A new analysis of several thousand breast cancer survivors found differences in the overall quality of life between black and white women during both active treatment and up to two years later. The findings show that white women reported higher physical and health-related quality of life during active treatment. However, black women reported higher spiritual quality of life scores.
“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,” said study co-author Andrew Olshan, Ph.D., associate director of population sciences at University of North Carolina (UNC) Lineberger Comprehensive Cancer Center.
The study, published in the journal Breast Cancer Research and Treatment, drew upon surveys that assessed health-related quality of life issues for women aged 20 to 74 years who lived in North Carolina and had breast cancer.
The analysis is part of the third phase of the Carolina Breast Cancer Study, a study first launched in 1993 as part of an effort to better understand why black women have been found to disproportionately die from breast cancer.
Researchers used surveys to measure the physical, functional, emotional, and spiritual-related quality of life of more than 2,100 women at five months after their breast cancer diagnosis, and at 25 months, when women have typically stopped receiving active treatment and begin the survivorship phase.
For spiritual quality of life, the findings show that black women scored two points higher than white women at five months, when they were in the midst of active treatment, and two years after diagnosis. Specifically, black women scored an average of 41.4 points on spiritual quality of life, while white women scored an average of 39.3 at five months.
Two years after diagnosis, black women scored an average of 40.5 on spiritual quality of life, while white women had an average score of 38.5. Even after adjusting for socioeconomic factors, black women continued to score higher than white women for spiritual quality of life two years after diagnosis, the study reports.
“Black women we surveyed had significantly better spiritual wellbeing than white women, and it was both statistically significant and clinically meaningful,” said the study’s first author Laura Pinheiro, a doctoral candidate in the UNC Gillings School of Global Public Health.
White women’s average scores for physical and functional quality of life, which track patients’ feelings of fatigue, nausea, pain, ability to work, sleep, acceptance of illness, and ability to enjoy things in normal life, were two to 2.5 points higher than black women at five months.
The average score for white women’s physical health at five months was 20.9, compared to 18.4 for black women. For functional health, white women scored an average of 20.1 compared to 18.2 for black women.
At 25 months after diagnosis, white women still scored higher for physical, social, and functional health-related quality of life, but the gap between the physical scores for white and black women narrowed compared to what they were at five months for physical health-related quality of life.
Pinheiro said that the findings, in-line with previous studies, may suggest that the health care system has had a positive impact on the black women’s overall physical health, helping to narrow those gaps.
“As these women are entering the health care system, perhaps some of their other health conditions are better managed,” Pinheiro said. “That is our speculation, and it will merit some additional investigation.”
Furthermore, after adjusting for socioeconomic factors during survivorship, differences in physical health-related quality of life were diminished.
“Our research suggests that improved social and economic conditions could improve access to care, reduce co-morbid 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 said.