Characterization of Clinical Symptoms by Race Among Women With Early-Stage, Hormone Receptor-Positive Breast Cancer Before Starting Chemotherapy

• Type of Material: Article
• Authors: Xin Hu, Emory University; Puneet Chehal, Emory University; Cameron Kaplan, University of Southern California; Rebecca A Krukowski, University of Tennessee Health Science Center; Roy H Lan, University of Tennessee Health Science Center; Edward Stepanski, ConcertAI; Lee Schwartzberg, West Cancer Center and Research Institute; Gregory Vidal, West Cancer Center and Research Institute; Ilana Graetz, Emory University
• Language: English
• Date: 2021-06-01
• Publisher: AMER MEDICAL ASSOC
• Publication Version: Final Published Version
• Copyright Statement: 2021 Hu X et al. JAMA Network Open.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2021.12076
• Title of Journal or Parent Work: JAMA NETWORK OPEN
• Volume: 4
• Issue: 6
• Start Page: e2112076
• End Page: e2112076
• Grant/Funding Information: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.; Funding provided by grant R21CA208161 from the National Cancer Institute.
• Keywords: RACIAL-DIFFERENCES; Medicine, General & Internal; 50 LARGEST CITIES; SURVIVAL; Science & Technology; UNITED-STATES; ADJUVANT CHEMOTHERAPY; MEASUREMENT EQUIVALENCE; EARLY DISCONTINUATION; BLACK-WHITE DISPARITIES; General & Internal Medicine; AFRICAN-AMERICAN WOMEN; Life Sciences & Biomedicine; QUALITY-OF-LIFE
• Research Categories: Health Sciences, Oncology; Health Sciences, Health Care Management

Abstract

Importance: Race disparities persist in breast cancer mortality rates. One factor associated with these disparities may be differences in symptom burden, which may reduce chemotherapy tolerance and increase early treatment discontinuation. Objectives: To compare symptom burden by race among women with early-stage breast cancer before starting chemotherapy and quantify symptom differences explained by baseline characteristics. Design, Setting, and Participants: A cross-sectional analysis of symptom burden differences by race among Black and White women with a diagnosis of stage I to III, hormone receptor-positive breast cancer who had a symptom report collected before chemotherapy initiation in a large cancer center in the southern region of the US from January 1, 2007, through December 31, 2015. Analyses were conducted from November 1, 2019, to March 31, 2021. Blinder-Oaxaca decomposition was used, adjusting for baseline sociodemographic and clinical characteristics. Main Outcomes and Measures: Four symptom composite scores with a mean (SD) of 50 (10) were reported before starting chemotherapy (baseline) and were derived from symptom items: general physical symptoms (11 items), treatment adverse effects (8 items), acute distress (4 items), and despair (7 items). Patients rated the severity of each symptom they experienced in the past week on a scale of 0 to 10 (where 0 indicates not a problem and 10 indicates as bad as possible). Results: A total of 1338 women (mean [SD] age, 54.6 [11.6] years; 420 Black women [31.4%] and 918 White women [68.6%]) were included in the study. Before starting chemotherapy, Black women reported a statistically significantly higher (ie, worse) symptom composite score than White women for adverse effects (44.5 vs 43.8) but a lower acute distress score (48.5 vs 51.0). Decomposition analyses showed that Black patients' characteristics were associated with higher symptom burden across all 4 scores. However, these differences were offset by relatively greater, statistically significant, unexplained physical, distress, and despair symptom reporting by White patients. Conclusions and Relevance: In this study, before starting chemotherapy, Black patients with early-stage breast cancer reported significantly higher burden for symptoms that may be exacerbated with chemotherapy and lower distress symptoms compared with White patients. Future studies should explore how symptoms change before and after treatment and differ by racial/ethnic groups and how they are associated with treatment adherence and mortality disparities..