Development and refinement of the Cardiovascular Health Equity through Food (CHEF) intervention for childhood cancer survivors

Rahela Aziz-Bose; Emily Jones; Anna Revette; Lucille Lokko; Puja J Umaretiya; Colleen A Kelly; Leanne Duhaney; Lisa B Kenney; Fang Fang Zhang; Kira Bona

doi:10.1007/s11764-024-01733-w

Development and refinement of the Cardiovascular Health Equity through Food (CHEF) intervention for childhood cancer survivors

J Cancer Surviv. 2025 Jan 4. doi: 10.1007/s11764-024-01733-w. Online ahead of print.

Authors

Rahela Aziz-Bose^{1

2

3

4}, Emily Jones⁵, Anna Revette⁶, Lucille Lokko⁵, Puja J Umaretiya⁷, Colleen A Kelly^{5

8}, Leanne Duhaney⁹, Lisa B Kenney^{5

8

10}, Fang Fang Zhang¹¹, Kira Bona^{5

8

10

6}

Affiliations

¹ Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. rahela_aziz-bose@dfci.harvard.edu.
² Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA. rahela_aziz-bose@dfci.harvard.edu.
³ Harvard Medical School, Boston, MA, USA. rahela_aziz-bose@dfci.harvard.edu.
⁴ Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA. rahela_aziz-bose@dfci.harvard.edu.
⁵ Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
⁶ Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.
⁷ Division of Pediatric Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁸ Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA.
⁹ Division of Cardiology, Boston Children's Hospital, Boston, MA, USA.
¹⁰ Harvard Medical School, Boston, MA, USA.
¹¹ Friedman School of Nutrition and Public Policy, Tufts University, Boston, MA, USA.

PMID: 39754703
DOI: 10.1007/s11764-024-01733-w

Abstract

Purpose: The aim of this study was to develop and refine Cardiovascular Health Equity through Food (CHEF), an intervention to address food insecurity (FI) in early childhood cancer survivors (CCS).

Methods: Single-center mixed-methods pilot study of a novel "food is medicine" intervention evaluating acceptability, satisfaction, and opportunities for refinement. CHEF participants were provided: (1) meal-kit delivery for 3 household meals/week for 3 months and (2) application assistance for federal nutrition benefits. Eligible participants were CCS < 1 year from cancer therapy completion, with self-reported FI or household income < 200% federal poverty level. Acceptability was defined as > 75% consent to participation, < 25% attrition, and > 75% program-component utilization. Surveys were completed at baseline and end-intervention, and semi-structured interviews were completed at months 1, 2, and 4.

Results: Ten families (100%) consented to participation, with 0% attrition. Ninety-seven percent of meal kits were successfully received and > 90% cooked. Four families utilized study-team assistance in navigating benefits participation. One hundred percent of families would participate again, and 80% would recommend to others. Qualitative feedback supported CHEF's timing following treatment and positive impact on family cooking engagement. Broader non-English language accessibility, formalized benefits counseling, and extended duration were identified as refinement opportunities.

Conclusion: CHEF was highly acceptable among CCS in early survivorship. The next steps include proof-of-concept evaluation of the refined intervention's impact on cardiovascular-relevant outcomes among CCS with FI.

Implications for cancer survivors: Interventions directly addressing food insecurity, a known cardiovascular risk factor, have the potential to support well-being and address health disparities among childhood cancer survivors.

Keywords: Cardiovascular health; Childhood cancer survivors; Food insecurity; Social determinants of health.

Grants and funding

T32 CA136432-12/NH/NIH HHS/United States