title: Racial differences in quality of life and employment outcomes in insured women with breast cancer.
abstract: OBJECTIVE
  Prior studies indicate that racial disparities are not only present in cancer survival, but also in the quality of cancer survivorship. We estimated the effect of cancer and its treatment on two measures of survivorship quality as follows: health-related quality of life and employment and hours worked for initially employed and insured women newly diagnosed with breast cancer.
  
  
  METHODS
  We collected employment data from 548 women from 2007 to 2011; 22 % were African-American. The outcomes were responses to the SF-36, CES-D, employment, and change in weekly hours worked from pre-diagnosis to 2 and 9 months following treatment initiation.
  
  
  RESULTS
  African-American women reported a 2.77 (0.94) and 1.96 (0.92) higher score on the mental component summary score at the 2 and 9 month interviews, respectively. They also report fewer depression symptoms at the 2-month interview, but were over half as likely to be employed as non-Hispanic white women (OR = 0.43; 95 % CI = 0.26 to 0.71). At the 9-month interview, African-American women had 2.33 (1.06) lower scores on the physical component summary score.
  
  
  CONCLUSIONS
  Differences in health-related quality of life were small and, although statistically significant, were most likely clinically insignificant between African-American and non-Hispanic white women. Differences in employment were substantial, suggesting the need for future research to identify reasons for disparities and interventions to reduce the employment effects of breast cancer and its treatment on African-American women.
  
  
  CONCLUSIONS
  African-American breast cancer survivors are more likely to stop working during the early phases of their treatment. These women and their treating physicians need to be aware of options to reduce work loss and take steps to minimize long-term employment consequences.
authors.affiliation: Department of Healthcare Policy and Research and the Massey Cancer Center, Virginia Commonwealth University, 830 East Main Street, Richmond, VA, 23219, USA, cjbradley@vcu.edu.
authors.forename: Cathy J
authors.initials: CJ
authors.lastname: Bradley
authors.forename: Amber
authors.initials: A
authors.lastname: Wilk
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000208:ethnology* / Q000523:psychology; D003863:Depression / Q000208:ethnology; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D019458:Insurance Coverage; D008875:Middle Aged; D011788:Quality of Life; D012959:Socioeconomic Factors; D013312:Stress, Physiological; D013315:Stress, Psychological / Q000208:ethnology; D014768:Virginia; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult