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Racial Disparities in Emotional Distress Among Cancer Survivors: Insights from the Health Information National Trends Survey (HINTS)

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Abstract

The purpose of this study was to examine the impact of race, cancer history, and their interaction on emotional distress among a nationally representative sample of US adults. Data utilized for this analysis were obtained from the first, second, and fourth iterations of the fourth cycle of the Health Information National Trends Survey (HINTS). The study sample included 3959, 3630, and 3677 respondents for the years 2011, 2012, and 2014, respectively, for a total sample size of 11,266. A multivariable ordered logistic regression model was used to assess the relationship between emotional distress, race, and cancer history. The effect of cancer history on emotional distress was found to be moderated by race. Specifically, emotional distress was significantly higher among African American cancer survivors. Factors found to be protective against emotional distress included healthy lifestyle, older age, and higher income. Factors associated with high levels of emotional distress included poor general health status, low self-efficacy, and being female. The authors recommend the design, advancement, and implementation of evidence-based culturally sensitive interventions aimed at effectively screening and managing psychological distress symptoms, particularly among African American long-term cancer survivor patient populations.

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References

  1. Hewitt M, Rowland JH, Yancik R (2003) Cancer survivors in the United States: age, health, and disability. J Gerontol Ser A Biol Med Sci 58(1):M82–M91

    Article  Google Scholar 

  2. Desplenter F, Bond C, Watson M, Burton C, Paul M, Lee AJ, Lefevre K, Simoens S, Laekeman G (2012) Incidence and drug treatment of emotional distress after cancer diagnosis: a matched primary care case–control study. Br J Cancer 107(9):1644–1651

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psycho-Oncology 10(1):19–28

    Article  CAS  PubMed  Google Scholar 

  4. Singer S, Das-Munshi J, Brahler E (2010) Prevalence of mental health conditions in cancer patients in acute care—a meta-analysis. Ann Oncol: Off J Eur Soc Med Oncol ESMO 21(5):925–930

    Article  CAS  Google Scholar 

  5. Breen SJ, Baravelli CM, Schofield PE, Jefford M, Yates PM, Aranda SK (2009) Is symptom burden a predictor of anxiety and depression in patients with cancer about to commence chemotherapy? Med J Aust 190(7):S99

    PubMed  Google Scholar 

  6. Alcorso J, Sherman KA (2015) Factors associated with psychological distress in women with breast cancer-related lymphoedema. Psycho-oncology

  7. Hong JS, Tian J (2014) Prevalence of anxiety and depression and their risk factors in Chinese cancer patients. Support Care Cancer 22(2):453–459

    Article  PubMed  Google Scholar 

  8. Burgoyne MJ, Bingen K, Leuck J, Dasgupta M, Ryan P, Hoffmann RG (2015) Cancer-related distress in young adults compared to middle-aged and senior adults. J Adolesc Young Adult Oncol 4(2):56–63

    Article  PubMed  Google Scholar 

  9. Hellstadius Y, Lagergren J, Zylstra J, Gossage J, Davies A, Hultman CM, Lagergren P, Wikman A (2015) Prevalence and predictors of anxiety and depression among esophageal cancer patients prior to surgery. Dis Esophagus: Off J Int Soc Dis Esophagus/ISDE. doi:10.1111/dote.12437

    Google Scholar 

  10. Grassi L, Rosti G (1996) Psychosocial morbidity and adjustment to illness among long-term cancer survivors: a six-year follow-up study. Psychosomatics 37(6):523–532

    Article  CAS  PubMed  Google Scholar 

  11. Orom H, Nelson CJ, Underwood W, Homish DL, Kapoor DA (2015) Factors associated with emotional distress in newly diagnosed prostate cancer patients. Psycho-oncology

  12. Cohen M (2013) The association of cancer patients’ emotional suppression and their self-rating of psychological distress on short screening tools. Behav Med 39(2):29–35

    Article  PubMed  Google Scholar 

  13. Delgado-Guay M, Ferrer J, Rieber AG, Rhondali W, Tayjasanant S, Ochoa J, Cantu H et al (2015) Financial distress and its associations with physical and emotional symptoms and quality of life among advanced cancer patients. Oncologist 20(9):1092–1098

    Article  PubMed  PubMed Central  Google Scholar 

  14. Oancea SC, Brinkman TM, Ness KK, Krull KR, Smith WA, Srivastava DK, Robison LL, Hudson MM, Gurney JG (2014) Emotional distress among adult survivors of childhood cancer. J Cancer Surviv 8(2):293–303

    Article  PubMed  PubMed Central  Google Scholar 

  15. Nelson CJ, Balk EM, Roth AJ (2010) Distress, anxiety, depression, and emotional well-being in African-American men with prostate cancer. Psycho-Oncology 19(10):1052–1060

    Article  PubMed  Google Scholar 

  16. Hesse BW, Nelson DE, Kreps GL, Croyle RT, Arora NK, Rimer BK, Viswanath K (2005) Trust and sources of health information: the impact of the internet and its implications for health care providers: findings from the first health information national trends survey. Arch Intern Med 165(22):2618–2624

    Article  Google Scholar 

  17. Kroenke K, Spitzer RL, Williams JBW, Löwe B (2009) An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics 50:613–621

    PubMed  Google Scholar 

  18. Pronk NP, Katz AS, Gallagher J, Austin E, Mullen D, Lowry M, Kottke TE (2011) Adherence to optimal lifestyle behaviors is related to emotional health indicators among employees. Popul Health Manag 14(2):59–67

    Article  PubMed  Google Scholar 

  19. Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65(1):5–29

    Article  PubMed  Google Scholar 

  20. Heinze JE, Kruger DJ, Reischl TM, Cupal S, Zimmerman MA (2015) Relationships among disease, social support, and perceived health: a lifespan approach. Am J Community Psychol 1–12

  21. Mosher CE, Duhamel KN, Egert J, Smith MY (2010) Self-efficacy for coping with cancer in a multiethnic sample of breast cancer patients: associations with barriers to pain management and distress. Clin J Pain 26(3):227–234

    Article  PubMed  PubMed Central  Google Scholar 

  22. Basen-Engquist K, Hughes D, Perkins H, Shinn E, Taylor CC (2008) Dimensions of physical activity and their relationship to physical and emotional symptoms in breast cancer survivors. J Cancer Surviv 2(4):253–261

    Article  PubMed  PubMed Central  Google Scholar 

  23. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA (2005) Physical activity and survival after breast cancer diagnosis. JAMA 293(20):2479–2486

    Article  CAS  PubMed  Google Scholar 

  24. McTiernan A, Rajan KB, Tworoger SS, Irwin M, Bernstein L, Baumgartner R, Gilliland F, Stanczyk FZ, Yasui Y, Ballard-Barbash R (2003) Adiposity and sex hormones in postmenopausal breast cancer survivors. J Clin Oncol: Off J Am Soc Clin Oncol 21(10):1961–1966

    Article  CAS  Google Scholar 

  25. Bultz BD, Carlson LE (2006) Emotional distress: the sixth vital sign-future directions in cancer care. Psychooncology 15(2):93–95

    Article  PubMed  Google Scholar 

  26. Pinquart M, Duberstein PR (2010) Depression and cancer mortality: a meta-analysis. Psychol Med 40(11):1797–1810

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Reynolds P, Hurley S, Torres M, Jackson J, Boyd P, Chen VW (2000) Use of coping strategies and breast cancer survival: results from the Black/White Cancer Survival Study. Am J Epidemiol 152(10):940–949

    Article  CAS  PubMed  Google Scholar 

  28. Zhang AY, Gary F, Zhu H (2015) Attitudes toward cancer and implications for mental health outcome in African-American cancer patients. J Cancer Educ 30(1):138–144

    Article  CAS  PubMed  Google Scholar 

  29. Lee‐Jones C, Humphris G, Dixon R, Bebbington Hatcher M (1997) Fear of cancer recurrence—a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears. Psycho-Oncology 6(2):95–105

    Article  PubMed  Google Scholar 

  30. Paradies Y (2006) A systematic review of empirical research on self-reported racism and health. Int J Epidemiol 35(4):888–901

    Article  PubMed  Google Scholar 

  31. Thorpe RJ Jr, Kelley-Moore JA (2012) Life course theories of race disparities: a comparison of cumulative dis/advantage perspective and the weathering hypothesis. Race Ethn Health 355–374

  32. Van Ryn M, Burke J (2000) The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med 50(6):813–828

    Article  PubMed  Google Scholar 

  33. Kilbourne AM, Switzer G, Hyman K, Crowley-Matoka M, Fine MJ (2006) Advancing health disparities research within the health care system: a conceptual framework. Am J Public Health 96(12):2113–2121

    Article  PubMed  PubMed Central  Google Scholar 

  34. Steffen PR, Hinderliter AL, Blumenthal JA, Sherwood A (2001) Religious coping, ethnicity, and ambulatory blood pressure. Psychosom Med 63(4):523–530

    Article  CAS  PubMed  Google Scholar 

  35. Hamilton JB, Powe BD, Pollard AB 3rd, Lee KJ, Felton AM (2007) Spirituality among African American cancer survivors: having a personal relationship with god. Cancer Nurs 30(4):309–316

    Article  PubMed  Google Scholar 

  36. Faller H, Schuler M, Richard M, Heckl U, Weis J, Kuffner R (2013) Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. J Clin Oncol: Off J Am Soc Clin Oncol 31(6):782–793

    Article  Google Scholar 

  37. Kreitler S, Peleg D, Ehrenfeld M (2007) Stress, self-efficacy and quality of life in cancer patients. Psycho-Oncology 16(4):329–341

    Article  PubMed  Google Scholar 

  38. Mishel MH, Germino BB, Gil KM, Belyea M, LaNey IC, Stewart J, Porter L, Clayton M (2005) Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. Psycho-Oncology 14(11):962–978

    Article  PubMed  Google Scholar 

  39. Kramer JA, Curran D, Martine P, De Haes JCJM, Bruning P, Klijn J, Van Hoorebeeck I, Paridaens R (2000) Identification and interpretation of clinical and quality of life prognostic factors for survival and response to treatment in first-line chemotherapy in advanced breast cancer. Eur J Cancer 36(12):1498–1506

    Article  CAS  PubMed  Google Scholar 

  40. Zachariae R, Pedersen CG, Jensen AB, Ehrnrooth E, Rossen PB, von der Maase H (2003) Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. Br J Cancer 88(5):658–665

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Gordon HS, Street RL, Sharf BF, Kelly PA, Souchek J (2006) Racial differences in trust and lung cancer patients’ perceptions of physician communication. J Clin Oncol 24(6):904–909

    Article  PubMed  Google Scholar 

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Correspondence to Andrew R. Hansen.

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Apenteng, B.A., Hansen, A.R., Opoku, S.T. et al. Racial Disparities in Emotional Distress Among Cancer Survivors: Insights from the Health Information National Trends Survey (HINTS). J Canc Educ 32, 556–565 (2017). https://doi.org/10.1007/s13187-016-0984-7

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  • DOI: https://doi.org/10.1007/s13187-016-0984-7

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