Racial/ethnic differences in quality of life after diagnosis of breast cancer
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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.
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.
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.
Racial/ethnic differences in quality of life exist during the cancer survivorship period. Latinas with low acculturation are a particularly vulnerable subgroup.
Greater attention should be devoted to identifying women disproportionately affected by breast cancer and developing interventions targeting their unique survivorship concerns.
KeywordsBreast cancer Quality of life Minority health Racial/ethnic differences
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.
- 1.Smedley BD, Stith A, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC Institute of Medicine: The National Academy Press; 2003.Google Scholar
- 2.US Department of Health and Human Services, Nation Institutes of Health, National Cancer Institute. Living beyond cancer: Finding a new balance. President’s Cancer Panel: 2003–2004 Annual Report. Washington, D.C.; 2004.Google Scholar
- 3.Hewitt M, Greenfield S, Stovall E. Cancer patient to cancer survivor: lost in transition. Washington: The National Academy Press; 2006.Google Scholar
- 12.Trentham-Dietz A, Sprague BL, Klein R, Klein BE, Cruickshanks KJ, Fryback DG, et al. Health-related quality of life before and after breast cancer diagnosis. Breast Cancer Res Treat. 2007: E-pub ahead of print.Google Scholar
- 32.Greene FL, Page DL, Fleming ID, Fritz A, Balch CM. AJCC cancer staging manual. 6th ed. Philadelphia: Lippincott Raven Publishers; 2002.Google Scholar
- 34.Moore RJ, Butow P. Culture and oncology: impact of context effects. New York: Kluwer; 2004.Google Scholar
- 36.Marin G, Van Oss Marin B. Research with Hispanic populations. Applied Social Research Methods Series, issue number 23, Sage Publications, Newbury Park, CA, 1991.Google Scholar
- 37.Dillman DA. Mail and telephone surveys: the total design method. New York: Wiley; 1997.Google Scholar
- 49.Wildes KA, Miller AR, San Miguel de Majors S, Ramirez AG. The religiosity/spirituality of Latina breast cancer survivors and influence on health-related quality of life. Psycho-Oncology. 2008: Epub ahead of print.Google Scholar
- 51.Stephens C, Stein K, Landrine H. The role of acculturation in life satisfaction among Hispanic cancer survivors: results of the American Cancer Society’s study of cancer survivors. Psycho-Oncology. 2009:Epub ahead of print.Google Scholar