Abstract
Background: Metastatic or Stage 4 breast cancer (MBC) is a heterogeneric, life ending illness with a treatment course of multiple sequential therapies. There are documented racial disparities in breast cancer outcomes and treatment equity, but little is known about the racial or socio-economic differences during MBC and end of life (EOL) care. Aim1: Describe a cohort of patients deceased from MBC - patient, tumor, treatment, symptoms and end of life care characteristics. Aim 2 – Compare patient, symptoms and end of life care characteristics according to race and neighborhood deprivation. Methods: Cohort of deceased patients from large, breast cancer program from October 2016 until June 2019. Protocolized, retrospective chart review for patient (age, race, neighborhood deprivation score,derived from zip code), tumor (ER, PR, Her 2, subtype), symptoms (25 symptoms + overall wellbeing rated 0-10 at last visit before death; generalized anxiety, screening depression and overall distress), end of life care (palliative care consult, hospice, length of time in hospice, place of death, ICU admission prior to death, goals of care discussion documented). Results: Cohort of N=130. Black - N=17 (13%); White - N=112 (86.2%). Dichotomized according to median (69) NDI, N=58 (49.2%) in more deprived neighborhoods. Triple negative breast cancer subtype N= 7(41%) Black and N=34 (30%) white. Survival: Survival overall was 1175 days. Black survival was less than half of white. Black – 501 days (SD – 339); White – 1242 days (SD 1363), p=.031.No survival differences according to neighborhood. Of the 25 symptoms measured during breast cancer treatment cough,nausea, hot flashes, headaches, and overall health were significantly (p <.05) worse for black vs. white patients with no differences noted for other symptoms. Dizziness, nausea, vomiting, anxiety, depression, overall distress and overall health were significantly (P<.05) worse for patients from more deprived neighborhoods. Among the 130 deceased MBC patients N=108 (81.8%) had palliative care services, N=65 (50%) had no advance directives, N=52 (40%) did not use hospice services, and N=16 (12%) died in the ICU. No difference between Black and White patients or patients from more vs. less deprived neighborhoods for these outcomes. Conclusion: There is racial and economic disparity in MBC survival and symptoms prior to death. Overall end of life planning is not well addressed in this population.
Citation Format: Rachel Heckman, Keerthana Senthil, Margaret Quinnl Rosenzweig, Welch Hilda Ann. Influence of race and economic deprivation on metastatic breast cancer outcomes [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A057.
