Disparities in Chronic Stress, QOL, and Physical Activity among Black and White Breast Cancer Survivors

项目摘要/摘要-项目2 报告表明，黑人乳腺癌幸存者的健康相关生活质量(HRQOL)比白人差， 尽管一些研究表明黑人有更高的精神幸福感。有几个因素导致了这些 HRQOL中的种族差异。数据显示，慢性生活压力对HRQOL有负面影响。慢性生活压力是 定义为慢性心理社会压力，源于对金钱、住房、工作条件的担忧， 邻里环境、家庭状况、公共服务、犯罪和暴力。研究表明，更高的 黑人的重大生活事件的流行率高于白人。除了慢性生活压力外，癌症特有的压力 (例如，对复发的恐惧)也会影响乳腺癌幸存者的HRQOL。然而，关于HRQOL的研究已经 主要集中在黑人乳腺癌幸存者的一项测量和纵向研究 在多个时间点的压力和HRQOL还没有被进行。体力活动是一项关键的生活方式因素 乳腺癌后的健康生存和更好的HRQOL。尽管数据支持体力活动是有益的 对慢性压力和生活质量的影响，符合建议的非裔美国女性比例较低 有氧运动指南与非西班牙裔白人的比较。慢性应激的累积负担和 不良的行为反应(例如，缺乏运动)可能会导致身体“磨损”增加 调节系统，并超出身体修复其生理系统的能力。这种病理生理学 机制，即所谓的恒定负荷，是慢性应激的标志，并受频率和 压力事件的严重性。通过测量多个生理指标来量化非稳态负荷。 指标，包括代谢、免疫和炎症标志物。了解不平衡负荷如何调节 感知慢性应激(生活应激和癌症特异性应激)、体力活动和 黑人和白人乳腺癌幸存者之间的HRQOL差异尚未确定。我们的初选 目的是调查慢性压力和体力活动是否与HRQOL和种族差异有关 乳腺癌存活者的HRQOL；以及这些关联是否由异位负荷所调节。其中 黑人和白人女性乳腺癌幸存者，我们的目标是：目标1：调查纵向关系 感知的慢性压力(生活压力和癌症特有的压力)和HRQOL之间的关系。目标2：调查 客观测量的体力活动与HRQOL的纵向关系目标3：调查 恒定负荷是否是慢性应激和体力活动(总能量消耗， 持续时间和久坐行为)对HRQOL的影响。

Project Summary/Abstract – Project 2 Reports indicate Black breast cancer survivors have poorer health-related quality of life (HRQOL) than Whites, although some studies suggest that Blacks have higher spiritual wellbeing. Several factors contribute to these racial disparities in HRQOL. Data show that chronic life stress negatively impacts HRQOL. Chronic life stress is defined as chronic psychosocial stress stemming from concerns about money, housing, job condition, neighborhood environment, family situation, public services, crime and violence. Studies indicate a higher prevalence of major life events for Blacks than Whites. In addition to chronic life stress, cancer-specific stress (e.g. fear of recurrence) also affects HRQOL in breast cancer survivors. However, studies on HRQOL have primarily focused on one measurement and longitudinal studies in Black breast cancer survivors measuring stress and HRQOL at multiple time points have not been conducted. Physical activity is a key lifestyle factor in healthy survivorship and better HRQOL after breast cancer. Despite data supporting physical activity’s beneficial effect on chronic stress and quality of life, a lower percentage of African-American women meet recommended guidelines for aerobic activity compared to Non-Hispanic Whites. The cumulative burden of chronic stress and adverse behavioral responses (e.g. physical inactivity), may lead to increased “wear and tear” on the body’s regulatory system, and exceed the body’s ability to repair its physiological systems. This pathophysiological mechanism, known as allostatic load, is a marker of chronic stress and is influenced by the frequency and severity of stressful events. Allostatic load is quantified through measurement of multiple physiological indicators, including metabolic, immune and inflammatory markers. Understanding how allostatic load mediates the relationship between perceived chronic stress (life stress and cancer-specific stress), physical activity and HRQOL differentially among Black and White breast cancer survivors has not been determined. Our primary goal is to investigate if chronic stress and physical activity are associated with HRQOL and racial disparities in HRQOL among breast cancer survivors; and whether these associations are mediated by allostatic load. Among Black and White female breast cancer survivors, our aims are to: AIM 1: Investigate the longitudinal relationship between perceived chronic stress (life stress and cancer-specific stress) and HRQOL. AIM 2: Investigate the longitudinal relationship between objectively-measured physical activity and HRQOL. AIM 3: Investigate whether allostatic load is a mediator of the effects of chronic stress and physical activity (total energy expenditure, duration, and sedentary behavior) on HRQOL.