Food Insecurity and Forgone Medical Care Among Cancer Survivors

Abstract

PURPOSE: Financial hardship is increasingly understood as a negative consequence of cancer and its treatment. As patients with cancer face financial challenges, they may be forced to make a trade-off between food and medical care. We characterized food insecurity and its relationship to treatment adherence in a population-based sample of cancer survivors. METHODS: Individuals 21 to 64 years old, diagnosed between 2008 and 2016 with stage I-III breast, colorectal, or prostate cancer were identified from the New Mexico Tumor Registry and invited to complete a survey, recalling their financial experience in the year before and the year after cancer diagnosis. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95%CIs. RESULTS: Among 394 cancer survivors, 229 (58%) were food secure in both the year before and the year after cancer diagnosis (persistently food secure), 38 (10%) were food secure in the year before and food insecure in the year after diagnosis (newly food insecure), and 101 (26%) were food insecure at both times (persistently food insecure). Newly food-insecure (OR, 2.82; 95% CI, 1.02 to 7.79) and persistently food-insecure (OR, 3.04; 95% CI,1.36 to 6.77) cancer survivors were considerably more likely to forgo, delay, or make changes to prescription medication than persistently food-secure survivors. In addition, compared with persistently food-secure cancer survivors, newly food-insecure (OR, 9.23; 95% CI, 2.90 to 29.3), and persistently food-insecure (OR, 9.93; 95% CI, 3.53 to 27.9) cancer survivors were substantially more likely to forgo, delay, or make changes to treatment other than prescription medication. CONCLUSION: New and persistent food insecurity are negatively associated with treatment adherence. Efforts to screen for and address food insecurity among individuals undergoing cancer treatment should be investigated as a strategy to reduce socioeconomic disparities in cancer outcomes.

Social needs and health‐related quality of life among African American cancer survivors: Results from the Detroit Research on Cancer Survivors study

“…In the context of cancer care, several previous studies have estimated the prevalence of food insecurity and described interventions to improve food insecurity. Our estimate that 14.8% of African American cancer survivors in Detroit experience food insecurity is similar to an estimate from Simmons et al, 32 who reported that 17.4% of patients approached in waiting rooms of a university cancer center experienced food insecurity, but lower than estimates among underserved oncology patients in New York City (56% food insecure) 33 or population‐based cancer survivors in New Mexico (36% food insecure) 34 . Differences in measures of food insecurity and in populations included, particularly with respect to socioeconomic factors, food environments, and access to social programs designed to increase food security, likely contribute to these differences in estimates.…”

Food security status and breast cancer screening among women in the United States: Evidence from Health and Retirement Study and Health Care and Nutrition Study

“…The present ndings align with the existing research suggesting that food insecurity negatively impacts health services access and utilization among US residents. The existing literature suggests that food insecurity is associated with delaying medical care [37], lower treatment adherence [38,39], and poor chronic disease management [18,40]. Berkowitz and colleagues in 2014 attributed these trends to the 'treat or eat' dilemma experienced by food-insecure people; in such instances, they are forced to choose between accessing medical services or meeting the basic needs of food and shelter [41].…”

Food Insecurity Is an Independent Risk Factor for Depressive Symptoms in Survivors of Digestive Cancers

“…FI is prevalent in the United States and a strong mediator of disparities in cancer mortality (49). Although many patients will be food insecure prior to their diagnosis of a digestive cancer, cancer is financially costly to treat and could place individuals at risk of becoming food insecure (14,20). Even patients with commercial insurance are at risk of the detrimental financial impact of cancer care due to increasing out-of-pocket costs (15).…”

“…The additional burden of cancer care (e.g., treatment costs, missed days of work) can lead many survivors vulnerable to developing unmet health-related social needs, such as FI. (20,22). Also, individuals living in food insecure households are more likely to consume low-cost, high-calorie dense foods, smoke, and delay preventative care (49).…”

“…[16][17][18][19]. FI, the lack of consistent access to enough food for an active and healthy life, is prevalent among cancer survivors (20)(21)(22)(23)(24)(25). In prior studies, FI has been associated with worse diet quality, difficulty with being able to afford prescribed medications, and higher smoking rates among cancer survivors (26)(27)(28).…”