Discrimination and quality of life among breast cancer survivors.

Abstract

250 Background: We examined the role of race/ethnicity, education, and medical discrimination on global and breast cancer-specific (BCS) quality of life (QoL). Methods: Telephone interviews were administered to 536 Asian, Black, Hispanic and White women identified through the Greater Bay Area Cancer Registry who were aged 20+ when diagnosed with a first invasive primary breast cancer between 2006 and 2009. Women reported perceptions of discriminatory experiences while receiving breast cancer care. QoL was assessed with a single item asking about global QoL over the past 4 weeks ( “excellent” vs “less than excellent”) and a summary score for the 6-item breast cancer subscale of the FACT-B (higher scores indicated more concerns (or worse QoL)). Race/ethnicity and education were combined into an 8-category variable (4 race/ethnic groups x 2 education groups). Psychometric analyses was used to create a summed medical discrimination score using 7 items that comprised a single factor, and split into tertiles to indicate no, low, and moderate/high levels of discrimination. Main effects for race/ethnicity x education and medical discrimination were identified using logistic and linear regression models. Adjusted analyses controlled for age, marital status, health insurance, stage, histology, and tumor size. Results: In adjusted analyses, disparities across combined race/ethnicity x education groups were observed for global QoL (Wald χ2(7) = 23.32, p < 0.01) but not for BCS QoL (F= 0.78, p= 0.60). Black and Asian women reported lower global QoL than college-educated White women. Medical discrimination was related to global (Wald χ2(2) = 6.98, p= 0.03) and BCS QoL (F= 6.14, p< 0.01). Women reporting moderate/high levels of medical discrimination had significantly lower odds of excellent QoL (OR= 0.416, p< 0.01) and more breast cancer concerns (β= 1.19, t= 3.50, p< 0.001) than women reporting no discrimination. Conclusions: Medical discrimination was associated with lower global and BCS QoL. More research is needed to identify specific factors at the individual, provider, and organizational levels that contribute to perceptions of medical discrimination so that they can be addressed and QoL can be improved for breast cancer patients.