(EA03-11-25) FoodRx: A Mixed-Methods Approach to Improving Food Security in Cancer Care

Scientific conference where the work was recently presented: Social Interventions Research and Evaluation Network (SIREN) 2025 National Research Meeting: Advancing the Science of Social Care

Date on which the work was previously presented at the scientific conference listed: February 4, 2025

Objectives: One in four cancer survivors report food insecurity. Our objective was to understand the barriers to and facilitators for addressing food insecurity in the clinical workflow of a National Cancer Institute-designated comprehensive cancer center.

Methods: Electronic health record (EHR) data were extracted from the Indiana University Health Data Warehouse for patients with a cancer diagnosis (n=20,305) from 01/01/2021 to 05/15/2024. EHR data included demographic and clinical characteristics. Univariable analysis of dietitian and social work referrals utilized binary logistic regression models. Descriptive EHR data and the Systems Engineering Initiative for Patient Safety (SEIPS) 101 model guided focus group data collection and deductive thematic analysis using a rapid qualitative approach to characterize the clinical work system for addressing food insecurity in cancer care. Two 45-minute semi-structured focus groups were conducted with gynecologic oncology physicians (n=4) on 07/03/2024 and advanced practice providers (n=3) on 07/31/2024.

Results: Cancer survivors at risk of food insecurity (n=984) were 49% and 81% more likely to be referred to a dietitian [OR 1.49; 95% CI (0.83, 2.69); p=0.040] or a social worker [OR 1.81; 95% CI (1.08, 3.04); p=0.004], respectively, compared to food secure peers (n=18,260). Clinicians reported that long travel distances for patients and not knowing what resources are available where patients live are barriers to intervening on food insecurity.

Conclusions: Study findings highlight gaps and opportunities in the cancer care workflow for informing the co-design, implementation, and evaluation of future food insecurity interventions embedded in healthcare. Our study is responsive to the US Preventive Services Task Force 2025 report calling for rigorous research to determine the impact of healthcare-based efforts to improve patient food security.

Funding Sources: The study was supported by the NIH through the Summer Program for Academic Research in Cancer (R25CA269039), and by the Regenstrief Institute’s Health Equity and Disparities Research Pilot Program and the Health Equity Advancing through Learning Health Systems Research Collaborative.