FOOD (Food to Overcome Outcomes Disparities)

项目摘要 世界卫生组织将粮食安全定义为获得充足、安全、营养的食物， 保持健康和积极的生活。粮食安全包括实际和经济上获得粮食， 满足人们的饮食需求和偏好。18项，12个月的时间参考美国家庭食品 安全调查模块（USDA）将个人分类为具有高度粮食安全、边缘粮食安全、 粮食安全水平低，或者说粮食安全水平非常低。美国的粮食不安全状况正在加剧，总体患病率为 12.7%（粮食安全程度低和极低）。移民和少数民族普遍缺乏粮食安全 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，并且往往买不起处方药。 食物不安全的患者有显着更高的营养风险，抑郁，经济紧张水平， 生活质量营养干预提高了生活质量。癌症患者尤其 由于治疗方案和疾病的强度， 过程本身。一项针对纽约市一组未得到充分服务的癌症患者的研究显示， 粮食不安全，38%的人粮食安全程度很低。治疗依从性是一个重要的 癌症患者生存的决定因素。然而，在少数民族癌症患者中， 社会经济和支持性护理需求与患者报告的漏诊放射相关，和/或 化疗预约粮食不安全可能作为一个中介因素，作为功能，社会和 随着粮食不安全的加剧，情感幸福感显著下降。在我们工作之前， 只有一项研究调查了癌症患者的食物不安全状况。迄今为止，没有证据表明 解决粮食不安全问题干预措施及其缓解癌症和其他慢性病的潜力 完成治疗的差异。克服结果差异的食物（FOOD）解决了这一差距， 第一次大型研究，检查弱势群体的食物干预及其对乳腺癌的影响 完成癌症治疗。结果有可能指导方案和政策的改变。食物将利用 一项三组随机对照试验，旨在评估基于医院的医学定制食品储藏室的影响 （储藏室）与食品券计划（配送）与家庭杂货配送计划（配送） 完成癌症治疗。食物是纪念斯隆凯特琳癌症中心 (MSK)移民健康和癌症差异（IHCD）服务，纽约市食品银行，新的 约克市理事会、纽约市卫生和医院、我们传递上帝的爱和圣巴纳巴斯 医院本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， 该研究考察了一个可扩展的、基于诊所的食品储藏室、一个食品券计划和家庭杂货配送。

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.