We may be living in a world where people survive cancer but die early because they don’t have access to nutritious food. A national study by Penn LDI Senior Fellow Jaya Aysola, Penn medical student John Lin, and colleagues found that food insecurity was associated with early mortality among cancer survivors.

But here’s the good news: Cancer survivors who got support from programs like SNAP or WIC didn’t face that same increased risk. Unfortunately, people above the cutoff to qualify for food assistance were going hungry, and this group of cancer survivors, “too rich” for help, but still food insecure, was at higher risk of death, the study shows.

The researchers analyzed National Health Interview Survey (NHIS) and National Death Index (NDI) data from January 2011 through December 2019 to investigate the associations between food insecurity and cancer-specific and all-cause mortality, adjusting for patient characteristics, behaviors, and socioeconomic indicators. They also explored the association of food assistance programs with food insecurity and mortality. They included 5,603 survivors of cancer in their study.

Food Insecurity Linked to Higher Risk of Death for Cancer Survivors, but Food Assistance May Help

Over a median follow-up of 7.6 years, there were 1,556 deaths from all causes. Among these, 169 deaths occurred in individuals experiencing food insecurity at the beginning of the study, and 1,387 occurred in those who were food secure. People who reported a lack of access to food or food insecurity were significantly more likely to die during the study period.

 “Food matters when it comes to cancer care and outcomes, and not just any food: Nutrient-dense food. Food insecurity in the US manifests as a lack of access to nutrient-rich food, and our study finds that among cancer survivors, this increases one’s risk of mortality,” said Aysola.

This increased risk of early death remained even after accounting for differences in age, demographics, socioeconomic status, health behaviors, and existing medical conditions. The relationship between food insecurity and mortality did not vary by age or income level.

However, among households receiving food assistance, food insecurity was not associated with higher risk of death from cancer or from all causes. In contrast, among households not receiving food assistance, food insecurity was linked to a higher risk of both cancer-related and overall mortality.

Food insecurity was associated with increased risk of cancer-specific and all-cause mortality among individuals with household incomes at or above 200% of the Federal Poverty Level (FPL). However, this association was not observed among individuals with incomes below 100% of the FPL, likely reflecting differences in access to food assistance programs.

Access to food assistance was strongly related to income: a majority (54%) of individuals with incomes below 100% of the FPL received food assistance, compared to only 17% of those between 100% and 200% of the FPL. Only 2% of those with incomes above 200% of the FPL received food assistance.

Food Insecurity Persists Above Food Assistance Income Thresholds

These findings underscore that food insecurity is not limited to the lowest-income households. The results suggest that food assistance programs may help reduce the link between food insecurity and cancer mortality. Importantly, the study shows that cancer survivors with incomes above eligibility thresholds for programs like SNAP and WIC are still vulnerable to food insecurity, and this insecurity is associated with worse cancer and all-cause mortality outcomes.

Study Limitations and Recommendations

In this study, cancer diagnoses were self-reported, and food security was measured at a single time point, which may not capture changes over time. The dataset also lacked clinical details such as cancer stage and treatment history. Despite adjusting for many factors, some confounding is possible.

Nonetheless, between 17% and 55% of people diagnosed with cancer qualify as food insecure. The strong evidence linking food insecurity to adverse health outcomes and the associations highlighted in this research suggest potential actions physicians can take. Many adults who report food insecurity do not participate in food assistance programs. Physicians could screen for food insecurity as part of routine care and refer patients to community resources such as food banks and meal delivery services. Collaborating with registered dietitians or nutritionists to create dietary plans that align with patients’ medical needs and financial limitations may also enhance care for individuals with cancer.

Cuts to SNAP were signed into law on July 4, 2025; however, policymakers could consider expanding income eligibility criteria for federal food assistance programs.

 “The practice and policy implications of our findings are clear. National societies should recommend that practices screen for and address food insecurity amongst their patients. Practice reforms, though, should be accompanied by advocacy that changes policy that calls for expanding eligibility for federal food assistance programs,” said Aysola.

---

The study, “Mortality Outcomes for Survivors of Cancer With Food Insecurity in the U.S.” was published in JAMA Health Forum on June 20, 2025 by John C. Lin, Jiaxuan Sun, Ruiqi Yan, Lucy S. Wang, Anne Marie McCarthy, Guangyu Tong, and Jaya Aysola.

---

Author

---