Food insecurity prior to hematopoietic stem cell transplant is associated with malnutrition and worse outcomes.

Abstract

Food insecurity (FI), defined as the lack of continuous access to adequate food, affects 17-55% of cancer patients. Effects may be exacerbated in hematopoietic stem cell transplant (HSCT) patients, who face nutritional challenges due to treatment side effects, leading to weight loss and malnutrition. We hypothesize that pre-HSCT FI increases the risk of malnutrition, requiring nutrition support, and adverse psychosocial outcomes. Between February 2018 and August 2022, 284 patients were screened before HSCT for FI. 71 (25%) were excluded due to missing data. Of the remaining 213, 20 (9.4%) reported pre-HSCT FI. Patients with FI were more likely to develop malnutrition during HSCT (70% vs. 45.1%, p = 0.034) and need total parenteral nutrition compared to those without FI (65% vs. 34.2%, p = 0.013). Patients with FI also were more likely to screen positive for depression (40% vs. 10.4%, p = 0.002) and financial toxicity (75% vs. 25%, p < 0.001). There were no significant differences in survival or other secondary outcomes. Our study demonstrates that pre-HSCT FI significantly increases likelihood of malnutrition, the need for total parenteral nutrition, and adverse psychosocial outcomes in HSCT patients. These findings highlight the critical importance of early identification and interventions to address FI as part of comprehensive cancer care.