Advertisement

Food insecurity among adult cancer survivors in the United States

  • M. L. TregoEmail author
  • Z. M. Baba
  • K. I. DiSantis
  • M. L. Longacre
Article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Cancer survivorship Food security NHANES Nutrition Economic burden 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30.  https://doi.org/10.3322/caac.21332.CrossRefGoogle Scholar
  2. 2.
    Weir HK, Thompson TD, Soman A, Moller B, Leadbetter S. The past, present, and future of cancer incidence in the United States: 1975 through 2020. Cancer. 2015;121(11):1827–37.  https://doi.org/10.1002/cncr.29258.CrossRefGoogle Scholar
  3. 3.
    Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271–89.CrossRefGoogle Scholar
  4. 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. 5.
    President’s Cancer Panel. Living beyond cancer: finding a new balance. 2004.Google Scholar
  6. 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
  7. 7.
    Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15):1572–82.  https://doi.org/10.1056/NEJMsa060185.CrossRefGoogle Scholar
  8. 8.
    Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomark Prev. 2016;25:1029–36.  https://doi.org/10.1158/1055-9965.EPI-16-0133.CrossRefGoogle Scholar
  9. 9.
    Greenlee H, Shi Z, Sardo Molmenti CL, Rundle A, Tsai WY. Trends in obesity prevalence in adults with a history of cancer: results from the US National Health Interview Survey, 1997 to 2014. J Clin Oncol. 2016;34(26):3133–40.  https://doi.org/10.1200/JCO.2016.66.4391.CrossRefGoogle Scholar
  10. 10.
    Brennan ME, Gormally JF, Butow P, Boyle FM, Spillane AJ. Survivorship care plans in cancer: a systematic review of care plan outcomes. Br J Cancer. 2014;111(10):1899–908.  https://doi.org/10.1038/bjc.2014.505.CrossRefGoogle Scholar
  11. 11.
    Jones LW, Demark-Wahnefried W. Diet, exercise, and complementary therapies after primary treatment for cancer. Lancet Oncol. 2006;7(12):1017–26.  https://doi.org/10.1016/s1470-2045(06)70976-7.CrossRefGoogle Scholar
  12. 12.
    Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):242–74.CrossRefGoogle Scholar
  13. 13.
    Zhang FF, Liu S, John EM, Must A, Demark-Wahnefried W. Diet quality of cancer survivors and noncancer individuals: results from a national survey. Cancer. 2015;121(23):4212–21.CrossRefGoogle Scholar
  14. 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. 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.
  16. 16.
    Seligman HK, Schillinger D. Hunger and socioeconomic disparities in chronic disease. N Engl J Med. 2010;363(1):6–9.  https://doi.org/10.1056/NEJMp1000072.CrossRefGoogle Scholar
  17. 17.
    Guy GP, Yabroff KR, Ekwueme DU, Smith AW, Dowling EC, Rechis R, et al. Estimating the health and economic burden of cancer among those diagnosed as adolescents and young adults. Health Aff. 2014;33(6):1024–31.  https://doi.org/10.1377/hlthaff.2013.1425.CrossRefGoogle Scholar
  18. 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. 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. 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
  21. 21.
    Stergiou-Kita M, Qie X, Yau HK, Lindsay S. Stigma and work discrimination among cancer survivors: a scoping review and recommendations. Can J Occup Ther. 2017;84(3):178–88.CrossRefGoogle Scholar
  22. 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.
  23. 23.
    Vaccaro JA, Huffman FG. Sex and race/ethnic disparities in food security and chronic diseases in U.S. older adults. Gerontol Geriatr Med. 2017;3:2333721417718344.  https://doi.org/10.1177/2333721417718344. CrossRefGoogle Scholar
  24. 24.
    Gregory CA, Coleman-Jensen A. Food insecurity, chronic disease, and health among working-age adults. Wasington, DC2017 contract no.: ERR-235.Google Scholar
  25. 25.
    Bilodeau M, Ma C, Al-Sayegh H, Wolfe J, Bona K. Household material hardship in families of children post-chemotherapy. Pediatr Blood Cancer. 2017;65:e26743.  https://doi.org/10.1002/pbc.26743.CrossRefGoogle Scholar
  26. 26.
    Simmons LA, Modesitt SC, Brody AC, Leggin AB. Food insecurity among cancer patients in Kentucky: a pilot study. J Oncol Pract. 2006;2(6):274–9.CrossRefGoogle Scholar
  27. 27.
    Gany F, Lee T, Ramirez J, Massie D, Moran A, Crist M, et al. Do our patients have enough to eat? Food insecurity among urban low-income cancer patients. J Health Care Poor Underserved. 2014;25(3):1153–68.  https://doi.org/10.1353/hpu.2014.0145.CrossRefGoogle Scholar
  28. 28.
    Gany F, Leng J, Ramirez J, Phillips S, Aragones A, Roberts N, et al. Health-related quality of life of food-insecure ethnic minority patients with cancer. J Oncol Pract. 2015;11(5):396–402.  https://doi.org/10.1200/jop.2015.003962.CrossRefGoogle Scholar
  29. 29.
    Alaimo K. Food insecurity in the United States: an overview. Top Clin Nutr. 2005;20(4):281–98.CrossRefGoogle Scholar
  30. 30.
    Pruitt SL, Leonard T, Xuan L, Amory R, Higashi RT, Nguyen OK, et al. Who is food insecure? Implications for targeted recruitment and outreach, National Health and Nutrition Examination Survey, 2005-2010. Prev Chronic Dis. 2016;13:E143.  https://doi.org/10.5888/pcd13.160103.CrossRefGoogle Scholar
  31. 31.
    Gundersen C, Kreider B, Pepper J. The economics of food insecurity in the United States. Appl Econ Perspect Policy. 2011;33(3):281–303.CrossRefGoogle Scholar
  32. 32.
    Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr. 2009;141(3):542.  https://doi.org/10.3945/jn.110.135764.Google Scholar
  33. 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. 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
  35. 35.
    Rees JR, Zens MS, Gui J, Celaya MO, Riddle BL, Karagas MR. Non melanoma skin cancer and subsequent cancer risk. PLoS One. 2014;9(6):e99674.  https://doi.org/10.1371/journal.pone.0099674.CrossRefGoogle Scholar
  36. 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
  37. 37.
    Choi SK, Fram MS, Frongillo EA. Very low food security in US households is predicted by complex patterns of health, economics, and service participation. J Nutr. 2017;147(10):1992–2000.  https://doi.org/10.3945/jn.117.253179.CrossRefGoogle Scholar
  38. 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. 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. 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
  41. 41.
    Stroud C, Walker LR, Davis M, Irwin CE. Investing in the health and well-being of young adults. J Adolesc Health. 2015;56(2):127–9.CrossRefGoogle Scholar
  42. 42.
    Tarasuk V, Mitchell A, McLaren L, McIntyre L. Chronic physical and mental health conditions among adults may increase vulnerability to household food insecurity. J Nutr. 2013;143(11):1785–93.  https://doi.org/10.3945/jn.113.178483.CrossRefGoogle Scholar
  43. 43.
    Hanson KL, Olson CM. Chronic health conditions and depressive symptoms strongly predict persistent food insecurity among rural low-income families. J Health Care Poor Underserved. 2012;23(3):1174–88.  https://doi.org/10.1353/hpu.2012.0116.CrossRefGoogle Scholar
  44. 44.
    Birt DF, Phillips GJ. Diet, genes, and microbes: complexities of colon cancer prevention. Toxicol Pathol. 2014;42(1):182–8.  https://doi.org/10.1177/0192623313506791.CrossRefGoogle Scholar
  45. 45.
    Shapira N. The potential contribution of dietary factors to breast cancer prevention. Eur J Cancer Prev. 2017;26(5):385–95.  https://doi.org/10.1097/cej.0000000000000406.CrossRefGoogle Scholar
  46. 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
  47. 47.
    Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol. 2005;23(24):5814–30.  https://doi.org/10.1200/jco.2005.01.230.CrossRefGoogle Scholar
  48. 48.
    Irwin ML, Cartmel B, Harrigan M, Li F, Sanft T, Shockro L, et al. Effect of the LIVESTRONG at the YMCA exercise program on physical activity, fitness, quality of life, and fatigue in cancer survivors. Cancer. 2017;123(7):1249–58.CrossRefGoogle Scholar
  49. 49.
    Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev. 2015;73(10):643–60.  https://doi.org/10.1093/nutrit/nuv027.CrossRefGoogle Scholar
  50. 50.
    Dinour LM, Bergen D, Yeh M-C. The food insecurity–obesity paradox: a review of the literature and the role food stamps may play. J Am Diet Assoc. 2007;107(11):1952–61.  https://doi.org/10.1016/j.jada.2007.08.006.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Public HealthArcadia UniversityGlensideUSA
  2. 2.Department of HealthWest Chester UniversityWest ChesterUSA

Personalised recommendations