TY - JOUR
T1 - Area Deprivation Index and Rurality in Relation to Financial Toxicity among Breast Cancer Surgical Patients
T2 - Retrospective Cross-Sectional Study of Geospatial Differences in Risk Profiles
AU - Corkum, Joseph
AU - Zhu, Victor
AU - Agbafe, Victor
AU - Sun, Susie X.
AU - Chu, Carrie
AU - Colen, Jessica Suarez
AU - Greenup, Rachel
AU - Offodile, Anaeze C.
N1 - Funding Information:
This research was generously supported by funds from the University Cancer Foundation via the Sister Institution Network Fund at the University of Texas MD Anderson Cancer Center. Dr Offodile reports research funding from the Blue Cross Blue Shield Affordability Cures Research Consortium, Rising Tide Foundation for Clinical Cancer Research, and University Cancer Foundation. He also has received honoraria from the Indiana University and University of Tennessee Departments of Surgery and is an unpaid board member of the Patient Advocate Foundation. Dr Greenup receives support from the NIH.
Funding Information:
Support: This research was generously supported by funds from the University Cancer Foundation via the Sister Institution Network Fund at the University of Texas MD Anderson Cancer Center. Dr Offodile reports research funding from the Blue Cross Blue Shield Affordability Cures Research Consortium, Rising Tide Foundation for Clinical Cancer Research, and University Cancer Foundation. He also has received honoraria from the Indiana University and University of Tennessee Departments of Surgery and is an unpaid board member of the Patient Advocate Foundation. Dr Greenup receives support from the NIH.
Publisher Copyright:
© 2022 by the American College of Surgeons.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Background: Financial toxicity (FT) depicts the burden of cancer treatment costs and is associated with lower quality of life and survival in breast cancer patients. We examined the relationship between geospatial location, represented by rurality and Area Deprivation Index (ADI), and risk of FT. Study Design: A single-institution, cross-sectional study was performed on adult female surgical breast cancer patients using survey data retrospectively collected between January 2018 and June 2019. Chart reviews were used to obtain patient information, and FT was identified using the COmprehensive Score for Financial Toxicity questionnaire, which is a validated instrument. Patients' home addresses were used to determine rurality using the Rural Urban Continuum Codes and linked to national ADI score. ADI was analyzed in tertiles for univariate statistical analyses, and as a continuous variable to develop multivariable logistic regression models to evaluate the independent associations of geospatial location with FT. Results: A total of 568 surgical breast cancer patients were included. Univariate analyses found significant differences across ADI tertiles with respect to race/ethnicity, marital status, insurance type, education, and rurality. In multivariable analysis, advanced cancer stage (odds ratio [OR] 2.26, 95% CI 1.15 to 4.44) and higher ADI (OR 1.012, 95% CI 1.01 to 1.02) were associated with worsening odds of FT. Increasing age (continuous) (OR 0.976, 95% CI 0.96 to 0.99), married status (vs unmarried) (OR 0.46, 95% CI 0.30 to 0.70), and receipt of bilateral mastectomy (OR 0.56, 95% CI 0.32 to 0.96) were protective of FT. Conclusions: FT was significantly associated with areas of greater socioeconomic deprivation as measured by the ADI. However, in adjusted analyses, rurality was not significantly associated with FT. ADI can be useful for preoperative screening of at-risk populations and the targeted deployment of community-based interventions to alleviate FT.
AB - Background: Financial toxicity (FT) depicts the burden of cancer treatment costs and is associated with lower quality of life and survival in breast cancer patients. We examined the relationship between geospatial location, represented by rurality and Area Deprivation Index (ADI), and risk of FT. Study Design: A single-institution, cross-sectional study was performed on adult female surgical breast cancer patients using survey data retrospectively collected between January 2018 and June 2019. Chart reviews were used to obtain patient information, and FT was identified using the COmprehensive Score for Financial Toxicity questionnaire, which is a validated instrument. Patients' home addresses were used to determine rurality using the Rural Urban Continuum Codes and linked to national ADI score. ADI was analyzed in tertiles for univariate statistical analyses, and as a continuous variable to develop multivariable logistic regression models to evaluate the independent associations of geospatial location with FT. Results: A total of 568 surgical breast cancer patients were included. Univariate analyses found significant differences across ADI tertiles with respect to race/ethnicity, marital status, insurance type, education, and rurality. In multivariable analysis, advanced cancer stage (odds ratio [OR] 2.26, 95% CI 1.15 to 4.44) and higher ADI (OR 1.012, 95% CI 1.01 to 1.02) were associated with worsening odds of FT. Increasing age (continuous) (OR 0.976, 95% CI 0.96 to 0.99), married status (vs unmarried) (OR 0.46, 95% CI 0.30 to 0.70), and receipt of bilateral mastectomy (OR 0.56, 95% CI 0.32 to 0.96) were protective of FT. Conclusions: FT was significantly associated with areas of greater socioeconomic deprivation as measured by the ADI. However, in adjusted analyses, rurality was not significantly associated with FT. ADI can be useful for preoperative screening of at-risk populations and the targeted deployment of community-based interventions to alleviate FT.
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U2 - 10.1097/XCS.0000000000000127
DO - 10.1097/XCS.0000000000000127
M3 - Article
C2 - 35426394
AN - SCOPUS:85128320173
SN - 1072-7515
VL - 234
SP - 816
EP - 826
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 5
ER -