Abstract: The Symptom Experience, Management and Outcomes According to Race and Social Determinants (SEMOARS) Background: Black women with breast cancer in the United States have a lower 5 year survival than whites for stage-matched disease. Our past and ongoing work and that of others suggests that symptom incidence, cancer related distress and ineffective communication contribute to racial disparity in dose reduction and early therapy termination.
Aims :1) Examine and compare chemotherapy received/chemotherapy prescribed over time and in total of matched black and white women prescribed BC chemotherapy. 2) Examine and compare the symptom incidence, distress and management, clinical encounter including patient centeredness of care and management experience of matched black and white women receiving BC chemotherapy over time. 2a) Correlate the symptom incidence symptom incidence, distress and management experience of matched black and white women receiving BC chemotherapy to Aim 1. 3) Explore the effects of social determinants of health including age, income, education, zip code and lifetime stress exposure on Aims 1, 2 and 3. Hypothesis: Inherent differences including race and possibly social determinants of health between black and white women in the experience, perception, communication and outcomes of symptoms during breast cancer chemotherapy interfere with chemotherapy adherence. Methods: Longitudinal frequent repeated-measures (18 data collections), comparative, mixed methods (audiotapes of clinic visits) descriptive design of 179 white and 179 black women from 6 sites at Western Pennsylvania and Northeast Ohio over the course of chemotherapy. Innovation: The intense assessment of symptoms, distress and quality of life and the clinical encounter in multiple repeated measures as compared by race and social determinants of health on the ability to receive full dose chemotherapy is patient centered and innovative. Significance/Public Health: If these relationships and racial differences are confirmed and the mediating factors identified as actionable targets, this information will fill a critical gap in the quality care literature, advancing the understanding and potential mitigation strategies for the static racial survival disparity in breast cancer. These identified targets hold implication for public health.
This proposal, in response to PA-16-160, National Institute of Minority Health and Disparity (NIMHD) Research Project Grant (Parent R01) has the goal of creating an important explanatory model regarding the process of symptom experience, symptom reporting, management and symptom outcomes leading to the ability to receive full dose of prescribed therapy according to race and considering social determinants for women receiving breast cancer chemotherapy. Defining barriers to receiving full dose and timely therapeutics are an important strategy for mitigation of treatment and survival disparity in breast cancer.
