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Treatment-related symptoms among underserved women with breast cancer: the impact of physician–patient communication

  • Epidemiology
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Abstract

Low-income, minority women are more likely to be undertreated for breast cancer (BC) treatment-related symptoms than whites. This study assessed the impact of patient–physician communication on symptom resolution. A cross-sectional, California statewide survey was conducted among 921 low-income women with BC. Ethnic/racial differences in BC treatment-related symptoms (pain, nausea/vomiting, depression) reporting and physician’ awareness of these symptoms were assessed by patient report. Multivariate logistic regression models were used to investigate the impact of patient–physician communication on symptom resolution. Depression was the most common symptom reported by patients (66%), yet physicians were the least aware of it (26.3%), especially among less-acculturated Latinas (18.9%) and Asian/Pacific Islanders (14%; P < 0.001). Greater patient-perceived self-efficacy in communication with physicians and greater physician awareness of the symptom positively predicted pain resolution, controlling for sociodemographic variables, comorbidity, and treatment received (AOR = 1.05, P < 0.0001; AOR = 6.12, P < 0.001). Physician awareness was a significant determinant of depression resolution (AOR = 13.46, P < 0.001). Yet patient-perceived self-efficacy played a much more important role than physicians’ awareness in nausea resolution (AOR = 1.04, P = 0.0002). Less-acculturated Latinas tended to achieve less symptom resolution than whites, while this negative impact disappeared or was moderated after patient–physician communication was considered. This study suggests that physicians under-recognized depression, especially among Latinas. The resolution of BC treatment-related symptoms can be addressed by appropriate educational interventions targeted at patient–physician communication. Effective patient–physician communication can moderate disparities in symptom resolution among Latinas, regardless of language acculturation.

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References

  1. National Cancer Institute Breast Cancer (2008) Available from URL: http://www.cancer.gov/cancertopic/types/breast. Accessed 29 May 2008

  2. Soerjomataram I, Louwman MWJ, Bibot JG, Roukema JA, Coebergh JWW (2008) An overview of prognostic factors for long-term survivors of breast cancer. Breast Cancer Res Treat 107:309–330. doi:10.1007/s10549-007-9556-1

    Article  CAS  PubMed  Google Scholar 

  3. Taylor R, Davis P, Boyages J (2003) Long-term survival of women with breast cancer in New South Wales. Eur J Cancer 39:215–222. doi:10.1016/S0959-8049(02)00486-0

    Article  PubMed  Google Scholar 

  4. Peto R, Boreham J, Clarke M et al (2000) UK and USA breast cancer deaths down 25% in year 2000 at ages 20–69 years. Lancet 355:1822. doi:10.1016/S0140-6736(00)02277-7

    Article  CAS  PubMed  Google Scholar 

  5. National Cancer Institute SEER Cancer Statistics Review (1975–2002) Available from URL: http://seer.cancer.org/csr/1975_2002/. Accessed 29 May 2008

  6. Cella D (1994) Quality of life: concepts and definition. J Pain Symptom Manage 9:186–192. doi:10.1016/0885-3924(94)90129-5

    Article  CAS  PubMed  Google Scholar 

  7. Powe BD, Hamilton J, Hancock N, et al. (2007) Quality of life of African American cancer survivors: a review of the literature. Cancer 109:435–445

    Article  PubMed  Google Scholar 

  8. Smith KW, Avis NE, Assmann SF (1999) Distinguish between quality of life and health status in quality of life research: a meta-analysis. Qual Life Res 8(5):447–459. doi: 10.1023/A:1008928518577

    Article  CAS  PubMed  Google Scholar 

  9. Mith W, Bourne D, Squair J, Phililips D, Chambers W (1999) A retrospective cohort study of post mastectomy pain syndrome. Pain 83:91–95. doi:10.1016/S0304-3959(99)00076-7

    Article  Google Scholar 

  10. Booth CM, Clemons M, Dranitsaris G et al (2007) Chemotherapy-induced nausea and vomiting in breast cancer patients: a prospective observational study. J Support Oncol 5(8):374–380

    PubMed  Google Scholar 

  11. Badger TA, Braden CJ, Mishel MH (2001) Depression brudent, self-help interveetions, and side effect experience in women receiving treatment for breast cancer. Oncol Nurs Forum 28:567–574

    CAS  PubMed  Google Scholar 

  12. Byar KL, Berger AM, Bakken SL (2006) Impact of adjuvant breast cancer chemotherapy on fatigue, other symptoms, and quality of life. Oncol Nurs Forum 33:E18–E26. doi:10.1188/06.ONF.E18-E26

    Article  PubMed  Google Scholar 

  13. Booth CM, Clemons M, Dranitsaris B et al (2007) Chemotherapy-induced nausea and vomiting in breast cancer patients: a prospective observational study. J Support Oncol 5:374–380

    PubMed  Google Scholar 

  14. Walker LG, Heys SD, Walker MB et al (1999) Psychological factors can predict the response to primary chemotherapy in patients with locally advanced breast cancer. Eur J Cancer 35(13):1783–1788. doi:10.1016/S0959-8049(99)00169-0

    Article  CAS  PubMed  Google Scholar 

  15. Stevens P, Dibble SL, Miakowski C (1995) Prevalence, characteristics and impact of post-mastectomy pain syndrome. Pain 83:91–95

    Google Scholar 

  16. Eversley R, Estrin D, Dibble S et al (2005) Post-treatment symptoms among ethnic minority breast cancer survivors. Oncol Nurs Forum 32(2):250–256. doi:10.1188/05.ONF.250-256

    Article  PubMed  Google Scholar 

  17. Janz NK, Mujahid M, Chung LK et al (2007) Symptom experience and quality of life of women following breast cancer treatment. J Womens Health 16:1348–1361. doi:10.1089/jwh.2006.0255

    Article  Google Scholar 

  18. Yoon J, Marlin JL, Tao ML et al (2008) Symptoms after breast cancer treatment: are they influenced by patient characteristics? Breast Cancer Res Treat 108(1):69–77. doi:10.1007/s10549-007-9580-1

    Article  PubMed  Google Scholar 

  19. Ashing-Giwa K, Ganz PA, Petersen L (1999) Quality of life of African–Americans and white long term breast carcinoma survivors. Cancer 85:418–426. doi:10.1002/(SICI)1097-0142(19990115)85:2<418::AID-CNCR20>3.0.CO;2-9

    Article  CAS  PubMed  Google Scholar 

  20. Stanton AL, Bernaards CA, Ganz PA (2005) The BCPT symptom scales: a measure of physical symptoms for women diagnosed with or at risk for breast cancer. J Natl Cancer Inst 97(6):448–456

    Article  PubMed  Google Scholar 

  21. Castel LD, Saville BR, Depuy V et al (2008) Racial differences in pain during 1 year among women with metastatic breast cancer: a hazards analysis of interval-censored data. Cancer 112:162–170. doi:10.1002/cncr.23133

    Article  PubMed  Google Scholar 

  22. Maly RC, Umezawa Y, Leake B, Silliman RA (2004) Determinants of participation in treatment decision-making by older breast cancer patients. Breast Cancer Res Treat 85:201–209. doi:10.1023/B:BREA.0000025408.46234.66

    Article  PubMed  Google Scholar 

  23. Woodward NJ, Wallston BS (1987) Age and health care beliefs: self-efficacy as mediator of low desire for control. Psychol Aging 2:3–8. doi:10.1037/0882-7974.2.1.3

    Article  CAS  PubMed  Google Scholar 

  24. Greene MG, Adelman R, Charon R, Hoffman S (1986) Ageism in the medical encounter: an exploratory study of the doctor–elderly patient relationship. Lang Commun 6:113–124. doi:10.1016/0271-5309(86)90010-8

    Article  PubMed  Google Scholar 

  25. Breen N, Kessler LG, Brown ML (1996) Breast cancer control among the underserved—an overview. Breast Cancer Res Treat 40:105–115. doi:10.1007/BF01806006

    Article  CAS  PubMed  Google Scholar 

  26. Newman LA, Martin IK (2007) Disparities in breast cancer. Curr Probl Cancer 31(3):134–156. doi:10.1016/j.currproblcancer.2007.01.003

    Article  PubMed  Google Scholar 

  27. Pendleton DA, Bochner S (1980) The communication of medical information in general practice consultations as a function of patients’ social class. Soc Sci Med 14A:669–673

    CAS  Google Scholar 

  28. Chen JY, Diamant AL, Thind A, Maly RC (2008) Determinants of breast cancer knowledge among newly diagnosed, low-income, medically underserved women with breast cancer. Cancer 112(5):1153–1161. doi:10.1002/cncr.23262

    Article  PubMed  Google Scholar 

  29. Maly RC, Frank JC, Marshall GN, DiMatteo MR, Reuben DB (1998) Perceived efficacy in patient–physician interactions (PEPPI): validation of an instrument in older persons. J Am Geriatr Soc 46(7):889–894

    CAS  PubMed  Google Scholar 

  30. Marin G, Sabogal F, Marin B, Otero-Sabogal R, Perez-Stable E (1987) Development of a short acculturation scale for Hispanics. Hisp J Behav Sci 9:183–205. doi:10.1177/07399863870092005

    Article  Google Scholar 

  31. Badger TA, Braden CJ, Mishel MH (2001) Depression brudent, self-help interventions, and side effect experience in women receiving treatment for breast cancer. Oncol Nurs Forum 28:567–574

    CAS  PubMed  Google Scholar 

  32. Compas BE, Stoll MF, Thomsen AH et al (1999) Adjustment to breast cancer: age-related differences in coping and emotional distress. Breast Cancer Res Treat 54:195–203. doi:10.1023/A:1006164928474

    Article  CAS  PubMed  Google Scholar 

  33. Sharpe M, Strong V, Allen K et al (2004) Major depression in outpatients attending a regional caner center: screening and unmet treatment needs. Br J Cancer 90:314–320. doi:10.1038/sj.bjc.6601578

    Article  CAS  PubMed  Google Scholar 

  34. Unutzer J, Katon W, Callahan CM et al (2002) Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA 288:2836–2845. doi:10.1001/jama.288.22.2836

    Article  PubMed  Google Scholar 

  35. Valente SM, Saunders JM, Cohen MZ (1994) Evaluating depression among patients with cancer. Cancer Pract 2:65–71

    CAS  PubMed  Google Scholar 

  36. Interian A, Martinez IE, Guarnaccia PJ et al (2007) A qualitative analysis of the perception of stigma among Latinos receiving antidepressants. Psychiatr Serv 58:1591–1594. doi:10.1176/appi.ps.58.12.1591

    Article  PubMed  Google Scholar 

  37. Maguire P (1985) Improving the detection of psychiatric problems in cancer patients. Soc Sci Med 20:819–823. doi:10.1016/0277-9536(85)90336-3

    Article  CAS  PubMed  Google Scholar 

  38. Passik SD, Dugan W, McDonald MV et al (1998) Oncologists’ recognition of depression in their patients with cancer. J Clin Oncol 16:1594–1600

    CAS  PubMed  Google Scholar 

  39. Payne R, Medina E, Hampton JW (2003) Quality of life concerns in patients with breast cancer: evidence for disparity of outcomes and experiences in pain management and palliative care among African–American women. Cancer 97:311–317. doi:10.1002/cncr.11017

    Article  PubMed  Google Scholar 

  40. Cleeland CS, Gonin R, Baez L et al (1997) Pain and treatment of pain in minority patients with cancer. The Eastern cooperative oncology group minority outpatient pain study. Ann Intern Med 127(9):813–816

    CAS  PubMed  Google Scholar 

  41. Anderson KO, Richman SP, Hurley J (2001) Cancer pain management among underserved minority outpatients. Cancer 94(8):2295–2304. doi:10.1002/cncr.10414

    Article  Google Scholar 

  42. Juarez G, Ferrell B, Borneman T (1999) Cultural considerations in education for cancer pain management. J Cancer Educ 14:168–173

    CAS  PubMed  Google Scholar 

  43. Anderson KO, Mendoza TR, Valero V et al (2000) Minority cancer patients and their providers-pain management attitudes and practice. Cancer 88:1929–1938. doi:10.1002/(SICI)1097-0142(20000415)88:8<1929::AID-CNCR23>3.0.CO;2-2

    Article  CAS  PubMed  Google Scholar 

  44. Kris MG, Hesketh PJ, Somerfield MR et al (2006) American society of clinical oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol 24:2932–2947. doi:10.1200/JCO.2006.06.9591

    Article  CAS  PubMed  Google Scholar 

  45. Roila F, Hesketh PJ, Herrstedt J et al (2006) Antiemetic subcommittee of the multinational association of supportive care in cancer. Prevention of chemotherapy-and radiotherapy-induced emesis: results of the 2004 Perugia International Antiemetic Consensus Conference. Ann Oncol 17:20–28. doi:10.1093/annonc/mdj936

    Article  CAS  PubMed  Google Scholar 

  46. National Comprehensive Cancer Network NCCN Clinical Practice Guidelines in Oncology: Antiemesis, V.1. 2007. Available from URL: http://www.nccn.org/ professionals/physician_gls/PDF/antiemesis.pdf. Accessed 3 Aug 2007

  47. Bernstein R Hispanic Population Passes 40 million: Census Bureau Reports. US Census Bureau News, US Department of Commerce, Washington, D.C. Released June 9, 2005. Available from URL: http://www.census.gov/population/www/cen2000/briefs.html. Accessed 9 Sept 2005

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Acknowledgments

This study was funded by the American Cancer Society (# TURSG-02-081) and the California Breast Cancer Research Program (# 7PB-0070).

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Authors and Affiliations

  1. Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Ste 1800, Los Angeles, CA, 90024, USA

    Rose C. Maly & Yihang Liu

  2. Department of Family Medicine, David Geffen School of Medicine, and School of Nursing at UCLA, Los Angeles, CA, USA

    Barbara Leake

  3. Department of Family Medicine, Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada

    Amardeep Thind

  4. Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Allison L. Diamant

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  1. Rose C. Maly
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Correspondence to Rose C. Maly.

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Maly, R.C., Liu, Y., Leake, B. et al. Treatment-related symptoms among underserved women with breast cancer: the impact of physician–patient communication. Breast Cancer Res Treat 119, 707–716 (2010). https://doi.org/10.1007/s10549-009-0418-x

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  • DOI: https://doi.org/10.1007/s10549-009-0418-x

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