“Food is like all we do all day”: a qualitative exploration of nutritional challenges and intervention needs among families of early childhood cancer survivors

PURPOSE: Cardiovascular disease is the leading cause of non-malignant death among childhood cancer survivors (CCS). Food insecurity is a known modifiable cardiovascular risk factor; perspectives on nutrition for CCS parents navigating food insecurity and cardiovascular risk factors are needed. We aimed to describe parent-identified priorities regarding nutrition, explore barriers to and facilitators of healthy eating, and elicit preferences on nutrition intervention design in early survivorship. METHODS: We conducted a single-center qualitative study embedded within a larger survey study. Twenty semi-structured qualitative interviews were conducted with parents of CCS < 1-year from cancer therapy completion in a purposively sampled cohort based on food insecurity status and the presence of cardiovascular risk factors. We conducted thematic analysis to identify how parents define and prioritize healthy eating, what factors drive their food choices, and preferences for nutrition interventions. RESULTS: Four key themes were identified: (1) healthy eating is highly valued in survivorship; (2) achieving nutritional goals is limited by cost, time, and dietary considerations; (3) early survivorship is a period of ongoing, unmet nutrition and resource needs; and (4) interventions should be modular, empowering, and address access barriers. CONCLUSION: Although nutrition is highly valued, families with and without food insecurity encounter substantial barriers to healthy eating in early survivorship-a pivotal window for nutrition intervention. Families expressed a strong need for multifaceted and modular nutrition interventions that address access barriers and promote empowerment. Our findings may inform the design of future interventions aimed at improving cardiometabolic health and reducing cardiovascular outcome disparities among CCS.