LAUSR

Food insecurity can negatively impact adherence and receipt of high-quality cancer care. The purpose of the study was to (1) compare the prevalence of COVID-19 associated food insecurity by cancer history and (2) examine determinants associated with COVID-19 related food insecurity among cancer survivors. We used nationally-representative data from the COVID-19 Household Impact Survey (n = 10,760), collected at three time points: April 20-26, May 4-10, and May 30th -June 8th of 2020. Our primary exposure was cancer survivor status, based on participant self-report of a cancer diagnosis (n=854, 7.1%). Primary outcomes of food insecurity were categorized on how often participants reported the following: We worried our food would run out before we got money to buy more or The food that we bought just didn't last, and we didn't have money to get more; Respondents were categorized as food insecure if they chose often true or sometimes true. Multivariable Poisson regression was used to identify demographic determinants of food insecurity among cancer survivors. Thirty-two percent of cancer survivors were food insecure. Cancer survivors aged 30-44 years and those aged 60 or above were more likely to report being food insecure compared to respondents without a history of cancer in the same age categories (30-44 years, 59.9% versus 41.2% p = 0.01, 60 or above years 27.2% versus 20.2%, p = 0.01). Cancer survivors without a high school diploma were more likely to report food insecurity compared to adults with no history of cancer (87.0% versus 64.1%, p = 0.001). In multivariable models, uninsured cancer survivors (adjusted Prevalence Ratio (aPR) aPR: 2.39, 95% CI: 1.46-3.92) and those on Medicaid (aPR: 2.10, 95% CI: 1.40-3.17) were also more likely to report being food insecure. Food insecurity during the COVID-19 pandemic is vast but disparities persist. Among cancer survivors, differences in food insecurity were observed by age and SES.