The Time Is Now to Address Racial Disparities in Oncology Symptom Science
Although cancer mortality in the United States has decreased in most populations, non-Whites still have a disproportionately higher risk, and recent events have raised awareness of racial healthcare disparities. During a session on April 29, 2021, for the ONS 46th Annual Congress™, Margaret Quinn Rosenzweig, PhD, FNP-BC, AOCNP®, FAAN, of the University of Pittsburgh School of Nursing, Susan G. Dorsey, PhD, RN, FAAN, of the University of Maryland School of Nursing, and Angela Starkweather, PhD, ACNP-BC, FAAN, FAANP, of the University of Connecticut School of Nursing and School of Medicine, explored the application of the symptom science model to address the needs of underrepresented patients.
Racism Is a Public Health Threat
According to Rosenzweig, half of overall cancer survival racial disparities in Black Americans can be explained by late-stage diagnoses. However, a focus on screening encourages a narrow view of the issue and discourages exploration of other causes. As a result, national efforts began in the early 2000s to create theoretical frameworks to better understand racial healthcare gaps.
One such framework, the symptom science model, views the symptom experience as a dynamic process that should be managed in context of each patient’s illness and health, similar to other forms of precision medicine strategies. In this model, healthcare providers consider the impact of social determinants of health, such as race, ethnicity, and income, on symptom perception, management, and outcomes.
The events of summer 2020 in the United States urged the effort into greater action. COVID-19 coronavirus disparities, the death of George Floyd, and the rise of the Black Lives Matter movement led the American Medical Association to issue a statement recognizing racism as a public health risk. The vigor of healthcare providers response has important ramifications for Black Americans’ “tumor characteristics, potential response to therapy, and for expectation of toxicity in accordance with prescribed therapy,” Rosenzweig said.
Close the Gap With Personalized Care
Rosenzweig and her research team examined the relationship between incidents of dose alteration during early-stage breast cancer chemotherapy and symptom experience and found that they occurred most often for pain. In addition, Black patients reported feeling disparities in their symptom experience because they “do not feel heard” by White clinical staff. Oncology providers should be vigilant to address this disparity in their practices, she said.
“Personalization of care should be the goal for quality care,” Rosenzweig said. “This personalization also needs to occur when patients from any racial, religious, ethnic, sexual orientation, and income level interacts with cancer care providers. Institutional strategies to mitigate disparities in therapy toxicity should include in-depth initial assessments so that every patient's specific multilayer factors that may impact their ability to receive prescribed therapy are known at the onset of care. A prompt mitigation plan can be developed to ensure optimal treatment with minimal disruption and need for dose alteration.”
Because symptom science drives those strategies for clinicians, “researchers must better quantify dose response to patient navigation and support in accordance with assessed risk factors for poor therapy tolerance so that mitigation factors can be promptly initiated in response to risk,” she said.
Precision health applies those symptom science findings to practice. For chronic pain in patients with cancer, studies have identified a higher incidence in women, older adults, those who experience poverty or unemployment, and those living in rural settings. As with addressing racial disparities, personalized pain management requires a multidimensional approach.
“Universally, all clinicians must listen to their patients as they are undergoing therapy in a curious, respectful, and open manner so that they appreciate and try to understand the difficulties that individual patients face,” Rosenzweig said. “We know that one size does not fit all. Personalizing care recognizes that clinicians must be open to the complex individual patient.”