Differences in Fibroid Symptom Reporting among Asian and Caucasian Patients in a Multidisciplinary Fibroid Center

Abstract

Introduction: Uterine fibroids are prevalent in reproductive-age Asian women and can have a severe impact on health due to heavy bleeding, pelvic pain, and psychosocial harm. Current treatment, ranging from expectant management to hysterectomy, is aimed at symptom alleviation. Therefore, it is crucial for providers to accurately gauge symptom impact to determine appropriate treatments. A recent study reported differential symptom scores between Asian and Caucasian women treated at the Stanford Fibroid Center (SFC).1 In this pilot study, we aim to explore potential etiologies contributing to this finding by comparing fibroid size and location, clinical factors, and surveying sociocultural factors.  Methods: We utilized a mixed methods approach to uncover potential associations to differential Uterine Fibroid Symptom and Health-Related Quality of Life Symptom Severity Scores (UFS-QoL SSS) between Asian and Caucasian patients at SFC. We quantitatively analyzed fibroid imaging data and clinical risk factors from this cohort and qualitatively compared semi-structured interviews in a representative sub-sample.  Results: We found no significant difference in fibroid size or location between groups. However, Asians had significantly lower body mass index (P < 0.0001) and were more likely non-smokers (P = 0.0037) compared to Caucasians. After adjusting for these and other risk factors, pretreatment UFS-QoL SSS in Asian patients were still significantly lower (P < 0.0001). Qualitative interviews with Asian and Caucasian interviewees demonstrated comparable symptom experiences and quality of life, but more Asian participants described a negative impact from family and friends, less access to and distrust of medical providers, and pursuit of alternative therapies for their fibroids.  Conclusion: These findings suggest that the UFS-QoL questionnaire may be insufficient for capturing symptom burden in patients of different races. Further understanding on how the above factors modulate symptom reporting is warranted to help design appropriate fibroid treatment recommendations for diverse populations.