Characterization of Clinical Symptoms by Race Among Women With Early-Stage, Hormone Receptor-Positive Breast Cancer Before Starting Chemotherapy.
Characterization of Clinical Symptoms by Race Among Women With Early-Stage, Hormone Receptor-Positive Breast Cancer Before Starting Chemotherapy.
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DOI：
10.1001/jamanetworkopen.2021.12076
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发表时间：
2021-06-01
影响因子：
13.8
通讯作者：
Graetz I
中科院分区：
文献类型：
--
作者：
Hu X;Chehal PK;Kaplan C;Krukowski RA;Lan RH;Stepanski E;Schwartzberg L;Vidal G;Graetz I
黑人和白色女性早期乳腺癌患者在开始化疗前的症状负担是否存在差异？在这项对来自1个癌症中心的1338名患者进行的横断面观察性研究中，黑人女性在化疗开始前报告了与化疗相关的典型症状的较高负担，并且比白色女性的痛苦较低。黑人患者的基线特征与显著更高的症状负担相关，但这种症状负担被白色患者相对更高的、无法解释的身体、痛苦和绝望症状报告所抵消。通过考虑治疗前症状来捕获治疗相关毒性作用可能会为患者提供更好的治疗决策。乳腺癌死亡率的种族差异持续存在。与这些差异相关的一个因素可能是症状负担的差异，这可能会降低化疗耐受性并增加早期停药。比较不同种族的早期乳腺癌女性在开始化疗前的症状负担，并量化基线特征解释的症状差异。一项按种族对2007年1月1日至2015年12月31日在美国南部地区一家大型癌症中心诊断为I至III期激素受体阳性乳腺癌且在化疗开始前收集了症状报告的黑人和白色女性的症状负担差异进行的横断面分析。分析于2019年11月1日至2021年3月31日进行。使用Blinder-Oaxaca分解，调整基线社会人口统计学和临床特征。在开始化疗前（基线）报告了平均值（SD）为50（10）的4个症状综合评分，这些评分来自症状项目：一般身体症状（11项）、治疗不良反应（8项）、急性痛苦（4项）和绝望（7项）。患者将他们在过去一周内经历的每种症状的严重程度评定为0到10分（其中0表示没有问题，10表示尽可能糟糕）。共有1338名女性（平均[SD]年龄，54.6 [11.6]岁; 420名黑人女性[31.4%]和918名白色女性[68.6%]）被纳入研究。在开始化疗前，黑人女性报告的不良反应症状综合评分在统计学上显著高于（即更差）白色女性（44.5 vs 43.8），但急性痛苦评分较低（48.5 vs 51.0）。分解分析显示，黑人患者的特征与所有4个评分中较高的症状负担相关。然而，这些差异被白色患者报告的相对更大的、统计学显著的、无法解释的身体、痛苦和绝望症状所抵消。在这项研究中，在开始化疗之前，与白色患者相比，患有早期乳腺癌的黑人患者报告了可能因化疗而加重的症状的显著更高的负担和更低的痛苦症状。未来的研究应探讨治疗前后症状如何变化，以及种族/民族的差异，以及它们如何与治疗依从性和死亡率差异相关。这项队列研究比较了黑人和白色女性早期乳腺癌患者在开始化疗前的症状负担，并评估了与基线特征相关的症状差异。
Are there symptom burden differences between Black and White women with early-stage breast cancer before starting chemotherapy? In this cross-sectional observatonal study of 1338 patients from 1 cancer center, Black women reported a higher burden for symptoms typically associated with chemotherapy and lower distress than White women before chemotherapy intiation. Black patients’ baseline characteristics were associated with a significantly higher symptom burden, but this symptom burden was offset by relatively greater, unexplained reporting of physical, distress, and despair symptoms by White patients. Capturing treatment-related toxic effects by considering pretreatment symptoms may result in better-informed treatment decisions for patients. Race disparities persist in breast cancer mortality rates. One factor associated with these disparities may be differences in symptom burden, which may reduce chemotherapy tolerance and increase early treatment discontinuation. To compare symptom burden by race among women with early-stage breast cancer before starting chemotherapy and quantify symptom differences explained by baseline characteristics. A cross-sectional analysis of symptom burden differences by race among Black and White women with a diagnosis of stage I to III, hormone receptor–positive breast cancer who had a symptom report collected before chemotherapy initiation in a large cancer center in the southern region of the US from January 1, 2007, through December 31, 2015. Analyses were conducted from November 1, 2019, to March 31, 2021. Blinder-Oaxaca decomposition was used, adjusting for baseline sociodemographic and clinical characteristics. Four symptom composite scores with a mean (SD) of 50 (10) were reported before starting chemotherapy (baseline) and were derived from symptom items: general physical symptoms (11 items), treatment adverse effects (8 items), acute distress (4 items), and despair (7 items). Patients rated the severity of each symptom they experienced in the past week on a scale of 0 to 10 (where 0 indicates not a problem and 10 indicates as bad as possible). A total of 1338 women (mean [SD] age, 54.6 [11.6] years; 420 Black women [31.4%] and 918 White women [68.6%]) were included in the study. Before starting chemotherapy, Black women reported a statistically significantly higher (ie, worse) symptom composite score than White women for adverse effects (44.5 vs 43.8) but a lower acute distress score (48.5 vs 51.0). Decomposition analyses showed that Black patients’ characteristics were associated with higher symptom burden across all 4 scores. However, these differences were offset by relatively greater, statistically significant, unexplained physical, distress, and despair symptom reporting by White patients. In this study, before starting chemotherapy, Black patients with early-stage breast cancer reported significantly higher burden for symptoms that may be exacerbated with chemotherapy and lower distress symptoms compared with White patients. Future studies should explore how symptoms change before and after treatment and differ by racial/ethnic groups and how they are associated with treatment adherence and mortality disparities. This cohort study compares symptom burden among Black and White women with early-stage breast cancer before starting chemotherapy and assesses symptom differences associated with baseline characteristics.
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