Patient-Reported Symptom Burden in Routine Oncology Care: Examining Racial and Ethnic Disparities

Abstract

Racial and ethnic disparities are well-documented in cancer outcomes such as disease progression and survival, but less is known regarding potential disparities in self-reported symptom burden. The goal of this retrospective study was to examine differences in symptom burden by race and ethnicity in a large sample of cancer patients. We hypothesized that racial and ethnic minority patients would report greater symptom burden than non-Hispanic whites. Cancer patients completed the Edmonton Symptom Assessment Scale – revised (ESAS-r-CSS) at least once as part of clinical care in our center’s Radiation Oncology and/or Supportive Care Medicine clinics. Two indicators of symptom burden were evaluated: 1) total ESAS-r-CSS score (i.e., overall symptom burden), and 2) number of severe symptoms (i.e., severe symptomatology, defined as symptoms scores of 7 or higher). Among patients completing the ESAS-r-CSS on multiple occasions, the highest score for each indicator was used. Zero-inflated negative binomial analyses were conducted, adjusting for other sociodemographic and clinical characteristics. Included were 19,642 symptom reports made by 5,798 patients between January 2015 and June 2018. Patients who self-identified as black reported significantly higher symptom burden and more severe symptoms than self-identified white patients (p for each<0.02). Patients self-identifying their race as “other” also reported significantly more severe symptoms than white patients (p=0.03). No other racial or ethnic differences in symptom burden were observed. This study advances our understanding of racial disparities in patient-reported symptom burden during routine oncology care. Clinic-based electronic symptom monitoring may be useful to detect high symptom burden, particularly in patients who self-identify their race as black or other. Future research is needed to reduce symptom burden in racially-diverse cancer populations.