Carolina Breast Cancer Study Reinforces Relation Between Racial Disparity and QOL

Research conducted at the University of North Carolina Lineberger Comprehensive Cancer Center, as part of the Carolina Breast Cancer Study (CBCS) that was launched in 1993, has found that white women performed better than black women on physical and functional health-related quality-of-life (HRQOL) scores, but the numbers switched for spiritual HRQOL.

The objective of the present analysis was to assess racial differences in HRQOL, during active treatment and subsequently during the survivorship phase of women who were treated for breast cancer. The study used survey data from 3000 women (1105 were non-Hispanic white and 1037 were black) who participated in CBCS-III, the third segment of the study. The women, 20 to 74 years old and diagnosed between 2008 and 2013, were assessed on HRQOL at 5 and 25 months following diagnosis.

The measures included Functional Assessment of Cancer Therapy for breast cancer and Functional Assessment of Chronic Illness Therapy for Spiritual Well-Being. The physical and functional QOL measure tracks feelings of fatigue, nausea, pain, the woman’s ability to work, sleep, acceptance of illness, and ability to enjoy things in normal life.

The analysis showed that the physical and functional scores of white women included in the study were 2 to 2.5 points higher than the black women in the study (P<.0001)—this was during the active treatment phase. Black women however scored significantly better (2.1 points higher; P<.0001) than white women during the same phase. The observed differences were sustained at 20-months post treatment during the survival phase. When the researchers adjusted for demographic, socioeconomic, tumor, and treatment characteristics they found the physical and functional HRQOL gaps narrowed; interestingly, the spiritual HRQOL gaps actually widened.

“Black women generally had poorer physical and functional quality-of-life after the diagnosis of breast cancer, and socioeconomic and other factors explain some of these differences. However, for some domains, black women report better quality-of-life,” according to coauthor Andrew Olshan, PhD, associate director of population sciences at UNC Lineberger and the Barbara Sorenson Hulka Distinguished Professor in Cancer Epidemiology at the UNC Gillings School of Global Public Health.

The authors believe that socioeconomic differences are largely responsible for the difference in the physical and functional HRQOL scores, during treatment and after, providing opportunities for intervention that can improve the quality and equity of support services.

“Our research suggests that improved social and economic conditions could improve access to care, reduce comorbid conditions, and other factors that are associated with both the prognosis of breast cancer, quality of life, and the disparities seen between various groups,” Olshan added.

Reference

Pinheiro LC, Samuel CA, Reeder-Hayes KE, Wheeler SB, Olshan AF, Reeve BB. Understanding racial differences in health-related quality of life in a population-based cohort of breast cancer survivors. Breast Cancer Res Treat. 2016;159(3):535-543. doi: 10.1007/s10549-016-3965-y.