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

这项研究将调查激素受体阳性(HR+)的黑人和白人患者的乳房 癌症报告的不良症状不同，有助于做出不同的治疗决定，并最终 在健康结果方面的差异。尽管过去两年乳腺癌死亡率大幅下降 几十年来，黑人和白人(B-W)的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同样诊断的白人女性的两倍。 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 一种口服至少五年的芳香酶抑制剂，显著提高存活率 患有HR+乳腺癌的女性。不幸的是，AET的使用率很低，依从性也很低 在黑人女性和白人女性中的比例。所有AET患者的AET依从率都很低 HR+乳腺癌，最常见的原因是副作用。我们将调查患者之间的关键联系 HR+乳腺癌的症状、后续治疗过程和健康结局。AET的副作用 明确限制服药依从率，并经常促使临床医生和患者改变或停止服药 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会导致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，强调三个症状之间的相关性 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 是为了了解治疗途径中潜在可改变因子的B-W差异如何促进B-W。 W死亡率差异。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的B-W差异(频率、严重程度、类型) 不良症状；2)调查黑人患者和他们的提供者对 与白人患者相比，AET依从性和处方治疗变化方面的症状相同； 3)检查患者报告的症状、服药依从性和治疗是否以及如何发生变化 影响乳腺癌预后的B-W差异，包括死亡率、复发和住院。我们会 检查由西癌症中心护理的患者，该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，以及 田纳西州西部地区。在美国50个最大的地区中，该地区的B-W乳腺癌死亡率差距最大 城市。我们将利用来自多个来源的九年数据，包括患者报告的测量、临床 数据，以及医疗保险和医疗补助受益人的索赔记录。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.