Evaluating the Impact of Social and Built Environments on Health-RelatedQuality of Life among Cancer Survivors

Janet N. Chu, Alison J. Canchola, Theresa H.M. Keegan, Alyssa Nickell, Ingrid Oakley-Girvan, Ann S. Hamilton, Rosa L. Yu, Scarlett Lin Gomez, Salma Shariff-Marco

Research output: Contribution to journalArticlepeer-review


Background: With almost 17 million U.S. cancer survivors, understanding multilevel factors impacting health-related quality of life (HRQOL) is critical to improving survivorship outcomes. Few studies have evaluated neighborhood impact on HRQOL among cancer survivors. Methods: We combined sociodemographic, clinical, and behavioral data from three registry-based studies in California. Using a three-level mixed linear regression model (participants nested within block groups and study/regions), we examined associations of both independent neighborhood attributes and neighborhood archetypes, which capture interactions inherent among neighborhood attributes, with two HRQOL outcomes, physical (PCS) and mental (MCS) composite scores. Results: For the 2,477 survivors, 46% were 70 years, 52% were non-Hispanic White, and 53% had localized disease. In models minimally adjusted for age, stage, and cancer recurrence, HRQOL was associated with neighborhood socioeconomic status (nSES), racial/ethnic composition, population density, street connectivity, restaurant environment index, traffic density, urbanicity, crowding, rental properties, and non-single family units. In fully adjusted models, higher nSES remained associated with better PCS, and restaurant environment index, specifically more unhealthy restaurants, associated with worse MCS. In multivariable-adjusted models of neighborhood archetype, compared with upper middle-class suburb, Hispanic small town and inner city had lower PCS, and high status had higher MCS. Conclusions: Among survivors, higher nSES was associated with better HRQOL; more unhealthy restaurants were associated with worse HQROL. As some neighborhood archetypes were associated with HRQOL, they provide an approach to capture how neighborhood attributes interact to impact HRQOL.

Original languageEnglish (US)
Pages (from-to)161-174
Number of pages14
JournalCancer Epidemiology Biomarkers and Prevention
Issue number1
StatePublished - Jan 2022

ASJC Scopus subject areas

  • Epidemiology
  • Oncology


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