A geospatial analysis of healthy food resource access to combat obesity in endometrial cancer survivors living in the deep south: Is it equitable?
Authors: Patel Khilen , Escamilla Veronica , Wolfe Lauren , Morris Tinea , Pradhan Ipsita , Orr Brian Christopher , Graybill Whitney , Creasman William Thomas , Ross Jerlinda 
Published: June 2022

e18507

Background: Obesity is a known risk factor for primary endometrial cancer. Several reports demonstrate a higher rate of mortality and shortened life span in obese patients with endometrial cancer, attributable at least in part to obesity-related comorbidities. This study examined endometrial cancer survivors’ access to healthy food resources recommended by ASCO and the Commission on Cancer (CoC) survivorship guidelines to combat obesity. Methods: Participants included women seen between 2015 – 2020 at an academic medical center in the Deep South for treatment of endometrial cancer who lived in South Carolina. Demographic and comorbidity data were abstracted from medical records. A socioeconomic status (SES) score (SES-1 = low, SES 5 = high) was generated for each patient using census block-group-level data. Food desert data were obtained from the United States Department of Agriculture (USDA). A social vulnerability index (SVI) was assigned to each patient using data from the Center for Disease Control and Prevention (CDC) to evaluate the negative effects of neighborhood external stresses on human health. SVI is a composite of 15 factors including socioeconomic status, household composition and disability, and minority status and language. Food resources were obtained from a publicly available database. Geospatial techniques assessed patient geospatial access (driving distance, i.e., recommended resource access of ̃½-mile radius in an urban area, 10-mile radius in a rural area around a patient’s home) to healthy food resources in relation to patient’s sociodemographic characteristics. Results: Of the 712 endometrial cancer survivors included in the analysis, 23% identified as African American and 29% lived in the lowest SES census block-groups (SES-1 and SES-2). More than half of the patients had low grade cancer; more than two-thirds had Stage I or Stage II disease. The mean BMI for African Americans was 41 and 37 for Caucasian Americans. Forty percent of survivors lived in a food desert. Survivors living in a food desert with low SES (SES-1 and SES-2) had significantly higher social vulnerability (p = 0.0001), higher poverty rates (p = 0.0001), and lower median income (p = 0.0001). The average driving distance was 0.1 miles (range 0.017 – 12.0 miles) with those in lower SES (SES-1 and SES-2) and those living in a food desert driving further (p = 0.05). Conclusions: Obesity rates were high among endometrial cancer patients living in the Deep South. Endometrial cancer survivors with higher social vulnerability and lower income were more likely to live in food deserts. Oncologic providers of survivorship care must understand healthy food resource access and patient SES to help women with a history of endometrial cancer fulfill ASCO and CoC recommended guidelines targeting obesity. Survivorship programs should be focused on meeting these social needs for holistic care.