Longitudinal Changes in Stress and Isolation Among Multi-Ethnic Breast Cancer Survivors Throughout COVID-19

Abstract

As COVID-19 transitions to a more manageable phase, it remains unclear whether its impact on mental health has similarly eased among cancer survivors. This longitudinal study tracked how the levels of stress and isolation experienced by breast cancer survivors (BCS) of different racial/ethnic groups have changed as the pandemic evolved. BCS enroled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort were surveyed between July and September of 2020, 2021, and 2022. An 11-item isolation/stress score was repeatedly measured in each survey. Mixed-effects linear regression models were used to analyse changes in the isolation/stress scores over time across different racial/ethnic groups and to identify the socioeconomic factors associated with the racial disparities observed. In total, 1899 BCS responded (response rate: 62.8%), of whom 69% were White and 24% Black. The median time from diagnosis to first survey was 5.1 years (IQR: 2.3-9.2). The isolation/stress score decreased continuously for White BCS (P-trend < 0.001), but only began declining for Black BCS in the last wave of survey. Black BCS had significantly higher isolation/stress scores in 2021 and 2022 compared to Whites (both p < 0.01). The racial differences became insignificant after adjusting for certain socioeconomic factors. Notably, BCS who were single, on Medicaid, without a high school degree, or with annual household income less than $35,000 had significantly higher isolation/stress scores (all p < 0.05). The findings remained consistent in sensitivity analysis using inverse probability weighting to account for non-response. Our findings suggested that the levels of stress and isolation of BCS did not improve equally across different racial/ethnic groups as the pandemic subsided. This may be associated with disparities in socioeconomic factors like insurance coverage, education level, income level and family composition. Understanding these barriers and challenges is crucial for developing targeted interventions and support systems for vulnerable populations as we recover from the pandemic and prepare for future health challenges.

Keywords: breast cancer survivors; longitudinal survey; mental health; social isolation; stress.

FIGURE 1

Isolation/stress scores in three waves of surveys by racial/ethnic groups.