2335 - Impact of Socioeconomic Disadvantage on Quality of Life Changes at End of Radiotherapy

Purpose/Objective(s): This study evaluated the impact of socioeconomic disadvantage on quality-of-life (QOL) burden before and after radiotherapy (RT) in cancer patients treated at an urban safety-net facility.

Materials/Methods: Patients with head and neck, lung, or gastrointestinal cancer treated with RT between April 2019 – March 2020 and August 2021 – December 2024 were included. Functional Assessment of Cancer Therapy (FACT) questionnaires were administered before RT and at end of treatment (EOT). Socioeconomic disadvantage was measured using the Area Deprivation Index (ADI), which ranks residence zip codes by income, education, employment, and housing quality (range: 1-100; higher numbers indicate greater disadvantage). General linear models were employed to test differences in change in FACT scores by ADI and sociodemographic factors.

Results: Baseline surveys were completed by 67 patients. Median age was 62 years. Most patients were male (61.2%) and English-speaking (73.1%). Racial and ethnic distribution was 34.3% white, 32.8% Black, 32.8% other/missing, with 28.4% identifying as Hispanic. The majority (52.2%) had Medicare while 28.4% had Medicaid. Of the 67 patients, 54 completed EOT surveys. Median ADI was 21 (range: 2-60). Patients were stratified into low-ADI (=21) and high-ADI (>21) groups. Patients in the low-ADI group were more likely to be female (p=0.05), speak English (p=0.01), and live closer to the hospital (5.9 vs. 7.5 miles, p=0.04). At baseline, low-ADI patients reported higher physical (mean 23.3 vs. 20.0, p=0.03) and functional well-being (mean 17.4 vs. 14.2, p=0.04) than high-ADI patients (Table).

Overall FACT scores declined by mean 5.7 points at EOT (mean -2.4 in physical well-being domain). Low-ADI patients had greater decrease in FACT scores than high-ADI patients post RT (mean -10.7 vs. -0.65, p=0.08). This difference was less pronounced when adjusting for baseline scores (adjusted mean -9.9 vs. -1.5, p=0.15). On multivariable analysis adjusting for sex, race, Hispanic ethnicity, and insurance (all p<0.1 for overall FACT score in univariable analysis), the QOL decline by ADI was attenuated (adjusted mean -6.22 vs. -4.48, p=0.77).

Conclusion: Patients with less socioeconomic disadvantage reported superior QOL at baseline but a greater QOL decline on univariable analysis. However, post-RT QOL changes did not differ significantly by ADI after adjusting for sociodemographic factors.

Abstract 2335 - Table 1: Mean FACT scores by ADI before and after radiotherapy