Abstract PD4-01: Longitudinal health related quality of life (HRQOL) and subsequent adherence to breast cancer chemotherapy among African American women
Authors: Rosenzweig MQ , Liang Z 
Published: May 2016

Background: Racial breast cancer survival disparity is attributed, in part, to disparity in cancer treatment. Changes in HRQOL influencing treatment adherence over the chemotherapy course may be under recognized as a potential etiology of racial disparity in breast cancer treatment.

Objective: To describe African American breast cancer women's HRQOL and the relationship of HRQOL with adherence (dose prescribed without delay) rates to prescribed chemotherapy over three time points of chemotherapy (baseline, midpoint and completion). Methods: Descriptive analysis of an ongoing randomized controlled trial of a psycho-educational intervention to encourage acceptance and adherence to chemotherapy for African American women with breast cancer. The present study used HRQOL data from the parent study and descriptively reported change of quality of life over three time points: baseline – pre chemotherapy (Time 1); at midpoint of chemotherapy (Time 2) and at completion of chemotherapy (Time 3). A further analysis of HRQOL and its role as a potential mediator with treatment adherence was assessed. Descriptive analysis of secondary aim of the parent study, The Attitudes, Communication, Treatment and Support (ACTS) intervention. The Functional Assessment of Cancer Therapy (FACT) was used to measure HRQOL including physical, social, functional and emotional subscales. Adherence data were extracted from medical records. Linear mixed modeling analysis method was used.

Results: One hundred and twenty six African American patients were included from the ongoing parent study for this analysis, 67 from the intervention group and 69 from the usual care group. Subjects were recruited from four cancer centers in western Pennsylvania and one from Western Ohio. Subjects were diagnosed with any stage invasive breast cancer and were undergoing chemotherapy. Overall HRQOL decreased significantly over three time points (p&lt;0.01) primarily driven from the physical subscale. Adherence to prescribed chemotherapy was significantly correlated with HRQOL (r=0.32, p&lt;0.01). Physical well-being subscales decreased significantly over time. Energy, treatment side effects, feeling ill and spending time in bed during chemotherapy were items that decreased in score (increased in severity) most over three time points (decreased score &gt;0.5 from time1 to time3). Energy and pain were the items with the lowest scores for the physical well-being subscale at baseline and the two follow up assessments (mean score&lt;3.0 out of 4).

Conclusions: Worsening in physical symptoms and functional status was demonstrated over time among African American women receiving breast cancer chemotherapy. Lack of adherence to prescribed chemotherapy was significantly correlated with declining HRQOL.

Implications for Practice: The influence of HRQOL on chemotherapy dose reduction and early treatment cessation was primarily from physical factors during chemotherapy for African American women. Clinically this emphasizes the importance of close QOL and symptom screening, encouraging symptom reporting and the need to exhaust symptom management options before early treatment termination.

Citation Format: Rosenzweig MQ, Liang Z. Longitudinal health related quality of life (HRQOL) and subsequent adherence to breast cancer chemotherapy among African American women. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD4-01.