Abstract 4832: The impact of neighborhood-level disadvantage on the patient-reported outcomes of primary brain tumor patients
Authors: Karim Zuena A. , Reinhart Kimberly , Celiku Orieta , Kim Yeonju , Miller Hope , Vera Elizabeth , Vo Jacqueline B. , Armstrong Terri S. , Stockdill Macy L. 
Published: March 2024

Abstract
There is increased recognition that social determinants of health may impact well-being and health in those with various cancers, but they have not been systematically evaluated in primary brain tumor (PBT) patients. Here, we examined the association between Area Deprivation Index (ADI), a measurement of sociodemographic neighborhood disadvantage, and patient-reported outcomes (PROs) in a cohort of adult PBT patients enrolled in a large National Institutes of Health observational trial (NHS, NCT02851706, PI: Armstrong). We utilized linear regression to assess the relationship between ADI (less advantaged [ADI≥40, n=153, 24%], more advantaged [ADI&lt;40, n=490, 76%]) and patient symptom burden (MDASI-BT), anxiety, and depression (PROMIS Short Forms v1.0 8a). Logistic regression was used to evaluate the association between ADI and health-related quality of life using the 5 dimensions of the EQ-5D-3L. Models were adjusted for age, sex, race/ethnicity, tumor grade, Karnofsky Performance Score (KPS), and tumor recurrence. A sub-analysis stratifying by tumor grade (low, high) was completed. Among 643 PBT patients, the majority resided in more advantaged areas (n=490; 76%) and had high-grade tumors (n=448; 70%). Those who were less advantaged reported more symptom severity (β=1.10, SE=1.05, P=0.041), more activity-related interference (β=1.11, SE=1.05, P=0.03), and had 4.68 times the odds of having moderate-severe difficulty completing self-care tasks (95% confidence interval [1.46, 14.96], P=0.009) compared to those who were more advantaged. KPS was a significant predictor for all three outcomes, and age at diagnosis was significant for PBT symptom severity. Among patients with low-grade tumors, those who were less advantaged reported higher symptom interference (β=1.24, SE=1.10, P=0.020), affective symptoms (β=1.24, SE=1.08, P=0.007), treatment-related symptoms (β=1.21, SE=1.08, P=0.021), general disease symptoms (β=1.26, SE=1.10, P=0.016), activity-related interference (β=1.26, SE=1.09, P=0.006), mood-related interference (β=1.20, SE=1.09, P=0.039), and anxiety (β=1.03, SE=1.02, P=0.023), with KPS being a significant predictor for all outcomes except anxiety. Overall, less advantaged PBT patients reported worse symptom severity and activity-related interference, and those with low-grade tumors experienced more affective symptoms, including fatigue, general disease and treatment-associated symptoms, and symptoms of anxiety, but not neurologic or cognitive symptoms. Living in less advantaged areas may lead to barriers to care access, symptom management medications, or other neighborhood resources that could alleviate PBT patient symptom burden but may compound over time for those with poor performance status or low-grade tumors. These results highlight the need for targeted supportive interventions for PBT patients living in less advantaged areas.
Citation Format: Zuena A. Karim, Kimberly Reinhart, Orieta Celiku, Yeonju Kim, Hope Miller, Elizabeth Vera, Jacqueline B. Vo, Terri S. Armstrong, Macy L. Stockdill. The impact of neighborhood-level disadvantage on the patient-reported outcomes of primary brain tumor patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4832.