Association between food insecurity and healthcare utilization among patients at a breast oncology center.

143 Background: A breast cancer (BC) diagnosis often creates or exacerbates financial stress. As a result, many patients with BC struggle with a lack of consistent access to nutritious food due to limited resources, a condition termed “food insecurity” (FI). We investigated the association between FI and healthcare utilization among breast oncology patients at our urban academic medical center. Methods: Screening for health-related social needs (HRSN) was conducted primarily through the electronic patient portal, at appointment registration for a breast oncology clinic visit. The 8-item HRSN survey included 2 questions on access to food resources and 1 question quantifying emergency department (ED) visits over the past year. Any level of food hardship or concern constituted a positive FI screen. We conducted a retrospective analysis among patients evaluated between 11/2/22 and 4/20/24. Clinical and demographic data were obtained from the electronic health record (EHR). We evaluated the association between FI and health care utilization measures (ED visits, inpatient admissions) with a Pearson's Chi-squared test and univariate logistic regression. Results: A total of 2820 patients were screened for HRSN and provided responses to at least 1 FI question, of which 19.7% (555) reported some level of FI. Food-insecure patients self-reported significantly higher rates of ED visits in the past 12 months compared to food-secure patients: 43.2% vs 22.6% reported at least 1 ED visit, respectively (p<0.001), and 25.0% vs 8.45% reported multiple ED visits, respectively (p<0.001). Overall, FI was associated with 2.5 times the odds of self-reporting at least 1 ED visit (univariate OR 2.47, p<0.001). Similarly, on review of EHR data, 33.3% of food-insecure patients had at least 1 ED visit (vs 20.0% of food-secure patients, p<0.001), and 6.13% had 3 or more ED visits (vs 2.83%, p<0.001) during the study period. On univariate analysis, food-insecure patients had double the odds of having at least 1 ED visit documented in the EHR (univariate OR 2.00, p<0.001). We examined reasons for ED presentations among 186 food-insecure patients with ED visits during the study period, and found that 23.8% had at least 1 cancer-related complaint (oncological treatment-related (16.8%) and/or BC symptom-related (8.6%)). The incidence of inpatient admissions during the study period was similar among food-insecure vs food-secure patients (19.8% vs 18.4%, p=0.467). Conclusions: In this analysis of FI and health care delivery measures, ED utilization was significantly higher among food-insecure patients. A quarter of food-insecure patients who presented to the ED had oncological complaints. FI may be a marker of unmet healthcare needs in patient with cancer, and targeted interventions focused on symptom monitoring and management are warranted to optimize healthcare utilization.