March 2020 Issue
Cancer Nutrition: Food is Medicine Organizations Improve Patients’ Health
By Brianna Tobritzhofer, MS, RD, LD
Vol. 22, No. 3, P. 12
As the second most common cause of death in the United States, cancer is a debilitating disease that has extensive nutrition implications. According to the American Cancer Society, there were approximately 740,000 new cancer cases in the country in 2019, 42% of which were potentially avoidable with changes in lifestyle and eating habits.1 Fortunately, there are many community initiatives dedicated to reducing cancer rates and improving the nutrition status of those diagnosed with the disease. Food is Medicine organizations, for example, are available in several states as a resource for cancer patients. Dietitians should become familiar with these organizations so they can make appropriate referrals and ensure patients have what they need to implement nutrition and lifestyle recommendations provided in clinical settings.
Background on the Organizations
Food is Medicine organizations provide community-based nutrition services focused on offering home-delivered and medically tailored meals to patients at risk of malnutrition from serious illnesses. Programs are dedicated to meeting MNT requirements for conditions such as renal disease, congestive heart failure, HIV/AIDS, and cancer. Open Arms of Minnesota (OAM), a Food is Medicine organization in Minneapolis, has been providing free nutrition services for more than 30 years and introduced services for cancer patients in 2005, according to its client database. Currently, more than 50% of OAM’s 1,000 clients have a cancer diagnosis. Its services also are available for clients with HIV/AIDS, end-stage renal disease, congestive heart failure, multiple sclerosis, atrophic lateral sclerosis, and COPD.
OAM and other Food is Medicine organizations help champion the American Cancer Society’s nutrition guidelines, which are focused on promoting healthful individual choices and community action.2 These guidelines are challenging for some cancer patients to follow on their own. For example, there’s a considerable financial burden associated with a cancer diagnosis. The Agency for Healthcare Research and Quality estimates that the direct medical costs for cancer in the United States in 2015 were $80.2 billion. Approximately 52% of those costs were for hospital outpatient or office-based provider visits, and 38% were for inpatient hospital stays.1 Community initiatives, such as Food is Medicine, are vital to address financial and other barriers that prevent cancer patients from obtaining the nutrition they need. Food is Medicine organizations strive to provide free resources for cancer patients to help them maintain a nutritious diet, manage treatment side effects, and improve treatment success.
How Food is Medicine Organizations Work
What makes Food is Medicine programs unique is their focus on medically tailored meals. According to the Food is Medicine Coalition, an association of nonprofit medically tailored food and nutrition service providers, medically tailored meals are delicious, nutritious meals designed by dietitians to meet the unique medical needs of severely ill people to keep them healthy and at home.3
Each Food is Medicine organization is required to have at least one dietitian on staff and professional chefs who develop menu selections specifically to meet the various medical needs of cancer patients who must manage comorbidities, side effects, and complications. For example, OAM has a flavor-neutral menu that includes bland, soft foods for cancer patients struggling with taste changes, food aversions, and mouth sores. It also has a high-calorie and high-protein menu for clients who need support with weight and strength maintenance, as well as low-sodium, gluten-free, dairy-free, and vegan options. All of the food on OAM’s menus can be modified to a puréed texture. OAM clients also have the option to receive a “nausea care pack” with their deliveries, which includes food items that help alleviate side effects related to cancer treatment. The menu options Food is Medicine programs offer vary, but generally they follow evidence-based guidelines established by reputable organizations such as the American Heart Association and the Academy of Nutrition and Dietetics. The meal deliveries these programs provide typically contain between 50% and 100% of their clients’ overall nutritional needs.
Processes for meal production vary by program, but most produce meals from a central kitchen. Chefs and volunteers are responsible for preparing and cooking the meals. Programs typically staff a logistics and delivery team that organizes delivery schedules; employees and/or volunteers coordinate meal deliveries.
Funding for Food is Medicine programs and services also varies. Many are supported by individual donations, foundations, grants, and health care partnerships.
In addition to medically tailored meals, many Food is Medicine organizations provide services to engage their clients and expand the impact of their missions. Some of the services include ongoing nutrition classes, grocery deliveries, and group meals for seniors. For example, OAM offers monthly cooking classes and provides written nutrition information in each client’s weekly meal delivery. The organization also owns and operates five urban farms throughout the Twin Cities, where produce is grown using organic methods. The produce is then harvested and used for client meals and a community supported agriculture program. OAM also gives clients ingredient labels for every food item they receive plus nutrition facts information upon request.
Nutrition counseling is another essential service Food is Medicine organizations offer. Most of their on-staff dietitians are available to meet with clients by telephone or in person to discuss nutrition goals that help them make the connection between how the medically tailored meals they receive impact their health. The support the RDs provide is intended to help clients overcome barriers and learn to make healthful choices on their own. OAM currently has three full-time dietitians who work with clients. In 2019, approximately 35% of clients who received nutrition counseling from OAM dietitians had a cancer diagnosis.
Finding a Food is Medicine Organization
People can find Food is Medicine organizations in 22 different states throughout the country. OAM, as well as various other programs, have services available specific to cancer patients. Many of the organizations have shipping programs that enable them to deliver meals to clients who live outside of their core delivery areas. Clients can visit www.fimcoalition.org/partners for more information about Food is Medicine organizations.
Before clients are approved to receive services, typically Food is Medicine organizations will require referrals from medical providers. Most will require verification of the client’s illness, nutritional status, and difficulty accessing and/or preparing healthful foods. Some programs, including OAM, also provide meals for their clients’ caregivers and dependents. And after clients have received services for a certain length of time, the organizations usually will require them to undergo recertification to update their clients’ diagnoses, medical status, and nutritional needs.
It’s important to keep in mind that Food is Medicine organizations differ in terms of the types of illnesses they serve, the menus and services offered, and their application process. If clients have questions about their local Food is Medicine organization, they should contact the organization directly to obtain accurate information.
Dietitians should determine whether they have Food is Medicine organizations in their area and keep the programs on a list of resources for their clients who have cancer. In the future, Food is Medicine organizations may become more widely available and a routine component of health care for cancer patients.
Food is Medicine organizations have the potential to improve the health and quality of life of their clients. By providing home-delivered, nutrient-dense meals to cancer patients, organizations intend to help reduce the risk of and prevent complications from malnutrition. According to the European Journal of Oncology Nursing, a reported 20% of cancer patients die from malnutrition rather than their primary cancer diagnosis.4 In 2019, approximately 22% of new clients with cancer who were referred to OAM had a severe malnutrition diagnosis. The healthful meals and nutrition education the program provides aim to help improve health outcomes for these individuals.
Many of these clients with cancer that OAM serves report health benefits after services begin. According to OAM’s internal client survey, one individual diagnosed with lymphoma and severe malnutrition in 2019 reported a 12-lb weight gain after only two months of receiving meals from OAM. Another individual with colon cancer had an unintended 40-lb weight loss before becoming an OAM client. Since receiving meals, she has maintained her weight and stopped progression of her malnutrition. Overall, 92% of OAM clients report that receiving meals from the organization helps them eat more healthfully, and 91% report that the meals have made a difference in maintaining their health.
Several research studies have been conducted to support the benefits of Food is Medicine organizations. One study conducted in partnership between MANNA, a Philadelphia-based Food is Medicine organization, and a health insurance company in 2017, found improved health outcomes after providing medically tailored meals and nutrition counseling to chronically ill members. A 26% reduction in inpatient admissions and 7% reduction in emergency department visits was observed among individuals with Medicaid and Medicare coverage.5 Similar results were found in research led by a San Francisco–area Food is Medicine organization, Project Open Hand, in 2014. Home-delivered, medically tailored meals lead to a 63% reduction in hospitalizations, 50% increase in medication adherence, and 58% decrease in client emergency department visits among patients with HIV and type 2 diabetes.6
Although the findings of Food is Medicine studies are promising, most of the methods used have been observational. Thus, more research is needed to confirm the benefits of these programs. There haven’t been any Food is Medicine studies specifically conducted on cancer patients. At present, most of the benefits of Food is Medicine programs for cancer patients are anecdotal. Nevertheless, these programs are a useful resource for dietitians to refer their cancer patients to, especially those who have difficulty accessing and/or preparing healthful meals on their own.
— Brianna Tobritzhofer, MS, RD, LD, is the senior manager of nutrition services for Open Arms of Minnesota. She also provides freelance writing services through her business, Bri Toby Nutrition Company.
1. American Cancer Society. Cancer facts & figures 2019. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf. Published 2019. Accessed December 1, 2019.
2. ACS guidelines for nutrition and physical activity. American Cancer Society website. https://www.cancer.org/healthy/eat-healthy-get-active/acs-guidelines-nutrition-physical-activity-cancer-prevention/guidelines.html. Updated April 13, 2017. Accessed December 4, 2019.
3. The medically tailored meal intervention. Food is Medicine Coalition website. http://www.fimcoalition.org/our-model. Accessed December 1, 2019.
4. Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs. 2005;9 Suppl 2:51-63.
5. HealthPartners Plans. Food as medicine model: a framework for improving member health outcomes and lowering health costs. https://www.healthpartnersplans.com/media/100225194/food-as-medicine-model.pdf. Accessed December 3, 2019.
6. Palar K, Napoles T, Hufstedler LL, et al. Comprehensive and medically appropriate food support is associated with improved HIV and diabetes health. J Urban Health. 2017;94(1):87-99.