A National Evaluation of Food Insecurity in a Head and Neck Cancer Population

Associations between low food security and subjective memory complaints among Latino adults

BACKGROUND

Low food security is related with worse cognitive outcomes and poor mental health (e.g., higher anxiety and depression) may explain these associations. Subjective memory complaints may be important indicators of everyday memory problems. Despite a higher prevalence of food insecurity among Latinos, few have explored the links between low food security and subjective memory complaints in Latinos, or potential mechanisms underlying the associations.

METHODS

We used the Sangre Por Salud Biobank sample of 2,481 self-reported Latino patients aged 18-85 from a federally qualified community health center in Phoenix, AZ. Food security was assessed using the 6-item Household Food Security Survey Module and subjective memory complaints were measured using the Frequency of Forgetting Scale. We used linear regressions to test associations between low food security and subjective memory complaints, whether associations were explained by anxiety and depression, and whether associations differed by age or biological sex.

RESULTS

Around 76% of the sample were food secure, with 18% and 6% experiencing low and very low food security, respectively. In multivariate analyses, compared to the food secure, both low and very low food security related with higher subjective memory complaints and these associations were not modified by age or biological sex. Associations between low food security and subjective memory complaints were no longer significant after adjusting for anxiety and depression, suggesting that poor mental health may mediate associations between low food security and subjective memory complaints.

CONCLUSIONS

Experiences of low food security were related with more frequent memory complaints. Subjective memory complaints are related with future cognitive impairment and dementia, making them important early markers of cognitive problems. Future studies should evaluate potential cognitive benefits of addressing food insecurity and its downstream effects on mental health.

Food and nutrition insecurity and clinical and anthropometric indicators in individuals with cancer eligible for radiotherapy

OBJECTIVES

to analyze the association between food and nutrition insecurity (FNI) and sociodemographic, clinical, and anthropometric indicators in individuals with cancer eligible for curative radiotherapy.

METHODS

Study with the collection of sociodemographic and clinical data, and nutritional, anthropometric, and FNI assessment. Estimated Prevalence Ratio (PR) and 95% confidence intervals (95% CI) of FNI and exposure variables using the Poisson regression model with robust variance.

RESULTS

252 individuals were evaluated, 51.2% female, 60.7% elderly, 40.1% with breast or uterine cancer, 27.8% with urological cancer, 18.2% with head and neck cancer, and 7.5% with difficulty acquiring an enteral diet or nutritional supplement. The prevalence of FNI was 17.9%, 6.4% being moderate and 3.6% severe. FNI was less frequent in the high-income tertile (PR = 0,38; 95% CI: 0,18-0,79), and in individuals with urological tumors (PR = 0.12; 95% CI: 0.04-0.37), while higher prevalences were identified in non-white individuals (PR = 1,82; 95% CI: 1.01-3.28) among those with stage IV tumor (PR = 1.42; 95% CI: 1.03-1.95), with severe weight loss (PR = 2.99; 95% CI: 1.75-4.82), severely malnourished (PR = 2.58; 95% CI: 1.34-4.95) and bedridden (PR = 5.54; 95% CI: 2.72-11.29). Additionally, a higher prevalence of FNI associated with a reduction in usual food consumption (PR = 2.09; 95% CI: 1.24-3.54), the need to modify the consistency of the diet (PR = 3.45; 95% CI: 2.11-5.67), use of caloric supplements (PR = 2.07; 95% CI: 1.17-3.69) or enteral feeding (PR = 3.46; 95% CI: 2.01-5.94).

CONCLUSION

One in five individuals with cancer presented FNI associated with socioeconomic and nutritional vulnerability in the radiotherapy pre-treatment phase.

Uncovering Care Challenges for Head and Neck Cancer Patients and Caregivers in the United States: A Scoping Review

Individuals undergoing treatment for head and neck cancer (HNC) face numerous challenges, including financial and food insecurity, which affect both the patients and their caregivers. This scoping review explores and consolidates the current literature addressing the care challenges experienced by HNC patients and their caregivers. Eligible studies were identified through a search of MEDLINE and Embase databases. The scoping review was conducted in accordance with Arksey and O'Malley's five-stage methodology and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Data extraction and analysis were performed using a thematic approach. The inclusion criteria encompassed full-text articles published in English that examined challenges faced by both adult HNC patients and caregivers as primary outcomes in the United States. Eligible studies underwent assessment using the Covidence data screening and extraction tool. Information encompassing general study details, article characteristics, and scoping review-relevant details were extracted through Research Electronic Data Capture (REDCap). Out of the 822 articles initially identified, 40 met the inclusion criteria. The majority of these comprised descriptive surveys (n = 23; 54%), retrospective chart reviews (n = 7; 18%), cross-sectional studies (n = 6; 15%), and prospective cohort studies (n = 13). Within the included studies, the majority of the studies (n = 36) concentrated on quantifying and describing the financial toxicity and out-of-pocket costs experienced by patients with HNC. Two articles concentrated on challenges associated with providing nutritional care to patients with HNC. Additionally, four studies explored the quality of life and the burden experienced by caregivers of patients undergoing treatment for HNC. Despite the existing body of literature addressing the financial challenges faced by patients with HNC, a noticeable gap exists in the literature concerning challenges related to providing nutritional care and the obstacles faced by caregivers in delivering care to this population. This scoping review offers a comprehensive overview of these challenges and the literature's current focus on addressing them. The findings emphasize the necessity for further research to gain a deeper understanding of the experiences of both patients and caregivers, evaluate the impact of interventions, and bridge knowledge gaps. Ultimately, such endeavors will contribute to enhancing the quality of care and support for individuals affected by HNC.

The Burden of Food Insecurity on Quality of Life in Adults with Diabetes

Background: This study aimed to investigate the relationship between food insecurity and physical- and mental-health-related quality of life in adults with diabetes. Methods: Using two years of national Medical Expenditure Panel Survey data (2016-2017), we investigated the relationship between food insecurity and physical-health-related (PCS) and mental-health-related (MCS) quality of life in adults with diabetes. PCS and MCS were measured with the Short-Form 12 health survey and food insecurity was measured with the USDA 10-item adult scale. Analyses were weighted to represent the US adult population. Adjusted linear regression models, including covariates of age, gender, education, race/ethnicity, marital status, region, poverty level, employment status, health insurance, and comorbidities were used. Results: After adjustment, food-insecure adults with diabetes maintained significantly lower quality of life compared to food-secure adults with diabetes (PCS: -3.44, 95%CI -4.63, -2.25; MCS: -5.37, 95%CI -6.68, -4.06). This drop in PCS was larger than the drop for chronic conditions, including arthritis (-3.77, 95%CI -5.02, -2.52), emphysema (-2.82, 95%CI -5.12, -0.53), stroke (-2.63, 95%CI -4.11, -1.15), cancer (-2.59, 95%CI -4.00, -1.17), and heart attack (2.58, 95%CI 4.68, 0.48). Similarly, the drop for MCS was larger than for chronic pain (-2.37, 95%CI -3.24, -1.50) and arthritis (-1.31, 95%CI -2.28, -0.33). Conclusions: Food insecurity was associated with a significant reduction in both physical- and mental-health-related quality of life in adults with diabetes, with a magnitude of effect greater than adjusted estimates for the drop in quality of life for key chronic conditions. Addressing food insecurity through integration of social and medical care may lead to improvements in quality of life for adults with diabetes.

Landscape analysis of environmental data sources for linkage with SEER cancer patients database

One of the challenges associated with understanding environmental impacts on cancer risk and outcomes is estimating potential exposures of individuals diagnosed with cancer to adverse environmental conditions over the life course. Historically, this has been partly due to the lack of reliable measures of cancer patients' potential environmental exposures before a cancer diagnosis. The emerging sources of cancer-related spatiotemporal environmental data and residential history information, coupled with novel technologies for data extraction and linkage, present an opportunity to integrate these data into the existing cancer surveillance data infrastructure, thereby facilitating more comprehensive assessment of cancer risk and outcomes. In this paper, we performed a landscape analysis of the available environmental data sources that could be linked to historical residential address information of cancer patients' records collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. The objective is to enable researchers to use these data to assess potential exposures at the time of cancer initiation through the time of diagnosis and even after diagnosis. The paper addresses the challenges associated with data collection and completeness at various spatial and temporal scales, as well as opportunities and directions for future research.

Enhancing food access in a comprehensive cancer center area of influence through local partner capacity building

BACKGROUND

Food insecurity, an economic and social condition of limited food access, is associated with poor diet quality-a risk factor for several common cancers. The University of Texas MD Anderson Cancer Center supports healthy food access through community-led evidence translation by actively partnering with community-based organizations (CBOs). These partnerships aim to enhance the capacity of food assistance CBOs to effectively implement evidence-based food insecurity mitigation programs in the cancer center's area of influence.

METHODS

This case study aims to describe the cancer center's model for local food access capacity building and detail operationalization in the context of a whole-community cancer prevention effort (Be Well Baytown) in Baytown, Texas.

RESULTS

Elements central to the capacity building model include (i) assessment of baseline needs and capacity, (ii) empowering a community champion within a relevant CBO, (iii) mapping inter-sectoral community partnerships, collaborations, and linkages, and (iv) leveraging systems, connections, and resources to provide an enabling environment for overall food access systems growth. Through this process, Be Well Baytown enhanced the capacity of a local food pantry leading to increases in total reach, pounds of food distributed, and number of food distribution events in collaboration with intersectoral partners from 2018 to 2023.

CONCLUSION

This case study highlights the model's implementation as a co-benefit community partnership strategy to maximize the impact of food security programs integrated with comprehensive cancer center prevention efforts.

Measuring food insecurity among a national sample of children with recurrent acute otitis media

INTRODUCTION

Acute otitis media is one of the most common reasons for pediatric medical visits in the United States. Additionally, past studies have linked food insecurity and malnutrition with increased infections and worse health outcomes. However, there is a lack of information on the risk factors for food insecurity in specific patient populations, including the pediatric recurrent acute otitis media (RAOM) population.

METHODS

The 2011 to 2018 National Health Interview Survey (NHIS) datasets were used to obtain a national estimate of the presentation of food insecurity within pediatric patients with RAOM. Relevant sociodemographic information and prevalence were identified. A multivariable logistic regression model was used to determine sociodemographic risk factors. Calculations were conducted using R with the "survey" package to account for the clustering and sampling of the NHIS.

RESULTS

Of 3844 children with RAOM who responded to the food insecurity module, 20.8 % (19.0-22.6 %) were food insecure. Age, race/ethnicity, percentage of federal poverty level status, insurance status, and self-reported health status were significant and were not independent of food insecurity status. Using multivariable regression, this study found the following sociodemographic risk factors: age 6-10 and age > 10 (reference: age 0-2); Black (reference: Non-Hispanic White); 100 % to 200 % and <100 % federal poverty level (reference: >200 % federal poverty level); public insurance or uninsured status (reference: private insurance); and poor to fair self-reported health status (reference: good to excellent).

DISCUSSION

Children with RAOM who were older, Black, less insured, living in lower-income households, and of poorer health had a greater association with being food insecure. Due to the frequency of RAOM pediatric visits, identifying at-risk groups as well as incorporating food insecurity screening and food referral programs within clinical practice can enable otolaryngologists to reduce disparities and improve outcomes in a targeted approach.

Prevalence of Food Insecurity Among Cancer Survivors in the United States: A Scoping Review

BACKGROUND

Medical financial hardship is an increasingly common consequence of cancer treatment and can lead to food insecurity. However, food security status is not routinely assessed in the health care setting, and the prevalence of food insecurity among cancer survivors is unknown.

OBJECTIVE

This scoping review aimed to identify the prevalence of food insecurity among cancer survivors in the United States before the COVID-19 pandemic.

METHODS

Five databases (PubMed, Scopus, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Web of Science, and ProQuest Dissertations and Theses) were systematically searched for articles that reported on food security status among US patients receiving active cancer treatment or longer-term cancer survivors and were published between January 2015 and December 2020.

RESULTS

Among the 15 articles meeting the inclusion criteria, overall food insecurity prevalence ranged from 4.0% among women presenting to a gynecologic oncology clinic to 83.6% among patients at Federally Qualified Health Centers. Excluding studies focused specifically on Federally Qualified Health Center patients, prevalence of food insecurity ranged from 4.0% to 26.2%, which overlaps the food insecurity prevalence in the general US population during the same time period (range, 10.5% to 14.9%). Women were more likely than men to report being food insecure, and the prevalence of food insecurity was higher among Hispanic and Black patients compared with non-Hispanic White patients.

CONCLUSIONS

Given significant heterogeneity in study populations and sample sizes, it was not possible to estimate an overall food insecurity prevalence among cancer survivors in the United States. Routine surveillance of food security status and other social determinants of health is needed to better detect and address these issues.

Food Insecurity Among People With Cancer: Nutritional Needs as an Essential Component of Care

A cancer diagnosis can upend work and family life, leading patients to reallocate resources away from essentials such as food. Estimates of the percentage of people navigating a cancer diagnosis and food insecurity range between 17% and 55% of the cancer patient population. The complexity of addressing food insecurity among those diagnosed with cancer during different phases of treatment is multifactorial and often requires an extensive network of support throughout each phase. This commentary explores the issue of food insecurity in the context of cancer care, explores current mitigation efforts, and offers a call to action to create a path for food insecurity mitigation in the context of cancer. Three programs that address food insecurity among those with cancer at various stages of care are highlighted, drawing attention to current impact and actionable recommendations to make programs like these scalable and sustainable. Recommendations are grounded in the National Academies of Sciences, Engineering, and Medicine social care framework through 5 essential domain areas: awareness, adjustment, assistance, alignment, and advocacy. This commentary seeks to highlight opportunities for the optimization of cancer care and reframe food access as an essential part of treatment and long-term care plans.

Emerging Disparities in Prevention and Survival Outcomes for Patients with Head and Neck Cancer and Recommendations for Health Equity

Purpose of Review

The aim of this review is to describe less known and emerging disparities found in the prevention and survival outcomes for patients with head and neck cancer (HNC) that are likely to play an increasingly important role in HNC outcomes and health inequities.

Recent Findings

The following factors contribute to HNC incidence and outcomes: (1) the effect of rurality on prevention and treatment of HNC, (2) dietary behavior and nutritional factors influencing the development of and survival from HNC, and (3) barriers and benefits of telehealth for patients with HNC.

Summary

Rurality, nutrition and diet, and telehealth usage and access are significant contributors to the existing health disparities associated with HNC. Population and culturally specific interventions are urgently needed as well as more research to further define the issues and develop appropriate population and individual level solutions.