title: Examining predictive models of HRQOL in a population-based, multiethnic sample of women with breast carcinoma.
abstract: BACKGROUND
  This study examined health related quality of life (HRQOL) and its predictors among African-, Asian-, Latina-, and European American breast cancer survivors (BCS) using a socio-ecologically and culturally contextual theoretical model of HRQOL.
  
  
  METHODS
  We employed a case-control, cross sectional design with a population-based sample from the California Cancer Registry. Descriptive, bivariate, and multivariate regression analyses were conducted.
  
  
  RESULTS
  The sample included 703 BCS: 135 (19%) African-, 206 (29%) Asian-, 183 (26%) Latina-, and 179 (26%) European Americans. Latinas reported the lowest HRQOL (p < 0.0001). The final regression model explained 70% of variance in HRQOL. Years since diagnosis, number of comorbidities, role limitation, emotional wellbeing, quality of doctor-patient relationship, social support, and life stress are significant HRQOL determinants. Exploratory regression analyses indicate ethnic differences in significant predictors for HRQOL.
  
  
  CONCLUSIONS
  HRQOL among this multiethnic sample ranged from fair to good. Bivariate analysis suggests that ethnic differences in HRQOL exist. However, regression analyses demonstrated that socio-ecological factors in conjunction with medical characteristics are more salient to HRQOL outcomes, and that ethnic group membership may be a proxy for socio-ecological context. Furthermore, the influence of ethnicity, culture, and social-ecology are complex; research with large, population-based samples are necessary to disentangle the impact of contextual factors on HRQOL.
authors.affiliation: Center of Community Alliance for Research and Education (CCARE), Division of Population Sciences, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, USA. kashing@coh.org
authors.forename: Kimlin T
authors.initials: KT
authors.lastname: Ashing-Giwa
authors.forename: Judith S
authors.initials: JS
authors.lastname: Tejero
authors.forename: Jinsook
authors.initials: J
authors.lastname: Kim
authors.forename: Geraldine V
authors.initials: GV
authors.lastname: Padilla
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hellemann
mesh_terms: D001741:Black or African American / Q000523:psychology; D001213:Asian / Q000523:psychology; D001943:Breast Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D002140:California; D002277:Carcinoma / Q000208:ethnology* / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D017059:Models, Econometric; D011788:Quality of Life; D012042:Registries; D018434:Sickness Impact Profile; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D016896:Treatment Outcome; D044465:White People / Q000523:psychology