African-American Cancer Survivors and Discrimination

By Jane Farrell

Cancer and its treatment can accelerate the rate of aging because they both destabilize and damage biological systems in the body. New research published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society, found that African American cancer survivors who reported high levels of discrimination exhibited greater aging and frailty than those reporting lower levels of discrimination.

For the study, Jeanne Mandelblatt, MD, MPH, director of the Institute for Cancer and Aging Research at Georgetown University’s Lombardi Comprehensive Cancer Center in Washington, D.C., and her colleagues examined survey responses from 2,232 adults participating in the Detroit Research on Cancer Survivors (ROCS) Study, a population-based cohort of African American adult cancer survivors who had been diagnosed with breast, colorectal, lung, or prostate cancer within five years. The investigators used what is called a deficit accumulation index to measure aging-related disease and function, and they examined survey responses to questions including ones related to perceived discrimination. Types of discrimination that were assessed included those related to employment, education, renting and buying property, and treatment by police or neighbors. 

“Discrimination can act as a chronic stressor, which can throw the body off balance, resulting in increases in blood pressure, heart rate, metabolism, inflammation, and numerous other factors. These stressors can also increase rates of aging, leading to greater risk of frailty,” said. Mandelblatt, who is also a professor of oncology and medicine at Georgetown University School of Medicine. “We hypothesize that discrimination can lead to an older biological age than a person’s actual chronological age. This is important to understand as there have been virtually no studies of the relationships between discrimination and aging in the setting of cancer survivorship.”

According to a news release from Wiley, the publisher of CANCER, the team found that only 24.4% of participants had deficit accumulation scores indicating no signs of aging-related frailty. Also, survey responses indicated that two-thirds of participants experienced major discrimination in their lives. Survivors with four to seven types of discrimination events had the largest increase in deficits, even after controlling for age; time from diagnosis; cancer type, stage, and therapy; and sociodemographic variables.

“Our results indicate that after considering the effects of traditional factors on poor health—such as income, education, and types of cancer treatment—discrimination was significantly linked to frailty independent of the other variables,” said Ann Schwartz, PhD, co-lead author on the paper and the leader of the Detroit ROCS Study. “Regardless of whether you were rich or poor, if you experienced more discrimination, then you reported greater levels of frailty.” Schwartz is also professor and associate chair of oncology at Wayne State University School of Medicine and deputy center director at Karmanos Cancer Institute in Detroit.