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LIVING IN A USDA-DEFINED FOOD DESERT IS ASSOCIATED WITH POSTOPERATIVE RECURRENCE FOLLOWING SURGERY AMONG PATIENTS WITH COLON CANCER
Claire E. Wild
*1,6, Jincong Q. Freeman
2,3,4, Armaan Jamal
2, Jasmin Tiro
2,3,5, Kayla Councell
6, Benjamin D. Shogan
6,11University of Chicago Pritzker School of Medicine, Chicago, IL; 2Department of Public Health Sciences, University of Chicago, Chicago, IL; 3Cancer Prevention and Control Program, UChicago Medicine Comprehensive Cancer Center, Chicago, IL; 4Center for Health and the Social Sciences, University of Chicago, Chicago, IL; 5Center to Eliminate Cancer Inequity, Chicago, IL; 6The University of Chicago Medicine, Chicago, IL
Background: The standard of care for non-metastatic colon cancer is surgical resection. Consuming a high-fat, low-fiber diet is a key behavioral risk factor for primary tumor development and a behavior that is constrained by one’s environment. However, less is known about whether diet is a contributing factor for driving postoperative colon cancer recurrence. Research has shown that patients residing in areas with low access to major grocery stores are more likely to have access to foods low in fiber and high in fat. Here, we hypothesize that living in an area with low food access is associated with the development of postoperative recurrence in patients undergoing surgical resection for colon cancer.
Methods: This was a retrospective study. Patients were eligible if: aged ?18 years, diagnosed with stage I-III colon adenocarcinoma, and underwent surgical resection between 2015-2023. Demographic, pathologic, and recurrence data were acquired from our institutional cancer registry. We merged registry with the USDA Food Access Research Atlas (FARA) via FIPS codes at the census tract level per the 2020 census. USDA FARA defines a food desert as an area with both low income and low access to grocery stores. To assess time to recurrence and recurrence-free survival at 2 years, we compared Kaplan-Meier curves using the log-rank test, followed by Cox regression adjusting for age at surgery, race, and pathologic stage.
Results: Of 184 patients included, the mean age at surgery was 65.6 years (SD 14.2); 52.2% were male; 45.4% were White and 44.9% were Black; and 23.0%, 37.1%, and 39.9% were stage I, II, and III, respectively. Overall, 63 (33.5%) patients were living in a food desert; they were more likely to be non-Hispanic Black and have a higher BMI. With a median follow-up of 1.1 years, patients living in a food desert had a shorter median survival time for time to recurrence (1.8 vs 2.0 years,
p = 0.026) and for recurrence-free survival (1.8 vs 2.0 years;
p = 0.009). On multivariable Cox regression, compared with patients not living in a food desert, those living in a food desert had a greater risk of time to recurrence (adjusted hazard ratio [aHR] 1.68, 95% CI: 0.73-3.88) or recurrence-free survival (aHR 1.93, 95% CI: 0.86-4.31), though not statistically significant due to limited sample size.
Conclusion: Living in a food desert was associated with postoperative time to recurrence and recurrence-free survival following surgery among patients with colon cancer. Further research is needed to understand the mechanisms by which living in a food-scarce area drives recurrence.
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