Abstract B026: Racial and educational differences in symptom burden and supportive care among breast cancer patients undergoing chemotherapy

Background: Treatment-related side effects (e.g., pain, fatigue, nausea/vomiting) are commonly reported among cancer patients and impact patients' health-related quality of life (HRQOL) and treatment adherence. While there is extensive literature documenting disparities in cancer treatment and outcomes, less is known about racial and educational differences in symptom burden and access to supportive care services during treatment. As part of a National Cancer Institute-funded research study, Cancer Health Accountability for Managing Pain and Symptoms (CHAMPS), we examined racial and educational variations in symptom reports and supportive care referrals among breast cancer patients undergoing chemotherapy at two cancer centers.

Methods: We surveyed 61 Black and White stages I-III breast cancer patients undergoing chemotherapy at one academic and one community-based cancer center during 2016-2018. Survey items assessed patient sociodemographics, HRQOL and symptoms, supportive care, and care satisfaction. Using a community-based participatory research approach, our community/academic/medical partnership administered patient surveys and evaluated symptom burden and supportive care referrals stratified by race (Black vs. White) and education (less than a college degree vs. college degree or higher).

Results: Overall, the most commonly reported HRQOL/symptom concerns included employment interference (44.3%), social life interference (39.3%), financial difficulties (34.4%), worry (29.5%), skin toxicities (26.2%), and pain (26.2%). Compared with White patients, Black patients were more likely to report moderate-to-severe anxiety (41.2% vs. 20.5%, p=.05) and vomiting (17.6% vs. 2.3%, p=.03). Patients with less than a college degree were more likely to report moderate-to-severe constipation than patients with a college degree or higher (20.0% vs. 0.0%, p=.028). In terms of supportive care services, patients were most often referred to cancer support groups (83.9%), nutrition/dietary consultations (54.1%), and financial counseling (54.1%). Black patients were less likely to be referred to supportive services for cancer-specific communication with their families than their White counterparts (16.7% vs. 38.6%, p=.04). No statistically significant educational differences in supportive care referrals were observed.

Conclusions: Breast cancer patients experience a range of HRQOL/symptom concerns and supportive care needs during treatment; however, racial and educational differences exist in these cancer care outcomes. Given longstanding disparities in cancer care outcomes, and the survival and HRQOL benefits of supportive care services, future research should examine barriers to equitable supportive care and opportunities for improvement

Citation Format: Cleo A. Samuel, Jennifer Schaal, Olive M. Mbah, Wendi Elkins, Eugenia Eng, Linda Robertson, Stephanie Baker, Kristin Z. Black, Crystal Dixon, Katrina Ellis, Fatima Guerrab, Lauren Jordan, Alexandra F. Lightfoot, Neda R. Padilla, Christina Younge, Samuel Cykert. Racial and educational differences in symptom burden and supportive care among breast cancer patients undergoing chemotherapy [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B026.

Evaluating Potential Racial Inequities in Low-dose Computed Tomography Screening for Lung Cancer

BACKGROUND

Lung cancer is the leading cause of cancer death in the US, and significant racial disparities exist in lung cancer outcomes. For example, Black men experience higher lung cancer incidence and mortality rates than their White counterparts. New screening recommendations for low-dose computed tomography (LDCT) promote earlier detection of lung cancer in at-risk populations and can potentially help mitigate racial disparities in lung cancer mortality if administered equitably. Yet, little is known about the extent of racial differences in uptake of LDCT.

OBJECTIVE

To evaluate potential racial disparities in LDCT screening in a large community-based cancer center in central North Carolina.

METHODS

We conducted a retrospective study of the initial patients undergoing LDCT in a community-based cancer center (n = 262). We used the Pearson chi-squared test to assess potential racial disparities in LDCT screening.

RESULTS

Study results suggest that Black patients may be less likely than White patients to receive LDCT screening when eligible (χ2 = 51.41, p < 0.0001).

CONCLUSION

Collaboration among healthcare providers, researchers, and decision makers is needed to promote LDCT equity.

The Affordable Care Act and Ethnic Disparities in Colorectal Cancer Screening

INTRODUCTION

Cost sharing can deter the use of health services and act as a potential contributor to racial/ethnic disparities in cancer. The Affordable Care Act required most health plans to cover, without cost sharing, preventive services, including colorectal cancer screening. Population-based data were used to estimate the impact of the Affordable Care Act's cost-sharing provision (together with other Affordable Care Act provisions targeting preventive care) on ethnic disparities in colorectal cancer screening, comparing Hispanics with non-Hispanics.

METHODS

An interrupted time series quasi-experimental analysis was used to examine ethnic differences in colorectal cancer screening pre- and post-implementation of the Affordable Care Act (analysis performed in 2018). The study cohort included insured individuals aged 50-64 years who participated in the Medical Expenditure Panel Survey from 2007 through 2015 (n=44,343).

RESULTS

During the pre-Affordable Care Act period, screening rates decreased annually for non-Hispanics by -0.38 per 100 adults per year (95% CI= -0.55, -0.22) but remained level for Hispanics (annual trend per 100 adults: 0.01, 95% CI= -0.34, 0.35). After cost sharing was eliminated in 2011, colorectal cancer screening rates increased for both Hispanics (by 1.29 per 100 adults, 95% CI=0.69, 1.89) and non-Hispanics (by 0.58 per 100 adults, 95% CI=0.18, 0.99). The difference in trend increases between Hispanics and non-Hispanics was not statistically significant (0.70%, 95% CI= -0.24, 1.64).

CONCLUSIONS

These findings suggest that Affordable Care Act implementation resulted in increased colorectal cancer screening; however, the effect of the law was not significantly different between Hispanics and non-Hispanics. These results provide indications that more needs to be done to reduce racial/ethnic disparities in colorectal cancer screening.

Effect of Patient Navigation on Breast Cancer Screening Among African American Medicare Beneficiaries: A Randomized Controlled Trial

BACKGROUND

There is growing evidence that patient navigation improves breast cancer screening rates; however, there are limited efficacy studies of its effect among African American older adult women.

OBJECTIVE

To evaluate the effect of patient navigation on screening mammography among African American female Medicare beneficiaries in Baltimore, MD.

DESIGN

The Cancer Prevention and Treatment Demonstration (CPTD), a multi-site study, was a randomized controlled trial conducted from April 2006 through December 2010.

SETTING

Community-based and clinical setting.

PARTICIPANTS

The CPTD Screening Trial enrolled 1905 community-dwelling African American female Medicare beneficiaries who were ≥65 years of age and resided in Baltimore, MD. Participants were recruited from health clinics, community centers, health fairs, mailings using Medicare rosters, and phone calls.

INTERVENTIONS

Participants were randomized to either: printed educational materials on cancer screening (control group) or printed educational materials + patient navigation services designed to help participants overcome barriers to cancer screening (intervention group).

MAIN MEASURE

Self-reported receipt of mammography screening within 2 years of the end of the study.

KEY RESULTS

The median follow-up period for participants in this analysis was 17.8 months. In weighted multivariable logistic regression analyses, women in the intervention group had significantly higher odds of being up to date on mammography screening at the end of the follow-up period compared to women in the control group (odds ratio [OR] 2.26, 95 % confidence interval [CI]1.59-3.22). The effect of the intervention was stronger among women who were not up to date with mammography screening at enrollment (OR 3.63, 95 % CI 2.09-6.38).

CONCLUSION

Patient navigation among urban African American Medicare beneficiaries increased self-reported mammography utilization. The results suggest that patient navigation for mammography screening should focus on women who are not up to date on their screening.