Home > PUM One on One: Margaret Quinn Rosenzweig, Addressing Racial and Economic Breast Cancer Survival Disparities

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PUM One on One: Margaret Quinn Rosenzweig, Ph.D., professor and vice chair of research in the department of acute and tertiary care at the University of Pittsburgh School of Nursing  

On the Frontlines of Addressing Racial and Economic Breast Cancer Survival Disparities


 

 

 

As a nurse, nurse practitioner, nurse educator and researcher for over 30 years, Margaret and her team’s research is focused on the factors that ensure that all women with breast cancer receive timely diagnosis, treatment, and support. Specifically, their research, education, and outreach initiatives are directed toward African American women with breast cancer, women with metastatic breast cancer, and community engagement to address racial and economic breast cancer survival disparity. In addition, the group is leading a national initiative in the training of advanced practice oncology providers.

 

Featured Organization overview: The Allegheny County Breast Consortium (ACBC): Developing Synergy for Breast Cancer Control

Faculty member Margaret Rosenzweig, PHD, CRNP-C, AOCN, FAAN

Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh

Allegheny County continues to experience racial and economic breast cancer survival disparity at an unacceptable rate. The Allegheny County Breast Consortium, a group of more than 20 representatives from community, health care and academic organizations, formed in 2012 at the Graduate School of Public Health and is now housed at the School of Nursing. This cooperative group is building a network of breast cancer community engagement offering support, education and advocacy for underserved women in Allegheny County, specifically in Braddock, McKeesport and Penn Hills.

PUM:  Tell us more about the significance of the projected work associated with the Pitt Seed project and what your cooperative group hopes to accomplish with the outreach work specifically to reach African-American women in your targeted areas. In July 2018, your organization received a grant from the inaugural Pitt Seed program (The Allegheny County Breast Consortium: Developing Synergy for Breast Cancer Control). This cooperative group is building a network of breast cancer community engagement offering support, education and advocacy for underserved women in Allegheny County, specifically in Braddock, McKeesport and Penn Hills. 

(Pictured ACBC Team, Left to Right: Sara Jo Klein, Kenneth Hunter, Jacqueline Simon, Margaret Quinn Rosenzweig, Mary Connolly, Ann Welsh, Janice Elerby )  click image to enlarge

Rosenzweig:  Allegheny County experiences racial and economic breast cancer survival disparity at an unacceptable rate. Despite an overall decline in female breast cancer death rates, disparity in survival rates persists. The efforts to address this disparity through the work of the ACBC was generously funded through the Office of the Chancellor. The ACBC is a community outreach program designed to assist women in Allegheny County in accessing existing breast cancer resources. We hope to reach out to these women to share with them our resources and knowledge to assist them in getting the care they deserve. The ACBC has noted three Pittsburgh communities with high rates of poor breast cancer screening including McKeesport, Braddock, and Penn Hills. By working intimately with these communities, our team hopes to tailor community outreach plans to best benefit the communities we’re serving.

In building an infrastructure base with a powerful network of breast cancer allies, we will offer access to existing breast cancer resources for these underserved women. We want them to know that they are not alone, and we are there to provide help and support. Our goal is to establish a sustainable, independent community support, education, and advocate group in these communities after one year.

 

 

(Pictured: Braddock Turns Positively Pink! January 2019, Billboards go up in Braddock, PA encouraging residents to get free mammograms. Cancer survivors from Braddock are featured on the billboards as part of ACBC's educational outreach to the community.) Click image to enlarge.  

Community outreach is an important component of the Allegheny County Breast Consortium (ACBC)'s mission. The diverse and highly productive research team is uniquely situated, enthusiastic, and well-qualified.  The Allegheny County Breast Consortium has come to #TurnBraddockPositivelyPink! ACBC offers information for free #mammography and breast evaluations. Look for new billboards and information regarding ACBC's outreach to the community.  Strong clinical and community associations allow an excellent infrastructure for community outreach. These community efforts in breast cancer education and support are funded locally and recognized through numerous community awards.

 

 

PUM: We know that more Black Women die of breast cancer in fact it is reported that in the U.S., Black women with breast cancer have lower five-year survival rates compared to all other races. What key factors are contributing to these rates and disparities? 

Rosenzweig: The reasons are multifactorial including environmental factors, patient factors, implicit bias on the part of clinicians and structural issues related to the equitable delivery of cancer care. Our team’s past and continued work suggest that symptom incidence, cancer related distress, and ineffective communication with clinicians around these symptoms contribute to this disparity. These symptoms then may trigger chemotherapy dose reduction, treatment delays, or early termination of therapy. If we can better manage symptom incidence and distress with symptom management and effective palliative care, we can help these patients get through their treatment and ensure that they receive equal cancer treatment.  

The disparity in breast cancer survival is multifactorial. White women have higher breast cancer incidence rates, but African American women have higher incidence rates before age 40 and are more likely to die from breast cancer at every age. There are disease factors but also to economic and sociodemographic factors.
Other factors include the incidence of obesity, diabetes, and heart disease that is greater in African American women than White women, and these factors can have a negative impact on breast cancer outcomes. When it comes to addressing these disparity gaps, we need to take a holistic approach and factor in information from all sides.

PUM:  In your role with the University of Pittsburgh’s School of Nursing your team’s research is focused on the factors that ensure that all women with breast cancer receive timely diagnosis, treatment, and support. Your research, education, and outreach initiatives are directed toward African-American women with breast cancer, women with metastatic breast cancer, and community engagement to address racial and economic breast cancer survival disparity. Tell us more about your nearly decade of work and some of your ongoing challenges.  Why have you devoted a good deal of your career to finding solutions as it relates to this critical issue. 

Rosenzweig: I devote time to this issue because the lack of equity in the delivery of cancer care is a fixable problem. Shortly after I graduated from nursing school, I served as a registered nurse in the Jesuit Volunteer Corps serving in farm worker communities in Louisiana. The impact of poverty on health outcomes was a powerful, indelible lesson for me, and it launched a lifelong interest in improving disparities and outcomes for patients.

I am a cancer nurse and developed my research career to better explore disparity in cancer care. I began my research career by exploring metastatic (Stage 4) breast cancer experiences according to race and income. We found that low-income African American women experience symptom distress that was not well communicated to clinicians or well managed. This contributed to non-adherence to anti-cancer therapies. The challenge was to further explore the topics of economic and racial distress and advocate for women who were most at risk based on their demographics.

In 2011 we launched the Attitudes, Communication, Treatment and Support (ACTS) Intervention to Reduce Breast Cancer Treatment Disparity that was funded through the American Cancer Society.  We analyzed factors that may lead to a woman not initiating breast cancer treatment or discontinuing her treatment. Worsening symptoms led to an inability to continue their treatment. This tells us that better symptom management can help women get through their treatment.

The lessons learned from the ACTS Intervention have led to the Symptom Experience, Management and Outcomes According to Race and Social Determinants (SEMOARS) study, an R01 NIH funded grant. The SEMOARS study is focused on exploring the symptom and distress experience of breast cancer chemotherapy for Black women compared to White women and focusing in on the holistic view of the person, their social determinants of health, symptom profiles during breast cancer chemotherapy and the ability to receive full chemotherapy dosages.  

PUM: It is reported that with breast cancer screenings becoming available and widespread in the 1980s, the death rate for women dropped 43 percent, but that is not the case for African-American women, why is this the case?  

Rosenzweig: There are many factors that contribute to this disparity, including genetic and biological factors, Black women are at higher risk of developing aggressive triple-negative breast cancer, and do so at a younger age than white women. Many social determinants may provide a barrier or deterrent to timely diagnosis and treatment. In terms of treatment, there are increased delays and early termination of anti-cancer therapies among Black women, that may contribute to the overall survival disparities.

PUM:  Tell us more about your research as it relates to the longitudinal study of 179 Black women and 179 White women at six sites undergoing chemotherapy to determine if “ineffective communication contributes to a racial disparity in dose reduction and early therapy termination.”

Rosenzweig: The Symptom Experience, Management and Outcomes According to Race and Social Determinants (SEMOARS) study is comparing the symptom incidence and distress, symptom reporting methods and outcomes, including the ability to receive full dose of prescribed chemotherapy between Black and White women as they proceed through chemotherapy. We are looking at prescribed chemotherapy and comparing this to the chemotherapy received over time.  Because clinician communication may be a component of perceived racial bias during cancer therapy, we are also audiotaping clinic visits, and then assessing and scoring these visits according to a scoring technique called the “patient centeredness of care”.  We compare these scores from the audiotaped visits between Black and White women.

PUM:  There is so much information out in the universe about when women should receive a mammogram, what is the best practices recommendations? 

 

Rosenzweig: It is recommended that women receive mammograms every year to every two years starting at age 50. Some women with increased risk factors should start sooner. Women should know what their breast feel like so that they can advocate for an evaluation if they notice any abnormality.

PUM: You are also a part of a community team to ensure women with breast cancer receive timely diagnosis, treatment and support across the cancer-care continuum. What sort of mechanisms and procedures are you recommending finding better solutions?

Rosenzweig: The Allegheny County Breast Consortium (ACBC) is a group of individuals from throughout Allegheny County who are interested in the racial breast cancer survival disparity that is present in our community. Our preliminary work has established that there are communities that are ready for change and ready to receive a screening and wellness message. We selected these communities and are working within the communities to establish an ongoing presence to offer education regarding breast cancer screening, diagnosis, treatment or survivorship. 

An important part of cancer treatment are the clinicians in the community who need to recognize when screening should occur, when something should be evaluated and how to manage a woman who has been treated for breast cancer with her survivorship needs. There are unmet educational needs for the advance practice providers. Support and treatment for these women depend on well trained advanced practice providers. Therefore, we developed an interactive electronic curriculum that teaches practice and communication skills to advanced practice providers new to oncology and working within the community.

PUM: Tell us more about what you enjoy most about your research and work?  Before you became a research scientist and professor, you worked as a cancer nurse practitioner. Prior to that, you were a nursing school graduate who served in the Jesuit Volunteer Corps. Early on you spent a year living with and caring for people from poor communities in Louisiana. How do you bring all of your experience full circle to appreciate the work you have ahead? 

Rosenzweig: I still work as an oncology nurse practitioner through the Magee Breast Cancer Program. I teach students, conduct research and assess ways to strengthen communities to diminish risk from cancer. It is a truly an honor to do this work. The Jewish tradition teaches it is one’s obligation to “heal the world”. Although we cannot heal the world form all injustice and sadness, that does not mean that we should not try.

PUM:  From your leadership position, what does the future look like for the fight against breast cancer for all women? 

Rosenzweig: The future in breast cancer is positive and hopeful.  There are new therapies coming to patients at lightning speed. We want to ensure that cancer care is not just equal but truly equitable – meaning we need to consider the unique life circumstances of all women and tailor the supportive care to her.

Personalized symptom management strategies are the future.

The future of breast cancer treatment relies on both advancing our understanding of genetics, treatment options, and targeted therapies, and in education and awareness, preventative screening, and enhanced communication with clinicians. Breast cancer treatment needs to be considered in the context of the woman’s’ life, her family and her community. Strengthening communities economically and assuring adequate food services, opportunities for physical activity, good education and safety will go a long way in the prevention and control of cancer.

 

Click images to enlarge.

 

 

 

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