White patients’ physical responses to healthcare treatments are influenced by provider race and gender

See article on page 1519–1526, in this issue

The prognostic disparities in different molecular subtypes between young Chinese and White American breast cancer patients remain unclear. The goal of this study was to explore the prognostic differences in different molecular subtypes between Chinese and White American patients aged ≤ 40 years. We included Chinese and White female breast cancer patients at or under the age of 40 from the Surveillance, Epidemiology, and End Results database (SEER) and the West China Hospital of Sichuan University. The chi-square test, log-rank test, and Cox proportional hazards model were employed to evaluate the distribution and survival disparities in the two racial/ethnic cohorts and different molecular subtypes. An annualized hazard function was used to calculate the annual failure rate among different molecular subtypes. This study included 20,859 female breast cancer patients at or under the age of 40, of whom 18,400 were White women and 2,459 were Chinese women. With a median follow-up time of 47 months, the 5-year breast cancer-specific survival (BCSS) rates for young Chinese and White women were 93.9% and 90.0%, respectively (P< 0.001). Molecular subtype was found to be a significant predictor in both young Chinese and White patients (P< 0.001), but different trends were observed in the two racial/ethnic cohorts when exploring the association between BCSS and molecular subtypes. Among young White patients, the hormone receptor (HoR) (+)/epidermal growth factor receptor 2 (HER2) (+) subtype had the best 5-year BCSS rate, while in young Chinese patients, the HoR (+)/HER2 (+) and HoR (+)/HER2 (-) showed comparable survival curves and both showed superior 5-year BCSS than other subtypes. Stratification by molecular subtypes, young Chinese patients demonstrated a superior 5-year BCSS in HoR (+)/HER2 (-) (96.3% vs 92.9%, P< 0.001) and triple-negative subtypes (88% vs 81.7%, P= 0.006) compared to young White American patients, while no significant differences were found in HoR (+)/HER2 (+) and HER2 enriched tumors. The annual hazard function for BCSS showed that there were significantly different trends in the HoR (+)/HER2 (-) and HoR (+)/HER2 (+) subtypes between young Chinese and White patients. There are disparities in prognosis and annualized hazard function between young Chinese and White females with breast cancer in different molecular subtypes.

Allergic reactions including anaphylaxis after receipt of the first dose of Pfizer-BioNTech COVID-19 vaccine - United States, December 14-23, 2020.

Ethical Considerations Regarding the Use of Race in Pulmonary Function Testing

Background: Metastatic triple-negative breast cancer (mTNBC) is an aggressive tumor phenotype with a poor prognosis and few treatment options. The prevalence of mTNBC is disproportionately higher among African American (AA) women, compared with white women. Data identifying the drivers of racial differences in mTNBC or characterizations of treatment patterns and clinical outcomes in AA patients with mTNBC are limited. Methods: This retrospective study used the Flatiron Health electronic health record-derived de-identified database (January 2011-March 2020). Adult AA and white female patients with confirmed mTNBC treated in US community oncology practices were included. Differences in mTNBC prevalence among AA and white patients were assessed by age, health insurance coverage, geographic region and stage at initial diagnosis. Descriptive statistics were used to analyze clinical characteristics, treatment patterns and time to treatment initiation between AA and white patients. Racial differences in overall survival (OS) were examined using Kaplan-Meir analysis and a multivariate Cox regression model. Results: Of the 21,804 Flatiron patients diagnosed with metastatic breast cancer (mBC), 2116 eligible patients with mTNBC were identified; 383 (18%) were AA and 1155 (55%) were white. TNBC prevalence was twice as high among AA patients (23%) than white patients (12%). Racial differences in TNBC prevalence (AA vs white patients) were particularly higher among patients aged 45 to 65 y (26% vs 13%), patients in the Northeast (27% vs 11%) and those with initial diagnosis at Stage II (30% vs 13%) or Stage III (27% vs 15%). AA patients with TNBC were younger (mean age: 60 vs 63 y; P &amp;lt; 0.001) and more likely to have Medicaid at the time of diagnosis (10% vs 3%; P &amp;lt; 0.001) than white patients. Clinical characteristics were generally similar between AA and white patients, including the distribution of staging at initial diagnosis, disease recurrence, Eastern Cooperative Oncology Group performance status (ECOG PS), and sites and number of metastases. Regardless of race, 25% of all patients with mTNBC had no documentation of receiving anti-cancer treatment in the database. Untreated patients in both race groups were older, had poorer ECOG PS and were less likely to have visceral metastases than treated patients (all P &amp;lt; 0.001); they also had poorer survival than treated patients (median OS: 4.7 vs 13.1 months from diagnosis for all treated patients; unadjusted hazard ratio [HR], 0.51 [95% CI: 0.46, 0.57]). Among both AA and white treated patients, single-agent chemotherapy was the most prevalent first-line treatment (most common agent: capecitabine). More than half of treated patients initiated treatment in &amp;lt; 30 days, and median time-to-treatment initiation did not differ by race. Although OS was numerically lower in AA patients (median OS, 10.3 vs 11.9 months in white patients), the difference was not significant when adjusted for prognostic and treatment factors (adjusted HR, 1.09 [95% CI: 0.95, 1.25]). Conclusions: The prevalence of mTNBC was twice as high among AA compared with white patients in US community oncology practices. Unlike prior research, race did not show an association with OS in this population. Regardless of race, 1 in every 4 patients with mTNBC had not received documented anti-cancer treatment, potentially due to poor PS and concerns about treatment tolerance. OS was poor for both AA and white patients with mTNBC, particularly for untreated patients. Effective treatment remains a substantial unmet need for all patients with mTNBC. In light of the lack of racial differences in this patient cohort, prospective studies are needed to further elucidate underlying biological differences that may have predictive or prognostic significance for AA patients with TNBC. Citation Format: Amie Tan, Vincent Shen, Luciana Preger, Bann-mo Day, Edith P. Mitchell. Assessing racial differences in patients with metastatic triple-negative breast cancer: Real-world evidence from US community oncology practices [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-53.

Background: REASSURE (NCT02141438) is a global, prospective, single-arm, observational study of Ra-223 use in patients with mCRPC with bone metastases within routine clinical settings. Using data from the second planned interim analysis, we compared baseline characteristics, survival, and safety outcomes among White, Black, and Asian patients treated with Ra-223 in the US subset of REASSURE. Methods: In this descriptive analysis (data collection 8-20-2014 to 3-20-2019), we examined baseline characteristics, OS, and safety outcomes for the US subset enrolled into REASSURE stratified by race (White, Black, Asian). Results: Of the 498 men in the US subset, 414 (83.1%) reported as White, 58 (11.7%) as Black, and 10 (2.0%) as Asian; race was not reported for 16 (3.2%) patients. Median age at study entry was 74.0, 69.5, and 71.0 years for White, Black, and Asian men, respectively. The proportion of patients whose prostate cancer was American Joint Committee on Cancer (AJCC) 7th edition stage III or IV at initial diagnosis was 45.2%, 58.6%, and 60.0% for White, Black, and Asian patients, respectively. The proportion of patients who completed 6 Ra-223 injections was similar across groups. Median duration of observation from the start of Ra-223 treatment was 11.3 months (range 0.4-41.3 months) for White patients, 14.9 months (range 0.7-39.1 months) for Black patients, and 20.5 months (range 4-27.7 months) for Asian patients. Median OS for White, Black, and Asian patients was 17.3 months (95% CI, 15.2-19.2 months), 19.5 months (95% CI, 12.9-27.1 months), and 21.8 months (95% CI, 3.58 months-not applicable), respectively. Any treatment-emergent drug related AE, treatment-emergent SAE, or drug-related SAE occurred in 45.2%, 41.4%, and 10.0% of White, Black, and Asian patients, respectively. Any-grade and grade ≥3 drug-related hematological TEAEs occurred in 8.4% and 5.3% of White patients, respectively, 15.5% and 12.1% of Black patients, respectively, and were not observed in Asian patients. Incidence of bone fractures was 4.1%, 3.4%, and 0% in White, Black and Asian patients respectively. Conclusions: This descriptive analysis of REASSURE found that Black patients were younger and presented with later-stage disease at diagnosis compared with White patients. A trend toward longer OS was seen in Black and Asian patients compared with White patients. AEs occurred at similar rates among groups. Drug-related hematological TEAEs, which have been reported with Ra-223 treatment, were more common in Black patients compared with White and Asian patients. Given the very small number of Asian patients enrolled in REASSURE, comparisons with this group should be interpreted with caution. Citation Format: Peter S. Conti, Oliver Sartor, Mary-Ellen Taplin, Daniel Y. Song, Saby George, Jeffrey Tomaszewski, John Sylvester, Constantine Mantz, Robert W. Given, Robert Brookland, Jeff Meltzer, Matthew J. Korn, Richard Andres, Svetlana Babajanyan, Celestia Higano. Baseline characteristics, safety, and efficacy of Radium-223 in metastatic castration resistant prostate cancer by race: Insights from the REASSURE US subset [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C160.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

2020 Rise to the challenge

Racism Is a Modifiable Risk Factor: Relationships Among Race, Ethnicity, and Colorectal Cancer Outcomes

Black multiple myeloma patients undergoing upfront autologous stem cell transplant have similar survival outcomes compared to Whites: A propensity-score matched analysis.

Effect of Race and Insurance Status on Outcomes after Vascular Access Placement for Hemodialysis

ObjectiveReal-world data characterizing differences between African American (AA) and White women with metastatic triple-negative breast cancer (mTNBC) are limited. Using 9 years of data collected from community practices throughout the United States, we assessed racial differences in the proportion of patients with mTNBC, and their characteristics, treatment, and overall survival (OS).MethodsThis retrospective study analyzed de-identified data from 2,116 patients with mTNBC in the Flatiron Health database (January 2011 to March 2020). Characteristics and treatment patterns between AA and White patients with mTNBC were compared using descriptive statistics. OS was examined using Kaplan-Meier analysis and a multivariate Cox proportional hazards regression model.ResultsAmong patients with metastatic breast cancer, more AA patients (23%) had mTNBC than White patients (12%). This difference was particularly pronounced in patients who lived in the Northeast, were aged 45–65, had commercial insurance, and had initial diagnosis at stage II. AA patients were younger and more likely to have Medicaid. Clinical characteristics and first-line treatments were similar between AA and White patients. Unadjusted median OS (months) was shorter in AA (10.3; 95% confidence interval [CI]: 9.1, 11.7) vs. White patients (11.9; 95% CI: 10.9, 12.8) but not significantly different. After adjusting for potential confounders, the hazard ratio for OS was 1.09 (95% CI: 0.95, 1.25) for AA vs. White patients.ConclusionsThe proportion of patients with mTNBC was higher in AA than White mBC patients treated in community practices. Race did not show an association with OS. Both AA and White patients with mTNBC received similar treatments. OS was similarly poor in both groups, particularly in patients who had not received any documented anti-cancer treatment. Effective treatment remains a substantial unmet need for all patients with mTNBC.

Unequal treatment: report of the institute of medicine on racial and ethnic disparities in healthcare

Allergic reactions including anaphylaxis after receipt of the first dose of Moderna COVID-19 vaccine - United States, December 21, 2020-January 10, 2021.

Compared with white individuals, black men and women have a higher incidence and mortality from colorectal cancer and may develop cancer at a younger age. Colorectal cancer screening might be less effective in black individuals, if there are racial differences in the age-adjusted prevalence and location of cancer precursor lesions. To determine and compare the prevalence rates and location of polyps sized more than 9 mm in diameter in asymptomatic black and white individuals who received colonoscopy screening. Colonoscopy data were prospectively collected from 67 adult gastrointestinal practice sites in the United States using a computerized endoscopic report generator between January 1, 2004, and December 31, 2005. Data were transmitted to a central data repository, where all asymptomatic white (n = 80 061) and black (n = 5464) patients who had received screening colonoscopy were identified. Prevalence and location of polyps sized more than 9 mm, adjusted for age, sex, and family history of colorectal cancer in a multivariate analysis. Both black men and women had a higher prevalence of polyps sized more than 9 mm in diameter compared with white men and women (422 [7.7%] vs 4964 [6.2%]; P < .001). Compared with white patients, the adjusted odds ratio (OR) for black men was 1.16 (95% confidence interval [CI], 1.01-1.34) and the adjusted OR for black women was 1.62 (95% CI, 1.39-1.89). Black and white patients had a similar risk of proximal polyps sized more than 9 mm (OR, 1.13;95% CI, 0.93-1.38). However, in a subanalysis of patients older than 60 years, proximal polyps sized more than 9 mm were more likely prevalent in black men (P = .03) and women (P < .001) compared with white men and women. Compared with white individuals, black men and women undergoing screening colonoscopy have a higher risk of polyps sized more than 9 mm, and black individuals older than 60 years are more likely to have proximal polyps sized more than 9 mm.