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Black and hispanic women have less support during cancer evaluation and treatment: results from a prospective patient reported outcomes program in gynecologic malignancy
  1. Lauren Philp1,2,
  2. Stephanie Alimena3,
  3. Mackenzie Sullivan4,
  4. Marcela Del Carmen5,
  5. Amy Bregar5,
  6. Eric Eisenhauer5,
  7. Annekathryn Goodman5 and
  8. Rachel Clark Sisodia5
  1. 1Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
  2. 2Division of Gynecologic Oncology, University Health Network / Sinai Health System, Toronto, Ontario, Canada
  3. 3Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  4. 4Department of Obstetrics and Gynecology, Massachusetts General Hospital / Brigham and Women's Hospital, Boston, Massachusetts, USA
  5. 5Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Lauren Philp, Division of Gynecologic Oncology, University Health Network / Sinai Health System, 700 University Avenue, 6th Floor, Toronto, ON M5G 1X6, Canada; lauren.philp{at}uhn.ca

Abstract

Objective Race remains a significant predictor of poor outcomes in women with gynecologic cancer and minority patients consistently report worse quality of life during cancer treatment. Disparities between patients in strength of social and emotional supports may contribute to these outcomes. This study’s objective was to describe the racial differences in patient reported outcomes of women being evaluated or treated for a gynecologic malignancy at a large tertiary cancer hospital.

Methods In this prospective cohort study, all patients presenting for care at a tertiary care gynecologic oncology clinic between January 2018 and September 2019 were evaluated for inclusion. All patients were administered validated patient reported outcome measure questionnaires at serial visits. Demographic data was gathered including self-reported race. Patients were characterized as White, Black, Asian, Hispanic/Latino, or Other. Patient reported outcomes were compared between respondents of different races using linear and logistic regression.

Results Between January 2018 to September 2019, 2022 patients with a known race completed questionnaires. Of these patients, 86.7% were White, 4.3% Black, and 4.9% Hispanic/Latino and 58.7% had a known cancer diagnosis. Non-White patients were significantly less likely to complete questionnaires (p<0.001). Non-White patients reported significantly lower levels of emotional support on all questions (Patient-Reported Outcomes Measurement Information System (PROMIS) emotional support: Q1 p<0.001, Q2 p<0.001, Q3 p=0.013, Q4 p=0.002), and lower overall emotional (p=0.005) and instrumental (p=0.005) support scores when compared with White patients. Hispanic/Latino patients reported the lowest levels of emotional and instrumental support and more cognitive (p=0.043) and financial (p=0.040) difficulties associated with treatment. Black women reported having less support with chores while sick (p=0.014) and being less likely to have someone to talk to (p=0.013).

Conclusions Significant differences exist in patient reported outcomes between women of different racial backgrounds. Hispanic/Latino and Black women have less support during gynecologic cancer evaluation and treatment as compared with White women.

  • quality of life (PRO)/palliative care
  • postoperative care
  • genital neoplasms, female

Data availability statement

Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a team selected by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if requested.

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Data availability statement

Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a team selected by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if requested.

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Footnotes

  • Contributors LP performed data collection and analysis and wrote the manuscript. SA performed data analysis and manuscript editing and MS performed data analysis. MDC, AB, EE and AG were involved in data collection and manuscript editing. RCS was the senior responsible author who developed the study hypothesis, supervised data collection and analysis and performed manuscript editing. LP is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.