News — More than 2 million new cases of cancer were diagnosed in 2024, according to the American Cancer Society. How well these cancers respond to treatment depends not only on the type and severity of each malignancy, but also on the social and economic status of each patient. That status also can determine a patient’s access to good nutrition.
“For patients who are undergoing cancer treatment and are already struggling with nausea, vomiting and diarrhea as side effects, add on top of that the difficulties affording food, and it's a recipe for malnutrition and poor outcomes,” said Anthony Sung, M.D., director of the Center for Survivorship and Patient-Oriented Research at The University of Kansas Cancer Center and professor of hematologic malignancies and cellular therapeutics at KU Medical Center. “We know that having a good nutritional status is tied to having better outcomes and doing well with cancer therapies.”
The financial pressures of a cancer diagnosis, including the cost of care, insurance issues and loss or interruption of employment, can make it hard for a patient to afford healthy food. Some patients end up choosing between paying for medications and care or paying for groceries. Estimates of the percentage of cancer patients who are food-insecure range between 17% and 55%, according to a 2022 study published in the Journal of the National Cancer Institute, compared with 12% for the general population.
Along with Anna Arthur, Ph.D., MPH, assistant professor of dietetics and nutrition at KU School of Health Professions, Sung is leading a multicenter trial, funded by a five-year, nearly $4 million grant awarded last fall by the National Institutes of Health, to tackle food insecurity in people with blood cancers who are receiving transplant or cellular therapy (TCT). Memorial Sloan Kettering Cancer Center, Duke University and Stanford also are participating in the trial, known as NOURISH (Nutrition Outreach in Systems of Healthcare).
TCT patients were chosen for the trial because they struggle a lot with nausea and other side effects and have especially high rates of malnutrition. They often end up needing to be fed intravenously, which, Sung noted, is less healthy, associated with complications such as infection and more expensive than regular food. Also, three-quarters of TCT patients must relocate temporarily to live near a quaternary cancer center to receive TCT, removing them from their normal sources of support.
Food insecurity can be addressed by directing patients to food banks, but that can present logistical problems such as distance and transportation, as well as stigma, Sung noted. Home-delivered meals are another option, but delivery makes them expensive. Instead, NOURISH, which will begin enrolling participants this spring, will provide bags of nutritious food directly to food-insecure TCT patients during their clinic visits. Participants will also receive recipes and be able to watch videos of cooking demonstrations to prepare the recipes. Each cancer center will work with a local food bank — KU Cancer Center is collaborating with Harvesters in Kansas City — to provide and prepare the bags of food. The bags will focus on a balanced diet containing whole grains, protein, healthy fats and “shelf-stable” foods, which can be stored safely at room temperature, said Arthur, who is co-principal investigator on the trial.
“And because malnutrition is such an issue in this patient population, we can, during the treatment phase, liberalize the diet. The focus might need to shift from a balanced diet low in saturated fats and plenty of fiber and whole grains to just making sure they are getting enough calories and protein to get through treatment as well-nourished as possible,” said Arthur.
Participants in the study will be assessed before, during and after TCT treatment. The researchers hypothesize that the study participants receiving the food bags will have less malnutrition than the control group, who will not receive food bags but will receive information on food banks. All participants’ nutrition statuses will be measured using the Global Leadership Initiative on Malnutrition assessment. The researchers will also measure the impact of NOURISH on other clinical outcomes such as mental health and hospitalizations.
They also hope to see whether NOURISH may reduce costs to health systems by decreasing the need for intravenous nutrition for TCT patients. Rather than reimbursing for each related service, many insurers reimburse health systems for TCT with a “bundled payment,” a lump sum. Reducing costs to health systems would provide them with an incentive to continue the partnership between the food banks and the cancer centers to provide food to TCT patients who need it, even after the trial and funding conclude.
“This is not just a research study; it’s part of our commitment to our patients, and to make sure our therapies are inclusive of all patients and that means addressing food insecurity,” said Sung. “Our hope is that we can show benefit in this population, and then extend this model to all cancer patients.”
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