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

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.

Distinct sleep disturbance and cognitive dysfunction profiles in oncology outpatients receiving chemotherapy

“…Given that this study evaluated a very limited number of social determinants of health, future research needs to explore additional characteristics (e.g., neighborhood, food security, environmental exposures). 52 While previous studies found an association between older age and higher levels of CRCI, as well as sleep disturbance, 4,7,8 patients in our High class were more likely to be younger. Of note, our finding is consistent with a study by the developers of the AFI who noted that younger individuals may react more strongly to small cognitive changes, while older individuals may have lower expectations, having adapted to alterations in cognition that accompany normal aging.…”

Patient-reported outcomes regarding radiation therapy in patients with multiple myeloma

“…It also stands to reason that increasing time from diagnosis and requirement for additional treatment lines is associated with increasing symptom burden. Multiple studies have demonstrated disparities in cancer outcomes among nonwhite patients [19][20][21][22] and this is suggested here. Further investigation of this is warranted in this setting as well.…”

Neuropathic pain prevalence and risk factors in head and neck cancer survivors

“…Related factors such as socioeconomic status, community behaviors towards health, and access to health care are common discussion points with regard to race and pain. 93,94 Interestingly, this association between race and NP is not consistent in the literature. In studies of chemotherapy-induced peripheral neuropathy, race is not a significant predictor of neuropathy.…”

“…However, environment, rather than genetic predisposition, is believed to play a bigger role in this relationship. Related factors such as socioeconomic status, community behaviors towards health, and access to health care are common discussion points with regard to race and pain 93,94 . Interestingly, this association between race and NP is not consistent in the literature.…”