Unmet Need for
Symptom Management from
Breast Cancer Treatment
Jean Yoon, Jennifer Malin, Diana Tisnado,
May Lin Tao, Patricia Ganz, Katherine Kahn
Los Angeles Women’s Study
RAND, Santa Monica
UCLA General Internal Medicine and Health Services Research
Background
 Treatment and early detection of breast
cancer has improved patient survival.
 Quality of life and symptom
management have become important for
patients with breast cancer.
 Symptoms vary by patient
characteristics and type of treatment.
Previous Research
 Most quality of breast cancer care studies focus on
whether women received screening, timely diagnosis,
and appropriate interventions.
 Several studies examined pain management for
cancer patients.
 Few studies have analyzed whether patients have
received appropriate management of other symptoms.
- IOM describes one aspect of quality of care and desirable health
outcomes as management of physical and psychological symptoms
Study Design
 Los Angeles Women’s Study conducted
in 2000.
 Population-based study.
 Patients identified through Rapid Case
Ascertainment.
 1,219 women responded to survey with
63% response rate.
Defining Unmet Need
 Had symptom severe enough that it
interfered with mood or functioning
 Arm problems, nausea/vomiting, hot
flashes, vaginal dryness, problems with
sleep.
 Wanted help for her symptoms
 Did not receive any help for her symptoms
Analysis
 Bivariate and multivariate analyses of unmet need
by patient characteristics.
- Patient characteristics included age, race, language, education,
income, marital status, working status, insurance coverage,
treatments received, number of severe symptoms, health status,
comorbid conditions, stage at diagnosis.
 Bivariate analysis of reasons for unmet need by
race/ethnicity.
 Results weighted for non-response and adjusted for
clustering at hospital level.
Sample Race/Ethnicity
White
Black
Hispanic Spanish
Hispanic English
Other
N
834
112
104
103
66
%
65
12
9
8
6
Sample Characteristics
Mean age (SD)
67 (14)
% with at least one comorbidity
83%
Stage at diagnosis:
In situ (13%), I (38%), II (30%), III (5%),
IV (2%), Unknown (11%)
Prevalence of
Unmet Need
N
Have
severe
symptom
Wanted
help for
symptoms
Received
help for
symptoms
%
Difficulty sleeping
Hot flashes
Nausea / vomiting
Vaginal dryness
Arm problems
Any symptom
353
248
158
148
138
577
28
19
12
11
11
46
68
74
78
66
77
77
70
51
91
48
69
75
Symptom Prevalence by
Race/Ethnicity
N
%
112
104
43
44
66
35
White
834
47
Hispanic English
language
103
49
Black
Hispanic Spanish
language
Other
Chi-square
p-value
0.0626
Unmet Need Prevalence
by Race/Ethnicity
Black
Hispanic Spanish
language
Other
N
%
24
21
60
55
9
44
White
104
34
Hispanic English
language
13
32
Chi-square
p-value
<0.0001
Race/Ethnicity as
Predictors of Unmet Need
Black
Hispanic Spanish language
Other
White
Hispanic English language
Odds Ratios
3.61*
2.69*
1.37
1.00
0.94
* P<0.05
Model included age, education, income, working status, health status, comorbid
condition, treatments received, stage at diagnosis, and number of severe symptoms.
Reasons for Unmet Need
by Race/Ethnicity
Patient Report of
Black/Hisp
Span/Other
N=54
White/Hisp
Eng
N=117
Pvalue
MD didn’t think Rx would
benefit patient
27
14
0.0056
MD didn’t know about Rx
20
11
0.035
MD didn’t know about
problem
37
30
0.2397
MD didn’t appreciate how
much problem was bothering
patient
17
14
0.4651
Conclusion
 Prevalence of unmet need varied by type of
symptom.
 Black and Hispanic Spanish-speaking women
were less likely to report having a symptom and
more likely to report an unmet need.
 Among women with an unmet need, more black,
Hispanic Spanish-speaking, and other women
reported the reasons as the MD did not think
treatment would benefit her and the MD did not
know about treatments.
Limitations
 Survey relied on patient self-report of severe
symptoms, and the variability of symptom
severity among patients was not determined.
 Results are not generalizable to
premenopausal women.
 Asian American women 60-75 years of age
were allocated to another study and not able
to be included.
Implications for
Practice and Policy
 Symptoms cannot always be cured but can be
managed.
 Providers should systematically evaluate
symptoms and their effects on function and
quality of life.
 Research continues to highlight the need to
address the causes of unequal treatment