ABSTRACT
Food insecurity (FI), defined as a lack of consistent access to enough food for every person in a household to
live an active, healthy life due to insufficient money or other resources, affects 17 million (12.8%) of American
households. FI is exacerbated in patients with complex medical conditions, and it is associated with worse health
outcomes and increased healthcare utilization and costs. Strategies to address FI such as home-delivered meals
or food assistance programs like the Supplemental Nutrition Assistance Program (SNAP) and food
banks/pantries/pharmacies may improve healthcare outcomes. However, home-delivered meals are associated
with higher costs due to individualized delivery while food assistance programs have several barriers to
participation. We propose to leverage the strengths of both those approaches in a novel healthcare-community
partnership between cancer centers and food banks called Nutrition OUtReach In Systems of Healthcare
(NOURISH), to directly deliver food to patients in clinic. Patients, caregivers, dietitians, social workers, nurses,
physicians, food bank staff, and community members will work together to determine medically tailored options
for the patient population; food banks will oversee sourcing and preparing bags of food; and healthcare providers
will distribute bags to patients in clinic after their appointments. Because NOURISH does not require patients to
make an extra trip and bags are distributed discreetly to avoid stigma, it increases adoption; because food is
handed out in clinic, it lowers costs. We propose to evaluate NOURISH in a multicenter randomized controlled
trial in FI patients with hematologic malignancies receiving transplant and cellular therapy (TCT). We chose this
population for three reasons: (1) TCT patients are in great need as approximately 75% will relocate to live near
a quaternary cancer center (QCC) for a month or more while receiving TCT, removing them from their normal
sources of support; (2) TCT patients are at high risk for malnutrition and other adverse outcomes, often struggling
with nausea, anorexia, and other side effects that can be exacerbated by FI; (3) TCT may be a model for
sustaining care: while other Food is Medicine initiatives have shown economic benefits, because cost savings
do not flow to healthcare systems, there is little incentive for implementation. In contrast, TCT is among the most
expensive medical procedures, and healthcare systems are typically reimbursed through bundled payments. As
a result, QCCs have an incentive to pursue strategies that may lower costs and improve outcomes. For example,
many TCT patients with FI will receive total parenteral nutrition, at significant cost. NOURISH may prevent
malnutrition and the need for intravenous nutrition through much cheaper food assistance. The success of our
randomized controlled trial will provide a compelling rationale for QCCs to continue to fund food banks in their
communities, providing much-needed financial support to sustain these partnerships while improving access and
outcomes for patients. Furthermore, positive experiences in TCT may lead to the expansion of these healthcare-
community partnerships to the broader cancer population and beyond.