||5R21CA208161-02 Interpret this number
||University Of Tennessee Health Sci Ctr
||The Role of Adverse Symptoms and Clinical Response on Racial Disparity Outcomes in Breast Cancer
This study will investigate whether black and white patients with hormone receptor-positive (HR+) breast
cancer report adverse symptoms differently, contributing to diverse treatment decisions and ultimately
disparities in health outcomes. Despite significant reductions in breast cancer mortality over the past two
decades, black-white (B-W) mortality disparities continue to widen. Among the 70% of breast cancer patients
that have HR+ tumors, black women have double the death rate of white women with the same diagnosis.
Adjuvant endocrine therapy (AET), typically using the selective estrogen receptor antagonist tamoxifen and/or
an aromatase inhibitor given orally for at least five years, significantly and substantially improves survival rates
in women with HR+ breast cancer. Unfortunately, there is significant underuse and lower adherence to AET
among black women compared to their white counterparts. AET adherence rates are low for all patients with
HR+ breast cancer, most often due to adverse side effects. We will investigate the crucial link between patient
symptoms and subsequent treatment course and health outcomes in HR+ breast cancer. Side effects of AET
clearly limit medication adherence rates and often trigger clinicians and patients to change or discontinue
treatment. To our knowledge, no one has investigated how AET-related side effects and adherence and
provider treatment decisions may be driving disparities in B-W health outcomes and mortality. Our study is
guided by the Symptom Management Model, which emphasizes the interrelatedness of three symptom
management dimensions (symptom experience, management strategies, and health outcomes) while
incorporating distinct domains and levels of analyses, including person/health and environment. Our main goal
is to understand how B-W differences in potentially modifiable factors in the treatment pathway contribute to B-
W mortality disparities. To accomplish this goal, we will pursue the following aims: 1) To determine whether we
observe statistically and clinically significant B-W differences (frequency, severity, type) in patient-reported
adverse symptoms; 2) To investigate whether black patients and their providers respond differently to the
same symptoms in terms of AET adherence and prescribed treatment changes compared to white patients;
and 3) To examine if and how patient-reported symptoms, medication adherence, and treatment changes
impact B-W disparities in breast cancer outcomes, including mortality, recurrence, and hospitalizations. We will
examine patients cared for by the West Cancer Center, an industry leader in leveraging technology to collect
and utilize patient-reported outcomes in real-time clinical settings and the largest cancer care provider in the
West Tennessee region. This region has the highest B-W breast cancer mortality disparity of the 50 largest US
cities. We will leverage nine years of data from multiple sources, including patient-reported measures, clinical
data, and claims records for Medicare and Medicaid beneficiaries. Our results will provide actionable
mechanisms for targeted interventions to reduce B-W disparities in breast cancer.
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