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Racial/ethnic differences in quality of life after diagnosis of breast cancer

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Abstract

Introduction

Most studies on quality of life of breast cancer survivors have not had adequate representation of ethnic minorities. The purpose of this study was to determine whether racial/ethnic differences in quality of life exist between white, African American, and Latina women in the early stages of survivorship.

Methods

2268 women were identified by two Surveillance, Epidemiology and End Results (SEER) registries (6/05–2/07) and asked to complete a survey (mean 9 months post-diagnosis, 72.1% response rate). Latina and African American women were over-sampled. Regression models compared quality of life across race/ethnicity (white, African American, Latina [low vs. high acculturation]), sequentially controlling for sociodemographics, clinical, and treatment factors.

Results

There were significant racial/ethnic differences in quality of life controlling for sociodemographics, clinical factors and treatment factors. Lower acculturated Latinas compared to whites had significantly lower functional well-being, emotional well-being, and breast cancer concerns (p values  < 0.05). African Americans had significantly higher emotional well-being than whites. Age, co-morbidities, cancer stage, and chemotherapy also influenced quality of life. A significant interaction was found between race/ethnicity and age for physical well-being (p = 0.041) and for emotional well-being (p = 0.042). Specifically, racial/ethnic differences were only observed among older women (≥50 years), with less acculturated Latinas reporting the lowest quality of life.

Conclusions

Racial/ethnic differences in quality of life exist during the cancer survivorship period. Latinas with low acculturation are a particularly vulnerable subgroup.

Implications

Greater attention should be devoted to identifying women disproportionately affected by breast cancer and developing interventions targeting their unique survivorship concerns.

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Acknowledgements

This work was funded by grants R01 CA109696 and R01 CA088370 from the National Cancer Institute (NCI) to the University of Michigan. Dr. Katz was supported by an Established Investigator Award in Cancer Prevention, Control, Behavioral, and Population Sciences Research from the NCI (K05CA111340).

The collection of Los Angeles County cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the NCI’s Surveillance, Epidemiology and End Results (SEER) Program under contract N01-PC-35139 awarded to the University of Southern California, contract N01-PC-54404 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement 1U58DP00807-01 awarded to the Public Health Institute. The collection of metropolitan Detroit cancer incidence data was supported by the NCI SEER Program contract N01-PC-35145. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.

Special thanks to Ain Boone, Cathey Boyer, and Deborah Wilson for their data collection efforts at the Metropolitan Detroit Cancer Surveillance System (MDCSS) and to Alma Acosta, Marlene Caldera, Norma Caldera, Maria Isabel Gaeta, Urduja Trinidad, and Mary Lo at the Cancer Surveillance Program in Los Angeles; and to Barbara Salem, Ashley Gay and Paul Abrahamse at the University of Michigan.

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Authors and Affiliations

  1. Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA

    Nancy K. Janz

  2. Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA

    Mahasin S. Mujahid

  3. Veterans Administration Center for Practice Management, Ann Arbor Veterans Administration Health Care System and Outcomes Research, University of Michigan Medical Center, Ann Arbor, MI, USA

    Sarah T. Hawley

  4. Division of General Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA

    Sarah T. Hawley & Steven J. Katz

  5. Department of Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA

    Jennifer J. Griggs

  6. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Amy Alderman

  7. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Ann S. Hamilton

  8. Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA

    John Graff

  9. Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA

    Steven J. Katz

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  1. Nancy K. Janz
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  2. Mahasin S. Mujahid
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  3. Sarah T. Hawley
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  8. Steven J. Katz
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Correspondence to Nancy K. Janz.

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Janz, N.K., Mujahid, M.S., Hawley, S.T. et al. Racial/ethnic differences in quality of life after diagnosis of breast cancer. J Cancer Surviv 3, 212–222 (2009). https://doi.org/10.1007/s11764-009-0097-y

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