Interpersonal Processes of Care Disparities, Symptom Distress, and Chemotherapy Dosing in Women With Early-Stage Breast Cancer

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Abstract
Background: Communication is an important tool in combatting racial and economic healthcare disparities in cancer care. The ability to communicate treatment-related distress and troubling symptoms can allow proactive symptom mitigation and adherence to a prescribed cancer treatment. Few studies have explored how racial and economic differences in patient–clinician interactions in cancer care influence symptom distress and chemotherapy adherence. Objectives: This study aimed to examine racial differences in interpersonal processes of care and their association with symptom distress and optimal chemotherapy dose among women diagnosed with early-stage breast cancer (ESBC). Methods: Black and White women newly diagnosed with ESBC and prescribed chemotherapy for a diagnosis of invasive breast cancer were recruited. The Interpersonal Processes of Care Survey and Symptom Distress Scale were included in this analysis. Ratios of prescribed chemotherapy to received chemotherapy were recorded as total chemotherapy percentage. Results: Persons who were Black perceived worse scores in communication, including “lack of clarity,” “discrimination due to race/ethnicity,” and “disrespectful office staff.” Participants who lived in areas of greater deprivation perceived worse levels of “discrimination due to race/ethnicity” compared to those living in areas of less deprivation. Participants who perceived higher “discrimination due to race/ethnicity” were less likely to achieve optimal chemotherapy doses. Those who perceived worse scores for “lack of clarity,” “discrimination due to race/ethnicity,” “disrespectful office staff,” and “compassion” had significantly higher levels of symptom distress. Discussion: Symptom distress during ESBC chemotherapy must be communicated via patient–provider interaction. Patients' perceptions of discrimination and bias may inhibit this process. This interaction requires further interrogation to develop an inclusive symptom communication protocol.

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