Characterizing the Role of Social Factors on Quality of Life and Survival in Health Disparity Populations

This dissertation explored social factors and their relationships to long-terms health outcomes among cancer survivors and caregivers who are recognized health disparity populations. First, I examined different social structures in terms of contextual factors, network factors, and types of patient-caregiver relationships, and associations to quality of life (QOL). I also investigated the relationship between the quality of social relationships, in terms of social functioning and caregiving burden, and QOL. Finally, I examined different sources of social support, including clinical and non-clinical sources, and how these were related to survival. As a whole, the findings from this work suggest that different aspects of social factors matter differently in regard to the outcome of interest. Among rural cancer survivors, social factors only impacted mental health QOL (MHQOL), and not physical health QOL. Although, for both rural survivors and caregivers, the quality of social relationships, but not the structures of those relationships, were associated the MHQOL, wherein those reporting better quality had better MHQOL. Concerning survival, the source of the social relationship and subsequent support as it related to cancer care, was important, as indicated by the finding that better patient provider communication (PPC) was associated with survival. Interestingly, and different from the QOL work, the non-clinical support did not seem to influence survival. Eliminating long-term cancer outcomes among marginalized populations will require addressing the social factors described here, and also those fundamental, upstream factors that impact health. In summary, this work suggests that improving the experiences and health outcomes among health disparity populations will require diverse approaches, depending on the population at hand as well as the desired achieved outcome. Approaches to improving QOL may necessitate more approaches focused on improving the quality of survivor and caregiver relationships, whereas improving survival should consider focusing on ensuring that cancer patients have access to quality PPC and other clinical support services. While these are promising findings, there are still a number of unanswered questions that will require continued investigations to understand how social structures, the quality of social support, and different sources of support impact long-term health outcomes among cancer survivors and their caregivers.