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Racial differences in symptom management experiences during breast cancer treatment

Supportive Care in Cancer volume 26, pages 1425–1435 (2018)Cite this article

Abstract

Purpose

Racial disparities in cancer treatment-related symptom burden are well documented and linked to worse treatment outcomes. Yet, little is known about racial differences in patients’ treatment-related symptom management experiences. Such understanding can help identify modifiable drivers of symptom burden inequities. As part of the Cancer Health Accountability for Managing Pain and Symptoms (CHAMPS) study, we examined racial differences in symptom management experiences among Black and White breast cancer survivors (BCS).

Methods

We conducted six focus groups (n = 3 Black BCS groups; n = 3 White BCS groups) with 22 stages I–IV BCS at two cancer centers. Focus groups were audio-recorded and transcribed verbatim. Based on key community-based participatory research principles, our community/academic/medical partner team facilitated focus groups and conducted qualitative analyses.

Results

All BCS described positive symptom management experiences, including clinician attentiveness to symptom concerns and clinician recommendations for pre-emptively managing symptoms. Black BCS commonly reported having to advocate for themselves to get information about treatment-related symptoms, and indicated dissatisfaction regarding clinicians’ failure to disclose potential treatment-related symptoms or provide medications to address symptoms. White BCS often described dissatisfaction regarding inadequate information on symptom origins and clinicians’ failure to offer reassurance.

Conclusions

This study elucidates opportunities for future research aimed at improving equity for cancer treatment-related symptom management. For Black women, warnings about anticipated symptoms and treatment for ongoing symptoms were particular areas of concern. Routine symptom assessment for all women, as well as clinicians’ management of symptoms for racially diverse cancer patients, need to be more thoroughly studied and addressed.

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Funding

This study was conducted with funding support from the National Cancer Institute Award Diversity Supplement Award (grant number: 3 R01 CA150980-04S1).

Author information

Authors and Affiliations

  1. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA

    Cleo A. Samuel, Jemeia Kollie, Olive Mbah & Jessica Taylor

  2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA

    Cleo A. Samuel & Samuel Cykert

  3. The Partnership Project, 620 S. Elm St, Suite 381, Greensboro, NC, 27406, USA

    Jennifer Schaal

  4. Department of Medicine, University of Pittsburgh, 5150 Centre Avenue, POB 2 Room, 438, Pittsburgh, PA, 15232, USA

    Linda Robertson

  5. Department of Public Health Studies, Elon University, Campus Box 2337, Elon, NC, 27224, USA

    Stephanie Baker

  6. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA

    Kristin Black, Katrina Ellis, Eugenia Eng & Amanda Kotey

  7. Cancer Health Disparities Training Program, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7440, Chapel Hill, NC, 27599-7440, USA

    Kristin Black, Katrina Ellis & Eugenia Eng

  8. Department of Public Health Education, University of North Carolina at Greensboro, 437 Coleman Building, P.O. Box 26170, Greensboro, NC, 27402-6169, USA

    Crystal Dixon

  9. Department of Public Health Education, North Carolina Central University, 1801 Fayetteville St, Durham, NC, 27701, USA

    Fatima Guerrab

  10. Sisters Network Greensboro, P.O. Box 20304, Greensboro, NC, 27420, USA

    Nora Jones & Vickie Whitt

  11. Guilford College, 5800 W Friendly Ave, Greensboro, NC, 27410, USA

    Claire Morse

  12. School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, CB#7110, Chapel Hill, NC, 27599, USA

    Samuel Cykert

Authors
  1. Cleo A. Samuel
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  2. Jennifer Schaal
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  3. Linda Robertson
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  4. Jemeia Kollie
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  5. Stephanie Baker
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  6. Kristin Black
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  7. Olive Mbah
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  8. Crystal Dixon
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  9. Katrina Ellis
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  10. Eugenia Eng
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  11. Fatima Guerrab
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  12. Nora Jones
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  13. Amanda Kotey
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  14. Claire Morse
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  15. Jessica Taylor
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  16. Vickie Whitt
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  17. Samuel Cykert
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Corresponding author

Correspondence to Cleo A. Samuel.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Samuel, C.A., Schaal, J., Robertson, L. et al. Racial differences in symptom management experiences during breast cancer treatment. Support Care Cancer 26, 1425–1435 (2018). https://doi.org/10.1007/s00520-017-3965-4

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  • DOI: https://doi.org/10.1007/s00520-017-3965-4

Keywords

  • Breast cancer
  • Blacks/African-Americans
  • Symptom management
  • Patient-provider communication