Exploring Cumulative Social Determinants Burden, Cancer, and Accelerated Aging: The Role of Physical Activity as a Moderator

Project Summary/Abstract Despite progress in the fight against cancer, a disproportionate burden of cancer continues for many people disadvantaged by the social, political, and environmental systems in which they live. The same social determinants of health (non-medical factors) that contribute to disparities in cancer diagnosis, stage of disease, and cancer survival have been found, in non-cancer settings, to be associated with accelerated aging. Treatment for cancer accelerates the aging process which manifest clinically as the premature onset of other chronic illnesses, subsequent cancers, and frailty compared to healthy controls. However, the extent to which cancer treatment and SDOH interact, leading to potential compounding effects on accelerated aging is critically important and may help demarcate important differences in patients who otherwise seem deceptively similar because they share the same cancer diagnosis. Simply knowing who is at risk for accelerated aging is simply the starting point to advance health equity. Modifiable behaviors, such as physical activity has been found in non-cancer settings to have anti-aging effects through decreasing age-associated inflammation. We also know that socially disadvantaged groups engage in less physical activity than those who are more affluent. As such, exercise could operate to either increase the risk of accelerated aging, provide protection, or promote resilience. To address these gaps, the proposed case-control cohort study leverages the All of Us research program to examine the association between SDOH and accelerated aging (measured as deficit accumulation frailty index), and physical activity (active minutes per week), in a large, racially/ethnic diverse, nationally representative sample of adults with and without cancer. Specific aims are to 1) Determine the individual SDOH factors that are associated with accelerated aging (frail, pre-frail, robust) in adults with cancer compared to those without cancer, 2) Examine the cumulative SDOH burden associated with accelerated aging (frail, pre- frail, robust) in adults with cancer compared to those without cancer, and 3) Test whether participants’ physical activity (active minutes over 7-day period), moderates the effect of cumulative SDOH burden on accelerated aging (frail, pre-frail, robust) in adults with cancer compared to those without a history of cancer. Results will help advance the Healthy People 2030 and NIMHHD goal of improving the health and well-being of socially disadvantaged groups, by understanding which SDOH factors or combination of factors elevate the risk of accelerated aging in an already compromised group of cancer survivors. Further identifying potentially modifiable risk and resilience factors (physical activity) can inform the future development of behavioral interventions to help mitigate these effects.