Study: Oncology Dietitians Rarely Ask Patients with Cancer About Food Insecurity

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Most oncology dieticians interviewed by investigators at the University of Illinois Urbana-Champaign said that they do not use a validated tool to screen individuals with cancer for food insecurity, study results show.

The results of other studies have suggested that many individuals with cancer experience food insecurity, but few dietitians routinely ask if they are having issues affording or obtaining food.

The dietitians’ estimates of the prevalence of food insecurity varied widely, from less than 20% to 50% of patients. The dietitians included in the study worked in various types of clinical settings, including outpatient cancer treatment centers and inpatient units at hospitals in rural, suburban, and urban locations across the United States.

Just 2 of 41 dietitians reported using a validated screener, while 4 additional dietitians reported using other tools, such as screening questions developed by local food banks or recommended by professional organizations for oncology nutritionists.

“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,” Anna Arthur, Ph.D., MPH, RDN, who was a professor of food science and human nutrition at the University of Illinois at the time of the study, said in a statement.

Individuals with cancer may be sick from the disease and treatment adverse effects that may affect their ability to follow dietary recommendations, Amirah Burton-Obanla, a graduate student in nutritional sciences at the University of Illinois said in the statement.

Some of the dietitians reported that food insecurity was more prevalent among certain populations, such as elderly individuals and individuals diagnosed with cancer of the gastrointestinal tract or head and neck.

The burdensome cost of cancer treatment and nutritional products can also be obstacles for patients.

“Patients with lower incomes may be unable to afford the recommended nutritional supplements that could help them get optimal nutrition during treatment,” Burton-Obanla said.

Additionally, dietitians in the study reported that lack of transportation is a huge barrier to obtaining food. Individuals living in rural areas and those who lacked family members or friends who could provide rides or assistance with shopping or preparing meals were likely to be at greater risk of food insecurity.

Furthermore, the few dietitians who did ask their patients if they were food insecure said that they used various strategies to assist individuals with obtaining food or transportation, such as connecting them with food pantries, government benefits, grants that provide bus tokens and gas cards, and Meals on Wheels and other meal services.

Despite the efforts, most dietitians felt they had little control over their patients’ food security.

“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,” Brenda Koester, the associate director of the Family Resiliency Center at the university, said in the statement. “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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