Abstract C11: Racial differential in pain and nausea during breast cancer chemotherapy
Authors: Rosenzweig Margaret Quinn , Wesmiller Susan 
Published: May 2016

Introduction: Racial survival disparity in breast cancer persists despite advances in breast cancer screening and treatment. Attention has been recently focused on breast cancer treatment disparity as a causative etiology for breast cancer survival disparity. Our previous work has indicated that symptom related toxicity, specifically pain may interfere with the ability to receive full dose and timely chemotherapy among African American women receiving chemotherapy and that pain and nausea are two symptoms that present in a differential manner between races in the immediate breast cancer post-operative period. Pain and nausea were chosen for this study as possible dose limiting symptoms. We We compared pain and nausea between African American and White women as they underwent breast cancer chemotherapy.

Experimental Procedures: Two large cohorts of women undergoing breast cancer treatment were combined. The first cohort of largely Caucasian women were recruited between 2006 and 2013 in order to study cognitive function among woman undergoing Anastrazole treatment for early stage breast cancer (AIM). One cohort underwent chemotherapy before Anastrazole therapy, and another received only chemotherapy. These groups constitute the first cohort for this study, from which baseline (before chemotherapy) and 6 month after initiation of chemotherapy measurements were abstracted. The second cohort was recruited into a study of only African American women recommended to receive breast cancer chemotherapy. Recruitment began December, 2009 and ended September, 2014. Measurement from both cohorts were at baseline (prior to chemotherapy) and at completion of chemotherapy (4-6 months after initiation). Pain was measured in the AIM study by the Brief Pain Inventory (PBI), using an 11-point scale increasing with severity. Nausea was measured using the Breast Cancer Prevention Trial (BCPT) symptom checklist as a 0-4 point scale. Symptoms in the ACTS study were measured with the McCorkle Symptom Scale on a 1-5 scale increasing with severity. Scores for all instruments were rescaled to categorical 0 (none/hardly any), 1 (minimal), 2 (moderate) or 3 (severe) to indicate worsening severity of symptoms. Descriptive analysis was used for demographics and chi square for group differences.

Data Results: Data were combined for analysis. There were 297 women between the 2 studies with data for analysis, n=148 (White) and n=149 (African American). The mean age for the AIMS Study was 59.37 (5.74), the mean age for the ACTS study was 53.7 (9.83). At baseline, white women experienced significantly less pain (p &lt; .001) and these differences persisted at 6 months. (p &lt; .001). African American women reporting pain levels at 0 (None/Hardly) at baseline was N=51 and at 6 months N =42. White women reporting pain levels at O (None/Hardly) at baseline was N=90 and at 6 Months N=80. African American women reporting 3 (Severe) was N=31 at baseline and N=28 at 6 month measurement while N=0 white women reported severe pain at baseline and only N=2 at 6 month measurement.

There were low levels of nausea with no racial differentiation at baseline and at 6 months. Of the white sample, 93.2 % and 93% of the African American women reported experiencing nausea “not at all” or “hardly ever” at baseline. At 6 months post-baseline, 98% of the white and 90.5% of the African American women reported experiencing nausea not at all or hardly ever.

Conclusions and Implications for Practice: The results of this study document racial differences in symptoms in breast cancer. Understanding these differences is imperative, especially knowing that pain may be a primary reason for interruptions in the treatment plan. These interruptions cause treatment disparity in dose and completion rates which may be implicated in breast cancer survival disparity.

Citation Format: Margaret Quinn Rosenzweig, Susan Wesmiller. Racial differential in pain and nausea during breast cancer chemotherapy. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C11.