Abstract 3214: Associations of socioeconomic status and gut microbiome with psychoneurological symptom cluster in gynecologic cancer patients
Authors: Barandouzi Zahra , Eng Tony , Khanna Namita , Shelton Joseph , Patel Pretesh , Scott Isabelle , Meador Rebecca , Bruner Deborah 
Published: April 2023

Abstract
Introduction: Emerging evidence highlights the role of socioeconomic status (SES) in symptom burden related to cancer treatments. However, its underlying biological mechanisms are not fully understood. Thus, the present study aimed to evaluate the associations between patients’ education, as an indicator of SES, and the gut microbiome with psychoneurological symptoms (PNS) cluster in gynecologic cancer patients over time.
Methods: Nineteen women with cervical and endometrial cancers treated with radiotherapy or chemo-radiotherapy were followed at pre-treatment, 6-8 weeks, and 6 months post-treatment. Functional assessment of cancer therapy-general (FACT-G) and patient health questionnaire-9 (PHQ-9) were used to measure symptoms. An average Z score of at least three out of five symptoms was computed as the PNS cluster total score. Patients’ SES was evaluated using data on education. Rectal swabs were also collected at the same time points and sequenced using 16S rRNA V4 regions. The Kruskal-Wallis and permutational multivariable analysis of variance tests were used to compare α-diversity (within one sample) and β-diversity (between samples) between patients with high and low PNS cluster as well as patients with “below college” and “college or above” level education. The linear discriminant analysis effect size (LEfSe) tested taxa differences between study groups. Also, the linear mixed effect model was used to evaluate the association of the gut microbiome, education, and the PNS cluster over cancer treatment.
Results: The patients’ mean age was 58 years, 47% were Black, and 66% had college or above education. Among the participants, 63% had endometrial cancer with stage I disease (63%). There was a different taxonomy profile between patients with high and low PNS as well as patients with “below college” and “college or above” levels of education. Patients with high PNS had a lower α-diversity compared to patients with low PNS (Shannon, p=0.03, Evenness, p=0.03). Also, patients with below college-level education had a lower α-diversity trend after treatment (higher diversity is seen in the “normal” gut) but did not reach significant results. The mixed effects model results showed that low α-diversity, below college-level education, and low abundance of Fusicatenibacter and Ruminococcus were associated with high PNS cluster over cancer treatment.
Conclusions: The present study demonstrated alteration in the gut microbiome composition between patients with high and low PNS cluster as well as patients with high and low education. The associations between the gut microbiome and education with the PNS cluster suggest the role of educational level and biological factors in developing PNS cluster. More studies using a larger sample size are required to evaluate the interactions of the gut microbiome and SES to shed light on their role in symptom development.
Citation Format: Zahra Barandouzi, Tony Eng, Namita Khanna, Joseph Shelton, Pretesh Patel, Isabelle Scott, Rebecca Meador, Deborah Bruner. Associations of socioeconomic status and gut microbiome with psychoneurological symptom cluster in gynecologic cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3214.