Food Insecurity and Overall Survival in Locally Advanced Breast Cancer Patients Receiving Comprehensive Nodal Irradiation: The Food Insecurity–Obesity Paradox

This is the authors' abstract. We don't add key points for this paper.

Purpose: Residents of food-insecure areas (FIAs) experience worse cancer outcomes, but underlying mechanisms remain poorly understood. Prior studies have not determined whether inequalities result from differences in cancer characteristics, treatment delivery, adherence, or food insecurity (FI) itself. We hypothesized that patients with locally advanced breast cancer (LABC) residing in FIAs would demonstrate worse overall survival (OS) despite receiving similar cancer treatments with comparable treatment adherence. Methods and Materials: tests assessed differences in demographic, clinical, and treatment variables. Kaplan-Meier analysis and multivariable Cox regression models evaluated OS. Conclusions: Patients with LABC residing in FIAs had a 5.5 times higher mortality risk despite similar cancer characteristics, treatments, and adherence. Higher obesity rates among FIA residents that increased following treatment represent a novel characterization of the FI-obesity paradox in patients with breast cancer. These findings support residence in an FIA as an independent predictor of mortality and suggest that interventions must address nutritional quality and access.