title: Early referral to supportive care specialists for symptom burden in lung cancer patients: a comparison of non-Hispanic whites, Hispanics, and non-Hispanic blacks.
abstract: BACKGROUND
  Effective management of symptoms in cancer patients requires early intervention. This study assessed whether the timing of referral to the Supportive Care Center (SCC) and symptom burden outcome varied by race or ethnicity in lung cancer patients who had been seen at a tertiary cancer center.
  
  
  METHODS
  Non-Hispanic white (n = 752), Hispanic (n = 111), and non-Hispanic black (n = 117) patients with nonsmall cell lung cancer comprised this sample. Data on sociodemographic factors, stage of disease, comorbid conditions, and symptom severity (pain, depressed mood, fatigue) served as potential predictor variables.
  
  
  RESULTS
  Whereas the mean time (15 months; median = 7 months) from initial presentation at the cancer center to referral to the SCC did not vary by race or ethnicity, we found that Hispanics and non-Hispanic blacks had higher symptom burden when they first presented at the cancer center than non-Hispanic whites. Severe pain, depressed mood, and fatigue were significant predictors for early referral (<7 months) of non-Hispanic whites, but only severe fatigue (P <.05) was predictive of early referral for Hispanics and non-Hispanic blacks. Furthermore, while the proportion of non-Hispanic white patients reporting severe pain, depressed mood, and fatigue significantly decreased (P <.001) at first follow-up visit after referral to the SCC; among Hispanics, improvement was only observed for depressed mood. No improvement in any of these symptoms was observed for non-Hispanic blacks.
  
  
  CONCLUSIONS
  Whereas the timing of referral to supportive services did not vary by race, disparities in symptom burden outcomes persisted. Additional studies are needed to validate our findings.
authors.affiliation: Department of Epidemiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA. creyes@mdanderson.org
authors.forename: Cielito C
authors.initials: CC
authors.lastname: Reyes-Gibby
authors.forename: Karen O
authors.initials: KO
authors.lastname: Anderson
authors.forename: Sanjay
authors.initials: S
authors.lastname: Shete
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.forename: Sriram
authors.initials: S
authors.lastname: Yennurajalingam
mesh_terms: D000328:Adult; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data*; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D010166:Palliative Care; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D013038:Specialization; D044465:White People / Q000706:statistics & numerical data*