Impact of medically tailored meals plus nutrition counseling on treatment adherence in vulnerable lung cancer patients: Results from NutriCare randomized controlled trial.

Abstract

1672 Background: This study aims to evaluate the impact of a Food is Medicine intervention on reducing treatment interruptions among vulnerable patients with lung cancer in a multi-site randomized controlled trial (RCT). Methods: Newly diagnosed stage I-IV lung cancer patients (n=249) enrolled from four cancer centers (MD Anderson Cancer Center, The Ohio State University Comprehensive Cancer Center, Fox Chase Cancer Center, and Tufts Medical Center) were randomized to the NutriCare (intervention; n=134) or NutriTool (control; n=115) arm in a 1:1 ratio. Patients on NutriTool received a nutrition toolkit for cancer survivors and monthly nutrition information and recipes. Patients on NutriCare additionally received 6-8 months (mo) of tapered home-delivered medically tailored meals (initially 21 meals/week) plus remote nutrition counseling provided by registered dietitians. Treatment interruptions, including overall interruptions and those due to treatment toxicities, were assessed using the relative dose intensity (RDI) and number of treatment cycles with dose delay or reduction among patients receiving curative or first-line palliative treatment. The primary analysis was intention-to-treat, comparing treatment interruptions between arms using Poisson regression models. Results: The mean (SD) of RDI was 0.84 (0.26) and 0.81 (0.26) for patients on NutriCare and NutriTool, respectively (p=0.24), with approximately 31% of the NutriCare patients having RDI reduction of 15% or more compared to 38% of the NutriTool patients (p=0.36). After restricting the analyses to treatment interruptions due to toxicities, 14.4% of NutriCare versus 25.4% of NutriTool patients experienced RDI reduction of 15% or more (p=0.08). After multivariable adjustments, NutriCare patients had 16% lower risk of having RDI reduction of 15% or more (relative risk [RR]=0.84, 95% confidence interval [CI]: 0.47-1.47) and 41% lower risk of having toxicity-related RDI reduction of 15% or more (RR=0.59, 95% CI: 0.28-1.24) than NutriTool patients. For dose delays, NutriCare patients had 35% lower risk of having any dose delay (RR = 0.65, 95% CI: 0.28-1.49) and 44% lower risk of having toxicity-related dose delay (RR=0.56, 95% CI: 0.16-1.97) compared to NutriTool patients. For dose reduction, NutriCare patients had 19% lower risk of having any dose reduction (RR=0.81, 95% CI: 0.49-1.34) and 35% lower risk of having toxicity-related dose reduction (RR=0.65, 95% CI: 0.35-1.22) compared to NutriTool patients. None of the differences reached statistical significance. Conclusions: Findings suggest that a Food is Medicine intervention comprising medically tailored meals and nutrition counseling may reduce treatment interruptions among vulnerable patients with lung cancer undergoing treatment. Clinical trial information: NCT04986670 .