Racial differences in symptom management experiences during breast cancer treatment

doi:10.1007/s00520-017-3965-4

. 2018 May;26(5):1425-1435.

doi: 10.1007/s00520-017-3965-4. Epub 2017 Nov 18.

Racial differences in symptom management experiences during breast cancer treatment

Cleo A Samuel^{1

2}, Jennifer Schaal³, Linda Robertson⁴, Jemeia Kollie⁵, Stephanie Baker⁶, Kristin Black^{7

8}, Olive Mbah⁵, Crystal Dixon⁹, Katrina Ellis^{7

8}, Eugenia Eng^{7

8}, Fatima Guerrab¹⁰, Nora Jones¹¹, Amanda Kotey⁷, Claire Morse¹², Jessica Taylor⁵, Vickie Whitt¹¹, Samuel Cykert^{13

14}

Affiliations

¹ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA. cleo_samuel@unc.edu.
² Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA. cleo_samuel@unc.edu.
³ The Partnership Project, 620 S. Elm St, Suite 381, Greensboro, NC, 27406, USA.
⁴ Department of Medicine, University of Pittsburgh, 5150 Centre Avenue, POB 2 Room, 438, Pittsburgh, PA, 15232, USA.
⁵ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA.
⁶ Department of Public Health Studies, Elon University, Campus Box 2337, Elon, NC, 27224, USA.
⁷ Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
⁸ Cancer Health Disparities Training Program, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7440, Chapel Hill, NC, 27599-7440, USA.
⁹ Department of Public Health Education, University of North Carolina at Greensboro, 437 Coleman Building, P.O. Box 26170, Greensboro, NC, 27402-6169, USA.
¹⁰ Department of Public Health Education, North Carolina Central University, 1801 Fayetteville St, Durham, NC, 27701, USA.
¹¹ Sisters Network Greensboro, P.O. Box 20304, Greensboro, NC, 27420, USA.
¹² Guilford College, 5800 W Friendly Ave, Greensboro, NC, 27410, USA.
¹³ Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
¹⁴ School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, CB#7110, Chapel Hill, NC, 27599, USA.

PMID: 29150730
PMCID: PMC6363352
DOI: 10.1007/s00520-017-3965-4

Racial differences in symptom management experiences during breast cancer treatment

Cleo A Samuel et al. Support Care Cancer. 2018 May.

. 2018 May;26(5):1425-1435.

doi: 10.1007/s00520-017-3965-4. Epub 2017 Nov 18.

Authors

Affiliations

¹ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA. cleo_samuel@unc.edu.
² Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA. cleo_samuel@unc.edu.
³ The Partnership Project, 620 S. Elm St, Suite 381, Greensboro, NC, 27406, USA.
⁴ Department of Medicine, University of Pittsburgh, 5150 Centre Avenue, POB 2 Room, 438, Pittsburgh, PA, 15232, USA.
⁵ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA.
⁶ Department of Public Health Studies, Elon University, Campus Box 2337, Elon, NC, 27224, USA.
⁷ Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
⁸ Cancer Health Disparities Training Program, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7440, Chapel Hill, NC, 27599-7440, USA.
⁹ Department of Public Health Education, University of North Carolina at Greensboro, 437 Coleman Building, P.O. Box 26170, Greensboro, NC, 27402-6169, USA.
¹⁰ Department of Public Health Education, North Carolina Central University, 1801 Fayetteville St, Durham, NC, 27701, USA.
¹¹ Sisters Network Greensboro, P.O. Box 20304, Greensboro, NC, 27420, USA.
¹² Guilford College, 5800 W Friendly Ave, Greensboro, NC, 27410, USA.
¹³ Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
¹⁴ School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, CB#7110, Chapel Hill, NC, 27599, USA.

PMID: 29150730
PMCID: PMC6363352
DOI: 10.1007/s00520-017-3965-4

Abstract

Purpose: Racial disparities in cancer treatment-related symptom burden are well documented and linked to worse treatment outcomes. Yet, little is known about racial differences in patients' treatment-related symptom management experiences. Such understanding can help identify modifiable drivers of symptom burden inequities. As part of the Cancer Health Accountability for Managing Pain and Symptoms (CHAMPS) study, we examined racial differences in symptom management experiences among Black and White breast cancer survivors (BCS).

Methods: We conducted six focus groups (n = 3 Black BCS groups; n = 3 White BCS groups) with 22 stages I-IV BCS at two cancer centers. Focus groups were audio-recorded and transcribed verbatim. Based on key community-based participatory research principles, our community/academic/medical partner team facilitated focus groups and conducted qualitative analyses.

Results: All BCS described positive symptom management experiences, including clinician attentiveness to symptom concerns and clinician recommendations for pre-emptively managing symptoms. Black BCS commonly reported having to advocate for themselves to get information about treatment-related symptoms, and indicated dissatisfaction regarding clinicians' failure to disclose potential treatment-related symptoms or provide medications to address symptoms. White BCS often described dissatisfaction regarding inadequate information on symptom origins and clinicians' failure to offer reassurance.

Conclusions: This study elucidates opportunities for future research aimed at improving equity for cancer treatment-related symptom management. For Black women, warnings about anticipated symptoms and treatment for ongoing symptoms were particular areas of concern. Routine symptom assessment for all women, as well as clinicians' management of symptoms for racially diverse cancer patients, need to be more thoroughly studied and addressed.

Keywords: Blacks/African-Americans; Breast cancer; Patient-provider communication; Symptom management.

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Conflict of interest statement

Conflict of Interest: The authors declare that they have no conflict of interest.

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References

1. Vandyk AD, Harrison MB, Macartney G, Ross-White A, Stacey D. Emergency department visits for symptoms experienced by oncology patients: a systematic review. Support Care Cancer. 2012;20(8):1589–99. doi:10.1007/s00520-012-1459-y. - DOI - PubMed
1. Eversley R, Estrin D, Dibble S, Wardlaw L, Pedrosa M, Favila-Penney W. Post-treatment symptoms among ethnic minority breast cancer survivors. Oncology nursing forum. 2005;32(2):250–6. doi:10.1188/05.ONF.250-256. - DOI - PubMed
1. Walling AM, Weeks JC, Kahn KL, Tisnado D, Keating NL, Dy SM et al. Symptom prevalence in lung and colorectal cancer patients. Journal of pain and symptom management. 2015;49(2):192–202. doi:10.1016/j.jpainsymman.2014.06.003. - DOI - PMC - PubMed
1. Coyle N, Adelhardt J, Foley KM, Portenoy RK. Character of terminal illness in the advanced cancer patient: pain and other symptoms during the last four weeks of life. Journal of pain and symptom management. 1990;5(2):83–93. - PubMed
1. Kenzik KM, Ganz PA, Martin MY, Petersen L, Hays RD, Arora N et al. How much do cancer-related symptoms contribute to health-related quality of life in lung and colorectal cancer patients? A report from the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium. Cancer 2015;121(16):2831–9. doi:10.1002/cncr.29415. - DOI - PMC - PubMed

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[1] Vandyk AD, Harrison MB, Macartney G, Ross-White A, Stacey D. Emergency department visits for symptoms experienced by oncology patients: a systematic review. Support Care Cancer. 2012;20(8):1589–99. doi:10.1007/s00520-012-1459-y. - DOI - PubMed

[2] Vandyk AD, Harrison MB, Macartney G, Ross-White A, Stacey D. Emergency department visits for symptoms experienced by oncology patients: a systematic review. Support Care Cancer. 2012;20(8):1589–99. doi:10.1007/s00520-012-1459-y. - DOI - PubMed

[3] Eversley R, Estrin D, Dibble S, Wardlaw L, Pedrosa M, Favila-Penney W. Post-treatment symptoms among ethnic minority breast cancer survivors. Oncology nursing forum. 2005;32(2):250–6. doi:10.1188/05.ONF.250-256. - DOI - PubMed

[4] Eversley R, Estrin D, Dibble S, Wardlaw L, Pedrosa M, Favila-Penney W. Post-treatment symptoms among ethnic minority breast cancer survivors. Oncology nursing forum. 2005;32(2):250–6. doi:10.1188/05.ONF.250-256. - DOI - PubMed

[5] Walling AM, Weeks JC, Kahn KL, Tisnado D, Keating NL, Dy SM et al. Symptom prevalence in lung and colorectal cancer patients. Journal of pain and symptom management. 2015;49(2):192–202. doi:10.1016/j.jpainsymman.2014.06.003. - DOI - PMC - PubMed

[6] Walling AM, Weeks JC, Kahn KL, Tisnado D, Keating NL, Dy SM et al. Symptom prevalence in lung and colorectal cancer patients. Journal of pain and symptom management. 2015;49(2):192–202. doi:10.1016/j.jpainsymman.2014.06.003. - DOI - PMC - PubMed

[7] Coyle N, Adelhardt J, Foley KM, Portenoy RK. Character of terminal illness in the advanced cancer patient: pain and other symptoms during the last four weeks of life. Journal of pain and symptom management. 1990;5(2):83–93. - PubMed

[8] Coyle N, Adelhardt J, Foley KM, Portenoy RK. Character of terminal illness in the advanced cancer patient: pain and other symptoms during the last four weeks of life. Journal of pain and symptom management. 1990;5(2):83–93. - PubMed

[9] Kenzik KM, Ganz PA, Martin MY, Petersen L, Hays RD, Arora N et al. How much do cancer-related symptoms contribute to health-related quality of life in lung and colorectal cancer patients? A report from the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium. Cancer 2015;121(16):2831–9. doi:10.1002/cncr.29415. - DOI - PMC - PubMed

[10] Kenzik KM, Ganz PA, Martin MY, Petersen L, Hays RD, Arora N et al. How much do cancer-related symptoms contribute to health-related quality of life in lung and colorectal cancer patients? A report from the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium. Cancer 2015;121(16):2831–9. doi:10.1002/cncr.29415. - DOI - PMC - PubMed

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Racial differences in symptom management experiences during breast cancer treatment

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Racial differences in symptom management experiences during breast cancer treatment

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