title: Prognostic significance of psychosocial factors in African-American and white breast cancer patients: a population-based study.
abstract: BACKGROUND
  It has been suggested that psychosocial factors, such as coping and emotional support, influence cancer survival, but results have been inconclusive. Given the scarce data from racially/ethnically diverse populations, the authors investigated the prognostic significance of selected psychosocial variables in a cohort of African-American women and white women with breast cancer.
  
  
  METHODS
  The authors examined the effects of coping styles, perceived emotional support, fatalism, and health locus of control on survival for a population-based cohort of 145 African-American women and 177 white women who were diagnosed with breast cancer in Connecticut between January 1987 and March 1989 and were followed for survival for approximately 10 years. Cox proportional hazards models were adjusted for sociodemographic factors, biomedical factors (American Joint Committee on Cancer stage at diagnosis, histologic grade, comorbidity, obesity, menopausal status, and treatment), and lifestyle factors.
  
  
  RESULTS
  Fully adjusted models showed that lower perceived emotional support (disagreeing with the statement, "cancer is a topic I can talk about freely with my friends/relatives") at diagnosis was associated with a higher risk of death from any cause (hazard ratio, 1.39; 95% confidence interval, 1.09-1.79). Adjustment for additional tumor characteristics (nuclear grade, estrogen and progesterone receptor status) and genetic alterations (p53, HER-2) did not alter the findings. No other psychosocial factors significantly predicted survival in patients with breast cancer.
  
  
  CONCLUSIONS
  Higher levels of perceived emotional support showed a moderate but significant association with increased survival in African-American and white women with breast cancer who were followed for 10 years after diagnosis when adjusting for known prognostic factors. Survival was not related to coping styles, fatalism, or health locus of control.
authors.affiliation: Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520, USA. hosanna.soler@yale.edu
authors.forename: Hosanna
authors.initials: H
authors.lastname: Soler-Vila
authors.forename: Stanislav V
authors.initials: SV
authors.lastname: Kasl
authors.forename: Beth A
authors.initials: BA
authors.lastname: Jones
mesh_terms: D000223:Adaptation, Psychological; D001741:Black or African American / Q000523:psychology*; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000401:mortality / Q000523:psychology*; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011584:Psychology; D012944:Social Support; D044465:White People / Q000523:psychology