Cancer Health Research Articles

Study Protocol for a Cross-Sectional Survey on the Long-Term Impact of COVID-19 on Latino Health

ABSTRACT The COVID-19 pandemic has exacerbated the health inequities of Latinos nationwide. Latinos are 1.5 times more likely to get infected by SARS-CoV-2 than any other racial and ethnic groups and are 2.3 times more likely to be hospitalized from COVID-19 and 1.8 times to die from COVID-19. This research protocol aims to examine the effects of COVID-19 among a Latino population and identify social determinants of health that may contribute to increased susceptibility to COVID-19. The COVID-19 Latino Health Study consists of survey measures in nine domains: 1) demographic characteristics; 2) COVID-19 experiences; 3) food, diet, and sleep items; 4) quality of life; 5) health status; 6) smoking behaviors; 7) cancer health; 8) social capital; and 9) social connectedness. The study was conducted in English and Spanish. Respondents were recruited through social media websites (Twitter, Facebook, and Instagram), in-person community gatherings, and partnering with existing community-based organizations. A total of 869 respondents (522 English vs. 347 Spanish) participated in the cross-sectional study. Respondents were from 20 Spanish-speaking countries and territories of Latin America, with many individuals reporting a mixed Latino heritage. On average, Spanish-speaking respondents were 45 years old (SD = 14.4, range 18–87), with 40.6% (n = 141) and indicating an annual income of less than $20,000. At least 55% (n = 291) of Spanish-speaking respondents reported completing a GED or less. Comparatively, Latinos completing the survey in English were, on average, 30 years old (SD = 12.24, range 18–83), with 49.1% (n = 256) reporting income over $75,000. Furthermore, 57.5% (n = 300) of English respondents completed a bachelor’s degree or higher. This protocol explores the social determinants of health experienced by Latinos during the COVID-19 pandemic. We describe the data collection procedure and examine issues and challenges to conducting Latino health research during a pandemic.

Health Equity in Cardio-oncology: Investigating Mechanistic Causes Behind Adverse Cardiovascular and Cancer Health

Health Equity in Cardio-oncology: Investigating Mechanistic Causes Behind Adverse Cardiovascular and Cancer Health

Applying Digital Health in Cancer and Palliative Care in Europe: Policy Recommendations from an International Expert Workshop (MyPal Project).

Background: Digital health interventions are becoming increasingly important for adults, children, and young people with cancer and palliative care needs, but there is little research to guide policy and practice. Objectives: To identify recommendations for policy development of digital health interventions in cancer and palliative care. Design: Expert elicitation workshop. Setting: European clinical (cancer and palliative care, adult and pediatric), policy, technical, and research experts attended a one-day workshop in London, England, in October 2022, along with MyPal research consortium members. Methods: As part of the European Commission-funded MyPal project, we elicited experts' views on global, national, and institutional policies within structured facilitated groups, and conducted qualitative analysis on these discussions. Results/Implementation: Thirty-two experts from eight countries attended. Key policy drivers and levers in digital health were highlighted. Global level: global technology regulation, definitions, access to information technology, standardizing citizens' rights and data safety, digital infrastructure and implementation guidance, and incorporation of technology into existing health systems. National level: country-specific policy, compatibility of health apps, access to digital infrastructure including vulnerable groups and settings, development of guidelines, and promoting digital literacy. Institutional level: undertaking a needs assessment of service users and clinicians, identifying best practice guidelines, providing education and training for clinicians on digital health and safe digital data sharing, implementing plans to minimize barriers to accessing digital health care, minimizing bureaucracy, and providing technical support. Conclusions: Developers and regulators of digital health interventions may find the identified recommendations useful in guiding policy making and future research initiatives. MyPal child study Clinical Trial Registration NCT04381221; MyPal adult study Clinical Trial Registration NCT04370457.

Content comparison of the EORTC CAT Core, SF-36, FACT-G, and PROMIS role and social functioning measures based on the International Classification of Functioning, Disability and Health.

In line with the World Health Organizations' health definition, patient-reported outcome (PRO) measures frequently cover aspects of social health. Our study aimed to evaluate the role functioning (RF) and social functioning (SF) contents assessed by PRO measures commonly used in cancer patients. We analysed the item content of the SF and RF domains of the EORTC CAT Core, the EORTC QLQ-C30, the SF-36, and the FACT-G aswell as the PROMIS item bank covering the Ability to Participate in Social Roles and Activities. Following an established methodology we linked item content to the International Classification of Functioning, Disability and Health (ICF) framework. The content of 85 items was assigned to three ICF components ('Activities and Participation', 'Body Functions', and 'Environmental Factors'). The EORTC CAT Core RF items were mostly related to the first-level ICF categories'Domestic life' and 'Community, social and civic life', while its SF item bankfocused on 'Interpersonal interactions and relationships'. These three categories were also covered by the PROMIS social participation item bank. TheFACT-G Social/Family scale focused on environmental factors ('SupportandRelationships' and 'Attitudes') while the SF-36 Role-physical/emotional scales had a stronger focus on 'General tasks and demands' and 'Major life areas'. Our results highlight conceptual overlap and differences among PRO measures for the assessment of social health in cancer. This information may help toselect the most appropriate measure for a specific setting or study purpose and to better understand the possibilities of linking scores across different PRO measures.

Comprehensive 0utcomes for After Cancer Health: COACH.

TPS12141 Background: The landscape for cancer survivors continues to evolve as individuals live longer following primary therapy. For some, treatment is complete; for others, active surveillance or maintenance therapy may be indicated. Individual survivorship needs are diverse, influenced by tumor and treatment type, as well as social determinants of health. Digital interventions may support survivors in achieving personalized health goals throughout survivorship. The Comprehensive Outcomes for After Cancer Health (COACH) Study (NCT05349227) explores the feasibility of a digital health coaching (DHC) program for individuals enrolled with diverse tumor types and geographic regions. Methods: COACH is a multi-center, randomized, wait-list control trial enrolling 550 individuals ≥18 years old who are within 1-year of completion of primary cancer therapy at enrollment. Up to 100 participants, will be recruited at each of 6 study sites, of which 3 are currently enrolling. Consented individuals are randomized to 6 months of DHC or 6 months of data collection only, then cross-over for follow-up to 12-months. Both groups wear an activity tracker; complete patient reported outcome measures; and provide fecal specimens. The DHC program includes weekly Health Advisor calls and supplemental delivery of evidenced-based content via text, email or mobile platform. Topics fall in health domains of physical, mental/emotional, financial, social, and sexual, and emphasize nutrition, physical activity, sleep, and screening for recurrent or de novo cancer. Feasibility for this study is defined as a retention rate greater than or equal to 70%, and acceptability will be defined as less than or equal to 20% scoring “not at all helpful.” Trends over time will be assessed using linear mixed models using time as a fixed effect, as well as any covariates and interactions of interest. Descriptive statistics will be used to evaluate exploratory endpoints. A cross-cohort end-point related to physical function as measured by the PROMIS Physical Function 10a, will also be evaluated. To date, 72 individuals have enrolled, with Nebraska as the lead site, including 71 women, with a mean age of 61.78 (Range 33-74), from the U.S. Midwest (n = 57) and Northeast (n = 15). 4 identify as African American/Black, 68 as White. 50 have a breast, 13 ovarian, 8 endometrial, 1 gastric diagnosis. Nine have completed the first 6 months of the study. The study is novel in the breadth of data collected and potential to understand variability in patient experiences and provide insights into the feasibility, acceptability, and efficacy of a DHC intervention supporting individuals after primary cancer treatment. Clinical trial information: NCT05349227 .

Abstract 742: Trial in progress: Comprehensive outcomes for after cancer health (COACH), a randomized trial assessing health outcomes following primary cancer therapy

Abstract Purpose: This study evaluates feasibility and acceptability of a digital health coaching intervention for individuals who are within one year of completing primary cancer treatment of any modality, as well as its effect on health self-efficacy. Secondary endpoints evaluate trends in patient-reported outcomes (PRO), including financial toxicity, for which the Economic StraiN and Resilience in Cancer (ENRICh) tool is being validated. Additional endpoints explore associations between patient-reported symptoms, wearable, biomarker, and clinical data. This study seeks to fill a critical knowledge gap as to how health behavioral changes prompted by health coaching may modulate symptoms and physical/psychosocial well-being through the longitudinal tracking of patient reported, clinical, and bioinformatic data. Methods: This randomized, wait-list control trial is being conducted at geographically diverse National Cancer Institute-designated cancer centers. Per site enrollment is <150 participants, aged 18 and older, following completion of primary treatment for breast, ovarian, endometrial, lung, or gastric cancer or population specific (eg, ≥65 years) cohorts. A 6-month coaching intervention utilizing phone calls coupled with supplemental digital content via text, email, or web-based application is delivered during months 1 through 6 (intervention) or months 7 through 12 (wait-list control). PROMIS and other validated questionnaires and activity data are collected over 12 months. Gut microbiome specimens and the Diet History Questionnaire (DHQ) III are collected at enrollment and 6 months. Feasibility (retention rate ≥70%) and acceptability (≤20% scoring “not at all helpful”), are assessed with descriptive statistics. Summary Data: To date, 47 individuals have been enrolled at 3 study sites, Nebraska Medicine (36), Dana-Farber Cancer Institute (10), and The Ohio State University James Cancer Center (1). This includes 1 male and 46 female participants, with an average age of 63.62 (R 33-75), of whom 44 identify as White and 3 as Black or African American, and 47 identify as non-Hispanic. Among participants, 35 have a history of breast, 10 ovarian, 1 endometrial, and 1 gastric cancer. Two additional sites are planned to begin enrollment in 2023, one of which will primarily enroll participants identifying as Black and/or Hispanic. Conclusions: Enrollment is anticipated to complete by December 2023 with site-specific and composite results reported by December 2024. Novel outcomes related to the use of digital health coaching in the context of survivorship, as well as robust data assessing clinical, microbiome, dietary, patient-reported, and wearable data is expected to enhance existing evidence regarding outcomes in patients on both active surveillance and maintenance therapies for diverse tumor types. Citation Format: Kelly J. Brassil, Alexi Wright, Elizabeth Arthur, Austin Barr, Laura Flora, Barbara Halpenny, Mariah K. Jackson, Jessica Krok-Schoen, Robin Lally, Jennifer Loftis, Debra Lynch Kelly, Leorey Saligan, Rachael Schmidt, Grace L. Smith, Angela Starkweather, Anna Tavormina, Gisele Tlusty, Michael Vazquez, Marilyn Hammer. Trial in progress: Comprehensive outcomes for after cancer health (COACH), a randomized trial assessing health outcomes following primary cancer therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 742.

Abstract OT2-06-01: Breast Cancer Cohort of the Comprehensive Outcomes for After Cancer Health (COACH) Study: Study Protocol

Abstract Background: Women with breast cancer account for the largest cohort (23%) of over 18 million cancer survivors in the United States. Of the nearly 4 million breast cancer survivors, many, including individuals with metastatic breast cancer, will require lifelong treatment for chronic conditions. As part of a multi-site study including diverse tumor types, breast cancer survivors are being recruited to explore the feasibility and outcomes of a digital health coaching (DHC) program following the completion of primary therapy to support self-management of symptoms and general wellness. Trial design: A randomized-wait list control design will evaluate outcomes related to engagement in a DHC program following completion of primary therapy. Participants will be enrolled in a 6-month DHC program delivering evidence-based content via weekly calls, text, and email, in addition to usual support from their respective healthcare teams. The intervention group will receive coaching upon enrollment. The control group will receive coaching after a 6-month monitoring period. Twelve months of longitudinal clinical, patient-reported outcomes, activity tracking (via Fitbit), and microbiome data will be collected from both groups. Eligibility criteria: The breast cancer cohort will consist of individuals with both localized and metastatic disease within 1 year of completion of primary therapy, defined as treatment of curative intent, first-line or later, from which the individual is advancing to active surveillance or follow-up, with or without maintenance therapy. All study participants must be >18 years old, able to read and speak English, have access to mobile technology, and agree to wear and have data collected from an activity tracker. Specific aims: 1) Assess the feasibility and acceptability of a DHC program and its effect on participant health self-efficacy; 2) characterize associations between participant symptoms, physical/psychosocial well-being, and health self-management and gut microbiota changes; and 3) explore patient-generated health data outcomes among participants (patient reported and wearable biometrics outcomes). Statistical methods: Feasibility and acceptability will be assessed through descriptive statistics. Feasibility for this study is defined as a retention rate ≥70%, and acceptability is defined as ≤20% scoring “not at all helpful.” Secondary aims will be assessed using linear mixed models. Cross-cohort analysis of physical function, measured by the PROMIS Physical Function 10a, will be conducted. Assuming a power of 0.8 and significance level of .05, we will be able to detect a 2.51 difference in PROMIS score means between the control and intervention group (SD 10) with a sample of 500 total participants. Sub-group analysis will be conducted with the anticipated 250 participants in the breast cancer cohort with a focus on feasibility, acceptability, and descriptive and exploratory endpoints for this population as a whole and comparing early stage and metastatic participants. Target and present accruals: 500 individuals with diverse tumor types will be enrolled across 5 collaborating sites, of which 4 ill include individuals with breast cancer. An estimated 250 breast cancer participants (approximately 50% of the total study population), including 150 with de novo or progressive metastatic breast cancer, are planned to be recruited. To date, 1 Midwestern site has enrolled the first 7 breast cancer survivors. Two additional sites plan to enroll in July 2022, with the remaining 2 sites to begin enrollment by the end of 2022. Citation Format: Robin M. Lally, Rachael L. Schmidt, Gisele Tlusty, Elizabeth K. Arthur, Laura K. Flora, Jessica L. Krok-Schoen, Jessica T. Jones, Meagan Whisenant, Abbey Kaler, Debu Tripathy, Leorey Saligan, Marilyn Hammer, Austin Barr, Lindsey Jackson, Jennifer Loftis, Kelly J. Brassil. Breast Cancer Cohort of the Comprehensive Outcomes for After Cancer Health (COACH) Study: Study Protocol [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT2-06-01.

Predicting origin for bone metastatic cancer using deep learning-based pathology.

Predicting origin for bone metastatic cancer using deep learning-based pathology.

Exercise and Bone Health in Cancer: Enemy or Ally?

Bone health is often threatened in cancer patients. Bone metastasis and osteoporosis frequently occur in patients with cancer and may lead to different skeletal-related events, which may negatively affect patients' quality of life and are associated with high mortality risk. Physical exercise has been recognized as a potential adjunctive strategy in the cancer setting to improve physical function as well as treatment-related side effects. Nevertheless, exercise is often not recommended to patients with bone health impairments due to safety concerns. In the current review, we aimed, through a comprehensive review of the evidence, to explore the impact of exercise in terms of safety profile, bone outcomes, and the effects on other outcomes in patients with cancer affected by bone metastasis or at high risk of losing bone. Additionally, we explored the potential mechanisms by which exercise may act on bone, particularly the impact of mechanical load on bone remodeling. Finally, considerations about exercise prescription and programming in these populations are also discussed.

Learning the Treatment Process in Radiotherapy Using an Artificial Intelligence-Assisted Chatbot: Development Study.

In knowledge transfer for educational purposes, most cancer hospital or center websites have existing information on cancer health. However, such information is usually a list of topics that are neither interactive nor customized to offer any personal touches to people facing dire health crisis and to attempt to understand the concerns of the users. Patients with cancer, their families, and the general public accessing the information are often in challenging, stressful situations, wanting to access accurate information as efficiently as possible. In addition, there is seldom any comprehensive information specifically on radiotherapy, despite the large number of older patients with cancer, to go through the treatment process. Therefore, having someone with professional knowledge who can listen to them and provide the medical information with good will and encouragement would help patients and families struggling with critical illness, particularly during the lingering pandemic. This study created a novel virtual assistant, a chatbot that can explain the radiation treatment process to stakeholders comprehensively and accurately, in the absence of any similar software. This chatbot was created using the IBM Watson Assistant with artificial intelligence and machine learning features. The chatbot or bot was incorporated into a resource that can be easily accessed by the general public. The radiation treatment process in a cancer hospital or center was described by the radiotherapy process: patient diagnosis, consultation, and prescription; patient positioning, immobilization, and simulation; 3D-imaging for treatment planning; target and organ contouring; radiation treatment planning; patient setup and plan verification; and treatment delivery. The bot was created using IBM Watson (IBM Corp) assistant. The natural language processing feature in the Watson platform allowed the bot to flow through a given conversation structure and recognize how the user responds based on recognition of similar given examples, referred to as intents during development. Therefore, the bot can be trained using the responses received, by recognizing similar responses from the user and analyzing using Watson natural language processing. The bot is hosted on a website by the Watson application programming interface. It is capable of guiding the user through the conversation structure and can respond to simple questions and provide resources for requests for information that was not directly programmed into the bot. The bot was tested by potential users, and the overall averages of the identified metrics are excellent. The bot can also acquire users' feedback for further improvements in the routine update. An artificial intelligence-assisted chatbot was created for knowledge transfer regarding radiation treatment process to the patients with cancer, their families, and the general public. The bot that is supported by machine learning was tested, and it was found that the bot can provide information about radiotherapy effectively.

Costs of multimorbidity: a systematic review and meta-analyses

BackgroundMultimorbidity is a rising global phenomenon, placing strains on countries’ population health and finances. This systematic review provides insight into the costs of multimorbidity through addressing the following primary and secondary research questions: What evidence exists on the costs of multimorbidity? How do costs of specific disease combinations vary across countries? How do multimorbidity costs vary across disease combinations? What “cost ingredients” are most commonly included in these multimorbidity studies?MethodsWe conducted a systematic review (PROSPERO: CRD42020204871) of studies published from January 2010 to January 2022, which reported on costs associated with combinations of at least two specified conditions. Systematic string-based searches were conducted in MEDLINE, The Cochrane Library, SCOPUS, Global Health, Web of Science, and Business Source Complete. We explored the association between costs of multimorbidity and country Gross Domestic Product (GDP) per capita using a linear mixed model with random intercept. Annual mean direct medical costs per capita were pooled in fixed-effects meta-analyses for each of the frequently reported dyads. Costs are reported in 2021 International Dollars (I$).ResultsFifty-nine studies were included in the review, the majority of which were from high-income countries, particularly the United States. (1) Reported annual costs of multimorbidity per person ranged from I$800 to I$150,000, depending on disease combination, country, cost ingredients, and other study characteristics. (2) Our results further demonstrated that increased country GDP per capita was associated with higher costs of multimorbidity. (3) Meta-analyses of 15 studies showed that on average, dyads which featured Hypertension were among the least expensive to manage, with the most expensive dyads being Respiratory and Mental Health condition (I$36,840), Diabetes and Heart/vascular condition (I$37,090), and Cancer and Mental Health condition in the first year after cancer diagnosis (I$85,820). (4) Most studies reported only direct medical costs, such as costs of hospitalization, outpatient care, emergency care, and drugs.ConclusionsMultimorbidity imposes a large economic burden on both the health system and society, most notably for patients with cancer and mental health condition in the first year after cancer diagnosis. Whether the cost of a disease combination is more or less than the additive costs of the component diseases needs to be further explored. Multimorbidity costing studies typically consider only a limited number of disease combinations, and few have been conducted in low- and middle-income countries and Europe. Rigorous and standardized methods of data collection and costing for multimorbidity should be developed to provide more comprehensive and comparable evidence for the costs of multimorbidity.

A Cancer Health Needs Assessment Reveals Important Differences Between US-Born and Foreign-Born Latinos in California.

BackgroundCancer is the leading cause of death among Latinos, the largest minority population in the United States (US). To address cancer challenges experienced by Latinos, we conducted a catchment area population assessment (CAPA) using validated questions from the National Cancer Institute (NCI) population health assessment supplement at our NCI-designated cancer center in California.MethodsA mixed-methods CAPA was administered by bilingual-bicultural staff, with a focus on understanding the differences between foreign-born and US-born Latinos.Results255 Latinos responded to the survey conducted between August 2019 and May 2020. Most respondents were foreign-born (63.9%), female (78.2%), and monolingual Spanish speakers (63.2%). Results showed that compared to US-born Latinos, foreign-born individuals were older, had lower educational attainment, were most likely to be monolingual Spanish speakers, were low-income, and were more likely to be uninsured. Foreign-born Latinos had lower levels of alcohol consumption and higher consumption of fruits and vegetables. The rate of preventive cancer screenings for breast, cervical and colorectal cancer did not differ by birthplace, although a low fraction (35.3%) of foreign-born Latinas who were up-to-date compared to US-born Latinas (83.3%) with colorectal cancer screening was observed. Time since the last routine check-up for all preventable cancers (cervical p=0.0002, breast p=0.0039, and colorectal p=0.0196) is significantly associated with being up to date with cancer screening. Individuals who had a check-up of two or more years ago are 84% less likely to be up to date with pap smears than those who had a check-up within the year (p=0.0060). Individuals without health insurance are 94% less likely to be up to date with mammograms and colonoscopy/FIT tests (p=0.0016 and p=0.0133, respectively) than those who are insured. There is no significant association between screening and nativity.ConclusionsConsiderable differences in socio-economic and environmental determinants of health and colorectal cancer screening rates were observed between US-born and foreign-born Latinos. The present study represents the foundation for future targeted intervention among immigrant populations at our cancer center’s catchment area.

Exploring Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) Knowledge in Incarcerated Men.

People who are incarcerated have a disproportionately high risk of contracting human immunodeficiency virus (HIV). While there is no known cure for HIV, there are biomedical approaches that can successfully manage the virus and prevent its transmission. A total of 267 men who are incarcerated completed a cross-sectional survey focused on cancer health, HIV prevention, and mental health in three state prisons. The mean age was 39 years. The majority had an annual income of US$10,000 or less, self-identified as heterosexual, not married, had children, did not have any military status, and identified as African American/Black. Less than 4% indicated that they had heard about Pre-Exposure Prophylaxis (PrEP), and only 3% had heard of Post-Exposure Prophylaxis (PEP). PrEP and PEP effectively prevent HIV infection, but little attention has focused on increasing the knowledge and awareness of these HIV prevention interventions in the incarcerated population.

Stepping into the real world: a mixed-methods evaluation of the implementation of electronic patient reported outcomes in routine lung cancer care

BackgroundTo realize the broader benefits of electronic patient-reported outcome measures (ePROMs) in routine care, we used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to inform the translation of a clinically effective ePROM system (hereafter referred to as the PRM system) into practice. The study aimed to evaluate the processes and success of implementing the PRM system in the routine care of patients diagnosed with lung cancer.MethodA controlled before-and-after mixed-methods study was undertaken. Data sources included a self-report questionnaire and interviews with healthcare providers, electronic health record data for PRMs patients and historical controls, and field notes. Descriptive statistics, logistic regression modelling, negative binomial models, generalized estimating equations and repeated measures ANOVA were used to analyze quantitative data. Qualitative data was thematically analyzed.ResultsA total of 48/79 eligible people diagnosed with lung cancer completed 90 assessments during the 5-month implementation period (RE-AIM reach). Every assessment breached the pre-defined threshold and care coordinators reviewed and actioned 95.6% of breaches, resulting in 146 referrals to allied health services, most frequently for social work (25.3%), dietetics (18.5%), physiotherapy (18.5%) and occupational therapy (17.1%). PRMs patients had significantly fewer visits to the cancer assessment unit for problematic symptoms (M = 0.23 vs. M = 0.43; p = 0.035), and were significantly more likely to be offered referrals (71% vs. 29%, p < 0.0001) than historical controls (RE-AIM effect). The levels of ‘organizational readiness for implementing change’ (ORIC) did not show much differences between baseline and follow-up, though this was already high at baseline; but significantly more staff reported improved confidence when asking patients to complete assessments (64.7% at baseline vs. 88.2% at follow-up, p = 0.0046), and when describing the assessment tool to patients (64.7% at baseline vs. 76.47% at follow-up, p = 0.0018) (RE-AIM adoption). A total of 78 staff received PRM system training, and 95.6% of the PRM system alerts were actioned (RE-AIM implementation); and all lung cancer care coordinators were engaged with the PRM system beyond the end of the study period (RE-AIM maintenance).ConclusionThis study demonstrates the potential of the PRM system in enhancing the routine care of lung cancer patients, through leveraging the capabilities of automated web-based care options.Plain English summaryResearch has shown the clear benefits of using electronically collected patient-reported outcome measures (ePROMs) for cancer patients and health services. However, we need to better understand how to implement ePROMs as part of routine care. This study evaluated the processes and outcomes of implementing an ePROMs system in the routine care of patients diagnosed with lung cancer. Key findings included: (a) a majority of eligible patients completed the scheduled assessments; (b) patient concerns were identified in every assessment, and care coordinators reviewed and actioned almost all of these, including making significantly more referrals to allied health services; (c) patients completing assessments regularly were less likely to present to the cancer assessment unit with problematic symptoms, suggesting that ePROMs identified patient concerns early and this led to a timely response to concerns; (d) staff training and engagement was high, and staff reporting increased confidence when asking patients to complete assessments and when describing the assessment tool to patients at the end of the implementation period. This study shows that implementing ePROMs in routine care is feasible and can lead to improvements in patient care.

Abstract 434: Development of virtual outreach strategies to supply cancer education and prevention information during the COVID-19 pandemic

Abstract Background: The COVID-19 pandemic has forced many individuals to continue virtually via Zoom. To accommodate this change and remain accessible, the University of Arizona Cancer Center’s Office of Community Outreach and Engagement (COE) transitioned cancer education efforts to virtual webinars and social media. These multilingual and multicultural efforts were targeted toward residents of Arizona, as well as a broader network of participants. Objective: To develop accessible, virtual programming to engage communities across Arizona during the COVID-19 pandemic to continue cancer education and health promotion efforts in bilingual (English and Spanish) webinars where possible. Methods: Utilizing a vibrant social media presence, the COE team developed a weekly webinar series, entitled Let’s Taco ‘Bout Cancer!, a monthly Morning Cat Chat webinar, and an annual “Col-Chella” festival that focuses on cancer education. These series are based on informal interviews and conversations with cancer researchers, community health partners, cancer survivors/caretakers, and community advisory board members. All presentations were streamed via Zoom, social media accounts, and YouTube to be accessible for later use. Lastly, demonstration webinars (e.g. food preparation) for healthy behaviors were also implemented. Results: Since March 2020, more than 22,000 viewers have been recorded over 122 virtual cancer-related presentations that were given. Sixty-one percent of the presentations were in English and 39% were in Spanish. Collected surveys indicate the median age of the audience is 55 years old, 77% females, and 43% community members. Twenty-nine (29) percent identify as Hispanic, 48% as non-Hispanic white, and 17% as American Indian/Alaska Native. Evaluations reported that 86% of the audience were engaged, 94% that their knowledge was increased, and 69% indicated that their knowledge is applicable. Eighty-seven (87) percent thought the research topics discussed benefits their community and 83% preferred to receive cancer education materials via email. The collected evaluations indicate the audience’s top three priorities from the cancer center include: cancer prevention, education, and patient care. Discussion: Based on collected data, offering multicultural and multilingual outreach efforts virtually has allowed the COE team to continuously operate as an educational resource serving our diverse communities. Interacting and inviting members from Arizona’s Hispanic and American Indian communities, along with health professionals, has made the Cancer Center more relative to the population it serves as well as allowing Arizona residents to hear from their own community. Overtime, in-person efforts will resume with the inclusion of virtual engagement to have a well-rounded approach. Citation Format: Monica Yellowhair, Desiree Jones, Gabriela Ruiz, Octavio Castanos, Rene D. Herrera, Juan Contreras, David O. Garcia, Jennifer Hatcher. Development of virtual outreach strategies to supply cancer education and prevention information during the COVID-19 pandemic [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 434.

Abstract 3619: Vitamin D receptor function in African American prostate cancer is disrupted by reduced BAZ1A/SMARCA5

Abstract The biological drivers of prostate cancer (PCa) health disparities remain enigmatic. There are genomic differences, for example in the incidence of TMPRSS2 and ERG gene fusions which differ between European American (EA) and African American (AA) PCa. Accumulating epidemiological evidence suggests loss of vitamin D receptor VDR signaling contributes to AA PCa. Therefore, we investigated the VDR signaling in AA and EA prostate models. VDR protein levels were comparable between AA (RC43N, RC43T, RC77N, RC77T) and EA cells (HPr1AR, LNCaP) but RIME analyses identified significant AA-EA differences in VDR binding of coactivators (e.g. NCOA5), corepressors (e.g. HDAC2), and components of SWI/SNF and circadian rhythm complexes. ATAC-Seq identified 1α,25(OH)2D3-stimulated gain in nucleosome free (NF) regions was greatest in RC43N (non-malignant AA cells) and enriched for circadian rhythm transcription motifs (e.g. CLOCK). In RC43T AA PCa cells 1α,25(OH)2D3 led to a loss of NF free regions. Similarly, VDR ChIP-Seq revealed the cistrome was greater in AA cell models, and was dynamically altered in RC43N cells by 1α,25(OH)2D3 and overlapped with the SWI/SNF component SMARCA4, but 1α,25(OH)2D3 led to reduced VDR binding in RC43T cells. The 1α,25(OH)2D3-regulated transcriptome was largest in RC43N and RC43T but GSEA terms were frequently and oppositely enriched, for example Reactome S phase genes were negatively enriched in RC43N, but positively enriched in RC43T. Cistrome-transcriptome integration identified the most significant relationships between VDR binding and the magnitude of 1α,25(OH)2D3-regulated genes in RC43N. Global coregulator analyses identified significantly reduced BAZ1A/SMARCA5 in AA PCa in TCGA and a published cohort of ~1500 AA/EA tumors. Restoring BAZ1A expression in cells resulted in significantly enhanced 1α,25(OH)2D3-regulated transcriptome in RC43N and RC43T cells, and hypergeometric tests revealed the significant enrichment of direct VDR target genes. The footprint of altered AA VDR signaling was evident in three previously established clinical cohorts. Serum miRNA that predicted AA progression from HGPIN to PCa were enriched for 1α,25(OH)2D3-regulated VDR targets; AA tumors from a vitaminD3-treated chemotherapy trail were enriched for VDR-bound genes; and, tumors from men with low serum 25(OH)D3 levels were significantly enriched for VDR target genes identified in AA but not EA PCa. Together, these data suggest VDR transcriptional control is most potent and dynamic in AA prostate cells, and is primed to govern inflammatory and circadian pathways. Reduced BAZ1A/SMARCA5 expression and/or reduced environmental-regulated serum vitamin D3 levels most acutely suppress these actions in AA PCa. Therefore, the VDR axis lies at the cross-roads of biopsychosocial processes that contributes to PCa health disparities. Citation Format: Shahid Hussain, Manjunath Siddappa, Sajad A. Wani, Hedieh Jafari, Jaimie S. Gray, Hsu-Chang Wu, Hancong Tang, Mark D. Long, Isra Elhussin, Balasubramanyam Karanam, Honghe Wang, Rebecca Morgan, Gary Hardiman, Isaacson B. Adelani, Rotimi Oladapo, Adam R. Murphy, James R. Marshall, Chanita Highes Halbert, Lara E. Sucheston-Campbell, Clayton Yates, Moray J. Campbell. Vitamin D receptor function in African American prostate cancer is disrupted by reduced BAZ1A/SMARCA5 [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 3619.

Abstract 3677: Incorporating societal determinants of health with implementation science to increase tobacco cessation patient and community responsiveness

Abstract Background: Implementing tobacco cessation has been challenging across multi-racial and multi-ethnic regional communities. Multilayered influences of Societal Determinants of Health (SDH), social risks, environment, role of stress and perceived levels, tobacco addiction and behaviors are complex. Effective identification of social risk factors and unmet social needs of individuals can enhance tobacco treatment quality, and care coordination across the healthcare continuum. Integrating SDH and Implementation science into electronic health record (EHR) can provide both value and principles that promises to enhance patient and community responsiveness to address Catchment Area cancer burden and health disparities. Methods: We included a 33 item SDH measure to our tobacco use assessment (TUA) instrument and applied implementation science with tobacco cessation program at City of Hope (COH). Our SDH assesses patients’ appraisal of their contextual distress including access to primary and cancer related medical care, technology and digital access and proficiency, food insecurity, career/job, income, education distress; housing, living situation and social network/isolation and racism and discrimination stress. The measure follows a 5pt likert scale ranging from extreme stress to no stress. Results: This study compared 173 self-reported TUA. The mean age of first smoked a cigarette was 16 y.o. The mean age of first began smoking cigarettes regularly was 18 y.o. The mean total years of smoking was 36 years. Most participants were everyday smokers and on average, participants smoked I pack/day. &amp;gt;50% of the patients lived in a place where other people smoked cigarettes indoors. 55% of the patients tried to quit in the past 30 days. 60% of the patients indicated that it is EXTREMELY important for them to quit smoking/tobacco and indicated interest in tobacco cessation. Half of the patients indicated they are NOT SO confident in their ability to quit smoking/tobacco. Below are the items commonly endorsed as extreme stressful: Health and cancer outcomes, using telehealth (e.g., using a smartphone or tablet for tele/virtual clinical visits, patient portal, completing online forms, virtual classes), money or finances, and functional strain (e.g., family demands). Conclusions: SDH is complex and multilayered as well as understudied. The results support the small body of research documenting the necessity and utility of measuring and addressing SDH to correct health disparities. Increased prioritization including assessing and intervening with strategic planning and IT integration is required to better understand and address the cancer impact including tobacco cessation relevant to SDH. Successful tobacco control programs can benefit from IT integrated, culturally and community informed SDH assessments using implementation science principles. Citation Format: Kimlin T. Ashing, Sophia Yeung, Cary A. Presant, Jonjon Macalintal, Brian Tiep, J Sandoval, Brenda Gascon, R Salgia, Susan J. Brown, Steven Rosen. Incorporating societal determinants of health with implementation science to increase tobacco cessation patient and community responsiveness [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 3677.

Development, Testing, and Implementation of the Belgian Patient Reported Experience Measure for Pancreatic Cancer Care (PREPARE) Project: Protocol for a Multi-Method Research Project.

BackgroundPatients with pancreatic cancer do not feel involved in the development of their treatment and care plans. In Belgium, these plans are decided on during multidisciplinary team meetings. However, limited time is spent on the discussion of the preferences of the patient during these meetings. This research project aims to develop a patient-reported experience measure (PREM) for pancreatic cancer and assess if its use can support collaborative treatment decision-making.ObjectiveThis paper aims to outline the protocol for a multi-method research project to improve person-centered pancreatic cancer care in Belgium. Three subobjectives are pursued: (1) to develop a PREM to assess the experiences of care-related aspects in pancreatic cancer care, (2) to validate the PREM, and (3) to develop and evaluate an educational intervention to support the use of the PREM’s results.MethodsFor the development of the PREM, an exploratory mixed methods study design will be used. The study will start with a survey followed by a telephone interview involving patients with pancreatic cancer and digestive oncology health care professionals. Study two is the testing of the content and construct validity of the PREM. Study three involves the implementation study according to the Medical Research Council framework of a complex intervention introducing the PREM in practice. The effectiveness of the intervention will be investigated using a pragmatic randomized controlled trial study design.ResultsThe protocol presents the entire structure of the research project. Ethics approval to conduct the exploratory mixed methods study (objective 1) has been obtained, and recruitment has started since January 2022.ConclusionsThe poor prognosis of patients with pancreatic cancer should not be considered a hurdle to not study this patient population group. Involving patients in the research and decision-making processes early on is key. This project aims to realize a scientifically sound research process providing research outputs that can easily and timely be implemented in the care trajectory of patients with pancreatic cancer. This research project will also lead to recommendations on how to involve patients with pancreatic cancer and how the methodology of this research project can be translated to other patient groups.International Registered Report Identifier (IRRID)PRR1-10.2196/29004

DESC-1, a prospective study on epidemiologic factors influencing general population to engage with liquid biopsy based cancer screening.

e13630 Background: Liquid biopsy technology has delivered promising results for therapy monitoring and disease relapse detection. The simplicity of the procedure makes it attractive for early cancer detection despite its clinical value in this setting being as yet unknown. The objective of the study is to evaluate the acceptance of this new screening technology by the general population. Methods: Participants in a digital health study originally selected randomly from the general population of the canton of Geneva (Switzerland) were invited to participate in a survey investigating (1) their motivation and (2) what factors might affect their decision regarding whether to proceed to a liquid biopsy test for cancer screening. Results: 2’898 participants responded to the survey (participation rate: 35%), 1’568 are &gt; 50yo. Two thirds are female, 7.6% have a history of cancer, 80.8% have a family relative with a history of cancer. In the whole population: 97.7% are ready to use liquid biopsy as a cancer screening test. In the &gt; 50yo, 97.3% of women and 98.5% of men would do the test. In the &lt; 50yo, 97.2% of women and 98.6% of men would take it with X² = 0.018 (p = 0.89) for independence with sex. Age category, education level, income band, professional status, self-rated health, tobacco status, chronic disease, personal or familial history of cancer and COVID pandemic have no statistical impact on the incentive to do a liquid biopsy test. In the whole population, 94.6% would take the test knowing that there is a risk of a false positive. The median accepted false positive percentage error rate is 10% with interquartile rate (IQR) Q1: 5% and Q3: 15%. Ninety-six percent of respondents would take the test knowing that there is a risk of a false negative, accepting a median false negative percentage error rate of 10% with IQR Q1: 5% and Q3 : 20%. Most respondents (97.6%) will do the test knowing that additional tests or procedures could be required in case of positivity and 58.8% would take it yearly, while 24.6% only every two years. Fifty-nine percent believe that taking the test could influence their lifestyle, regardless of the result. Conclusions: This study shows that the surveyed population is ready to engage with liquid biopsy as a cancer screening tool despite its limitations and drawbacks. Willingness to take the test might depend on sex only in the &lt; 50yo population. Knowing the lack of demonstrated benefit, it is urgent to conduct trials assessing the clinical value, psychological impact and financial burden of liquid biopsy tests before incorporating this technology into cancer screening programs. Due to the very high level of interest demonstrated in our study, the possibility of direct-to-consumer availability should prompt health authorities and accreditation bodies to carefully weigh the impact of authorizing market access to liquid biopsy technologies for this purpose.

Addressing unmet needs of cancer care in a lower middle income country by establishing an electronic hospital based cancer registry.

e13621 Background: Sri Lanka (SL) is a Lower Middle Income Country (LMIC) which has seen its cancer incidence double in the last 25 years. National Cancer Institute Sri Lanka (NCISL) is the only dedicated cancer hospital in SL and provide care to around 40% of all patients diagnosed with cancer in the country. The existing SL Cancer Registry, primarily contains only socio-demographic data and there was no systematic method to capture cancer treatment and outcome data This presents a missed opportunity in identifying and bridging gaps in cancer care delivery and health equities in an effective manner. Methods: We built an electronic hospital based cancer registry using the “free to use” cloud based District Health Information System (DHIS2) software platform and prospectively collected disease, demographic, treatment and outcome data on selected cancers treated at the NCISL from 2016 onwards. This platform is easily adaptable and will allow downloading data to standard statistical software directly for data analysis and can be integrated with other existing health information systems. its easily adaptable . The variables captured were identified through focus group sessions with both healthcare workers and patient representatives. Results: To date, data from over 5,000 breast, 1500 colorectal and 600 thyroid cancer patients have been captured. From this database data on disease characteristics, demographic details, survival rates, treatment toxicities, referral pathways, health care seeking patterns, comorbidity data, health care related quality of life, treatment guideline concordance, out of pocket expenses incurred while on treatment, palliative care delivery, cancer care equity gaps can be elicited. Conclusions: Our database demonstrates that it is feasible to build low cost, easy to maintain yet good quality custom made data bases to collect cancer care related data. Careful selection of variables will allow health systems to identify existing gaps which is the key initial step in addressing them with a view of improving cancer related outcomes. Integrating demographic and outcome data within the same database will help in identifying health system inequities. Continuous data collection will allow assessing the efficacy of any intervention launched to bridge these gaps in the future. This database can also be adapted with minimal change by other LMICs to generate real world data to inform national cancer control policy planning.