FOOD (Food to Overcome Outcomes Disparities)

项目摘要 世界卫生组织将粮食安全定义为能够获得足够、安全、有营养的食物 保持健康和积极的生活。粮食安全包括获得粮食的物质和经济机会 满足人们的饮食需求和喜好。18个项目，12个月时间参考的美国家庭食品 安全调查模块(USDA)将个人归类为高度粮食安全、边际粮食安全、 粮食安全水平低，或者说粮食安全水平很低。美国的粮食不安全状况正在加剧，总体上 12.7%(低和极低的粮食安全)。移民和少数民族中普遍存在的粮食不安全问题 社区数量超过全国平均水平。粮食不安全与不坚持治疗有关。 食物不安全的患者更有可能推迟护理，而且往往负担不起处方药(S)。 食物不安全的患者有更高的营养风险、抑郁、经济压力和更低的 生活质量。营养干预可提高生活质量。癌症患者尤其是 由于治疗方案和疾病的强度，易受粮食不安全及其影响的影响 进程本身。对纽约市一群服务不足的癌症患者进行的一项研究显示，56%的人 粮食不安全，38%的人粮食安全水平很低。坚持治疗是一个重要的 癌症患者生存的决定因素。然而，在少数民族癌症患者中，没有得到满足 社会经济和支持性护理需求与患者报告的错过放射治疗有关，和/或 化疗预约。粮食不安全可能起到中介因素的作用，如功能性、社会性和 情绪幸福感随着食物不安全程度的增加而显著下降。在我们的工作之前，有过 只有一项研究调查了癌症患者的食物不安全问题。到目前为止还没有证据表明 解决粮食不安全问题的干预措施及其改善癌症和其他慢性病的潜力 治疗完成率的差异。克服结果差异的粮食(粮食)解决了这一差距，因为 首次对易感人群进行食物干预及其对乳房影响的大型研究 癌症治疗完成。结果有可能指导计划和政策的变化。食物将会利用 评估以医院为基础的医疗定制食品储藏室的影响的三组随机对照试验 (食品储藏室)与食品券计划(代金券)与家庭杂货递送计划(递送) 癌症治疗完成。食物是纪念斯隆·凯特琳癌症中心的合作伙伴关系 (MSK)移民健康和癌症差异(IHCD)服务，纽约州纽约市食品银行 纽约市议会、纽约市卫生和医院、我们传递的上帝之爱和圣巴纳巴斯 医院。这项研究建立在一项开创性的试点可行性随机对照试验的基础上， 它检查了一个可扩展的、以诊所为基础的食品储藏室、一个食品券计划和家庭杂货递送。

Project Summary The World Health Organization defines food security as having access to sufficient, safe, nutritious food to maintain a healthy and active life. Food security includes both physical and economic access to food that meets people's dietary needs and preferences. The 18-item, 12-month time-referenced U.S. Household Food Security Survey Module (USDA) categorizes individuals as having high food security, marginal food security, low food security, or very low food security. Food insecurity is growing in the U.S., with an overall prevalence of 12.7% (low and very low food security). The prevalence of food insecurity among immigrant and minority communities exceeds the national average. Food insecurity is associated with non-adherence to treatment. Food-insecure patients are more likely to postpone care and often cannot afford prescribed medication(s). Food-insecure patients have significantly higher levels of nutritional risk, depression, financial strain, and lower quality of life. Nutrition interventions result in enhanced quality of life. Cancer patients are particularly vulnerable to both food insecurity and its impact, due to the intensity of treatment protocols and the disease process itself. A study among a cohort of underserved cancer patients in New York City showed that 56% were food insecure, with 38% of the cohort with very low food security. Treatment adherence is an important determinant of survival among cancer patients. However, among ethnic minority cancer patients, unmet socioeconomic and supportive care needs are associated with patient-reported missed radiation, and/or chemotherapy appointments. Food insecurity potentially acts as a mediating factor, as functional, social, and emotional well-being decrease significantly with increasing food insecurity. Prior to our work, there had been only one study examining food insecurity in cancer patients. There is to date no evidence base on interventions to address food insecurity, and their potential to ameliorate cancer and other chronic disease treatment completion disparities. Food to Overcome Outcomes Disparities (FOOD) addresses this gap as the first large study of its kind to examine food interventions in vulnerable populations and their impact on breast cancer treatment completion. Results have the potential to guide program and policy change. FOOD will utilize a three arm randomized controlled trial to assess the impact of a hospital-based medically tailored food pantry (Pantry) versus a food voucher program (Voucher) versus a home grocery delivery program (Delivery) on cancer treatment completion. FOOD is a partnership between the Memorial Sloan Kettering Cancer Center (MSK) Immigrant Health and Cancer Disparities (IHCD) Service, the Food Bank for New York City, the New York City Council, the New York City Health and Hospitals, God's Love We Deliver, and Saint Barnabas Hospital. This study builds upon the foundation laid by a seminal pilot feasibility randomized controlled trial, which examined a scalable, clinic-based food pantry, a food voucher program, and home grocery delivery.