Oncology dietitians rarely ask cancer patients about food insecurity, study finds

Although studies suggest that many cancer patients experience food insecurity, few oncology dietitians routinely ask them if they are having problems affording or obtaining food, new research has found.

Despite awareness that many cancer patients are food insecure, most of the 41 registered dietitian nutritionists interviewed by researchers at the University of Illinois Urbana-Champaign said they did not use a validated tool to screen patients for it.

The dietitians' estimates of the prevalence of the problem varied widely, from less than 20% to more than 50% of their patients. The participants worked in various types of clinical settings, including outpatient cancer treatment centers and inpatient units at hospitals in urban, suburban and rural locales across the U.S.

Just two of the dietitians in the study reported using a validated screener, while four additional dietitians reported using other tools, such as screening questions developed by the local food bank or questions recommended by a professional organization for oncology nutritionists.

"This study highlights the need for developing education and training opportunities for oncology registered dietitians that will enhance their knowledge of food insecurity as well as their ability to screen for and address it with their patients," said Anna Arthur, the senior and corresponding author of the study who was then a professor of food science and human nutrition at the U. of I.

She is currently a professor of dietetics and nutrition at the University of Kansas Medical Center.

"Oncology patients face a number of barriers and burdens that increase their risks of food insecurity and malnutrition," said Amirah A. Burton-Obanla, a graduate student in nutritional sciences at Illinois and the first author of the study, published in the Journal of the Academy of Nutrition and Dietetics.

"They may be sick from the disease and treatment side effects. Many patients experience debilitating fatigue that prevents them from working and hinders their ability to follow dietary recommendations, prepare food and eat."

Some of the dietitians reported that food insecurity was more prevalent among certain populations, such as elderly patients and those diagnosed with cancers of the head and neck or gastrointestinal tract.

The burdensome costs of cancer treatment and nutritional products can be obstacles for patients as well.

"Patients with lower incomes may be unable to afford the recommended nutritional supplements that could help them get optimal nutrition during treatment," Burton-Obanla said.

One of patients' greatest barriers to obtaining needed food was a lack of transportation, study participants said. Patients living in rural areas and those who lacked family members or friends who could provide rides or assistance with shopping or preparing meals were likely to be at greater risk of food insecurity.

The few dietitians who did ask their patients if they were food insecure said they used various strategies to assist patients with obtaining food or transportation, such as connecting them with Meals on Wheels and other meal services, food pantries, government benefits and grants that provide gas cards and bus tokens.

Despite these efforts, most of the dietitians felt they had little control over their patients' food security.

"The quality of cancer survivors' diet is essential to their overall health, quality of life and survival," said Brenda Koester, the associate director of the Family Resiliency Center at the university and one of the co-authors of the study. "The inability to obtain adequate or nutritious food may lead to malnutrition and impact patients' tolerance and response to oncology treatment, increasing their risks of cancer recurrence and mortality."

With the number of cancer survivors expected to increase to more than 20 million by 2026, there is an urgent need to address food insecurity in this population, the authors wrote.

"Currently, there are no guidelines or recommendations on assessing oncology patients' food security status, but the findings suggest there's a need to do so using a validated screening tool," Koester said. "Implementing routine screenings as standard care in oncology settings would enable dietitians, potentially in collaboration with social workers and other health care providers, to identify food-insecure cancer survivors and develop early intervention strategies."

U. of I. scholars who co-wrote the study are Barbara H. Fiese, the co-director of the STRONG Kids 2 program and a professor emerita of human development and family studies; research specialist Stephanie Sloane; and Craig Gundersen, then the Soybean Industry Endowed Professor of Agricultural Strategy.