Area Deprivation Index Is Associated with Quality of Life and Psychosocial Well-being after Breast Cancer Surgery

Abstract

INTRODUCTION: Neighborhood-level factors have been shown to influence operative outcomes. To date, no study has been conducted to examine the relationship between area-level deprivation (ADI) and postmastectomy outcomes. METHODS: We conducted a cross-sectional survey of all adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 and June 2019. Patient-specific demographics, clinical history, 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 3 groups based on their ADI scores: 0–39 (prosperous/comfortable), 40–59 (mid-tier), and 60–100 (at risk/distressed). RESULTS: A total of 564 consecutive patients were identified; mostly White (75%) with a mean age of 60.2 ± 12.4 years, mean BMI of 28.8±7.1, mean Charlson Comorbidity Index of 3.5±2.0, and mean ADI of 42.3±25.7. Minority 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 at risk/distressed had significantly lower mean SF-12 physical (44.9 [95% CI 43.8–46.0] vs 44.9 [95% CI 43.7–46.1] vs 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] vs 69.3 [95% CI 65.1–73.6] vs 69.7 [95% CI 66.4–73.1], p = 0.01) than the mid-tier and prosperous/comfortable groups. CONCLUSION: Patients residing in deprived neighborhoods were more likely to have worse psychological well-being and quality of life. ADI should be incorporated in the shared-decision making process and perioperative counseling to engender value-based and personalized care, especially for vulnerable populations.