Abstract B096: Food insecurity and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits among income-eligible US pediatric acute lymphoblastic leukemia patients enrolled on a multi-center clinical trial
Authors: Aziz-Bose Rahela , Flamand Yael , Umaretiya Puja J. , Ilcisin Lenka , Valenzuela Ariana , Cole Peter D. , Gennarini Lisa M. , Kahn Justine M. , Kelly Kara M. , Michon Bruno , Tran Thai-Hoa , Welch Jennifer J. G. , Silverman Lewis B. , Bona Kira 
Published: January 2023

Abstract
Background Food insecurity (FI) is an adverse social determinant of health (SDoH) prevalent among pediatric cancer patients and associated with poorer health outcomes in general pediatrics. Receipt of federal SNAP benefits reduces FI in general pediatrics, and is thus a marker of appropriate resource support to mitigate adverse SDoH. Dana-Farber Cancer Institute (DFCI) Acute Lymphoblastic Leukemia (ALL) Consortium Trial 16-001 is the first pediatric oncology clinical trial to prospectively collect parent-reported SDoH, including income, SNAP receipt, and FI. We investigated whether income-eligible pediatric ALL families were successfully receiving SNAP benefits, and whether SNAP receipt was associated with FI. Methods Secondary analysis of children aged 1-17 years with de novo ALL enrolled on the DFCI 16-001-embedded SDoH cohort study at 6 US centers from 2017-2022. We utilized parent-reported SDoH data at diagnosis (T0) and 6-mos (T1) into therapy to identify families as (1) SNAP-eligible, proxied as household income &lt;130% Federal Poverty Level based on federal guidelines; and (2) food insecure, based on validated 2-item screen. McNemar’s test compared SNAP receipt at T0 vs T1 among those eligible at both timepoints. Associations between SNAP eligibility, SNAP receipt, and FI were evaluated with chi-square tests. Results At T0, among 262 evaluable families, 21% reported FI. A total of 20% (n=53) were SNAP-eligible, of whom 60% (n=32) reported FI and 53% (n=28) were receiving SNAP. Among 28 SNAP-recipient families, 61% reported FI. Similarly, at T1, among 223 evaluable families, 25% reported FI. A total of 28% (n=62) were SNAP-eligible, of whom 58% (n=36) reported FI and 58% (n=36) were receiving SNAP. Among 36 SNAP-recipient families, 56% reported FI. A significantly higher proportion of the 33 families SNAP-eligible at both T0 and T1 were receiving SNAP at T1 (70%) compared to T0 (52%) (p=0.034). Among eligible families, SNAP receipt was not associated with lower odds of FI at T0 (OR 1.03, p=0.96) or T1 (OR 0.83, p=0.73). Discussion FI, a well-defined adverse SDoH associated with inferior health outcomes, is highly prevalent among a trial-enrolled pediatric ALL population. Despite care delivery at highly resourced centers with dedicated staff to address social needs, a substantial proportion of likely eligible families (as proxied by income) were not receiving SNAP benefits 6-mos into therapy. Further, receipt of SNAP was inadequate to ameliorate FI in this cohort, with ~60% of SNAP recipients reporting concurrent FI both at T0 and T1. Ensuring successful connection of eligible families to existing benefits is an essential first step. However, high rates of FI among SNAP recipients indicate that resource navigation, though necessary, is not sufficient to address FI for this population. These data provide immediate targets for health equity interventions—including systematic benefits navigation, direct resource provision, and policy-based approaches for benefits augmentation—to address adverse SDoH and improve cancer outcomes.
Citation Format: Rahela Aziz-Bose, Yael Flamand, Puja J. Umaretiya, Lenka Ilcisin, Ariana Valenzuela, Peter D. Cole, Lisa M. Gennarini, Justine M. Kahn, Kara M. Kelly, Bruno Michon, Thai-Hoa Tran, Jennifer J. G. Welch, Lewis B. Silverman, Kira Bona. Food insecurity and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits among income-eligible US pediatric acute lymphoblastic leukemia patients enrolled on a multi-center clinical trial [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B096.