Background: Food insecurity (FI), the lack of reliable access to safe and nutritious food, is a major challenge for individuals undergoing cancer treatment. In Mexico, FI affects nearly 60% of the general population, and patients facing the combined stress of illness and economic hardship may be particularly vulnerable. Despite Mexico's high national food insecurity rates, no prior studies have examined this burden specifically among cancer patients, representing a critical knowledge gap. Despite assumptions that universal healthcare coverage (UHC) or public insurance could provide protection, non-medical costs such as transportation and food are still largely unaddressed. We aimed to determine the prevalence of FI in households affected by hematologic cancer and identify the main economic and social factors contributing to this hidden burden.

Methods: We conducted a cross-sectional study of 133 households of patients with hematologic malignancies at a single tertiary referral center in Mexico. Household food insecurity was assessed using the validated Latin American and Caribbean Food Security Scale (ELCSA). We collected comprehensive data on household sociodemographics, income, insurance status, and financial coping mechanisms. Bivariate and multivariate logistic regression analyses were performed to identify the independent predictors of food insecurity.

Results: Among 133 households (48% with a family member diagnosed with acute lymphocytic leukemia, 18% non-Hodgkin lymphoma), 98 (74%) experienced FI: 62% mild, 26% moderate, and 12% severe. This high prevalence affected a highly vulnerable population; the mean household size was 4.1 (±1.7) persons, with one-third of patients being children, and over half of households including minors. Most respondents were married (50%), and over 60% had completed middle school or less. The median monthly income was significantly lower in FI households (~USD 320 vs. ~USD 531, p<.001), with 53% of household respondents currently unemployed.

Non-medical financial burdens notably contributed to FI. Key findings included: 62% of households required loans or asset sales to continue treatment, 88% worried about treatment interruption, and 77% reported reduced food spending. This financial erosion was cumulative; the prevalence of requiring loans or asset sales rose from 43% in newly diagnosed households to 70% in those over one year from diagnosis. The burden of these costs was substantial; for example, average monthly transportation costs alone consumed nearly 7% of the cohort's average household income. Strikingly, 71% of households with UHC still experienced FI, and 50% of households earning above the regional minimum salary reported FI.

Multivariate analysis confirmed that financial coping mechanisms, rather than baseline income alone, were the most potent predictors. These factors not only predicted the presence of FI but also its severity; households requiring a loan had a 49% probability of experiencing moderate-to-severe FI, compared to just 7% for those without such debt. The patient's perceived risk of treatment interruption due to cost, a proxy for catastrophic financial toxicity, emerged as the strongest predictor of FI (OR=8.5), exceeding objective economic measures indicators. Predictive modeling quantified this systemic failure: households with multiple economic vulnerabilities faced a >90% probability of experiencing FI, while even the most protected households (with UHC, minimum salary, and no debt) still faced a 20% probability.

Conclusion: Seven in ten households with a family member battling hematologic cancer face food insecurity in our setting. Our findings show that even with universal health coverage, the risk of not having food persists, driven by unaddressed non-medical costs that force families into debt. This reality underscores the urgent need for public policies that look beyond medical bills to guarantee nutritional dignity, ensuring that a cancer diagnosis is not also accompanied by hunger.

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2025
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