Housing instability and psychological distress in African American cancer survivors: findings from the Detroit Research on Cancer Survivors study.

ABSTRACT

PURPOSE: As health care systems seek to screen for and address housing instability in patient populations, robust evidence linking unstable housing to patient-reported outcomes is needed. Housing instability may increase psychological distress in cancer survivors, potentially more so among African American cancer survivors who are also likely to experience disproportionate burden of housing instability. The purpose of this analysis was to estimate associations between housing instability and psychological distress in African Americans diagnosed with cancer. METHODS: We included survey responses from 2875 African American cancer survivors in the Detroit Research on Cancer Survivors (ROCS) study. We examined how housing instability at enrollment, using an item adapted from the Health Leads Screening Toolkit, related to psychological distress at enrollment, using Patient Reported Outcomes Measurement System (PROMIS) 4-item anxiety and depression short forms. Linear regression models adjusted for sociodemographic factors were used to estimate associations overall and stratified by stage at diagnosis. RESULTS: Approximately 12% of participants reported being unstably housed. Housing instability was associated with significant differences in PROMIS scores for both anxiety (difference 6.79; 95% CI 5.57-8.01) and depression (difference 6.16; 95% CI 4.99-7.34). We did not find meaningful differences stratifying by disease stage. CONCLUSION: Housing instability was experienced by over a tenth of this cohort of African American cancer survivors and was related to statistically and clinically meaningful differences in psychological distress even following adjustment for sociodemographics. IMPLICATIONS FOR CANCER SURVIVORS These findings provide evidence supporting screening of housing instability in cancer survivors, especially those from medically underserved populations.