Food insecurity (FI) is an emerging concern in cancer care, yet the multiple mechanisms driving this vulnerability remain underexplored. Existing research largely emphasizes financial hardship—often measured using adaptations of the United States Department of Agriculture (USDA) food security survey module—as the primary contributor. While financial hardships, such as increased medical expenses and employment disruptions, are significant for cancer patients, FI may also result from non-financial factors, including physical limitations related to cancer and its treatment, transportation barriers, and lack of social support that hinder food procurement and meal preparation. This thesis investigates predictors of FI among cancer patients at diagnosis and examines how cancer and its treatment influence FI through both financial and non-financial pathways after diagnosis. It draws on two studies to explore these issues. The first is a systematic literature review synthesizing evidence on FI and cancer using a food systems approach that considers both financial mechanisms (e.g., income loss, employment disruption, treatment costs) and non-financial mechanisms (e.g., physical impairments, transportation barriers, social isolation) linking cancer to FI after diagnosis. The second is a cross-sectional study that assesses the prevalence of FI at cancer diagnosis at a large medical center and identifies associated demographic and clinical predictors. In the first study, the systematic review found that financial hardship was frequently documented, with income loss, work disruptions, increased medical expenses, and material hardship particularly prevalent among younger adults, lower-income individuals, and racially/ethnically minoritized populations. However, methodological limitations—especially the predominance of cross-sectional designs—restricted causal inference and understanding of how FI changes throughout treatment. Non-financial contributors were often overlooked in both measurement tools and study designs. The most commonly used measurement tool in the included studies was the USDA Household Food Insecurity Module, or an adaptation of it, which focuses exclusively on the financial aspects of FI. In the second study, FI prevalence was 3.9%, lower than both state and national averages at the time of the survey, but disproportionately affected men, non-White patients, Medicaid recipients, and those with certain cancer types. Compared with both Vermont and national statistics, individuals of color were underrepresented in this dataset (97% White). Evidence from other studies indicates that marginalized populations often experience higher rates of FI. FI among cancer patients is multifactorial, with non-financial barriers remaining underrecognized. Standard screening tools may underestimate need by focusing solely on financial access. These findings highlight the importance of improved measurement tools, longitudinal research, and integrated interventions that reflect the experiences of cancer patients—particularly in those most at risk.
Makenzie Keen (Wed,) studied this question.