Association of food insecurity and financial hardship with healthcare utilization among adults with cancer treated in a large, urban cancer center.

Abstract

e13579 Background: Patients with cancer are particularly vulnerable to financial toxicity (FT), which can impact their access to food and other basic resources. Food insecurity (FI) and FT are actionable determinants of health. We examined the relationship between FI and FT with healthcare utilization in a cohort of adults receiving cancer care within a large, urban, comprehensive cancer center. Methods: Systematic screening for FI and FT was implemented across multiple outpatient oncology clinics in 2022 first in breast oncology clinic and later, hematologic malignancy and pediatric oncology clinics. FI was measured with a validated 2-item tool, and FT was measured with a previously established, abbreviated (2-item) Comprehensive Score of Financial Toxicity. Data were entered into the electronic health record by patient-report (portal) or after in-clinic paper screening. Patients included in this analysis were at least 18 years, had at least one encounter in a participating oncology clinic and completed screening for FI and FT at least once between 11/1/2022 and 6/1/2024. The primary outcome was visit to the emergency department (ED) within 6 months of a patient’s last screen for FI or FT. Due to co-linearity between FI and FT, multivariable (MV) logistic regression was used to model the association of FI and separately FT with ED visits, adjusting for demographic factors (age, language, patient reported race and ethnicity [non-Hispanic White [NHW], Hispanic [any race], non-Hispanic Black [NHB], other] and clinic location). Results: In total, 2,361 patients completed FI and FT screening. Most used English (77%) identified as NHW (38%) or Hispanic (29%) and were treated in breast oncology (88%). Across all clinics, 499 patients (21%) reported FI, 1,522 (64%) reported FT, and 190 (8%) had at least 1 ED visit. 159 patients with a positive FT screen (10%) had at least 1 ED visit, vs 31 patients (3.7%) with a negative screen. Controlling for demographic and clinic location, FT was associated with a 2.12 higher odds of ED visits compared with non-FT exposed patients (CI 1.40-3.28); race and ethnicity was also significantly associated with ED visits (Hispanic OR: 2.36 [CI 1.49-3.74]; NHB OR: 2.17 [CI 1.31-3.56]. 76 patients with a positive FI screen (15%) had at least 1 ED visit, vs 114 patients (6.1%) with a negative screen. FI was also associated with a 1.83 higher odds of ED visits (CI 1.30-2.56), as was ethnicity (Hispanic OR: 2.56 [CI 1.56-3.91] and race (NHB OR: 2.19 [CI 1.32-3.61]). In both analyses, language, age, and clinic location were not significantly associated with ED visits. Conclusions: Implementing FI and FT screening may facilitate mitigation strategies for patients at-risk for increased healthcare utilization. While these associations may not be causal, addressing these factors may be a way to reduce ED visits.