Abstract 1016: Food insecurity among patients with cancer in the US
Authors: Marrero-Gonzalez Alejandro R. , Crawford Anna , Draper Fitzgerald , Incudine Andrea , Lindau Stacy Tessler , Graboyes Evan M. 
Published: March 2024

Introduction: Food insecurity (FI) is common among cancer patients and can lead to decreased treatment adherence, worse quality of life, and increased recurrence and mortality. Although some studies suggest that patients with cancer are particularly susceptible to FI, these studies have been limited by their small sample size, narrow sampling of cancer types and stages, and limited geographic scope. To address this gap, this study leverages data from a supportive care organization to characterize FI prevalence and associated risk factors in a nationwide sample of patients with diverse types of cancer.

Methods: This cross-sectional study included adults with cancer undergoing treatment referred to Family Reach, a national organization that provides financial support to cancer patients and their families, from 2020-2023. The primary outcome was FI, defined as a self-reported concern that the family would run out of food before getting enough money to buy more. Estimates of FI were provided for the cohort stratified by cancer type; multivariable logistic regression was used to evaluate the association of cancer type (primary independent variable) with FI, adjusted for oncologic and demographic covariates.

Results: Of 6,615 patients with cancer, 62.9% reported FI. Across cancer types, FI prevalence ranged from 56% (brain) to 68% (gynecologic). FI did not vary significantly by cancer type on multivariable logistic regression adjusted for oncologic, geographic, and demographic factors (Table 1). A variety of demographic factors were associated with FI (Table 1).

Table 1. Characteristics of Patients with Cancer With Food Insecurity Referred to Family Reach and Factors Associated with Food Insecurity Using Multivariable Logistic Regression Analysis. Outcome N (%) aOR (95% CI) Outcome N (%) aOR (95% CI) Outcome N (%) aOR (95% CI) Cancer Type Age, y Region of US • Breast 1,348 (32.4) Ref - • 18-64 3,887 (93.3) Ref - • Pacific 465 (11.2) Ref - • Brain 118 (2.8) 0.84 (0.61 - 1.16) • ≥65 279 (6.7) 0.38 (0.3 - 0.48) • Mountain 246 (5.9) 0.94 (0.71 - 1.23) • Gastrointestinal 500 (12) 1.13 (0.92 - 1.38) Gender • West South Central 489 (11.7) 1.09 (0.87 - 1.38) • Genitourinary 115 (2.8) 1.1 (0.78 - 1.55) • Male 1,298 (31.2) Ref - • West North Central 213 (5.1) 1.09 (0.82 - 1.44) • Gynecologic 274 (6.6) 1.21 (0.95 - 1.54) • Female 2,859 (68.6) 1.04 (0.91 - 1.19) • East South Central 302 (7.2) 1.6 (1.21 - 2.13) • Head and Neck 82 (2) 1.08 (0.72 - 1.62) • Other 9 (0.2) 1.07 (0.25 - 4.6) • East North Central 466 (11.2) 1.02 (0.81 - 1.29) • Hematologic 958 (30) 0.95 (0.79 - 1.15) Race and Ethnicity • South Atlantic 941 (22.6) 1.14 (0.93 - 1.4) • Lung 247 (5.9) 0.99 (0.77 - 1.26) • Non-Hispanic White 1,725 (41.4) Ref - • Middle Atlantic 851 (20.4) 0.76 (0.62 - 0.94) • Melanoma/Sarcoma 200 (4.8) 0.97 (0.74 - 1.28) • Non-Hispanic Black 1,249 (30) 1.6 (1.4 - 1.83) • New England 193 (4.6) 1 (0.74 - 1.36) • Other 324 (7.8) 1 (0.79 - 1.25) • Hispanic White 832 (20) 1.63 (1.36 - 1.96) Preferred Language Stage • Asian or Pacific Islander 130 (3.1) 1.1 (0.82 - 1.49) • English 3,686 (88.5) Ref - • I 415 (10) Ref - Health Insurance • Spanish 328 (7.9) 1.69 (1.26 - 2.28) • II 652 (15.7) 1.01 (0.81 - 1.25) • Private/commercial 718 (17.2) Ref - • Other 61 (1.5) 1.26 (0.81 - 1.98) • III 814 (19.5) 1.11 (0.9 - 1.37) • Self-pay 240 (5.8) 2.35 (1.74 - 3.16) • IV 1,254 (30.1) 1.07 (0.87 - 1.32) • Medicaid 1,588 (38.1) 1.87 (1.62 - 2.16) • Not applicable 1,031 (24.7) 0.87 (0.69 - 1.08) • Medicare 536 (12.9) 2.23 (1.81 - 2.76) Relapsed • Medicare + Medicaid 122 (2.9) 2.98 (2.06 - 4.3) • Yes 631 (15.1) Ref - • Other 782 (18.8) 1.45 (1.23 - 1.7) • No 3,535 (84.9) 1.11 (0.95 - 1.29) Employment • Dual employment 1,343 (32.2) Ref - • Single employment 2,428 (58.3) 1.24 (1.1 - 1.38) • Dual unemployment 261 (6.3) 1.7 (1.31 - 2.21)

Conclusion: Nearly two-thirds of patients with cancer served by a large national cancer support organization reported FI. FI was common across all types of cancer and was associated primarily with demographic characteristics. These FI prevalence and risk factor data can be used by researchers, clinicians, and community-based organizations to understand and address FI among patients with cancer.

Citation Format: Alejandro R. Marrero-Gonzalez, Anna Crawford, Fitzgerald Draper, Andrea Incudine, Stacy Tessler Lindau, Evan M. Graboyes. Food insecurity among patients with cancer in the US [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1016.