Neighborhood Deprivation and Rurality Associated with Patient-Reported Outcomes and Survival in Men with Prostate Cancer in NRG RTOG 0415.

Rurality and neighborhood deprivation can contribute to poor patient-reported outcomes (PROs), which has not been systematically evaluated in patients with specific cancers in national trials.

To examine the impact of rurality and neighborhood socioeconomic and environmental deprivation on PROs and survival in men with prostate cancer in xxxx.

Data from men with prostate cancer in trial xxxx were analyzed. 1,092 men were randomized to receive conventional radiotherapy (RT) or hypofractionated RT.

Rurality was categorized as urban or rural. Neighborhood deprivation was assessed using the Area Deprivation Index (ADI) and air pollution indicators (NO2 and PM2.5) via patient ZIP codes.

Expanded Prostate Cancer Index Composite (EPIC) measured cancer-specific quality of life (QOL). Hopkins Symptom Checklist measured anxiety/depression. EuroQoL-5 Dimension (EQ-5D) assessed general health.

We analyzed 751 patients in trial xxxx. At baseline, patients from the most deprived neighborhoods had worse bowel (p=0.011), worse sexual (p=0.042), and worse hormonal (p=0.015) scores; patients from the most deprived areas had worse self-care (p=0.04) and more pain (p=0.047); and patients from rural areas had worse urinary (p=0.03) and sexual (p=0.003) scores vs. patients from urban areas. Longitudinal analyses showed that the 25% most deprived areas (p=0.004) and rural areas (p=0.002) were associated with worse EQ-5D VAS score. Patients from urban areas (HR=1.81, p=0.033) and the 75% less deprived neighborhoods (HR=0.68, p=0.053) showed relative decrease in risk of recurrence or death (DFS).

Prostate cancer patients from the most deprived neighborhoods and rural areas had low QOL at baseline, poor general health longitudinally, and worse DFS. Interventions should screen populations from deprived neighborhoods and rural areas to improve patient access to supportive care services.

International journal of radiation oncology, biology, physics. 2023 Feb 01 [Epub ahead of print]

Jinbing Bai, Stephanie L Pugh, Ronald Eldridge, Katherine A Yeager, Qi Zhang, W Robert Lee, Amit B Shah, Ian S Dayes, David P D'Souza, Jeff M Michalski, Jason A Efstathiou, John M Longo, Thomas M Pisansky, Jordan M Maier, Sergio L Faria, Anand B Desai, Samantha A Seaward, Howard M Sandler, Mary E Cooley, Deborah W Bruner

Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA. Electronic address: ., NRG Oncology Statistics and Data Management Center, Philadelphia, PA., Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA., Department of Geography, The University of North Carolina at Chapel Hill, Chapel Hill, NC., Duke University Medical Center, Durham, NC., WellSpan Health-York Cancer Center, York, PA., McMaster University, Juravinski Cancer Center, Hamilton Health Science, Hamilton, ON., University of Western Ontario, University of Western Ontario, London, ON., Washington University School of Medicine, St Louis, MO., Massachusetts General Hospital Cancer Center, Boston, MA., Zablocki VAMC and the Medical College of Wisconsin, Milwaukee, WI., Mayo Clinic, Rochester, MN., Wayne State University-Karmanos Cancer Institute, Detroit, MI., McGill University, Montreal, QC., Summa Health System - Akron Campus, Akron, OH., Kaiser Permanente Medical Center - Santa Clara, CA., Cedars-Sinai Medical Center, Los Angeles, CA., Dana-Farber/Harvard Cancer Center, Boston, MA.