Food insecurity and nutritional vulnerability in women with cancer: financial toxicity as a driver of survivorship inequities.

Food insecurity is an underrecognized determinant of nutritional vulnerability among women with cancer. Although oncology nutrition guidelines increasingly emphasize early screening, dietitian referral, body-composition preservation, and survivorship-oriented dietary patterns, many women experience financial toxicity after diagnosis through out-of-pocket medical costs, income loss, transportation expenses, caregiving disruption, and competing household needs. These economic pressures can restrict access to adequate, safe, and nutrient-dense foods, thereby worsening malnutrition risk, diet quality, sarcopenia, obesity-related metabolic dysfunction, fatigue, and treatment intolerance. The problem is especially relevant in breast, gynecologic, and other women's cancers, where endocrine therapy, menopausal transition, long-term survivorship care, and gendered caregiving roles may amplify nutritional and economic strain. This Mini Review synthesizes the health-economic pathway linking financial toxicity, food insecurity, and nutritional vulnerability in women with cancer. It discusses clinical mechanisms, evidence connecting food insecurity with care disruption and mortality, and implementation priorities for equitable nutrition care. A practical framework is proposed in which food insecurity screening, malnutrition assessment, financial navigation, dietitian referral, social support, and outcome monitoring are integrated into survivorship care. Equity should be evaluated not by service volume alone, but by whether women at greatest nutritional and financial risk receive timely, effective, and sustainable support.

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