Impact of neighborhood deprivation on disability free survival in patients with aggressive B cell non-Hodgkin lymphoma.

person Madelyn Burkart Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL info_outline Madelyn Burkart, Nicholas Demetriou, Ashwin Sunderraj, Shou Ma, Jane N. Winter, Leo I. Gordon, Jonathan Moreira, Reem Karmali, Ishan Roy

Authors person Madelyn Burkart Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL info_outline Madelyn Burkart, Nicholas Demetriou, Ashwin Sunderraj, Shou Ma, Jane N. Winter, Leo I. Gordon, Jonathan Moreira, Reem Karmali, Ishan Roy Organizations Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, Feinberg School of Medicine, Northwestern University, Chicago, IL, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, Northwestern University Feinberg School Of Medicine, Division Of Hematology/Oncology, Department Of Medicine, Chicago, IL, Northwestern University Feinberg School of Medicine, Chicago, IL, Shirley Ryan AbilityLab, Chicago, IL Abstract Disclosures Research Funding No funding received None. Background: Advancements in treatment over the last decade have greatly improved survival in B cell non-Hodgkin’s lymphoma (NHL), yet not all patients (pts) benefit the same. Non-Hispanic Black (NHB), uninsured and lower socioeconomic status pts continue to suffer worse survival. However, the impact of neighborhood deprivation on disability has not been explored. We aimed to assess the association between neighborhood deprivation and disability free survival (DFS) in NHL pts. Methods: 258 aggressive NHL pts treated between 2005-2020 were included. Pts without documented follow up were excluded. Race/ethnicity was categorized as non-Hispanic white (NHW), Hispanic, NHB and other. Primary outcomes included progression free survival (PFS), overall survival (OS) and DFS. DFS was defined as time to needing any rehabilitative, home-health or skilled nursing services immediately following induction therapy, indicating disability and lack of functional independence. Neighborhood deprivation was assigned using the national Area Deprivation Index (ADI), a validated measure classifying neighborhood adversity. Pts were categorized into high (67-99), intermediate (34-66) or low (1-33) ADI scores, with least disadvantaged designated by lower scores. Kaplan-Meier analyses were used to compare PFS, OS and DFS. Results: Demographic data is shown in the table; 45% were female, 65% were NHW, 10% were NHB, 8% were Hispanic and 10% were other. Median age at diagnosis was 57 years. There was no difference in PFS or OS between racial/ethnic groups (p=0.91 and p=0.23 respectively). Payor source influenced both PFS and OS (p<0.001 and p<0.001 respectively), with self-pay associated with worse PFS and OS. Neighborhood deprivation based on ADI did not influence PFS (p=0.33) or OS (p=0.76). High ADI score was associated with worse DFS compared to lower ADI scores (p=0.03). ADI score differed significantly based on race/ethnicity (p<0.0001), with more NHB pts residing in areas of high ADI scores (40% vs 5% NHW vs 10% Hispanic). There was no association between ADI score and a pt’s ECOG performance status, IPI score or albumin at diagnosis (p=0.87, p=0.78 and p=0.59 respectively). Conclusions: NHL pts with higher neighborhood adversity experience more disability after treatment despite similar survival. Further work is needed to better understand how neighborhood factors are contributing to disability before community-level strategies for improvement can be developed. Total N (N=258) Low ADI (N=153) Intermediate ADI (N=76) High ADI (N=29) P-value Gender (%) Male Female 142 116 57 62 34 53 9 13 P=0.25 Age (%) >/= 60 years old < 60 years old 133 124 53 66 35 24 12 10 P=0.09 Race/ethnicity (%) NHW NHB Hispanic Other 168 25 21 27 65 24 52 52 29 36 38 33 5 40 10 15 P<0.0001 Diagnosis (%) DLBCL MCL 197 61 59 61 31 26 10 13 P=0.69 IPI score (%) Low Low-intermediate High-intermediate High 74 89 54 41 59 61 54 63 27 31 31 29 14 8 15 7 P=0.78