Elucidating mechanisms of quality-of-life disparities in Hispanic women with breast cancer: An examination of disease stage, coping, and affect

Objectives Compared to non-Hispanic white (NHW) women, Hispanic women with breast cancer (BCa) are more likely to be diagnosed at later stages of disease and experience reduced quality of life (QOL) following diagnosis. We hypothesized that the demands of later-stage disease results in a perceived inability to cope and greater distress for Hispanic women, resulting in decreased QOL. Methods Hispanic (51%) and NHW (49%) women (N = 198) with newly diagnosed stage 0-3 BCa in Miami were enrolled in two trials between 2006 and 2019. In this cross-sectional analysis, a multiple-group structural equation modeling approach was applied to baseline measures of coping confidence (Measure of Current Status Scale), negative and positive affect (Affect Balance Scale), QOL (Functional Assessment of Cancer Therapy - Breast), and disease stage. Results In our model, later-stage disease was not associated with worse QOL for Hispanic or NHW women. However, there were differences between Hispanic and NHW women on the path from disease stage to (1) coping confidence, (2) positive affect, and (3) negative affect, such that later disease stage was associated with lower coping confidence (b[SE] = -1.75[0.59], p = 0.002), less positive affect (b[SE] = -0.21[0.10], p = 0.026), and greater negative affect (b[SE] = 0.15[0.08], p = 0.052) among Hispanic, but not NHW, women. In addition, an indirect effect was found from greater stage to poorer QOL via less positive affect among Hispanic women only (b[SE] = -0.49[0.24], p = 0.041). Conclusions This data supports our theory that Hispanic women experience worse emotional distress at later-stage disease than do NHW women, in turn impacting QOL.

Automated summary

Hispanic women with breast cancer in later stages experience greater emotional distress and poorer emotional states compared to non-Hispanic white women, potentially impacting their quality of life. However, the impact of later-stage disease on quality of life did not significantly differ between the two ethnic groups.