Abstract P6-08-05: Racial and Economic Disparities in Social Support and Symptom Distress among Women Diagnosed with Early-Stage Breast Cancer
Authors: Abujaradeh Hiba , Mazanec Susan , Sereika Susan M. , Brufsky Adam M. , Bender Catherine M. , Connolly Mary C. , Rosenzweig Margaret Q. 
Published: March 2023

Abstract
Introduction: Social support (SS) is predictive of symptom distress among patients with breast cancer (BC) during the treatment and post-treatment phases. There is evidence of racial and economic disparities in SS seen among patients with cancer. Little is known about how race and income influence SS among patients with BC. Objectives: 1) To describe SS in women with early-stage BC prior to or at their first chemotherapy treatment (i.e., baseline); 2) To examine how SS varies by race, income level, ability to meet basic financial needs at baseline; and 3) To examine the association between SS and symptom distress at baseline.
Methods: This secondary analysis employed a descriptive, correlational, comparative design with data from the baseline time point of SEMOARS: The Symptom Experience, Management and Outcomes According to Race and Social Determinants of Health (R01-MD012245), a multi-site, repeated, multi-method study comparing the symptom experience and management in Black and White women with early-stage BC. Inclusion criteria were female, Black or White race, age at least 18 years and prescribed chemotherapy for BC stages 1–3. Measures included self-reported race; income level measured by annual income (low: &lt; $29,999; medium: $30,000 to $69,999, high: ≥ $70,000) and affordability of basic needs (single item: yes or no). The Interpersonal Support Evaluation List includes four subscales (possible range 0-30), assessing the perceived availability of support (emotional, tangible, self-esteem, and belonging). The Symptom Distress Scale measures the current experiences of 11 symptoms and their severity (possible range: item:1-5; total score:13-65). Descriptive, comparative, correlational, and regression analyses were used.
Results: Participants (N=248; mean age 52.9±12.3 years) were 58.9% White and 41.1%, Black, 54% married/partnered, 57.3% employed, 70.8% had some college education, and 98% insured. Half of the sample (50.5%) reported high income, 30.3% reported medium income, and 19.2% low income. One-fifth (18.5%) reported an inability to afford basic needs. Income and race are moderately correlated, with Black patients more likely to have low income (39.5% vs. 7.6) and less likely to have high income (22.4% vs. 66.7%) (Cramer’s V=.472; p&lt;.001). On average, patients reported moderately high levels of SS (emotional=26±5; tangible=25±6; self-esteem=23±4; belonging=25±5). Compared to White patients, Black patients reported lower levels of SS: emotional (24.4 vs. 27.0; p&lt;.001), tangible (24.3 vs. 25.8; p=.02), and belonging (24.3 vs. 25.6; p=.02). Using one-way analysis of variance with multiple comparisons there were significant differences in SS by income level, where patients with low income had lower SS levels (all subscales) when compared with patients of high income (all p&lt;.001) and lower tangible SS when compared with medium income (p=.005). Patients with a medium income had lower emotional and tangible SS when compared with those having high income (p=.003; .022; respectively). Inability to afford basic needs was associated with lower SS (all subscales; p&lt;.01). For all SS subscales lower SS was associated with worse symptom distress (r= -.213;p=.004 to r=-.265; p&lt;.001). Adjusting for race and income (high vs. low and medium; low vs. medium and high), lower scores for each SS subscale, except belonging, were predictive of higher symptom distress scores (all p&lt;.05).
Discussion: For this cohort, Black race, low income, and inability to afford basic needs were associated with lower levels of baseline SS. Regardless of race and income, poor baseline emotional, tangible, and self-esteem SS were significantly correlated with increased symptom distress.
Future Directions: SS is a predictive marker of symptom distress as patients begin BC chemotherapy. Interventions to increase SS in Black and/or low-income women with BC at the patient, clinic, and community level are needed.
Coefficients of associations for individual social support subscales with symptoms distress adjusting for race and income level
[UnTable-Footnote]–Notes: n=175; SS: social support; race was categorized as (0= Black; 1= White); †income level was categorized as (0=medium and high; 1=low: reference)
Citation Format: Hiba Abujaradeh, Susan Mazanec, Susan M. Sereika, Adam M. Brufsky, Catherine M. Bender, Mary C. Connolly, Margaret Q. Rosenzweig. Racial and Economic Disparities in Social Support and Symptom Distress among Women Diagnosed with Early-Stage Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-08-05.