Cancer
Patient Experience and Provider Symptom Review During Survivorship Care Among Black and White Survivors in the Carolina Endometrial Cancer Study Mu Jin* Mu Jin Jin Jin Jin Jin Jin Jin UNC-Chapel Hill
Background: Endometrial cancer (EC) is the most common gynecologic cancer in the United States. National Comprehensive Cancer Network (NCCN) survivorship guidelines recommend evaluation of 9 symptom domains: cardiac toxicity; mental health (anxiety, depression, trauma, and distress); fatigue; lymphedema; hormone-related symptoms; pain; sexual function; sleep disorders; and healthy lifestyle components (weight, diet, and physical activity). We investigated variation by race in patient-reported symptoms and whether symptoms were discussed with medical providers.
Methods: We analyzed data from 555 EC survivors enrolled in the ongoing Carolina Endometrial Cancer Study. We estimated the association between race and patient-reported symptoms (and symptom discussions) using multivariable Poisson regression models to calculate prevalence ratios (PR) and 95% confidence intervals (CI) adjusted for age at survey, tumor stage, and treatment received.
Results: The cohort included 202 Black and 353 White survivors (mean age at survey=63, mean time since diagnosis=1.8 years). Majority of survivors reported weight/diet concerns (80%), sleep disorders (63%), and pain (55%). All symptom domains had higher prevalence among Black survivors compared to White, with the largest differences seen for hormone-related symptoms (50% vs. 17%), lymphedema (43% vs. 28%) and pain (61% vs. 51%). In multivariable models, Black survivors were 41% more likely to report lymphedema (CI: 1.10, 1.81) and 43% more likely to report hormone-related symptoms (CI: 1.15, 1.77) compared to White survivors. Provider discussions were statistically different only for fatigue. Black survivors who reported fatigue were 14% less likely to discuss their symptoms with a provider than White survivors (79% vs. 93%, PR=0.86; 0.75-0.99).
Conclusion: Widespread implementation of NCCN survivorship guidelines may help reduce racial disparities in long-term EC survivorship outcomes.