To be young, Black, and living with breast cancer: a systematic review of health-related quality of life in young Black breast cancer survivors

PURPOSE: Compared with young White women, young Black women are more likely to present with aggressive breast cancer (BC) subtypes that are potentially linked to worse health-related quality of life (HRQOL); however, there is limited consensus regarding HRQOL needs among young Black BC survivors. Employing Ferrell's framework on QOL in BC (i.e., physical, psychological, social, and spiritual well-being), we conducted a systematic review on HRQOL among Black BC survivors aged <50 years and proposed recommendations for advancing HRQOL research and care for this population. METHODS: Literature searches were conducted in MED-LINE/PubMed, EMBASE, CINAHL, and PsycINFO to identify relevant articles published from 1995 to 2015. Abstracts and full-text articles were screened using predetermined inclusion/exclusion criteria and evaluated for quality. RESULTS: A total of 2533 articles were identified, but six met eligibility criteria. Most studies examined multiple HRQOL domains, with the psychological domain most represented. Compared with their older, White, and BC-free counterparts, young Black BC survivors reported greater fear of dying, unmet supportive care needs, financial distress, and lower physical/functional well-being. However, spiritual well-being appeared favorable for young Black survivors. Research gaps include the absence of longitudinal studies and under-representation of studies examining physical, social, and particularly, spiritual HRQOL in young Black BC survivors. CONCLUSIONS: Young Black BC survivors generally experience suboptimal HRQOL after BC diagnosis. As few studies have reported on HRQOL among this group, future research and oncology care should prioritize young Black women in ways that recognize their unique concerns, in order to ensure better HRQOL outcomes both during and after treatment

Understanding racial differences in health-related quality of life in a population-based cohort of breast cancer survivors

PURPOSE: 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. METHODS: We used data from the third phase of the Carolina Breast Cancer Study (CBCS-III). CBCS-III enrolled 3,000 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. RESULTS: The cohort included 2,142 Non-Hispanic White (n=1,105) and Black women (n=1,037) 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. CONCLUSIONS: 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

Community Level Correlates of Low Birthweight Among African American, Hispanic and White Women in California

OBJECTIVES: Racial and ethnic groups in the US exhibit major differences in low birthweight (LBW) rates. While previous studies have shown that community level social indicators associated with LBW vary by race and ethnicity, it is not known whether these differences exist among racial or ethnic groups who live in the same neighborhood or community. To address this question, we examined the association of community level features with LBW among African American, White and Hispanic women who live in similar geographic areas. METHODS: The analysis is based on geocoded birth certificates for all singleton live births in the year 2000 to women residing in 805 California ZIP codes. Community level social and demographic data were obtained from U.S. Census data files for the year 2000 and surrogate indices of population level alcohol and drug abuse and dependence were derived from hospital discharge data (HDD). Tobit and bootstrap analyses were used to test associations with birth outcomes, maternal characteristics, and community level social and demographic features within and across the three groups of women living in similar geographic areas. RESULTS: The results demonstrate major racial and ethnic differences in community level correlates of LBW. Rates of LBW among African Americans were lower if they lived in areas that were more densely populated, had greater income disparities, were more racially segregated, and had low rates of alcohol abuse or dependence. These associations were different or absent for Hispanic and White women. CONCLUSIONS FOR PRACTICE: The results suggest that despite living in the same areas, major differences in neighborhood features and social processes are linked to birth outcomes of African American women compared to Hispanic and White women. Further research, especially using multilevel approaches, is needed to precisely identify these differences to help reduce racial and ethnic disparities in LBW

Maternal Differences and Birth Outcome Disparities: Diversity Within a High-Risk Prenatal Clinic

BACKGROUND: We examined the influence of race/ethnicity on appointment attendance, maternal psychiatric and medical diagnoses, and birth outcomes within a diverse, low income, high risk pregnant population to determine whether birth outcome disparities would be lessened in a sample with high biopsychosocial risk across all groups METHODS: Data were retrospectively obtained on all women scheduled for appointments in the San Francisco Genera Hospital (SFGH) High-Risk Obstetrics (HROB) clinic during a three-month period. General linear model and logistic regression procedures were used to examine the associations of race/ethnicity with maternal characteristics, clinic attendance, and birth outcomes. RESULTS: Our sample included 202 maternal-infant pairs (Hispanic 57%, Black 16%, Asian 15%, White 12%). Racial/ethnic differences were seen in language (p < .001), gravidity (p < .001), parity (p = .005), appointment attendance (p < .001), diabetes (p = .005), psychiatric diagnosis (p = .02), illicit drug use (p < .001), smoking (p < .001). These maternal characteristics, including rate of attendance at specialized prenatal appointments, did not predict birth outcomes with the exception of an association between diabetes and earlier gestational age (p = .03). In contrast, Black maternal race/ethnicity was associated with earlier gestational age at birth (p = .004) and lower birth weight (p < .001) compared to Whites. CONCLUSIONS: Within a diverse maternal population of high biopsychosocial risk, racial/ethnic disparities in birth outcomes persist. These disparities have implications for infant health trajectory throughout the lifecourse and for intervention implementation in high risk groups