Social Health Determinants Impact Psychoneurological Symptoms in BC Survivors

Stress was linked with increased fatigue, anxiety, and sleep disturbance.

Some social determinants of health, including heightened financial needs and stress levels, were linked to greater rates of psychoneurological symptoms in survivors of breast cancer, according to data presented at the 50th Annual Oncology Nursing Society Congress.

Data from an adjusted model demonstrated a significant relationship between financial needs (P = .002) and stress (P < .001) with increased psychoneurological symptoms among patients with breast cancer who were disease survivors (n = 74). Stress was also significantly associated with increased fatigue (P = .042), anxiety (P < .001), and sleep disturbance (P = .003).

“Twenty-four to 68% of breast cancer survivors experience co-occurring psychoneurological symptoms,” Zahra A. Barandouzi PhD, RN, an assistant professor at the Nell Hodgson Woodruff School of Nursing at Emory University as well as a member of the Winship Cancer Institute in Atlanta, Georgia, and her coauthors wrote in the presentation. “Psychoneurological symptoms include pain, fatigue, sleep disturbances, depressive symptoms, and anxiety. Psychoneurological symptoms are the lasting effects of cancer and its treatment. [The] burden of psychoneurological symptoms has raised curiosity about the factors influencing its severity.”

To conduct their study, investigators performed a secondary data analysis that included 74 patients with breast cancer who were disease survivors. Psychoneurological symptoms were examined via the Patient-Reported Outcomes Measurement Information System (PROMIS) 29 v1.0 questionnaires. Psychoneurological symptom cluster score was determined by taking the average of symptoms.

Individual-level social determinants of health were assessed via a questionnaire which identified needs across 8 domains. Community-level social determinants of health were assessed using the Area Deprivation Index. Statistical analysis was performed using linear regression models, which were created to determine the multidimensional impact of social determinants of health on psychoneurological symptom burden.

At baseline, the mean patient age was 53.95 years (SD ± 9.91) and the mean body mass index was 31.18 (SD ± 6.52). Most patients were non-Hispanic Black (52.70%), were educated at a college level or above (82.44%), and had an Area Deprivation Index of less than 75 (78.08%). Patients had stage 0 or I (52.70%), II (35.13%), or III (12.18%) disease.

Findings from an unadjusted model demonstrated that financial needs were significantly associated with increased fatigue (P = .004), depressive symptoms (P < .001), pain (P = .0007), and psychoneurological symptoms (P < .001). Stress also displayed a significant association with increased fatigue (P = .002), depressive symptoms (P < .001), anxiety (P < .001), pain (P = .016), sleep disturbance (P = .001), and psychoneurological symptoms (P < .001). Moreover, social connection via the phone was significantly associated with increased fatigue (P = .003) and pain (P = .004).

Alcohol use, transportation needs, physical activity, physical social connections, and Area Deprivation Index were not significantly associated with any of the social determinants of health variables, according to the unadjusted model. In the adjusted model, fatigue was also significantly associated with social connection via the phone (P = .040).

In their discussion, Barandouzi and her coauthors noted the importance of targeted interventions to address these challenges to improve symptom management and enhance the quality of life for patients with breast cancer. Support systems aimed at tackling financial burdens and stress management can also improve symptom relief and outcomes for patients, they added.

“Higher financial needs and stress levels were associated with increased severity of psychoneurological symptoms in breast cancer survivors,” Barandouzi and her coauthors wrote in conclusion. “Although further large-scale studies are necessary to validate these findings, the results underscore the potential impact of these 2 factors on cancer symptoms.”

References

Barandouzi ZA, Choi H, Lin Y, Bruner D, Li H. The multidimensional impact of social determinants of health on symptoms in breast cancer survivors. Presented at: 50th Annual Oncology Nursing Society Congress; April 9-April 13, 2025; Denver, CO.