Abstract PD8-09: Impact of Neighborhood Disadvantage on Biological and Clinical Indicators of Anxiety and Breast Cancer Survival
Authors: Goel Neha , Ream Molly , Hernandez Alexandra , Clarke Estaez , O’Neil Daniel S. , Antoni Michael 
Published: March 2023

Abstract
Introduction: Women living in disadvantaged neighborhoods consistently having worse breast cancer survival. Recent studies have identified that disparities by neighborhood disadvantage persist after controlling for patient, tumor, and National Comprehensive Cancer Network-guideline concordant treatment. This suggests unaccounted mechanisms by which neighborhood disadvantage “gets under the skin” to impact to shorter breast cancer survival.
Methods: Women with stage 0-3 breast cancer between 1998-2005 were enrolled in a clinical trial for stress management 2-10 weeks post-surgery and before initiating adjuvant treatment. At baseline, women provided an evening-time serum cortisol sample and were administered a structured clinical interview of anxiety symptoms (Hamilton Anxiety Rating Scale; HAM-A). Of the 240 women who enrolled in the study and completed baseline procedures, home addresses were provided by 225 women (93.8%). The addresses were used to determine the Area Deprivation Index (ADI), a validated measure of neighborhood disadvantage. Women were categorized as low (1-3) versus high (4-10) ADI. Linear regression analysis was used to assess the relationship between ADI and serum cortisol and logistic regression to assess whether ADI group predicted the presence of clinically significant anxiety per the HAM-A. Cox regression analysis was used to determine predictors of breast cancer-specific survival.
Results: The average age of our population was 50.4 years old (range 23-70 years) and the majority were non-Hispanic White (63.6%). Most patients had stage 1 (37.8%) or 2 (38.2%) disease. The majority lived in advantaged neighborhoods (low ADI, 77.8%). On the HAM-A, 46.8% of women reported clinically significant anxiety symptoms. When controlling for age, stage, and type of surgery, women with a high ADI had higher cortisol levels than women in with a low ADI (Beta=.19, t(117)=2.18, p=.031). Moreover, accounting for age, stage, and type of surgery, women with a high ADI were nearly two times as likely to have clinically significant anxiety symptoms in the HAM-A clinical interview (OR 1.99, 95%CI 1.01, 3.90, p=.046). Moreover, after controlling for study condition (stress intervention vs. control), age, stage, Black race, and treatment, women with living in neighborhoods with an increasing ADI (disadvantaged neighborhoods) had shorter 5-year breast cancer-specific survival (HR=.096 95%CI 0.02, 0.64) compared to women living in neighborhoods with a lower ADI (advantaged neighborhoods).
Conclusion: This study identified that neighborhood disadvantage is significantly associated with higher levels of cortisol, clinical anxiety, and shorter 5-year breast cancer-specific survival. Future studies need to evaluate stress pathways as a potential mechanism by which neighborhood disadvantage impacts breast cancer-specific survival.
Table 1. Multiple Regression Illustrating Relationship between ADI and Serum Cortisol.
Table 2. Logistic Regression Illustrating Relationship between ADI and Anxiety on HAM-A Clinical Interview.
Citation Format: Neha Goel, Molly Ream, Alexandra Hernandez, Estaez Clarke, Daniel S. O’Neil, Michael Antoni. Impact of Neighborhood Disadvantage on Biological and Clinical Indicators of Anxiety and Breast Cancer Survival [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD8-09.