Cancer survivors of different racial and ethnic groups and countries of origin report differential health-related quality of life experiences.
Numerous physical, mental, and social factors influence cancer survivors’ health-related quality of life (HRQOL). Most cancer research regarding HRQOL in the United States does not include the country of origin when assessing racial and ethnic differences. A study published in the Journal of the National Cancer Institute has reported significant differences in HRQOL among cancer survivors by race, ethnicity, and country of origin, even after adjusting for clinical and demographic factors, including social determinants of health. Including these factors in future research and screening can help identify patients at high risk for poor HRQOL.
Study Population
A total of 5366 cancer survivors were enrolled. The mean age was 59.8 years and 60% of the participants were female. The population comprised approximately 17% Asian, 21% Hispanic, 18% non-Hispanic Black, and 41% non-Hispanic White participants.
Population Divided into Four HRQOL Clusters
Using the Patient-Reported Outcomes Measurement Information System T-scores the population was divided into four HRQOL clusters. The high-HRQOL cluster comprised approximately 26% of the population. These individuals reported high functioning and low symptoms, which was approximately 10 points better than the US general population. The average-HRQOL cluster comprised approximately 34% of the participants, having functioning and a symptom burden similar to the general population. The low-HRQOL cluster was approximately 29% of the sample, with functioning and a symptom burden approximately 5 points worse than the general population. The very low-HRQOL cluster was approximately 11% of the sample, reporting functioning and a symptom burden approximately 15 points worse than the general population.
HRQOL Health Disparities Among Ethnic Groups
Black, Caribbean, Chinese, Filipino, Mexican, and other Hispanic participants were less likely to be in the average-HRQOL cluster than White participants. Black, Chinese, Filipino, Mexican, and other Hispanic participants were less likely to be in the low-HRQOL cluster than White participants. Caribbean participants were likelier to be in the very low-HRQOL cluster than White individuals.
Impact of Race and Ethnicity on Birth and HRQOL in the US
Race and ethnicity interaction with birth in the US was significant. Black cancer survivors not born in the US were less likely to be in the average- and low-HRQOL clusters than Black participants born in the US. Chinese survivors not born in the US were less likely to be in the very low-HRQOL cluster than those born in the US. Survivors from other Hispanic groups not born in the US were less likely to be in the average-HRQOL cluster than those born in the US.
Disparities in HRQOL Among Ethnic Groups
A relatively high proportion of American Indian and Alaska Native, Cuban, Dominican, and Puerto Rican participants was in the very low-HRQOL cluster. Relatively high percentages of survivors of Indian, Japanese, and Vietnamese origins were in the low-HRQOL cluster.
Important covariates in clustering useful for screening and intervention include a history of a mental health condition, sleep disturbance, lower financial well-being, and lower spiritual well-being.
Source
Reeve, B. B., Graves, K. D., Lin, L., Potosky, A. L., Ahn, J., Henke, D., Pan, W., & Fall-Dickson, J. M. (2022). Health-related quality of life by race, ethnicity, and country of origin among cancer survivors. Journal of the National Cancer Institute, 115(3), 258–267. https://doi.org/10.1093/jnci/djac230
