Characterizing Definitively Treated Cancer Patients Living Within Food Priority Areas (FPAs) to Find Predictors of Perceived Access to Healthy Meals

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Adequate nutrition is essential at all time points during cancer care. However, up to 25% of urban Americans live within a food priority area (FPA), which is defined as a zip code encompassing low quantity and quality of grocers, inadequate transportation, and low median income. While the effects of residing in FPAs has been well-characterized for various comorbid conditions such as hypertension and cardiovascular disease, there is little data on how poor access to nutritious meals affects cancer care. Therefore, we aim to better characterize the nutritional needs of our definitively treated cancer patients and we hypothesize that living in an FPA will be an important predictor of subjective nutritional needs. Validated psychosocial and nutrition questionnaires were prospectively administered to patients with curable thoracic, gynecologic (GYN), gastrointestinal (GI), or head and neck (H&N) cancers at multiple institutions within a single health system during initial consultation or at time points up to one year of completing definitive therapy. Patients were categorized by their FPA status as described above. In October 2019, additional questions on access to nutritious foods were added to the survey. Chi-square tests were used to assess associations of categorical variables. Binary logistic regression was utilized to determine predictors of monetary concerns for nutritious meals. In the study period June 2019 to February 2020, 245 patients (Thoracic: 38%; GI: 31%; GYN: 41%; H&N: 24%) were offered the survey with an 82% completion rate (N = 201). 20% (49/245) of the patients offered the survey live within an FPA. Patients that lived in an FPA were more likely to be black (31/59, 52%, p = 0.0001), single (36/72, 50%, p = 0.0001), live alone (14/28, 50%, p = 0.018), and have a lower median income (p = 0.004). Of the 88 patients who finished the more recently expanded nutrition section, approximately a quarter (23/88) worry about affording food, one third of whom live within an FPA (p = 0.076). On MVA, black race was the only factor that predicted for monetary concerns for nutritious meals (OR: 4.50; 95%CI: 1.24-16.25; p = 0.022). Prospectively collected data establishes the burden of nutritional needs in patients undergoing definitive treatment for cancer. Race was the only significant predictor for nutritious food affordability, whereas living in an FPA did not correlate with subjective nutritional needs. Despite the low patient numbers in this preliminary analysis, these data suggest that the association between the perceived nutritional needs of cancer patients may require a more holistic analysis extending beyond residential zip codes to truly characterize the nutritional chasm present in our patient population.