Abujaradeh Hiba, O'Brien Julia, Mazanec Susan R, Bender Catherine M, Schlemmer Isabelle M, Brufsky Adam M, Nasrollahi Elham, Rosenzweig Margaret
University of Pittsburgh School of Nursing, Pittsburgh, PA, USA (H.A., J.O.B., C.M.B., I.M.S.).
Case Western University Frances Payne Bolton School of Nursing, Cleveland, OH, USA (S.R.M.).
J Pain Symptom Manage. 2025 Jun;69(6):663-672. doi: 10.1016/j.jpainsymman.2025.03.010. Epub 2025 Mar 17.
Limited research has examined racial disparities in symptom burden prior to chemotherapy initiation, during and at the chemotherapy completion.
To describe and compare the symptom burden (fatigue, pain, and physical functioning) and change over time between Black and White women receiving Early-Stage Breast Cancer (ESBC) chemotherapy while considering social determinants of health.
A longitudinal, repeated measures comparative design was employed. Time points of symptom measurement (PROMIS domains) at baseline, mid and end point were adjusted as per patient chemotherapy schedule. Linear mixed models were applied.
There were 149 patients, 36% Black 64% White (54 ± 12 years) recommended to receive ESBC chemotherapy with adequate data for symptom analysis. PAIN: Main effect of race was significant (F(1, 390) = 29.43, P < .001) for pain.Black patients experienced significantly higher pain scores compared to White patients at pretherapy (Mean Difference; MD = 3.7, P = .034), midpoint (MD = 5.8, P = .002), and endpoint (MD = 7.8, P < .001). In the adjusted model, Black race and higher BMI were significant predictors of higher pain scores. Black patients experienced significant deterioration in pain over time.
The scores for fatigue increased significantly from baseline for Black patients by endpoint (MD = 8.7, P < .001) and for White patients at midpoint (MD = 5.7) and at endpoint (MD = 10.1, P < .001). In the adjusted model, higher BMI predicted worse fatigue scores.
Black patients had significantly lower physical function scores compared to White patients at midpoint (MD = 4.0, P = .027). Physical function decreased by endpoint in Black (MD = 7.8, P < .001), and White patients (MD = 7.7, P < .001). In the adjusted model, only higher BMI and cardiopulmonary comorbidities significantly predicted worse physical function.
Symptom burden significantly increased over the course of chemotherapy for all patients. Scores for pain and physical function were higher overall for Black patients and deteriorated at a greater rate for Black vs. White women over the course of chemotherapy. BMI was a significant predictor of pain, fatigue, and physical function, this assessment holds implications for proactive assessment and mitigation strategies.
仅有有限的研究考察了化疗开始前、化疗期间及化疗结束时症状负担方面的种族差异。
描述并比较接受早期乳腺癌（ESBC）化疗的黑人和白人女性的症状负担（疲劳、疼痛和身体功能）及其随时间的变化，同时考虑健康的社会决定因素。
采用纵向重复测量比较设计。根据患者化疗时间表调整基线、中点和终点时症状测量（PROMIS领域）的时间点。应用线性混合模型。
共有149例患者，36%为黑人，64%为白人（54±12岁），被推荐接受ESBC化疗且有足够数据用于症状分析。疼痛：种族的主效应在疼痛方面显著（F(1, 390) = 29.43，P <.001）。与白人患者相比，黑人患者在治疗前（平均差异；MD = 3.7，P =.034）、中点（MD = 5.8，P =.002）和终点（MD = 7.8，P <.001）时的疼痛评分显著更高。在调整模型中，黑人种族和较高的BMI是疼痛评分较高的显著预测因素。黑人患者的疼痛随时间显著恶化。
黑人患者的疲劳评分从基线到终点显著增加（MD = 8.7，P <.001），白人患者在中点（MD = 5.7）和终点（MD = 10.1，P <.001）时疲劳评分也显著增加。在调整模型中，较高的BMI预测疲劳评分更差。
在中点时，黑人患者的身体功能评分显著低于白人患者（MD = 4.0，P =.027）。黑人患者（MD = 7.8，P <.001）和白人患者（MD = 7.7，P <.001）在终点时身体功能均下降。在调整模型中，只有较高的BMI和心肺合并症显著预测身体功能更差。
所有患者在化疗过程中症状负担均显著增加。黑人患者的疼痛和身体功能评分总体上更高，且在化疗过程中黑人女性比白人女性恶化速度更快。BMI是疼痛、疲劳和身体功能的显著预测因素，这一评估对主动评估和缓解策略具有启示意义。
