The Effect of Race and Area Deprivation on Symptom Profiles over the Course of Early-Stage Breast Cancer

This study compared common symptoms (fatigue, pain), overall physical functioning and changes over time between Black and White women receiving early-stage breast cancer (ESBC) chemotherapy.

A longitudinal, repeated measures comparative design was employed. Time points of symptom measurement (PROMIS domains) at baseline, mid and end point were adjusted as per patient chemotherapy schedule.

Linear mixed models were applied.

There were 147 patients, 36% Black 64% White (54±12 years) recommended to receive early-stage breast cancer chemotherapy with adequate data for symptom analysis.

Main effect of race was significant (F(1, 390) = 29.43, p<.001) for pain with Black patients experiencing significantly higher pain scores compared to White patients at pretherapy (Mean Difference; MD=3.7, p=.034), midpoint (MD=5.8, p=.002), and endpoint (MD=7.8, p<.001).

Fatigue significantly increased (deteriorated) at endpoint (MD_T1-T3= 8.7, p<.001) for Black patients. Among White patients, fatigue significantly increased at midpoint (MD_T1-T2= 5.7) and at endpoint (MD_T1-T3=10.1, p<.001; MD_T2-T3=4.3, p= .017). Physical function: Black patients had significantly lower physical function scores compared to White patients at midpoint (MD=4.0, p=.027). Physical function decreased by endpoint in Black (MD_T1-T3=7.8, p<.001), and White patients (MD_T1-T3=7.7, p<.001).

Symptom burden significantly increased over the course of chemotherapy for all patients. Scores for pain and physical function were higher overall for Black patients and deteriorated at a greater rate for Black vs. White women over the course of chemotherapy. This assessment holds implication for proactive assessment and mitigation strategies.