Examining the mediating role of cancer-related problems on spirituality and self-rated health among African American cancer survivors: a report from the American Cancer Society's Studies of Cancer Survivors-II.
OBJECTIVE
African American (AA) cancer survivors report poorer self-rated health (SRH) compared to other racial/ethnic groups. Spirituality is often linked to positive health outcomes, with AAs reporting greater levels of spirituality. This study examined the potential mediating role of cancer-related problems in the relationship between spirituality and SRH among AA cancer survivors compared to non-African American (non-AA) survivors.


METHODS
We analyzed data on 9006 adult cancer survivors from the American Cancer Society's Study of Cancer Survivors-II. Preliminary analyses compared characteristics of AAs and non-AAs and identified significant covariates of SRH. We tested a path model using multi-group structural equation modeling (SEM), and then examined race as a moderator.


RESULTS
Of the three domains of spirituality assessed, AAs had higher levels of peace (p < .001) and faith (p < .001), but not meaning, compared to non-AAs; and of four domains of cancer-related problems assessed, AAs had greater physical distress (p < .001), emotional distress (p < .001), and employment/finance problems (p < .001), but not fear of recurrence. In SEM analyses adjusting for number of comorbidities and income, race moderated the impact of spirituality and cancer-related problems on SRH. Specifically, spirituality had significantly stronger associations with cancer-related problems among AAs than non-AAs. Spirituality was positively associated with all four domains of cancer-related problems, but only physical distress was associated with SRH among AAs.


CONCLUSIONS
The negative effects of physical distress may attenuate the positive effects of spirituality on AA's SRH. Future studies should consider racial/ethnic differences in the determinants and conceptualization of SRH, which is a known predictor of survival.
HEALing Community Center, Research and Community Health, USA.
Alicia L
AL
Best
American Cancer Society, Behavioral Research Center, USA.
Kassandra I
KI
Alcaraz
Washington University, School of Medicine, USA.
Amy
A
McQueen
American Cancer Society, Behavioral Research Center, USA.
Dexter L
DL
Cooper
Tuskegee University, National Center for Bioethics in Research and Health Care, USA.
Rueben C
RC
Warren
American Cancer Society, Behavioral Research Center, USA.
Kevin
K
Stein
D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D026441:Mind-Body Therapies; D009369:Neoplasms / Q000523:psychology*; D012307:Risk Factors; D057566:Self Report; D029181:Spirituality; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
cancer; disparities; oncology; self-rated health; spirituality; survivors