Food for thought: A scalable decentralized community oncology Food Is Medicine program.

278 Background: Food insecurity among cancer patients has been correlated with poorer quality of life, mental health, and treatment adherence. Cancer patients in rural settings have greater food insecurity while also having less access to food resources. We describe the implementation of a decentralized Food Is Medicine (FIM) model at Tennessee Oncology (TO), one of the largest physician-owned oncology practices with 37 medical oncology locations throughout middle and eastern Tennessee. Methods: Using baseline Hunger Vital Sign (HVS) data, we selected four rural clinics with high rates of food insecurity. Patients with new cancers, undergoing treatment, and screening positive on the HVS were offered enrollment. The program consisted of delivering monthly 20 item food boxes to patients at their local clinic. The contents, collaboratively selected by Second Harvest Food Bank of Middle Tennessee and TO Registered Dietitians, were designed to provide a significant portion of patients’ nutritional needs for the month. Boxes were couriered to clinics from a medically integrated pharmacy. A HIPAA-compliant tracking board ensured consistent delivery and receipt. Medical assistants at pilot and control clinics received education about promoting food insecurity screening. Results: From 8/1/2024 – 5/1/2025, the pilot identified 24 eligible patients of which 22 remained enrolled (91.6%). Five patients became ineligible due to enrolling in hospice or passing away. In pilot clinics, HVS screening increased by 22% compared to 4% in control clinics. 102 of 108 boxes (94.4%) were received by patients. Hospitalization was the main reason for not receiving a box. Twelve randomly selected patients were contacted to provide feedback. All wished to remain in the program and see it expanded. Team members provided feedback that the program was easy to execute and did not detract from other duties. The program cost per patient was $17.30/month. Conclusions: Our FIM pilot demonstrated high patient enrollment, retention, satisfaction, process efficiency, and low cost. Future work will include scaling through clinic expansion, improving screening processes, collecting and reporting impact on food insecurity and cancer outcomes, and identifying sustained funding opportunities through foundations, navigation billing, and medical meals.