Increasingly, health care systems are becoming stakeholders in urban design and infrastructure planning processes, and are considering how neighborhood environments can support the health of communities and patient populations within health system catchment areas. To this end, health systems are: contracting with planning firms to create Health District Plans with urban infrastructure that promotes healthy lifestyles; working alongside community partners to improve alignment and delivery of local health and supportive care resources; and are incorporating neighborhood-level data in electronic health records (EHR) as a new type of patient “vital sign.” And while extant literature indicates associations between neighborhood built environments and health outcomes, particularly for obesity, in the United States (US) general population, few studies have explored these relationships in cancer survivors – even fewer in non-white cancer survivor populations.
Cancer survivors are at heightened risk of weight gain after diagnosis, since they are susceptible to the energy-balance-related causes of weight gain common in the general population, as well as to cancer treatment-related weight gain. From 1997 to 2014, obesity increased more rapidly among adult cancer survivors compared with the general population. Colorectal and breast cancer survivors and non-Hispanic black survivors were at the highest risk of experiencing obesity during this period. Recent evidence among survivors of obesity-related cancers suggests that weight gain is related to higher risk of recurrence, cancer mortality, and all-cause mortality.
In a recent publication, we assessed the cross-sectional association of residential neighborhood walkability with body mass index (BMI) in 2089 African Americans who had recently been diagnosed with cancer in Metropolitan Detroit, Michigan. Similar to prior research in the general population, among these cancer survivors, we found BMI to be inversely associated with greater neighborhood walkability. When we stratified these analyses by biologic sex, we observed the inverse associations in men but not women and, separately, among survivors reporting any regular physical activity post-diagnosis. The sex-specific findings are similar to those observed in previous studies of general populations. To our knowledge, this is the first survivorship investigation of neighborhood walkability and BMI to focus solely on African Americans, to include survivors of more than one obesity-related cancer (i.e., breast, colorectal, prostate), to incorporate men, and to use a multidimensional walkability index. Our research provides initial evidence that built environment factors influence weight among African American cancer survivors and support for health systems involvement in local urban design and planning decisions.
This research was conducted in collaboration with colleagues at Wayne State University, using data from cancer survivors participating in the Detroit Research on Cancer Survivors (ROCS) cohort study.