Examining the impact of socioeconomic status and socioecologic stress on physical and mental health quality of life among breast cancer survivors

Oncol Nurs Forum. 2009 Jan;36(1):79-88. doi: 10.1188/09.ONF.79-88.


Purpose/objectives: To examine how physical and mental health quality of life (QOL) varies in relation to the socioeconomic status and ethnicity among breast cancer survivors; to determine key socioecologic factors influencing outcomes.

Design: Cross-sectional.

Setting: Participants were recruited from the California Cancer Surveillance Program, from hospital registries, and from community agencies in southern California.

Sample: 703 multiethnic population-based breast cancer survivors, including European, African, Latina, and Asian Americans.

Methods: Participants completed a mailed questionnaire or answered a telephone survey. To identify socioeconomic status and socioecologic stress, four measures were used: household income, education, job type, and the Life Stress Scale.

Main research variables: Physical and mental health QOL, socioeconomic status (income, education, and job type), and socioecologic stress.

Findings: After controlling for the demographic and medical information, health-related QOL was significantly correlated to socioeconomic status, such that higher socioeconomic status groups expressed better QOL. Ethnic variations existed in QOL according to socioeconomic status. Socioecologic stress was the most important factor influencing physical and mental health QOL.

Conclusions: The findings provide additional evidence that low socioeconomic status and high socioecologic stress exacerbate negative QOL sequelae.

Implications for nursing: Practice and research implications include the need for greater attention to QOL outcomes among at-risk lower socioeconomic status survivors and the recognition of the unique contributions of socioeconomic status, socioecologic stress, and ethnicity on physical and mental health QOL.

MeSH terms

  • Adult
  • African Americans / psychology
  • African Americans / statistics & numerical data
  • Asian Americans / psychology
  • Asian Americans / statistics & numerical data
  • Breast Neoplasms / ethnology
  • Breast Neoplasms / psychology*
  • Comorbidity
  • Cross-Sectional Studies
  • Educational Status
  • Employment / statistics & numerical data
  • European Continental Ancestry Group / psychology
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Health Surveys
  • Hispanic Americans / psychology
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Income / statistics & numerical data
  • Mental Health
  • Middle Aged
  • Quality of Life*
  • Severity of Illness Index
  • Socioeconomic Factors*
  • Stress, Psychological / ethnology
  • Stress, Psychological / etiology
  • Stress, Psychological / psychology*
  • Survivors / psychology*
  • Survivors / statistics & numerical data