Perceived discrimination and quality of life for African American and Caucasian American cancer patients: a coping mediation analysis of subtle and overt microaggressions

ABSTRACT

Objective

Perceived discrimination (PD; e.g. racism, agism, sexism, etc.) negatively impacts quality of life (QOL) among cancer patients. Prior research has established that for African American Cancer Patients (AACPs) only disengagement/denial coping mediated the PD-QOL relationship. In contrast, for Caucasian American Cancer Patients (CACPs), both agentic and disengagement/denial coping were mediators of the PD-QOL relationship. However, according to social constraint theory there may be a difference between subtle and overt PD in terms of the utility of certain coping mechanisms in relation to QOL, especially for AACPs.

Method

217 AACPs and 121 CACPs completed measures of PD, coping (agentic, disengagement/denial, adaptive disengagement) and QOL. PD items were classified as subtle or overt microaggressions. PD was mainly attributed to race/ethnicity by AACPs and to income, age, and physical appearance for CACPs.

Results

: In both subtle and overt microaggression models with CACPs, agentic coping and disengagement/denial coping were significant mediators of PD-QOL. Like CACPs, for AACPs, agentic and disengagement/denial coping were significant in the context of subtle microaggressions. In contrast, for overt microaggression only disengagement/denial coping was a significant mediator of the PD-QOL relationship for AACPs. Adaptive disengagement was related to QOL only for AACPs.

Conclusions

: Whereas more research is needed, it appears that overt microaggressions for AACPs, that consist mainly of racial and ethnic maltreatment, constitute a class of social contexts that may raise above the threshold for serious threat and harm, and, as a result, disengagement/constraint may reduce negative consequences. This additional burden for AACPs contributes to disparities in QOL. Future research is needed on the utility of adaptive disengagement for AACPs in relation to PD.

KEYWORDS:

• Perceived discrimination
• agentic coping
• adaptive disengagement coping
• quality of life
• cancer
• microaggression

Acknowledgements

The authors would like to thank all of those who participated in this study and those who facilitated the accrual of participants in various parts of the US.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability

The dataset (MicroMacroPD) will be available 5-1-2024 in the CurateND repository (curate.nd.edu)

Authors’ contributions

All authors contributed to the writing and revisions of the manuscript. TVM conducted the data analysis and wrote the data analytic and results sections. TVM, NSB, and EJP wrote the remaining sections, reviewed the final version of the entire manuscript, agreed on submission to this journal and take responsibility for the contents of this article.

Additional information

Funding

This work was supported by National Institutes of Health, National Cancer Institute (CA94914). The sponsor had no involvement in the conduct of this study.