Distinct Sources of Social Adversity, Stress, and Coping Mechanisms Among Breast Cancer Patients to Identify Areas for Intervention.

Background: Social adversity from neighborhood disadvantage (ND), objectively measured using the Area Deprivation Index [ADI], is a known factor contributing to breast cancer (BC) disparities and has been associated with heightened psychophysiologic stress response processes, more aggressive tumor biology, and worse disease outcomes. While many aspects of ND may be less accessible for modification, some subjective experiences of ND may be modifiable through psychosocial intervention. This study investigates a critical gap in the literature regarding the link between objective ND and potentially modifiable subjective perceptions of ND.

Methods: From 2020-2024, 610 adult patients (English, Spanish, Creole-speaking) receiving care for BC at a South Florida National Cancer Institute-designated cancer center and sister safety-net hospital enrolled in a cohort study and completed measures for neighborhood-level adversity (Neighborhood Social Environment Adversity Survey [NSEAS]) and individual-level (Perceived Stress Scale [PSS], Impact of Event Scale-Intrusions [IES-I]) perceived stress as well as coping mechanisms (John Henryism Active Coping Scale [JHAC], Social Provisions Scale [SPS], Management of Current Stress [MOCS]). ADI was derived from residential addresses.

Results: Multiple regression analyses found 1) women living in areas of higher objective ND reported greater levels of perceived ND [NSEAS], 2) greater subjective ND related to greater general [PSS] but not cancer-specific stress [IES-I], and 3) women with greater coping mechanisms [JHAC, SPS, MOCS] reported lower levels of subjective ND (ps<.05).

Conclusions: This study clarified relationships among sources of social adversity, stress, and coping mechanisms.

Impact: These findings may help inform intervention design for BC patients living in social adversity.