Abstract B039: The impact of social and built environments on quality of life among cancer survivors
Authors: Shariff-Marco Salma , Canchola Alison J. , Keegan Theresa H.M. , Nickell Alyssa , Oakley-Girvan Ingrid , Hamilton Ann S. , Gomez Scarlett L. 
Published: August 2020

Abstract
Background: With over 16 million cancer survivors in the U.S., understanding factors that improve health-related quality of life (HRQOL) after cancer diagnosis is critical. Previous studies have identified demographic, clinical and behavioral factors that shape HRQOL among cancer patients and have observed poorer HRQOL among racial/ethnic minorities, individuals of low socioeconomic status (SES), or those with comorbidities. Few studies have considered the influence of neighborhood factors (census block group SES (nSES), census tract poverty, county segregation) on HRQOL. Thus, we proposed to assess racial/ethnic disparities in HRQOL and evaluate the extent to which these disparities are explained by neighborhood factors.
Methods: We pooled data on 2,500 diverse (i.e., multiethnic, varied SES, multiple cancer sites) cancer survivors from three population-based cancer survivorship studies in California and linked them to the California Neighborhoods Data System. Separately for the two continuous HRQOL outcomes (physical and mental composite scores, PCS and MCS, from SF36), using a 3-level model with participants nested within block groups, which are nested within study/region, we calculated least squares means and parameter estimates for each racial/ethnic group, with and without adjustment for covariates. Predisposing factors included age, gender, education, employment, income, health insurance status, marital status and significant clinical and tumor characteristics. Health behaviors included physical activity and body mass index.
Results: Among 2,477 cancer survivors, we observed racial/ethnic disparities in HRQOL, with African Americans reporting the lowest (worst) PCS (42.7), Latinos reporting the lowest MCS (48.4) and Asians/Pacific Islanders reporting the highest scores (PCS: 45.4; MCS: 51.1) in unadjusted models. In models adjusted for age and cancer recurrence (and stage for PCS), both PCS and MCS increased with higher nSES. Assessed separately, the following neighborhood factors were associated with decreased MCS after adjusting for nSES: higher population density, street connectivity (gamma), % renting, % non-single-family units, more parks, and restaurant index (more unhealthy). No other neighborhood factor was associated with PCS after adjusting for nSES. Compared to non-Hispanic (NH) Whites, African American disparities in PCS were fully attenuated after adjusting for nSES. Similarly adjusting for neighborhood factors fully attenuated Hispanic disparities in MCS. For PCS, adjusting for predisposing, nSES, and/or behavioral factors resulted in Hispanics having better HRQOL compared to NH Whites.
Conclusions: Among a diverse cohort of cancer survivors, neighborhood attributes were associated with HRQOL. Racial/ethnic disparities in HRQOL were attenuated with inclusion of neighborhood factors in the models. Elucidating the pathways through which these neighborhood attributes impact HRQOL will be important to improving survivorship outcomes.
Citation Format: Salma Shariff-Marco, Alison J. Canchola, Theresa H.M. Keegan, Alyssa Nickell, Ingrid Oakley-Girvan, Ann S. Hamilton, Scarlett L. Gomez. The impact of social and built environments on quality of life among cancer survivors [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B039.