Incorporating experienced racism, which contributes to adverse health effects and widens existing disparities, is needed to improve outcomes for cancer survivors in marginalized groups. These study findings were published in Cancer.

A team of researchers explored how experienced racism may affect the mental and physical health of cancer survivors from marginalized racial/ethnic populations. Among the outcomes of interest were days of poor mental and physical health, depression, inadequate sleep, and activity limitations.

They analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) surveys conducted by the Centers for Disease Control and Prevention (CDC), specifically the data from states that administered 2 optional modules: the cancer survivorship module and reaction to race module.

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Data from 48,200 survivors were analyzed. The racial/ethnic breakdown of the total population was 81% were White, 10% were Black, 4% Hispanic, 1% Asian, 1% multiracial, 1% American Indian or Alaska Native (AI/AN), 0.5% Native Hawaiian and Pacific Islander, and 0.5% Additional groups.

The researchers found all patients in historically marginalized racial/ethnic groups were more likely to experience at least 1 adverse health outcome compared with their non-Hispanic White counterparts.

Compared with White survivors, Black, AI/AN, Hispanic, multiracial, and Additional groups survivors were at a higher risk for poor mental health.

These survivors also had a greater risk of depression diagnosis. Specifically, AI/AN, Hispanic, and Additional group survivors were 1.32 (95% CI, 1.18-1.48), 1.05 (95% CI, 0.96-1.14), and 1.38 (95% CI, 1.13-1.67) times, respectfully, more likely to receive a diagnosis of depression.

Reports of poor physical health were more likely in AI/AN (1.62; 95% CI, 1.47-1.79), Black (1.03; 95% CI, 0.97-1.11), Hispanic (1.05; 95% CI, 0.95-1.15), Multiracial (1.67; 95% CI, 1.51-1.84), and Additional groups (1.23; 95% CI, 0.99-1.53) than in White survivors.

Although all racial/ethnic groups were more likely to experience inadequate sleep, Black survivors and Hispanic survivors were 1.46 (95% CI, 1.39-1.54) and 1.16 (95% CI, 1.07-1.25), respectively, more likely to experience inadequate sleep than White survivors.

A key finding from this research is that all adverse health outcomes of interest associated with physical and emotional experience of racism. The survivors who experienced both physical and emotional distress from racism seem to have the highest risk for adverse outcomes.

The researchers concluded that poor mental and physical health is likely to occur in cancer survivors from marginalized populations compared with their non-Hispanic White counterparts.  The increased risk among these populations indicates that eliminating disparities is necessary to achieve equitable outcomes.

“Special attention to survivorship care needs of historically marginalized racial and ethnic populations and those experiencing racism are needed in future cancer survivorship studies,” they wrote.


Karvonen KA, Balay‐Dustrude E, Do A, Bradford MC, Phipps A, Rosenberg AR. Race, ethnicity, and experienced racism are associated with adverse physical and mental health outcomes among cancer survivors. Cancer. Published online July 3, 2023. doi:10.1002/cncr.34913