Background: Racial discrimination has been associated with decreased health-related quality of life (QOL) in the general population; however, its impact on QOL in cancer survivors is unclear. This study aims to examine how experiences of discrimination (EOD) impact QOL in breast cancer survivors and whether these associations vary by individual- and structural-level factors.

Methods: The association of EOD assessed at baseline (∼12 months post-diagnosis) was assessed in the Women's Circle of Health Follow-up Study, a population-based longitudinal cohort study of Black breast cancer survivors in New Jersey. QOL was assessed at follow-up (∼24 months postdiagnosis) using the Functional Assessment of Cancer Therapy - Breast (FACT-B). Multivariable linear regression models adjusted for confounders assessed the association of EOD (none, low, high) with QOL. We also examined statistical interaction by individual-level factors (coping and spirituality) and structural-level factors (neighborhood socioeconomic status and residential segregation).

Results: Of 216 study participants, 74% reported experiencing discrimination. In fully adjusted models, women with high EOD had lower overall QOL (no discrimination, mean FACT-B: 114.8; 95% CI, 107.9-121.7; high discrimination, mean FACT-B: 101.1; 95% CI, 94.2-108.0). Although no evidence was observed of statistically significant interaction, women with high spirituality had better overall QOL, regardless of EOD (high spirituality/low discrimination: 128.2; 95% CI, 121.9-134.5; high spirituality/high discrimination: 115.4; 95% CI, 108.5-122.3; low spirituality/no discrimination: 103.5; 95% CI, 93.8-113.2).

Conclusions: Among Black breast cancer survivors, discrimination was associated with poorer QOL. Spirituality may mitigate the harmful effects, as women with high spirituality, even in the context of high discrimination, reported higher QOL.

Keywords: breast cancer; discrimination; quality of life; racism; spirituality; survivorship.

© 2025 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.

背景： 种族歧视与普通人群健康相关生活质量（QOL）下降有关；然而，其对癌症幸存者生活质量的影响尚不清楚。本研究旨在探讨经历歧视（EOD）如何影响乳腺癌幸存者的QOL，并考察这些关联是否因个体和结构性因素而有所不同。

方法： 在新泽西州进行的一项基于人群的纵向队列研究——女性健康圆桌会随访研究中，对基线时（诊断后约12个月）评估的经历歧视进行了关联分析。QOL在随访期（诊断后约24个月）使用功能癌症治疗量表-乳腺癌（FACT-B）进行评估。多变量线性回归模型调整了混杂因素，以考察经历歧视（无、低、高）与QOL之间的关联。我们还通过个体层面的因素（应对和灵性）以及结构层面的因素（邻里社会经济地位和居住隔离）检查了统计交互作用。

结果： 在216名研究参与者中，74%的人报告经历过歧视。在完全调整后的模型中，经历高程度歧视的女性的整体QOL较低（无歧视：平均FACT-B得分为114.8；95% CI, 107.9-121.7；高度歧视：平均FACT-B得分101.1；95% CI, 94.2-108.0）。尽管没有观察到显著的统计交互作用证据，但高灵性的女性无论经历何种程度的歧视，其整体QOL都较好（高灵性/低歧视：128.2；95% CI, 121.9-134.5；高灵性/高度歧视：115.4；95% CI, 108.5-122.3；低灵性/无歧视：103.5；95% CI, 93.8-113.2）。

结论： 在黑人乳腺癌幸存者中，歧视与较差的生活质量有关。高灵性可能缓解这种负面影响，即使是在高度歧视的背景下，具有高灵性的女性报告了更高的生活质量。