Paskett Electra D, Alfano Catherine M, Davidson Mario A, Andersen Barbara L, Naughton Michelle J, Sherman Aurora, McDonald Paige Green, Hays Jennifer
Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, USA.
Cancer. 2008 Dec 1;113(11):3222-30. doi: 10.1002/cncr.23891.
Small samples with few minority women and/or the absence of comparisons to peers without cancer histories have limited previous research suggesting racial differences in breast cancer survivors' health-related quality of life (HRQoL). This study not only compared HRQoL of African American and white breast cancer survivors, but also compared the HRQoL of these women to that of same-race women with no cancer history.
Data from the Women's Health Initiative-Observational Study were used, including 5021 cancer survivors and 88,532 women without a history of cancer. Multivariate regression analyses estimated differences in breast cancer survivors' baseline HRQoL (RAND36), depressive symptoms (CES-D short-form), and sleep quality (WHIIRS).
African American breast cancer survivors reported worse physical functioning and general health compared with white survivors. Among African Americans, survivors reported worse role limitations due to physical health, pain, general health, and vitality than women without a history of cancer. This was most evident in those with more recent diagnoses. Most significant differences between groups were small in magnitude (Cohen d = .21-.36).
These results add to the increasing knowledge of cancer disparities by showing that African American women have small, but clinically meaningful, decrements in physical HRQoL compared with white survivors and with African American women without cancer. Because African American women also face diagnosis with higher grade tumors and higher breast cancer mortality, more research is needed to examine the physical and psychosocial experiences of African American breast cancer survivors to elucidate the mechanisms leading to poorer outcomes.
以往研究样本量小，少数族裔女性数量少，且未与无癌症病史的同龄人作比较，这限制了有关乳腺癌幸存者健康相关生活质量（HRQoL）种族差异的研究。本研究不仅比较了非裔美国人和白人乳腺癌幸存者的HRQoL，还将这些女性的HRQoL与无癌症病史的同种族女性进行了比较。
使用了来自妇女健康倡议观察性研究的数据，包括5021名癌症幸存者和88532名无癌症病史的女性。多变量回归分析估计了乳腺癌幸存者基线HRQoL（RAND36）、抑郁症状（CES-D简表）和睡眠质量（WHIIRS）的差异。
与白人幸存者相比，非裔美国乳腺癌幸存者的身体功能和总体健康状况较差。在非裔美国人中，与无癌症病史的女性相比，幸存者因身体健康、疼痛、总体健康和活力而报告的角色限制更严重。这在那些近期诊断的患者中最为明显。各组之间的大多数显著差异幅度较小（科恩d值=.21-.36）。
这些结果进一步增加了对癌症差异的认识，表明与白人幸存者以及无癌症的非裔美国女性相比，非裔美国女性在身体HRQoL方面有虽小但具有临床意义的下降。由于非裔美国女性还面临更高分级肿瘤的诊断和更高的乳腺癌死亡率，因此需要更多研究来考察非裔美国乳腺癌幸存者的身体和心理社会经历，以阐明导致较差结果的机制。
