presents the HEAL cohort at enrollment and at the QOL measurement (n=805). See Alfano et al.19
for a figure of this process. However, for the analyses that are presented here, 1 woman did not have complete data sufficient to compute psychosocial scales; thus, the final sample size available for analysis was 804 women.
HEAL eligibility and participation.
presents demographic and medical characteristics of the 804 participants who provided data at the QOL measurement point, compared to the 304 participants who did not provide QOL data at the follow-up period. As shown in this table, there were key differences in the distributions between the two groups of women. Non-completers were significantly more likely to be younger or older (p<0.01), of lower educational attainment (p<0.01), and either Black or Hispanic (p<0.01). Also, non-completers were slightly, but significantly, more likely to be diagnosed at a more advanced breast cancer stage (p<0.01) and more likely to have received treatment (p<0.01).
Demographic and clinical characteristics of 804 HEAL participants who completed the quality of life follow-up survey, compared to 304 participants who did not.
Data on physical and mental health functioning summary scores by socioeconomic level and by race/ethnicity are provided in . Race/ethnicity was a significant correlate of physical (p=0.01) and mental (p<0.01) summary scores. Black women reported statistically significantly lower physical functioning scores, compared with White and Hispanic women, but higher mental health scores compared with White and Hispanic women. Employment status was also significantly associated with physical functioning (p<0.01). Restricting the analyses to women aged 35-64, the age of the Black women, or conducting analyses without the “other” race category, did not alter the pattern of findings.
Mean (SD) and least-squares mean values of functional status scores by race/ethnicity and socioeconomic level [n = 771].
presents data on the specific and independent eight subscale scores for the SF-36, compared to national norms.23
As seen in this figure, HEAL participants reported lower scores on most of the subscale scores, but particularly the physical functioning, role-physical, and role-emotional scores. The largest differences were in physical functioning and role-physical subscales, where the scores for these breast cancer survivors were approximately one standard deviation below population means.
Mean SF-36 subscale scores for HEAL participants [n=771] compared with US population norms
Tables and present the results of analyses to determine the relationships between demographic variables and both hormone-related symptoms and BCIA scale scores. Significant relationships between symptom level and sociodemographic variables were reported for Black women versus other women in cognitive/mood (p<0.01), incontinence (p<0.01), and weight/appearance (p<0.01) symptoms. contains the results of the BCIA on five scales, each representing a different dimension of life. Scores for the Exercise/Diet subscale differed significantly by educational levels (p<0.01). Higher education level was associated with a more positive impact of breast cancer on exercise/diet subscale (p for trend < 0.01). White and Black women reported a greater negative impact of cancer on the caregiving/finances domain, compared to Hispanic women. Hispanic women reported significantly greater positive impact of cancer on religiosity compared with both Black and White women. Employment levels were significantly related to the Caregiving/Finances (p<0.01) and Social/Emotional (p=0.05) scores, with women who were unemployed (seeking a job or on leave) reporting a greater negative impact of cancer than employed women. FOR scores were greater among White and Hispanic women, compared to Black women.
Mean and least-squares mean (LSM) values for symptoms scale scores, by race/ethnicity and socioeconomic level [n = 771].
Mean and least-squares mean (LSM) values for BCIA and fear of recurrence scale scores, by race/ethnicity and socioeconomic level [n = 771].
We examined differences in the fatigue and lymphedema by the same demographic data (data not shown in table). A total of 27.4 percent of women reported short-term fatigue, 37.0% reported long-term fatigue, and 35.6% reported no fatigue. For self-reported lymphedema, 13.9% reported current lymphedema, 6.1% reported past lymphedema, and 80.0% reported never having lymphedema.
contains the results of regression models using both socioeconomic indicators from and potential mechanisms from (hormonal and other symptoms, impact of cancer, and fear of recurrence) as correlates of physical and mental health functioning scores. In the final model, where demographic and psychosocial variables were included together, race was significantly related to physical functioning, with Black participants and participants in the “Other” ethnic category reporting poorer functioning compared to the White referent group (p<0.01, 0.05). Not working outside the home, being retired or disabled and being unemployed (on leave, looking for work) were associated with poorer physical functioning compared to currently working (p<0.01, <0.01). More severe urinary incontinence symptoms and greater fear of recurrence were both associated with lower physical functioning scores (p=0.04, 0.04, respectively). A less negative impact of cancer on the caregiver/financial domain was associated with an increase in physical functioning (p=0.01). However, a less negative impact of cancer on the social/emotional domain was related to a decrease in physical functioning (p=0.03). More positive impact of cancer on exercise/diet was related to an increase in physical functioning (p<0.01). In addition, current lymphedema and both short- and long-term fatigue were related to poorer physical functioning (p<0.01 for all three variables), in both the unadjusted and the adjusted models.
Linear regression models relating functional status scores to physiological and psychosocial variables and background characteristics [n = 767]†.
In the fully adjusted model, race/ethnicity was related to the mental health component score. Black women reported better mental health than White women (p=0.06), whereas Hispanic women reported poorer mental health than White women (p=0.05). The variables that were found to be significant in the unadjusted model were still significantly related to the mental health component score in the adjusted model. More severe cognitive/mood symptoms and greater fear of recurrence were associated with poorer mental health (both p<0.01). Less negative impact of cancer on the social/emotional domain was related to better mental health (p<0.01). Short- and long-term fatigue were significantly related to poorer mental health in both unadjusted and adjusted analyses (both p<0.01 for long-term fatigue; p=0.01 and <0.01 for short-term fatigue). Self-reports of current lymphedema were positively and significantly related to mental health summary score in the unadjusted analysis (p<0.01), but were only borderline significantly related to mental health summary scores in the adjusted analyses (p=0.06).