Presence of Cumulative Physiological Stress Prior to Diagnosis Linked to Poor Health-Related Quality of Life in African American and Black Breast Cancer Survivors

New Brunswick, N.J. October 5, 2020 – Although breast cancer does not discriminate between race or gender, research suggests that there is increased breast cancer mortality and poorer health-related quality of life in female African American and Black survivors of the disease. Investigators at Rutgers University recently conducted a study to determine the association of pre-diagnostic allostatic load, which is a composite measure of cumulative physiological stress and wear and tear on the body, with health-related quality of life in this population. Senior and corresponding author Adana A.M. Llanos, PhD, MPH of Rutgers Cancer Institute of New Jersey and Rutgers School of Public Health along with author Elisa V. Bandera, MD, PhD of Rutgers Cancer Institute, Rutgers School of Public Health  and Robert Wood Johnson Medical School share more about the findings published in Breast Cancer Research and Treatment (doi: 10.1007/s10549-020-05901-1).

Why is this topic important to explore?

African American and Black women are known to experience higher psychosocial stress than other groups, which has a negative impact on various health outcomes. They also experience poorer quality of life and increased risk of death following a breast cancer diagnosis. Cumulative stress, which we can measure using allostatic load scores, has been studied extensively in the context of cardiovascular disease and in recent years has also been shown to be associated with cancer. Given all of this, we hypothesized that higher allostatic load before a diagnosis of breast cancer might be associated with poorer quality of life after a diagnosis of breast cancer among African American and Black women.

Can you describe the work and tell us what the team discovered?

In the Women’s Circle of Health Follow-Up Study (WCHFS), which is a longitudinal study of African American and Black survivors of breast cancer, we computed allostatic load scores using medical record data from up to 12 months before breast cancer diagnosis. Examples of the clinical data included in the computation of allostatic load scores are: systolic and diastolic blood pressure, glucose levels, albumin levels, body mass index, and use of medications to control hypertension, diabetes, or hypercholesterolemia. We assessed quality of life measures using a validated questionnaire (Functional Assessment of Cancer Therapy-Breast Cancer [FACT-B]), which was completed by WCHFS participants at 24 months post breast cancer diagnosis. Using these data, we assessed whether there were significant associations between pre-diagnostic allostatic load scores and measures of quality of life among 409 WCHFS participants. We found that higher allostatic load scores were significantly associated with poorer functional well-being and lower general quality of life (based on symptoms and concerns in relation to breast cancer treatment).

What are the implications of these findings?

The results of this study suggest that poorer quality of life is one of the potential consequences of higher cumulative physiologic stress before breast cancer diagnosis among Black women. These novel findings might be useful for identifying women who could be at greater risk for impaired quality of life and who might benefit from tailored survivorship care. These findings might also inform the development and implementation of targeted preventive strategies to improve allosteric load and health-related quality of life among Black breast cancer survivors in the near future.

This work was supported in part by grants from the National Cancer Institute (P01CA151135, P30CA072720, R01CA100598, R01CA185623, K01CA193527, and K07CA222158). Additional award information can be found here.