Racial Differences in Breast Cancer Therapeutic Toxicity: Implications for Practice

Abstract

Disparities in treatment intensity can contribute to racial disparities in overall breast cancer survival. A natural extension of measuring racial disparities in treatment intensity is consideration of the distribution of treatment toxicities, symptoms, and distress that lead to chemotherapy dose reductions, holds or early termination. There is growing evidence that therapeutic toxicity during early-stage breast cancer treatment may be greater among Black women than White. Important components of symptom management involve the communication of symptoms, the self-care abilities of the patient, the patient's perception of the clinical encounter, and the patient centeredness of the clinical encounter. Racial differences in the symptom reporting, the clinical “reception” and response to symptoms, the prescribed management, and the patient adherence to symptom management requires further investigation. Further research must also consider the structural inequities, as well as institutional and interpersonal racism that contribute to racial differences in cancer symptom burden leading to potential decreases in dose intensity of potentially life-saving early cancer treatment. See related article by Hu et al., p. 167

Racial Disparities in Breast Cancer Treatments and Adverse Events in the SEER-Medicare Data

“…To punctuate our findings, the rates of AEs in AA patients were globally higher than those in W patients, but the differences were small. However, we hypothesize that differences in AEs or perceived AEs by caregivers can result in differences in treatments that impact outcomes, as suggested previously [36]. It is likely that as more and more private oncology practices integrate into hospital-owned systems, the trends we observed in lesser treatment in the AA population in the NCH setting will begin to shift to the trend we see in the Outpatient database, where AA patients actually have higher rates of treatment and more equivalent rates of AEs.…”

“…Treatment-induced AEs impose significant obstacles to tolerating therapy, quality of life, and the ability to administer adequate therapy, a factor that affects outcomes [35]. A large retrospective review of 12 published articles from four large databases concluded that AAs were significantly more likely to delay the initiation of therapy, to have dose-density reductions, and to discontinue treatment than W patients with early-stage BC [36]. This has been attributed to differences in the trigger points applied by treating oncologists to reduce or change drugs or stop treatment, or to differences in the frequency of AEs in different circumstances [36].…”

“…A large retrospective review of 12 published articles from four large databases concluded that AAs were significantly more likely to delay the initiation of therapy, to have dose-density reductions, and to discontinue treatment than W patients with early-stage BC [36]. This has been attributed to differences in the trigger points applied by treating oncologists to reduce or change drugs or stop treatment, or to differences in the frequency of AEs in different circumstances [36]. However, despite more frequent rates of incomplete or delayed treatment of AA patients due to AEs, only a few drugs, including anthracyclines [37] and taxanes [37,38], cause specific differences in AEs experienced by AA compared with W BC patients.…”

Quality of Life After Axillary Lymph Node Dissection Among Racial and Ethnic Minority Women

“…Moreover, minority women in our study disproportionately experienced larger decreases in physical QOL after ALND, although the reason for this disparity is unclear. Studies have reported that racial minorities may experience more chemotherapy toxicity 21,22 or more severe radiation fibrosis, 23,24 which may also contribute to more troublesome arm symptoms and worse QOL. In addition, shoulder dysfunction and range-of-motion limitations after ALND, which were not di-rectly captured in our study, may also contribute to QOL reductions that may vary by race and ethnicity.…”

“…Table 1 summarizes clinicopathological characteristics of the cohort stratified by race and ethnicity. Compared with Asian and White women, Black and Hispanic women had a higher baseline BMI (median [IQR], 30 [26][27][28][29][30][31][32][33][34] and 28 [23][24][25][26][27][28][29][30][31][32] vs 23 [21][22][23][24][25][26][27][28][29] and 26 [22][23][24][25][26][27][28][29][30], respectively; P < .001), higher clinical nodal stage at presentation (clinical nodal positivity, 83% and 87% vs 60% and 72%, respectively; P = .03), and higher rates of objective lymphedema (40% and 39% vs 17% and 21%; P = .02). Additionally, Black women were less likely than other racial or ethnic groups to have private insurance (46% vs ≥70% for the other 3 groups; P < .001).…”