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Understanding racial differences in health-related quality of life in a population-based cohort of breast cancer survivors

Abstract

Purpose

Although racial disparities in health-related quality of life (HRQOL) among women with breast cancer (BC) are well documented, less is known about HRQOL changes over time among women of different races. Our objective was to assess racial differences in HRQOL during active treatment and survivorship phases of BC care.

Methods

We used data from the third phase of the Carolina Breast Cancer Study (CBCS-III). CBCS-III enrolled 3000 women in North Carolina aged 20–74 years diagnosed with BC between 2008 and 2013. HRQOL assessments occurred 5 and 25 months post diagnosis, representing distinct phases of care. HRQOL measures included the Functional Assessment of Cancer Therapy for BC and Functional Assessment of Chronic Illness Therapy for Spiritual Well-Being. Analysis of covariance models were employed to assess racial differences in changes in HRQOL.

Results

The cohort included 2142 Non-Hispanic White (n = 1105) and Black women (n = 1037) who completed both HRQOL assessments. During active treatment, Whites reported physical and functional scores 2–2.5 points higher than Blacks (p < 0.0001). Spiritual HRQOL was 2.1 points higher for Blacks (p < 0.0001). During survivorship, differences persisted. After adjusting for demographic, socioeconomic, tumor, and treatment characteristics, physical and functional HRQOL gaps narrowed, but spiritual HRQOL gaps widened.

Conclusions

Racial differences in physical and functional HRQOL during active treatment and survivorship may be largely mediated by socioeconomic factors. However, our results suggest that among Black women, spiritual HRQOL is well supported throughout the BC care continuum. These results inform opportunities for improving the quality and equity of supportive services for women with BC.

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Acknowledgments

Melissa Troester, Jessica Tse, and Mary Beth Bell.

Funding

This study was supported by the University Cancer Research Fund of North Carolina, the National Cancer Institute Specialized Program of Research Excellence in Breast Cancer at UNC (NIH/NCI P50-CA58223), and the Susan G. Komen for the Cure Foundation (3 R01 CA150980 05S1).

Author contribution

All authors have read and approved the manuscript for submission to Breast Cancer Research and Treatment. This manuscript has not been published elsewhere and is not under consideration by another journal.

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Correspondence to Laura C. Pinheiro.

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Conflict of Interest

Authors Dr. Samuel and Dr. Wheeler have received a research grant from Pfizer for another unrelated study. All other authors (Ms. Pinheiro, Dr. Reeder-Hayes, Dr. Olshan, and Dr. Reeve) declare that they have no conflicts of interest to disclose.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Research involving animal and human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Pinheiro, L.C., Samuel, C.A., Reeder-Hayes, K.E. et al. Understanding racial differences in health-related quality of life in a population-based cohort of breast cancer survivors. Breast Cancer Res Treat 159, 535–543 (2016). https://doi.org/10.1007/s10549-016-3965-y

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Keywords

  • Health-related quality of life
  • Racial disparities
  • Breast cancer outcomes