The Role of Adverse Symptoms and Clinical Response on Racial Disparity Outcomes in Breast Cancer

这项研究将调查是否黑人和白色患者激素受体阳性（HR+）乳腺癌 癌症报告不良症状的不同，有助于不同的治疗决定，并最终 健康结果的差异。尽管在过去的两年中乳腺癌死亡率显著下降， 几十年来，黑人-白人（B-W）死亡率差距继续扩大。在70%的乳腺癌患者中， 患有HR+肿瘤的黑人女性的死亡率是白色女性的两倍。 辅助内分泌治疗（AET），通常使用选择性雌激素受体拮抗剂他莫昔芬和/或 口服芳香酶抑制剂至少5年，显著提高生存率 HR+乳腺癌患者中。不幸的是，有显着的使用不足和较低的坚持AET 黑人女性和白色女性的比例。所有患者的AET依从率均较低， HR+乳腺癌，最常见的是由于不良副作用。我们将调查病人和病人之间的关键联系 HR+乳腺癌的症状和后续治疗过程和健康结果。AET的副作用 明确限制药物依从率，并经常引发临床医生和患者改变或停止 治疗据我们所知，还没有人研究过AET相关的副作用和依从性， 提供者的治疗决定可能导致B-W健康结果和死亡率的差异。我们的研究是 以症状管理模式为指导，强调三个症状的相互关联性 管理维度（症状体验、管理策略和健康结果）， 纳入不同领域和不同层次的分析，包括人/健康和环境。我们的主要目标 是了解治疗途径中潜在可改变因素的B-W差异如何影响B- 死亡率差距。为了实现这一目标，我们将追求以下目标：1）确定我们是否 观察患者报告的统计学和临床显著B-W差异（频率、严重程度、类型） 不良症状; 2）调查黑人患者及其提供者是否对 与白色患者相比，AET依从性和处方治疗变化方面的症状相同; 和3）检查患者报告的症状、药物依从性和治疗变化是否以及如何变化 影响乳腺癌结局的B-W差异，包括死亡率、复发率和住院率。我们将 检查由西癌症中心照顾的患者，西癌症中心是利用技术收集 并在实时临床环境中利用患者报告的结果， 田纳西州西部地区。该地区在美国50个最大的地区中具有最高的B-W乳腺癌死亡率差异 城市我们将利用来自多个来源的9年数据，包括患者报告的指标、临床指标和临床指标。 医疗保险和医疗补助受益人的数据和索赔记录。我们的结果将提供可操作的 有针对性的干预机制，以减少乳腺癌的B-W差异。

This study will investigate whether black and white patients with hormone receptor-positive (HR+) breast cancer report adverse symptoms differently, contributing to diverse treatment decisions and ultimately disparities in health outcomes. Despite significant reductions in breast cancer mortality over the past two decades, black-white (B-W) mortality disparities continue to widen. Among the 70% of breast cancer patients that have HR+ tumors, black women have double the death rate of white women with the same diagnosis. Adjuvant endocrine therapy (AET), typically using the selective estrogen receptor antagonist tamoxifen and/or an aromatase inhibitor given orally for at least five years, significantly and substantially improves survival rates in women with HR+ breast cancer. Unfortunately, there is significant underuse and lower adherence to AET among black women compared to their white counterparts. AET adherence rates are low for all patients with HR+ breast cancer, most often due to adverse side effects. We will investigate the crucial link between patient symptoms and subsequent treatment course and health outcomes in HR+ breast cancer. Side effects of AET clearly limit medication adherence rates and often trigger clinicians and patients to change or discontinue treatment. To our knowledge, no one has investigated how AET-related side effects and adherence and provider treatment decisions may be driving disparities in B-W health outcomes and mortality. Our study is guided by the Symptom Management Model, which emphasizes the interrelatedness of three symptom management dimensions (symptom experience, management strategies, and health outcomes) while incorporating distinct domains and levels of analyses, including person/health and environment. Our main goal is to understand how B-W differences in potentially modifiable factors in the treatment pathway contribute to B- W mortality disparities. To accomplish this goal, we will pursue the following aims: 1) To determine whether we observe statistically and clinically significant B-W differences (frequency, severity, type) in patient-reported adverse symptoms; 2) To investigate whether black patients and their providers respond differently to the same symptoms in terms of AET adherence and prescribed treatment changes compared to white patients; and 3) To examine if and how patient-reported symptoms, medication adherence, and treatment changes impact B-W disparities in breast cancer outcomes, including mortality, recurrence, and hospitalizations. We will examine patients cared for by the West Cancer Center, an industry leader in leveraging technology to collect and utilize patient-reported outcomes in real-time clinical settings and the largest cancer care provider in the West Tennessee region. This region has the highest B-W breast cancer mortality disparity of the 50 largest US cities. We will leverage nine years of data from multiple sources, including patient-reported measures, clinical data, and claims records for Medicare and Medicaid beneficiaries. Our results will provide actionable mechanisms for targeted interventions to reduce B-W disparities in breast cancer.