Racial Disparities in Emotional Distress Among Cancer Survivors: Insights from the Health Information National Trends Survey (HINTS)

Abstract

The purpose of this study was to examine the impact of race, cancer history, and their interaction on emotional distress among a nationally representative sample of US adults. Data utilized for this analysis were obtained from the first, second, and fourth iterations of the fourth cycle of the Health Information National Trends Survey (HINTS). The study sample included 3959, 3630, and 3677 respondents for the years 2011, 2012, and 2014, respectively, for a total sample size of 11,266. A multivariable ordered logistic regression model was used to assess the relationship between emotional distress, race, and cancer history. The effect of cancer history on emotional distress was found to be moderated by race. Specifically, emotional distress was significantly higher among African American cancer survivors. Factors found to be protective against emotional distress included healthy lifestyle, older age, and higher income. Factors associated with high levels of emotional distress included poor general health status, low self-efficacy, and being female. The authors recommend the design, advancement, and implementation of evidence-based culturally sensitive interventions aimed at effectively screening and managing psychological distress symptoms, particularly among African American long-term cancer survivor patient populations.

Prevalence and predictors of depression, pain, and fatigue in older‐ versus younger‐adult cancer survivors

“…These variables were chosen "a priori" on the basis of the literature demonstrating a relationship between these variables and depressive symptoms. [29][30][31][32][33][34] Case-wise deletion was used for missing values.…”

“…Predictor variables included age, gender, race, ethnicity, cancer type, and marital/living status. These variables were chosen “a priori” on the basis of the literature demonstrating a relationship between these variables and depressive symptoms . Case‐wise deletion was used for missing values.…”

Distress among African American and White adults with cancer in Louisiana

“…10,[27][28][29][30] However, many of these studies were restricted to only one specific cancer site and thus did not include a diverse sample of diagnoses, 22,24,25,27,29,31 or focused only on long-term survivors who were no longer receiving cancer treatment. 21,27 Additionally, only 5-25% of participants in these studies were African American, so inconsistent findings may have been attributed to sampling bias or a lack of power. Moreover, studies that included disproportionately low numbers of African American patients are less generalizable to individuals in Louisiana, which includes a larger proportion of African American patients compared to most other states.…”

“…However, existing research of racial disparities in cancer-related distress is limited to studies that were conducted outside of Louisiana, and methodological issues in these studies impede the ability to identify clear patterns in findings. Some studies have found that African Americans were more likely than White patients to experience distress, [20][21][22][23] whereas others found that African Americans were less likely to have distress, [24][25][26][27] or that there was no significant association between race and distress. 10,[27][28][29][30] However, many of these studies were restricted to only one specific cancer site and thus did not include a diverse sample of diagnoses, 22,24,25,27,29,31 or focused only on long-term survivors who were no longer receiving cancer treatment.…”

Anxiety and Depression in Cancer Survivors

“…The Health Information National Trends Survey (HINTS) study has found that African American survivors report higher levels of distress compared to other survivors and non-cancer controls. 55 Gay and bisexual prostate cancer survivors also report more distress than heterosexual prostate cancer survivors. 56 Married prostate cancer survivors with lower levels of partner support and unmarried survivors reported more distress than married survivors with high levels of partner support.…”