Comparison of symptom clusters between Black and White patients with cancer within an electronic patient-reported outcome remote symptom monitoring program.
Authors: Olisakwe Sandra C. , Deng Luqin , Franks Jeffrey , Caston Nicole E. , Williams Courtney , Azuero Andres , McGowen Chelsea , Diaz Bryanna , McNair Carrie C. , McElhany Sheila , Dent D'Ambra , Eltoum Noon , Parks Katherine , El Dick Joud , Weiner Bryan J. , Howell Doris , Stover Angela M. , Basch Ethan , Young Pierce Jennifer , Rocque Gabrielle Betty 
Published: September 2024

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Background:
Disparities in pain management for Black patients with cancer are well-documented, but less is known about other symptom clusters like gastrointestinal (GI), respiratory, and urinary symptoms. This study assessed racial disparities in electronically reported symptom clusters among Black and White patients with cancer enrolled in a Remote Symptom Monitoring (RSM) program.
Methods:
Patients with cancer at the University of Alabama at Birmingham (UAB) and the Mitchell Cancer Institute (MCI) reported symptoms weekly using the Patient Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAEs). The GI symptom cluster included decreased appetite, nausea, vomiting, constipation, and diarrhea; the respiratory cluster included cough and shortness of breath; the urinary cluster included frequent urinary problems. We assessed the presence of any moderate/severe symptoms or any severe symptoms (triggering a nurse alert) in the clusters. The study evaluated surveys submitted within the first six months after RSM enrollment. Generalized linear mixed effects modeling with random effects adjusting for cancer type, sex, and age were used to calculate the odds of reporting any moderate/severe pain between Black and White patients.
Results:
Among 1454 patients (31% Black, 69% White), 17,937 surveys were analyzed. The median age for Black patients was 59 (IQR 47-66) and 63 (IQR 54-71) for White patients. Breast cancer was most common in both groups (36% Black, 23% White), followed by gynecological (20% Black, 17% White) and gastrointestinal cancers (19% Black, 18% White). At baseline, both races reported similar proportions of moderate/severe or severe symptom for all clusters (Table). During the first six months in the RSM program, symptom proportions remained similar (Table). These findings were consistent in adjusted analysis for the GI (OR 0.85; 95% CI 0.68-1.07), respiratory (OR 1.18; 95% CI 0.87-1.61), and urinary clusters (OR 0.92; 95% CI 0.61-1.39).
Conclusions:
Our findings suggest no significant racial disparities in reporting moderate/severe or severe symptoms among Black and White patients with cancer at baseline or within their initial six months in the RSM program across GI, respiratory, and urinary symptom clusters.

Survey characteristics.

Total Surveys(N=17,937)
Baseline Surveys
6 Months Surveys

White (n=999)

Black(n=455)

White(n=11,344)

Black(n=5139)

Gastrointestinal Symptoms, No. (%)

Severe
1376 (8)
121 (12)
59 (13)
783 (7)
413 (8)

Moderate/Severe
4701 (26)
300 (30)
130 (29)
2971 (26)
1300 (25)

Respiratory Symptoms, No. (%)

Severe
438 (2)
28 (3)
29 (6)
241 (2)
140 (3)

Moderate/Severe
1612 (9)
90 (9)
62 (14)
996 (8)
464 (9)

Urinary Symptoms, No. (%)

Severe
333 (2)
31 (3)
13 (3)
184 (2)
105 (2)

Moderate/Severe
620 (3)
44 (4)
21 (5)
372 (3)
183 (4)