Abstract B026: Racial and educational differences in symptom burden and supportive care among breast cancer patients undergoing chemotherapy
Authors: Samuel Cleo A. , Schaal Jennifer , Mbah Olive M. , Elkins Wendi , Eng Eugenia , Robertson Linda , Baker Stephanie , Black Kristin Z. , Dixon Crystal , Ellis Katrina , Guerrab Fatima , Jordan Lauren , Lightfoot Alexandra F. , Padilla Neda R. , Younge Christina , Cykert Samuel 
Published: August 2020

Abstract
Background: Treatment-related side effects (e.g., pain, fatigue, nausea/vomiting) are commonly reported among cancer patients and impact patients' health-related quality of life (HRQOL) and treatment adherence. While there is extensive literature documenting disparities in cancer treatment and outcomes, less is known about racial and educational differences in symptom burden and access to supportive care services during treatment. As part of a National Cancer Institute-funded research study, Cancer Health Accountability for Managing Pain and Symptoms (CHAMPS), we examined racial and educational variations in symptom reports and supportive care referrals among breast cancer patients undergoing chemotherapy at two cancer centers.
Methods: We surveyed 61 Black and White stages I-III breast cancer patients undergoing chemotherapy at one academic and one community-based cancer center during 2016-2018. Survey items assessed patient sociodemographics, HRQOL and symptoms, supportive care, and care satisfaction. Using a community-based participatory research approach, our community/academic/medical partnership administered patient surveys and evaluated symptom burden and supportive care referrals stratified by race (Black vs. White) and education (less than a college degree vs. college degree or higher).
Results: Overall, the most commonly reported HRQOL/symptom concerns included employment interference (44.3%), social life interference (39.3%), financial difficulties (34.4%), worry (29.5%), skin toxicities (26.2%), and pain (26.2%). Compared with White patients, Black patients were more likely to report moderate-to-severe anxiety (41.2% vs. 20.5%, p=.05) and vomiting (17.6% vs. 2.3%, p=.03). Patients with less than a college degree were more likely to report moderate-to-severe constipation than patients with a college degree or higher (20.0% vs. 0.0%, p=.028). In terms of supportive care services, patients were most often referred to cancer support groups (83.9%), nutrition/dietary consultations (54.1%), and financial counseling (54.1%). Black patients were less likely to be referred to supportive services for cancer-specific communication with their families than their White counterparts (16.7% vs. 38.6%, p=.04). No statistically significant educational differences in supportive care referrals were observed.
Conclusions: Breast cancer patients experience a range of HRQOL/symptom concerns and supportive care needs during treatment; however, racial and educational differences exist in these cancer care outcomes. Given longstanding disparities in cancer care outcomes, and the survival and HRQOL benefits of supportive care services, future research should examine barriers to equitable supportive care and opportunities for improvement
Citation Format: Cleo A. Samuel, Jennifer Schaal, Olive M. Mbah, Wendi Elkins, Eugenia Eng, Linda Robertson, Stephanie Baker, Kristin Z. Black, Crystal Dixon, Katrina Ellis, Fatima Guerrab, Lauren Jordan, Alexandra F. Lightfoot, Neda R. Padilla, Christina Younge, Samuel Cykert. Racial and educational differences in symptom burden and supportive care among breast cancer patients undergoing chemotherapy [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B026.