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Erschienen in:
09.09.2022 | Breast Oncology
Area Deprivation Index is Associated with Variation in Quality of Life and Psychosocial Well-being Following Breast Cancer Surgery
Erschienen in: Annals of Surgical Oncology | Ausgabe 1/2023
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Background
Neighborhood-level factors have been shown to influence surgical outcomes through material deprivation, psychosocial mechanisms, health behaviors, and access to resources. To date, no study has examined the relationship between area-level deprivation (ADI) and post-mastectomy outcomes.
Methods
A cross-sectional survey of adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 to June 2019 was carried out. Patient-specific characteristics and ADI information were abstracted and correlated with postoperative global- (SF-12) and condition-specific (BREAST-Q) quality-of-life performance via multivariable regression. Patients were classified into three ADI terciles: 0–39 (low deprivation), 40–59 (moderate deprivation), and 60–100 (high deprivation).
Results
A total of 564 consecutive patients were identified, being mostly white (75%) with mean age of 60.2 ± 12.4 years, median body mass index of 27.8 [interquartile range (IQR) 24.3–32.2) kg/m2, median Charlson Comorbidity Index of 3 (IQR 2–5), and mean ADI of 42.3 ± 25.7. African American and Hispanic patients and those with high BMI were more likely to reside in highly deprived neighborhoods (p = 0.003 and p < 0.001). In adjusted models, patients in highly deprived neighborhoods had significantly lower mean SF-12 physical (44.9 [95% CI, 43.8–46.0] versus 44.9 [95% CI, 43.7–46.1] versus 46.3 [95% CI, 45.3–47.3], p = 0.03) and BREAST-Q psychosocial well-being scores (63.5 [95% CI, 59.32–67.8] versus 69.3 [95% CI, 65.1–73.6] versus 69.7 [95% CI, 66.4-73.1], p = 0.01) relative to moderate- and low-deprivation groups.
Conclusions
Patients residing in the most deprived neighborhoods were identified to have worse psychological well-being and quality-of-life. The ADI should be incorporated into the shared decision-making process and perioperative counseling to engender value-based and personalized care, especially for vulnerable populations.