Nurs Res. 2023;72(2):103-113. doi: 10.1097/NNR.0000000000000636. Epub 2022 Dec 9.
Cancer survivors (defined as individuals from diagnosis to the end of life) in treatment experience multiple physical and psychological symptoms (e.g., fatigue, pain, depression, anxiety, disturbed sleep) that influence their well-being and treatment outcomes. Underrepresented cancer survivors may disproportionately experience greater symptom burden (number of symptoms, symptom severity, depression, anxiety).
The aim of this study was to examine the relationships of social determinants of health, including age, ethnicity, education, income and whether income meets the survivor's needs, neighborhood (rural vs. urban), access to healthcare (e.g., insurance), and social isolation, with symptom burden in cancer survivors.
This secondary analysis included baseline data from 400 cancer survivors of solid tumor cancers undergoing chemotherapy or targeted therapy who participated in a larger randomized trial of symptom management interventions. Symptom burden was measured by the Center for Epidemiological Studies-Depression scale for depression and Patient-Reported Outcomes Measurement Information System scores for anxiety and social isolation, summed severity index of 16 symptoms from the General Symptom Distress Scale, and the total number of symptoms. Self-reported comorbid conditions were measured using the Bayliss tool. General linear models were used to relate symptom measures (one at a time) to age, number of comorbid conditions, level of education, marital status, income meeting needs, and size of metropolitan neighborhood. Additional covariates included site of cancer, its treatment, and whether the cancer was metastatic.
Non-Hispanic White survivors ( n = 191) were older and had more comorbid conditions, a higher proportion of metastatic cancers, and higher levels of education and income compared with Hispanic survivors ( n = 168) and non-Hispanic survivors of other races ( n = 41). Compared with the other two groups, Hispanic survivors had the lowest rate of health insurance availability, and non-Hispanic survivors of other races had the lowest social isolation. Age, number of comorbid conditions, and social isolation were significantly associated with number of symptoms, symptom severity, and depression. Age and social isolation were associated with anxiety. In addition, the symptom severity of non-Hispanic White survivors was lower than that of Hispanic survivors and non-Hispanic survivors of other races.
These findings highlight the health disparities in symptom burden experienced among cancer survivors when considering their social determinants of health. Assessing these may help clinicians address health disparities in cancer care.
治疗中的癌症幸存者（定义为从诊断到生命结束的个体）经历多种身体和心理症状（例如疲劳、疼痛、抑郁、焦虑、睡眠障碍），这会影响他们的幸福感和治疗效果。代表性不足的癌症幸存者可能会经历更大的症状负担（症状数量、症状严重程度、抑郁、焦虑）。
本研究旨在探讨健康社会决定因素（包括年龄、种族、教育、收入以及收入是否满足幸存者的需求、社区（农村与城市）、获得医疗保健（例如保险）和社会隔离）与癌症幸存者症状负担之间的关系。
这是一项二次分析，纳入了 400 名正在接受化疗或靶向治疗的实体瘤癌症幸存者的基线数据，他们参加了一项更大规模的症状管理干预措施的随机试验。症状负担通过流行病学研究中心抑郁量表评估抑郁，通过患者报告的结局测量信息系统评估焦虑和社会隔离，通过一般症状困扰量表评估 16 个症状的总和严重程度指数，以及症状总数。使用 Bayliss 工具评估共病情况。使用一般线性模型将症状测量值（一次一个）与年龄、共病数量、教育水平、婚姻状况、收入是否满足需求以及大都市社区规模相关联。其他协变量包括癌症部位、治疗方法以及癌症是否转移。
与西班牙裔幸存者（n=168）和其他非裔美国幸存者（n=41）相比，非西班牙裔白种人幸存者（n=191）年龄更大，共病数量更多，转移性癌症比例更高，教育和收入水平更高。与其他两组相比，西班牙裔幸存者的医疗保险可用性最低，而其他非裔美国幸存者的社会隔离程度最低。年龄、共病数量和社会隔离与症状数量、症状严重程度和抑郁显著相关。年龄和社会隔离与焦虑相关。此外，非西班牙裔白种人幸存者的症状严重程度低于西班牙裔幸存者和其他非裔美国幸存者。
这些发现强调了考虑癌症幸存者健康社会决定因素时，他们在症状负担方面存在的健康差异。评估这些因素可能有助于临床医生解决癌症护理中的健康差异。
