Abstract A068: Association of perceived discrimination on patient-physician communication and quality of life among breast cancer survivors
Authors: Yang Freddie , Graetz Ilana , Anderson Janeane , Hu Xin 
Published: September 2024

Background: Discrimination adversely affects mental and physical health. Using mediation analysis, we explore whether patient-provider communication mediates the relationship between perceived discrimination and health-related quality of life among early-stage breast cancer survivors. Methods: We analyzed surveys from 303 early-stage breast cancer survivors. Discrimination was measured with the Experiences of Everyday Discrimination Scale which assesses the frequency of perceived discrimination (range: 1/almost every day – 6/never). Patient-provider communication was captured with the Patient and Physician Peer Assessment (range: 1/poor-5/excellent). Mental and physical quality of life was captured with the SF-12 health survey (range: 1/poor - 100/excellent). We used descriptive analysis to identify factors associated with perceived discrimination and adjusted regression to examine the association of perceived discrimination on patient-provider communication and quality of life scores. We also performed a mediation analysis to determine the extent to which patient-provider communication mediates the relationship between perceived discrimination and mental and physical health scores. Results: Overall, 58% of participants reported facing some form of discrimination. When they were asked to identify the primary source of discrimination that they encountered, gender and race emerged as the two most common. Stratified by race, White respondents reported feeling most discriminated against due to their gender, followed by education/income, weight, race, and physical appearance. Conversely, Black patients predominantly identified race as the primary reason for discrimination, with physical appearance, gender, weight, national origin, and education/income following in descending order of frequency. Less frequent perceived discrimination was associated with a 2.77 (95%CI: 0.88 to 4.65, p = 0.004) higher average mental health score and 2.18 (95%CI: 0.33 to 4.04, p = 0.02) physical health score, and 0.18 (95%CI: 0.06 to 0.31, p = 0.003) higher patient-provider communication score. In both unadjusted and adjusted mediation analyses, we observed a very small and statistically insignificant “indirect effect”, indicating there is no evidence for the existence of mediation effect. Conclusion: Perceived discrimination among breast cancer survivors was associated with poorer patient-provider communication and lower mental and physical health scores. However, patient-provider communication does not serve as a mediator for the adverse impact of discrimination on self-reported mental and physical health. This suggests that mitigating the effects of discrimination requires collective efforts of all stakeholders within the healthcare system, rather than solely relying on healthcare providers.

Citation Format: Freddie Yang, Ilana Graetz, Janeane Anderson, Xin Hu. Association of perceived discrimination on patient-physician communication and quality of life among breast cancer survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A068.