The Correlation Between Discrimination and Frailty in Black Cancer Survivors

A recent study by researchers from Georgetown University’s Lombardi Comprehensive Cancer Center and the Barbara Ann Karmanos Cancer Institute in Detroit has shown that Black people discriminated against are likelier to have poorer health and increased frailty. Researchers centered on the significance of this frailty for those who have survived cancer.

The study, published in Cancer, measured frailty based on various factors, such as multiple chronic conditions, weak muscle strength, and difficulty performing daily activities.

“Discrimination can act as a chronic stressor that can throw the body off balance, increasing blood pressure, heart rate, metabolism, inflammation, and numerous other factors,” said the study’s lead investigator, Jeanne Mandelblatt, MD, MPH, director of the Georgetown Lombardi Institute for Cancer and Aging Research. "These stressors can also increase aging rates, leading to a greater risk of frailty. We hypothesize that discrimination can lead to an older biological age than a person’s chronological age." She added that it's important to note that there have been no studies on the relationship between discrimination and aging in cancer survivorship to refer back to. 

The researchers used various modes of communication, such as phone, written, and online surveys, to gather information from participants. The survey focused on seven specific areas related to discrimination experienced by the participants throughout their lives. These areas included being unfairly denied a promotion or fired from their job, not being hired for a job, undergoing unfair treatment by law enforcement officers, being discouraged by a teacher or advisor from continuing their education, receiving worse medical care than others, being denied housing due to their race, and moving into a neighborhood where neighbors made life difficult. The participants were also asked about any aging-related diseases they had and their ability to maintain a healthy lifestyle.

Based on the survey results, most cancer survivors were classified as either prefrail (42.7 percent), meaning they had some health difficulties, or frail (32.9 percent). Only 24.4 percent of those surveyed had few or no signs of frailty. When queried about the seven discrimination areas, 63.2 percent of the participants reported experiencing significant discrimination, with an average respondent reporting 2.4 types.

“For those cancer survivors who reported four to seven types of discrimination events, we observed a large, clinically meaningful increase in frailty scores compared to survivors with fewer discrimination events,” explained Mandelblatt. “Significantly, this pattern of discrimination affecting frailty was consistent across the four types of cancer surveyed, indicating that discrimination is an important factor to study and understand in Black cancer survivors to improve their quality and length of life.”

“Our results indicate that after considering the effects of traditional factors on poor health, such as income, education, and types of cancer treatment, discrimination was a significant factor explaining frailty, and it acted independently of the other variables,” said  Ann Schwartz, PhD, MPH, co-lead author on the paper and co-principal investigator of the Detroit ROCS.

The researchers' next aim is to explore the connections between significant discrimination, persistent life stressors, and indications of biological aging. They also plan to investigate how cancer and its treatment contribute to physical aging among ethnic and racial minorities. 

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