Examining allostatic load, neighborhood socioeconomic status, symptom burden and mortality in multiple myeloma patients

Abstract

The objective of this study is to examine the association between neighborhood socioeconomic status (nSES) and baseline allostatic load (AL) and clinical trial endpoints in patients enrolled in the E1A11 therapeutic trial in multiple myeloma (MM). Study endpoints were symptom burden (pain, fatigue, and bother) at baseline and 5.5 months, non-completion of induction therapy, overall survival (OS) and progression-free survival (PFS). Multivariable logistic and Cox regression examined associations between nSES, AL and patient outcomes. A 1-unit increase in baseline AL was associated with greater odds of high fatigue at baseline (adjusted OR [95% CI] = 1.21 [1.08–1.36]) and a worse OS (adjusted hazard ratio, [95% CI] = 1.21 [1.06–1.37]). High nSES was associated with worse baseline bother (middle OR = 4.22 [1.11–16.09] and high 4.49 [1.16–17.43]) compared to low nSES. There was no association between AL or nSES and symptom burden at 5.5 months, non-completion of induction therapy or PFS. Additionally, there was no association between nSES and OS. AL may have utility as a predictive marker for OS among patients with MM and may allow individualization of treatment. Future studies should standardize and validate AL patients with MM.

Oncologic anthropology: Global variations in breast cancer risk, biology, and outcome

“…Allostatic load represents the concept that lifetime stressors (including exposures to racism and poverty) can influence cancer risk through epigenetics and effect on the neuroendocrine system. [23][24][25] The systemic racism as a legacy of colonial-era slavery has left African Americans particularly vulnerable to the impact of allostatic load on breast cancer risk and outcome. 23 Social determinants of health related to allostatic load, coupled with selected germline F I G U R E 3 Incidence of breast cancer phenotypes by race among women 20 years and older in the United States.…”

“…Allostatic load represents the concept that lifetime stressors (including exposures to racism and poverty) can influence cancer risk through epigenetics and effect on the neuroendocrine system 23–25 . The systemic racism as a legacy of colonial‐era slavery has left African Americans particularly vulnerable to the impact of allostatic load on breast cancer risk and outcome 23 .…”