Nutrition Assistance No Guarantee Against Food Insecurity for Families Fighting Cancer

Across health care, there has been some discussion about how providers can help patients whose health is impacted by poverty, creating an inability to obtain basic needs, like safe housing, healthy food—or even enough food.

But a recent study showed that even when patients—in this case, families of children with acute lymphoblastic leukemia (ALL)—are connected to resources through large medical centers, they still experience food insecurity.

The research was presented earlier this month at the 15th American Association of Cancer Research Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.

Because receiving Supplemental Nutrition Assistance Program (SNAP) benefits has been shown to reduce food insecurity and is one way to address adverse social determinants of health (SDOH), researchers sought to determine how many of the families were eligible for SNAP and if SNAP reduced food insecurity. The Dana-Farber Cancer Institute (DFCI) Acute ALL Consortium Trial 16-001 is the first pediatric oncology clinical trial to prospectively collect parent-reported SDOH, including income, SNAP receipt, and food insecurity, the authors said.

The pediatric patients, aged 1 to 17 years, were enrolled in the clinical trial at 6 cancer centers from 2017 to 2022. As a secondary analysis, researchers analyzed parent-reported income at diagnosis and 6 months into therapy as a proxy to identify families that were SNAP eligible. According to federal guidelines, households with incomes lower than 130% of the federal poverty level are eligible for SNAP.

Food insecurity among the group of 262 evaluable families was assessed using a validated 2-item screening tool.

Multiple regression techniques examined the association between SNAP eligibility, SNAP receipt, and parent-reported food insecurity.

The study showed that 21% of the 262 families at diagnosis and 25% of 223 families evaluable 6 months into therapy reported food insecurity.

At diagnosis, 20% of the families were SNAP eligible. Of these, 60% reported food insecurity but only 53% were receiving SNAP benefits.

Six months into therapy, 28% of the families were SNAP eligible, and of those, 58% reported food insecurity and 58% were receiving SNAP—in other words, receiving the benefit was not enough to become food secure.

Among the 33 families that were SNAP eligible at both time points, the fraction receiving SNAP benefits increased from 52% to 70%.

“Food insecurity is connected to worse health outcomes in general pediatrics,” Rahela Aziz-Bose, MD, a pediatric oncology fellow at Boston Children’s Hospital and Dana-Farber Cancer Institute and lead author of the study, said in a statement. “The most important finding was that poverty and food insecurity are very common in this group of patients,” she said.

“It is promising that we could help some of the families who were eligible at diagnosis to enroll and receive benefits,” said Aziz-Bose. “However, there were families who became newly eligible between the 2 time points and were not receiving benefits at 6 months, highlighting that poverty is a dynamic state⁠—families can move from one category to another as they progress through treatment, especially as the effects of out-of-pocket payments, transportation to visits, and lost income from a parent/caregiver having to give up a job all add up.”

“We need to universally screen for financial hardship at multiple points throughout pediatric cancer treatment,” Aziz-Bose said, adding that perhaps “because of the financial stress associated with cancer treatment, the SNAP benefit amount needs to be higher for these families.”

The main limitation of this study is that SNAP eligibility could only be assessed through a proxy measure (self-reported income) and, since this was a retrospective analysis, it could not be confirmed. In addition, a more detailed analysis is needed to determine the cause/effect relationship between food insecurity and receiving SNAP benefits.