ALCANCE Food for Health Equity: Community-driven development of a food insecurity intervention for patients with cancer.

Abstract

208 Background: Food insecurity is prevalent among patients undergoing cancer treatment and has been associated with decreased adherence to cancer therapies, malnutrition risk, and poor quality of life. While food insecurity disproportionately impacts low-income, immigrant and non-English speaking populations, few studies have assessed the needs and preferences for these populations as it relates to interventions that can address this growing problem. In previous work, we identified that 50% of populations in our partner clinic screened positive for food insecurity. This study aimed to assess the needs and preferences of low-income, culturally diverse patients with cancer who screened positive for food insecurity and to co-develop an intervention to address these needs. Methods: Participants were recruited among low-income and immigrant adults ≥18 years of age who screened positive for food insecurity using the 2-item Hunger Vital Sign as part of an ongoing parent randomized controlled trial evaluating a precision medicine intervention. 1:1 semi-structured interviews were conducted in English or Spanish to assess dietary habits, barriers to obtaining healthy food, and preferences regarding intervention assistance options, including on-site food pantry, home delivery of food boxes, food vouchers, and cash transfers. Interviews responses were transcribed and thematically analyzed. Results: Of the 110 patients screened for food insecurity as part of the parent trial, 40 (36.4%) screened positive for food insecurity. Among these patients, 31 identified as Hispanic or Latinx (77.5%), and 26 (65%) indicated Spanish as their primary language. Nineteen (47.5%) reported a household income of <$34,000, 24 (60%) were on Medicaid, and 14 (35%) identified as disabled. A total of 10 participants were randomly selected and consented to participate in interviews. Three main themes emerged from interviews: 1) cancer diagnoses necessitated changes to food behaviors including emphasis on nutrient dense and symptomatically tolerated foods; 2) contributors to food insecurity included higher costs of healthy food options, lack of employment during treatment, limited support, and coexisting expenses including financial toxicity from cancer treatment; 3) priorities for assistance included limiting sense of reliance on charity, autonomy in choosing desired food items that are culturally preferent, and timing assistance with other expenses to maximally relieve financial strain. Conclusions: Food insecurity is a critical issue among patients with cancer with disproportionate impact on low-income and immigrant populations. Various opportunities for intervention are well-received by patients and have the potential to reduce the burden of food insecurity among these populations.