Food insecurity among adult cancer survivors in the United States
The purpose of this study was to examine the prevalence of food insecurity among US adults with a history of a cancer diagnosis and to understand if socio-demographic factors and cancer characteristics (i.e., time since diagnosis, cancer type) relate to food insecurity.
This was a secondary analysis of cancer survivors drawn from the National Health and Nutrition Examination Surveys (NHANES) 2011–2014. Weighted analyses included descriptive, bivariate, and multinomial logistic regression.
Of the cancer survivors identified in the sample (n = 1,022), 8.36% were food insecure. In bivariate analysis, several factors were significantly associated with food insecurity among cancer survivors, including female gender, younger age, non-Hispanic black or Hispanic race/ethnicity, lower income, no insurance coverage, lower education, single relationship status, having children at home, having poor health or diet, and cancer characteristics (i.e., non-melanoma skin cancer, female reproductive cancer). In logistic regression analyses, odds of food insecurity decreased with older age and higher income and increased with poor health, although cancer type was no longer significant.
Though a low proportion of cancer survivors indicated being food insecure, food insecurity was evident, and this study identified socio-demographic factors related to food insecurity which may be important to consider in clinical and community health settings serving cancer survivors.
Implications for Cancer Survivors
Nutrition is essential throughout the cancer care trajectory, including survivorship. Clinicians should consider processes for screening patients, especially younger and lower income patients, for food insecurity through all stages of treatment and particularly as part of survivorship planning. Furthermore, availability and referral to community partners for nutrition and food support is essential.
KeywordsCancer survivorship Food security NHANES Nutrition Economic burden
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
- 4.National Cancer Institute. Office of Cancer Survivorship: Statistics. NIH National Cancer Institute Division of Cancer Control and Population Sciences. 2019. https://cancercontrol.cancer.gov/ocs/statistics/statistics.html#ref1. Accessed 17 Feb 2019.
- 5.President’s Cancer Panel. Living beyond cancer: finding a new balance. 2004.Google Scholar
- 6.Hewitt M, Greenfield S, Stovall E, editors. From cancer patient to cancer survivor: lost in transition. Washington, DC: National Academies Press; 2006.Google Scholar
- 14.Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household food security in the United States in 2017. Washington, DC2018 Contract No.: ERR-256.Google Scholar
- 15.US Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination Survey Food Security Questionnaire. https://wwwn.cdc.gov/nchs/data/nhanes/2015-2016/questionnaires/FSQ_Family_I.pdf: U.S. Department of Health and Human Services; 2016.
- 18.Yabroff KR, Dowling EC, Guy GP Jr, Banegas MP, Davidoff A, Han X, et al. Financial hardship associated with cancer in the United States: findings from a population-based sample of adult cancer survivors. J Clin Oncol. 2016;34(3):259–67. https://doi.org/10.1200/jco.2015.62.0468.CrossRefGoogle Scholar
- 19.Claxton C, Levitt L, Long M. Payments for cost sharing increasing rapidly over time. Kaiser Family Foundation, Peterson-Kaiser Health System Tracker. 2016. https://www.healthsystemtracker.org/brief/payments-for-cost-sharing-increasing-rapidly-over-time/#item-start. Accessed 17 Feb 2019.
- 20.Ekwueme DU, Yabroff RK, Guy GP Jr, Banegas MP, de Moor JS, Li C, et al. Medical costs and productivity losses of cancer survivors—United States, 2008–2011. Morb Mortal Wkly Rep. 2014;63(23):505–10.Google Scholar
- 22.Gehrke AK, Feuerstein M. Cancer, comorbidity and workplace discrimination: The US experience. Eur J Cancer Care. 2017;26(5):e12748. https://doi.org/10.1111/ecc.12748.
- 24.Gregory CA, Coleman-Jensen A. Food insecurity, chronic disease, and health among working-age adults. Wasington, DC2017 contract no.: ERR-235.Google Scholar
- 33.US Centers for Disease Control and Prevention, National Center for Health Statistics. National health and nutrition examination survey (NHANES) data. https://wwwn.cdc.gov/nchs/nhanes/Default.aspx: U.S. Department of Health and Human Services; 2014.
- 34.Johnson CL, Dohrmann SM, Burt VL, Mohadjer LK. National Health and Nutrition Examination Survey: Sample design, 2011–2014. Vital Health Statistics, Series 2. 2014(162):1–33.Google Scholar
- 36.Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household food security in the United States in 2016. United States Department of Agriculture2017 October 8. 2017; Contract no.: economic research report no. (ERR-237).Google Scholar
- 38.Johnson CL, Paulose-Ram R, Ogden CL, Carroll MD, Kruszon-Moran D, Dohrmann SM, et al. National Health and Nutrition Examination Survey: analytic guidelines, 1999-2010. Vital Health Stat. 2013;2(161):1–24.Google Scholar
- 39.Coleman-Jensen A, Nord M, Andrews M, Carlson S. Household food security in the United States in 2011. U.S. Department of Agriculture, Economic Research Service. 2012; Contract No.: ERR-141.Google Scholar
- 40.Nass SJ, Beaupin LK, Demark-Wahnefried W, Fasciano K, Ganz PA, Hayes-Lattin B, et al. Identifying and addressing the needs of adolescents and young adults with cancer: summary of an Institute of Medicine workshop. Oncologist. 2015;20(2):186–95. https://doi.org/10.1634/theoncologist.2014-0265.CrossRefGoogle Scholar
- 46.Aghajanpour M, Nazer MR, Obeidavi Z, Akbari M, Ezati P, Kor NM. Functional foods and their role in cancer prevention and health promotion: a comprehensive review. Am J Cancer Res. 2017;7(4):740–69.Google Scholar