Cancer
Comparing neighborhood environment classifications with markers of chronic stress among breast cancer survivors Sarah Lima* Sarah Lima Georgetown University Lombardi Comprehensive Cancer Center
Background: Neighborhood factors have been associated with adverse breast cancer endpoints, possibly through stress pathways. We evaluated which socioeconomic and environmental neighborhood measures were associated with markers of chronic stress among breast cancer survivors.
Methods: This cross-sectional study included 76 breast cancer survivors in Washington DC metro area. Neighborhood features included self-reported neighborhood stress, census-based socioeconomic measures (deprivation, racial and economic segregation) and satellite-based physical environment (greenspace, walkability, noise). Virtual audits of the street-level environment via Google Street View are ongoing. Participants reported perceived stress. Allostatic load and C-reactive protein (CRP) were available for a subset of participants (n=40). Quality of life (QoL) measures included general, functional, and social QoL. Correlations between neighborhood measures and outcomes were assessed. Neighborhood features were examined with chronic stress using box plots and linear regression. QoL was assessed by neighborhood as a potential intermediary.
Results: Correlations were moderate to strong within neighborhood domains but weak to moderate across domains. Neighborhood features were weakly correlated or uncorrelated with perceived neighborhood stress (r range: 0.00 for ADI to -0.21 for Gini index). Gini index and noise were consistently related to perceived stress. Perceived neighborhood stress, ADI, greenspace, and walkability were consistently associated with allostatic load and CRP. Perceived neighborhood stress, segregation, and noise were associated with QoL measures.
Conclusion: Socioeconomic and environmental features of neighborhood are related to chronic stress and QoL. Composite deprivation measures were less frequently related to chronic stress. Interventions within socioeconomic or environmental domains may be viable, however a comprehensive measure that encapsulates both domains is needed.