Abstract PO2-10-01: Discrimination, Trust, and Pain Outcomes Among Black Women with Early-Stage Breast Cancer After Mastectomy
Authors: Smith-Graziani Demetria , Cao Yichun , Switchenko Jeffrey , Rimawi Mothaffar , Brewster Abenaa 
Published: May 2024

BACKGROUND Differences in perception, assessment, communication, and management of pain contribute to racial/ethnic pain disparities in breast cancer (BC). We previously found that Black women (BW) reported higher pain severity and interference with life after breast surgery compared to White women after adjusting for type of surgery and other potential confounders. Racial/ethnic inequities persist despite prior trials to improve disparate pain outcomes. This is likely because multiple factors contribute to pain expression, and structural factors affect the ability to control pain adequately. Perceived discrimination is associated with mistrust of medical providers. These factors are known to affect clinical outcomes, but their impact on pain has been understudied. In this preliminary analysis, we examine medical discrimination, trust in physician, and pain outcomes among BW with early-stage breast cancer after mastectomy. METHODS We surveyed BW with stage 0-III breast cancer who had mastectomy &lt; 2 years of study enrollment at Baylor St. Luke’s Medical Center or Harris Health Smith Clinic in Houston, TX. Participants completed a demographic survey as well as the Brief Pain Inventory (BPI), Discrimination in Medical Settings Scale (DMS), and Trust in Physician Scale (TPS). In the BPI, participants reported their pain severity (PS) on a 0-10 scale at its worst, least, and on average. They reported pain interference with life (PI) from 0-10, types of pain treatments, and % relief from pain treatments. DMS and TPS questions were assessed on 5-point Likert scale. We performed chart review to obtain baseline clinical data related to BC diagnosis and treatment and comorbidities. We summarized patients’ baseline demographic and clinical information using descriptive statistics. PI and DMS were scored as a mean of the total items of each survey. We created mean Trust and Mistrust scores using means of the TPS questions related to each category. RESULTS Of the 37 BW surveyed, 36 (97.3%) were non-Hispanic. 23 (62.2%) had HR+ BC, and 2 (6.7%) had HER2+ disease. 26 (70.3%) women received chemotherapy, 10 (27%) received radiation therapy, and 17 (45.9%) received endocrine therapy. 26 (70.3%) women had &gt; 1 comorbidity; the mean (SD) number reported was 1.3 (1.1). Mean BMI was 30.9 (6.6). 10 (29.4%) women completed high school, and 8 (23.5%) completed some college. 19 (55.9%) had a household income &lt; $25,000, and 11 (32.4%) had private health insurance. Mean worst PS was 4.2 (3.1), and mean average PS was 3.6 (2.9). Mean composite PI score was 2.7 (2.7). 11 (29.7%) women were taking opioids for pain, 17 (45.9%) were taking non-opioid analgesics, and 3 (8.1%) were receiving non-medication treatments. Mean % pain relief with treatment was 52.3% (38.3). Mean DMS score was 1.2 (0.6). Mean composite TPS Trust and Mistrust scores were 4.4 (0.7) and 1.8 (1.0), respectively. CONCLUSION BW may continue to experience pain requiring opioid and/or non-opioid analgesics up to 2 years following mastectomy. Study participants reported relatively low levels of discrimination and high levels of trust on average. We are currently enrolling additional participants in the Emory Healthcare System and Grady Memorial Hospital in Atlanta, GA. After enrolling at least 80 total patients, we will determine the association between DMS and pain outcomes among participants adjusting for demographic, socioeconomic, and clinical factors as well as assess TPS as a potential mediator in the causal pathway between DMS and PS.

Citation Format: Demetria Smith-Graziani, Yichun Cao, Jeffrey Switchenko, Mothaffar Rimawi, Abenaa Brewster. Discrimination, Trust, and Pain Outcomes Among Black Women with Early-Stage Breast Cancer After Mastectomy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-10-01.