# Neighborhood-level disadvantage and lifestyle-based supportive care in head and neck cancer: insights from the Midwestern United States

## TL;DR

This study shows that neighborhood disadvantage affects survival in head and neck cancer patients, suggesting lifestyle interventions could help reduce health inequities.

## Contribution

The study explores the impact of neighborhood-level disadvantage on head and neck cancer survival, proposing lifestyle-based interventions to address social inequities.

## Key findings

- Neighborhood disadvantage, measured by ADI, correlates with age, HPVp16 status, and comorbidity count in HNC patients.
- Survival status at study end showed over 50% of the most disadvantaged patients were deceased or lost to follow-up.
- Kaplan–Meier curves revealed survival variations by neighborhood disadvantage quintiles.

## Abstract

Survivorship care in head and neck cancer (HNC) is complex, influenced by tumor site, treatment modality, and social determinants of health. Neighborhood-level factors may affect cancer outcomes, yet the impact of neighborhood disadvantage on HNC survival remains underexplored. This study examined the association between neighborhood disadvantage and overall survival in HNC survivors. We conducted a retrospective cohort study of patients diagnosed with HNC (n = 440) at a single institution (2013–2023). Neighborhood disadvantage was measured using the Area Deprivation Index (ADI) national percentile and stratified into quintiles. Clinical, demographic, and treatment data were extracted from electronic health records. Overall survival was analyzed using Kaplan–Meier curves and the Cox proportional hazards model. Multiple linear regression identified predictors of ADI. Significant differences across ADI quintiles were observed for age at diagnosis (p = 0.025), HPVp16 status (p < 0.001), and comorbidity count (p = 0.028). In multivariable regression, only age (p = 0.04) and HPVp16 status (p < 0.001) remained significant. Median survival did not differ significantly; however, survival status at study end was notable, with >50% of participants in the most disadvantaged quintile deceased or lost to follow-up. Kaplan–Meier curves demonstrated variation in survival by ADI quintile. Neighborhood disadvantage influences HNC survivorship. Integrating community-level and lifestyle-based interventions (e.g., nutrition education, physical activity promotion, stress reduction, and behavioral health support) into survivorship care may mitigate effects of social inequities. Incorporating neighborhood context into survivorship planning may improve outcomes and promote equity in HNC care.