Quality-of-Life Indicators for African American and European American Long-term Survivors of Early-stage Breast Cancer

Quality-of-Life Indicators for African American and European American Long-term Survivors of Early-stage Breast Cancer by Cher de Rossiter Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Psychology Walden University December 2014 Abstract This meta-analysis investigated the difference in perceptions of health-related quality of life (HRQOL) among long-term early-stage breast cancer survivors (BCS). The comparison was between African American and European American women. Initial pilot searches suggested that enough studies existed for a meaningful meta-analysis of a BCS population at least 5 years post diagnosis. Only studies using the outcome measureThis meta-analysis investigated the difference in perceptions of health-related quality of life (HRQOL) among long-term early-stage breast cancer survivors (BCS). The comparison was between African American and European American women. Initial pilot searches suggested that enough studies existed for a meaningful meta-analysis of a BCS population at least 5 years post diagnosis. Only studies using the outcome measure HRQOL were included in the study; this yielded an initial sample of 212 study reports, with 56 reports entering the coding phase of the process. African American women were grossly underrepresented in this set of studies in comparison to the overall breast cancer population. Separate analyses of Medical Outcomes Study 36Item ShortForm Health Survey, Quality of Life-Cancer Survivor and Quality of Life Index – Cancer Version III instruments were executed. However, no stringent comparison across instruments of the difference between the HRQOL of African American and European American women was possible. When African American women were included in the populations, researchers often did not report their data separately but rather included their data in an overall population and thus differences were masked. The data that were available, including qualitative studies for African American women, suggested that there was a lower perception of the quality of survival in some areas for African American women. These differences suggest the need for greater attention to the physical components of African American BCS. The results point to a need to improve African American participant recruitment in research and to use online databases as a results repository to improve data availability for analysis. Quality-of-Life Indicators for African American and European American Long-term Survivors of Early-stage Breast Cancer by Cher de Rossiter Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Psychology Walden University December 2014 Dedication For the sisters who walk the long road of living with breast cancer. For the men who support them, as the men in my life did in doing this work, John, Geoffrey, and Bruce, providing motivation, inspiration, and love. For the women who hold them up, as the sisters of my heart did for me, Pat, Marti, Susie, Judy and Jess giving love and refuge in adversity, perspective, wisdom and sometimes a good swift kick in the pants. Acknowledgments Without Dr. Ragsdale I would not have had the courage to attempt a metaanalysis or to continue to keep on until it was done, without Dr. Hendricks Noble I think I would have quit in the first year, and without Dr. Milo, I wouldn’t have even got to a dissertation. Many, many thanks. Dr. Borenstein was kind enough to email clarifications on his book when I was confused and desperately trying to learn how to do a meta-analysis. His kindness helped me find my way through and I am truly grateful.