Address Cancer Health Disparities Research Articles

The Chickahominy T.R.U.T.H. (Trust, Research, Understand, Teach, and Heal) Project-A Tribal Community-Academic Partnership for Understanding the Impact of Structural Factors on Perceived Cancer Risk in Rural Virginia.

In 2022, the Virginia Chickahominy Indian Tribe partnered with Virginia Commonwealth University Massey Comprehensive Cancer Center to investigate concerns about a potential cancer cluster near a local landfill. While investigating cancer clusters is complex due to long latency and multifactorial causes, the community's concerns about structural factors driving cancer risk warrant exploration. Thus, the Chickahominy T.R.U.T.H. (Trust, Research, Understand, Teach, and Heal) Project was created as a community-academic partnership to (1) identify structural factors and barriers associated with perceived cancer risk and care; (2) assess cancer knowledge, care access gaps, and perceived risks, including testing private and community water sources; (3) develop and deploy culturally tailored cancer education and resource navigation, including groundwater safety education, policies, and remediation. We will conduct 150 in-person interviews and water tests among residents within a four-mile radius of the landfill, and deploy 1000 structured questionnaires among Charles City County residents. In this paper, we provide an overview of the ongoing project design, development, and progress in support of the project's objectives. This collaborative investigation aims to address cancer health disparities, enhance research and health policy advocacy, and honor the sacred knowledge of an underserved community, laying the groundwork for a long-term partnership to guide future research questions.

Abstract A135: Addressing cancer health disparities through global oncology initiatives at a comprehensive cancer center

Abstract Background: The Mayo Clinic Comprehensive Cancer Center (MCCCC) is uniquely positioned to address cancer health disparities globally through the Community Outreach & Engagement (COE) Office and Program’s resources and partnerships in the areas of cancer research, education, and training. The goal of the COE Global Oncology Initiatives (GOI) is to lessen the cancer burden on patients globally by building global capacity through research, education, and training in MCCC impact regions. While MCCCC continues to build institutional relationships worldwide through the GOI, it has specifically increased research collaborations in Africa over the past 5 years. The purpose of this study is to synthesize and report the global oncology reach through scholarly output of collaborative efforts in ongoing research activities with partnering African countries. By analyzing and documenting research outputs within this area, we aim to better understand research priorities and needs, increase inclusivity of African populations, and improve potential avenues for impactful studies in global alliance networks. Methods: Publications were found by using key search terms and by using the map feature on Mayo Clinic’s Elsevier-hosted publication database to locate partner institutions throughout Africa. Only publications in the past 5 years, which included an African researcher as an author, and are relevant to cancer research were included. Duplicate publications were removed from the final dataset. Results: There are 86 unique MCCCC members collaborating with 11 different African countries (Algeria, Egypt, Ghana, Kenya, Morocco, Nigeria, South Africa, Tanzania, Tunisia, Uganda, and Zimbabwe). A total of 50 unique publications have been published, with an African country being represented 72 times. The majority of MCCCC global oncology work is with researchers in Sub-Saharan nations (n=43). Egypt, however, has the largest single country representation (n=22), followed by South Africa (n=14) and Nigeria (n=13). 164 unique African researchers across 133 different institutions have worked with MCCCC members. Prostate and liver cancer were the most represented cancers at 6 instances, respectively. Discussion: Overall, 86 MCCCC members are involved in global research that address cancer health disparities through equal partnership with African researchers, which has resulted in multiple research output. Some of the publications were led by global consortia or cohort studies. These collaborations have been mutually beneficial for MCCCC members and African investigators, elevating cancer research in Africa. This includes increased research scholarship, extramural funding for cancer research in Africa, opening of more clinical trials across the continent, and increase in cancer biomedical workforce. Global research, especially one that is inclusive of the African populations, will foster the understanding of the genetic architecture of cancer, and help shape cancer care and control for Africans and people of African ancestry. Citation Format: Parisa Fathi, Manisha Salinas, Monica Albertie, Folakemi Odedina. Addressing cancer health disparities through global oncology initiatives at a comprehensive cancer center [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A135.

Abstract A071: Results from cancer clinical trials health education in racial/ethnically diverse populations

Abstract Background: The University of California, San Francisco (UCSF), a National Cancer Institute (NCI) designated comprehensive cancer center implemented NCI’s Clinical Trials (CT) Education Initiative to promote awareness and conduct culturally tailored clinical trials engagement and education in racial/ethnically diverse populations. CT are studies that test ways to prevent, find and treat disease and ensure safety & effectiveness. Racial/ethnic groups have both the highest death rate and shortest survival rate for most cancers. Minority population CT participation is low and more diverse enrollment is needed for progress toward health equity. Methods: UCSF Community Health Educators engaged community partners and conducted CT education. Topics included what are clinical trials, how they work and advance progress, the value of diversity & inclusion, types and phases of CTs, informed consent, myths & facts, mistrust, other concerns & barriers, how to find & enroll in CT & sources for more information. Education sessions were evaluated using a 17-item pre-/post- survey to measure changes in CT knowledge and intention to participate. Changes in knowledge scores were assessed using the Wilcoxon Signed-rank sum test; changes in intent were assessed using the McNemar test. Results: There were 300 total participants (N=300 completed pre/post). Respondents: 76.5% female, 23.5% male; 53 average age; 70.9% African American, 1.4% American Indian, 8.4% Asian, 10.9% Latino, 1.7% Pacific Islander, 3.9% White & 2.8% Multiracial. CT education significantly increased overall knowledge, the intention to seek out CT information and join CT. Clinical trials knowledge score ranged from 0 to 11 pre-education, 4 to 11 post, and improved by 0.50 points (4.6%). Post-education respondents strongly agreed or agreed: 74% to talk to a healthcare provider about CT; 77% importance of people of color CT participation; 48% intend to join a CT. Conclusion: CT education is a strategy to address cancer health disparities through community engaged partnerships & education and demonstrated efficacy in increasing awareness & knowledge of CT and advanced intent to enroll. Citation Format: Michelle Moseley, Eva Pardo, Ghila Andemeskel, Kim Rhoads. Results from cancer clinical trials health education in racial/ethnically diverse populations [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A071.

Abstract C019: Comparing the effectiveness of different community education approaches on colorectal cancer knowledge

Abstract Introduction: Colorectal cancer (CRC) incidence and mortality varies greatly among racial/ethnic groups nationally. Community outreach and education are effective strategies to enhance knowledge of CRC and have been shown to increase screening for CRC. The University of New Mexico Comprehensive Cancer Center implements Screen to Save, a community-based CRC screening initiative through the National Outreach Network Program. During the COVID-19 pandemic, restrictions on in-person engagement led to the development and implementation of alternative delivery strategies. Our site continued in-person education as possible, and added Zoom and fully self-paced via QR code options for community member participation. Very little is known regarding the effectiveness of different delivery modes. The purpose of this research is to examine the relationship between method of education session delivery and participant CRC knowledge. Methods: Participants were recruited via community organizations, Facebook advertising, and referrals from local stakeholders. Both before and after a standardized health education session, participants completed a survey assessing their knowledge of CRC risk and screening recommendations. Participant demographics were descriptively summarized. Estimates of mean changes, and 95% confidence intervals (CI), were obtained for each content delivery type. Differences in these changes were compared using ANCOVA approaches. Results: There were 239 participants who completed the educational sessions in-person (n=81), via Zoom (n=66), or using the self-paced module (n=92), Groups did not differ significantly in composition for age (p=0.72) or gender (p=0.33), but did differ in race, ethnicity, and education level (p<0. 001). Those who participated in any delivery method improved their knowledge scores by 11.6 (95% CI: 9.9-13.3) percentage points. For in-person, Zoom, and self-paced groups, the improvements were 14.1 (95% CI: 10.6-17.6, p<0.001), 11.5 (95% CI: 9.1-13.8, p<0.001), and 9.4 (95% CI: 6.7-12.1, p<0.001) percentage points, respectively. When comparing pre vs post score differences among session types while adjusting for pre scores, and for baseline differences in race, ethnicity, and education, the differences in improvement for the three different session types were not significantly different (p=0.68). For in-person, Zoom, and self-paced groups adjusted improvements were 9.2 (95% CI: 0.5-17.5), 11.1 (95% CI: 1.9-19.8), and 10.1 (95% CI: 1.5-18.3) percentage points, respectively. Conclusion: Health education sessions delivered in person, via Zoom, and by self-paced online modules are associated with increases in participant knowledge of CRC. As Cancer Centers expand community outreach and engagement to address cancer health disparities in their catchment areas, a better understanding of the relative effectiveness of different delivery strategies is needed. Further research will help to discern population characteristics predictive of different strategies and link these approaches to screening uptake. Citation Format: Lila A. Baca, Yadira Aguero, Angelica Solares, Vernon Shane Pankratz, Shiraz I. Mishra, Miria Kano, Andrew L. Sussman. Comparing the effectiveness of different community education approaches on colorectal cancer knowledge [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C019.

Addressing cancer health disparities with a quality dashboard.

171 Background: Equity is lacking in cancer care. In 2021, the cancer center at our academic medical center established a quality dashboard with relevant performance measures. We aimed to evaluate our care in various domains of healthcare quality; however, no measures of equity were displayed. In 2023, we stratified our performance measures according to various population groups and evaluated group differences. In the next phase of this quality improvement cycle, we added the stratified results to the quality dashboard to display these group differences and prioritize equity. Methods: We identified performance measures that could be stratified by population groups, such as race, ethnicity, insurance type, and primary spoken language. Three measures, mortality index (MI), length of stay (LOS) index, and 30-day readmission rate, were calculated using a third-party program for the fiscal year 2022. Additionally, we stratified 2021 and 2022 data on patient satisfaction, assessed by the proportion of patients selecting the top answer to the likelihood of recommending the practice, by race and language. Each performance measure was color-coded in a quality dashboard according to the institution-set benchmarks (goals) and thresholds (satisfactory performance). Values better than or equal to the benchmark were displayed in green, between the benchmark and threshold in yellow, and worse than the threshold in red. Values worse than the benchmark were considered opportunities for improvement. Results: Population group differences are now captured on our quality dashboard. For the stratified MI results, white and Asian patient populations met the threshold, while the black patient population did not. Latinx patients did not meet the MI threshold, while the non-Latinx patient population did. Patients with Medicaid did not meet the MI, LOS, or readmission thresholds. Regarding patient satisfaction, the white patient population and those whose primary language was English met the benchmark, while the non-white patient population and the non-English speaking group did not. Conclusions: The quality dashboard, with the addition of measures stratified by sociodemographic factors, highlights signs of cancer health disparities at our institution. Leadership can use this tool to target resources to specific areas where disparities exist. The next steps include understanding contributing factors and setting appropriate benchmarks for future quality improvement work. Finally, we must understand the needs of other population groups facing cancer health disparities but not represented in the data, including the sexual and gender minority population.

Advancing Equity in Oncology: Innovative Approaches and Robust Frameworks to Address Cancer Health Disparities

The 2023 Summit on Cancer Health Disparities took place from April 28 through April 30, 2023. This manuscript summarizes three pivotal talks that underscored significant discussions on cancer inequities. Dr. Hiba Khan’s session, “Rising Tide of Biomarker Selected Studies – How Genomic Testing is Key to Unlocking Inequities in Oncology Clinical Trial Access,” delved into the vital role genomic testing plays in eliminating disparities within oncology clinical trials. The next session by Dr. Curtiland Deville, titled “Advanced Imaging and Stage Migration – How Findings More Diseases May Lead to More Opportunities,” explored how advanced imaging and disease stage migration can unearth further opportunities for equitable treatment access. Lastly, Dr. Samuel Washington’s presentation, “Applying a Social Determinant of Health Framework to Address Clinical Trial Inequities,” offered a thorough exploration into the use of social determinants of health as a strategy to rectify clinical trial inequities. Under the guidance of the session’s chair, Dr. Hala Borno, these presentations foster a nuanced understanding of cancer disparities, emphasizing the importance of innovative approaches and robust frameworks to bridge the gap in cancer care and research. This summary is an essential reference point for practitioners, policymakers, and stakeholders invested in overcoming the profound challenge of cancer disparities.

Abstract IA042: Global disparities: A global approach to understanding the generative mechanisms underpinning cancer health disparities

Abstract Advances in cancer research have resulted in a decline in overall cancer incidence and deaths, and an increase in the number of cancer survivors globally. However, this progress has not been shared equally in the global community with certain populations continuing to experience significant or worsening cancer disparities. There are gaps in our understanding of the etiologies and drivers of global cancer disparities. Studying cancer health disparities systematically with a coordinated global effort offers opportunities to understand and develop context-specific interventions which may be adapted and translated across multiple global settings. The science of health disparities has advanced significantly in the past decade, resulting in a strong foundational knowledge of the causes of disparities in specific communities. Future disparities research must now recognize the inherent complex and dynamic connections and interrelationships among multiple factors from which these cancer disparities emerge. Broader use of methodological approaches that more fully account for the complex socio-cultural context in which disparities occur will enable the development of sustainable, resource- and culturally-appropriate interventions to reduce disparities in multiple global settings. To prevent, reduce, and ultimately eliminate global cancer health disparities and achieve cancer health-equity globally, a value-driven, globo-centric effort is needed to unravel the complex generative mechanisms that underpin disparities in similar socio-biological contexts across Multiple settings globally. This session aims to discuss example approaches to systematically study and address cancer health disparities globally. Citation Format: James R. Alaro, Neal A. Palafox, Lynette Ann Denny. Global disparities: A global approach to understanding the generative mechanisms underpinning cancer health disparities [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA042.

Abstract B035: Addressing African American physician engagement in decentralized clinical trial by clinical trials and translation science consortium focus group participation

Abstract BACKGROUND: Despite decades of effort and proposed solutions to increase diversity in clinical trial participation, African Americans remain underrepresented. Race-specific review of clinical trial participation challenges suggests that engagement with African American physicians influence successful recruitment and appropriate enrollment of underrepresented groups in clinical research. Tailoring best-practices for minoritized populations cannot be sustainably facilitated without trusted community-academic partnerships. Engagement with African American community physicians creates capacity for leveraging resources critical to participation of African Americans in decentralized clinical trials (DCT). The Northeast Florida Clinical Trials and Translational Science (NEF-CTaTS) Consortium was formed in 2022 to address cancer health disparities experienced by minoritized, marginalized and underserved communities in NE Florida. AIM:The NEF-CTaTS Consortium convened a Focus Group with 22 African American community physicians who care for minoritized patients to solicit their input in fostering active research, research training, community outreach and engagement, and to address advantages of and barriers to forming a research network of minority physicians to conduct decentralized clinical trials and translational research. METHODS: Practicing community primary care physician members of the Northeast Florida Medical Society, a chapter of the National Medical Association where invited to participate. Physician demographic and practice information was collected from physicians who consented to participate prior to the Focus Group discussion. A Clinical Trial Needs Assessment was completed by each participating physician. The Physician Focus Group discussion was moderated by a skilled African American community physician member of the NEF-CTaTS consortium with extensive experience in conducting clinical trials. The discussion was recorded and transcribed for data analysis. IRB approval was obtained prior to informed consent, data collection and Focus Group Discussion. RESULTS: Qualitative analysis of the raw data is currently ongoing at the time of this submission. Transcribed discussion details and the observational notes identified thematic framework for descriptive statements, indexing, and sifting data. Mapping and interpretation of data is being analyzed for relationships, internal consistency, intensity of comments and specificity of responses. Analysis is scheduled to be complete within 4 weeks of abstract submission. CONCLUSIONS: Efforts to appropriately address disparities in clinical trial participation and DCT participation of African Americans require distinct and deliberate efforts to engage African American physician stakeholders. Addressing issues of trust and the impact of social-determinants of health on minoritized populations can be culturally and appropriately addressed by community-academic partnerships. Citation Format: Floyd Willis, Folakemi Odedina, Kim Barbel Johnson, Rogers Cain, Jennifer Crook. Addressing African American physician engagement in decentralized clinical trial by clinical trials and translation science consortium focus group participation [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B035.

Abstract 1915: Addressing cancer health disparities among US minority populations with patient-derived xenografts

Abstract Despite the tremendous advances in cancer prevention and treatment strategies that have been achieved since the war on cancer plan in the 1970’s, it is clear that not all communities are equally benefiting from such advances and that minority populations nearly always have worse cancer health outcomes. These cancer health disparities are the result of complex interactions between social determinants of health, population-specific cultural behaviors and lifestyles, and unique biological differences that associate with ancestry. Two major limitations to the advancement of precision medicine in minority groups include the lack of: i) race/ethnic appropriate genomic data, which will facilitate identifying priority targets for therapeutic development, and ii) patient-derived models, such as patient-derived xenografts (PDXs) that recapitulate the unique interactions of germline and somatic genetics that exist in minority patients. In this presentation we describe the development of an analytical pipeline to quantify continental genetic ancestry that we have developed for the Cancer Genomics Cloud as part of the PDX Development and Trials Center Research Network (PDXnet). This pipeline leverages a novel reference panel for the program SNPweights, which includes a greater representation of genomic data from Native and Latin American populations than previously published reference panels, and thus provides improved assignment of American continental ancestry. We use this pipeline to characterize the diversity of the PDX models in PDXnet, which represent a manifold increase in models with African and American continental genetic ancestry compared with those available in other public resources. Finally, we present power analyses to demonstrate that additional PDX models derived from patients from minority populations are critically needed to effectively address health equity goals in the US. Citation Format: Brian J. Sanderson, Paul Lott, Anuj Srivastava, PDXNet Consortium, Jeffrey H. Chuang, Luis G. Carvajal-Carmona. Addressing cancer health disparities among US minority populations with patient-derived xenografts [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1915.

Addressing cancer health disparities (CHD) in an independent community cancer clinic: All solutions are local.

e18522 Background: The COVID-19–associated global pandemic has brought many public and population health issues to light. A glaring issue is the disparities among and differences in susceptibility of diverse ethnicities. Viral infection is not the only area of healthcare facing this issue: disparities in prevalence, biology, prognosis, and outcomes of cancer exist, often based on socioeconomics and social determinants of health (SDoH). CHD have been debated and discussed at several levels, from local counties to the congress to the Centers for Medicare and Medicaid Services. Amid the debates and recommendations, it has been difficult to carve out a clear path forward. The complex factors involved include access to care because of financial challenges, biological and genetic factors, impact of SDoH, and access to screening, NGS testing, and clinical trials. CHD may contribute to almost 34% of deaths among adult cancer patients and additional spending of $230 billion. Addressing CHD could result in an indirect savings of as much as $1 trillion over 3 years (AACR, CDR, 2020). A comprehensive approach is needed to generate a groundswell of resources. This should include support for public policies aimed at improving understanding of the issue by all parts of the ecosystem (pharma, researchers, government agencies, physicians), adequate funding for federal and local initiatives, considerations of health in community planning and development, and collection of real-world data and evidence. At Carolina Blood and Cancer Care (CBCCA), the team decided to study this issue and initiate solutions one step at a time. Methods: CBCCA prioritized solutions in 5 categories. The top priority was to address issues impacting patients: access to care, NGS testing, cancer screening, SDoH, and clinical trial access. To address access to care issue (financial constraints), 2.5 FTEs (full-time equivalents) were allocated to carry out needs assessments and identify resources, including Medicaid eligibility, dual eligibility, other foundations, and sources for free drugs. A not-for-profit entity, No One Left Alone, was started to address CHD. Results: During 2021 CBCCA physicians saw 1787 unique cancer patients (both established and new). Of these, 319 needed IV anticancer treatment and an additional 104 needed oral oncolytics. Fifty-three could not pay for their cancer treatment. Another 101 patients needed assistance for out-of-pocket costs. Financial counselors procured free drugs worth $1,633,588 and an additional $135,931 in cash assistance for high out-of-pocket costs. The pharmacy team raised $253,218 for 64 patients (374 transactions) for out-of-pocket costs. As a result, not a single patient was left without treatment. Conclusions: Financial toxicity was addressed by allocating 0.5 FTE per oncologist to ensure access to care. In the next phase, CBCCA will address access to NGS testing.

The role of real-world evidence (RWE) registries using NGS testing to address cancer health disparities (CHD) in small community oncology practices.

e18519 Background: CHD may result from multiple factors, including access to care, screening, and clinical trials; limited uptake of biomarker and next-generation sequencing (NGS) testing; and unfavorable social determinants of health. CHD may contribute to almost 34% of deaths among adult cancer patients and additional spending of $230 billion. Addressing CHD could result in an indirect savings of as much as $1 trillion over 3 years (AACR, CDR, 2020). Biomarker testing enables the option of targeted treatment, providing better outcomes and reduced toxicity. The NGS testing rate is very low in some regions and among minority populations, and underuse worsens disparities. Carolina Blood and Cancer Care Associates (CBCCA) has created best practices to improve biomarker testing and provide standard-of-care treatment in advanced cancer. Methods: As a part of a pledge to decrease CHD, CBCCA partnered with 2 national NGS testing vendors to create a RWE registry to identify appropriate patients and provide access to NGS biomarker tests for somatic mutations, including whole exome sequencing (WES). Liquid biopsy was made available when tissue was unavailable. Results: CBCCA has 1 suburban and 1 rural location, with an ethnically diverse population. Regular care was provided for 1466 of the 1786 unique cancer patients seen in 2021, and 442 participated in a RWE registry. Nonparticipants were survivors having routine follow-up care (n = 512), patients with early-stage or noninvasive disease (510), or patients who refused testing because they were responding to ongoing treatment or had reservations. NGS testing was obtained for 354 patients, 31% of whom were members of ethnic minority groups. Liquid biopsy was used for 133 samples, and the remaining 221 were analyzed with somatic NGS panels or WES. Of the liquid biopsies, 24 patients had actionable mutations; an additional 52 had findings of germline implications. Actionable mutations that could be treated with an FDA-approved drug were identified using tissue-based NGS testing in 38 pt. In tissue-based testing, WES detected more results with germline implications, compared to somatic testing alone. Another 64 tests found mutations treatable with an approved drug in another tumor type. The NGS and biomarker testing rate (either tissue or liquid biopsy) was 84% of eligible pt. Of the patients tested with NGS, clinically actionable variants that could be treated with an approved agent were found in 23% (same tumor type) and 28% (another tumor type). Another 40% of patients had results with germline implications, of which P53 deletion was the most common finding. Conclusions: It is feasible to increase the NGS testing rate in appropriate situations. In this study, actionable mutations impacting treatment selection were found in up to 25% of patients where targeted therapy could be offered.

Addressing cancer health disparities in a multilateral collaboration in an independent community cancer clinic: translating words into action.

No One Left Behind, a program to provide financial assistance and access to cancer care at Carolina Blood and Cancer Care Associates in South Carolina, will be discussed during a session of the Community Oncology Alliance 2022 Community Oncology Conference.

Diversifying preclinical research tools: expanding patient-derived models to address cancer health disparities

Cancer health disparities define a critical healthcare issue for racial/ethnic minorities in the USA. Key findings have led to cancer treatment improvements tailored to minority patients, but such successes have been rare. Here, we highlight how the use of patient-derived xenograft (PDX) and organoid models could resolve current blocks toward precision cancer health equity.

Abstract IA-37: Addressing cancer health disparities among Indigenous communities

Abstract Many Indigenous Peoples around the world continue to experience substantial inequities in health as a result of the enduring legacy of colonisation, marginalization and disempowerment. While there are many thousands of miles that separate our presenters by distance, we are united in our conviction to work collaboratively to improve the health and wellbeing of Indigenous peoples and to honor the cultural diversity and strengths within our communities with whom we are fortunate to work alongside. Providing global, national and regional perspectives from New Zealand, Australia and Canada, this presentation will capture both the common strengths and shared challenges faced by Indigenous Peoples within the realm of health, wellness, and cancer. Harnessing learnings and reflections from previous World Indigenous Cancer Conferences (WICCs), and the presenters research activities, they will discuss the challenges and solutions to improve cancer surveillance, strengthening our ability to develop and monitor cancer control plans with a focus on improving equity in cancer outcomes. This session directly responds to the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) and Indigenous People's rights to self-determination. Citation Format: Nadine R. Caron, Gail Garvey, Nina Scott, Warren Clarmont, Kevin Linn. Addressing cancer health disparities among Indigenous communities [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-37.

Abstract PO-072: Care coordination for older cancer patients with multi-morbidities: Implications for addressing cancer health disparities

Abstract Purpose: Newly diagnosed cancer patients with multi-morbidities require a clinical care team of higher complexity due to greater care coordination demands to simultaneously coordinate cancer care and chronic disease management. Whereas teams of lower complexity may streamline care needs by using one clinician or discipline type to manage all care needs. However, this requires clinicians to understand that they are assuming other clinical roles and responsibilities or else care needs go unmanaged leading to poor health outcomes. Given that chronic disease management drops off following the cancer diagnosis, we examined whether cancer patients identifying as non-Hispanic Black, with dual Medicaid coverage, more chronic diseases, and later cancer stage were more likely to have a clinical care team of higher complexity in the 4-months post cancer diagnosis. Methods: Surveillance, Epidemiology and End Results (SEER)-Medicare data were used to identify patients with invasive breast, colorectal, or non-small cell lung cancer with a co-diagnosis of cardiopulmonary disease or diabetes (n=85,876). The data were linked with American Medical Association files to identify clinician's discipline (e.g., oncology, primary care, cardiology) from encounter claims. Using Zaccaro's classification of multi-team systems, we categorized the degree of complexity of the clinical care team: lower (1-2 disciplines and 1-3 clinicians) versus higher (2+ disciplines and 4+ clinicians). We used multivariable logistic regression to examine patient factors associated with having a clinical care team of higher complexity (compared with lower). Results: Among older cancer patients with multi-morbidities, the most common clinical care team composition was oncology with primary care (37%) followed by oncology, primary care, and medical subspecialty (34%). In the adjusted model, cancer patients were less likely to have a clinical care team of higher complexity if they were non-Hispanic Black compared to non-Hispanic White (OR: 0.88; 95% CI: 0.83, 0.93), dual Medicaid-Medicare covered compared with Medicare only (OR: 0.63; 95% CI: 0.61, 0.65), and diagnosed with stage III cancer compared to stage I (OR: 0.87; 95% CI: 0.84, 0.90). Cancer patients were more likely to have a clinical care team of higher complexity if they had cardiopulmonary disease (OR: 1.74; 95% CI: 1.68, 1.81) or diabetes (OR: 1.69; 95% CI: 1.63,1.75) compared with hypertension only. Conclusion: Clinical care teams of lower complexity were associated with identifying as Black, Medicaid coverage, and later stage, which are known factors associated with poorer care outcomes. This warrants further investigation to examine whether clinicians are assuming other clinicians' roles and responsibilities for patient care or if cancer care is taking precedence over other chronic diseases. Future research to address cancer care disparities need to focus on clinical care teams and the healthcare organizational context that provide and optimize care coordination for newly diagnosed cancer patients with multi-morbidities. Citation Format: Michelle Doose, Dana Verhoeven, Janeth I. Sanchez, Veronica Chollette, Sallie J. Weaver. Care coordination for older cancer patients with multi-morbidities: Implications for addressing cancer health disparities [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-072.

Abstract IA-04: Leveraging the potential of artificial and machine learning technologies to address cancer health disparities

Abstract How can we realize the potential of artificial intelligence and machine learning for addressing cancer inequities and advancing cancer health disparities research? This presentation will discuss areas where bias can be introduced into the AI and machine learning design, development, implementation, use and standardization for cancer care. What are the factors that contribute to bias in the research continuum and how can we mitigate them? The presentation will provide some promising and actionable examples of how we can leverage the transformative potential of AI and machine learning to address cancer health disparities. Citation Format: Irene Dankwa-Mullan. Leveraging the potential of artificial and machine learning technologies to address cancer health disparities [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-04.

Abstract PO-253: Overcoming barriers to colorectal cancer screening for underserved patients: Lessons from the COVID-19 pandemic

Abstract Introduction This patient navigation initiative works to address cancer health disparities by improving education and access to screening and cancer care. This initiative includes partnerships with local Federally Qualified Health Centers (FQHCs) and primary care physicians (PCPs), primarily focused on increasing colorectal cancer (CRC) screening rates among underserved populations in Western New York (WNY) who may have low health literacy. Grounded in health services research, we aimed to improve clinical care by implementing evidence-based guidelines into practice by working directly with underserved communities in our area to improve CRC screening rates at an urban FQHC. Methods Throughout the COVID-19 pandemic, our navigators pivoted to a hybrid schedule with remote access to health systems, splitting time between our cancer center and remotely at home until allowed back on-site to work at the FQHC. Colonoscopy halted in NY between March and June 2020, resulting in scheduling challenges due to significant backlogs of cancelled procedures during the shutdown and regional hold on elective procedures. Endoscopists across WNY had reduced capacity for postponed procedures, leading to the prioritization of scheduling for symptomatic patients. Therefore, navigators focused screening efforts on widely disseminating stool-based tests to patients due for average-risk CRC screening and prioritizing patients with positive screening results to coordinate colonoscopy appointments. Results Between April 2020 through March 2021, our pre-pandemic goal was to educate 550 patients and screen 300 patients. During this timeframe, navigators provided screening education to 632 patients and screened 232 patients despite significant challenges presented by the COVID-19 pandemic. With many colonoscopy procedures being cancelled and/or rescheduled, stool-based tests were widely available and became a more common choice for patients. To date, since April 2020, navigators have educated 807 patients and have navigated 306 patients to complete CRC screening. Of those 306 patients, 234 chose to complete at-home stool-based testing. In 2020, CRC screening rates remained over 50%, exceeding national FQHC targets. This was achieved through targeted patient outreach, education, and navigation, despite significant challenges with the shutdown and the COVID-19 pandemic. Conclusions Stool-based tests paired with targeted outreach and education were an efficient tool for CRC screening during this challenging time. Navigators regularly cross-check records to be sure results are received by ordering physicians and properly coded for accurate data reporting. This is especially important for positive test results and timely follow up, which may lead to improved health outcomes. Moving forward, this paired approach may be an effective strategy for improving screening rates among hard-to-reach patient populations and patients facing substantial barriers to accessing routine medical care. Citation Format: Kathryn M. Glaser, Christina Crabtree-Ide, Alyssa McNulty, Ellis Gomez, Nicole Donofrio, Tessa Flores, Mary E. Reid. Overcoming barriers to colorectal cancer screening for underserved patients: Lessons from the COVID-19 pandemic [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-253.

Abstract 2972: Identifying clinically relevant molecular distinctions in gastric cancer development among US minorities to address cancer health disparities

Abstract Gastric cancer (GC) is the third leading cause of cancer-related deaths worldwide. While overall incidence and mortality rates have dropped in recent decades, GC remains a significant health disparity in Hispanic/Latino Americans (HLAs) and in Asian Americans, Native Hawaiians and Pacific Islanders (AANHPIs), who are twice as likely to be diagnosed with and die from GC compared to non-Hispanic whites. In the U.S, these two groups represent the largest and fastest growing minority populations, respectively. Despite such high minority cancer burden, currently there are few FDA-approved targeted therapies for GC, in contrast to dozens of approved targeted therapies for breast, lung, colon, and prostate cancers. The low numbers of GC targeted therapies can be partially explained by limited availability of race/ethnic appropriate cancer genome data and of minority patient-derived models, limiting target identification and drug efficacy studies. Filling these research gaps is crucially important to improve cancer health disparities. Our group has spearheaded the development of the University of California Minority Patient-Derived Xenograft Development and Trial Center (UCaMP) with the goal of addressing these critical issues for GC patient care. In our initial efforts, we have successfully established both patient-derived xenograft (PDX) and organoid (PDO) models for 10 minority GC patient samples. Our PDX and PDO models recapitulate the tumor heterogeneity observed in the patient samples, but also demonstrate varying levels of clonal evolution upon increased time in culture. Importantly, when we performed whole exome, RNA and DNA methylation sequencing on patient tumor and model sample sets, we observe high prevalence of cell cycle regulation/cyclin-dependent kinase (CDK) and PI3K/AKT/mTOR pathway alterations. This is significant, as the FDA has already approved several CDK inhibitors and PI3K/AKT/mTOR inhibitors for other cancer types and even more have shown promise in clinical trials. Indeed, when treat our patient-derived models with these inhibitors, we observe significant responses both in vitro and in vivo. Our findings highlight an important molecular distinction of GC development in racial/ethnic U.S. minorities that provides a rationale for alternative treatments to address GC health disparities that plague these groups and help bring the field closer to precision cancer medicine. Citation Format: Nicole B. Coggins, Hongyong Zhang, Paul Lott, Ana Estrada-Florez, Ted Toal, Alexa Morales Arana, Guadalupe Carvajal, Amanda Kirane, May Cho, Javier Torres, Elizabeth Quino, Sienna Rocha, Rasika Venkatesh, Luis Carvajal-Carmona. Identifying clinically relevant molecular distinctions in gastric cancer development among US minorities to address cancer health disparities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2972.

Abstract C125: University of Guam/University of Hawaii Cancer Center partnership: Fifteen years of progress in addressing cancer health disparities in Pacific Islanders

Abstract The University of Guam (UOG)/University of Hawaii Cancer Center (UHCC) Partnership aims to grow cancer research capacity at UOG; develop cancer health disparities research at UHCC focusing on Pacific Islanders (PI); raise awareness of cancer and cancer prevention in Guam (GU), Hawaii (HI) and the US Associated Pacific Islands (USAPI); and increase the number of cancer and biomedical science researchers of PI ancestry in the United States. An infrastructure comprising 5 principal investigators, over 30 participating faculty, administrative staff, and external and internal reviewers, backed by institutional support and NCI sponsorship, has supported 15 years of research, training, and outreach designed to reduce cancer health disparities and advance health equity among PI in GU, HI, and the USAPI. Since 2009, the Partnership has funded 18 cancer research projects addressing cancer research priorities of global and regional relevance, including cervical cancer and betel nut chewing—a traditional practice associated with oral pre/carcinoma, affecting 600 million users worldwide. Approximately 75 manuscripts have been published, approximately 100 abstracts presented, and 16 grants secured. To address the under-representation of PI in biomedical sciences, the Partnership has supported 30 graduate fellows, including 8 doctoral students at UH. Two PhD graduates are now faculty members at UOG and engaged in cancer health disparities research. UOG's Micronesian Studies Program now offers a cancer health disparities track, developed by the Partnership and tailored for the Pacific region. In addition, UOG/UHCC faculty, junior investigators, and pre/postdocs receive mentorship, career development, and summer research fellowships; to date, 8 UOG faculty have participated in the summer fellowship program at UHCC, and two have subsequently secured pilot funding. Outreach projects have explored community-based participatory approaches to youth tobacco use prevention and cessation in Guam, and the use of social networking to reduce tobacco-related cancer risk. Community-based participatory research has also led to landmark tobacco-control legislation in Guam, resulting in decreased tobacco use and increased tobacco taxes, a percentage of which supports cancer programs and patient services in Guam, including the Guam Cancer Registry. Current outreach efforts aim to increase cervical cancer screening among Micronesian migrants and build cancer-prevention knowledge and awareness among physicians who serve them in Guam and Hawaii. In conclusion, the Partnership has significantly increased research capacity at UOG and cultivated interest in cancer research among under-represented minority students at the partnering institutions. Supported by NCI grants U54CA143727 and U54CA143728. Citation Format: Carl-Wilhelm Vogel, David C. Ward, Neal A. Palafox, Hali R. Robinett, Rachael T. Leon Guerrero, John A. Peterson. University of Guam/University of Hawaii Cancer Center partnership: Fifteen years of progress in addressing cancer health disparities in Pacific Islanders [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C125.

Abstract D040: University of Guam/University of Hawaii Cancer Center Partnership: Sixteen years of progress in addressing cancer health disparities in Pacific Islanders

Abstract The University of Guam (UOG)/University of Hawaii Cancer Center (UHCC) Partnership aims to grow cancer research capacity at UOG, develop cancer health disparities research at UHCC focusing on Pacific Islanders (PI), raise awareness of cancer and cancer prevention in Guam (GU), Hawaii (HI) and the US Associated Pacific Islands (USAPI), and increase the number of cancer and biomedical science researchers of PI ancestry in the United States. An infrastructure comprised of 4 principal investigators, over 30 participating faculty, administrative staff, and external and internal reviewers, backed by institutional support and NCI sponsorship, has supported 16 years of research, training, and outreach designed to reduce cancer health disparities and advance health equity among PI in GU, HI, and the USAPI. Since 2009, the Partnership has funded 19 cancer research projects addressing cancer research priorities of global and regional relevance, including cervical cancer and Areca (betel) nut chewing - a traditional practice associated with oral pre/carcinoma, affecting 600 million users worldwide. Ninety peer-reviewed manuscripts have been published, over 100 abstracts presented, and 19 grants secured. To address the underrepresentation of PI in biomedical sciences, the Partnership has supported 33 graduate students including 7 doctoral students at UH. Two PhD graduates are now faculty members at UOG and engaged in cancer health disparities research. UOG’s Micronesian Studies Program now offers a cancer health disparities track, developed by the Partnership and tailored for the Pacific region. In addition, UOG/UHCC faculty, junior investigators, and pre/postdocs receive mentorship, career development, and summer research fellowships; to date, eight UOG faculty have participated in the summer fellowship program at UHCC and most had received U54pilot funding. Outreach projects have explored community-based participatory approaches to youth tobacco use prevention and cessation in Guam, and the use of social networking to reduce tobacco-related cancer risk. Community-based participatory research has also led to landmark tobacco control legislation in Guam, resulting in decreased tobacco use and increased tobacco taxes, a percentage of which supports cancer programs and patient services in Guam including the Guam Cancer Registry. Current outreach efforts aim to increase colorectal cancer screening and HPV vaccination while building knowledge and awareness among physicians who serve Pacific Islanders in Guam and Hawaii. In conclusion, research capacity at UOG has significantly increased, disparities research at UHCC has expanded, and underrepresented minority students are pursuing careers in cancer research. Supported by NCI grants U54CA143727 and U54CA143728. Citation Format: Rachael T Leon Guerrero, Margaret Hattori-Uchima, Hali R Robinett, Carl-Wilhelm Vogel, Neal A Palafox. University of Guam/University of Hawaii Cancer Center Partnership: Sixteen years of progress in addressing cancer health disparities in Pacific Islanders [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D040.