Food Insecurity and Cardiovascular Risk Among Survivors of Pediatric Hematologic Malignancies

Background: Childhood cancer survivors (CCS) experience cardiovascular (CV) mortality rates seven times higher than the general population, with racial and socioeconomic disparities in CCS CV outcomes. Food insecurity is a known modifiable CV risk factor that impacts 1 in 4 children with cancer at the time of diagnosis. The prevalence of food insecurity in the post-treatment period is unknown, but represents an opportunity for targeted intervention. Among a cohort of early CCS, we aimed to 1) evaluate the feasibility of systematic parent-reported food insecurity data collection, and 2) characterize the prevalence and overlap of food insecurity and CV risk.

Methods: Pediatric patients (<18 years) with hematologic malignancies who completed cancer-directed therapy at a quaternary academic pediatric cancer center within the past year were recruited at in-person clinic visits. Parent/guardians of participants provided consent and electronically completed a single-timepoint Household and Nutrition Survey, reporting on relevant domains of child exposures including a validated 8-item measure of household- and child-level food insecurity. Medical record abstraction was performed to evaluate CV risk, defined as any of the following: hypertension (systolic or diastolic blood pressure >95^th percentile), elevated body mass index (>85^th percentile), dyslipidemia, or impaired glucose tolerance; or receipt of anthracycline chemotherapy, chest radiation, or total body irradiation. Feasibility was defined as ≥75% consent rate and ≥75% complete food insecurity data.

Results: Among 70 eligible patients, 62 (89%) consented to participate, and 59 (95%) contributed surveys with no missing food insecurity data; 51 (86%) consented to medical record abstraction. Patients had a mean age of 7.4 years; 48% were female; parent-reported child racial/ethnic identities included 11 (19%) Asian, 7 (12%) Black, and 8 (14%) Hispanic. Fifteen (25%) patients were exposed to food insecurity, with 12 (20%) exposed to both household- and child-level food insecurity, 2 (3%) only household-level food insecurity, and 1 (2%) only child-level food insecurity. Forty-one (80%) participants had CV risk factors, with 16 (39%) due to clinical conditions, 10 (24%) due to therapeutic exposures, and 15 (37%) due to both. Ninety-two percent (12/13) of patients with food insecurity had concurrent CV risk factors, compared to 76% (29/38) of food secure patients.

Conclusions: A majority of children with hematologic malignancies will go on to become long-term survivors; therefore, identification of modifiable risk factors and intervention to mitigate risk is paramount in this population. Our findings demonstrate the feasibility of systematically screening childhood cancer survivors for food insecurity in the early post-treatment period. Food insecurity – a modifiable CV risk factor – is highly prevalent and overlaps with other CV risk conditions in pediatric hematologic malignancy survivors. Interventions targeting food insecurity are urgently needed to mitigate CV risk and advance equity in survivorship outcomes.