• Cancer, Breast

• Disparate Metastatic Breast Cancer (MBC) Symptom Severity and Management Barriers

• The ACT Intervention to Reduce Breast Cancer Treatment Disparity in African American Women

Rosenzweig, Margaret Q.
8/1/03-7/31/08

K07 CA100588 NIH
 

Disparate Metastatic Breast Cancer (MBC) Symptom Severity and Management Barriers

The primary purpose of the study is to provide the applicant wit the means and structure of achieving two immediate foals and one long-term goal. The long-term goal is to become an independent investigator and leader of a multidisciplinary cancer research team focusing on improving symptom severity in palliative care. To accomplish this goal, there will be a training program comprising formal coursework, directed readings, seminars, and mentored practicum, including instruction in quantitative analysis and focus-group methodology as well as the studies described below.

The immediate goals (1) to enhance understanding of the difference in symptom occurrence and symptom severity in low income and racially disparate groups of patients with MBC and (2) to better understand the barriers to the use of symptom-management strategies by patients and to determine if these barriers differ based on income or racial factors.

In order to accomplish these goals, two small studies will be completed, culminating in a larger study proposal appropriate for an R01 application. Guided by the Dodd Symptom Management Theory, the first study will quantify symptoms and symptom severity among patients with MBC and will measure the influence of race and income status on symptom occurrence and severity. The second study will be qualitative, using focus groups to identify potential barriers to symptom management.

The research findings will be foundational to the preparation of a larger research application and future interventional studies for symptom reduction for all patients in palliative care. Training and research activities will take place at the University of Pittsburgh Cancer Institute (UPCI), an NCI-designated Comprehensive Cancer Center; facilities of the University of Pittsburgh Medical Center (UPMC) and the University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Nursing. Supportive activities will take place at the Yale University School of Nursing, Harvard University and through the University of Wisconsin, Milwaukee.

Rosenzweig, M.   

05/01/06-04/30/09

 Susan G. Komen Breast Cancer Foundation

The ACT Intervention to Reduce Breast Cancer Treatment Disparity

in African American Women

Increasingly it has been noted that AA women do not receive the same dosages of breast cancer treatment as white women.  The reason for this is not clear, but may be provider institution or patient based.  In addition, it appears that LIAA women suffer disproportionately from bc treatment related emotional and physical distress.  Unique beliefs, attitudes and stressors among LIAA women, communication barriers with predominately white health care providers and a lack of understanding/belief of bc treatment in reducing the risk of bc recurrence or metastasis are believed to be etiologic factors for bc treatment and symptom management disparity.

The intervention we propose is an “ACT” (adherence, communication treatment) intervention of first “bolus” and 3 “booster” education and coaching session for LIAA women receiving first breast cancer treatment.  The ACT educational materials will be developed with LIAA bc survivors.  Focus groups will explore the unique beliefs, attitudes and stressors of LIAA women that may affect initial bc treatment.  They will also address communication problems with (predominantly white) doctors and nurses and strategies for enhanced communication.  Lastly, the survivor focus groups will guide how to present and teach pathology report (staging), resultant implications and treatment information. 

Following focus group analysis, we will have the “ACT” materials developed for testing.  The intervention will be given in a “bolus” dose (baseline) covering all the topics of reinforce the original teaching.  The testing of the ACT intervention will be through a pilot study of 10 subjects/group, randomized (toss of a coin chances) to usual care (standard patient education) vs. ACT patients.  Patient outcomes such as symptom distress, doses of treatment, and feelings of mastery will be measured in both groups and compared.

Addressing the patient component of health disparity model does not diminish the responsibility of providers or institutions in decreasing disparity.  Instead ACT reinforces the patient centeredness of care and empowers and coaches LIAA women to access equitable and needed care from providers and institutions.