Understanding Quality Of Life And The Impact Of Physical Activity On Quality Of Life Among Black Breast Cancer Survivors: A Convergent Mixed Methods Study

Background: Compared with White breast cancer survivors (BCS), Black BCS are more likely to experience adverse cancer treatment effects (e.g., pain and swelling from lymphedema) and suboptimal quality of life (QoL). QoL is a multi-dimensional concept that focuses on different aspects of wellbeing (e.g., emotional/mental). Regular physical activity (PA) (e.g., 150 minutes of moderate PA per week) has been shown to improve QoL in predominantly White cancer survivors. Little is known about the benefits of PA on QoL in Black BCS. Very few studies have examined the association between PA and QoL over time by race. Limited evidence exists on Black women’s experiences, perspectives, concerns, and elements of QoL.

Purpose: The primary objectives were to: (1) investigate the effect of PA on QoL (social wellbeing, emotional/mental wellbeing, and relationship and body image) in post-treatment White and Black BCS with lymphedema; (2) explore the QoL experiences in relation to PA and QoL concerns in Black BCS; and (3) combine quantitative and qualitative data to obtain a better understanding of QoL and its relationship with PA among an under-represented group.

Methods: A mixed methods convergent design was used to compare and contrast two forms of data (qualitative and quantitative), analyze the data separately, and integrate both types of data at the same time to obtain a comprehensive understanding of the research problem. In the quantitative arm, linear mixed effects models were tested on an existing data source in a subset of participants in the exercise and control groups in a 12-month completed randomized clinical trial. In the qualitative arm, primary data was collected in semi-structured interviews and analyzed using a thematic analysis.

Results: There were 173 participants included in the quantitative analysis, averaging 59 years of age; about 33% of the participants were Black women. There were no significant differences in the QoL outcomes between the control and exercise groups at 12 months. Exercise improved emotional/mental wellbeing and body image as it relates to social barriers at 12 months in Black and White BCS, but the changes in these outcomes over time were only statistically significant in White BCS (p<0.05). In the qualitative arm, there were 10 Black BCS, averaging 58 years of age. Two coders achieved a Kappa of 0.77, which is a moderate level of agreement. Five major themes (important elements or patterns within the data relevant to the research questions) emerged: defining QoL (what QoL means to them), behavioral changes (e.g., altering behaviors due to cancer or other major life events), phases of cancer (e.g., breast cancer diagnosis), QoL experiences and factors affecting QoL, and impactful statements from cancer survivors (other meaningful information shared by the participants). The survivors reported multiple QoL concerns (e.g., fear of recurrence) and body image issues. Most participants believed that PA could improve their QoL and expressed the benefits of engaging in PA. Most findings in the quantitative arm were supported by the qualitative results with some differences in QoL (e.g., social wellbeing) and the influence of PA on social wellbeing.

Conclusions: Results show that PA can improve certain aspects of QoL (e.g., emotional/mental wellbeing) over time in Black BCS. However, the significance of the effect on QoL was isolated to White BCS. The significance of the effect on QoL was limited by the small sample size in Black women. After further analysis, the effects on QoL are likely to be significant in a larger sample of Black women. There is a need for further research in this area in larger samples of Black women and in comparative studies with Black and White women. The current findings warrant supportive care services and interventions to help improve the QoL and target the needs of Black BCS.