Pinheiro Laura C, Samuel Cleo A, Reeder-Hayes Katherine E, Wheeler Stephanie B, Olshan Andrew F, Reeve Bryce B
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 1101 McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA.
Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
Breast Cancer Res Treat. 2016 Oct;159(3):535-43. doi: 10.1007/s10549-016-3965-y. Epub 2016 Sep 1.
Although racial disparities in health-related quality of life (HRQOL) among women with breast cancer (BC) are well documented, less is known about HRQOL changes over time among women of different races. Our objective was to assess racial differences in HRQOL during active treatment and survivorship phases of BC care.
We used data from the third phase of the Carolina Breast Cancer Study (CBCS-III). CBCS-III enrolled 3000 women in North Carolina aged 20-74 years diagnosed with BC between 2008 and 2013. HRQOL assessments occurred 5 and 25 months post diagnosis, representing distinct phases of care. HRQOL measures included the Functional Assessment of Cancer Therapy for BC and Functional Assessment of Chronic Illness Therapy for Spiritual Well-Being. Analysis of covariance models were employed to assess racial differences in changes in HRQOL.
The cohort included 2142 Non-Hispanic White (n = 1105) and Black women (n = 1037) who completed both HRQOL assessments. During active treatment, Whites reported physical and functional scores 2-2.5 points higher than Blacks (p < 0.0001). Spiritual HRQOL was 2.1 points higher for Blacks (p < 0.0001). During survivorship, differences persisted. After adjusting for demographic, socioeconomic, tumor, and treatment characteristics, physical and functional HRQOL gaps narrowed, but spiritual HRQOL gaps widened.
Racial differences in physical and functional HRQOL during active treatment and survivorship may be largely mediated by socioeconomic factors. However, our results suggest that among Black women, spiritual HRQOL is well supported throughout the BC care continuum. These results inform opportunities for improving the quality and equity of supportive services for women with BC.
虽然乳腺癌（BC）女性患者在健康相关生活质量（HRQOL）方面的种族差异已有充分记录，但对于不同种族女性HRQOL随时间的变化情况了解较少。我们的目标是评估BC护理的积极治疗和生存阶段HRQOL的种族差异。
我们使用了卡罗来纳乳腺癌研究（CBCS-III）第三阶段的数据。CBCS-III招募了北卡罗来纳州3000名年龄在20 - 74岁之间、于2008年至2013年被诊断为BC的女性。HRQOL评估在诊断后5个月和25个月进行，代表不同的护理阶段。HRQOL测量包括乳腺癌的癌症治疗功能评估和精神健康的慢性病治疗功能评估。采用协方差分析模型评估HRQOL变化中的种族差异。
该队列包括2142名完成了两项HRQOL评估的非西班牙裔白人（n = 1105）和黑人女性（n = 1037）。在积极治疗期间，白人报告的身体和功能得分比黑人高2 - 2.5分（p < 0.0001）。黑人的精神HRQOL高2.1分（p < 0.0001）。在生存期间，差异仍然存在。在调整了人口统计学、社会经济、肿瘤和治疗特征后，身体和功能HRQOL差距缩小，但精神HRQOL差距扩大。
积极治疗和生存期间身体和功能HRQOL的种族差异可能在很大程度上由社会经济因素介导。然而，我们的结果表明，在黑人女性中，精神HRQOL在整个BC护理过程中得到了很好的支持。这些结果为改善BC女性支持性服务的质量和公平性提供了机会。
