Correlates and mediators of worry about breast cancer recurrence.

Abstract

9098 Background: Worry about recurrence (worry) is a persistent concern of women with breast cancer; however, little is known about racial/ethnic differences or mechanisms in the health care experience that may explain differences. Methods: 3,133 women with nonmetastatic breast cancer diagnosed from 6/05-2/07 and reported to Detroit or Los Angeles SEER registries were surveyed (mean 9 months post-diagnosis). Latina and African American (AA) women were oversampled (final n= 2,268, response rate 72.4%). A worry scale was constructed as the mean response to 3 items (5-point Likert) measuring worry about cancer returning to same breast, other breast, or spreading to other parts of the body (higher scores = more worry). Race/ethnicity categories were white, AA, and Latina (categorized into low vs. high acculturation by the Short Acculturation Scale for Hispanics). The worry scale was regressed on race/ethnicity controlling for sociodemographics (e.g., age, education), and then clinical (e.g., stage, comorbidites, frequency of pain, fatigue), risk (e.g., smoker, family history) and treatment (surgery, radiation, chemotherapy) factors. Health system factors that may mediate associations were next considered (e.g., symptom management, care coordination; specified as low, moderate, high). Results: Low acculturated Latinas reported more worry than other groups (adjusted for sociodemographics), worry scores 3.62 vs. 3.06, 2.47, 2.78 for higher acculturated Latinas, AAs, and whites, p<0.001). Factors independently associated with worry were younger age, smoker, comorbidities, more pain and fatigue, and radiation (ps <0.05). Less worry was associated with more coordinated care (3.39, 3.06, 2.92, for low, moderate, and high, p=0.038) and better management of symptoms (3.29, 3.00, 2.96 for low, moderate, and high, p=0.010) controlling for sociodemographics, and clinical/risk/treatment factors. Race/ethnicity remained significant and essentially unchanged adjusted for all factors (p <.0.001). Conclusions: Less acculturated Latina breast cancer patients were vulnerable to the highest levels of worry about recurrence. Interventions aimed at improving symptom management and coordinating care hold promise in reducing worry. No significant financial relationships to disclose.