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Contextual factors influencing health-related quality of life in African American and Latina breast cancer survivors

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Abstract

Purpose

This study explored the relationships between systemic- and individual-level contextual factors and health-related quality of life (HRQOL) in a cohort of African American and Latina breast cancer survivors (BCS).

Methods

Baseline questionnaire data of 320 BCS who participated in a HRQOL psycho-educational intervention were abstracted from the parent study. Hierarchical regression analysis tested the independent effects of contextual factors on HRQOL.

Results

HRQOL was higher in BCS who: were diagnosed at < stage 2 (b = − 1.38, p < 0.05), expressed satisfaction with their health care (b = 0.20, p < 0.001), had fewer comorbidities (b = − 0.60, p < 0.001) and depressive symptoms (b = − 0.30, p < 0.001), and practiced healthy diet and exercise habits (b = 0.02, p < 0.05). Demographic and cancer-related factors accounted for 14 % of the variance in HRQOL (F[6, 274] = 7.25, p < 0.001). The socio-cultural context (i.e., ethnicity, life stress, perceived social support) explained 20 % of the variance in HRQOL (FΔ[3, 271] = 27.32, p < 0.001). The health care system context contributed an additional 8 % to explaining HRQOL (FΔ[1, 270] = 34.88, p < 0.001). Health status and behavioral factors accounted for 18 % of the variance (FΔ[4, 266] = 29.55, p < 0.001). The full model explained 59 % of the variance in HRQOL (F[14, 266] = 27.76, p < 0.001).

Conclusions

HRQOL in ethnic minority BCS is multifaceted and is significantly influenced by cancer-related, socio-cultural, health care system, health status, and behavioral contextual factors. Therefore, survivorship research and practice must address broad multi-level domains to achieve equitable and optimal breast cancer outcomes.

Implications for cancer survivors

To enhance HRQOL, survivors must be provided the know-how and support to maintain healthy lifestyle and self-management practices. Advocates must engage the care team to consider systemic factors, including life stress and community resources, to be more patient-centered.

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Acknowledgments

The current study was supported in part by a grant from the Loma Linda University School of Public Health Center for Health Research. The parent study was funded by a Department of Defense Breast Cancer Research Program Idea Award grant to Dr. Kimlin Ashing, Ph.D.

Conflicts of interest

Aria Miller, Kimlin Ashing, Naomi Modeste, Patti Herring, and Diadrey-Anne Sealy declare that they have no conflicts of interest, financial, or otherwise.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. School of Public Health, Loma Linda University, Loma Linda, CA, 92350-1707, USA

    Aria M. Miller, Naomi N. Modeste, R. Patti Herring & Diadrey-Anne T. Sealy

  2. Center of Community Alliance for Research and Education (CCARE), Department of Population Sciences, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010-3000, USA

    Aria M. Miller, Kimlin Tam Ashing & Kimlin Tam Ashing

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  1. Aria M. Miller
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  2. Kimlin Tam Ashing
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Correspondence to Kimlin Tam Ashing.

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Miller, A.M., Ashing, K.T., Modeste, N.N. et al. Contextual factors influencing health-related quality of life in African American and Latina breast cancer survivors. J Cancer Surviv 9, 441–449 (2015). https://doi.org/10.1007/s11764-014-0420-0

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