Impact of Racial/Ethnic Discrimination on Quality of Life among Breast Cancer Survivors: The Pathways Study.

Although racial/ethnic disparities in healthcare access, treatment, and cancer outcomes are well documented, the impact of racial/ethnic discrimination on cancer survivorship is unclear. We examined associations between quality of life (QoL) and self-reported discrimination among 3,991 women with breast cancer recruited 2006-2013 from the Pathways Study in the Kaiser Permanente Northern California integrated health care system, using linear regression models. Overall, 31% of women reported experiencing racial/ethnic discrimination, with differences by race/ethnicity (82% among non-Hispanic Black women to 19% among non-Hispanic White women) and nativity (40% among foreign-born Hispanic women to 76%to U.S.-born Asian American women). Experiencing racial/ethnic discrimination was associated with lower QoL in fully adjusted models with mean QoL score=119.6 (95% confidence interval (CI)=102.0-137.1) for those who did not report discrimination, 115.5 (98.0-133.0) for those who reported some discrimination/< median, and 110.2 (92.7-127.7) for those who reported more discrimination/≥ median). Discrimination was associated with lower QoL among women who used passive coping strategies, or lived in neighborhoods with high neighborhood socioeconomic status, high levels of segregation, or non-enclaves. Among breast cancer survivors, clinically meaningful differences in QoL scores were associated with racial/ethnic discrimination. Studies are needed to understand potential pathways through which these social factors impact survivorship outcomes.