Jan. 19, 1999 Ethnicity plays no role in determining quality of life for long-term breast cancer survivors, according to a first-of-its-kind study led by researchers from UCLA's Jonsson Cancer Center. Sociological factors such as life stress, relationship status, education and income, however, do affect how well women cope after having the disease, the study found.
Dr. Patricia Ganz, director of the Division of Cancer Prevention and Control Research at UCLA's Jonsson Cancer Center, conducted the ground-breaking study examining ethnicity and quality of life, evaluating 278 California breast cancer patients - 117 African American women and 161 white women. No differences in quality of life were found between African American women and white women based solely on their race, according to an article on the study co-authored by Ganz and appearing in Friday's (Jan. 15) issue of the journal Cancer.
"People want to know if there are differences in how well they'll do that are based on factors such as race," said Ganz, who has been conducting quality of life research since 1980. "We've found that cancer is the leveling factor. You can be white, pink or purple, and cancer will be the common denominator. There's a lot of talk about celebrating differences, but cancer survivorship is one area where we're more similar than dissimilar."
Additionally, the study found that participants were doing well five to eight years out from their diagnosis, which Ganz said should be heartening news for women who are only now being diagnosed with breast cancer.
"What we've found is reassuring," Ganz said. "These women are functioning at a very good level."
Ganz conducted the study with Kimlin Ashing-Giwa of the Alhambra-based California School of Professional Psychology. Ashing-Giwa, who also is a member of the Jonsson Cancer Center, said the results "challenge the assumption that ethnicity determines health-related quality of life outcomes."
"This research suggests that factors such as socioeconomic level and life stress are important in assessing quality of life and that ethnicity, per se, is not a major factor, although it may influence some of the significant predictors," Ashing-Giwa said.
The study examined the patients' physical, psychological, social and functional well-being using standard measures to gauge quality of life, including perceived health and stress levels. The study found that long-term survivors who had better health perceptions, fewer stresses, higher incomes, better educations and shared living situations reported a better quality of life, regardless of ethnicity.
"When someone is faced with cancer, they're first concerned with, 'Will I survive?' " Ganz said. "After they've gotten through the shock and treatment, what they want to know is 'How am I going to survive, what is the quality of that survival going to be?' With the information from this study we can prepare them, and that's why this research is so important."
Ganz said little is known about the long-term effects of breast cancer on a woman's quality of life and psychosocial function. Even less information has been gathered about long-term (greater than five years) survivors among minority women. Previous quality of life studies have focused primarily on women with more recent diagnoses (within the last two years), and sample sizes were smaller and predominantly white, Ganz said.
Today, there are more than one million breast cancer survivors and the demand for information is increasing. This year alone, more than 180,000 women will be diagnosed with breast cancer, according to the American Cancer Society.
Information gleaned from the study provides insight into the lives of breast cancer survivors that could be used by physicians, mental health professionals, patients and their families to improve coping skills, Ganz said.
"Survivors want to know if what they're experiencing is normal," Ganz said, adding that additional quality of life research must be done to expand that knowledge.
The findings also support a growing body of research that suggests breast cancer survivors can look forward to a favorable quality of life. A majority of the African American and white women studied reported fairly good quality of life, although sexual function was "a little problematic" for some survivors surveyed, Ganz said.
Because the long-term survivors surveyed had health perceptions similar to those of healthy women of like ages, the study suggests that the aging process may have a greater impact on quality of life than a past history of breast cancer.
Participants in the study, conducted between January and March of 1996, were recruited from the California Tumor Registry and represented women from throughout the state, Ganz said. Respondents completed a 33-page survey form designed to analyze perceptions of health and life stress and physical and mental functions, including sexual activity, social support, body image, spirituality and demographics.
The women were questioned about pain and fatigue and the impact of physical activities such as walking and climbing stairs. They also were asked about depression and anxiety, as well as their ability to engage in routine social activities. Family and work life also were examined, Ganz said.
Participants ranged in age from 32 to 90. Seventy-five percent had some college education and 42 percent were employed at the time of the survey. Sixty percent were married, 21 percent widowed and 19 percent were single. The African American women suffered greater life stresses, were more likely to be single and reported less income than the white women, according to the study. Most respondents were disease-free at the time of the survey, although common disorders such as arthritis, hypertension and allergies were reported by about one-third of respondents.
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