What mediates the racial/ethnic disparity in psychosocial stress among breast cancer patients?

Abstract

Background Prior studies have observed greater levels of psychosocial stress (PSS) among non-Hispanic (nH) African American and Hispanic women when compared to nH White patients after a breast cancer diagnosis. We aimed to determine the independent and interdependent roles of socioeconomic position (SEP) and unmet support in the racial disparity in PSS among breast cancer patients. Methods Participants were recruited from the Breast Cancer Care in Chicago study (n = 989). For all recently diagnosed breast cancer patients, aged 25–79, income, education, and tract-level disadvantage and affluence were summed to create a standardized socioeconomic position (SEP) score. Three measures of PSS related to loneliness, perceived stress, and psychological consequences of a breast cancer diagnosis were defined based on previously validated scales. Five domains of unmet social support needs (emotional, spiritual, informational, financial, and practical) were defined from interviews. We conducted path models in MPlus to estimate the extent to which PSS disparities were mediated by SEP and unmet social support needs. Results Black and Hispanic patients reported greater PSS compared to white patients and greater unmet social support needs (p = 0.001 for all domains). Virtually all of the disparity in PSS could be explained by SEP. A substantial portion of the mediating influence of SEP was further transmitted by unmet financial and practical needs among Black patients and by unmet emotional needs for Hispanic patients. Conclusions SEP appeared to be a root cause of the racial/ethnic disparities in PSS within our sample. Our findings further suggest that different interventions may be necessary to alleviate the burden of SEP for nH AA (i.e., more financial support) and Hispanic patients (i.e., more emotional support).

Racial/Ethnic Disparity in the Relationship of Mental and Physical Health With Colorectal Cancer Screening Utilization Among Breast and Prostate Cancer Survivors

“…Another important finding is that NHB and NHO/Hispanic survivors with both frequent poor mental and physical health were 95% less likely to receive guideline-concordant CRC screening. This finding was consistent with prior literature, [42][43][44][45][46] with lower screening use possibly explained by poor physical and/or mental health. In breast cancer, Bowen et al 42 found that NHB and NHO survivors were more likely to report lower score in physical health domain.…”

“…Similarly, greater psychosocial stress, which may influence physical health outcomes through psychological mechanisms, was also observed in these two racial/ethnic groups because of socioeconomic disparities in breast cancer. 45 Furthermore, Black prostate cancer survivors with bowel and bladder incontinence were more likely to screen positive for depression symptoms. 43 Together, racial/ethnic differences and the influence of mental and physical health in breast and prostate cancers play important roles in survival outcomes.…”

Digital Health Psychosocial Intervention in Adult Patients With Cancer and Their Families: Systematic Review and Meta-Analysis

“…First, the majority of participants in the included studies were White and female, which does not reflect the broader patient population with cancer, including non-White ethno-racial groups (ie, African American or Black, American Indian and Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and Hispanic or Latino populations). It is well documented in the literature that the impact of cancer on psychological distress and quality of life is worse for racial and ethnic minority groups [ 100 - 102 ]. Therefore, future trials should include more participants from underrepresented groups to reduce health care disparities and improve generalizability in diverse populations [ 103 ].…”

Race, ethnicity, and experienced racism are associated with adverse physical and mental health outcomes among cancer survivors

“…1 Those who do survive are at greater risk for inferior physical and mental health outcomes compared with their White peers. [2][3][4] Specifically, Black, Hispanic, and Indigenous survivors experience poorer physical and mental health outcomes, such as increased late effects of cancer treatment, [5][6][7] impairment in activities of daily life, 8 sleep, 9 psychosocial stress, 3 and health-related quality of life. [10][11][12][13] Notably, these adverse outcomes are in the context of a greater burden of mental and physical health challenges survivors of cancer face in comparison to their noncancer-exposed peers.…”

“…Individuals from historically marginalized racial and ethnic groups diagnosed with cancer are less likely to survive than their White counterparts 1 . Those who do survive are at greater risk for inferior physical and mental health outcomes compared with their White peers 2–4 . Specifically, Black, Hispanic, and Indigenous survivors experience poorer physical and mental health outcomes, such as increased late effects of cancer treatment, 5–7 impairment in activities of daily life, 8 sleep, 9 psychosocial stress, 3 and health‐related quality of life 10–13 .…”