Abstract
Even after controlling for stage, comorbidity, age, and insurance status, black women with breast cancer (BC) in the USA have the lowest 5-year survival as compared with all other races for stage-matched disease. One potential cause of this survival difference is the disparity in cancer treatment, evident in many population clinical trials. Specifically, during BC chemotherapy, black women receive less relative dose intensity with more dose reductions and early chemotherapy cessation compared with white women. Symptom incidence, cancer-related distress, and ineffective communication, including the disparity in patient-centeredness of care surrounding patient symptom reporting and clinician assessment, are important factors contributing to racial disparity in dose reduction and early therapy termination. We present an evidence-based overview and an explanatory model for racial disparity in the symptom experience during BC chemotherapy that may lead to a reduction in dose intensity and a subsequent disparity in outcomes. This explanatory model, the Symptom Experience, Management, Outcomes and Adherence according to Race and Social determinants + Genomics Epigenomics and Metabolomics (SEMOARS + GEM), considers essential factors such as social determinants of health, clinician communication, symptoms and symptom management, genomics, epigenomics, and pharmacologic metabolism as contributory factors.
Highlights
Breast cancer (BC) incidence is similar among black and white women [1], except for younger black women aged 45 and under, who have higher incidence rates [2]
Unconditional logistic regression and likelihood ratio test o ATP-binding cassette, subfamily B (ABCB1) was associated with decreased odds of taxane-induced peripheral neuropathy (TIPN) OR 0.47; 95% CI 0.28–0.79; p = .004 o Tubulin Beta 2A Class IIa (TUBB2A) was associated with increased odds of TIPN OR 1.80; 95% CI 1.20–2.72; p =
Cumulative dose analysis and additive model o Ephrin Receptor A5 (EPHA5) was associated with TIPN HR 2.3; 95% CI 1.6–3.9; p = .0074 o Ephrin Receptor A6 (EPHA6) was associated with TIPN HR 1.9; 95% CI 1.2–2.9; p = .0063 o Ephrin Receptor A8 (EPHA8) was associated with TIPN HR 1.9; 95% CI 1.1–3.2; p =
Summary
Breast cancer (BC) incidence is similar among black and white women [1], except for younger black women aged 45 and under, who have higher incidence rates [2]. SEMOARS + GEM model identifies crucial factors that contribute to racial disparity in dose reduction and early chemotherapy termination These factors include symptom phenotype and intensity, symptom reporting and management, and social determinants of health. Race/ethnicity, age, income, education, zip code, allostatic load, comorbidity, and self-efficacy/belief in prescribed medication are social determinants of health that may be associated with increased symptoms resulting in dose reductions, chemotherapy holds, and early therapy cessation [68,69,70,71,72,73,74]. Miaskowski et al examined factors across multiple tumor types associated with increased symptom distress during cancer chemotherapy and found younger age, female sex, low social support, and socioeconomic status to be characteristic. Logistic regression Medicaid/no insurance versus private/private+Medicare* related to adherence to chemotherapy: β= –2.111; Adjusted OR 0.121; p= .016
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