Association between area deprivation index and quality of life and psychosocial well-being following breast cancer surgery.

Abstract

e18612 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 been conducted to examine the relationship between area-level deprivation (ADI) and post-mastectomy outcomes. Methods: We conducted a cross-sectional survey of all adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 to June 2019. Patient-specific demographics, clinical history and ADI information were abstracted and correlated with post-operative global- (SF-12) and condition-specific (Breast-Q) quality-of-life performance via multivariable regression. Patients were classified into three 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, mean body mass index (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. Conclusions: 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 counselling to engender value-based and personalized care, especially for vulnerable populations.