Black Cancer Patients Research Articles

Assessment of poor cardiovascular health metrics and related disparities among cancer patients in the United States: a nationwide analysis of over 1.5 million individuals

Abstract Background Cancer, a major health challenge and a leading cause of mortality in the United States, significantly impacts cardiovascular health (CVH). The American Heart Association (AHA) emphasizes several CVH metrics to improve health outcomes, yet disparities in CVH persist nationwide. The specific impact of these disparities on the CVH of individuals with cancer, however, has yet to be fully explored. Purpose This study aims to utilize a detailed and nationally representative dataset from the U.S. to assess the prevalence of poor CVH among adults with a cancer diagnosis, focusing on uncovering sociodemographic disparities. Methods We utilized self-reported data from the Behavioral Risk Factor Surveillance System (2011 to 2019). This system, a state-based telephone survey, gathering data on cancer diagnoses, CVH metrics, and sociodemographic characteristics. We measured CVH through a composite score (0-7) based on the AHA’s seven CVH indicators: hypertension, high cholesterol, smoking, body mass index, diabetes, physical activity, and fruits and vegetables consumption. Individuals scoring between 0 and 2 were defined as having poor CVH. Multivariable generalized linear models within a binomial framework was applied to estimate adjusted prevalence ratios (aPRs) for poor CVH among cancer patients. Results Of 1,575,187 U.S. adults (representing an estimated 154.5 million; 50.7% female, 10.9% non-Hispanic black), 7.8% reported a cancer diagnosis between 2011 and 2019. Adjusted* findings show that having cancer (vs without) associated with a 16% higher prevalence of poor CVH (aPR=1.16; 95% CI [1.12-1.19]). Age-specific analysis revealed increased prevalence of poor CVH in middle-aged (45-64; aPR=3.55) and elderly (≥65; aPR=3.58) cancer patients, indicating a 255% and 358% rise, respectively, with p_interaction <0.001. Female cancer patients experienced a 22% lower prevalence of poor CVH than males (aPR=0.78; p_interaction <0.001). Non-Hispanic black cancer patients faced a 42% higher prevalence of poor CVH than their non-Hispanic white counterparts (aPR=1.42; p_interaction=0.001). Higher-income and education levels associated with 52% and 53% reduced prevalence of poor CVH, respectively (p_interaction <0.001; Table). Conclusions Our research identifies a strong correlation between cancer and deteriorating CVH metrics across U.S. adults, with pronounced variations based on sociodemographic factors. Specifically, the prevalence of poor CVH is substantially higher among cancer patients who are middle-aged, elderly, or identify as non-Hispanic Black, compared to other groups. Conversely, female cancer patients and those with a higher socioeconomic status appear to have a reduced risk of poor CVH. These outcomes stress the critical need for targeted, equitable public health initiatives that address both the cardiovascular and broader health needs of cancer patients, particularly among those most vulnerable.Table1

Abstract A042: Patient poverty burden influences the molecular biology of ER+ breast cancer

Abstract Although the incidence of estrogen receptor positive (ER+) breast cancer is similar for Black and White women in the US, Black patients have significantly worse outcomes. Black women in the US have also have worse health care options, poorer educational opportunities, and face significantly higher rates of poverty burden. Collectively contributing to an overall lower socioeconomic status (SES) compared to White women. However, cancer health disparities research primarily exists in two forms: 1) The impact of socioeconomic factors on cancer outcomes, and 2) The molecular underpinnings associated with genetic ancestry on cancer biology. This siloing results in an incomplete picture of how systemic factors (i.e. racism, poverty burden) contribute to the biology of breast cancer in addition to, and along-with, ancestral genetics. Consequently, differences in the molecular biology between tumors from Black and White women remains a gap in knowledge in the field, because ancestral genetics cannot explain the breadth of disparities that patients face. Recent studies have found that Black cancer patients have a unique gene expression profile that may modulate treatment response. For instance, ER+ breast tumors in Black women have distinct signatures of defective DNA damage repair (DDR) that associate with more aggressive tumor growth. However, how factors of SES contribute to these differences in molecular biology and whether these differences alter treatment response remain unknown. One challenge to addressing these questions is that existing datasets significantly underrepresent Black women and are not sufficiently annotated to understand the complex interplay between molecular biology and factors of SES. Here, we present analysis of RNA expression datasets from 60 ER+ patient tumors (38 Black, 22 White), with corresponding SES and patient outcome annotations. Altogether, these data begin to define the complex interplay between factors of SES and changes in gene expression in addition to patient outcomes for women with ER+ breast cancer. Citation Format: Jerry T. DeWitt. Patient poverty burden influences the molecular biology of ER+ breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A042.

Testing home-based exercise strategies in underserved minority cancer patients undergoing chemotherapy (THRIVE) trial: a study protocol.

Higher rates of physical inactivity and comorbid conditions are reported in Hispanic/Latinx and Black cancer patients receiving chemotherapy compared to their White counterparts. Despite the beneficial effect of exercise training for cancer patients, rates of participation in exercise oncology clinical trials are low among disadvantaged and racial and ethnic minority groups. Here, we will examine the effect of an exercise intervention using a novel, accessible, and cost-effective home-based exercise approach among Hispanic/Latinx and Black cancer patients receiving chemotherapy on exercise participation and cardiovascular disease risk. The THRIVE trial is an 8-month prospective, three-arm study of 45 patients who are randomized in a 1:1:1 fashion to a supervised exercise intervention (SUP), unsupervised exercise (UNSUP), or an attention control (AC) group. Eligible patients include those with breast, colorectal, or prostate cancer, who are sedentary, overweight or obese, self-identify as Hispanic/Latinx or Black, and plan to receive chemotherapy. Patients randomized to the SUP group participate in a home-based 16-week periodized aerobic and resistance exercise program performed three days per week, supervised through video conference technology. Patients randomized to the UNSUP group participate in an unsupervised 16-week, telehealth-based, periodized aerobic and resistance exercise program performed three days per week using the same exercise prescription parameters as the SUP group. Patients randomized to the AC group receive a 16-week home-based stretching program. The primary outcome is changes in minutes of physical activity assessed by 7-day accelerometry at post-intervention. Secondary outcomes include cardiovascular risk factors, patient-reported outcomes, and physical function. Outcome measures are tested at baseline, post-intervention at month 4, and after a non-intervention follow-up period at month 8. The THRIVE trial is the first study to employ a novel and potentially achievable exercise intervention for a minority population receiving chemotherapy. In addition, this study utilizes an intervention approach to investigate the biological and behavioral mechanisms underlying exercise participation in these cancer patients. Results will guide and inform large randomized controlled trials to test the effect of home-based exercise on treatment outcomes and comorbid disease risk in minority patients with cancer undergoing chemotherapy. https://classic.clinicaltrials.gov/ct2/show/NCT05327452, identifier (NCT#05327452).

Abstract 6161: Investigating the relationships between race and socioeconomic status on the biology of ER+ breast cancer

Abstract Black women in the US have worse health care options, poorer educational opportunities, and decreased income quality which collectively contribute to an overall lower socioeconomic status (SES) compared to white women. Furthermore, although the incidence of estrogen receptor positive (ER+) breast cancer is similar for Black and white women in the US, Black patients have significantly worse outcomes. The field has traditionally focused on systemic factors such as SES to explain outcome disparities. Consequently, differences in the molecular biology between tumors from Black and White women remains a gap in knowledge in the field. Recent studies have found that Black cancer patients have a unique gene expression profile that may modulate treatment response. However, how SES contributes to these differences in molecular biology and whether these differences in SES alter treatment response remain unknown. One challenge to addressing these questions is that existing datasets significantly underrepresent Black women and are not sufficiently annotated to understand the complex interplay between molecular biology and SES. Here, we present analysis of RNA expression datasets from 60 ER+ patient tumors (38 Black, 22 White), with corresponding SES and patient outcome annotations which suggest that the ECM and TIME of ER+ breast cancer are influenced by race and factors of SES including BMI and community poverty burden. We further provide evidence that these alterations in the TME may also associate with worse patient outcomes. Citation Format: Jerry Tyler DeWitt, Elena Oropeza, Svasti Haricharan. Investigating the relationships between race and socioeconomic status on the biology of ER+ breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6161.

Abstract A077: Investigating the relationship of socioeconomic status on the molecular biology of ER+ breast cancer

Abstract Black women in the US have worse health care options, poorer educational opportunities, and decreased income quality which collectively contribute to an overall lower socioeconomic status (SES) compared to White women. Furthermore, although the incidence of estrogen receptor positive (ER+) breast cancer is similar for Black and White women in the US, Black patients have significantly worse outcomes. The field has traditionally focused on systemic factors such as SES to explain outcome disparities. Consequently, differences in the molecular biology between tumors from Black and White women remains a gap in knowledge in the field. Recent studies have found that Black cancer patients have a unique gene expression profile that may modulate treatment response. For instance, ER+ breast tumors in Black women have distinct signatures of defective DNA damage repair (DDR) that associate with more aggressive tumor growth. However, how SES contributes to these differences in molecular biology and whether these differences alter treatment response remain unknown. One challenge to addressing these questions is that existing datasets significantly underrepresent Black women and are not sufficiently annotated to understand the complex interplay between molecular biology and factors of SES. Here, we present analysis of RNA expression datasets from 60 ER+ patient tumors (38 Black, 22 White), with corresponding SES and patient outcome annotations. Altogether, these data begin to define the complex interplay between factors of SES and changes in gene expression in addition to patient outcomes for women with ER+ breast cancer. Citation Format: Jerry T DeWitt. Investigating the relationship of socioeconomic status on the molecular biology of ER+ breast cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr A077.

Black cancer patients navigating a health-care system of racial discrimination.

Exposure to racial discrimination may exacerbate disparities throughout the cancer care continuum. Therefore, we explored how experiences of racial discrimination in the health-care setting manifest for Black cancer patients and how it contributes to racial disparities in cancer care. This qualitative analysis used semistructured in-depth interviews with Black cancer survivors not on active treatment from May 2019 to March 2020. All interviews were audio recorded, professionally transcribed, and uploaded into Dedoose software for analysis. We identified major themes and subthemes that highlight exposure to racial discrimination and its consequences for Black cancer patients when receiving cancer care. Participants included 18 Black cancer survivors, aged 29-88 years. Most patients experienced racial discrimination when seeking care. Participants experienced racial discrimination from their interactions with health-care staff, medical assistants, front desk staff, and health insurance administrators. Exposure to overt racial discrimination in the health-care setting was rooted in racial stereotypes and manifested through verbal insults such as physicians using phrases such as "you people." These experiences impacted the ability of the health-care delivery system to demonstrate trustworthiness. Patients noted "walking out" of their visit and not having their health issues addressed. Despite experiences with racial discrimination, patients still sought care out of necessity believing it was an inevitable part of the Black individual experience. We identified that exposure to racial discrimination in the health-care setting is pervasive, affects health-seeking behaviors, and degrades the patient-clinician relationship, which may likely contribute to racial disparities in cancer care.

Big advocacy, little recognition: the hidden work of Black patients in precision medicine

As cost-effective next-generation genome sequencing rapidly develops, calls for greater inclusion of Black people in genomic research, policy, and practice are necessary for effective translation of genomic science into precision population health and medicine. Employing a community-based participatory mixed methods research design, we developed a semi-structured survey that was disseminated to three cancer advocacy organizations. Of the 81 survey respondents 49 (60%) self-identified as Black, and 26 (32%) indicated a prior breast cancer diagnosis. Black participants’ expressed concerns about genetic testing were evenly distributed between concerns that could be addressed through genetic counseling (24%) and concerns about subsequent use of their genetic data (27%). Patient advocates contributed to contextualization of respondent concerns in terms of community experiences. Although genetic counseling services and policies governing genomic data use are not always accessible to many Black communities, advocates on our research team provided a bridge to discussion of the intersection between respondent concerns and the roles advocates play in filling gaps in access to genetic counseling and data governance. Concerns expressed by Black patients underscore a shared need among all patients for access to education, inclusion in research, and assurances regarding the use and handling of genetic data. Black cancer patients have joined in patient-led efforts to overcome systemic inequities in cancer care to improve their health outcomes through representation. Often their efforts are overshadowed by a relentless burden of continued health disparities. Future research should support their hidden work as a means to reduce barriers and improve representation in genomic databases.

Effect of chronic disease on racial difference in COVID-19-associated hospitalization among cancer patients.

Research indicates that Black cancer patients have higher rates of COVID-19 hospitalization than their White counterparts. However, the extent to which chronic diseases contribute to racial disparities remains uncertain. We aimed to quantify the effect of chronic diseases on racial disparity in COVID-19-associated hospitalization among cancer patients. We linked Louisiana Tumor Registry's data with statewide COVID-19 data and hospital in-patient discharge data to identify patients diagnosed with cancer in 2015-2019 who tested positive for COVID-19 in 2020 and those with COVID-19-associated hospitalization. Multivariable logistic regression and mediation methods based on linear structural equations were employed to assess the effects of the number of chronic diseases (0, 1-2, ≥3) and individual chronic diseases. Of 6381 cancer patients who tested positive for COVID-19, 31.6% were non-Hispanic Black cancer patients. Compared with non-Hispanic White cancer patients, non-Hispanic Black cancer patients had a higher prevalence of chronic diseases (79.5% vs 66.0%) and higher COVID-19-associated hospitalization (27.2% vs 17.2%). The odds of COVID-19-associated hospitalization were 80% higher for non-Hispanic Black cancer patients than non-Hispanic White cancer patients (odds ratio = 1.80, 95% confidence interval = 1.59 to 2.04). After adjusting for age, sex, insurance, poverty, obesity, and cancer type, number of chronic diseases explained 37.8% of the racial disparity in COVID-19-associated hospitalization, and hypertension, diabetes, and chronic renal disease were the top 3 chronic diseases explaining 9.6%, 8.9%, and 7.3% of the racial disparity, respectively. Chronic diseases played a substantial role in the racial disparity in COVID-19-associated hospitalization among cancer patients, especially hypertension, diabetes, and renal disease. Understanding and addressing the root causes are crucial for targeted interventions, policies, and health-care strategies to reduce racial disparity.

Black voices on gynecologic cancer: Understanding experiences.

e18680 Background: Structural racism and bias affects care of Black gynecologic cancer patients. Factors associated with disparities in Black cancer death rates have been associated with structural racism which has systematically limited the standard of living (wealth, housing, education, healthy food and healthcare) for Black people. Recent studies point to implicit bias, and lack of cultural sensitivity playing a significant role in the health outcomes of Black cancer patients. For instance, despite NCCN guidelines, oncologists underprescribe chemotherapy for older Black women with ovarian cancer and underdose chemotherapy for Black women with cervical cancer. Moreover, Black women dying from advanced uterine cancer are given pain medication at lower rates & there are disparities in palliative care utilization amongst Black patients with metastatic gynecologic cancer. The voices of Black patient advocates are frequently missing from research studies. By centering the voices of Black patient advocates, we can identify new means of addressing & positively impacting disparities within the clinical care spectrum (from diagnosis to survivorship). Our study group, Black Voices on Gynecologic Cancer: Understanding Experiences, aimed to identify common and unique scenarios of racism and bias in the experiences of Black patients with gynecologic cancer seeking medical attention. Methods: Focus groups were advertised using social media and partner patient advocacy organizations. We conducted five focus groups of 24 Black gynecologic cancer survivors using a Zoom platform. Key themes were identified through individual and group review of transcripts. Results: The themes that emerged from the focus groups included: (1) lack of communication and/or clarity in patient/provider communication - “… my first appointment with my gyn I did…share that…I'm having these hot flashes, night sweats…so he gave me some medicine, but… they´d never really addressed and had a conversation about like this is what your body will be experiencing…So, I really have been dependent on other women that have gone through this.”, (2) insufficient mental health support throughout and after treatment, (3) experiences with misdiagnosis (4) provider’s inadequate management of patient pain, (5) failure to mention clinical trials and (6) difficulty navigating insurance. Conclusions: Our study identified gaps in the care of Black gynecologic cancer patients. The second phase of BVOGUE will reduce structural barriers that prohibit authentic patient and community engagement around gynecologic cancer care and participation in academic research for Black cancer patients. We will pilot modules for both cancer education and research advocacy. This model will serve as a roadmap for all cancer centers creating action plans for engagement, inclusion, and participation.

The Onc Docs: Partnering with Black cancer patients for cancer education.

e18681 Background: In 2022, there will be approximately 224,080 new cancer cases and 73,680 cancer deaths among Black individuals in the United States. Black people are disproportionately burdened by cancer due to higher incidence and mortality levels across multiple cancer types. Yet, their stories are underrepresented in media and the top podcasts for cancer education do not feature Black experts. We formed our podcast, The Onc Docs, to highlight the (under-told) stories of Black individuals with cancer and to provide education about cancer from Black patient survivors, patient advocates and oncologists.We sought to understand the current landscape of podcasts focused on the Black cancer experience & to assess public engagement with The Onc Docs across social media platforms. Methods: We conducted a search of "Black cancer" in Google, Spotify and Apple podcasts. Search engines were also utilized to identify podcasts with a focus on the Black cancer experience. Finally, we reviewed our publicly available listener and follower statistics. Results: At least 12 podcasts on the Black cancer experience were identified with the majority available on Google Podcasts. Seven of the twelve podcasts focused on breast cancer in Black women while two podcasts discussed prostate cancer and one featured brain tumors. Two podcasts (17%) published episodes for one or more years. The remaining podcasts (n = 10) were in existence for an average of 3 months. Three podcasts had published an episode in 2022. Since starting our podcast in September 2020, we have 958 Twitter followers and 400 followers on Instagram. According to Spotify, from 2021-2022, our podcast was heard in 4 countries, increased 87% in streams, 40% in listeners and 235% in hours spent listening to our episodes. On Google Podcasts, we have 4 subscribers. Each month, about 100 unique visitors navigate to our website. Conclusions: Podcasts on the Black cancer experience are needed especially those with a focus apart from breast cancer. Prior podcasts may lack longevity due to a lack of financial and infrastructural support needed to sustain a podcast. In the past year, our work has garnered attention from the general public and gained traction with patient advocacy and scientific associations like Black in Cancer, Cancer Research UK, and Touch Breast Cancer. However, additional efforts & support are needed to ensure consistent creation and delivery of episodes. For instance, we can utilize Facebook, the largest social media platform, to expand our reach. With future growth, we will be able to access data analytic tools to determine the demographic breakdown of our audience and if we are reaching Black listeners.

Abstract C109: Testing Home-based Exercise Strategies in Underserved Minority Cancer Patients Undergoing Chemotherapy (THRIVE) Trial: A study protocol

Abstract Background: Higher rates of physical inactivity and comorbid conditions are reported in Hispanic and Black cancer patients receiving chemotherapy, compared to their White counterparts. Despite the beneficial effect of exercise training for cancer patients, rates of participation in clinical cancer trials are low among disadvantaged and racial and ethnic minority groups. This is possibly due to more barriers and less access to exercise training. Therefore, there is a crucial need for better understanding of how to apply exercise interventions using novel, accessible, and cost-effective home-based exercise approaches for Hispanic and Black communities, particularly during chemotherapy. In this study, we will examine the effect of supervised and unsupervised exercise on minutes of physical activity among Hispanic and Black cancer patients undergoing chemotherapy for breast, colorectal, and prostate cancer. Methods: The THRIVE trial is an 8-month prospective, three-arm study of 135 patients who are randomized in a 1:1:1 fashion to a supervised exercise intervention (SUP), unsupervised exercise (UNSUP), or an attention control group. Eligible patients include those with early-stage breast, colorectal, or prostate cancer, planning to receive chemotherapy, are sedentary, overweight or obese, and self-identifying as Hispanic or Black. Patients randomized to the SUP group participate in a home-based 16-week periodized aerobic and resistance exercise program performed three days per week, supervised through video conference technology. Patients randomized to the UNSUP group participate in an unsupervised 16-week, telehealth-based, periodized aerobic and resistance exercise program performed three days per week using the same exercise prescription parameters as the SUP group. The attention control group receive a 16-week home-based stretching program. The primary outcome is changes in minutes of physical activity assessed by 7-day accelerometry at month 4. Secondary outcomes include cardiovascular risk factors, patient-reported outcomes, and physical function. Outcome measures are tested at baseline, post-intervention at month 4, and after a non-intervention follow-up period at month 8. Discussion: The THRIVE trial is the first study to employ a novel and potentially achievable exercise intervention for a minority population receiving chemotherapy. In addition, this study utilizes an intervention approach to investigate the biological and behavioral mechanisms underlying exercise participation in these cancer patients. Results from this study will guide and inform large randomized controlled trials to test the effect of home-based exercise on treatment outcomes and comorbid disease risk in minority patients with cancer undergoing chemotherapy. Citation Format: Huimin Yan, Noelle Merchant, Ashley Desameau, Cherardi NeiraViscue, Paola Gonzalo-Encabo, Dong-Woo Kang, Rebekah L. Wilson, Mary K. Norris, Danny Nguyen, Daniel Gundersen, Laura L. Hayman, Rachel A. Freedman, Timothy Rebbeck, Christina M. Dieli-Conwright. Testing Home-based Exercise Strategies in Underserved Minority Cancer Patients Undergoing Chemotherapy (THRIVE) Trial: A study protocol [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 C109.

Music Therapy for Pain in Black and White Cancer Patients: A Retrospective Study.

Racial pain disparities present challenges to cancer symptom management. Music therapy has demonstrated benefits for pain and is a promising treatment option for diverse populations due to music's multicultural presence. However, Black cancer patients are under-represented in music therapy trials. This study compared pain severity, treatment approaches, and responses to music therapy between Black and white cancer patients. The findings will be used to generate hypotheses for future music therapy research to address racial disparities in pain management. We conducted a retrospective program evaluation of Black and white patients who received music therapy at an NCI-Designated Comprehensive Cancer Center. We used the Edmonton Symptom Assessment Scale (ESAS) to assess pain. We abstracted opioid use, music therapy referral reasons, and treatment approaches from the electronic health record. Among 358 patients, 18% were Black, 42% reported moderate-to-severe pain, and 47% received opioids. Black patients reported higher baseline pain than white patients, but similar proportions of Black and white patients received opioids. Greater proportions of Black patients received music therapy referrals for pain (73% vs. 56%, P=0.04) and engaged in active techniques (92% vs. 82%, P=0.04). Black and white patients reported clinically meaningful pain reduction of similar magnitude after music therapy. Black patients discussed spirituality more commonly during music therapy, whereas white patients focused on family bonds. Black and white patients reported clinically meaningful pain reduction through varying music therapy approaches. Our findings may help inform cultural adaptations of music therapy to address racial pain disparities in oncology.

Thirteen cancers associated with HIV infection in a Black South African cancer patient population (1995-2016).

South Africa's HIV epidemic has evolved over time in terms of numbers of people living with HIV, access to antiretroviral treatment (ART) and age. These changes have profoundly influenced local cancer patterns. The Johannesburg Cancer Study has, over a period of 22 years (1995-2016), recruited over 20 000 incident black cancer patients who consented to provide answers to a questionnaire and blood samples (serum, DNA). This has presented a unique opportunity to examine the evolving association of HIV with cancer in Africa. We used logistic regression models to explore case-control associations between specific cancers and HIV, using participants with non-infection related cancers as controls. Using data of 20 835 cancer patients with confirmed HIV status, we found the following cancers to be associated with HIV: Kaposi's sarcoma (ORadj ; 95%CI): (99.1;72.6-135.1), non-Hodgkin lymphoma (11.3;9.3-13.6), cervical cancer (2.7;2.4-3.0), Hodgkin lymphoma (3.1;2.4-4.2), cancer of the eye/conjunctiva (18.7;10.1-34.7), anogenital cancers (anus [2.1;1.4-3.2], penis [5.4;2.7-10.5], vulva [4.8;3.5-6.4], vagina [5.5;3.0-10.2]), oropharyngeal cancer (1.6;1.3-1.9), squamous cell carcinoma of the skin (3.5;2.4-4.9), melanoma (2.0;1.2-3.5) and cancer of the larynx (1.7;1.3-2.4). Kaposi's sarcoma odds ratios increased from the pre-ART (1995-2004) to the early ART (2005-2009) period but declined in the late ART (2010-2016) period. Odds ratios for cancers of the eye/conjunctiva, cervix, penis and vulva continued to increase in recent ART periods. Our study confirms the spectrum of HIV-associated cancers found in other African settings. The odds ratios of conjunctival and HPV-related cancers continue to rise in the ART era as the HIV positive population ages.

Social determinants and health-related quality of life in a sample of diverse, low socioeconomic status cancer patients.

In the United States, medically underserved populations, such as ethnoracially underrepresented groups, the limited English proficient (LEP), and the unemployed, may be vulnerable to poor functioning in cancer survivorship. The present study examined whether race/ethnicity, LEP status, and unemployment status were associated with poor health-related quality of life (HRQL) in four domains (physical, social, emotional, and functional well-being (FWB)) in a diverse, low socioeconomic status (SES) sample of cancer patients. The sample included 1592 ethnoracially diverse, low SES, primarily foreign-born adult oncology patients participating in an enhanced patient navigation program in 11 New York City hospital-based cancer clinics. This secondary cross-sectional analysis of program intake data examined bivariate associations between sociodemographic and clinical factors and poor HRQL (Functional Assessment of Cancer Therapy-General scores ≤70). Factors found to be related to poor HRQL (at p<0.05) were entered into logistic regressions with overall HRQL and the four HRQL subscales as outcomes. The Benjamini-Hochberg Procedure controlled for potentially inflated type-I error rate due to multiple comparisons. All three predictor variables (race/ethnicity, LEP status, and unemployment status) were significantly associated with increased odds of reporting poor FWB. Specifically, non-Hispanic White and Hispanic cancer patients had 2.7 and 1.5 times the odds of reporting poor FWB than non-Hispanic Black patients. The unemployed had 1.4 times the odds of reporting poor FWB than their employed or retired counterparts. Limited EP patients had 1.4 times the odds of reporting poor FWB than EP participants. Non-Hispanic Black patients evidenced significantly lower odds of reporting poor HRQL across all subscale domains compared with other ethnoracial groups. LEP and unemployed individuals were more likely to report poor FWB, which may indicate that the most marginalized cancer patients face significant barriers to adequate functioning. Interventions that promote functional abilities (i.e., activities of daily living, self-care, and work retention) and policies and programs that reduce systemic inequality and address social determinants of health may aid in improving HRQL for these underserved groups in survivorship. Non-Hispanic Black cancer patients were less likely than other groups to report poor physical, social, emotional, and FWB. Identifying protective factors in this group may aid in efforts to improve HRQL for all patients.

Temporal trends in Black-White disparities in cancer surgery and cancer-specific survival in the United States between 2007 and 2015.

The American Society of Clinical Oncology (ASCO) has strived to address racial/ethnic disparities in cancer care since 2009. Surgery plays a pivotal role in cancer care; however, it is unclear whether and how racial/ethnic disparities in cancer surgery have changed over time. This cohort study included 1,113,256 White and Black cancer patients across 9 years (2007-2015) using patient data extracted from the Surveillance, Epidemiology, and End Results (SEER)-18 registries. Patient data were included from 2007 to adjust insurance status and by 2015 to obtain at least a 3-year survival follow-up (until 2018). The primary outcome was a surgical intervention. The secondary outcomes were the use of (neo)adjuvant chemotherapy and cancer-specific survival (CSS). Adjusted associations of the race (Black/White) with the outcomes were measured in each cancer type and year. The gap between surgery rates for Black and White patients narrowed overall, from an adjusted odds ratio (aOR) of 0.621 (0.592-0.652) in 2007 to 0.734 (0.702-0.768) in 2015. However, the racial gap persisted in the surgery rates for lung, breast, prostate, esophageal, and ovarian cancers. In surgically treated patients with lymph node metastasis, Black patients with colorectal cancer (CRC) were less likely to receive (neo)adjuvant chemotherapy than White patients. Black patients undergoing surgery were more likely to have a worse CSS rate than White patients undergoing surgery. In breast cancer patients, the overall trend was narrow, but continuously present, with an adjusted hazard ratio (aHR) of 1.224 (1.278-1.173) in 2007 and 1.042 (1.132-0.96) in 2015. Overall, progress has been made toward narrowing the Black-White gap in cancer surgical opportunity and survival. Future efforts should be directed toward those specific cancers for which the Black-White gap continues. Additionally, it is worth addressing the Black-White gap regarding the use of (neo)adjuvant chemotherapy for CRC treatment.

Access to definitive treatment and survival for intermediate-risk and high-risk prostate cancer at hospital systems serving health disparity populations.

6555 Background: Socioeconomic and racial disparities in prostate cancer (PCa) can be attributed to patient-level and physician-level factors. However, there is growing interest in investigating the role of the facility of care in driving cancer disparities. Therefore, we sought to examine receipt of guideline-concordant definitive treatment, time to treatment initiation (TTI), and survival for men with PCa receiving care at hospital systems serving health disparity populations (HSDPs). Methods: We conducted a retrospective analysis of the National Cancer Database (2004-2016) among men with intermediate-risk or high-risk PCa eligible for definitive treatment. The primary outcomes were receipt of definitive treatment and TTI within 90 days of diagnosis. The secondary outcome was survival. We defined HSDPs as minority-serving hospitals – facilities in the highest decile of proportion of Non-Hispanic Black (NHB) or Hispanic cancer patients – and/or high-burden safety-net hospitals – facilities in the highest quartile of proportion of underinsured patients. We used mixed-effect models with facility-level random intercept to compare outcomes between HSDPs and non-HSDPs among the entire cohort and among men who received definitive treatment. We evaluated interactions between HSDP status and race for each of the outcomes. Results: The cohort included 821,931 men with intermediate-risk or high-risk PCa. We included 968 non-HSDPs (72.2%) and 373 HSDPs (27.8%) facilities. Treatment at HSDPs was associated with lower odds of receipt of definitive treatment (aOR 0.64; 95% CI 0.57-0.71; p < 0.001), lower odds of TTI within 90 days of diagnosis (aOR 0.74; 95% CI 0.68-0.79; p < 0.001), and worse survival (aHR 1.05; 95% CI 1.02-1.09; p = 0.003). However, no difference was found in survival among patients who received definitive treatment. NHB men at HSDPs had also worse outcomes than NHB men treated at non-HSDPs as well as NHW men treated at HSDPs (Table). Conclusions: Patients treated at HSDPs were less likely to receive timely definitive treatment and had worse survival. NHB men have worse outcomes than NHW at HSDPs. NHB men with PCa remain largely disadvantaged since they are more likely to be treated at hospitals with worse outcomes and have worse outcomes than other patients at those same institutions. [Table: see text]

Lung cancer risk in persons enrolled in low-dose CT screening (LDCT) versus incidental lung nodule programs (ILNP).

8553 Background: LDCT screening saves lives, but <10% of eligible persons participate; eligibility criteria are imperfect; geographic, racial and socio-economic disparities have emerged. ILNP may expand access to early detection. We compared rates of lung cancer diagnosis in LDCT and ILNP population subsets. Methods: Prospective observational cohort study of enrollees in LDCT and ILNP in a community healthcare system in AR, MS and TN. We compared LDCT vs 4 ILNP cohorts (C) based on USPSTF 2021 LDCT eligibility criteria: <50 years (C1, too young); >80 years (C2, too old); 50 – 80 years (C3, ineligible smoking history); 50 – 80 years (C4, eligible). For certain analyses, we stratified the LDCT cohort by baseline (T0) Lung-RADS score (0-2 v 3-4). We used a Cox model to calculate crude and adjusted hazard ratios (aHR) for lung cancer diagnosis within 24 months of enrollment. Results: From 2015-2021, 7050 persons were in LDCT- 6073 (86%) Lung-RADS 0-2 (no/benign lesions), 977 (14%) Lung-RADS 3 or 4 (possibly malignant lesion) on T0 scan; 17,579 were in ILNP, 16%, 10%, 57% and 16% respectively in C1-4. Demographics and tobacco use history of the ILNP cohorts differed strikingly; C4 was very similar to LDCT (Table). Black persons were significantly more in C1 (too young) and C3 (insufficient tobacco use). Diagnosis of lung cancer at 36 months ranged from 1% in C1 to 15% in C4, compared to 3% in LDCT; aHR for lung cancer diagnosis within 2 years ranged from 0.23 to 5.12 (all LDCT ref), but ranged from 0.04 to 1.02 with reference to LDCT Lung-RADS 3-4. Most patients in LDCT and ILNP C2-4 had early stage. There were proportionately more Black lung cancer patients in C1-4, and 3 times more Black patients in C3 and 4 than in LDCT. Conclusions: ILNP provides early-detection access to a larger, more diverse population than LDCT, potentially alleviating race and socio-economics-based outcomes disparities. [Table: see text]

Proposing a social determinants of health (SDOH) EMR dashboard to improve heath equity in cancer care.

e18548 Background: There are biological differences in the clinical outcomes of Black or Hispanic cancer patients compared with non-Hispanic Whites (NHWs); however minorities have disadvantages in social determinants of health (SDOH) that influence cancer outcomes too. The World Health Organization defines SODH as the conditions in which people are born, grow, live, work, age, and maintains that they are largely responsible for health inequities . Most the oncology professionals do not consider that this issue is necessarily part of their scope of practice and they rely on social workers and others to address these issues, and they are not aware that SDOH can impact clinical outcomes of cancer patients. Methods: Memorial Cancer Institute (MCI) part of the Memorial Healthcare System (MHS) is the 3rd largest Public Health Care System in the country. We found important disparities in immunotherapy outcomes in our MCI minority lung cancer patients ( Raez LE. Research Trends. 2021 Feb (20) 63–74 and Dickson F. JTO Vol. 16 (10) S904–5), some of these are related to SDOH. In order to increase awareness of SDOH and identify the impact of SDOH on cancer outcomes, our MHS value-based care team has been working to incorporate SDOH screening and follow-up as an important part of treatment plan development since 2018. At that time, MHS implemented an SDOH dashboard in our EPIC EMR to show the SDOH areas of risk. In 2021, MHS built a best practice alert in Epic to notify health care providers about SDOH issues that might impact treatment outcomes. Results: MHS has implemented a SDOH dashboard in the EPIC EMR that is accessible and easily noticed by the providers and updated constantly by our social workers and other health professionals screening for SDOH. Providers do not need to do extra work other than to be aware that the best cancer treatment that they are recommending for a patient might not have the desired outcome if some of these 13 SDOH are not considered during the planning phase of treatment. The SDOH dashboard uses color coding to indicate if any SDOH is at risk (red) or not at risk or low risk (green) allowing the provider to easily focus in on areas of concern when SDOH is reviewed. Conclusions: Using an easy to access and easy to read SDOH dashboard in the EMR allows oncology providers to address SDOH in the development of oncology treatment plans which we believe will lead to improved health care outcomes.[Table: see text]

Exploiting the tumor immune microenvironment and immunometabolism using mitochondria-targeted drugs: Challenges and opportunities in racial disparity and cancer outcome research.

Black and Hispanic cancer patients have a higher incidence of cancer mortality. Many factors (e.g., socioeconomic differences, insufficient access to healthcare) contribute to racial disparity. Emerging research implicates biological disparity in cancer outcomes. Studies show distinct differences in the tumor immune microenvironment (TIME) in Black cancer patients. Studies also have linked altered mitochondrial metabolism to changes in immune cell activation in TIME. Recent publications revealed a novel immunomodulatory role for triphenylphosphonium‐based mitochondrial‐targeted drugs (MTDs). These are synthetically modified, naturally occurring molecules (e.g., honokiol, magnolol, metformin) or FDA‐approved small molecule drugs (e.g., atovaquone, hydroxyurea). Modifications involve conjugating the parent molecule via an alkyl linker chain to a triphenylphosphonium moiety. These modified molecules (e.g., Mito‐honokiol, Mito‐magnolol, Mito‐metformin, Mito‐atovaquone, Mito‐hydroxyurea) accumulate in tumor cell mitochondria more effectively than in normal cells and inhibit mitochondrial respiration, induce reactive oxygen species, activate AMPK and redox transcription factors, and inhibit cancer cell proliferation. Besides these intrinsic effects of MTDs in redox signaling and proliferation in tumors, MTDs induced extrinsic effects in the TIME of mouse xenografts. MTD treatment inhibited tumor‐suppressive immune cells, myeloid‐derived suppressor cells, and regulatory T cells, and activated T cells and antitumor immune effects. One key biological disparity in Black cancer patients was related to altered mitochondrial oxidative metabolism; MTDs targeting vulnerabilities in tumor cells and the TIME may help us understand this biological disparity. Clinical trials should include an appropriate number of Black and Hispanic cancer patients and should validate the intratumoral, antihypoxic effects of MTDs with imaging.

Racial differences in survival outcomes for early-stage (T1 tumor) penile cancer: Analysis from the Surveillance, Epidemiology, and End Results (SEER) database.

5 Background: Penile cancer is a rare malignancy that accounts for less than 1% of male cancers in the United States. Localized disease, particularly T1 tumors (no invasion the corpora spongiosum, corpora cavernosa or adjacent structures using the AJCC 7th edition staging system) are potentially curable with local surgery. We present the racial differences in survival outcomes for T1, penile cancer from the SEER database. Methods: From 2004 to 2016, we identified all patients with T1 (coded as T1, T1a, T1b),N0,M0 penile cancer in the SEER-18 database were included. Univariate Kaplan-Meier analysis and multivariable (adjusting for age, year of diagnosis, race, socioeconomic status, primary tumor site and type of surgery) Cox-Regression analysis were conducted to investigate prognostic variables for cancer specific survival (CCS). Results: A total of 4,406 patients were identified with penile cancer; 1,941 patients had T1 disease and were further evaluated (Table). On multivariable analysis, Black (HR: 1.72, CI 1.01- 2.94; p=0.046) and Hispanic individuals (HR: 2.15, CI 1.36- 3.40; p= 0.001) had worse CSS compared to the White men with T1 disease. Logistic regression analysis shows no difference in the application of primary surgical resection by race (p=0.065). In the univariate analysis, patients who underwent primary site surgery had better 5-year CSS (HR: 0.36, CI 0.22-0.60; p <0.001). Among those undergoing primary surgery, the 5-year CSS was superior with excisional biopsy (HR: 0.22, CI 0.12-0.40; p < 0.001) compared to simple/partial removal of the primary tumor. Conclusions: Significant racial disparities in CSS exist in early-stage penile cancer patients. CSS is worse in Black and Hispanic T1 penile cancer patients compared to White patients. CSS is also decreased in those without any primary surgery and in those treated with simple/partial surgical removal compared to excisional biopsy. Further research on the cause of racial disparity outcomes in penile cancer is needed.[Table: see text]