1 Department of Public Health Sciences, University of Virginia , Charlottesville, Virginia.
2 Department of Population Science, Rutgers Cancer Institute of New Jersey , New Brunswick, New Jersey.
J Womens Health (Larchmt). 2019 Feb;28(2):284-293. doi: 10.1089/jwh.2018.7025. Epub 2018 Oct 10.
While the incidence of epithelial ovarian cancer (EOC) is lower among African American (AA) women compared with European American (EA) women, AA women have markedly worse outcomes. In this study, we describe individual, social, and societal factors in health-related quality of life (HRQL) in AA women diagnosed with EOC in the African American Cancer Epidemiology Study (AACES) that we hypothesize may influence a patient's capacity to psychosocially adjust to a diagnosis of cancer.
There were 215 invasive EOC cases included in the analysis. HRQL was measured using the SF-8 component scores for physical (PCS) and mental (MCS) health. We used least squares regression to test the effects of individual dispositional factors (optimism and trait anxiety); social level (perceived social support); and societal-level factors (SES defined as low family income and low educational attainment, and perceived discrimination) on HRQL, while adjusting for patient age, tumor stage, body mass index, and comorbidity. Mediation analysis was applied to test whether social support and physical activity buffer impacts of EOC on HRQL.
Optimism, trait anxiety, social support, poverty, and past perceived discrimination were significantly associated with HRQL following diagnosis of EOC. Specifically, higher family income, lower phobic anxiety, and higher social support were associated with better wellbeing on the MCS and PCS (p < 0.01). Higher perceived discrimination was associated with both lower MCS and PCS, whereas higher optimism was associated with higher MCS. Physical activity (MET-min/week) and social support displayed significant overall mediation for effects of SES on MCS and PCS, but not for trait anxiety.
Both pre- and postdiagnosis characteristics of AA women with EOC are important predictors of HRQL after cancer diagnosis. Individual, social, and societal-level factors each contribute to HRQL status with EOC and should be assessed.
尽管非裔美国女性（AA）上皮性卵巢癌（EOC）的发病率低于欧洲裔美国女性（EA），但 AA 女性的预后明显更差。在这项研究中，我们描述了在非裔美国人癌症流行病学研究（AACES）中诊断为 EOC 的 AA 女性的健康相关生活质量（HRQL）的个体、社会和社会因素，我们假设这些因素可能影响患者对癌症诊断的心理社会适应能力。
共有 215 例浸润性 EOC 病例纳入分析。HRQL 使用 SF-8 成分评分进行测量，包括身体（PCS）和心理（MCS）健康。我们使用最小二乘法回归来检验个体特质因素（乐观和特质焦虑）；社会水平（感知社会支持）；以及社会经济地位（SES，定义为家庭收入低和教育程度低，以及感知歧视）对 HRQL 的影响，同时调整患者年龄、肿瘤分期、体重指数和合并症。中介分析用于检验社会支持和体力活动是否缓冲 EOC 对 HRQL 的影响。
乐观、特质焦虑、社会支持、贫困和过去感知歧视与 EOC 诊断后 HRQL 显著相关。具体而言，家庭收入较高、焦虑程度较低和社会支持较高与 MCS 和 PCS 的健康状况较好相关（p<0.01）。感知歧视越高，MCS 和 PCS 越低，而乐观越高，MCS 越高。体力活动（MET-min/周）和社会支持对 SES 对 MCS 和 PCS 的影响显示出显著的总体中介作用，但对特质焦虑没有。
AA 女性在 EOC 前后的特征都是癌症诊断后 HRQL 的重要预测因素。个体、社会和社会经济因素都对 EOC 的 HRQL 状况有贡献，应该进行评估。
