Social Vulnerability Index Contributes to Patient History: Women Treated with Chemotherapy for Early-Stage Breast Cancer

Abstract

Background In women scheduled for chemotherapy for early-stage breast cancer (BC), we investigated associations of the Center for Disease Control and Prevention’s (CDC) Social Vulnerability Index (SVI) with pre-treatment demographics, health behavior, functional and quality of life factors, and treatment toxicities during chemotherapy. Methods Patients participated in a home-based walking program during chemotherapy. The SVI Overall score (CDC website for linking zip codes in the electronic medical record) is comprised of four themes: Socioeconomic, Household Composition, Minority Status/Language, and Household Type/Transportation. SVI scores range from 0 = lowest to 1 = highest vulnerability. Participant SVI scores were derived from zip codes listed in the patient’s address in the electronic medical record. Associations of study variables with SVI were evaluated with Spearman correlation for continuous variables and Kruskal-Wallis Tests for categorical variables. Results In a sample of 309 women (NCT02167932, 03/2014-11/2016; NCT02328313, 10/2014-01/2019); NCT03761706, 02/2018-06/2020), mean age was 56 years (range 23–83) and 75% White. Higher (greater vulnerability) SVI Overall was associated with Black race (p < .001), lower education (p = 0.02), non-marriage (p = < .0001), higher body mass index (p = .03), fewer walking minutes/week (p = < .001), smoking (p = 0.02), alcohol use (p < .001), Mental Health Index-Depression (p = 0.01), and lower emotional social support (p = 0.008). During chemotherapy, moderate, severe or very severe (MSVS) symptoms were associated with higher SVI Overall for hot flashes (p = .03), arthralgia (p = .02), myalgia (p = .02), peripheral neuropathy (p = .01), edema of limbs (p = .04), and nausea (p < .001). Conclusions SVI scores derived from addresses in the patient record can provide information that adds to the patient’s social history in ways that may be informative for cancer care.