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Patterns of racial/ethnic disparities in baseline health-related quality of life and relationship with overall survival in patients with colorectal cancer

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Abstract

Purpose

Racial disparities are evident in colorectal cancer (CRC) prognosis with black patients experiencing worse outcomes than Hispanics and whites, yet mediators of these disparities are not fully known. The aim of this study is to identify variables that contribute to racial/ethnic disparities in health-related quality of life (HR-QoL) and overall survival in CRC.

Methods

Using SF-12 questionnaires, we assessed HR-QoL in 1132 CRC patients by calculating their physical (PCS) and mental composite summary (MCS) scores. Associations between poor PCS/MCS and sociodemographic factors were estimated and survival differences were identified by race/ethnicity.

Results

Hispanic patients who never married were at greater risk of poor PCS (OR 2.69; 95% CI 1.11–6.49; P = 0.028) than were currently married patients. College education was associated with a decreased risk of poor PCS in Hispanic and white, but not black, patients. Gender was significantly associated with poor MCS among white patients only. CRC patients who reported a poor PCS or MCS had poor survival, with differences in median survival times (MSTs) by race. The effect of PCS was strongest in white CRC patients with a difference in overall MST of > 116 months between those with favorable versus poor physical HR-QoL. Black patients who reported poor Physical and Mental HR-QoL showed significant risk of a poor outcome.

Conclusion

These findings suggest that racial/ethnic disparities in CRC survival may be related to differences in HR-QoL. Identified mediators of HR-QoL could supplement current CRC management strategies to improve patients’ survival.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Funding

Funding support for this study was provided in part by the Center for Translational and Public Health Genomics of MD Anderson and the NIH through MD Anderson's Cancer Center Support Grant CA016672.

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Author notes

  1. Alem A. Belachew and Monica E. Reyes contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Alem A. Belachew, Monica E. Reyes, Yuanqing Ye, Xifeng Wu & Michelle A. T. Hildebrandt

  2. Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Gottumukkala S. Raju

  3. Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    M. Alma Rodriguez

  4. Office of Cancer Survivorship, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    M. Alma Rodriguez

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  1. Alem A. Belachew
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Correspondence to Michelle A. T. Hildebrandt.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Cite this article

Belachew, A.A., Reyes, M.E., Ye, Y. et al. Patterns of racial/ethnic disparities in baseline health-related quality of life and relationship with overall survival in patients with colorectal cancer. Qual Life Res 29, 2977–2986 (2020). https://doi.org/10.1007/s11136-020-02565-8

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  • DOI: https://doi.org/10.1007/s11136-020-02565-8

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