Abstract
BACKGROUND: Breast cancer survivors (BCS) are at risk of developing psychological distress associated with their cancer and are also more likely to experience comorbid diabetes mellitus (DM), which may worsen distress. Effective patient-physician communication is associated with increased psychological well-being, higher quality of life, and may prolong survival. We aimed to examine the association between race/ethnicity, patient-provider communication, and cancer-related distress in BCS with comorbid DM. METHODS: BCS with DM were surveyed using the Impact of Events Scale-Revised (IES-R) to assess for cancer-related post-traumatic stress (PTS) and the Patient Reactions Assessment (PRA) to assess their views of provider communications with their cancer (PRA-C) and DM providers (PRA-D). Bivariate analyses were conducted to examine the relationships between race/ethnicity, cancer-related PTS, and PRA scores. Pearson's correlation coefficients were used to examine the relationship between PRA and IES-R scores by race/ethnicity. RESULTS: A total of 181 female BCS with DM [mean (SD) age: 66.7 (7.0) years] who self-identified as White (39.8%), Black (32.0%), or Hispanic/Other (28.2%) were included. Non-White groups reported worse communication with their cancer (p = 0.01) but not with their DM providers (p = 0.09). BCS with cancer-related PTS had lower PRA-C scores (p = 0.04) but no difference in PRA-D scores (p = 0.22), versus those without cancer-related PTS. PRA-C and IES-R scores were significantly correlated, such that better communications with cancer (r = -0.23, p = 0.01) but not DM providers (r = -0.13, p = 0.08), were associated with lower IES-R scores. In subgroup analyses, the correlation between cancer-related PTS and PRA-C scores was significant in Hispanic/Other BCS (r = -0.39, p = 0.01), in contrast to Black (r = -0.12, p = 0.42) and White BCS (r = -0.09, p = 0.49); no significant correlation was observed between cancer-related PTS and PRA-D scores by race/ethnicity. CONCLUSIONS: Compared to White BCS, minoritized BCS with comorbid DM report less satisfaction in communications with their cancer providers, which is associated with higher levels of cancer-related distress.