Symptom Distress During Breast Cancer Chemotherapy Does Race Matter?

Symptom Distress During Breast Cancer Chemotherapy Does Race Matter?

Margaret Quinn Rosenzweig, PhD, FNP-BC,AOCNPAssociate Professor University of Pittsburgh School of NursingFundingAmerican Cancer Society, RSGT-09-150-01-CPHPSPreliminary WorkNCI-KO7 CA 100 588 (03-08)Susan G. Komen Foundation, POP33008Center for Research University of Pittsburgh School of Nursing

Oscar Howe and the Visual Politics of Agriculture: A Corn-Textual Analysis by Travis Nygard

BackgroundAA women have worse survival disparity than white women in breast cancer.Multifactorial: Environment, Patient and ProviderMore under-dosing secondary to BMI or co-morbidities.


Under-Dosing?AA patients with cancer including AA women with breast cancer historically experience greater chemotherapy related symptom distress than white women.Chemo is held, decreased or discontinued with symptom distress


Specific AimsDetermine the cumulative and individual symptom distress of women during breast cancer chemotherapy.2. Compare the cumulative and individual symptom distress of women during breast cancer chemotherapy according to race.


SampleStarting January 1, 2010 - December 31,2011All AA women receiving chemotherapy with matched white sample.One urban cancer center with routine symptom assessment and distress screening.


Design

Retrospective chart reviewMatched pair analysisMatched white women 1:1 for age and stageExcel to SPSS v.20


InstrumentThe 9 item Edmonton Symptom Assessment Scale is used in routine clinic practice as a patient symptom reporting tool. Potential score is 0-90. Higher scores indicate worse distress.The incidence and severity of symptoms were measured at baseline and each chemotherapy administration visit.


Total Chemotherapy Visits240 visits for AA women (mean 7.7 chemo visits/patient) 250 visits for W women (mean 7.6 chemo visits/patient).


Mean Symptom Scores Total Mean ESAS Scores were worse during chemotherapy for AA than white women.

Mean ScoresAA (n=28)White (n=28)P valueAt Baseline9.4/ 12.88.6/12.5p=.131Total12.7/8.3/P=.001


Disparity in Specific SymptomsTotal mean scores for 4 of the 9 symptoms over the course of chemotherapy.

AAWhiteP valueNauseaMean/SD1.26/2.4Mean/SD.4/1.4P=.000AppetiteMean/SD1.14/2.2Mean/SD.3/.9P=.000Shortness of BreathMean/SD.90/1.8Mean/SD.24/.72P=.000FatigueMean/SD 3.2/3.2Mean/SD2.1/2.5P=.000


Chemotherapy Dose ReductionWhite - 1/28 white patients dose reduced, no early cessation.African American - 1/28 patients dose reduced, 3/28 AA patients had early chemotherapy cessation


ConclusionsOverall symptom distress and specific symptoms during breast cancer chemotherapy are worse for AA women than matched White controls. Clinical significance is unknown.


ConclusionThis awareness can help nurses provide targeted anticipatory guidance and preventative measures in order to decrease symptom burden, and possibly prevent chemotherapy dose reduction and early treatment cessation.


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Symptom Distress During Breast Cancer Chemotherapy Does Race Matter?