Every day in New Mexico, some people must make the difficult decision whether to put food on the table or spend money on other necessities, such as a utility bill or rent.
“Food insecurity is an early indicator of financial trouble,” said Jean McDougall, PhD, an assistant professor in The University of New Mexico Department of Internal Medicine and a member of the Cancer Control and Population Science Program at the UNM Comprehensive Cancer Center.
Cancer-related financial hardship has been an interest of McDougall’s for much of her career. Recently she published a paper surveying nearly 400 patients identified from the New Mexico Tumor Registry, in which her team assessed patients’ level of food security before and after their cancer diagnosis.
McDougall and her team measured the food insecurity in 394 patients between the ages of 21 and 64 who had been diagnosed with cancer between 2008 and 2016.
The findings showed that 26 percent of the patients were food insecure both before and after their cancer diagnosis, while 10 percent of the patients were food secure prior to diagnosis and became newly food insecure after diagnosis.
Participants were asked to rate how true the following statements were:
Within the past 12 months, we worried whether our food would run out before we got money to buy more.
Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more.
Patients who responded that these statements were often true or sometimes true were categorized as food insecure.
“I was surprised to learn that 36 percent of cancer survivors surveyed were food insecure in the year after their cancer diagnosis,” McDougall said.
McDougall said the study didn’t look specifically at what caused the food insecurity, particularly among the 10 percent of patients who slipped from secure to insecure.
“I think people don’t really realize how quickly food insecurity can happen,” she said. “It doesn’t take much for a person to become food insecure.”
Factors can include a loss of income from having to take time off from work and travel expenses if the cancer treatment facility is far away.
“One of the biggest challenges for people in the study was the loss of income, either for the patient or their partner,” she said.
That timing, accompanied by new medical expenses, can be financially challenging. The cost of treatment itself is tougher to pin down because of complexities in insurance coverages and reimbursements, McDougall said.
Food insecurity was more common among younger patients. A number of factors could account for that, McDougall said, including the tendency for younger patients to have less savings, more debt and children in the home.
Food insecurity can lead to difficult decisions for recovering patients.
Food usually is something that people buy week by week. Not being able to pay for food can lead to harder choices down the line, including forgoing utility bills or refilling prescriptions and delaying other medical care.
The study is just the first step for McDougall.
“Now that we’re talking about it and it’s such a big problem, the question is: how do you identify and empower the people who are food insecure?” she said.
That will take more study and more research.
She said she wants to look deeper into how a system of screening questions could be implemented at clinics that would check for patients experiencing food security and then match them with appropriate resources, be they grocery vouchers, food banks or the Supplemental Nutrition Assistance Program (SNAP).
“Because I’m a researcher, I want to know how best to implement screening and food resource referral into the clinic,” McDougall said. “We need to figure out how to get patients and providers talking about food security and how to address it in our health care system.”
Food Insecurity and Forgone Medical Care Among Cancer Survivors was published on May 8, 2020, in JCO Oncology Practice.
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