Journal of Cancer Survivorship

, Volume 3, Issue 4, pp 212–222 | Cite as

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

  • Nancy K. Janz
  • Mahasin S. Mujahid
  • Sarah T. Hawley
  • Jennifer J. Griggs
  • Amy Alderman
  • Ann S. Hamilton
  • John Graff
  • Steven J. Katz



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.


Breast 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. 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. 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. 3.
    Hewitt M, Greenfield S, Stovall E. Cancer patient to cancer survivor: lost in transition. Washington: The National Academy Press; 2006.Google Scholar
  4. 4.
    Bloom JR, Steward SL, Chang S, Banks P. Then and now: quality of life of young breast cancer survivors. Psycho-Oncology. 2004;13:147–60.CrossRefPubMedGoogle Scholar
  5. 5.
    Costanzo ES, Lutgendorf SK, Mattes ML, Trehan S, Robinson CB, Tewfik F, et al. Adjusting to life after treatment: distress and quality of life following treatment for breast cancer. Br J Cancer. 2007;97(12):1625–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Cotton SP, Levine EG, Fitzpatrick CM, Dold KH, Targ E. Exploring the relationships among spiritual well-being, quality of life, and psychological adjustment in women with breast cancer. Psycho-oncology. 1999;8(5):429–38.CrossRefPubMedGoogle Scholar
  7. 7.
    Friedman LC, Kalidas M, Elledge R, Chang J, Romero C, Husain I, et al. Optimism, social support and psychosocial functioning among women with breast cancer. Psycho-oncology. 2006;15(7):595–603.CrossRefPubMedGoogle Scholar
  8. 8.
    Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Belin T. Quality of life in long term disease free survivors of breast cancer: a follow-up study. J Natl Cancer Inst. 2002;94:39–49.PubMedGoogle Scholar
  9. 9.
    Ganz PA, Guadagnoli E, Landrum MB, Lash TL, Rakowski W, Silliman RA. Breast cancer in older women: quality of life and psychosocial adjustment in the 15 months after diagnosis. J Clin Oncol. 2003;21:4027–33.CrossRefPubMedGoogle Scholar
  10. 10.
    Janz NK, Mujahid MS, Hawley ST, Griggs JJ, Hamilton AS, Katz SJ. Racial/ethnic differences in adequacy of information and support for women with breast cancer. Cancer. 2008;113:1058–67.CrossRefPubMedGoogle Scholar
  11. 11.
    Pollack L, Greer GE, Rowland JH, Miller A, Doneski D, Coughlin SS, et al. Cancer survivorship: a new challenge in comprehensive cancer control. Cancer Causes Control. 2005;16:51–9.CrossRefPubMedGoogle Scholar
  12. 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
  13. 13.
    Ashing-Giwa KT, Padilla GV, Bohorquez DE, Tejero JS, Garcia M. Understanding the breast cancer experience of Latina women. J Psychosoc-Oncol. 2006;24:19–52.CrossRefPubMedGoogle Scholar
  14. 14.
    Garofalo JP, Hammann HA, Ashworth K, Baum A. Stress and quality of life in African American breast cancer survivors. Ethn Dis. 2006;16:732–8.PubMedGoogle Scholar
  15. 15.
    Powe B, Hamilton J, Hancock N, Johnson N, Finnie R, Ko J, et al. Quality of life of African American cancer survivors. Cancer. 2007;109:435–45.CrossRefPubMedGoogle Scholar
  16. 16.
    Katz SJ, Lantz PM, Paredes Y, Janz NK, Fagerlin A, Liu L, et al. Breast cancer treatment experiences of Latinas in Los Angeles County. Am J Public Health. 2005;95:2225–30.CrossRefPubMedGoogle Scholar
  17. 17.
    Ayanian JZ, Jacobsen PB. Enhancing research on cancer survivors. J Clin Oncol. 2006;24:5149–53.CrossRefPubMedGoogle Scholar
  18. 18.
    Fatone AM, Moadel AB, Foley FW, Fleming M, Jandorf L. Urban voices: the quality-of-life experience among women of color with breast cancer. Palliat Support Care. 2007;5:115–25.PubMedCrossRefGoogle Scholar
  19. 19.
    Gil KM, Mishel MH, Belyea M, Germino B, Porter LS, Carlton Laney I, et al. Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors. Oncol Nurs Forum. 2004;31:633–9.CrossRefGoogle Scholar
  20. 20.
    Ashing-Giwa K, Tejero JS, Kim J, Padilla GV, Hellemann G. Examining predictive models of HRQOL in a population-based, multiethnic sample of women with breast carcinoma. Qual Life Res. 2007;16:413–28.CrossRefPubMedGoogle Scholar
  21. 21.
    Bowen DJ, Alfano CM, McGregor BA, Kuniyuki A, Bernstein L, Meeske K, et al. Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors. Breast Cancer Res Treat. 2007;106:85–95.CrossRefPubMedGoogle Scholar
  22. 22.
    Ashing-Giwa K. Quality of life of African-American and white long term breast carcinoma. Cancer. 1999;85:418–26.CrossRefPubMedGoogle Scholar
  23. 23.
    Northouse LL, Caffey M, Deichelbohrer L, Schmidt L, Guziatek-Trojniak L, West S, et al. The quality of life of African American women with breast cancer. Res Nurs Health. 1999;22:449–60.CrossRefPubMedGoogle Scholar
  24. 24.
    Rao D, Debb S, Blitz D, Choi SW, Cella D. Racial/ethnic differences in the health-related quality of life of cancer patients. J Pain Symptom Manage. 2008;36:488–96.CrossRefPubMedGoogle Scholar
  25. 25.
    Culver JL, Arena PL, Antoni MH, Carver CS. Coping and distress among women under treatment for early stage breast cancer: Comparing African Americans, Hispanics, and non-Hispanic Whites. Psycho-Oncology. 2002;11:495–504.CrossRefPubMedGoogle Scholar
  26. 26.
    Spencer SM, Lehman JM, Wynings C, Arena P, Carver CS, Antoni MH, et al. Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patients. Health Psychol. 1999;18:159–68.CrossRefPubMedGoogle Scholar
  27. 27.
    Baker F, Denniston M, Smith T, West MM. Adult cancer survivors: how are they faring? Cancer. 2005;104:2565–76.CrossRefPubMedGoogle Scholar
  28. 28.
    Kornblith AB, Powell M, Regan MM, Bennett S, Krasner C, Moy B, et al. Long-term psychosocial adjustment of older vs. younger survivors of breast and endometrial cancer. Psycho-oncology. 2007;16:895–903.CrossRefPubMedGoogle Scholar
  29. 29.
    Giedzinska AS, Meyerowitz BE, Ganz PA, Rowland JH. Health-related quality of life in a multiethnic sample of breast cancer survivors. Ann Behav Med. 2004;28:39–51.CrossRefPubMedGoogle Scholar
  30. 30.
    Janz NK, Mujahid MS, Lantz PM, Fagerlin A, Salem B, Morrow M, et al. Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer. Qual Life Res. 2005;14:1467–79.CrossRefPubMedGoogle Scholar
  31. 31.
    Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Holzel D. Predictors of quality of life of breast cancer patients. Acta Oncol. 2003;42:710–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Greene FL, Page DL, Fleming ID, Fritz A, Balch CM. AJCC cancer staging manual. 6th ed. Philadelphia: Lippincott Raven Publishers; 2002.Google Scholar
  33. 33.
    Ahles TA, Saykin AJ, Furstenberg CT, Cole B, Mott LA, Titus-Ernstoff L, et al. Quality of life of long-term survivors of breast cancer and lymphoma treated with standard-dose chemotherapy or local therapy. J Clin Oncol. 2005;23:4399–405.CrossRefPubMedGoogle Scholar
  34. 34.
    Moore RJ, Butow P. Culture and oncology: impact of context effects. New York: Kluwer; 2004.Google Scholar
  35. 35.
    Aziz NM, Rowland JH. Cancer survivorship research among ethnic minority and medically Underserved groups. Oncol Nurs Forum. 2002;29:789–801.CrossRefPubMedGoogle Scholar
  36. 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. 37.
    Dillman DA. Mail and telephone surveys: the total design method. New York: Wiley; 1997.Google Scholar
  38. 38.
    Cella D, Tulsky D, Gray G. The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11:570–9.PubMedGoogle Scholar
  39. 39.
    Brady M, Cella D, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, et al. Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol. 1997;15:974–86.PubMedGoogle Scholar
  40. 40.
    Bradley CJ, Neumark D, Luo Z, Schenk M. Employment and cancer: findings from a longitudinal study of breast and prostate cancer survivors. Cancer Invest. 2007;25:47–54.CrossRefPubMedGoogle Scholar
  41. 41.
    Bradley CJ, Given CW, Roberts C. Disparities in cancer diagnosis and survival. Cancer. 2001;91:178–88.CrossRefPubMedGoogle Scholar
  42. 42.
    Lantz PM, Mujahid M, Schwartz K, Janz NK, Fagerlin A, Salem B, et al. The influence of race, ethnicity and individual socioeconomic factors of breast cancer stage at diagnosis. Am J Public Health. 2006;96:2173–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Arora NK, Johnson P, Gustafson DH, McTavish F, Hawkins RP, Pingree S. Barriers to information access, perceived health competence, and psychosocial health outcomes: test of a mediation model in a breast cancer sample. Patient Educ Couns. 2002;47:37–46.CrossRefPubMedGoogle Scholar
  44. 44.
    Griggs JJ, Sorbero ME, Mallinger JB, Quinn M, Waterman M, Brooks B, et al. Vitality, mental health, and satisfaction with information after breast cancer. Patient Educ Couns. 2007;66:58–66.CrossRefPubMedGoogle Scholar
  45. 45.
    Hawley ST, Janz NK, Hamilton A, Griggs JJ, Alderman AK, Mujahid M, et al. Latina patient perspectives about informed treatment decision making for breast cancer. Patient Educ Couns. 2008;73:363–70.CrossRefPubMedGoogle Scholar
  46. 46.
    Sammarco A, Konecny LM. Quality of life, social support, and uncertainty among Latina breast cancer survivors. Oncol Nurs Forum. 2008;35(5):844–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Lim J, Yi J, Zebrack B. Acculturation, social support, and quality of life for Korean immigrant breast and gynecological cancer survivors. Ethn Health. 2008;13(3):243–60.CrossRefPubMedGoogle Scholar
  48. 48.
    Ashing-Giwa K, Padilla GV, Tejero JS, Kim J. Breast cancer survivorship in a multiethnic sample. Cancer. 2004;101:450–65.CrossRefPubMedGoogle Scholar
  49. 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
  50. 50.
    Krause N, Batida E. Religion, suffering, and health among older Mexican Americans. J Aging Stud. 2009;23:114–23.CrossRefGoogle Scholar
  51. 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
  52. 52.
    Porter LS, Clayton MF, Belyea M, Mishel MH, Gil KM, Germino B. Predicting negative mood state and personal growth in African American and White long term breast cancer survivors. Ann Behav Med. 2006;31(3):195–204.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Nancy K. Janz
    • 1
  • Mahasin S. Mujahid
    • 2
  • Sarah T. Hawley
    • 3
    • 4
  • Jennifer J. Griggs
    • 5
  • Amy Alderman
    • 6
  • Ann S. Hamilton
    • 7
  • John Graff
    • 8
  • Steven J. Katz
    • 4
    • 9
  1. 1.Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborUSA
  2. 2.Department of Society, Human Development, and HealthHarvard School of Public HealthBostonUSA
  3. 3.Veterans Administration Center for Practice ManagementAnn Arbor Veterans Administration Health Care System and Outcomes Research, University of Michigan Medical CenterAnn ArborUSA
  4. 4.Division of General Medicine, Department of Internal MedicineUniversity of Michigan Medical CenterAnn ArborUSA
  5. 5.Department of Medicine, Division of Hematology and OncologyUniversity of MichiganAnn ArborUSA
  6. 6.Department of SurgeryUniversity of MichiganAnn ArborUSA
  7. 7.Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  8. 8.Karmanos Cancer InstituteWayne State University School of MedicineDetroitUSA
  9. 9.Department of Health Management and PolicyUniversity of Michigan School of Public HealthAnn ArborUSA

Personalised recommendations