Impact of neighborhood disadvantage on biological and clinical indicators of anxiety among newly diagnosed patients with breast cancer.

Abstract

568 Background: Women living in disadvantaged neighborhoods consistently having worse breast cancer (BC) 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 persistent disparity suggests unaccounted mechanisms by which neighborhood disadvantage “gets under the skin” to impact to shorter BC survival. Methods: Women with stage 0-3 BC 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, using the University of Wisconsin Neighborhood Atlas. Women were categorized as low (1-3) versus high (4-10) ADI. Linear regression analyses 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. 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). Conclusions: This study identified that neighborhood disadvantage is significantly associated with higher levels of cortisol and clinical anxiety. Future studies need to evaluate stress pathways as a potential mechanism by which neighborhood disadvantage "gets under the skin" to impact BC-specific survival.