Identifying and Addressing Nutritional Inequities and Psychosocial Needs of Cancer Patients Residing in Zip-Code Designated Food Priority Areas (FPAs)

Abstract

Nutrition is an essential aspect of cancer care at all time points leading to and after definitive therapy. Yet, cancer patients who reside in FPAs may experience limited access to healthy meals, possibly affecting cancer outcomes. There is no prospective data evaluating the consequence of residing in FPAs as it relates to perceived nutritional access, psychosocial needs, or nutritional status of cancer patients before, during, and after definitive treatment. Therefore, this study aims to characterize the nutritional needs of cancer patients undergoing curative radiation treatment (RT). We hypothesize that FPA residence will correlate with perceived lack of access to healthy food as well as other unmet psychosocial cancer needs at multiple time points during care. Under IRB approval, a prospective, cross-sectional analysis was done using a questionnaire consolidated from previously validated surveys assessing the nutritional and psychosocial needs of patients with curable lung, head/neck, gynecological, or gastrointestinal cancers at different time points of cancer care (pre-treatment, 1 month, 6 months, and 1 year after completion of RT). Groups were compared using Χ2 and Mann-Whitney U tests as appropriate. Binary logistic regression was used to identify predictors of healthy food access. From May 2019 to December 2022, 320 of 434 patients completed the survey, giving a compliance rate of 74%. Twenty-six percent of patients resided in zip-code designated FPAs. Patients who lived in FPAs were more likely to self-identify as black (60.5% vs 39.5%; p<0.001), single (p<0.001), have a lower median income (p<0.001), and were more likely to receive care at our inner-city photon therapy center (p<0.001) compared to non-FPA residents. Compared with non-FPA patients, the cohort who lived in FPAs had higher unmet nutritional needs (p = 0.003), which included a greater demand for healthier ways to eat (67.6%vs.54.4; p = 0.047) and a greater concern of having inadequate funds to buy healthy meals (44.4%vs.19.9%; p = 0.002). On MVA, marital status, median income, race, educational level and FPA residence were included, however only black race (OR:8.85; 95% CI:3.73-16.32; p<0.001) and education level (Elementary School: OR:8.32; 95% CI:1.19-58.33; p = 0.001, REF: Graduate/Professional) were predictors for nutritious meals uncertainty. Inequities in nutritional needs were clearly identified in patients residing in FPAs when compared to non-FPA patients. Race and educational level are important factors in identifying patients in need of nutritional support. These demographics along with FPA-designated zip codes can be used to identify at-risk patients during clinic visits, where continuous nutritional and psychosocial support can be provided.