title: The effects of cancer and racial disparities in health-related quality of life among older Americans: a case-control, population-based study.
abstract: BACKGROUND
  Understanding the impact of the cancer care system on racial/ethnic disparities in health-related quality of life (HRQOL) is increasingly important as the number of cancer survivors in the United States grows. The authors prospectively assessed changes in HRQOL before and after a first cancer diagnosis among non-Hispanic whites (NHWs), African Americans (AAs), Hispanics, and Asians in a cohort of Medicare beneficiaries with and without cancer.
  
  
  METHODS
  Data from the Surveillance, Epidemiology, and End Results linked with the Medicare Health Outcomes Survey were used to identify 1778 individuals aged ≥65 years with prostate, breast, or colorectal cancer from 1998 to 2007. The Medical Outcomes Trust Short Form 36 (SF-36) instrument was used to measure HRQOL. By using propensity scores, each patient with cancer (case) was matched to 5 individuals without cancer (noncancer controls), and differences in HRQOL according to race/ethnicity were assessed. Mixed effects analysis of covariance models was used to assess differences in HRQOL, adjusting for baseline HRQOL, demographics, and self-reported comorbid conditions while controlling for each individual's managed care plan. Stratified analyses were used to assess racial/ethnic disparities between cases and noncancer controls.
  
  
  RESULTS
  Before cancer diagnosis, NHWs had better HRQOL scores than AAs and Hispanics on the Role-Physical and Role-Emotional SF-36 subscales. Cancer diagnosis/treatment negatively impacted individuals' lives regardless of race/ethnicity. However, among cases, gaps between racial/ethnic groups narrowed (compared with controls) before and after cancer diagnosis for some SF-36 HRQOL measures.
  
  
  CONCLUSIONS
  Racial/ethnic HRQOL gaps exist among cancer survivors but may narrow because of exposure to the cancer care system. Further research to understand why this occurs will help inform initiatives to manage the impact of cancer on HRQOL among elderly cancer survivors.
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Pinheiro
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Wheeler
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Chen
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Mayer
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Lyons
authors.forename: Bryce B
authors.initials: BB
authors.lastname: Reeve
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D057216:Propensity Score; D011471:Prostatic Neoplasms / Q000453:epidemiology*; D011788:Quality of Life; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States
keywords: cancer; elderly; health-related quality of life; patient-reported outcomes; racial disparities