Effects of neighborhood disadvantage on cortisol and interviewer-rated anxiety symptoms in breast cancer patients initiating treatment.

Abstract

Shorter breast cancer (BC) survival outcomes persist by neighborhood disadvantage independent of patient, tumor, and treatment characteristics. This suggests unaccounted mechanisms by which neighborhood disadvantage "gets under the skin" to impact BC survival outcomes. Here, we evaluate the relationship between neighborhood disadvantage andclinicaland neuroendocrinemarkers of stress in BC patients. Women with stage 0-IIIBC were enrolled 2-10weeks post-surgery and before initiating adjuvant treatment in a study examining stress and stress management processes. Women provided an afternoon-evening (PM) serum cortisol sample and were administered the Hamilton Anxiety Rating Scale (HAM-A).Homeaddresses were used to determine the Area Deprivation Index (ADI), a validated measure of neighborhood disadvantage.Multiple regression assessed the relationship between ADI and PM serum cortisol and the presence ofelevatedHAM-Asymptoms. Our sample (n = 225) was predominately middle-aged (M = 50.4years; range 23-70years), non-Hispanic White (64.3%), with stage I (38.1%), or II (38.6%) disease. The majority (n = 175) lived in advantaged neighborhoods (ADI 1-3). After controlling for age, stage, and surgery type, women from high ADI (4-10) (vs low ADI) neighborhoods had higher PM cortisol levels (β = 0.19, 95% CI [0.24, 5.00], p = 0.031) and were nearly two times as likely toreport the presence ofelevatedanxiety symptoms (OR = 1.96, 95% CI [1.00, 3.86], p = 0.050). Neighborhood disadvantage is significantly associated with higher levels ofPM cortisoland elevatedanxietysymptoms suggesting stress pathways could potentially contribute to relationships between neighborhood disadvantage and BC survival.