Understanding the nutritional challenges of food insecure cancer survivors

Burton Obanla, Amirah

Permalink

https://hdl.handle.net/2142/120423 Copy

Description

Title

Understanding the nutritional challenges of food insecure cancer survivors

Author(s)

Burton Obanla, Amirah

Issue Date

2023-04-27

Director of Research (if dissertation) or Advisor (if thesis)

• Arthur, Anna
• Prescott, Melissa

Doctoral Committee Chair(s)

Miller, Michael

Committee Member(s)

Ellison, Brenna

Department of Study

Nutritional Sciences

Discipline

Nutritional Sciences

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

Ph.D.

Degree Level

Dissertation

Keyword(s)

• nutrition
• cancer survivor
• food insecurity

Abstract

At the start of January 2022, there were 18 million cancer survivors in the United States. The number of cancer survivors is projected to reach 22.5 million by the year 2032. Navigating life after a cancer diagnosis can be traumatic for many survivors as they face challenges in their financial status, nutritional status, as well as their health-related quality of life. Many studies have reported that cancer survivors experience financial hardships and a decline in nutritional status and health-related quality of life. These three factors combined can create a cascade of events that ultimately lead to the development of food insecurity. For cancer survivors already experiencing food insecurity, a cancer diagnosis may worsen conditions of food insecurity. The overall objective of this dissertation was to examine the nutritional challenges of food insecure cancer survivors. Aim 1. Registered oncology dietitians provide care to cancer patients throughout the cancer continuum. However, it is unclear whether oncology dietitians routinely assess food security and food access needs among their patients. There are currently no standard of care guidelines recommending screening for and addressing food insecurity within the oncology setting. This study collected qualitative data from 40 oncology Registered Dietitian Nutritionists (RDNs) across the United States to explore their knowledge, attitudes, and practices concerning FI with their cancer patients. Interestingly, most oncology dietitians reported that they do not routinely screen food security status using a validated measuring. This research emphasizes the need for implementation of routine food security screening in oncology clinics, as well as interventions that target cancer survivors’ food access needs. Aim 2. It is well known that receiving a cancer diagnosis is associated with several financial hardships that can impact cancer survivors. Side-effects from cancer and cancer treatment also make cancer survivors prone to sub-optimal nutrition and decreased quality of life. Decreased quality of life can also contribute to worse financial hardships and nutritional status. Financial hardships, sub-optimal nutrition, and a decreased quality of life are three factors that uniquely affect most cancer survivors, and when combined, these factors may lead to the development or exacerbation of food insecurity. The purpose of this aim was to determine the prevalence of FI and examine the association between FI with dietary intake and health-related quality of life among a hospital-based sample of 231 cancer survivors. Linear regression models found no significant associations between FI and dietary intake (fruit & vegetable intake, grams of fiber intake, and % energy from fat consumed per day). However, logistic regression models did find significantly increased risk of FI in participants with lower overall HRQOL, as well as all HRQOL subscales (physical, emotional, functional, social). More research is needed to understand how FI impacts survivors’ nutritional status and response to oncologic treatment. Aim 3. Considering the severity of financial hardship that many cancer survivors face, some may adopt coping mechanisms to offset the impact of financial hardship. Some of these coping mechanisms include skipping doctor’s appointments, filling prescription medication, and purchasing cheaper foods, which in many cases, are referred to as food-away-from-home. These food-away-from-home meals are often more convenient because they are easily accessible and require minimal preparation before consumption. Cancer survivors experience sub-optimal nutrition vulnerabilities, yet maintaining a healthy diet is essential for their overall health and survival. Food insecurity may serve as a barrier to obtaining healthy foods and increase the risk of a decline in nutritional status. The purpose of this aim was to examine the association between FI and food-away-from-home meal expenditures, as well as investigate if FI modifies the relationship between food-away-from-home frequency (# of meals in the last 7 days) and diet quality (HEI 2015 total score). This study found a significant inverse relationship between FI and food-away-from-home expenditures. However, we did not detect an association between food-away-from-home frequency and diet quality when stratified by food security status. Overall, these studies add to the growing body of literature examining the relationship between FI and cancer-related outcomes. Future studies should consider how other social determinants of health co-exist with FI to impact cancer-related outcomes. These results have important implications for future interventions and policies specifically targeting cancer survivors and their food access needs.

Graduation Semester

2023-05

Type of Resource

Thesis

Copyright and License Information

©2023 Amirah Burton-Obanla

Owning Collections