3141 - The Effect of Residing in a Food-Insecure Area on Locally Advanced Breast Cancer Survival
Presenter(s)
A. D. Thompson1, L. H. D. D. Escobal2, M. Mathai3, G. Singh4, D. Alicia5, S. Ruff4, M. Kidorf4, S. Koduri6, M. J. Ferris4, S. Cheston4, A. Patel7, M. Rao4, S. McAvoy8, E. Nichols8, W. Citron7, S. Dudley9, and M. A. L. Vyfhuis4; 1Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, 2University of Maryland Radiation Oncology, Baltimore, MD, 3University of Maryland School of Medicine, Baltimore, MD, United States, 4Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 5Department of Radiation Oncology, Maryland Proton Treatment Center, Baltimore, MD, 6Department of Radiation Oncology, NYU Langone Health, New York City, NY, 7University of Maryland Radiation Oncology at the Tate Cancer Center, Glen Burnie, MD, 8University of Maryland Medical Center, Baltimore, MD, 9University of Maryland Upper Chesapeake Medical Center KCC Radiation Oncology, Bel Air, MD
Purpose/Objective(s):
Residents of food-insecure areas (FIAs) are associated with worse cancer outcomes, but the underlying reasons—such as differences in cancer characteristics, treatment delivery, and adherence—remain poorly understood. This study examines the impact of food insecurity (FI) on overall survival (OS) in locally advanced breast cancer (LABC) patients receiving comprehensive nodal irradiation (CNI), and explores differences in cancer characteristics, treatments, and compliance.Materials/Methods:
This retrospective study analyzed 939 LABC patients treated with CNI from 2016-2023. ?2 and Mann-Whitney U tests were used to assess differences in demographic, clinical, and treatment variables as indicated. Kaplan-Meier analysis and multivariate cox regression models evaluated OS.Results:
Median follow-up was 25.0 months for non-FIA residents and 28.8 months for FIA residents. FIA residents (n = 60; 6.4%) were more likely to identify as Black (p < 0.001), single (p < 0.001), with comorbidities such as hypertension (HTN; p < 0.001), diabetes mellitus (DM; p < 0.001), hyperlipidemia (HLD; p = 0.04), higher BMI (p = 0.03), smoking status (p < 0.001), and a higher ECOG PS (p < 0.001). Cancer characteristics (histology, staging, ER/PR/HER2 status, triple-negative [TN] status), and treatment modalities (type of surgery, chemotherapy, or endocrine therapy) did not differ between groups. FIA residents received higher radiation doses (p < 0.001), and longer endocrine therapy (p = 0.013). Multivariate analysis revealed a lower risk of death associated with endocrine therapy delivery (HR = 0.12, 95% CI: 0.02–0.95, p = 0.045) and longer endocrine therapy duration (HR = 0.96, 95% CI: 0.94–0.98, p < 0.001). Increased risk of death was associated with DM (HR = 2.96, 95% CI: 1.13–7.76, p = 0.027), new pulmonary conditions at follow up, (HR = 9.57, 95% CI: 3.46–26.49, p < 0.001) and FI (HR = 5.52, 95% CI: 1.76–17.27, p = 0.003). Other cancer characteristics (ER/PR/HER2/TN status), treatment modalities (surgery type or concurrent/adjuvant chemotherapy), and comorbidities (HTN, HLD, smoker, BMI, ECOG PS) did not improve model fit. 5-year OS was 74.9% for FIA residents vs. 90.2% for non-FIA residents (p = 0.005).Conclusion:
LABC patients residing in FIAs had a 5.5 times higher risk of mortality than those in food-secure areas, despite having similar cancer characteristics, treatments and adherence. Factors such as race, marital status, ECOG PS, BMI, HTN, HLD, and smoking status did not significantly influence OS, further suggesting that food insecurity may play a critical role in survival outcomes. While these findings highlight a strong association between FI and worse OS for LABC patients, further research is needed to establish causality and explore potential mechanisms. We are designing a prospective clinical trial to evaluate whether interventions to improve food access can enhance outcomes for LABC patients.