Racial Disparities Impact Symptom Burden in Breast Cancer Patients

June 03, 2021 - Black women with early-stage breast cancer reported a higher symptom burden for adverse treatment effects before chemotherapy, but lower levels of distress compared to White women, according to a recent study published in JAMA Network Open.

Breast cancer is one of the most common cancers in the US among women, second only to skin cancer. While Black women and White women get breast cancer at similar rates, Black women are much more likely to die from breast cancer, according to the Centers for Disease Control and Prevention’s (CDC) website.

“Although differences in treatment, health care access, and comorbidities explain some of the differences in mortality, they do not fully explain this disparity. Another important factor may be symptom burden,” the study stated.

“Severe or uncontrolled physical symptoms and mental health issues may decrease tolerance for the full chemotherapy course and are associated with early treatment discontinuation, which may increase breast cancer mortality.”

Researchers analyzed symptom reports from 1,338 patients from a cancer center. All patients were diagnosed with stage I to III hormone receptor-positive breast cancer and completed a symptom report prior to starting chemotherapy. Researchers used a Blinder-Oaxaca decomposition model to isolate baseline sociodemographic and clinical characteristics.

“Black patients’ baseline characteristics were associated with a significantly higher symptom burden, but this symptom burden was offset by relatively greater, unexplained reporting of physical, distress, and despair symptoms by White patients,” the study stated.

The study measured four symptom composite scores: treatment adverse effects, general physical symptoms, despair, and acute distress. Each patient rated the severity of their symptoms on a zero to ten scale.

“For all composite scores, decomposition of differences between Black and White patients consistently showed a negative and statistically significant explained difference,” the study explained.

“Thus, if Black patients had the same characteristics as White patients, such as living in neighborhoods with higher incomes, they would have reported a lower symptom burden.”

Black patients and White patients reported similar mean scores in general physical symptoms, but White patients reported lower mean treatment adverse effects scores.

However, “the explained difference was negative, implying that, if the average Black patient had the same characteristics as the average White patient, she would have reported a 0.5-point lower mean treatment adverse effects score,” the study explained.

Meanwhile, White patients reported three distress symptoms significantly more than Black patients: feeling nervous, tense, or anxious, feeling worried, and crying a lot. Researchers saw no significant differences between despair symptom reporting between Black patients and White patients.

“Moreover, the positive and statistically significant unexplained difference found in physical, distress, and despair symptom scores suggests that White women reported significantly more severe symptoms than Black women with comparable characteristics,” the study pointed out.

“In other words, given Black patients’ characteristics, if they reported symptoms as if they were the average White patient, Black patients’ symptom burden scores would be higher (ie, worse). This pattern provides evidence of race-based differences in symptom reporting and illustrates the insights gained from exploring the masked underlying variations in symptom reporting by race.”

The study also noted that many symptoms often made worse by chemotherapy, such as appetite and weight changes, and hair loss, were more severe among Black patients at the baseline. This may indicate an even higher symptom burden during chemotherapy, which could be feeding into the high chemotherapy discontinuation rates among Black women.

Overall, the results shed light on differences in how Black and White women report symptoms, and this could have multiple implications on treatment. For example, since neighborhood-level income was tied to differences in symptoms by race, researchers suggested that care teams should take a closer look at social context and provide support programs for patients in underserved communities.

Racial disparities in cancer care are known and many researchers aim to close the mortality gap. In December 2020, the Engaging Research to Achieve Cancer Care Equity (ERACE) initiative began, creating a race and ethnicity-based cancer registry, striving to achieve equitable health outcomes.

Meanwhile, MIT researchers recently developed a predictive analytics tool that can forecast a patient’s risk of breast cancer. Another recent study utilized genetic testing to determine how frequent mutations occurred among different known breast cancer genes.