Abstract PR17: The mediating role of unmet social support needs on the racial/ethnic disparity in psychosocial stress among breast cancer patients
Authors: Sánchez Díaz Carola T. , Rauscher Garth H. , Molina Yamile 
Published: August 2020

Background: A breast cancer diagnosis is a stressful life event that can reduce quality of life and put a patient at increased risk for additional health problems and may also affect survivorship more generally. Greater levels of psychosocial stress (PSS) have been reported among non-Latina (nL) Black and Latina women when compared to nL White patients, and the absence of adequate social support among cancer patients has been associated with greater psychosocial stress. The goal of these analyses was to examine whether there existed a racial/ethnic disparity in three validated measures of psychosocial stress and how racial disparities are explained by distal mechanisms (i.e., SES) and proximal mechanisms (i.e., unmet social support needs) among recently diagnosed urban breast cancer patients in the Breast Cancer Care in Chicago (BCCC) study (2005-2008).

Methods: The BCCC was a cross-sectional study of 989 recently diagnosed breast cancer patients, including 397 non-Latina White (white), 411 non-Latina Black (black), and 181 Latina patients diagnosed with a first primary breast cancer (in situ or invasive) aged 30-79. Income, education and tract level disadvantage and affluence were summed to create a standardized socioeconomic status (SES) score. Low SES was defined as less than one standard deviation below the sample mean. Three measures of PSS were defined based on the Cohen perceived stress subscale (inter-item reliability or alpha = 0.74), UCLA felt loneliness scale (alpha=0.79), and the Cockburn psychological consequences scale (alpha=0.93). High PSS was defined as &gt;1 standard deviation above the mean for each. Unmet emotional, spiritual, informational, financial, and practical support were based on questions regarding support needed and received. We conducted structural equations models in M-Plus in order to disentangle the separate mediating roles of SES and unmet social support needs on disparities in PSS.

Results: Black and Latina patients reported greater levels of loneliness (32% vs. 23% vs. 16%, p&lt;0.001), stress (23% and 21% vs. 12%, p=0.001) and psychological consequences (24% and 23% vs. 12%, p&lt;0.001) compared to white patients. Black and Latina patients also reported greater levels of unmet emotional, informational, financial and practical need (p=0.001 for all). In mediation models, all of the disparity in the three PSS outcomes could be explained by SES, with a substantial portion of the mediating influence of SES being further transmitted by unmet financial and practical support needs. Neither tumor nor treatment characteristics appeared to mediate the disparity in PSS.

Conclusions: A substantial disparity in distress among breast cancer patients exists and underlying inequities in SES appear to be a “root” cause of the PSS disparity, as opposed to being driven by tumor and treatment differences. Results suggest that providing equitable financial (e.g., health insurance coverage) and practical (e.g., navigation) resources could narrow the racial/ethnic gap in PSS.

This abstract is also being presented as Poster C094.

Citation Format: Carola T. Sánchez Díaz, Garth H. Rauscher, Yamile Molina. The mediating role of unmet social support needs on the racial/ethnic disparity in psychosocial stress among breast cancer patients [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR17.