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Symptom management after breast cancer treatment: is it influenced by patient characteristics?

Breast Cancer Research and Treatment volume 108, pages 69–77 (2008)Cite this article

Abstract

Purpose With improved patient survival from breast cancer, more interest has evolved regarding the symptoms women experience in association with breast cancer treatments. We studied the extent to which symptoms for women with incident breast cancer are addressed by their physicians and how symptom management varies with patient characteristics. Methods As part of the Los Angeles Women’s (LAW) Study, we categorized women from a population-based study of incident breast cancer (n = 1,219) as having an unmet need if she had at least one severe symptom (any of the following: nausea/vomiting, arm problems, hot flashes, vaginal dryness, difficulty sleeping) for which she did not receive the help she wanted. Multivariable analyses predicted having any unmet need as a function of patient demographic and health characteristics. Results The prevalence of unmet need varied by the type of symptom with the highest proportion of women receiving help for nausea and vomiting (0.91) and the lowest for vaginal dryness (0.48). Black women (OR = 3.61, 95% CI: [1.57, 8.31]), and Spanish-speaking Hispanic women (OR = 2.69, 95% CI: [1.22, 5.94]) were significantly more likely than white women to report an unmet need. More black and Hispanic women compared to white women cited the doctor not thinking treatment would benefit her (P = 0.02), not appreciating how much the problem bothered her (P = 0.03), not knowing about treatments (P < 0.0001), or insurance/cost barriers (P = 0.009) as reasons for her unmet need. Conclusion These results show the persistence of racial disparities in the receipt of appropriate care within the health care system.

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Fig. 1

Notes

  1.  Asian women 55–70 years were not available for this study as they had already been assigned to a different study protocol. †224 patients identified by Rapid Case Ascertainment were excluded for the following reasons: male gender (5), false positive pathology (1), breast cancer diagnosis later than study window (17), no breast cancer diagnosis (62), breast cancer not incident (139). ‡333 patients identified by Rapid Case Ascertainment were not eligible for patient survey for the following reasons: physician indicated survey contact with patient could adversely affect patient (usually for mental health reasons—16), patient did not live in or receive care in Los Angeles County (other than diagnosis—19), patient was deceased and could not be surveyed (81), patient had clinical problem precluding self-report survey (severe dementia—52, hearing impairment unable to be surveyed by phone despite several attempts using technology for hearing impaired calls—29, too ill with medical problems—39), patient spoke neither English nor Spanish—the two languages in which the survey was fielded (97). §704 patients refused survey participation (of 1,590 eligible) including 420 who refused at baseline survey and the remaining 284 who could not be located at baseline but finally refused at follow-up survey two years after diagnosis. **50 patients completed the baseline survey at 24 months post diagnosis, rather than at the time of the baseline survey fielding. Their symptom data will be described in a subsequent manuscript in association with the follow-survey data 24 months after diagnosis. ††Symptoms were asked about individually including: hot flashes, difficulty sleeping, arm problems, vaginal dryness, nausea, and vomiting

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Acknowledgments

We would like to acknowledge Dennis Deapen, MD, Donna Morell, and Ann Hamilton for assistance in using the Los Angeles County SEER Rapid Case Ascertainment (RCA) program. Financial support: National Cancer Institute Grant # R01 CA 81338-01A1. Dr. Ganz was also supported by an American Cancer Society Clinical Research Professorship award. Dr. Malin was supported by a CI-10 Damon Runyon-Lilly Clinical Investigator Award from the Damon Runyon Cancer Research Foundation.

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Authors and Affiliations

  1. School of Public Health, Health Services Department, University of California at Los Angeles, Box 951772, 90095-1772, Los Angeles, CA, USA

    Jean Yoon

  2. Amgen, Thousand Oaks, CA, USA

    Jennifer L. Malin

  3. Division of General Internal Medicine and Health Services Research, School of Medicine, University of California at Los Angeles, 911 Broxton Avenue, Box 951736, 90095-1736, Los Angeles, CA, USA

    Diana M. Tisnado & Katherine L. Kahn

  4. Valley Radiotherapy Associates Medical Group, El Segundo, CA, USA

    May Lin Tao

  5. RAND, Santa Monica, CA, USA

    John L. Adams, Martha J. Timmer & Katherine L. Kahn

  6. School of Public Health and School of Medicine, University of California at Los Angeles, CHS A2-125, Box 956900, 90095-6100, Los Angeles, CA, USA

    Patricia A. Ganz

  7. Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, CA, USA

    Patricia A. Ganz

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  1. Jean Yoon
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Correspondence to Katherine L. Kahn.

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Yoon, J., Malin, J.L., Tisnado, D.M. et al. Symptom management after breast cancer treatment: is it influenced by patient characteristics?. Breast Cancer Res Treat 108, 69–77 (2008). https://doi.org/10.1007/s10549-007-9580-1

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Keywords

  • Breast cancer
  • Disparities
  • Quality of care
  • Symptom management