Dataset Information

Socioeconomic disparities in psychosocial service recommendation and receipt among young Black breast cancer survivors.

ABSTRACT:

Purpose

Black cancer survivors are less likely to receive desired psychological services than non-Hispanic White survivors. Black cancer survivors with low socioeconomic status may face additional barriers to receipt of psychological services. This study examined socioeconomic disparities in psychological service recommendation, attempts to access, and receipt among Black breast cancer (BC) survivors.

Methods

Black BC survivors (n = 249) completed surveys at baseline (T1) and follow-up (T2; M 1.6 years post-T1). At T1, participants reported socioeconomic characteristics (employment, income, insurance, and education) and psychological symptoms (hospital anxiety and depression scale [HADS]). Self-reported address was used to identify area deprivation index (ADI), a composite measure of neighborhood socioeconomic disadvantage (least disadvantaged = 1; most disadvantaged = 10). At T2, participants reported provider recommendations for, attempts to access, and receipt of psychological services. Logistic regressions examined relationships between socioeconomic characteristics and psychological service variables, controlling for baseline psychological symptoms.

Results

In multivariable analyses, being employed was associated with a lower likelihood of attempts to access (OR = 0.25) and receipt of (OR = 0.37) psychological services, above and beyond the effect of psychological symptoms. Univariate analyses demonstrated that participants from more disadvantaged areas (i.e., higher ADI) were more likely to receive psychological services (OR = 1.20), but this effect became non-significant in multivariable analyses.

Conclusion

Results highlight the importance of an intersectional perspective in considering mental health care disparities; both race/ethnicity and socioeconomic status should be incorporated when considering barriers and facilitators of psychological care.

SUBMITTER: Conley CC

PROVIDER: S-EPMC9149038 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ImportanceYoung women with breast cancer are increasingly choosing bilateral mastectomy (BM), yet little is known about short-term and long-term physical and psychosocial well-being following surgery in this population.ObjectiveTo evaluate the differential associations of surgery with quality of life (QOL) and psychosocial outcomes from 1 to 5 years following diagnosis.Design, setting, and participantsCohort study.SettingMulticenter, including academic and community hospitals in North America.ParticipantsWomen age ≤40 when diagnosed with Stage 0-3 with unilateral breast cancer between 2006 and 2016 who had surgery and completed QOL and psychosocial assessments.Exposures (for observational studies)Primary breast surgery including breast-conserving surgery (BCS), unilateral mastectomy (UM), and BM.Main outcomes and measuresPhysical functioning, body image, sexual health, anxiety and depressive symptoms were assessed in follow-up.ResultsOf 826 women, mean age at diagnosis was 36.1 years; most women were White non-Hispanic (86.7%). Regarding surgery, 45% had BM, 31% BCS, and 24% UM. Of women who had BM/UM, 84% had reconstruction. While physical functioning, sexuality, and body image improved over time, sexuality and body image were consistently worse (higher adjusted mean scores) among women who had BM vs BCS (body image: year 1, 1.32 vs 0.64; P < .001; year 5, 1.19 vs 0.48; P < .001; sexuality: year 1, 1.66 vs 1.20, P < .001; year 5, 1.43 vs 0.96; P < .001) or UM (body image: year 1, 1.32 vs 1.15; P = .06; year 5, 1.19 vs 0.96; P = .02; sexuality: year 1, 1.66 vs 1.41; P = .02; year 5, 1.43 vs 1.09; P = .002). Anxiety improved across groups, but adjusted mean scores remained higher among women who had BM vs BCS/UM at 1 year (BM, 7.75 vs BCS, 6.94; P = .005; BM, 7.75 vs UM, 6.58; P = .005), 2 years (BM, 7.47 vs BCS, 6.18; P < .001; BM, 7.47 vs UM, 6.07; P < .001) and 5 years (BM, 6.67 vs BCS, 5.91; P = .05; BM, 6.67 vs UM, 5.79; P = .05). There were minimal between-group differences in depression levels in follow-up.Conclusions and relevanceWhile QOL improves over time, young breast cancer survivors who undergo more extensive surgery have worse body image, sexual health, and anxiety compared with women undergoing less extensive surgery. Ensuring young women are aware of the short-term and long-term effects of surgery and receive support when making surgical decisions is warranted.