{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T10:22:50Z","timestamp":1793787770435,"version":"4.6.1"},"reference-count":53,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2024,4,1]]},"abstract":"<jats:sec id=\"ab-ooi230099-4\"><jats:title>Importance<\/jats:title><jats:p>Socioeconomic deprivation is associated with increased risk of poor health and quality-of-life (QOL) outcomes in head and neck cancer (HNC) survivors. However, there are few data on how neighborhood deprivation affects patient-reported outcome measures (PROMs) in HNC survivors.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230099-5\"><jats:title>Objective<\/jats:title><jats:p>To investigate whether neighborhood socioeconomic deprivation is associated with symptom burden, psychological distress, and QOL among HNC survivors.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230099-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cross-sectional study used prospectively collected data from patients seen in a university-affiliated multidisciplinary HNC survivorship clinic between September 2018 and September 2021 who received radiotherapy for squamous cell carcinoma of the oral cavity, oropharynx, and larynx or hypopharynx.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230099-7\"><jats:title>Exposure<\/jats:title><jats:p>Neighborhood socioeconomic deprivation, measured using the Area Deprivation Index (ADI).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230099-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The PROMs pertaining to symptom burden and severity of psychological distress were measured using the Neck Disability Index, Insomnia Severity Index, the 10-item Eating Assessment Tool, the Generalized Anxiety Disorder 7-item scale, and the 8-item Patient Health Questionnaire. Physical and social-emotional QOL were obtained using the University of Washington QOL questionnaire. Multivariable linear regression analysis adjusting for individual-level sociodemographic, comorbidity, and treatment characteristics investigated the association between ADI and PROMs. A subgroup analysis was performed to compare the lowest (most affluent areas: ADI, 0%-20%) and highest (most deprived areas: ADI, 80%-100%) ADI quintiles.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230099-9\"><jats:title>Results<\/jats:title><jats:p>A total of 277 patients were included in the final analysis (mean [SD] age, 64.18 [9.60] years; 215 [77.6%] male). Cancer sites were the oral cavity (52 [18.8%]), oropharyngeal area (171 [61.7%]), and larynx or hypopharynx (54 [19.5%]). Multivariable analysis showed that for every 1-point increase in ADI, social-emotional QOL changed by \u22120.14 points (95% CI, \u20130.24 to \u20130.05 points), anxiety increased by 0.03 points (95% CI, 0.01-0.06 points), and neck disability worsened by 0.05 points (95% CI, 0.01-0.10 points). Compared with patients in the most affluent areas, those in the most deprived areas had significantly lower physical (\u201315.89 points; 95% CI, \u201325.96 to \u20132.31 points; Cohen <jats:italic>d<\/jats:italic>\u2009=\u2009\u22120.83) and social-emotional (\u201313.57 points; 95% CI, \u201322.79 to \u20133.49 points; Cohen <jats:italic>d<\/jats:italic>\u2009=\u2009\u22120.69) QOL and higher depression (2.60 points; 95% CI, 0.21-4.40 points; Cohen <jats:italic>d<\/jats:italic>\u2009=\u20090.52), anxiety (3.12 points; 95% CI, 1.56-4.66 points; Cohen <jats:italic>d<\/jats:italic>\u2009=\u20090.61), insomnia (3.55 points; 95% CI, 0.33-6.41 points; Cohen <jats:italic>d<\/jats:italic>\u2009=\u20090.54), and neck disability (5.65 points; 95% CI, 1.66-9.55 points; Cohen <jats:italic>d<\/jats:italic>\u2009=\u20090.66) scores.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230099-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this cross-sectional study, a higher ADI score was associated with higher risk of increased psychological distress, higher symptom burden, and decreased QOL after treatment among HNC survivors. These findings suggest that proactive, patient-centered interventions are needed to address these disparities.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2023.4672","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T16:34:10Z","timestamp":1708619650000},"page":"295","source":"Crossref","is-referenced-by-count":34,"title":["Neighborhood Deprivation and Symptoms, Psychological Distress, and Quality of Life Among Head and Neck Cancer Survivors"],"prefix":"10.1001","volume":"150","author":[{"given":"Zainab","family":"Balogun","sequence":"first","affiliation":[{"name":"School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren A.","family":"Gardiner","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, 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