When people become seriously ill, their ability to work may be diminished, and this can often lead to a number of tough circumstances, including food insecurity.
“Sometimes patients have to choose between food and medicine,” explained Meredith Doherty, PhD, LCSW, assistant professor at Penn’s School of Social Policy & Practice (SP2) and a member of the Penn Center for Cancer Care Innovation (PC3I). “Since our national safety net programs are insufficient, health care systems end up taking on a lot of social problems, like food insecurity, because we’re filled with professionals who see the problem and care.”
Cancer patients at Abramson Cancer Center (ACC) at Penn Presbyterian Medical Center (PPMC) now have access to free, healthy food through a community refrigerator program, Ujamaa Café™, provided by the Coalition for Food and Health Equity (CFHE) through support from the American Cancer Society.
Food insecurity, or the lack of consistent access to enough food for every person in a household to live an active, healthy life affects more than 34 million people in the United States, according to Feeding America. For people living with cancer, the risk of food insecurity is about double that of the general population, says Doherty.
There is no shortage of examples of caring professionals taking initiative to help patients access healthy food across the Penn Medicine system — from a food pantry at the Hospital of the University of Pennsylvania (HUP), to the Food Farmacy program at Penn Medicine Lancaster General Health, to a food bank partnership with Chester County Hospital's OBGYN Clinic and more. The community refrigerator at PPMC is the first food intervention program within an ACC location and is specifically designed to offer prepared, ready-to-eat snacks and meals.
Easy Access with Tech-Enabled Fridge
“Patients may be sitting the in the infusion center for three to four hours receiving chemotherapy, so we liked the idea of having healthy, prepared food they can grab in case they get hungry during treatment or forgot to bring a snack,” said Amy Schwartz, director of PPMC Cancer Service Line Operations, who helped lead the implementation of the project. “Having prepared food also takes the burden to cook off patients. Whether they’re tired after treatment, don’t have access to healthy food, or are just busy, we hope this helps take a bit of work off the patient.”
The community refrigerator was installed in June in the reception area of the ACC at PPMC. Patients don’t need to provide personal information or have a referral or other permission to access the fridge — they simply enter the code on the front of the door to open it and can select any food items they want for free.
“Ujamaa Cafes are strategically placed within locations of historic inaccess to healthy food options,” said Leeja Carter, PhD, CEO and founder of the CFHE. The café at PPMC grew out of discussions between Carter, Doherty and SP2 colleagues Millan AbiNader, LMSW, PhD, Tamara J. Cadet, PhD, LICSW, MPH, and Yoosun Park, MSW, PhD.
As part of the program, the refrigerator is tech-enabled to track which items are taken, so that staff can re-stock as needed and, over time, adjust stocking to meet preferences at a particular location. The New Jersey-based program supports the local small business economy by partnering with local restaurants and food entrepreneurs—particularly Black and minority-owned businesses—to provide the food for its refrigerators. In its initial rollout phase, the refrigerator at PPMC is stocked with a variety of overnight oats, grab-and-go snacks layered with fruit, oats, and chia pudding, and more menu items will be added in the future.
Nutrition Challenges for Cancer Patients
For cancer patients, nutrition concerns extend beyond access and ability to afford healthy food.
“The top issue I see is weight loss,” said Olga Kanteliotis, MA, RDN, LDN, a clinical dietitian specialist who works with cancer patients in the ACC at PPMC. As many as 80 to 85% percent of cancer patients struggle to maintain weight during cancer treatment, she says.
The reasons vary—chemotherapy can cause a lack of appetite or loss of taste and treatment can make patients too tired to cook or eat—but result is the same: if patients lose too much weight or become malnourished, it can affect how they feel, how their body responds to treatment, and their ability to continue certain treatment plans.
Kanteliotis employs a variety of techniques to help patients maintain their weight during treatment and recommends that patients focus on eating calorie-dense foods while going through treatment, but that may be difficult for someone who has a low or fixed income, doesn’t do their own grocery shopping, or is affected by other social determinants of health (SDOH), which are nonmedical factors that influence health outcomes and can contribute to health disparities.
As Doherty explains, food insecurity is just one factor among many that can affect a patient’s cancer treatment experience and overall health outcomes: “All of these variables are co-occurring together, there’s no separation between conditions.” In other words, it’s difficult to assess the impact of a food insecurity intervention for cancer patients because, in real life, health status and access to food are interwoven with a variety of other SDOH.
With that connectedness in mind, patients can choose to scan a QR code on the door to share their experience with the service and note if they’d like to participate in a future community-based participatory research (CBPR) project.
“The patients using the fridge are people who have access to high-quality care at Penn, in theory,” Doherty said. “We want to know more about the social determinants that impede their ability to maximally benefit from that care.”
Patients can find the community refrigerator in the Abramson Cancer Center lobby, located on the first floor of the Cupp Lobby, at PPMC. The current menu is available online here.