Effect of racism on cancer care in women with gynecologic cancers (016)

Objectives: Racism contributes to psychological and physical stress in Black patients within the United States healthcare system. We sought to evaluate whether increased race-based stress was associated with treatment interruptions in women undergoing cancer care. Methods: Patients attending visits for cancer treatment or surveillance at a single institution were approached to participate in this study. A brief health history (confirmed by chart review) and the Index of Race-Related Stress-Brief questionnaires (IRRS-B) were completed by enrolled participants. Statistical analyses were performed using RStudio (Version 1.4.1106). One-sided Wilcoxon rank-sum test checked the association between IRRS-B scores in women with and without treatment interruptions. One-sided Spearman’s correlation test was performed to examine if increased IRRS-B score was related to increased length of treatment interruption and/or increased time to treatment initiation. Kruskal-Wallis test was performed to assess the significance between race-related stress and multiple variables (race, cancer stage, insurance, social support, concern). Follow-up tests were completed for significant findings, and the familywise error rate was controlled by the false discovery rate (FDR) approach. Results: Of 200 women invited to participate, 72 participants enrolled in the study. The mean age of participants was 60.6 years (SD: 11.19). Among the participants, 49 (68.1%) identified as Black, 21 (29.2%) identified as White, and two (2.8%) identified as Hispanic. Black patients had a median (IQR) score of 38 (23-52), which was significantly higher than scores of White patients, who had a median (IQR) score of 10 (6-27) (FDR adjusted p-value = <0.001). Treatment interruptions were experienced by 18.1% of patients. Patients with treatment interruptions reported higher race-related stress, as measured by the IRRS-B, as compared to patients without treatment interruptions, with median (IQR) IRRS-B scores of 46 (29-57) and 27 (11.5-42.5), respectively (p-value = 0.023). Among patients who experienced treatment interruption, the median (IQR) length of treatment interruption was 7 (7 - 30) days. There was a significant moderate positive correlation between IRRS-B score and length of treatment interruption (correlation coefficient: 0.573, p-value = 0.02). Among all patients, the median (IQR) time to treatment initiation was 21 (7-30) days. There was a significant weak positive correlation between IRRS-B score and time to treatment initiation (correlation coefficient: 0.226, p-value = 0.035). Conclusions: Black patients undergoing treatment for gynecologic cancer reported significantly higher levels of race-related stress than White patients. The experience of racism was associated with increased treatment interruptions, longer time to treatment initiation, and longer treatment interruptions. Objectives: Racism contributes to psychological and physical stress in Black patients within the United States healthcare system. We sought to evaluate whether increased race-based stress was associated with treatment interruptions in women undergoing cancer care. Methods: Patients attending visits for cancer treatment or surveillance at a single institution were approached to participate in this study. A brief health history (confirmed by chart review) and the Index of Race-Related Stress-Brief questionnaires (IRRS-B) were completed by enrolled participants. Statistical analyses were performed using RStudio (Version 1.4.1106). One-sided Wilcoxon rank-sum test checked the association between IRRS-B scores in women with and without treatment interruptions. One-sided Spearman’s correlation test was performed to examine if increased IRRS-B score was related to increased length of treatment interruption and/or increased time to treatment initiation. Kruskal-Wallis test was performed to assess the significance between race-related stress and multiple variables (race, cancer stage, insurance, social support, concern). Follow-up tests were completed for significant findings, and the familywise error rate was controlled by the false discovery rate (FDR) approach. Results: Of 200 women invited to participate, 72 participants enrolled in the study. The mean age of participants was 60.6 years (SD: 11.19). Among the participants, 49 (68.1%) identified as Black, 21 (29.2%) identified as White, and two (2.8%) identified as Hispanic. Black patients had a median (IQR) score of 38 (23-52), which was significantly higher than scores of White patients, who had a median (IQR) score of 10 (6-27) (FDR adjusted p-value = <0.001). Treatment interruptions were experienced by 18.1% of patients. Patients with treatment interruptions reported higher race-related stress, as measured by the IRRS-B, as compared to patients without treatment interruptions, with median (IQR) IRRS-B scores of 46 (29-57) and 27 (11.5-42.5), respectively (p-value = 0.023). Among patients who experienced treatment interruption, the median (IQR) length of treatment interruption was 7 (7 - 30) days. There was a significant moderate positive correlation between IRRS-B score and length of treatment interruption (correlation coefficient: 0.573, p-value = 0.02). Among all patients, the median (IQR) time to treatment initiation was 21 (7-30) days. There was a significant weak positive correlation between IRRS-B score and time to treatment initiation (correlation coefficient: 0.226, p-value = 0.035). Conclusions: Black patients undergoing treatment for gynecologic cancer reported significantly higher levels of race-related stress than White patients. The experience of racism was associated with increased treatment interruptions, longer time to treatment initiation, and longer treatment interruptions.