Symptom Experience, Management, and Outcomes According to Race and Social Determinants Including Genomics, Epigenomics,
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Symptom Experience, Management, and Outcomes According to Race and Social Determinants Including Genomics, Epigenomics, and Metabolomics (SEMOARS + GEM): an Explanatory Model for Breast Cancer Treatment Disparity Maura K. McCall 1 & Mary Connolly 1 & Bethany Nugent 1 & Yvette P. Conley 1 & Catherine M. Bender 1 & Margaret Q. Rosenzweig 1
# The Author(s) 2019
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 patientcenteredness 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. Keywords Breast cancer . Symptom . Social determinants . Treatment disparity . Chemotherapy . African-American . Dose intensity
Introduction 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]. Yet black women die from BC at a rate 42% higher than white women [1, 3] and are more frequently diagnosed at later disease stages and with aggressive triple-negative (estrogen, progesterone, HER2/neu)
tumors [2]. This increase is particularly true in BC, confirmed when a meta-analysis reported a 1.22 odds ratio for a negative effect of African-American ethnicity on BC mortality [4]. These negative outcome differences persist after controlling for disease stage and tumor type, comorbidities, age, and insurance status, which leaves the underlying cause of this disparity unexplained [5, 6]. Receiving ≤ 85% of prescribed BC chemotherapy is associated with poor outcomes [7–9]. Racial
* Margaret Q. Rosenzweig [email protected]
Yvette P. Conley [email protected]
Maura K. McCall [email protected]
Catherine M. Bender [email protected]
Mary Connolly [email protected] Bethany Nugent [email protected]
1
University of Pittsburgh School of Nursing, 3500 Victoria Street, Pit
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