Skip to main content

Advertisement

SpringerLink
Log in

Understanding racial/ethnic differences in breast cancer-related physical well-being: the role of patient–provider interactions

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Racial/ethnic differences in cancer symptom burden are well documented, but limited research has evaluated modifiable factors underlying these differences. Our objective was to examine the role of patient–provider interactions to help explain the relationship between race/ethnicity and cancer-specific physical well-being (PWB) among women with breast cancer.

Methods

The Pathways Study is a prospective cohort study of 4505 women diagnosed with breast cancer at Kaiser Permanente Northern California between 2006 and 2013. Our analysis included white, black, Hispanic, and Asian participants who completed baseline assessments of PWB, measured using the Functional Assessment of Cancer Therapy for Breast Cancer, and patient–provider interactions, measured by the Interpersonal Processes of Care Survey (IPC) (N = 4002). Using step-wise linear regression, we examined associations of race/ethnicity with PWB, and changes in associations when IPC domains were added.

Results

We observed racial/ethnic differences in PWB, with minorities reporting lower scores than whites (beta, black: − 1.79; beta, Hispanic: − 1.92; beta, Asian: − 1.68; p < 0.0001 for all comparisons). With the addition of health and demographic covariates to the model, associations between race/ethnicity and PWB score became attenuated for blacks and Asians (beta: − 0.63, p = 0.06; beta: − 0.68, p = 0.02, respectively) and, to a lesser extent, for Hispanic women (beta: − 1.06, p = 0.0003). Adjusting for IPC domains did not affect Hispanic–white differences (beta: − 1.08, p = 0.0002), and slightly attenuated black–white differences (beta: − 0.51, p = 0.14). Asian–white differences narrowed substantially (beta: − 0.31, p = 0.28).

Conclusions

IPC domains, including those capturing perceived discrimination, respect, and clarity of communication, appeared to partly explain PWB differences for black and Asian women. Results highlight opportunities to improve providers’ interactions with minority patients, and communication with minority patients about their supportive care needs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Anderson KO, Green CR, Payne R (2009) Racial and ethnic disparities in pain: causes and consequences of unequal care. J Pain 10:1187–1204

    Article  PubMed  Google Scholar 

  2. Martinez KA, Snyder CF, Malin JL, Dy SM (2014) Is race/ethnicity related to the presence or severity of pain in colorectal and lung cancer? J Pain Symptom Manage 48:1050–1059

    Article  PubMed  PubMed Central  Google Scholar 

  3. Fisch MJ, Lee JW, Weiss M et al (2012) Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer. J Clin Oncol 30:1980–1988

    Article  PubMed  PubMed Central  Google Scholar 

  4. Reyes-Gibby CC, Anderson KO, Shete S, Bruera E, Yennurajalingam S (2012) Early referral to supportive care specialists for symptom burden in lung cancer patients: a comparison of non-Hispanic whites, Hispanics, and non-Hispanic blacks. Cancer 118:856–863

    Article  PubMed  Google Scholar 

  5. John DA, Kawachi I, Lathan CS, Ayanian JZ (2014) Disparities in perceived unmet need for supportive services among patients with lung cancer in the Cancer Care Outcomes Research and Surveillance Consortium. Cancer 120:3178–3191

    Article  PubMed  PubMed Central  Google Scholar 

  6. Walling AM, Keating NL, Kahn KL et al (2016) Lower patient ratings of physician communication are associated with unmet need for symptom management in patients with lung and colorectal cancer. J Oncol Pract 12:e654–e669

    Article  PubMed  PubMed Central  Google Scholar 

  7. Palmer NR, Kent EE, Forsythe LP et al (2014) Racial and ethnic disparities in patient-provider communication, quality-of-care ratings, and patient activation among long-term cancer survivors. J Clin Oncol 32:4087–4094

    Article  PubMed  PubMed Central  Google Scholar 

  8. Saha S, Arbelaez JJ, Cooper LA (2003) Patient-physician relationships and racial disparities in the quality of health care. Am J Public Health 93:1713–1719

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ngo-Metzger Q, Legedza AT, Phillips RS (2004) Asian Americans’ reports of their health care experiences. Results of a national survey. J Gen Intern Med 19:111–119

    Article  PubMed  PubMed Central  Google Scholar 

  10. Quach T, Nuru-Jeter A, Morris P et al (2012) Experiences and perceptions of medical discrimination among a multiethnic sample of breast cancer patients in the Greater San Francisco Bay Area, California. Am J Public Health 102:1027–1034

    Article  PubMed  PubMed Central  Google Scholar 

  11. Napoles AM, Gregorich SE, Santoyo-Olsson J, O’Brien H, Stewart AL (2009) Interpersonal processes of care and patient satisfaction: do associations differ by race, ethnicity, and language? Health Serv Res 44:1326–1344

    Article  PubMed  PubMed Central  Google Scholar 

  12. White-Means SI, Osmani AR (2017) Racial and ethnic disparities in patient-provider communication with breast cancer patients: evidence from 2011 MEPS and experiences with cancer supplement. Inquiry 54:46958017727104

    PubMed  Google Scholar 

  13. Kwan ML, Ambrosone CB, Lee MM et al (2008) The pathways study: a prospective study of breast cancer survivorship within Kaiser Permanente Northern California. Cancer Causes Control 19:1065–1076

    Article  PubMed  PubMed Central  Google Scholar 

  14. Johnson KS (2013) Racial and ethnic disparities in palliative care. J Palliat Med 16:1329–1334

    Article  PubMed  PubMed Central  Google Scholar 

  15. Brady MJ, Cella DF, Mo F et al (1997) Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol 15:974–986

    Article  PubMed  CAS  Google Scholar 

  16. Cella D, Hahn EA, Dineen K (2002) Meaningful change in cancer-specific quality of life scores: differences between improvement and worsening. Qual Life Res 11:207–221

    Article  PubMed  Google Scholar 

  17. Tsai W, Lu Q (2017) Acculturation matters in the relation between ambivalence over emotional expressions and well-being among Chinese American breast cancer survivors. Qual Life Res 26:2755–2762

    Article  PubMed  Google Scholar 

  18. Mulvaney-Day NE, Alegria M, Sribney W (2007) Social cohesion, social support, and health among Latinos in the United States. Soc Sci Med 64:477–495

    Article  PubMed  Google Scholar 

  19. DeHaven MJ, Hunter IB, Wilder L, Walton JW, Berry J (2004) Health programs in faith-based organizations: are they effective? Am J Public Health 94:1030–1036

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bronner YL (1995) Session II wrap-up: community-based approaches and channels for controlling hypertension in blacks: barriers and opportunities. J Natl Med Assoc 87:652–655

    PubMed  PubMed Central  CAS  Google Scholar 

  21. Dirksen SR, Erickson JR (2002) Well-being in Hispanic and non-Hispanic white survivors of breast cancer. Oncol Nurs Forum 29:820–826

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the National Cancer Institute (R01CA105274 and U01CA195565 to LHK). Dr. Check is supported by the Delivery Science Fellowship at Kaiser Permanente Northern California.

Author information

Authors and Affiliations

  1. Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA

    Devon K. Check, Marilyn L. Kwan, Janise M. Roh, Isaac J. Ergas & Lawrence H. Kushi

  2. Veterans Affairs Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25, Room B111, North Hills, CA, 91343, USA

    Neetu Chawla

  3. Division of General Internal Medicine, Weill Department of Medicine, 525 East 68th Street, F-2011, New York, NY, 10065, USA

    Laura Pinheiro

  4. Institute for Health and Aging, University of California San Francisco, 3333 California St. Suite 340, San Francisco, CA, 94118-0646, USA

    Anita L. Stewart

  5. Vallejo Medical Center, Kaiser Permanente Northern California, 975 Sereno Drive, Vallejo, CA, 94589, USA

    Tatjana Kolevska

  6. Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA

    Christine Ambrosone

Authors
  1. Devon K. Check
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Neetu Chawla
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marilyn L. Kwan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura Pinheiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Janise M. Roh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Isaac J. Ergas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anita L. Stewart
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tatjana Kolevska
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christine Ambrosone
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lawrence H. Kushi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Devon K. Check.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

This research complies with the current laws of the country in which it was performed. The study was approved by the Institutional Review Board of Kaiser Permanente Northern California.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Check, D.K., Chawla, N., Kwan, M.L. et al. Understanding racial/ethnic differences in breast cancer-related physical well-being: the role of patient–provider interactions. Breast Cancer Res Treat 170, 593–603 (2018). https://doi.org/10.1007/s10549-018-4776-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-018-4776-0

Keywords

Search

Navigation