Expert Explains the Increased Risk of Death in Patients With Food Insecurity

Food insecurity significantly increases the risk of death among cancer survivors, according to research published by Penn Medicine, highlighting that those who lack reliable access to healthy food face a 28% higher mortality risk compared with those who are food secure.

In an interview with CURE, Dr. Jaya Aysola sat down to expand on this research, in which, she says that the risk of death is caused by a limitation in access to nutrient-dense food, which contribute to obesity-related conditions and force trade-offs between basic needs and medical care. Overall, she says that this underscores the need for routine screening, expanded food assistance eligibility, and systemic advocacy.

This research was further investigated by researchers and published in the medical journal, JAMA Health Forum.

Aysola is an associate professor, Medicine and Pediatrics, as well as the assistant dean of Inclusion and Diversity, all at the Perelman School of Medicine. She is also the founder and executive director of Penn Medicine’s Center for Health Equity Advancement.

CURE: Can you help explain why nutrition and food security are so important for cancer survivors, even after treatment ends? Your study showed that cancer survivors experiencing food insecurity had a significantly higher risk of death. What might be some of the reasons behind this connection?

Aysola: Our study does not elucidate the mechanisms behind why this occurs; however, it provides some clues. We saw a connection with obesity-related cancers and all-cause mortality in our subgroup analyses. Food insecurity in the U.S. manifests as a lack of access to nutrient-dense food and instead, access to high-caloric, low-nutrient, obesogenic foods.

Potential mechanisms range from the need for nutrient-dense food to promote healing and recovery, to the relationship between nutrient-poor, high-caloric food — that individuals who are food insecure often consume — and obesity-related comorbidities and risk of death. Also, food insecurity is a marker for financial insecurity, setting up individuals to make tough choices between food and medications or other treatment or care that may impact outcomes.

For patients who may be struggling to afford nutritious food, what signs should they look out for, and how can they talk to their care team about getting help?

Patients who experience food insecurity know that they do and don’t need to look for signs per se. What they don’t know is the relationship between this and their cancer outcomes, nor do they see food insecurity as a medical issue to raise with their doctors. That is why doctors must screen for food insecurity proactively and find solutions to address it at the point of care, as well as through advocacy to enable the expansion of programs at the state and federal level to assist patients experiencing food insecurity.

What kinds of programs or support systems would you like to see become more common in cancer care?

Routine screening for health-related social needs, including food insecurity, by oncology clinics and recommendations and guidelines by national oncological societies on how to screen and address social needs and food insecurity at the point of care. The good news is that most oncology clinics have social workers who are trained to navigate local, state, and federal resources to meet patient social needs. The bad news is that these programs are insufficient to solve the issues and, with the current landscape, are at jeopardy.

Our study reveals that those patients in middle-income brackets experience food insecurity and are not eligible for federal food assistance programs. Our findings reveal that this group of patients is at most risk for early death. This tells us that income eligibility for food assistance programs must be revisited, and there is a role that physicians and their medical societies can play in advocating for change and expansion of eligibility criteria to support middle-income patients with cancer.

In the interim, clinics must get creative to support their patients with programs such as SNRT that helps screen patients, as well as FAST that supports food insecurity more specifically.

What steps can survivors, caregivers, or even community members take to advocate for better access to food assistance for people facing cancer?

Know that federal assistance programs matter, and who you vote for in local, state, and federal elections matters. Check out candidates' records on supporting policies that improve access to high-quality food and the expansion of federal assistance programs.

References

1. "Food insecurity linked to elevated mortality risk among cancer survivors," by Penn Medicine.
2. “Mortality Outcomes for Survivors of Cancer With Food Insecurity in the US” by Dr. John C. Lin, et al., JAMA Health Forum.

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