1. Symptom Distress During Breast Cancer Chemotherapy Does Race Matter? Margaret Quinn Rosenzweig, PhD, FNP-BC,AOCNP Associate Professor University of Pittsburgh School of Nursing Funding American Cancer Society, RSGT-09-150-01-CPHPS Preliminary Work NCI-KO7 CA 100 588 (03-08) Susan G. Komen Foundation, POP33008 Center for Research University of Pittsburgh School of Nursing

2. Background AA women have worse survival disparity than white women in breast cancer. Multifactorial: Environment, Patient and Provider –More under-dosing secondary to BMI or co-morbidities.

3. Under-Dosing? AA patients with cancer including AA women with breast cancer historically experience greater chemotherapy related symptom distress than white women. –Chemo is held, decreased or discontinued with symptom distress

4. Specific Aims 1.Determine the cumulative and individual symptom distress of women during breast cancer chemotherapy. 2. Compare the cumulative and individual symptom distress of women during breast cancer chemotherapy according to race.

5. Sample Starting January 1, 2010 - December 31,2011 All AA women receiving chemotherapy with matched white sample. One urban cancer center with routine symptom assessment and distress screening.

6. Design Retrospective chart review Matched pair analysis Matched white women 1:1 for age and stage –Excel to SPSS v.20

7. Instrument The 9 item Edmonton Symptom Assessment Scale is used in routine clinic practice as a patient symptom reporting tool. Potential score is 0-90. Higher scores indicate worse distress. The incidence and severity of symptoms were measured at baseline and each chemotherapy administration visit.

8. Total Chemotherapy Visits 240 visits for AA women –(mean 7.7 chemo visits/patient) 250 visits for W women – (mean 7.6 chemo visits/patient).

9. Mean Symptom Scores Total Mean ESAS Scores were worse during chemotherapy for AA than white women. Mean ScoresAA (n=28) White (n=28) P value At Baseline9.4/ 12.88.6/12.5p=.131 Total12.7/8.3/P=.001

10. Disparity in Specific Symptoms Total mean scores for 4 of the 9 symptoms over the course of chemotherapy. AAWhiteP value NauseaMean/SD 1.26/2.4 Mean/SD.4/1.4 P=.000 AppetiteMean/SD 1.14/2.2 Mean/SD.3/.9 P=.000 Shortness of BreathMean/SD.90/1.8 Mean/SD.24/.72 P=.000 FatigueMean/SD 3.2/3.2 Mean/SD 2.1/2.5 P=.000

11. Chemotherapy Dose Reduction White - 1/28 white patients dose reduced, no early cessation. African American - 1/28 patients dose reduced, 3/28 AA patients had early chemotherapy cessation

12. Conclusions Overall symptom distress and specific symptoms during breast cancer chemotherapy are worse for AA women than matched White controls. Clinical significance is unknown.

13. Conclusion This awareness can help nurses provide targeted anticipatory guidance and preventative measures in order to decrease symptom burden, and possibly prevent chemotherapy dose reduction and early treatment cessation.