Oncology Dietitians Don’t Usually Inquire About Food Insecurity in Cancer Patients, Study Finds

Food insecurity is common in the United States, impacting nearly 12% of households in 2017. Struggling to pay for food can lead people to put off needed medical care or to avoid getting prescriptions that they need. As a result, the American Cancer Society says it would be good practice for health care teams to screen for food insecurity in cancer patients. A new study finds that is not regularly occurring, however.

Researchers at the University of Illinois Urbana-Champaign surveyed oncology dietitians on food insecurity in cancer patients. Their responses show that the majority of dietitians did not regularly ask patients questions about their ability to afford or obtain food, and those who did generally weren’t using a validated screening tool. The team says this shows important information needed for patient care may be going by the wayside.

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Dr. Anna Arthur, senior author of the study and former professor of food science and human nutrition at the U of I, explains, “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.”

The researchers interviewed 41 registered dietician nutritionists who worked in a variety of settings, including outpatient cancer treatment centers and hospital inpatient units in communities of different sizes across the country. The researchers found that only two dietitians used a validated screener to see if patients had food insecurity, while four others used tools from resources like food banks or professional organizations for oncology nutritionists.

These dietitians said they tried to connect patients in need with services like Meals on Wheels, food pantries, government benefits, and grants for gas cards and bus tokens to help them get to places to purchase food. Despite this help, they reported feeling like they couldn’t do much to change the situation for patients.

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Those surveyed also had broad estimates of on how many of their patients were dealing with food insecurity, from less than 20% to more than half. There were higher rates reported among populations including the elderly and those with cancers of the head, neck, or gastrointestinal tract. Some causes they pinpointed were the cost of medical care and nutritional products, as well as a lack of transportation, particularly for those in rural areas and those who did not have loved ones available to drive them to the store or help them prepare food.

The researchers say many of these patients could be helped if a procedure was in place to screen for these problems.

Brenda Koester, study author and associate director of the Family Resiliency Center at the U of I, says, “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. 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.”

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The team notes that if this does not occur, malnutrition can lead to a poor reaction to treatment, which could raise the risk of recurrence and death.

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