships are considered reimbursed unless otherwise stated. Relationships are self-contained unless otherwise noted. I = nearest family member, Inst = my institution. Relationships may not be relevant to the subject of this manuscript. For more information on ASCO’s conflict of interest policy, see www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

Open Payments is a public database containing information provided by companies about payments to US licensed physicians (Open payments).

No potential conflicts of interest were reported.

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