Food insecurity: The missing piece in cancer treatment

Cancer care centers must screen children early for food insecurity and connect families with social welfare programs to improve treatment outcomes.

I work at a tiffin center so that I can take home leftovers for the kids.

We eat only once a week and share our food with our two children.

Families and caregivers of cancer-stricken children are always repeating this theme to us at Cuddles Foundation. Food insecurity can have a significant impact on cancer treatment.

What is food security, and how does this affect health?

Johns Hopkins University defines food insecurity as the state of not being able to afford adequate or healthy food. In 2021, the Food and Agriculture Organization estimates that approximately 2,3 billion people –which is 29,3 percent of the world’s population—would suffer from food insecurity. The 2022 Global Hunger Index Report placed India at 107th out of 121 nations, with a high burden of food insecurity and malnutrition.

India will account for almost one-quarter (by 2022) of the world’s undernourished. Malnutrition levels in India are well above acceptable limits, and a large number of women and children suffer from micronutrient deficiency disorders. This puts the public’s health at risk.

When food is scarce, other human needs such as housing and medication, utilities, and transportation often take precedence over the need for food. When budgets are tight, it is hard to spend on quality food such as fresh vegetables, fruits, and pulses. Instead, households choose cheaper alternatives that are less nutritious. It is often difficult to eat healthy food when budgets are tight. Instead, families opt for more affordable options that are less nutritious. Malnutrition can be a major problem in these situations. It can contribute significantly to morbidity, mortality, and other health problems, especially among children below five years of age.

In contrast, a household that is food secure can provide its members with adequate quantities and quality of food to protect them from nutritional deficiencies. This may also help prevent or delay non-communicable illnesses such as hypertension, diabetes, and heart ailments.

Children with cancer and food insecurity

Primary acute malnutrition is a form of malnutrition caused by an inadequate food supply due to economic, social, and environmental factors. It manifests in the form of wasting among children. It makes them too thin, weakens their immune system, and leaves them susceptible to disease and developmental delays. Children living in households with food insecurity are more likely to be hospitalized and have a longer recovery period when they get sick.

In India, it’s estimated that about 76,000 children could develop cancer each year. Nutrition plays a key role in their recovery. Children who are well-nourished experience fewer side effects, infections, and treatment delays. On the other hand, food insecurity can have a devastating impact on cancer treatment, causing adherence to the regimen and its completion. If a child is not receiving adequate nutrition, they are less likely to be able to cope with the side effects of treatment, such as diarrhea and mouth sores.

Malnutrition is common in children with cancer, particularly in countries of lower-middle income like India. About 40 percent are malnourished when a child is diagnosed with cancer. Cancer treatment can worsen the nutritional status of a child and lead to secondary acute malnutrition. A loss of body fat and muscle characterizes this type of malnutrition. It’s caused by the metabolic changes that are brought on by the cancer and its treatment. It is important to assess the level of food insecurity that may exist among children with cancer to ensure they receive adequate nutrition.

In 2021, the Cuddles Foundation conducted a study for a better understanding of the socioeconomic situation of the communities with which we work. The study included 1,105 children from 34 hospitals. The results revealed that 51,4% of the households surveyed earn INR 10,000 per month or less. Another 31.8 percent earn between INR 10,000 and INR 29972, while 11.8 percent earn between INR 29973 and 49961.

We investigated food insecurity in the communities with which we work, as food insecurity can be linked to socioeconomic disadvantage. The results showed that the majority of children (82%) whom we helped were at risk of food insecurity the year before they participated in our program. This was even before they received a cancer diagnosis.

Improved food security for cancer children

Cancer care centers can play a vital role in meeting the nutritional requirements of children with cancer.

  • Early screenings

The American Academy of Pediatrics and the American Diabetes Association advocate that patients be screened for food insecurity regularly in clinical settings. American Cancer Society also called on the need for food insecurity assessments to be a part of the cancer treatment. It is crucial because the response to cancer treatments is dependent on nutritional status. Assessing levels of food security in patients and caregivers, especially those who are economically disadvantaged, could have a significant impact on the course of treatment and recovery.

Ideally, cancer care centers should screen for food insecurity during the initial patient visit. In order to determine the cancer treatment requirements, pediatric cancer centers already use various assessments that cover the socioeconomic, demographic, and nutritional backgrounds of patients. Food insecurity can be measured using simple questionnaires and scales.

We used the hunger Vital Sign, which is a screening tool that both adults and kids can use. The device can identify households that are at risk of food security if they answer ‘often’ or sometimes’ to one or both statements in the survey (as opposed never’). The survey asks two questions:

  1. In the last 12 months, we were worried that we would run out of food before we had enough money to buy more.
  2. The food we purchased in the previous 12 months didn’t last as long, and we couldn’t afford to buy more.

These screening tools allow for holistic treatment of children with cancer and can help them to become more tolerant and tolerant towards treatment.

  • Regularly monitoring nutritional deficiencies.

Nutritional deficiencies can be corrected and monitored continuously during diagnosis and treatment to reduce side effects, increase chances of survival, and reduce nutritional morbidity.

  • Food insecurity and cancer: Creating awareness

A study revealed that 80,1 percent of caregivers were unaware of the correct foods to feed their children when cancer was diagnosed. In order to educate caregivers about the complex relationship between malnutrition and treatment outcomes, it is important to develop specific educational initiatives.

  • Families linked to assistance programs

The screening centers will help to link families eligible for food assistance with government and non-government programs as soon as possible. Some of the government food assistance programs under the National Food Security Act 2013 include the One Nation One Ration CardPoshan Abhiyaan, and Midday Meal Scheme.

Food insecurity has a profound impact on human health. Food insecurity and the malnutrition that results from it can compromise the chances of survival of cancer patients in India. They are at greater risk of infection and other treatment-related toxicities. Food insecurity screening can help connect children with cancer to resources to ensure they have regular and timely access to nutritious food. Access to healthy, adequate food can improve treatment outcomes.


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