Area Deprivation and Postoperative Quality of Life After Major Operations for Cancer

Abstract

Introduction: Neighborhood deprivation, a measure of socioeconomic status, has been associated with worse postoperative outcomes. Its impact on postoperative quality of life (QOL) has not been concretely determined. We performed a secondary analysis of a randomized controlled trial to test the hypothesis that increased neighborhood deprivation is associated with worse postoperative QOL.

Materials and methods: Secondary analysis was conducted of a cohort of patients who underwent major abdominal cancer operations originally recruited as part of a randomized controlled trial. Primary exposure was neighborhood deprivation of patients, measured by the area deprivation index (ADI). The primary outcome was the overall QOL measured by the Functional Assessment of Cancer Therapy-General scores at 90 d postoperatively. Secondary outcomes at postoperative 90 d were: days alive at home; caregiver burden, measured by the Zarit Burden Interview questionnaire; and mobility, measured by the life-space assessment.

Results: All 235 patients from the original trial analysis were included in our cohort (median age 65.0 y, 60.0% male). Most common cancers included bladder, colorectal, and foregut carcinoma. ADI was not associated with overall QOL (odds ratio [OR] 0.89; 95% confidence interval [CI] (0.59, 1.34), P = 0.85). ADI did not have a statistically significant association with days alive at home (OR 0.93; 95% CI (0.64, 1.36), P = 0.19), caregiver burden (OR 0.69; 95% CI (0.43, 1.10), P = 0.06), or postoperative mobility (OR 1.22; 95% CI (0.81, 1.84), P = 0.59).

Conclusions: This single-center study showed no association between neighborhood deprivation and postoperative QOL outcomes. Other social factors may play a significant role; future studies can explore this further.

Keywords: Deprivation; Oncology; Outcomes; Quality of life; Socioeconomic status; Surgery.