Abstract
Introduction: This study investigates sociodemographic predictors of low quality of life among a cohort of predominately underserved, minority oncology patients. Given the positive effects of a higher quality of life on patients’ survival rates, as well as the growing body of data supporting the effectiveness of psychosocial interventions in improving both quality of life and survival rates, the ability to quickly identify patients at risk for lower quality of life is critical. Establishing specific risk factors has the potential to help providers connect patients for whom psychosocial interventions may be especially beneficial to support services early in the course of their treatment.
Methods: We analyzed demographic, sociocultural, and quality of life data – measured with the Functional Assessment of Cancer Therapy Scale (General) (FACT-G) – from a consecutive sample of 265 oncology patients participating in an individualized patient-navigation program at the Center for Immigrant Health and Cancer Disparities at Memorial Sloan-Kettering Cancer Center. Data was collected in-person during enrollment interviews by bilingual program staff.
Results: The majority of the patients were female (68%); were born in Latin America (47%), the Caribbean (21%), the U.S. (16%), or Asia (9%); and preferred to speak English (43%), Spanish (38%), or Chinese (Mandarin, Cantonese, or Fujianese) (8%) in the healthcare setting. More than a third of patients had less than a high school education (39%) and 22% were unemployed before their diagnosis. The most common cancer diagnoses were breast (32%), colorectal (12%), gynecological (cervical, uterine, ovarian, or vulvar) (12%), lymphoma (6%), lung (5%), and prostate (5%). Patients who were foreign-born and who preferred to speak a language other than English in the healthcare setting were more likely to report lower quality of life (p = .015, p = .002, respectively). Similarly, patients who said they spoke English well, very well, or fluently had a higher quality of life than those who spoke it not well or not at all (p = .004). Patients who were employed at the time of interview and/or reported higher monthly incomes also had a significantly higher quality of life (p = .040, p = <.001, respectively). Among patients who knew their cancer stage, stage III or IV was associated with a lower quality of life than a diagnosis of stage I or II, as was reporting one or more comorbidities (p = .059, p = .017, respectively). Finally, patients with lower household food security as determined by the USDA's U.S. Household Food Security Module had a lower quality of life than those from food secure households (p = <.001).
Conclusions: These results highlight the fact that low-income immigrant oncology patients are at a higher risk for lower quality of life than their higher-income and U.S.-born peers, which may potentially put them at risk for poorer outcomes. While there has been significant progress in developing psychosocial interventions such as support groups and counseling tailored to oncology patients, much less has been done to target the specific and significant psychosocial needs of immigrant and minority patients. Given the fact that lower-income and minority patients continue to experience both lower quality of life and poorer outcomes than their higher-income and white counterparts, more research and interventions are needed to address the interrelationship between quality of life and outcomes, particularly the effect that targeted improvements in quality of life may have on the survival rates of low-income, immigrant, and minority patients.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A59.
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