Abstract B119: Discrimination in the medical setting is negatively associated with health-related quality of life for cancer survivors: Findings from an All of Us cross-sectional study
Authors: Arizpe Angel , Ochoa-Dominguez Carol Y. , Queen Katelyn , Farias Albert J. 
Published: December 2023

Abstract
Purpose: We assessed the association between discrimination (medical setting and perceived) and health-related quality of life (HRQoL) and explored whether perceived racial discrimination modifies these associations in a sample of cancer survivors. Methods: We analyzed responses from cancer survivors collected from May 2018 to July 2022 from the “All of Us” program. Discrimination in the medical setting (DMS) was measured using the 7-item scale, and perceived discrimination (PD) was assessed using the Everyday Discrimination 9-item scale. Scaled with increments of 5 units, continuous scores were created from both DMS(range: 0-5.6) and PD(0-9) measures where higher scores represented greater DMS/PD experiences. HRQoL, dependent variables, was assessed using the PROMIS-10 Global Health survey, where the sub-scale measured physical health (PH) and mental health (MH). Binary indicators were created for low PH (&lt;42) and low MH (&lt;40) using PROMIS’s t-values. Multivariable adjusted (age, sex, ethnicity/race, nativity, SES barriers, racial discrimination type, and treatment status) logistic models tested the associations between 1) PD and HRQoL, 2) DMS and HRQoL, and 3) explored whether perceived racial discrimination modified these relationships. Results: The median age in our sample (n=8892) was 67 years (IQR=19.9) and had median DMS and PD scores of 1(SD: 1.6) and 0.6(1), respectively. The sample was predominately White race (90.5%) and female (64%). Survivors who reported low PH (n=888) had a median score of 1(1.4) for DMS and 1.6(2) for PD. Among those with low MH (n=786), the median score for DMS was 1(1.4), and for PD was 1.8(2). Multivariable-adjusted models showed that for every 5-unit increase in the DMS score, there was an 85%(OR=1.85, 95%CI:1.66-2.08) and 66%(1.66, 1.48-1.86) increase in the likelihood for low PH and MH, respectively. Similarly, every 5-unit increase in PD was associated with a 30%(1.30, 1.21-1.40) and 28%(1.28, 1.19-1.38) increase likelihood of low PH and MH, respectively. We found significant interaction terms, indicating that discrimination due to race modified the relationship between DMS and MH, and PD and MH (pinteractionDMS=0.02, pinteractionsPD&lt;0.01). For every 5-unit increase in DMS and PD, among those who reported discrimination due to race, DMS and PD were associated with a 33%(1.33, 1.03-1.77) and 8%(1.08, 0.93-1.13) increase in odds of low MH, respectively. However, only statistical significance was reached for DMS (p&lt;0.001). Conclusion: Our study highlights that DMS has a negative impact on the MH of cancer survivors, especially for those indicating discrimination due to race. To improve survivors' HRQoL, healthcare systems, and policymakers need to address DMS by promoting inclusivity and equity at the societal and healthcare levels.
Citation Format: Angel Arizpe, Carol Y. Ochoa-Dominguez, Katelyn Queen, Albert J. Farias. Discrimination in the medical setting is negatively associated with health-related quality of life for cancer survivors: Findings from an All of Us cross-sectional study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B119.