Quality of Life Research

, Volume 16, Issue 3, pp 413–428

Examining predictive models of HRQOL in a population-based, multiethnic sample of women with breast carcinoma

  • Kimlin T. Ashing-Giwa
  • Judith S. Tejero
  • Jinsook Kim
  • Geraldine V. Padilla
  • Gerhard Hellemann

DOI: 10.1007/s11136-006-9138-4

Cite this article as:
Ashing-Giwa, K.T., Tejero, J.S., Kim, J. et al. Qual Life Res (2007) 16: 413. doi:10.1007/s11136-006-9138-4



This study examined health related quality of life (HRQOL) and its predictors among African-, Asian-, Latina-, and European American breast cancer survivors (BCS) using a socio-ecologically and culturally contextual theoretical model of HRQOL.


We employed a case–control, cross sectional design with a population-based sample from the California Cancer Registry. Descriptive, bivariate, and multivariate regression analyses were conducted.


The sample included 703 BCS: 135 (19%) African-, 206 (29%) Asian-, 183 (26%) Latina-, and 179 (26%) European Americans. Latinas reported the lowest HRQOL (p < 0.0001). The final regression model explained 70% of variance in HRQOL. Years since diagnosis, number of comorbidities, role limitation, emotional wellbeing, quality of doctor–patient relationship, social support, and life stress are significant HRQOL determinants. Exploratory regression analyses indicate ethnic differences in significant predictors for HRQOL.


HRQOL among this multiethnic sample ranged from fair to good. Bivariate analysis suggests that ethnic differences in HRQOL exist. However, regression analyses demonstrated that socio-ecological factors in conjunction with medical characteristics are more salient to HRQOL outcomes, and that ethnic group membership may be a proxy for socio-ecological context. Furthermore, the influence of ethnicity, culture, and social-ecology are complex; research with large, population-based samples are necessary to disentangle the impact of contextual factors on HRQOL.


Breast cancer Culture Ethnic minority Health disparities HRQOL Multiethnic Social-ecology 



Adherence Determinants Questionnaire


Analysis of variance


Breast cancer survivors


Breast cancer specific subscale (from the FACT)


California Cancer Registry


Functional Assessment of Cancer Therapy


Health related quality of life


Socio-economic status

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Kimlin T. Ashing-Giwa
    • 1
    • 2
  • Judith S. Tejero
    • 1
    • 2
  • Jinsook Kim
    • 3
  • Geraldine V. Padilla
    • 4
  • Gerhard Hellemann
    • 5
  1. 1.Center of Community Alliance for Research and Education (CCARE), Division of Population SciencesCity of Hope National Medical CenterDuarteUSA
  2. 2.Center for Culture and HealthUCLA School of MedicineLos AngelesUSA
  3. 3.Department of Community Health SciencesUCLA School of Public HealthLos AngelesUSA
  4. 4.Department of NursingUniversity of CaliforniaSan FranciscoUSA
  5. 5.Semel Institute of Neuropsychiatry — Biostatistics CoreUCLALos AngelesUSA