Quality of life concerns in patients with breast cancer: evidence for disparity of outcomes and experiences in pain management and palliative care among African-American women.

BACKGROUND: African-American women are at higher risk for breast cancer mortality compared with their white counterparts. Furthermore, African-American women present for diagnosis and treatment later in the disease process. It may be expected that this greater disease burden would impose more symptoms compared with women who present with earlier stage disease. However, the effect of breast cancer on the quality of life of African-American women largely has been unexplored.

METHODS: A qualitative literature review was conducted to identify racial disparities in the palliative care of patients with cancer and their impact on quality of life for African-American women. A Medline search was done encompassing the years between 1985 and 2000 and included the following search terms: breast cancer, palliative care, pain management, quality of life, health care disparities, and African Americans. Relevant articles were read and summarized for inclusion in this review.

RESULTS: Differences in treatment patterns, pain management, and the use of hospice care exist between African-American women and women in other ethnic groups. Explanations for these differences have not been researched well. In addition, the emotional, social, and other aspects of quality of life for African-American women with breast cancer are not well understood, in part due to the absence of a standardized quality-of-life measure.

CONCLUSIONS: Physicians and other health care providers must be educated better about pain management and hospice care and, in turn, must inform their patients better about these issues. Physicians' and researchers' considerations of the influence of race and ethnicity on quality of life are critical. Furthermore, future research should be focused on the establishment of a standardized measure for quality of life that better encompasses its social, spiritual, and emotional aspects. Quality-of-life measures should be incorporated into routine health surveillance mechanisms, with an increased emphasis on minority and other under-served populations.