Blacks Research Articles

Incident Epilepsy Among US Medicare Beneficiaries, 2019: Differences by Age, Sex, and Race/Ethnicity.

Epilepsy is common among older adults, but previous incident studies have had limited ability to make comparisons across key subgroups. We aimed to provide updated epilepsy incidence estimates among older adults, comparing across age, sex, and race/ethnicity. Using a random sample of 4,999,999 US Medicare beneficiaries older than 65 years, we conducted a retrospective cohort study of epilepsy incidence using administrative claims for 2016-2019. Sampled beneficiaries were enrolled in the Fee-for-Service (FFS) program in each of 2016-2018 and had no epilepsy claims in those years. Non-Hispanic Black and Hispanic beneficiaries were oversampled to ensure adequate cases for detailed comparisons. Incidence in 2019 was identified in the Master Beneficiary Summary File as ≥1 inpatient claim or ≥2 outpatient nondrug claims occurring at least 1 day apart (ICD-10 G40.x). Incidence models were estimated by age, sex, race/ethnicity, and combinations thereof, with adjustment for the racial/ethnic oversampling. We identified 20,545 incident epilepsy cases. The overall epilepsy incidence rate (IR) was 393 per 100,000 (99% CI 385-400). Incidence peaked at ages 85-89 (504 [481-529]) and was higher for men (396 [385-407]) than women (376 [366-385]). The sex difference in IRs was constant with age. Incidence was higher for non-Hispanic Black (678 [653-702]) and Hispanic (405 [384-426]), and lower for non-Hispanic Asian/Pacific Islander (272 [239-305]) beneficiaries, compared with non-Hispanic White beneficiaries (354 [299-408]). The age-specific IRs significantly differed by race/ethnicity and sex, but only among non-Hispanic Black beneficiaries-where men had higher rates at younger ages and women at older ages. We found higher epilepsy IRs among those enrolled in the Medicare FFS system 2016-2019 than previous studies using Medicare claims data from at least a decade ago. The risk of epilepsy onset is higher for those in their late 80s, men, and non-Hispanic Black and Hispanic older adults. There is also evidence that these age-graded risks operate differently for Black men and Black women. Efforts to provide care and services that improve quality of life for older adults living with epilepsy should consider differences by multiple social characteristics simultaneously: age, sex, and race/ethnicity.

Living less safely through the pandemic in England for people with serious mental and physical health conditions: qualitative interviews with service users and carers of Black African, Caribbean, and South-Asian descent.

COVID-19 Ethnic Inequalities in Mental health and Multimorbidities (COVEIMM) is a mixed methods study to explore whether COVID-19 exacerbated ethnic health inequalities in adults with serious mental and physical health conditions. We analysed data from electronic health records for England and conducted interviews in Birmingham and Solihull, Manchester, and South London. Sites were selected because they were pilot sites for the Patient and Carer Race Equality Framework being introduced by NHS England to tackle race inequalities in mental health. Prior to the pandemic people in England with severe mental illnesses (SMIs) faced an 11-17-year reduction in life expectancy, mostly due to preventable, long-term, physical health conditions. During the pandemic there was a marked increase in deaths of those living with an SMI. This qualitative interview study aimed to understand the reasons underlying ethnic inequalities in mortality and service use during the COVID-19 pandemic for adult service users and carers of Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi backgrounds living with serious multiple long-term mental and physical health conditions. We took a participatory action research approach and qualitative interviews undertaken by experts-by-experience and university researchers Participants were purposively sampled by ethnicity, diagnoses, and comorbidities across three geographically distinct sites in England. Transcriptions were coded inductively and deductively and analysed thematically. Findings indicated multiple points along primary and secondary health pathways for mental and physical health that have the potential to exacerbate the unjust gap in mortality that exists for Black and Asian people with SMIs. Issues such as timely access to care (face-to-face and remote), being treated in a culturally appropriate manner with empathy, dignity and respect, and being able to use services without experiencing undue force, racism or other forms of intersectional discrimination were important themes arising from interviews. These poor experiences create systemic and enduring healthcare harms for racialised groups with SMIs that need to be addressed. Our findings suggest a need to address these, not only in mental health providers, but across the whole health and care system and a need to ensure more equitable healthcare partnerships with service users, carers, and communities from racialised backgrounds who are often excluded.

Remaining in the wake: towards an endarkened paradigm for critical studies of whiteness

ABSTRACT Critiquing how critical whiteness studies (CWS) in US education has strayed towards a predominant focus on how white people understand their relationship to whiteness and away from understanding how whiteness oppresses People of Colour, Matias and Boucher articulated a Black whiteness studies approach to the critical study of whiteness that eschews white epistemological standpoints, engages the works of Scholars of Colour and expands beyond a focus on developing white people’s racial consciousness. However, their articulation of a Black whiteness studies falls short of addressing Black communities’ specific racial positioning, the unique ways Black people suffer under whiteness and the situated knowledges of Black communities. In this paper, I theorise at the intersections of CWS, endarkened feminisms and afropessimsim to extend Matias and Boucher’s work to propose an endarkened paradigm for critical studies of whiteness.

Race- associated molecular differences in uterine serous carcinoma

PurposeEndometrial cancer (EMCA) is the most common gynecologic malignancy, and new diagnoses are increasing in the United States. Black patients are more likely to present with advanced stage, be diagnosed with high-risk uterine serous carcinoma (USC) and die of their cancer.MethodsPatients with endometrial adenocarcinoma who received tumor FoundationOne CDx testing at our institution between January 2017 and August 2022 were identified. Genomic alterations, demographic and clinical characteristics were collected. Descriptive statistics and Fisher’s exact test were used to analyze data.ResultsA total of 289 patients (29.4% Black and 52.6% White) with advanced or recurrent endometrial adenocarcinoma underwent FoundationOne CDx testing. USC comprised 26.3% (76 of 289) of tested tumors. Of USC tumors, 33 of 76 (44%) were of Black race. USC occurred more frequently in Black patients (33 of 85 [38.8%] Black patients compared to 30 of 152 [19.7%] White patients, p<0.05). Among USC, CCNE1 amplification occurred more frequently in Black patients than in White patients (12 of 33 [36.36%] vs 2 of 30 [6.67%], p<0.05) while PI3K/AKT/mTOR pathway mutations occurred less frequently (16 of 33 [48.5%] vs 26 of 33 [86.7%], p=0.17). Among patients with CCNE1 amplification 73.3% (11 of 15) progressed on or within 12 months of first-line platinum-based therapy. CCNE1 amplification had significantly shorter median overall survival (97.3 months vs 44.3; HR (95%CI): 7.1 (10.03, 59.4) p< 0.05).ConclusionsBlack patients constituted 44% of patients with USC in our study and had an increased frequency of CCNE1 amplification. Patients whose tumors harbored CCNE1 amplification had shorter overall survival. Identifying actionable mutations in this high unmet need population is crucial to improving outcomes among Black patients with uterine malignancy. Development of new targeted-therapies will need to keep these alterations at the forefront as trials are being designed.

Hotep anti-Blackness: Misogynoir and queer exclusion in online conspiracy theorizing

Research suggests African Americans are more likely than Whites to support conspiracy theories, especially those related to the U.S. government. Locating the pedagogical practices of Black activists in the online hotep subculture, I use the concept of public pedagogy to understand how these activist influencers use social media to spread political messages in the public sphere. This essay situates hotep subculture as a conspiritualist project that uses Pan-Africanism, Afrocentricity, Black spirituality, and hip-hop culture to advance conspiracy theories among Black communities for consciousness-raising and economic independence. While hoteps have promulgated a pro-Black politic, their reliance on ethnonationalist homophobia and misogynoir promotes a form of erasure that is not only exclusionary and anti-Black but also reflects racial fears rooted in anxiety. This essay contributes to the growing literature on conspiritualism’s investment in white supremacy and the need for conspiritualist critiques to investigate how anti-Blackness shows up in discourses at the intersection of faith, spirituality, and global regimes of power. Drawing on the concepts of misogynoir and anti-Black heterotopias, Black gender and sexual minorities are framed within hotep discourse as subservient, deviant, and perilous to Black liberation.

The Relationship Between Racial Attitudes and Disordered Eating Behaviors in Black Men and Black Women.

Black individuals remain underrepresented in disordered eating research, despite evidence that both Black men and women present with disordered eating behaviors. Culturally-informed theoretical frameworks suggest that these behaviors may be linked to race-related sociocultural experiences, such as aspects of racial identity. While studies have focused on racial identity commitment, the association between attitudes toward one's racial identity and disordered eating remains underexplored. The present study examines whether positive attitudes toward one's Blackness and Black culture are associated with disordered eating. In a cross-sectional online sample of Black men and women (N = 458), we measured self-reported attitudes toward Blackness (i.e., centrality and private regard) and disordered eating behaviors (i.e., purging, binge eating, excessive exercise, and drive for thinness). In pre-registered linear regression models, private regard was negatively associated with purging and binge eating. Across all models, centrality was not associated with disordered eating. On average, Black women reported greater drive for thinness whereas Black men reported higher excessive exercise scores. This is the first study to demonstrate associations between racial attitudes and disordered eating among Black men and women. Our findings affirm unique correlates of disordered eating among Black people and suggest that positive attitudes toward one's Blackness and Black culture may be a protective factor against the development of disordered eating.

OTHR-12 INCIDENCE, CLINICAL PRESENTATION, MANAGEMENT AND ONE- AND TWO-YEAR SURVIVAL OF PATIENTS WITH MEDULLOBLASTOMA AT INKOSI ALBERT LUTHULI CENTRAL HOSPITAL, KWAZULU NATAL PROVINCE: A TEN YEAR REVIEW

Abstract OBJECTIVE Epidemiology, clinical presentation, stage and multidisciplinary treatment modalities for Medulloblastoma (Mb) at Inkosi Albert Luthuli Central Hospital (IALCH) for the 10 year period from 2003 to 2012. It also evaluated the 1 and 2 year survival rate. Methodology: Single center- retrospective study of Mb patients below the age of 18 years in a low and middle income country (LMIC) setting. RESULTS The 30 patients included in the study, median age was 9 years. Male to female ratio of 1.3:1. 70% were black race. Average incidence was 14 per 1000 children years. Headache was most common symptom in 70% of the patients. Majority presented with advanced non metastatic disease (T3b). All patients had shunt insertion prior to debulking surgery and 60% had gross total resection. More than half of the cases had reduced dose irradiation (30.6Gy) to the cranial and spinal compared to 36% who had 36Gy. 96% received concurrent vincristine with radiotherapy. 89.7% received adjuvant chemotherapy and 82.8% completed 6 cycles. There was not enough data to determine any trends in the different modalities of treatment offered over the period of 10 years. One year survival rate was 83.33% [95% CI 64.55; 93.70%] and probability of surviving two years was 80.00% [95% CI 60.87%; 91.60%]. CONCLUSION Children present with advanced stages requiring multi-level surgeries. Dedicated multi-disciplinary approach to treatment conferred decent survival outcomes despite the advanced stages at presentation. Similar successes were reflected in the only other study on the subject in Cape Town in a 3 decade retrospective study between the years 1985-2005. These studies highlight the importance of implementing multidisciplinary team management in parallel with modern radiotherapy techniques to improve survival for children with medulloblastoma. Current training programs like Access to Care Capetown could further improve the outcome in countries establishing or transitioning to new radiotherapy techniques.

B-321 Enhancing Early Detection of Prostate Cancer Using PSA-Guided Screening in High-Risk Men Under 50

Abstract Background Prostate Cancer remains a significant global public health concern. It is the most common cancer and the second leading cause of cancer death among men in the United States. Current guidelines, including those by the USPSTF, ACS and ASCO offer varying recommendations on PSA screening. Present clinical practice, primarily targeting men aged 50-69. Our study aimed to assess the feasibility and validity of using PSA for targeted screening in men under 50 who are at high risk, enhancing early detection of prostate cancer. Methods This retrospective analysis utilized data from our hospital's prostate cancer screening program collected from 2022 to 2023, including104 individuals under 50. Participants were categorized based on PSA levels 4-10 ng/mL (n=71) and over10 ng/mL (n=33). We analyzed the number of cases diagnosed with prostate cancer and the correlation with PSA levels, Gleason Scores (GS), family history, and ethnicity/race. Results In the104 participants, 88 of them were diagnosed with prostate cancer, highlighting an 84.6% detection rate. Among PSA levels 4-10 ng/mL group, 36 out of 43 White or Caucasian and 13 out of 13 Black or African American men were identified as GS 6-10. In the group PSA over 10 ng/mL, 18 White or Caucasian and 6 Black or African American individuals with more aggressive disease (GS 6-10). Importantly, a substantial fraction of these cases had a first-degree relative with prostate cancer, emphasizing the influence of family history on PSA screening decision. Conclusions Our findings suggest that PSA-guided screening in men under 50 at high risk can enhance the early detection of prostate cancer. The significant presence of intermediate-risk prostate cancer (GS 6 or 7) in populations at higher risk due to ethnicity/race and family history. Our study highlights the potential benefits of revisiting current screening guidelines to lower the age threshold for high-risk populations.

Heterogeneous genetic architectures of prostate cancer susceptibility in sub-Saharan Africa.

Men of African descent have the highest prostate cancer incidence and mortality rates, yet the genetic basis of prostate cancer in African men has been understudied. We used genomic data from 3,963 cases and 3,509 controls from Ghana, Nigeria, Senegal, South Africa and Uganda to infer ancestry-specific genetic architectures and fine-map disease associations. Fifteen independent associations at 8q24.21, 6q22.1 and 11q13.3 reached genome-wide significance, including four new associations. Intriguingly, multiple lead associations are private alleles, a pattern arising from recent mutations and the out-of-Africa bottleneck. These African-specific alleles contribute to haplotypes with odds ratios above 2.4. We found that the genetic architecture of prostate cancer differs across Africa, with effect size differences contributing more to this heterogeneity than allele frequency differences. Population genetic analyses reveal that African prostate cancer associations are largely governed by neutral evolution. Collectively, our findings emphasize the utility of conducting genetic studies that use diverse populations.

Exploring Dietary Salt Knowledge, Attitude, and Practices among People of African Descent in the United Kingdom: A Qualitative Study

Background/Objectives: People of African Descent (PoAD) in the United Kingdom (UK) are at an increased risk of hypertension and cardiovascular disease (CVD), partly due to dietary habits such as high salt intake. This study sought to understand the dietary salt-related knowledge, attitudes, and practises (KAP) of PoAD in the UK, to inform the development of culturally tailored interventions to reduce dietary salt intake in this population. Methods: We collected data on KAP from 21 PoAD across various regions in the UK through online semi-structured interviews and analysed them using reflexive thematic analysis (TA). Results: The age of the participants ranged from 20 to 70 years (43 ± 11). Six overarching themes were identified: (i) the multifaceted roles of salt in culinary practises, (ii) the increased awareness of health risks associated with high salt intake, (iii) the existence of knowledge gaps regarding recommended daily salt intake, (iv) the cultural influences on salt consumption levels, (v) the lack of engagement with food labels, and (vi) a limited awareness of salt reduction initiatives. Conclusions: Our findings highlight the significance of salt in the culture and culinary practises of PoAD. Despite general awareness of the health risks of excessive salt consumption, there was a notable deficiency in knowledge about the recommended salt intake levels as well as minimal engagement with nutritional labelling. These findings underline a need for culturally sensitive health interventions that integrate culinary practises, beliefs, and preferences of PoAD, aiming to effectively reduce salt intake and mitigate associated health risks.

Evaluation of guideline recommended treatment utilization among Black and White men with metastatic prostate cancer.

103 Background: Prostate cancer is the second leading cause of cancer death among men with a disproportionate burden on Black men. 1 Black men are twice as likely to die from prostate cancer compared to White counterparts. 2 Racial disparities in care delivery for early-stage disease are well documented and may contribute to disparate outcomes, 3–6 but less is known about racial gaps in advanced prostate cancer care, a stage where effective therapies can prolong life for years. 7 We sought to evaluate if treatment disparities were evident among Black and White men with metastatic prostate cancer. Methods: We performed a retrospective cohort study of patients with metastatic prostate cancer receiving treatment at a large public tertiary care health system between 2015 and 2020. Demographic, clinical, treatment, and medication prescribing data were extracted from the electronic health record. We excluded patients without ICD codes indicating metastatic disease, those without any documented medication data in our health system, and those who did not identify as Black or White race. We estimated the prevalence ratio (PR) of being prescribed each of the recommended treatment options for metastatic prostate cancer per National Comprehensive Care Network guidelines, including androgen deprivation therapy (ADT), novel anti-androgens, chemotherapy, and bone protection comparing Black men to White men using log-binomial regression. Results: We identified 1,594 patients with metastatic prostate cancer; 485 (30%) were Black. Black patients were younger and had higher Charlson scores compared to White men. Both groups were highly insured, Medicaid was more common for Black men (7.2% vs 2.2%). Prescribing of systemic treatments was similar by race (Table). Combination ADT and novel antiandrogen prescribing was also similar by race (PR 1.04 95% CI:(0.91 - 1.17), p=0.6). About 30% of both Black and White patients interacted with our Patient Navigation team, a group of oncology nurses focused on ensuring patients receive recommended care. Conclusions: In a large public tertiary care health system, we did not observe racial disparities in receipt of guideline recommended therapies for metastatic prostate cancer. High rates of insurance, a robust patient navigation program, and a well-developed pharmacy assistance program may have helped mitigate racial disparities in care. Ongoing analyses are evaluating prescribing patterns among patients with de novo metastatic disease. Future studies should explore delivery of prostate cancer therapies across health systems and the influence of patient navigation and pharmacy assistance programs on medication receipt. Prevalence ratios of treatment by race. Medication PR (95% CI) for Black v White men p-value ADT 1.04 (0.98-1.11) 0.19 Novel Antiandrogen 1.05 (0.95-1.16) 0.31 Bone protection 0.89 (0.76-1.04) 0.13 Chemotherapy 1.09 (0.85-1.39) 0.51

Percent Final Height Is a Novel Method That Identifies Differences Between the Rate of Development in American Children of Different Races.

The Greulich & Pyle (G&P) Radiographic Atlas of Skeletal Development uses hand x-rays obtained between 1926 and 1942 on children of Caucasian ancestry. Our study uses modern Caucasian, Black, Hispanic, and Asian children to investigate patterns of development as a function of percent final height (PFH). A retrospective review, at a single institution, was conducted using children who received a hand x-ray, a height measurement taken within 60 days of that x-ray, and a final height. BA and CA were compared between races. PFH was calculated by dividing height at the time of the x-ray by their final height. To further evaluate differences between races in CA or BA, PFH was then modeled as a function of CA or BA using a fifth-degree polynomial regression, and mean ages at the 85th PFH were compared. Patients were then divided into Sanders stages 1, 2-4, and 5-8 and the mean PFH, CA, and BA of the Asian, Black, and Hispanic children were compared with the White children using Student t test. P values less than 0.05 were considered significant. We studied 498 patients, including 53 Asian, 83 Black, 190 Hispanic, and 172 White patients. Mean BA was significantly greater than CA in Black males (1.27y) and females (1.36y), Hispanic males (1.12y) and females (1.29y), and White females (0.74y). Hispanic and Black patients were significantly more advanced in BA than White patients ( P <0.001). At the 85th PFH, White and Hispanic males were older than Black males by at least 7 months ( P <0.001), and White females were significantly older than Hispanic females by 6.4 months ( P <0.001). At 85th PFH for males, Hispanic and Black males had greater BA than White males by at least 5 months ( P <0.001), and Asian females had a greater BA than Black females by at least 5 months ( P <0.001). Compared with White children, Hispanic children were significantly younger at Sanders 2-4 than White children, and Black children were skeletally older at Sanders 5-8. BA was greater than CA by ≥1 year in Black and Hispanic children, and that these children had a significantly greater BA than their White counterparts. Black males and Hispanic females reached their 85th PFH at younger ages, and Hispanic males and Asian females were the most skeletally mature at their 85th PFH. Our results suggest that BA and CA may vary as a function of race, and further studies evaluating growth via the 85th PFH may be necessary. Therapeutic Study - Level IV.

Preventive Behaviors during the COVID-19 Pandemic in Delaware’s Underserved Communities: A Longitudinal Study (2021–2022)

The COVID-19 pandemic officially started in March 2020 and ended in May 2023. Preventive behaviors have been proven to be one of the most effective strategies for preventing COVID-19 transmission. Common preventive behaviors against COVID-19 include but are not limited to wearing a face mask, washing and sanitizing one’s hands frequently, avoiding crowds, and avoiding traveling. Underserved communities and racial/ethnic minorities across the U.S. have been disproportionately affected by the COVID-19 pandemic. Using a three-wave longitudinal survey conducted from early 2021 to late 2022, the present study investigated changes in the adoption of COVID-19-preventive behaviors among residents living in Delaware’s most underserved communities. We also examined whether changes in COVID-19-preventive behaviors differed by race. Our results indicated that fewer people adopted preventive behaviors as the pandemic progressed, and this finding is applicable to both Black people and White people. However, Black people had a consistently greater likelihood of adopting preventive behaviors compared to White people from early 2021 to late 2022. Scientific and policy implications are discussed.

Trends and Disparities in the Utilization of Thymectomy for Myasthenia Gravis in the United States.

In 2016, a randomized controlled trial demonstrated the clinical efficacy of trans-sternal thymectomy for patients with non-thymomatous myasthenia gravis (MG). Whether large-scale changes occurred in clinical practice after this trial is unknown. We performed a retrospective longitudinal cross-sectional analysis using National Inpatient Sample (NIS) data from 2012 to 2019. Our study included hospitalized adults at least 18 years of age diagnosed with MG without an associated thymoma. We used joinpoint regression to analyze annual trends in thymectomy volume and surgical approach (minimally invasive vs trans-sternal) from 2012 to 2019. Using logistic regression models, we examined patient and hospital-level factors that may have influenced whether thymectomy was performed, such as age, sex, race, insurance payor, hospital size and teaching status, and Elixhauser Comorbidity Index. Sampling weights were applied to account for the complex survey design of NIS. The total number of thymectomy procedures increased by 69.8% per year (95% CI 40.1-105.8) between 2012 and 2019. Trans-sternal thymectomies increased by 62.8% per year (95% CI 35.8-95.2) and minimally invasive thymectomies by 83.7% per year (95% CI 38.1-144.3). Thymectomies were significantly more likely to occur in 2017-2019 compared with 2012-2016 (OR 1.93, 95% CI 1.62-2.31). In a multivariable regression model, several factors decreased the odds of patients with MG having a thymectomy: older age, Black race (OR 0.62, 95% CI 0.49-0.77), female (OR 0.73, 95% CI 0.63-0.86), and higher Elixhauser Comorbidity Index. Patients in medium (OR 1.82, 95% CI 1.30-2.55) or large (OR 2.81, 95% CI 2.07-3.82) size and urban teaching hospitals (OR 6.09, 95% CI 2.65-13.97) were more likely to undergo thymectomy. Thymectomy is being performed more frequently for non-thymomatous MG, especially after 2016 after publication of a positive phase III clinical trial. There are several disparities in thymectomy utilization that warrant further attention.

Identifying Pregnant Patients With Suspected Intimate Partner Violence.

Intimate partner violence (IPV) is the leading cause of death in pregnant women. Although it can be difficult to identify patients experiencing IPV, injuries to the head, neck, or face due to an assault are known to correlate with intentional injury. The objective of this study is to assess the contemporary burden of IPV in pregnancy and describe the patient characteristics. The National Inpatient Sample was queried for all pregnant women between January 2016 and December 2019. Patients were divided into two groups: suspected IPV (SIPV) and no-SIPV groups. We defined SIPV as any pregnant patient with an identified head, neck, or face injuries categorized as intentional assault. Multivariable logistic regression analysis was performed to assess the association between SIPV and variables of interest. A total of 28,540 pregnant patients presented with traumatic injuries with 530 (.02%) identified as SIPV. Suspected IPV patients were younger (25 vs 27 years, P = .012), more likely to be of Black race (46% vs 28%, P = .002), more likely to be in the lowest income quartile (51% vs 38%, P = .031), less likely to have private insurance (12% vs 34%, P < .001), and have higher rates of substance use disorder (35% vs 18%, P < .001). Black race and history of substance use disorder were associated with increased odds of SIPV-related injuries (odds ratio [OR]: 2.01, interquartile range [IQR]: 1.27-3.16, P = .003 and OR: 2.30, IQR 1.54-3.43, P < .001, respectively). Our results suggest that there are significant racial and socioeconomic disparities in potential risk for IPV during pregnancy.

Factors associated with delays in receipt of neoadjuvant chemotherapy in patients with operable breast cancer.

126 Background: Delays in neoadjuvant chemotherapy initiation (NACTI) after breast cancer (BC) diagnosis have been associated with worse outcomes. We evaluated incidence and predictors of delays of NACTI among high clinical risk patients treated with NACT on a national level. Methods: We conducted a retrospective cohort study using the National Cancer Database. Eligibility included age ≥18 years, diagnosis of non-metastatic BC between 1/1/2010 – 12/31/2020, who were treated with NACT within 180 days of diagnosis. Patients who received neoadjuvant endocrine therapy were excluded. Time to chemotherapy (TTC) in days was recorded. Patients were categorized into sub-cohorts by receptor status and clinical stage: 1) Hormone Receptor positive/HER-2 negative (HR+/HER2-) and were lymph node (LN) LN+; 2) HER-2 positive (HER2+) cT2+ or LN+; and 3) triple negative BC (TNBC) cT2+ or LN+. Multivariable logistic regression, adjusted for demographic, socioeconomic and tumor characteristics, was used to identify characteristics associated with delays &gt; 60 days from diagnosis to NACTI. Multiple imputation was used for missing data. Results: We identified 145,697 eligible patients, 74% were White, 18% were Black, 3.3% were Asian, and 4.6% were Other/Unknown. Across all racial categories, 9.2% were Hispanic. Median age at diagnosis was 52 years (range 18-90), median TTC was 32 days (range 0-180), and 10% had a delay &gt; 60 days. There were 40,345 patients in the HR+/HER2- cohort, 56,868 in the HER2+ cohort, and 48,484 in the TNBC cohort; 12%, 9.0%, and 8.9% (p &lt; 0.001) had a delay in NACTI, respectively. In multivariable analysis among the HR+/HER2- sub-cohort, characteristics associated with delays in NACTI included Black race (OR 1.71, 95%CI 1.57-1.86) and Hispanic ethnicity (OR 1.76, 95%CI 1.60-1.94) compared to White and non-Hispanic patients. Patients with Medicare, Medicaid, or who were uninsured were more likely to be delayed (OR 1.44 95%CI 1.30-1.58, 2.10, 95%CI 1.92-2.29, 2.28, 95%CI 1.99-2.61) compared to those with commercial insurance. Results were similar in the HER2+and TNBC cohorts, as seen (Table). Conclusions: Among patients with operable BC who received NACT, patients who were Black, Hispanic, had Medicaid or no insurance had as high as a twofold increase in odds of a delay in NACTI. Targeted interventions to address these racial and socioeconomic disparities are necessary to ensure equitable care. Multivariable logistic regression adjusted for demographic, socioeconomic, and tumor characteristics variables (n = 145,697). HR+/HER2-N= 40,345 HER2+N= 56,868 TNBCN= 48,484 OR 95%CI OR 95%CI OR 95%CI Black Race 1.71 1.57-1.86 1.89 1.74-2.04 1.90 1.76-2.06 Hispanic Ethnicity 1.76 1.60-1.94 2.18 2.00-2.36 2.00 1.80-2.21 Medicare 1.44 1.30-1.58 1.46 1.34-1.61 1.45 1.32-1.61 Medicaid 2.10 1.92-2.29 2.13 1.96-2.31 2.14 1.96-2.34 No Insurance 2.28 1.99-2.61 2.36 2.07-2.70 2.25 1.96-2.59

In focus: Engaging Black and African American women in oncology supportive care interventions.

54 Background: For individuals navigating cancer, unaddressed psychosocial needs can adversely impact quality of life, treatment adherence, and healthcare expenditures. It is recognized that African American cancer survivors are more likely to experience distress, yet they are underrepresented in studies that evaluate interventions. Mind Over Matter (MOM) is a five-week psychoeducational program aimed at bolstering emotional coping skills. A previous study among predominantly White female-identifying breast cancer survivors revealed improvements from pre to post-MOM for anxiety, depression, and physical symptom severity and interference; no data exists for women who identify as Black and/or African American. This presentation will illustrate the strategies and processes implemented to recruit, consent, and retain Black and African American cancer survivors to test the feasibility and acceptability of MOM. Methods: In forming the research team, the diversity in institutions, experience, racial and cultural identities, and professional perspectives were prioritized. As a result of this process, team members were social workers and psychologists, one was at an HBCU institution, and another was a patient advocate from the Black community who was hired and trained enabling full participation in the research process. To improve access all aspects of the study were available online and the intervention was offered virtually in the evening to support participants' availability. Efforts were made to build relationships with non-profit organizations, then disseminating the study through emails, healthcare systems, and social media. Results: During the 3-month recruitment period, 79 individuals expressed interest in the study via email and the study website. Of these, 40 participants (50.6%) enrolled in the study, surpassing the goal of 27. Half of the enrolled survivors learned about the study through community, medical, and academic organizations, while 20% and 10% were referred via the home health system and social media, respectively. 17.5% were referred from unspecified sources. Conclusions: Through robust team development, strategic community partnerships, using a study design that addressed common barriers (e.g., program hours and delivery method, tech orientation, incentives) and a high touch approach, this study successfully enrolled half of the Black and African American female-identified cancer survivors who expressed interest in this mixed-methods study. Clinical trial information: NCT06168825 .

Impact of Medicaid expansion on receipt of pancreatectomy in early-stage pancreatic cancer.

106 Background: Pancreatic cancer is estimated to rank third in cancer-related mortality in 2024 by the American Cancer Society. Despite the proven increase in 5-year survival with pancreatectomy in Early Pancreatic Cancer (EPC), it is nationally underutilized. Medicaid expansion (ME) under the Affordable Care Act is associated with gains in insurance coverage and early cancer diagnosis in patients with pancreatic cancer. However, its impact on the receipt of pancreatectomy in EPC remains unclear. In this study, we looked at the impact of ME on the uptake of pancreatectomy in EPC. Methods: We performed a retrospective observational study using the Surveillance, Epidemiology, and End Results (SEER) database, which included patients diagnosed with EPC (Stage 1 and Stage 2) between 2006 and 2021. Multivariate logistic regression was performed to ascertain the effects of ME on the uptake of pancreatectomy in patients with EPC in states that expanded vs. states that did not, with 2014 as an inflection point for policy implementation. Results: During this study period, 29,384 were diagnosed with EPC, 10,777 patients were diagnosed pre-ME and 18,607 post-ME. The odds of receipt of pancreatectomy for EPC in non-expansion states after 2014 was 20% higher than before 2014. However, this was not statistically significant [AOR – 1.20 (0.98-1.48)]. There was also no significant difference between the odds of receipt of treatment for EPC for ME states before [AOR- 1.27 (1.06-1.51)] and after [AOR-1.21 (1.01-1.44)] 2014. Increasing age, male sex, Black and Hispanic race, having an income lower than $65,000, and living in less populated areas were all associated with lower odds of receipt of pancreatectomy in EPC. Conclusions: ME was not associated with increased uptake of pancreatectomy in EPC. However, prior studies have shown that ME is linked to an earlier stage at pancreatic cancer diagnosis. This suggests that despite earlier diagnosis, other barriers to receiving treatment exist. Future studies are warranted to identify the limitations of policy change to improve outcomes of such aggressive cancer. Logistic regression for receipt of pancreatectomy in early-stage pancreatic cancer. Receipt of Surgical Treatment for Early Pancreatic cancer Adjusted Odds Ratio (95% Confidence Interval) Non- ME States (Pre-Expansion) 1.00 (Reference) Non- ME States (Post -Expansion) 1.20 (0.98-1.48) ME States (Pre-Expansion) 1.27 (1.06-1.51) ME States (Post-Expansion) 1.21 (1.01-1.44) ME- Medicaid expansion.

National survey of patient perspectives on medication costs among co-pay assistance recipients with cancer.

246 Background: Individuals with cancer may seek assistance from co-pay assistance programs (CAPs) to help with high medication costs. However, little is known about these individuals’ perspectives on medication costs and their associations with other patient-reported outcomes (PROs). Methods: From 10-11/2022, we conducted a national, cross-sectional survey of CAP recipients with cancer, which asked about patient perspectives on medication costs (knowing monthly spending on medications, belief that health insurance would prevent high medication costs, and inability to afford care even with help paying for medications). We fit logistic regression models to describe associations between patient characteristics, including patient demographics and PROs (depression/anxiety symptoms [PHQ-4], financial toxicity [COST tool, score &lt;14 indicates high financial toxicity], and health literacy [Brief Health Literacy Screener]), with patient perspectives. Results: Among 1,108 survey participants (median age=72 [range 41-92], 60% male sex), the most common cancer types were multiple myeloma (54%) and prostate cancer (13%). The majority of participants reported knowing their monthly spending on medications (75%); most believed their health insurance would prevent them from high medication costs (67%); under half reported an inability to afford care even with help paying for medications (41%). Factors associated with lower odds of knowing monthly medication spending included Black race (OR=0.45, P=.005), having Medicare Advantage (OR=0.73, P=.036), lack of supplemental insurance (OR=0.68, P=.011), more comorbidities (OR=0.52, P=.002), depression symptoms (OR=0.61, P=.013), and lower health literacy (OR=0.43, P&lt;.001). Factors associated with believing that health insurance would prevent high medication costs were depression symptoms (OR=1.54, P=.02), anxiety symptoms (OR=1.40, P=.045), and financial toxicity (OR=2.24, P&lt;.001). Factors associated with reporting an inability to afford care even with help paying for medications included Hispanic ethnicity (OR=2.55, P=.024), more comorbidities (OR=1.84, P=.003), depression symptoms (OR=3.16, P&lt;.001), anxiety symptoms (OR=3.60, P&lt;.001), and financial toxicity (OR=7.83, P&lt;.001). Conclusions: In this large sample of CAP recipients with cancer, most reported knowing their monthly medication spending, believing health insurance would prevent high medication costs, and feeling able to afford care with help paying for medications. We identified patient characteristics associated with these perspectives and found correlations between depression/anxiety symptoms, financial toxicity, and low health literacy with greater concerns with medication costs. Effort to mitigate financial toxicity by reducing adverse effects of medication costs in oncology should consider patients’ perspectives and their impact on PROs.

Racial differences in adoption and outcomes of transcarotid artery revascularization among high-risk adults with carotid artery stenosis

IntroductionDifferential access to new technologies may contribute to racial disparities in surgical outcomes but has not been well-studied in the treatment of carotid artery stenosis. We examined race-based differences in adoption and outcomes of transcarotid artery revascularization (TCAR) among high-risk non-Hispanic (NH) NH Black and NH white adults undergoing carotid revascularization. MethodsWe conducted a retrospective analysis of TCAR, transfemoral carotid artery stenting (TF-CAS), and carotid endarterectomy (CEA) procedures performed for carotid artery stenosis from 1/2015 to 7/2023 in the Vascular Quality Initiative. NH Black and NH white adults were included if they met Centers for Medicare & Medicaid Services high-risk criteria. Hospitals and physicians were categorized as TCAR-capable if they had previously performed at least one TCAR prior to the time of a given procedure. We fit logistic and linear regressions, adjusted a priori for common demographic, clinical, and disease characteristics, to estimate associations of race with receipt of TCAR (versus CEA or TF-CAS), and to explore associations between race, hospital and physician characteristics, and perioperative composite stroke/death/myocardial infarction. ResultsOf 159,471 high-risk patients undergoing revascularization for carotid artery stenosis (mean age 72 years, 38.5% female, 5.3% NH Black), 28,722 (18.0%) received TCAR, including 16.9% of NH Black adults and 18.1% of NH white adults (P<0.001). After controlling for patient and disease characteristics, NH Black patients were less likely than NH white patients to receive TCAR (aOR 0.92, 95% CI 0.87 to 0.99). The use of TCAR did not vary by race among patients treated at TCAR-capable hospitals (aOR 0.98, 95% CI 0.91 to 1.05) or by TCAR-capable physicians (aOR 1.01, 95% CI 0.93 to 1.10); however, NH Black race was associated with lower odds of receiving treatment in these settings (TCAR-capable hospital: aOR 0.93 [0.88 to 0.98]; TCAR-capable physician: aOR 0.92 [0.87 to 0.98]). NH Black race was associated with higher odds of stroke/death/MI in the full cohort (aOR 1.18, 95% CI 1.03 to 1.36), but not in the subgroup of patients who received TCAR (aOR 0.87, 95% CI 0.56 to 1.34). ConclusionsTCAR attenuated racial disparities in perioperative morbidity and mortality associated with carotid revascularization, but NH Black adults were less likely than NH white adults to receive TCAR. Relatively worse access for NH Black adults to technologically-advanced treatment settings may partially explain the broader persistence of race-based differences in carotid revascularization treatment patterns and outcomes.