Yang Freddie, Hu Xin, Anderson Janeane N, Vidal Gregory A, Stepanski Edward, Schwartzberg Lee S, Graetz Ilana
Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Suite 636, Atlanta, GA, 30322, USA.
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, 30322, USA.
J Cancer Surviv. 2025 Aug 28. doi: 10.1007/s11764-025-01875-5.
Breast cancer is common among women in the US and can impact survivors' quality of life (QoL). Perceived discrimination, defined as unfair treatment based on group membership, is often associated with poorer QoL, while effective patient-provider communication is often linked to better QoL. However, whether communication can mitigate the negative effects of discrimination remains unclear. This study investigates the relationship between perceived discrimination and QoL among women with early-stage breast cancer, and the potential mediating role of patient-provider communication.
We analyzed baseline survey data from women with early-stage breast cancer enrolled in a randomized control trial. Validated instruments were used to measure perceived discrimination, patient-provider communication, and mental and physical QoL. We used linear regression to assess the association between discrimination and outcomes (QoL and patient-provider communication), and mediation analysis to evaluate if patient-provider communication mediated the relationship between discrimination and QoL.
Among 303 women surveyed, 35.6% reported experiencing discrimination at least yearly. Experiencing discrimination at least yearly was significantly associated with worse patient-provider communication, mental health QoL, and physical health QoL (p-values < 0.05). No significant mediating effect of patient-provider communication was observed in the discrimination-QoL relationships.
Perceived discrimination and patient-provider communication are both independently associated with QoL, however, patient-provider communication does not mediate the relationship between discrimination and QoL.
Perceived discrimination and patient-provider communication play distinct roles in breast cancer survivors' QoL. Improving the quality of life for cancer survivors requires addressing upstream sources of discrimination and bias, including structural racism.
乳腺癌在美国女性中很常见，会影响幸存者的生活质量（QoL）。感知到的歧视，即基于群体成员身份的不公平待遇，通常与较差的生活质量相关，而有效的医患沟通往往与更好的生活质量相关。然而，沟通是否能减轻歧视的负面影响仍不清楚。本研究调查了早期乳腺癌女性中感知到的歧视与生活质量之间的关系，以及医患沟通的潜在中介作用。
我们分析了一项随机对照试验中早期乳腺癌女性的基线调查数据。使用经过验证的工具来测量感知到的歧视、医患沟通以及心理和生理生活质量。我们使用线性回归来评估歧视与结果（生活质量和医患沟通）之间的关联，并进行中介分析以评估医患沟通是否介导了歧视与生活质量之间的关系。
在接受调查的303名女性中，35.6%报告至少每年经历一次歧视。至少每年经历一次歧视与较差的医患沟通、心理健康生活质量和身体健康生活质量显著相关（p值<0.05）。在歧视与生活质量的关系中未观察到医患沟通的显著中介作用。
感知到的歧视和医患沟通都与生活质量独立相关，然而，医患沟通并未介导歧视与生活质量之间的关系。
感知到的歧视和医患沟通在乳腺癌幸存者的生活质量中发挥着不同的作用。改善癌症幸存者的生活质量需要解决歧视和偏见的上游来源，包括结构性种族主义。
