1. Nalley, Catlin

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New research revealed a high prevalence of food insecurity among families of pediatric patients with acute lymphoblastic leukemia (ALL) enrolled in a cancer clinical trial, and almost half of the families eligible for the Supplemental Nutrition Assistance Program (SNAP) did not receive benefits. The findings presented at the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved also showed that receiving SNAP benefits was not sufficient to address food insecurity in this population.

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"Food insecurity is connected to worse health outcomes in general pediatrics," said lead study author Rahela Aziz-Bose, MD, a pediatric oncology fellow at Boston Children's Hospital and Dana-Farber Cancer Institute and lead author of the study. "It is incredibly important to understand whether patients who are being treated for cancer are experiencing food insecurity, because it is a risk factor on which we can intervene, and we can potentially improve outcomes."


Study Details

Given the association between poverty and adverse cancer outcomes in both adult and pediatric patients, this is an important area of research. One potentially modifiable metric of poverty, according to Aziz-Bose is food insecurity, which is defined as inadequate access to food because of financial constraints.


"Among pediatric cancer patients, up to one in four experience food insecurity during treatment," she noted during her presentation. "Receiving federal nutrition assistance benefits or SNAP is known to reduce food insecurity in general pediatrics, but it's not known whether the same is true in a pediatric cancer population, whose families may experience different financial stressors."


To answer this question, the researchers analyzed the prevalence of low income and food insecurity among ALL patients enrolled in the Dana-Farber Cancer Institute/ALL Consortium clinical trial at six U.S. cancer centers from 2017 to 2022. This included an ancillary study within this pediatric oncology trial which prospectively collected parent-reported social determinants of health data, including income, food insecurity, and receipt of SNAP benefits.


The specific aims of the study, Aziz-Bose said, were to investigate whether income-eligible pediatric ALL families were successfully receiving SNAP benefits and whether SNAP receipt was associated with a reduction in food insecurity.


To identify families that were SNAP-eligible, the researchers used parent-reported income at diagnosis and 6 months into therapy as a proxy. Based on federal guidelines, households with income lower than 130 percent of the federal poverty level are eligible for SNAP. Aziz-Bose and colleagues applied statistical methods to study the association between SNAP eligibility, SNAP receipt, and parent-reported food insecurity.


Key Findings

The data demonstrated that significant proportions of the families in this clinical trial were experiencing food insecurity, low income, or both, according to Aziz-Bose. "At baseline, among 262 families, 21 percent reported food insecurity and 20 percent were SNAP-eligible or low income," she reported at the AACR conference.


"Although there was some overlap, some families experienced one or the other, with a total of 29 percent of families experiencing either significant income poverty, food insecurity, or both," she continued. "Similarly at 6 months, 25 percent of families reported food insecurity, 28 percent were SNAP-eligible, and a total of 34 percent of families were experiencing either income poverty, food insecurity, or both."


Taking it a step further, Aziz-Bose and colleagues sought to understand how well these families had been connected to resources for which they were likely eligible. While Aziz-Bose noted that SNAP eligibility includes more criteria than income alone, these families are likely to qualify and so the researchers dug deeper into their enrollment status.


At baseline, the study authors observed that only 53 percent of likely eligible families reported receiving SNAP, and that number only increased to 58 percent at 6 months. "Nearly half of the eligible families were not receiving SNAP benefits, even though their children were being treated at highly resourced academic cancer centers," Aziz-Bose reported.


The data also showed that receiving SNAP benefits was not enough to address food insecurity. More than half of the families receiving benefits were still experiencing food insecurity both at diagnosis and at 6 months into therapy (61% and 56%, respectively.)


"One bright spot was that 33 families who were SNAP-eligible at both time points were examined and, of those families, more of them were receiving SNAP 6 months into therapy compared to baseline (an increase from 52% to 70%)," Aziz-Bose said. "However, the fact that the overall percentage of SNAP-receiving families did not increase over the 6 months into therapy indicates that some families became newly SNAP-eligible by 6 months on therapy and those families are not receiving SNAP benefits."


The study authors noted that the main limitation of this research is that SNAP eligibility could only be assessed through a proxy measure and, since this was a retrospective analysis, it could not be confirmed. They emphasized the need for a more detailed analysis to determine the cause/effect relationship between food insecurity and receiving SNAP benefits.


While discussing the key takeaways from their work, Aziz-Bose emphasized the prevalence of food insecurity among the trial-enrolled pediatric leukemia population and the need for assessment at multiple time points throughout therapy.


"Even at highly resourced centers, some of which have dedicated social needs or benefits navigator staff, a substantial proportion of likely eligible families were not receiving benefits 6 months into therapy, and receiving benefits were inadequate to ameliorate food insecurity with about 60 percent of recipients of SNAP continuing to report food insecurity even 6 months into treatment," she said.


Connecting eligible families to available benefits is an important first step, according to Aziz-Bose; however, food insecurity must be addressed through multiple different avenues. "High rates of food insecurity among SNAP recipients indicate that resource navigation alone will not be enough to address food insecurity, meaning that additional health equity interventions may need to include direct resource provision to pediatric cancer families, or policy-based approaches to augment benefits for these families," she concluded.


Catlin Nalley is a contributing writer.