Examining the interplay between race/ethnicity, patient-physician communication and cancer-related post-traumatic stress in breast cancer survivors with comorbid diabetes

Christina P Wang; Lauren Guerra; Karisma Pantaleon; Mita S Goel; Yael T Harris; Juan P Wisnivesky; Jenny J Lin

doi:10.1080/07347332.2025.2528831

Examining the interplay between race/ethnicity, patient-physician communication and cancer-related post-traumatic stress in breast cancer survivors with comorbid diabetes

J Psychosoc Oncol. 2025 Jul 13:1-9. doi: 10.1080/07347332.2025.2528831. Online ahead of print.

Authors

Christina P Wang¹, Lauren Guerra², Karisma Pantaleon², Mita S Goel³, Yael T Harris⁴, Juan P Wisnivesky², Jenny J Lin²

Affiliations

¹ Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
² Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
³ Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁴ Division of Endocrinology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA.

PMID: 40652447
DOI: 10.1080/07347332.2025.2528831

Abstract

Background: Breast cancer survivors (BCS) are at risk of developing psychological distress associated with their cancer and are also more likely to experience comorbid diabetes mellitus (DM), which may worsen distress. Effective patient-physician communication is associated with increased psychological well-being, higher quality of life, and may prolong survival. We aimed to examine the association between race/ethnicity, patient-provider communication, and cancer-related distress in BCS with comorbid DM.

Methods: BCS with DM were surveyed using the Impact of Events Scale-Revised (IES-R) to assess for cancer-related post-traumatic stress (PTS) and the Patient Reactions Assessment (PRA) to assess their views of provider communications with their cancer (PRA-C) and DM providers (PRA-D). Bivariate analyses were conducted to examine the relationships between race/ethnicity, cancer-related PTS, and PRA scores. Pearson's correlation coefficients were used to examine the relationship between PRA and IES-R scores by race/ethnicity.

Results: A total of 181 female BCS with DM [mean (SD) age: 66.7 (7.0) years] who self-identified as White (39.8%), Black (32.0%), or Hispanic/Other (28.2%) were included. Non-White groups reported worse communication with their cancer (p = 0.01) but not with their DM providers (p = 0.09). BCS with cancer-related PTS had lower PRA-C scores (p = 0.04) but no difference in PRA-D scores (p = 0.22), versus those without cancer-related PTS. PRA-C and IES-R scores were significantly correlated, such that better communications with cancer (r = -0.23, p = 0.01) but not DM providers (r = -0.13, p = 0.08), were associated with lower IES-R scores. In subgroup analyses, the correlation between cancer-related PTS and PRA-C scores was significant in Hispanic/Other BCS (r = -0.39, p = 0.01), in contrast to Black (r = -0.12, p = 0.42) and White BCS (r = -0.09, p = 0.49); no significant correlation was observed between cancer-related PTS and PRA-D scores by race/ethnicity.

Conclusions: Compared to White BCS, minoritized BCS with comorbid DM report less satisfaction in communications with their cancer providers, which is associated with higher levels of cancer-related distress.

Keywords: breast neoplasms; cancer survivors; diabetes mellitus; female; stress disorders post-traumatic.