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Effect of Food Insecurity on Endometrial Cancer Outcomes

Resident: Lucy Bates, MD

Faculty Advisor: Christina Washington, MD


Malnutrition is a known risk factor for poor cancer treatment outcomes such as suboptimal therapy response and decreased rates of survival. Oklahoma ranks highly in rates of food insecurity and obesity. Contributing factors include a high density of fast-food establishments, low access to nutritious foods, and lack of nutritional value in many low-cost foods. Around twenty-five percent of the Oklahoma population lives 10 miles or more from a supermarket. According to data from the Oklahoma Food Bank, 54 of Oklahoma’s 77 counties contain food deserts as defined by the US Department of Agriculture. The aim of this study is to show that access to high quality food influences survival outcomes in patients with endometrial cancer.


The project is a retrospective cohort study of patients at Stephenson Cancer Center seen between January 1, 2015 and December 31, 2016 with a new diagnosis of endometrial cancer. Patients were identified using ICD-9 codes from the electronic medical record. Baseline demographics and clinical outcomes were compared between patients who reside in food deserts at the time of diagnosis and those who did not reside in a food desert. Survival analysis was also assessed and presented as hazard ratios.


A total of 1,673 new patients were seen during the study period. 469 patients met inclusion criteria for analysis. For endometrial cancer patients living in food deserts, 5-year survival was 71%, compared with 67% for non-desert residents (p=0.438). Univariate Cox proportional analyses did not indicate a difference in survival for the study population (Hazard ratio [HR] = 1.20, 95% CI 0.75 – 1.92). Multivariate survival analysis included co-variates of age, BMI, smoking status, ethnicity, cancer stage and grade and demonstrated interaction for stage, grade and age.


This study failed to show a difference in endometrial cancer survival outcomes in women that live in food deserts and those that do not live in food deserts. Additional study of dietary habits and food insecurity in this patient population may illuminate further association between food quality and cancer outcomes. Interventions that improve access to better food quality in Oklahoma would address an important cancer care disparity.

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