OBJECTIVES: The high cost of cancer care leads to financial hardship for many cancer survivors. Food insecurity is an especially alarming problem among cancer survivors given the importance of nutrition on treatment efficacy and disease outcomes. This study assessed the prevalence of food insecurity and its association with delaying or forgoing healthcare among a diverse, population-based sample of cancer survivors.

METHODS: We conducted a cross-sectional survey of individuals age 21-64, diagnosed with stage I-III breast, colorectal, or prostate cancer between 2010 and 2016, identified from the population-based New Mexico Tumor Registry. Participants were administered an English or Spanish paper, online or telephone survey, depending on participant preference. Food insecurity in the year following diagnosis was measured using a validated tool from the US Department of Agriculture’s Core Food Security Module and questions from the Medical Expenditure Panel Survey Experiences with Cancer Supplement were used to ascertain receipt of cancer care. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS: The study included a total of 356 individuals with breast (n=218), colorectal (n=65), or prostate (n=73) cancer (mean age 51y; 70% female; 49% non-Hispanic White; 39% Hispanic or Latino; 39% income <$40,000; 71% privately-insured; 59% ≥1 comorbidity). In the year following diagnosis, 105 (29%) participants were food insecure. Compared to food secure cancer survivors, those reporting food insecurity were more than twice as likely (OR 2.49, 95% CI 1.35-4.58) to delay or forego prescription medications and three times as likely to delay or forego other types of treatment (OR 3.33, 95% CI 1.70-6.52).

CONCLUSIONS: The high prevalence of food insecurity and its association with foregoing or delaying medical suggest that screening for and intervening on food insecurity may be an important strategy for identifying individuals at risk of nonadherence and reducing disparities in cancer outcomes.