Symptom Distress During Breast Cancer Chemotherapy

Does Race Matter?

Margaret Quinn Rosenzweig, PhD, FNP-BC,AOCNP

Associate Professor

University of Pittsburgh School of NursingFunding•American Cancer Society, RSGT-09-150-01-CPHPS•Preliminary Work

•NCI-KO7 CA 100 588 (03-08)•Susan G. Komen Foundation, POP33008•Center for Research University of Pittsburgh School of Nursing

Background• AA women have worse survival disparity

than white women in breast cancer.

• Multifactorial: Environment, Patient and Provider– More 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 Aims1. Determine 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 31,2011

All AA women receiving chemotherapy with matched white sample.

One urban cancer center with routine symptom assessment and distress screening.

Design

• Retrospective chart review

• Matched pair analysis

• Matched white women 1:1 for age and stage– Excel to SPSS v.20

Instrument

The 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 Visits

• 240 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 Scores AA (n=28)

White (n=28)

P value

At Baseline 9.4/ 12.8 8.6/12.5 p=.131

Total 12.7/ 8.3/ P=.001

Disparity in Specific Symptoms• Total mean scores for 4 of the 9

symptoms over the course of chemotherapy.AA White P value

Nausea Mean/SD1.26/2.4

Mean/SD.4/1.4

P=.000

Appetite Mean/SD1.14/2.2

Mean/SD.3/.9

P=.000

Shortness of Breath

Mean/SD.90/1.8

Mean/SD.24/.72

P=.000

Fatigue Mean/SD 3.2/3.2

Mean/SD2.1/2.5

P=.000

Chemotherapy Dose Reduction• White - 1/28 white patients dose

reduced, no early cessation.

• African American - 1/28 patients dose reduced, 3/28 AA patients had early chemotherapy cessation

Conclusions• Overall symptom distress and

specific symptoms during breast cancer chemotherapy are worse for AA women than matched White controls.

• Clinical significance is unknown.

Conclusion

• This 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.