Race and income converge to shape women's experiences with advanced breast cancer

ATLANTA To determine the challenges of coping with metastatic breast cancer, researchers at the University of Pittsburgh schools of Nursing and Medicine evaluated the impact of race and income on women's experiences with the disease. They found that low-income African-American women were more likely to report physical and social distress and uncertainty about their future than other groups evaluated in the study. The results of the study were announced today at the 42nd American Society of Clinical Oncology (ASCO) Annual Meeting in Atlanta.

"As more and more women are living with metastatic breast cancer, it becomes ever more important to look at how women experience the disease differently based on their unique circumstances," said Margaret Quinn Rosenzweig, Ph.D., assistant professor, department of acute and tertiary care, University of Pittsburgh School of Nursing. "While we know that equitable treatment and symptom management are critical to breast cancer survival, we know much less about how quality of life and symptom distress vary according to women's race and income level, particularly for women living with advanced breast cancer."

The study looked at how women perceived barriers to treatment and to symptom management by evaluating the experiences of 57 women with metastatic breast cancer. Based on self-reporting, women were categorized into four groups: eight low-income African-American women, eight high-income African-American women, 16 low-income white women, and 25 high-income white women. Women filled out questionnaires on socio-demographics, symptom distress and quality of life, and were interviewed by the researchers to assess their experience with symptoms, self-care strategies and barriers to managing their symptoms.

The researchers found much higher levels of symptom distress and lower levels of quality of life reported by low-income African-American women than women from the other racial and economic groups. During the interviews, these women also reported uncertainty regarding the goals of treatment, explaining that they did not know what to expect from treatment and did not feel as though their treatment goals were explained by the medical professionals overseeing their care.

"One of the most striking findings is that just looking at race or income alone is not enough," said Dr. Rosenzweig. "The unique combinations of race and income delineate important distinctions. For example, low-income white women and low-income African-American women do not seem to share the same level of symptom distress. Low-income African-American women may have more vulnerability coming into advanced illness, making the experience much more difficult for them, than it is for higher income African-Americans or white women."

Dr. Rosenzweig went on to say that race and income need to be further disentangled in order to appreciate women's unique strengths and vulnerabilities as they live with metastatic breast cancer.

"This study also points to the crucial influence care providers can have on improving outcomes for patients by tailoring care more appropriately to give women the tools they need to better cope with advanced breast cancer," added Dr. Rosenzweig.

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Co-authors of the study include Susan Sereika, Ph.D., and Theresa Wiehagan, University of Pittsburgh School of Nursing; and Adam Brufsky, M.D., Ph.D, and Robert Arnold, M.D., University of Pittsburgh School of Medicine. The study was funded by a grant from the National Cancer Institute to the Center for Research in Chronic Disease at the University of Pittsburgh School of Nursing.

The study is abstract number 8609 in the 2006 ASCO Annual Meeting Proceedings.


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