Why screening for access to nutrition should be part of cancer treatment everywhere

Cancer patients need good nutrition in order to stay healthy during toxic treatments and recover after surgery. It could be simple and effective to improve outcomes and reduce disparities by ensuring they receive it. Swagata Yadavar reports about parallel efforts in India and the US to move this issue higher on the agenda.

Sahil, a 16-year-old student who had just completed his tenth-grade exams, developed severe headaches and felt that his nose was obstructed. Sahil Bacchav was sent to King Edward Memorial Hospital in Mumbai, where his tonsils were removed. He still didn’t feel well and stopped eating. He slept and ate nothing but his medicine at one point. He lost 25kg. Sahil and his family were referred to Tata Memorial Hospital in the same city. There, they learned that he had cancer of the nasopharynx. He would need to undergo chemotherapy and radiation. The radiation treatment caused Sahil’s oral mucositis. His mouth was painful and inflamed with ulcers. He couldn’t eat anything or swallow it and had to rely on a feeding tube.

Sahil’s parents alternated being by his side during his treatment at various hospitals. One parent stayed 50 km away with his twin brother, and the other was by Sahil’s side. His father, a civil worker who earns around $6 per day, couldn’t work for over six months. The family was left in dire financial circumstances. Rekha Bacchav is his mother. “We are struggling to pay for rent, medical bills, and household supplies. We have to borrow money to get by.”

Sahil struggled with eating for so many years before he was diagnosed. He needed to have a healthy diet to help him get through his treatment and to promote a full recovery. The family received help from an organization founded ten years ago to support children with cancer.

Sahil struggled to eat prior to his diagnosis. It was vital to ensure he had a healthy diet to support him throughout treatment.

The Cuddles Foundation is India’s only non-profit organization that assists children in fighting cancer through holistic nutrition. The Cuddles Foundation currently runs programs in 35 hospitals, both government and charitable, in 20 Indian cities.

Sahil had access to nutritionists, who closely monitored his health and developed a nutritional plan that met his needs. The foundation provided monthly rations for the family to ensure that they had the right food. Sahil has improved significantly; according to his mother, he is now able to eat, swallow, and gain weight.

According to the study “Food insecurity Screening in India,” more than eight out of ten children who receive nutrition help from the Cuddles Foundation faced the risk of food insecurity the year prior to enrolling in the Foundation’s FoodHeals program. The report stated that more than half of the families in India earned less than $100 per month. Another 32% made between $150 and $350, while 12% made between $350 and $600.

Cancer outcomes are affected by food insecurity.

It has only been recently that the impact of poor nutrition on cancer outcomes and the potential for improvement that this presents have begun to receive the attention they deserve. Theresa Hastert is an assistant professor in Population Studies at Karmanos Cancer Institute in Detroit, and she works on the Disparities Research Program.

She wrote: “People who are undergoing cancer treatments may have specific nutritional needs and be vulnerable to poor nutrient intake and risks associated with insufficient nutrition, such as immunosuppression and infection, or impaired postoperative healing.”

People with limited access to healthy food may struggle to adhere to treatment plans. Researchers at Memorial Sloan Kettering Cancer Center, New York, conducted a 2021 study that found cancer patients with food insecurity are at a greater risk of depression and have a lower level of social and emotional well-being. They are also more likely not to attend appointments and to experience treatment delays and interruptions.

According to the US Department of Agriculture, by 2020, the United States will be among the wealthiest nations on the planet, but 13.8 million households (10.5%) are food insecure. Food insecurity is higher for Black households (21.7%), Hispanic households (17.2%), and low-income families (28.6%).

According to studies, approximately 15-25% of cancer survivors and patients in the US are unable to access nourishing food on a regular basis. According to estimates, food insecurity can reach up to 55-70% among low-income cancer patients and those who are medically underserved. It is also higher in young cancer survivors.

In the US, 15-25% of cancer patients and survivors cannot depend on a consistent supply of nourishing food.

The problem of precarious food access is a worldwide issue. India accounts for almost a quarter (or 796,000) of the world’s malnourished. According to Indian Pediatrics, around 76,000 children and adolescents are diagnosed with cancer every year in India. According to the report published in 2022 by the Cuddles Foundation, Anju Moraka is the Foundation’s Director of Research, Knowledge Management, and Impact.

Food insecurity, which can lead to malnutrition, can affect treatment outcomes. According to Moraka, the malnutrition seen at the time of diagnosis may be caused by the food insecure environment or the disease.

“Screening food insecurity allows for holistic care, with the goal to improve tolerance and treatment outcomes.”

She argues that, given the fact that cancer treatment is affected by nutritional status, it makes sense to evaluate levels of food security in patients and caregivers when planning treatment and care. She says that food insecurity screenings can be used to identify households with food insecurity and provide holistic care for children with cancer.

The Cuddles Foundation provided nutritional supplements, hot meals, snacks, and ration packs to almost 13,000 children with cancer and their families between 2021-2022.

Some US oncology clinics are also experimenting with programs to address the nutritional concerns of some of their patients.

In a randomized controlled three-arm trial at four New York City Cancer Clinics, cancer patients who had insecure access to nutrition food were able to access weekly pre-packaged groceries from the existing food pantries within the clinics. They were also assigned to a “usual care” control or one of two interventions: receiving a debit card each month to buy food or weekly online grocery delivery. After six months, the treatment completion rate in both arms of intervention was higher than that in the control arm. 94.6% for debit cards and 82.5% for additional grocery deliveries vs. 77.5% in controls. The authors determined that the treatment completion rate among participants who received debit cards was higher than their threshold, indicating a promising intervention. The authors found that the quality of life significantly improved, depression symptoms declined in both the control and grocery delivery arms and food safety was enhanced in all components.

They concluded that “all interventions demonstrated the potential for improving food security among medically unserved and food-insecure cancer patients at risk of reduced nutrition status, reduced life quality, and worse survival.” They suggested, “All cancer patients should be screened to determine if they are food insecure, with evidence-based interventions available.”


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