The Effect of Race and Area Deprivation on Symptom Profiles Over the Course of Early-Stage Breast Cancer

Abstract

Context

Limited research has examined racial disparities in symptom burden prior to chemotherapy initiation, during and at the chemotherapy completion.

Objective

To describe and compare the symptom burden (fatigue, pain, and physical functioning) and change over time between Black and White women receiving Early-Stage Breast Cancer (ESBC) chemotherapy while considering social determinants of health.

Methods

A longitudinal, repeated measures comparative design was employed. Time points of symptom measurement (PROMIS domains) at baseline, mid and end point were adjusted as per patient chemotherapy schedule. Linear mixed models were applied.

Results

There were 149 patients, 36% Black 64% White (54 ± 12 years) recommended to receive ESBC chemotherapy with adequate data for symptom analysis.

Pain

Main effect of race was significant (F(1, 390) = 29.43, P < .001) for pain.Black patients experienced significantly higher pain scores compared to White patients at pretherapy (Mean Difference; MD = 3.7, P = .034), midpoint (MD = 5.8, P = .002), and endpoint (MD = 7.8, P < .001). In the adjusted model, Black race and higher BMI were significant predictors of higher pain scores. Black patients experienced significant deterioration in pain over time.

Fatigue

The scores for fatigue increased significantly from baseline for Black patients by endpoint (MD_T1-T3 = 8.7, P < .001) and for White patients at midpoint (MD_T1-T2 = 5.7) and at endpoint (MD_T1-T3 = 10.1, P < .001). In the adjusted model, higher BMI predicted worse fatigue scores.

Physical function

Black patients had significantly lower physical function scores compared to White patients at midpoint (MD = 4.0, P = .027). Physical function decreased by endpoint in Black (MD_T1-T3 = 7.8, P < .001), and White patients (MD_T1-T3 = 7.7, P < .001). In the adjusted model, only higher BMI and cardiopulmonary comorbidities significantly predicted worse physical function.

Conclusion

Symptom burden significantly increased over the course of chemotherapy for all patients. Scores for pain and physical function were higher overall for Black patients and deteriorated at a greater rate for Black vs. White women over the course of chemotherapy. BMI was a significant predictor of pain, fatigue, and physical function, this assessment holds implications for proactive assessment and mitigation strategies.