Margaret Q. Rosenzweig, PhD, is an oncology nurse and a Distinguished Service Professor of Nursing at the University of Pittsburgh School of Nursing. Dr. Rosenzweig’s research examines diagnosis, treatment, and survival differences among women with breast cancer based on their race. Her goal is to improve care so that all women receive timely diagnoses, treatment, and support during their breast cancer journeys.
The National Cancer Institute reports that Black people have higher death rates than any other racial or ethnic group for many cancer types. For example, similar numbers of Black and white women develop breast cancer. But Black women are more likely to die of the disease.
Dr. Rosenzweig recently sat down with HealthBeat to discuss racial disparities in breast cancer. She explained her current research and how that research can improve care for all patients with cancer.
Q: Tell us about your current research.
A: We know that racial disparities exist in cancer outcomes, but we don’t know exactly why. Some reasons may be based in biology and others may be due to factors that we call the social determinants of health.
Our previous research, published in Cancer in 2017, showed that Black patients felt more distress from the side effects of their breast cancer treatment than white patients did. This distress often led providers to reduce doses or patients to stop treatment early. We felt this may be a piece of the cancer survival disparity puzzle.
These findings led the National Institute of Minority Health and Health Disparities to fund our current study. This study is called the Symptom Experience, Management, Outcomes According to Race and Social (SEMOARS) determinants of health for women breast cancer chemotherapy.
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Q: What happens in the SEMOARS study?
A: We recruit both Black and white women who have recently been diagnosed with early stage breast cancer so that we can be there with them all the way through chemotherapy. We keep track of all the doses they receive, as well as any changes to their medicines. We track 16 symptoms.
Each woman also completes a total of 18 questionnaires during her course of chemotherapy. Questions focus on her symptoms and communications with her health care provider.
Before COVID-19, participating patients and providers allowed us to attend their visits and audiotape them. Our plan is to analyze how they communicate with each other. We want to know if there are racial differences in patient/provider communication around symptoms.
This study is currently underway at eight sites in both Pittsburgh and Cleveland. We are still recruiting patients. Currently about 40% of our participants are Black, but we would like that percentage to be even higher.
Q: What kind of response have you gotten when you invited women to join your study?
A: We’ve had tremendous success in recruiting patients. Nearly all eligible patients — 95% of them — have agreed to participate. That unusually high percentage shows how important this topic is to both Black and white women.
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Q: How do you know what questions to ask?
A: Our team has assembled an advisory group composed of former patients, clinicians, and community volunteers. They all have expertise in breast cancer and health disparities. They also are committed to breast health, public education, and support for Black women with breast cancer.
The study team and the advisory board worked together to decide many aspects of the study, including the informed consent process and selecting questionnaires. The advisory group and the research team continue to meet to discuss how the study is progressing and any emerging findings.
Q: What have you learned from the study so far?
A: Our early data follows our hypothesis, which is that Black patients feel more distress from chemotherapy symptoms and may stop treatment too early.
We find that all patients tend to show up for chemotherapy appointments. Once a patient commits to the treatment, they generally will come for the treatment. It’s just that the toxicity from the treatment may stop them from getting the full dose.
Q: How can health care providers help reduce disparities in care?
A: Even with the best of intentions, providers might not always know how to do friendly chitchat that helps people bond. We don’t all get to interact closely with people of different races and to forge strong connections with people different from ourselves.
We think part of the issues with patients’ symptoms might be in how they communicate about them. It’s possible that white clinical staff might interpret the conversations about symptoms in a way that perhaps doesn’t allow Black women to be fully heard or understood.
Health care providers of all races and types can help by remembering that all of our patients encounter difficulties outside of the clinic, including racism and discrimination. We need to remember that these stressors can then affect the ability to withstand cancer and its treatment.
Q: What do you hope your research will accomplish?
A: I want to be able to add to the evidence about racial disparities in cancer care so that policy will change at the clinical level. We may need to mandate much fuller assessments and close navigation as needed for all of our patients. Much of the conversation is about screening, but we need to look deeper to understand why Black women die from breast cancer at a higher rate than white women.
Neither screening nor communication is the only reason, but they’re both pieces of the puzzle.
I hope this research will give us an indication of what we providers can do differently in clinic and with our larger communities to help our patients.
Q: What do you wish breast cancer patients knew about treatment?
A: Chemotherapy is considered to be curative in early stage breast cancer. The symptoms of breast cancer chemotherapy can be difficult but it’s important to understand that they do go away. We want to get every dose into every patient because this is the best chance to have a good outcome.
I worry that we as health care providers give up too easily when our patients get overwhelmed by chemotherapy symptoms. We should be cheering them on and helping them get every dose even when it’s difficult.
National Cancer Institute. Cancer Disparities. National Institutes of Health. Link
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