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Symptom Distress During Breast Cancer Chemotherapy Does Race Matter?. Margaret Quinn Rosenzweig, PhD, FNP-BC,AOCNP Associate Professor University of Pittsburgh School of Nursing. Funding American Cancer Society, RSGT-09-150-01-CPHPS Preliminary Work NCI-KO7 CA 100 588 (03-08)
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Symptom Distress During Breast Cancer ChemotherapyDoes Race Matter? Margaret Quinn Rosenzweig, PhD, FNP-BC,AOCNP Associate Professor University of Pittsburgh School of Nursing • Funding • 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 Aims • 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.
Sample Starting 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.
Disparity in Specific Symptoms • Total mean scores for 4 of the 9 symptoms over the course of chemotherapy.
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.