Although data are emerging on racial differences in quality of life following prostate cancer diagnosis (2
), to our knowledge, this is the first empirical report to evaluate racial differences in emotional and physical well-being among prostate cancer patients while adjusting for economic factors, subjective stress, and religiosity. We found that African American men reported better emotional well-being compared to white men despite there being no racial differences in physical functioning. This finding is in contrast with the results of previous studies. (2
) It should be noted that racial differences in emotional well-being were modest and were close to, but below, the threshold that have been reported for minimally important differences for this variable. Similar differences have been reported in other research that compared African American and white cancer survivors.(21
African American men are exposed to a greater number of adverse life events (e.g., poverty, racial discrimination) prior to being diagnosed with cancer; these experiences may reduce the threat of being diagnosed with prostate cancer or may make them better prepared to cope with their diagnosis.(5
) Relatedly, African American men may use coping strategies that are effective at mitigating the negative emotional effects of being diagnosed with prostate cancer. For example, African American prostate cancer patients reported significantly greater levels of religiosity compared to white men (15
) and also reported that their personal relationship with God was an important source of support that reduced their worry and anxiety.(22
) It is important to note that religiosity did not have a significant effect on emotional or physical well-being. This could be because our measure of religiosity assessed participation in religious activities (e.g., prayer, church attendance) and beliefs, but did not evaluate whether or not these strategies were used to cope with their diagnosis. Future studies should examine the effects of religious and spiritual coping efforts on quality of life among prostate cancer patients and determine whether these strategies contribute to racial differences in quality of life.
Also in contrast with previous research (6
), with the exception of age, socioeconomic factors did not have a significant effect on emotional or physical functioning. Our findings demonstrate that the effects of economic variables on quality of life may be less important when they are put into greater context that includes men’s psychological functioning and their racial background. For example, race is an important indicator of one’s sociological, environmental, and clinical experiences; race may be more important to some aspects of quality of life because it represents the totality of one’s experiences, rather than the individual effects of a single economic factor. Similarly, economic factors, while important indicators of exposure to a variety of stressors (e.g., poverty, unemployment), could be less important when they are evaluated while adjusting for subjective stress because these perceptions reflect men’s actual experiences.
We also found that subjective stress had a significant adverse effect on emotional and physical functioning. In both cases, men who had greater stress reported poorer functioning. Our findings differ from those reported by Joseph and colleagues (23
), who did not find a significant relationship between subjective stress and disease-related side effects. Whether or not men experience disease-related side effects is one aspect of their quality of life; it could be that subjective stress has an impact on men’s overall emotional and physical functioning, but not their perceptions of specific side effects. Thus, greater attention to perceptions of stress may be needed as part of support programs for prostate cancer patients. Previous research has shown that problem-solving interventions that help women who have a family history of disease in a first-degree relative to address their appraisals of stress related to breast cancer are effective at minimizing psychological distress and improving health behaviors (24
). Helping men to identify specific sources of stress and use coping strategies that are most likely to be effective at managing these issues may reduce levels of stress and enhance quality of life.(26
) Similar types of interventions have also improved quality of life in prostate cancer patients in previous research.(27
In considering the results of our study, several limitations should be noted. First, only about 50% of eligible men enrolled in the study and there were racial differences in enrollment rates. However, our enrollment rates are similar to those that have been reported for other samples of cancer patients (12
) and reflect the difficulties that are inherent in enrolling this population into cancer research. Further, the modest rates of study enrollment and racial differences in participation are offset by the high rates of completing the baseline telephone interview and the diversity of our study sample. More than 80% of men who enrolled in the study completed the baseline telephone interview and African American men made up a substantial minority of study participants.
Despite these potential limitations, our findings underscore the importance of adjusting for psychological and cultural factors when evaluating the effects of race on quality of life in prostate cancer patients. In this cross-sectional study of African American and white prostate cancer patients, we found that after controlling for socioeconomic characteristics, psychological variables, and cultural factors there were no racial differences in physical well-being and that African American men scored better on emotional functioning. These findings raise questions about whether or not support programs are needed for African American men. Other research has shown that African American men report lower quality of life compared to white men (2
) and recover more slowly in terms of these outcomes (4
). It could be that quality of life decreases among African American men as they progress through different phases of prostate cancer survivorship. If this is the case, then informational or educational interventions, including those that address stress management (27
), may be indicated for this population. Similar types of interventions have been evaluated in previous research and have had positive effects on quality of life (27
); however, efforts have not been directed towards addressing the specific needs or QOL trajectory of African American men. Further longitudinal studies are needed to follow changes in QOL based on race and perceptions of stress throughout the course of treatment and long-term survivorship.