Health-Related Quality of Life of African American Female Breast Cancer Survivors, Survivors of Other Cancers, and Those Without Cancer, National Health Interview Survey, 2010
ORIGINAL RESEARCH — Volume 13 — June 7, 2016
Mechelle D. Claridy, MPH; William W. Thompson, PhD; Benjamin Ansa, MD, MSCR; Francesca Damus, MPH; Ernest Alema-Mensah, DMin, PhD; Selina A. Smith, PhD, MDiv
Suggested citation for this article: Claridy MD, Thompson WW, Ansa B, Damus F, Alema-Mensah E, Smith SA. Health-Related Quality of Life of African American Female Breast Cancer Survivors, Survivors of Other Cancers, and Those Without Cancer, National Health Interview Survey, 2010. Prev Chronic Dis 2016;13:160096. DOI: http://dx.doi.org/10.5888/pcd13.160096external icon.
PEER REVIEWED
Abstract
Introduction
The purpose of this study was to compare differences in health-related quality of life (HRQOL) between African American female breast cancer survivors, African American female survivors of other cancers, and African American women with no history of cancer.
Methods
Using data from the 2010 National Health Interview Survey (NHIS), the HRQOL of African American women aged 35 years or older was compared by cancer status. Physical and mental health items from the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale were used to assess differences in HRQOL.
Results
For summary physical and mental health measures, no significant differences were found between breast cancer survivors and women with no history of cancer; survivors of other cancers reported poorer physical and mental health than did women with no history of cancer. Similar differences were found at the item level. When we examined the 2 African American female cancer survivor groups, we found that cancer survivors whose cancer was being treated reported substantially poorer physical health and mental health than did those whose cancer was not being treated. Survivors who had private insurance and were cancer free reported better physical and mental health than did those who did not have private insurance and those who were not cancer free. Breast cancer survivors reported slightly better physical and mental health than did survivors of other cancers.
Conclusions
Our findings highlight the need for public health agencies to adopt practices to improve the mental and physical health of African American female survivors of cancer. Future research should investigate interventions for improving the HRQOL of African American female survivors of other cancers.
Introduction
Breast cancer survivors are the largest group of female cancer survivors worldwide (1). Although the number of breast cancer survivors is increasing because of continual improvements in diagnostic screening and cancer treatments (1–3), significant survival disparities exist by race and ethnicity. African American women have the lowest breast cancer survival rate of any racial/ethnic group in the United States, and they have a mortality rate that is 41% higher than that of white women (1,3). As a result, there has been considerable interest in understanding the health-related quality of life (HRQOL) of African American female breast cancer survivors (2,4).
HRQOL is a multidimensional population health outcome that supplements the more traditional measures of mortality and morbidity and is useful in providing broad summary measures of perceived health (5,6). HRQOL refers to a person’s subjective assessment of physical, emotional, social, and cognitive functioning in the context of disease symptoms and treatment (7). Its constructs include measures of overall health, physical health, mental health, and social functioning (8,9).
Over the past decade, analyses have been conducted to improve the understanding of factors that affect HRQOL among various breast cancer survivor groups, but studies that investigate how HRQOL differs among African American women with and without cancer are lacking. This study is among the first to examine and compare HRQOL among African American women with and without breast cancer using a nationally representative sample and adjusting for confounders. The purpose of this study was to compare the differences in HRQOL between African American female breast cancer survivors, African American female survivors of other cancers, and African American women with no history of cancer.
Methods
Participants
Data for this study were obtained from the 2010 National Health Interview Survey (NHIS), an annual, nationwide, in-person survey used to monitor the health of the US population on a range of health topics. Data collection for the NHIS uses multistage sampling to obtain a representative sample of the US civilian, noninstitutionalized population. One adult (aged ≥18 years) per sampled household is randomly selected and invited to participate in the Sample Adult Core component of the survey. The annual response rate of NHIS is approximately 73% of the eligible adults in the sample. The NHIS has been conducted annually since 1957 (10).
To focus on issues pertaining to cancer knowledge, attitudes, and practices in cancer-related health behaviors, the Centers for Disease Control and Prevention and the National Cancer Institute cosponsored and developed a Cancer Control Supplement for the NHIS. Since 2000, the NHIS Cancer Control Supplement has been administered approximately every 5 years (10).
We analyzed data from the 2010 NHIS to assess the HRQOL of 3 groups of African American women: survivors of breast cancer, survivors of other cancers, and those without cancer. The participants were adult African American women (including black, black Hispanic, and non-Hispanic black women) aged 35 years or older. On the basis of questions about whether a physician had told participants that they had a specific type of cancer, women were categorized into 3 mutually exclusive groups: those who had ever been told they had breast cancer, those who had ever been told they had cancer other than breast cancer, and those who had never been told they had cancer. Data were drawn from the Person, Sample Adult, and Cancer Control Supplement files (Sample Adult Cancer) (10).
Measures
Sociodemographic variables were self-reported age (35–54 years or ≥55 years), education level (less than a high school diploma, high school graduate, or college graduate), and marital status (married, separated/divorced or widowed, or never married/unmarried), insurance status (private vs other) and body mass index (BMI; underweight = <18.5 kg/m2, normal weight = 18.5–24.9 kg/m2, overweight = 25.0–29.9 kg/m2, and obese = ≥30.0 kg/m2). Income was not included as a sociodemographic variable, because a substantial proportion of respondents — in particular, older respondents — often do not answer this question, and the sample sizes for each cancer group would have been reduced, resulting in sparse cell sizes and statistical comparisons with low power. There were 8,148 African American women in the 2010 NHIS sample. African American women younger than 35 were excluded because of the small likelihood of cancer in this group, resulting in a total sample of 1,702 African American women aged 35 or older.
Cancer status was defined according to the response to 2 self-reported cancer history questions: “Have you ever been told by a physician that you have cancer?” and “Have you ever been told by a physician that you have breast cancer?” To create cancer status categories, respondents who replied yes to the question “Have you ever been told by a physician that you have cancer?” but no to the question “Have you ever been told by a physician that you have breast cancer?” were categorized as having other cancers (n = 74) (Appendix A); respondents who replied yes to both questions were categorized as having breast cancer (n = 62); and respondents who replied no to both questions were categorized as being without cancer (n = 1,566). Being “cancer free” was defined according to the response to one self-reported cancer history question: “To the best of your knowledge, are you now free of cancer?” Being “currently in treatment” was defined according to the response to a similar question: “Are you currently in active treatment?”
The 10-item Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Scale was used to assess HRQOL for both physical and mental health. PROMIS is a National Institutes of Health initiative to use Item Response Theory and Computer Adaptive Testing to develop and automate the administration of efficient, precise, and valid item banks measuring common patient-reported clinical outcomes (eg, pain, fatigue, physical function, and depression) (10). An effort within PROMIS was to develop a set of Global Health items to assess general perceptions of health (9). The 10 items developed for the Global Health set consist of 5 general health items, assessed by the question “In general, would you say your health is (excellent, very good, good, fair, or poor),” and 5 items derived from the core domains of the initial PROMIS item banks (ie, physical function, pain, fatigue, emotional distress, and social activities).
For the summary T-scores for physical and mental health, each domain contained 4 items (Appendix B). For the physical health T-scores, the items related to overall physical health, being able to carry out every day physical activity, pain, and fatigue. For the mental health T-scores, the items related to quality of life, mental health, satisfaction with social activities, and emotional problems (10). For analysis purposes at the item level, each item was coded into 2 categories: Good HRQOL (excellent, very good, good, not at all, a little bit, somewhat, none to mild; or pain rating of 0 to 5 days) and poor HRQOL (fair, poor, quite a bit, very much, moderately to very severe; or pain rating of 6 to 10 days). The physical and mental health summary scores were transformed to T-score distributions. Higher PROMIS scores represented better HRQOL.
Analytic plan
To account for the complex survey design and respondent sample weights, all statistical analyses were performed with SAS version 9.2 (SAS Institute, Inc). Descriptive frequencies and χ2 tests were conducted for each sociodemographic variable and individual PROMIS item by cancer status. At the item level, adjusted logistic regression models were used to assess differences in HRQOL by cancer status. For the PROMIS physical and mental health domain scores, adjusted multiple regression models were used to assess differences by cancer status. All analyses were adjusted for age, marital status, education level, and private insurance. In addition, subgroup analyses were conducted to assess both group differences and cancer-specific health history factors. Using linear regression analyses, we assessed the effect of current cancer treatment, whether individuals were considered to be cancer free, and private insurance status on the global physical and mental health T-scores. All parameter estimates were considered significant at P < .01.
Results
African American female breast cancer survivors and survivors of other cancers tended to be older, more likely to be unmarried, and more highly educated than African American women with no history of cancer. (Table 1) African American female survivors of other cancers were significantly less likely to have private insurance than were women in the other groups, and African American female breast cancer survivors were more likely to be overweight than women in the other groups. BMI was a significant predictor for HRQOL, and women who were obese had poorer health than women who were not.
The weighted national average odds ratio (OR) for the PROMIS physical health T-score was 53.0 (95% confidence interval [95% CI], 52.8–53.1), and it was 53.8 (95% CI, 53.7–54.0) for the mental health T-score in the 2010 NHIS sample. When the African American women included in this study were compared with age- and sex-matched non–African American women, African American women reported significantly lower scores than the non–African American women on both physical health (OR = 48.8 [95% CI, 48.1–49.4] vs OR = 51.1 [95% CI, 50.9–51.3]) and mental health (OR = 50.7 [95% CI, 50.2–51.3] vs OR = 53.3 [95% CI, 53.1–53.5]).
Significant univariate differences by cancer status for 6 of the 8 PROMIS domain-specific items were found among African American women (Table 2). For physical health, breast cancer survivors and women with no history of cancer had similar levels of self-reported health for all 4 items. Specifically, breast cancer survivors often reported excellent to good physical health (78.4%), being moderately or completely able to carry out physical activities (84.1%), low levels of fatigue (68.5%), and low levels of pain (75.3%). In contrast, compared with women with no history of cancer, survivors of other cancers reported poorer self-reported physical health on all 4 physical health items: poor physical health (OR = 2.33; 95% CI, 1.33–4.06), difficulty carrying out physical activities (OR = 2.58; 95% CI, 1.41–4.74), fatigue (OR = 2.17; 95% CI, 1.18–3.98), and pain (OR = 2.87; 95% CI, 1.72–4.78)].
For 2 of the 4 mental health domain specific items, women with no history of cancer reported better health than did survivors of other cancers (Table 2). Compared with women with no history of cancer, survivors of other cancers were more likely to report poorer mental health (OR = 2.01; 95% CI, 1.11–3.64) and lower satisfaction with social activities and relationships (OR = 2.03; 95% CI, 1.14–3.63).
Results from the weighted analyses (adjusted for age, marital status, education level, and insurance status) were similar to those of the unadjusted analyses for the 4 PROMIS physical health items, by cancer status (Table 3). No significant differences on any physical health items were found between breast cancer survivors and women with no history of cancer. In contrast, compared with women with no history of cancer, survivors of other cancers were more than twice as likely to report poorer HRQOL on all 4 physical items.
For the weighted adjusted analyses, no significant differences were found between breast cancer survivors and women with no history of cancer on any of the 4 mental health items. Similar to the results of univariate comparisons for the mental health items, compared with women with no history of cancer, survivors of other cancers reported poorer HRQOL on 2 mental health items: mental health (AOR = 1.93; 95% CI, 1.07–3.47) and satisfaction with social activities and relationships (AOR = 1.94; 95% CI, 1.11–3.40).
After adjusting for age, marital status, education, insurance status, and BMI, survivors of other cancers reported lower scores on the physical health domain than did women with no history of cancer (T-score = −5.40; 95% CI, −8.43 to −2.38) (Appendix C), representing a more than 50% difference in standard deviation. In contrast to that finding, no significant difference was found on the physical health domain between breast cancer survivors and women with no history of cancer. For the mental health domain, African American female survivors of other cancers reported lower mental health scores than African American women with no history of cancer (T-score = −3.10; 95% CI, −5.65 to −0.54), but the difference was not as large as the difference in physical health T-scores (ie, about a third of a standard deviation difference). No significant difference in mental health was found between breast cancer survivors and women with no history of cancer.
After adjusting for age, marital status, education level, treatment effects, cancer-free status, and insurance status, we found that breast cancer survivors reported better physical health and mental health than survivors of other cancers, (Table 4). Furthermore, women who did not have private insurance and were receiving cancer treatment reported substantially poorer physical health than did their counterparts. The effect of current treatment on mental health was significant but less than half the effect size of that found for physical health. Women who reported themselves as being cancer free reported both better physical and mental health than did women who had breast cancer or who were survivors of other cancer.
Discussion
The Healthy People 2020 initiative of the US Department of Health and Human Services emphasized HRQOL outcomes, recognizing them as a public health concern and including them as one of the 4 overarching goals. Examining and measuring HRQOL can help determine the burden of preventable diseases and provide valuable new insights into the relationships between HRQOL and risk factors. Most studies on HRQOL among African American female breast cancer survivors have made comparisons between only African American women and non–African American women (12); they also have been limited by the lack of comparison groups within African American women with other cancers and African American women with no history of cancer. We found only one previous study of African American women that made comparisons within this group (13) by including a control group of African American women who self-reported that they had previous breast cancer diagnosis. We believe that our study is the first to use a nationally representative sample and to compare various HRQOL measures among African American female breast cancer survivors, African American female survivors of other cancers, and African American women with no history of cancer (control group). Furthermore, few previous studies of African American female cancer survivors have adjusted for confounders such as age, education level, BMI, insurance status, and marital status or examined the effects of treatment and remission effects.
The African American women in this study reported substantially poorer physical and mental health compared with the general population. That these substantial health disparities have been corroborated previously is unsurprising (4,14,15). The more salient findings of this study were comparisons within subgroups of African American women. Breast cancer survivors and women with no history of cancer reported better physical and mental health, as determined by global HRQOL summary measures, compared with survivors of other cancers (12,14). For the physical health domain, survivors of other cancers reported poor physical health, difficulty carrying out physical activities, fatigue, and pain. For the mental health domain, survivors of other cancers reported poor mental health and satisfaction with social activities and relationships. In the one study that made comparisons similar to ours (13), results were similar except that Von Ah et al found significantly poorer outcomes for African American female breast cancer survivors than for African American women with no history of cancer for fatigue and satisfaction with social activities. The differences could be because the groups in the Von Ah et al study were drawn from convenience samples and were not nationally representative or because Von Ah et al selected African American female breast cancer survivors who were 2 to 20 years postdiagnosis. Overall, our results suggest resilience among breast cancer survivors in terms of physical and mental health compared with survivors of other cancers. In general, we found that, after adjustment for socio-demographic factors, African American female breast cancer survivors were functioning, both physically and mentally, as well as or better than African American female survivors of other cancers and African American women with no history of cancer. For individual mental and physical health items, this was not always the case.
Our study was also the first to make comparisons between the 2 cancer groups by cancer status, treatment effects, and remission effects. Interestingly, we found large physical health differences between breast cancer survivors and survivors of other cancers and between those who were currently being treated and those who were not. The group differences in mental health were smaller than the physical health differences for both cancer status and treatment. Conversely, the effect of being cancer free was similar across the physical and mental health domains. All of these differences highlight what might be considered low-hanging fruit for improving the physical and mental health for cancer survivors. These findings suggest that the potential to improve the physical and mental health of African American female cancer survivors is substantial during the first year following the diagnosis and treatment of cancer, in particular for survivors of other cancers.
There are strengths and limitations to our study. First, the NHIS data are self-reported, so reporting and recall bias may have occurred for the cancer outcomes, treatment variables, and HRQOL outcomes. Because of small sample size, we could not adjust for comorbidities; however, previous studies indicate that comorbidities have an effect on the HRQOL in African American female breast cancer survivors and African American survivors of other cancers (16). Another limitation is the use of binary outcomes for the item-level analyses. This use may have reduced the statistical power of the analyses and led to the nonsignificant findings for the comparisons between African American female breast cancer survivors and African American women with no history of cancer in this study. This is the only study we are aware of that used a nationally representative sample that provided comparisons on HRQOL indices between African American female breast cancer survivors, African American female survivors of other cancers, and African American women with no history of cancer. We also adjusted for known confounders: age, marital status, insurance status, BMI, education level, and treatment effects. Although NHIS data are weighted to be representative of the US population, the cancer subgroups used in this study may not be nationally representative.
Our findings highlight the need for public health agencies to adopt practices to improve the mental and physical health of all African American female survivors of cancer and provide evidence for where the most substantial differences occur among African American women. In particular, future research should investigate potential interventions for improving HRQOL among African American female survivors of cancers other than breast cancer. Mindfulness-based stress reduction, behavioral techniques, and exercise interventions are practices that, if implemented, may increase HRQOL related to mental and physical health (17–20). The survival rate of women with breast cancer increases when the disease is diagnosed and treated early. As advancements in technologies and research improve early detection and treatment, the number of breast cancer survivors will continue to increase. Therefore, it is necessary to consider factors that affect HRQOL among breast cancer survivors and develop strategies that will improve their HRQOL.
Acknowledgments
The National Cancer Institute (U54CA118638) and (RO1CA166785) and the National Institute on Minority Health and Health Disparities (P20MD006881) funded this study. The authors have no financial conflicts of interest to report. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Author Information
Corresponding Author: Mechelle D. Claridy, MPH, Department of Community Health and Preventive Medicine, and Cancer Research Program, Morehouse School of Medicine, 720 Westview Dr, SW, NCPC 229, Atlanta, GA 30310-1495. Telephone: 404-756-6704. Email: mclaridy@msm.edu.
Author Affiliations: William W. Thompson, National Centers on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; Benjamin Ansa, Selina A. Smith, Institute of Public and Preventive Health, Augusta University, Augusta, Georgia; Francesca Damus, Cancer Research Program, Morehouse School of Medicine, Atlanta, Georgia; Ernest Alema-Mensah, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, and Cancer Research Program, Morehouse School of Medicine, Atlanta, Georgia.
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Tables
Table 1. Descriptive Statistics for African American Women Aged 35 or Older, by Cancer Status, National Health Interview Survey, 2010
| Demographic Characteristic | Breast Cancer Survivors (n = 62) | Other Cancer Survivors (n = 74) | No History of Cancer (n = 1,566) | P Value |
|---|---|---|---|---|
| No. (Weighted %) | ||||
| Age, y | ||||
| 35–54 | 15 (24.2) | 22 (29.7) | 855 (54.6) | <.001 |
| =55 | 47 (75.8) | 52 (70.3) | 711 (45.4) | |
| Marital status | ||||
| Married | 15 (24.2) | 11 (14.9) | 444 (28.4) | <.001 |
| Not married | 47 (75.8) | 63 (85.1) | 1,122 (71.7) | |
| Education | ||||
| Less than a high school diploma | 17 (28.3) | 14 (19.4) | 348 (22.3) | <.001 |
| High school graduate or more | 43 (71.7) | 58 (80.6) | 1,212 (77.7) | |
| Private insurance | ||||
| Yes | 31 (50.0) | 23 (31.1) | 755 (48.3) | <.001 |
| No | 31 (50.0) | 51 (68.9) | 808 (51.7) | |
| Body mass index (kg/m2) | ||||
| Underweight (<18.5) | 1 (1.7) | 1 (1.4) | 22 (1.5) | <.001 |
| Normal (18.5–24.9) | 8 (13.6) | 17 (23.3) | 332 (22.0) | |
| Overweight (25.0–29.9) | 23 (39.0) | 22 (30.1) | 464 (30.7) | |
| Obese (=30.0) | 27 (45.8) | 33 (45.2) | 692 (45.8) | |
Table 2. Descriptive Statistics for PROMIS Physical and Mental Health Items, by Cancer Status, National Health Interview Survey, 2010
| Domain/Characteristic | Breast Cancer Survivors (n = 62) | Other Cancer Survivors (n = 74) | No History of Cancer (n = 1,566) |
|---|---|---|---|
| No. (Weighted %) | |||
| Physical | |||
| Physical health | |||
| Excellent to good | 44 (78.4) | 44 (60.2) | 1,162 (75.3) |
| Fair to poor | 18 (21.6) | 30 (39.3) | 404 (24.7) |
| Carry out physical activity | |||
| Completely to moderately | 50 (84.1) | 49 (64.2) | 1,347 (86.9) |
| A little to not at all | 12 (15.9) | 25 (35.8) | 219 (13.1) |
| Fatigue during the past 7 days | |||
| None to mild | 41 (68.5) | 37 (52.3) | 1,082 (67.3) |
| Moderately to very severe | 21 (31.5) | 37 (47.7) | 484 (32.8) |
| Pain (no. of days during the past 7 days) | |||
| 0–5 | 16 (75.3) | 30 (59.4) | 377 (75.9) |
| 6–10 | 46 (24.8) | 44 (40.6) | 1,189 (24.2) |
| Mental | |||
| Quality of life | |||
| Excellent to good | 50 (86.4) | 57 (82.4) | 1,325 (84.9) |
| Fair to poor | 12 (13.6) | 17 (17.6) | 241 (15.1) |
| Mental health | |||
| Excellent to good | 55 (92.9) | 57 (79.4) | 1,339 (86.2) |
| Fair to poor | 7 (7.1) | 17 (20.6) | 227 (13.8) |
| Satisfaction with social activities and relationships | |||
| Excellent to good | 51 (82.7) | 52 (73.0) | 1,327 (84.7) |
| Fair to poor | 11 (17.3) | 22 (27.0) | 239 (15.3) |
| Bothered with emotional problems | |||
| Never to rarely | 46 (73.3) | 42 (61.2) | 1,113 (70.5) |
| Sometimes to always | 16 (26.7) | 32 (38.8) | 453 (29.5) |
Abbreviation: PROMIS, Patient Reported Outcomes Measurement Information System.
Table 3. Weighted Multivariate Logistic Regression Models Using Cancer Group Membership to Predict PROMIS Physical and Mental Health Itemsa
| Domain/Dependent Variable | Breast Cancer Survivors | Other Cancer Survivors | ||
|---|---|---|---|---|
| AOR (95% CI) | P Value | AOR (95% CI) | P Value | |
| Physical | ||||
| Physical health | 1.21 (0.62–2.36) | .57 | 2.17 (1.25–3.76) | .006 |
| Carry out physical activity | 0.81 (0.42–1.56) | .53 | 2.37 (1.29–4.36) | .005 |
| Fatigue during the past 7 days | 0.99 (0.50–1.98) | .99 | 2.00 (1.08–3.71) | .03 |
| Pain during the past 7 days | 1.04 (0.59–1.83) | .90 | 2.74 (1.65–4.56) | <.001 |
| Mental | ||||
| Quality of life | 0.89 (0.46–1.73) | .73 | 1.42 (0.80–2.53) | .23 |
| Mental health | 0.92 (0.47–1.78) | .80 | 1.93 (1.07–3.47) | .03 |
| Satisfaction with social activities and relationships | 0.85 (0.45–1.60) | .61 | 1.94 (1.11–3.40) | .02 |
| Bothered with emotional problems | 0.99 (0.47–2.13) | .99 | 1.62 (0.88–3.00) | .12 |
Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; PROMIS, Patient Reported Outcomes Measurement Information System.
a Adjusted for age, marital status, education, and private insurance; never cancer group was the reference group.
Table 4. Weighted Multivariate Linear Regression Models for PROMIS Physical and Mental Health T-Scores, National Health Interview Survey, 2010a,b
| Outcome/Predictors | Model 1: Physical Health | Model 2: Mental Health | ||||
|---|---|---|---|---|---|---|
| ß | SE | P | ß | SE | P | |
| Cancer status | ||||||
| BCS | 3.81 | 0.14 | <.001 | 1.11 | 0.14 | <.001 |
| OCS | 1 [Reference] | |||||
| Private insurance | ||||||
| Yes | 4.11 | 0.14 | <.001 | 4.69 | 0.14 | <.001 |
| No | 1 [Reference] | |||||
| Current treatment | ||||||
| Yes | -5.38 | 0.01 | <.001 | -1.39 | 0.01 | <.001 |
| No | 1 [Reference] | |||||
| Cancer free | ||||||
| Yes | 2.14 | 0.17 | <.001 | 2.45 | 0.16 | <.001 |
| No | 1 [Reference] | |||||
Abbreviations: BCS, breast cancer survivor; NA, not applicable; OCS, other cancer survivor; PROMIS, Patient Reported Outcomes Measurement Information System; SE, standard error.
a Adjusted for age, marital status, and education level, treatment effects, cancer-free status, and insurance status.
b For Model 1, the ß value (SE) for breast cancer survivors was 5.05 (1.95) at P < .05. For Model 2, the ß value (SE) for breast cancer survivors was 3.30 (1.62) at P < .05.
Appendix A: Types of Cancers Other Than Breast Cancer, African American Women Aged 35 or Older, National Health Interview Survey, 2010
| Cancer Type | Frequencya |
|---|---|
| Cervix | 15 |
| Uterus | 11 |
| Colon | 10 |
| Ovary | 8 |
| Lung | 6 |
| Thyroid | 4 |
| Leukemia | 3 |
| Other | 3 |
| Bladder | 2 |
| Blood | 2 |
| Esophagus | 2 |
| Lymphoma | 2 |
| Stomach | 2 |
| Bone | 1 |
| Brain | 1 |
| Liver | 1 |
| Melanoma | 1 |
| Skin (don’t know) | 1 |
| Skin (nonmelanoma) | 1 |
| Throat/pharynx | 1 |
a Among the 71 subjects that provided responses to the types of other cancers they had, 6 individuals reported 2 different cancers.
Appendix B: PROMIS Physical and Mental Health Items, National Health Interview Survey, 2010
| PROMIS Item | Response Categories | Item Subdomain |
|---|---|---|
| Physical Health Domain | ||
| In general, how would you rate your physical health? | Excellent (5) – Poor (1) | Physical health |
| Does your health now limit you in doing vigorous activities such as running, lifting heavy objects, participating in strenuous sports? | Not at all (5) – Can’t do (1) | Physical functioning |
| In the past 7 days, how much did pain interfere with your day-to-day activities? | Very much (5) – Not at all (1) | Pain |
| In the past 7 days, how often did you feel tired? | Very much (5) – Not at all (1) | Fatigue |
| Mental Health Domain | ||
| In general, how would you say your quality of life is? | Excellent (5) – Poor (1) | Quality of life |
| In general, how would you rate your mental health, including your mood and your ability to think? | Excellent (5) – Poor (1) | Mental health |
| In general, how would you rate satisfaction with your social activities and relationship? | Excellent (5) – Poor (1) | Social discretionary |
| In the past 7 days, how often have you been bothered by emotional problems such as feeling anxious, depressed or irritable? | Always (5) – Never (1) | Emotional problems |
Abbreviation: PROMIS, Patient Reported Outcomes Measurement Information System.
Appendix C: Multivariate Adjusted Regression for PROMIS T-Scoresa, National Health Interview Survey, 2010
| PROMIS Global Health Domain | T-Score | Standard Error | 95% Confidence Interval |
|---|---|---|---|
| Physical | |||
| Breast cancer | −0.18 | 1.22 | −2.57 to 2.22 |
| Other cancer | −5.40 | 1.54 | −8.43 to −2.38 |
| No cancer | 1 [Reference] | ||
| Mental | |||
| Breast cancer | −0.55 | 0.94 | −2.40 to 1.30 |
| Other cancer | −3.10 | 1.30 | −5.65 to −0.54 |
| No cancer | 1 [Reference] | ||
Abbreviation: PROMIS, Patient Reported Outcomes Measurement Information System.
a Adjusted for age, marital status, and education level.
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