American Cancer Research Articles

Ongoing Symptoms and Concerns Experienced by Low-Risk Breast Cancer Survivors Following Active Treatment.

Little is known about the symptom burden of breast cancer survivors with early-stage disease. Many studies have focused on symptoms of patients who are undergoing or recently completed systemic therapy. However, with the increased use of Oncotype DX, the proportion of early-stage hormone receptor-positive patients who undergo chemotherapy has declined, making existing studies of the symptom experience less useful for these patients. The aim of this study was to assess symptom burden for early-stage breast cancer survivors. Eligible survivors had stage I-II, estrogen receptor (ER)- or progesterone receptor (PR)-positive and HER2neu-negative breast cancer, did not receive chemotherapy, were 6 months-5 years post-diagnosis, and were cancer-free. Survivors were enrolled at the University of Wisconsin Breast Center follow-up visits and were emailed a link to a patient-reported outcomes (PRO) survey. Survey domains were informed by American Cancer Society/American Society of Clinical Oncology (ACS/ASCO) survivorship guidelines and survivor/provider stakeholders. The prevalence of clinically significant symptoms are reported. Overall, 98 patients participated. On average, participants were 61.3 years of age (standard deviation [SD] 11.5) and 2.5 years post-diagnosis (SD 1.2); 71.3% underwent breast-conserving surgery. The average item-level missingness rate was low (2.0%). Most survivors (86.2%) experienced symptoms (38.8% reporting one to two symptoms; 47.9% reporting more than three symptoms). Early-stage breast cancer survivors report a high symptom burden. Given nearly 50% of survivors report more than three symptoms, many topics may not be discussed or addressed during time-limited follow-up visits. Some symptoms, such as sexual health, may be less feasible to address in-clinic given their complex/sensitive nature. Use of PROs allows for a comprehensive evaluation and identification of unrecognized needs, representing an opportunity to improve survivorship care.

The food environment and postdiagnosis weight gain among Black women breast cancer survivors in Maryland.

Weight management is included in the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guidelines for its clinical impact on breast cancer (BC) survivorship. Few studies have examined the impact of neighborhood-level factors associated with postdiagnosis weight change among Black BC survivors. We recruited 100 Black female BC survivors to complete an online survey, including demographic, clinical characteristics, and lifestyle factors, between January 5, 2022 and August 18, 2022. We utilized the 2023 County Health Rankings Food Environment Index (FEI), which ranges from 0 (worst) to 10 (best), to capture the food environment as the primary exposure for postdiagnosis weight gain. We calculated postdiagnosis weight gain as percent weight change from time at diagnosis to time of survey. Participants were grouped into categories of stable weight (within ± 3%) or weight loss (≤ -3%) compared to weight gain (≥ 3%). We calculated adjusted odds ratios (aORs) for the associations between county-FEI, clinical factors, and postdiagnosis weight gain. Among the 95 women who reported weight measurements, we observed that women living in counties with an FEI ≥ 8.8 (at or above median) were significantly less likely to experience weight gain (aOR 0.09; 95% CI 0.01-0.77). Stage, age at diagnosis, years since BC diagnosis, and BC treatments were not significantly associated with weight gain. Postdiagnosis weight gain is associated with poorer food environments among Black BC survivors in Maryland. Our findings will inform larger prospective studies and future interventions among this population.

Evidence-based recommendations regarding risk reduction practices for people at risk of or with breast cancer-related lymphedema: consensus from an expert panel.

Several recent studies have investigated the validity of precautionary practices for lymphedema risk reduction after breast cancer treatment, such as avoidance of blood pressure measurements, skin puncture, blood draws, and use of prophylactic compression during air travel. Other studies have elucidated risk factors for breast cancer-related lymphedema, such as axillary lymph node dissection and skin infection (cellulitis). Combining the current evidence base with the consensus opinion of lymphatic experts assembled at the American Cancer Society/Lymphology Association of North America Summit in October 2023, updated evidence-based risk reduction recommendations are presented for those with or at risk of breast cancer-related lymphedema. Recommendation topics include prospective surveillance, patient education, individual risk factors, exercise, blood pressure, skin care and hygiene, skin puncture and blood draws, surgical procedures, prophylactic compression, air travel, and hot climate and sauna. These recommendations will help inform education and medical choices for individuals treated for breast cancer who are at risk of or diagnosed with breast cancer-related lymphedema. More high-quality evidence is required to allow the development of risk reduction recommendations for other cancer types such as gynecological, melanoma, and head and neck. It is recommended that clinicians and organizations serving people at risk of or with lymphedema align risk reduction guidelines with the evidence-based recommendations provided within this consensus document and companion manuscripts from the American Cancer Society/Lymphology Association of North America Lymphedema Summit: Forward Momentum: Future Steps in Lymphedema Management.

Abstract PO3-27-07: Age at diagnosis and the food environment are associated with postdiagnosis weight gain among Black American breast cancer survivors in Maryland

Abstract Background: Weight management is now included in the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guidelines due to its clinical impact on breast cancer (BC) survivorship outcomes. While numerous individual-level risk factors for weight gain after BC diagnosis have been identified, such as younger age at diagnosis, cancer stage, and cancer treatments (chemotherapy), there are limited data on the impact of neighborhood-level factors associated with weight change postdiagnosis among Black BC survivors. Methods: Utilizing social media recruitment strategies and survivor networks, we recruited 100 Black female BC survivors to complete an online survey, including demographic, clinical characteristics, and lifestyle factors, between January 5, 2022, and August 18, 2022. To capture the food environment, we utilized the 2023 Food Environment Index County Health Rankings, which accounts for access to healthy foods due to proximity and income (considering the distance an individual lives from a grocery store or supermarket, locations for health food purchases in most communities, and the inability to access healthy food because of cost barriers). The index ranges from 0 (worst) to 10 (best). Our outcome of postdiagnosis weight gain was calculated as percent weight change from time at diagnosis to time of survey, calculated as ([weight at survey – weight at diagnosis]/weight at diagnosis) × 100. Participants were grouped into mutually exclusive categories of stable weight (within ± 3%) or weight loss (≤-3%) compared to weight gain (≥ 3%). Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were calculated for the associations between clinical factors, county-level food environment index, and postdiagnosis weight gain. Results: The average ages at time of survey and at primary BC diagnosis were 58.6 years (standard deviation [SD]= 10.1) and 49.1 years (SD=10.2), respectively. Most women (70%) were diagnosed with invasive BC and only 22% were currently undergoing treatment at the time of the survey. While only 7% reported being obese at the time of BC diagnosis, 54% reported being obese at the time of survey which was on average 9 years post-BC diagnosis; and while 61 women had weight loss or stable weight, 34 women experienced weight gain postdiagnosis. Among the 95 women included in multivariable models who reported weight and height measurements for calculating weight change, women ≥50 years of age at BC diagnosis (versus < 50 years) were 3.43 times more likely to gain weight after diagnosis (95% CI 1.13-11.50). Women living in counties with a Food Environment Index ≥8.8 (median cut-point compared to < 8.8) were significantly less likely to experience weight gain (aOR 0.11; 95% CI 0.01-0.90). Stage and BC treatments were not significantly associated with weight gain. Conclusions: Our study findings demonstrate the importance of evaluating the food environment during BC survivorship and longitudinal monitoring of weight postdiagnosis to mitigate weight gain among Black BC survivors. Our findings will be used to inform a larger prospective study and future interventions among this population. Citation Format: Avonne Connor, Katherine Ho, Kate Dibble, Kala Visvanathan. Age at diagnosis and the food environment are associated with postdiagnosis weight gain among Black American breast cancer survivors in Maryland [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-27-07.

A Comprehensive Integration of Data Regarding the Correlation of TNF-α rs1800629 Polymorphism with Susceptibility to Cervical Cancer.

Cervical cancer, globally, ranks as the runner-up among the most prevalent forms of cancer affecting women. The role of the tumor necrosis factor alpha (TNF-α) polymorphism in the susceptibility to cervical cancer has been a subject of interest. However, the current evidence regarding this association remains inconclusive. To address this uncertainty, eligible studies were systematically searched and retrieved from various databases including Cochrane Library, EMBASE, PubMed, Web of Science, CNKI, and Wanfang database. The search was conducted until September 01, 2023. The collected literature was then subjected to independent analysis by two authors. The pooled odds ratio along with the corresponding 95% confidence interval was calculated using different genetic models. Additionally, sensitivity and cumulative analyses were performed to assess the stability of the obtained results. A total of 29 case-control studies involving 8850 cases and 9286 controls were included in the present analysis. The findings revealed that the TNF-α rs1800629 polymorphism increased the risk of cervical cancer under the allele genetic model (A vs. G: OR = 1.277, 95% CI = 1.104-1.477, P = 0.001) in the general population. Subgroup analysis based on ethnicity demonstrated that this polymorphism was associated with an increased risk of cervical cancer in Caucasian and African women, but not in Asians. Furthermore, subgroup analysis based on country of origin indicated a significant correlation between the TNF-α rs1800629 polymorphism and an increased risk of cervical cancer in American and Chinese women, but not in Iranian women. The findings from this meta-analysis suggest that the TNF-α rs1800629 polymorphism is a risk factor for cervical cancer in the general population, particularly in Caucasian and African women. However, further well-designed studies are warranted to validate these findings.

Benefit-to-radiation-risk of low-dose computed tomography lung cancer screening.

The US National Lung Screening Trial (NLST) and Dutch-Belgian NELSON randomized controlled trials have shown significant mortality reductions from low-dose computed tomography (CT) lung cancer screening (LCS). NLST, ITALUNG, and COSMOS trials have provided detailed dosimetry data for LCS. LCS trial mortality benefit results, organ dose and effective dose data, and Biological Effects of Ionizing Radiation, Report VII (BEIR VII) organ dose-to-cancer-mortality risk data are used to estimate benefit-to-radiation-risk ratios of the NLST, ITALUNG, and COSMOS trials. Data from those trials also are used to estimate benefit-to-radiation-risk ratios for longer-term LCS corresponding to scenarios recommended by United States Preventive Services Task Force and the American Cancer Society. Including only screening doses, NLST benefit-to-radiation-risk ratios are 12:1 for males, 19:1 for females, and 16:1 overall. Including both screening and estimated follow-up doses, benefit-to-radiation-risk ratios for NLST are 9:1 for males, 13:1 for females, and 12:1 overall. For the ITALUNG trial, the benefit-to-radiation-risk ratio is 58-63:1. For the COSMOS trial, assuming sex-specific mortality benefits like those of the NELSON trial, the benefit-to-radiation-risk ratio is 23:1. Assuming a conservative 20% mortality benefit, annual screening in people 50-79 years old with a 20+ pack-year history of smoking has benefit-to-radiation-risk ratios of 23:1 (with follow-up doses adding 40% to screening doses) to 29:1 (with follow-up adding 10%) based on COSMOS dose data. Based on linear, no threshold BEIR VII dose-risk estimates, benefit-to-radiation-risk ratios for LCS are highly favorable. Results emphasize the importance of using modern CT technologies, maintaining low diagnostic follow-up rates, and minimizing both screening and diagnostic follow-up doses. The benefits of lung cancer screening significantly outweigh estimates of future harms associated with exposure to radiation during screening and diagnostic follow-up examinations. Our findings emphasize the importance of lung cancer screening practices using state-of-the-art computed tomography scanners and specialized low-dose lung screening and diagnostic follow-up techniques.

Evaluating Disparities in Colon Cancer Survival in American Indian/Alaskan Native Patients Using the National Cancer Database.

Studies demonstrate higher mortality rates from colon cancer in American Indian/Alaskan Native (AI/AN) patients compared to non-Hispanic White (nHW). We aim to identify factors that contribute to survival disparities. We used the National Cancer Database to identify AI/AN (n = 2127) and nHW (n = 527,045) patients with stage I-IV colon cancer from 2004 to 2016. Overall survival among stage I-IV colon cancer patients was estimated by Kaplan-Meier analysis; Cox proportional hazard ratios were used to identify independent predictors of survival. AI/AN patients with stage I-III disease had significantly shorter median survival than nHW (73 vs 77months, respectively; p < 0.001); there were no differences in survival for stage IV. Adjusted analyses demonstrated that AI/AN race was an independent predictor of higher overall mortality compared to nHW (HR 1.19, 95% CI 1.01-1.33, p = 0.002). Importantly, compared to nHW, AI/AN were younger, had more comorbidities, had greater rurality, had more left-sided colon cancers, had higher stage but lower grade tumors, were less frequently treated at an academic facility, were more likely to experience a delay in initiation of chemotherapy, and were less likely to receive adjuvant chemotherapy for stage III disease. We found no differences in sex, receipt of surgery, or adequacy of lymph node dissection. We found patient, tumor, and treatment factors that potentially contribute to worse survival rates observed in AI/AN colon cancer patients. Limitations include the heterogeneity of AI/AN patients and the use of overall survival as an endpoint. Additional studies are needed to implement strategies to eliminate disparities.

Application of Classification Techniques on Breast Cancer Prognosis

The most prevalent form of cancer for females is breast cancer in Americans, and additionally, it is Asia's and the United States' second most common cause of death among females. In the United States in 2009, 40,600 persons died from breast cancer, 400 of whom were men. Clinical breast exams, radiographs, and ultrasounds are all excellent methods for testing for breast cancer today. A strategy for presenting a set of input-output sets to a network is referred to as supervised learning. The subsequent model parameters are updated iteratively to minimize the discrepancy around system prediction and real outcomes for training data. Three classification methods were tested on a breast cancer database: Probabilistic Learning, Logistic Regression, and Neural Net. Experiments demonstrated that Neuro Net categorization surpasses Tree Based categorization and Naïve Bayesian classification in terms of accuracy and precision for breast cancer early detection. Although it is established that the use of Ml techniques can enhance our knowledge of cancer progression, these methods must be confirmed before they're able to be employed in clinical practice. In this paper, we give a review of contemporary ML techniques used in cancer progression modelling. The prediction models talked about here have been trained using an assortment of supervised algorithms for machine learning, as well as varied input features and data. We have put together an inventory of the most recent articles that use such methods for modelling cancer risk or patient outcomes in context with the increasing desire to employ ML methods in cancer studies.

Associations of Post-Diagnosis Lifestyle with Prognosis in Women with Invasive Breast Cancer.

Lifestyle habits can impact breast cancer development, but its impact on breast cancer prognosis remains unclear. We investigated associations of post-diagnosis lifestyle with mortality and recurrence in 1,964 women with invasive breast cancer enrolled in the Kaiser Permanente Northern California Pathways Study shortly after diagnosis with lifestyle information at baseline (2005-2013) and the 2-year follow-up. We calculated a post-diagnosis lifestyle score (range, 0-18) based on 9 diet, physical activity, and body weight recommendations from the American Cancer Society/American Society of Clinical Oncology (ACS/ASCO) using follow-up data (body weight also included baseline data); higher scores indicate greater guideline concordance. Similarly, we calculated a pre-diagnosis lifestyle score using baseline data to investigate pre- to post-diagnosis changes. We estimated hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional hazard models, with follow-up through December 2018 (observing 290 deaths and 176 recurrences). The 2-year post-diagnosis lifestyle score was inversely associated with all-cause mortality (ACM; HR per 2-point increase = 0.90; 95% CI, 0.82-0.98), and breast cancer-related mortality (HR, 0.79; 95% CI, 0.67-0.95), but not recurrence. Relative to women who maintained low concordance with recommendations at both time points, women who maintained high concordance had a lower risk of ACM (HR, 0.61, 95% CI, 0.37-1.03). Improved concordance with some specific recommendations (particularly PA) may be associated with a lower hazard of ACM (HRPA, 0.52; 95% CI, 0.35-0.78). Results suggest that women with breast cancer may benefit from a post-diagnosis lifestyle aligned with ACS/ASCO guidelines. This information may potentially guide lifestyle recommendations for breast cancer survivors to reduce mortality risk.

Clinical Features and Outcomes of Primary Liver Cancer in American Indian/Alaska Natives

Huyser, Michelle MD; Attwood, Kristopher PhD; Takabe, Kazuaki MD, FACS; Schwarz, Roderich E MD, FACS Author Information

Abstract C044: A case and control genetic profile of tissue and serum in African American men

Abstract Prostate cancer is the most common non-cutaneous cancer among men. A man with 1,2 or 3 first degree relatives with prostate cancer, has a 2,5, and 11-fold increased risk of developing prostate cancer. The heritability rate of prostate cancer is 58%. African American men have the highest incidence and mortality rate of prostate cancer in American. Men of African descent, globally, are more likely to die from prostate cancer than any other ancestral groups. We performed Immunohistochemistry(IHC) and RNA seq analysis on African American tissue and serum samples, with a focus on HMGA2, which has been shown promote EMT, invasion, and metastasis in cancer. Acknowledgements: These studies were supported by NIH/NIMHD U54MD007590 and U54MD013376. Our sample set included 3 benign and 2 prostate cancer tumors from African Americans. IHC markers showed HMGA2 staining within epithelial cells of the prostate cancer tissue. This result validates studies that show that distinct subtypes of prostate cancer may arise from luminal and basal epithelial cell types. RNA seq results showed HMGA to be non-significantly down-regulated in tumor samples. The most differentially expressed (DE) gene, however, was SNORD116-18. Studies have shown SNORD116-18 expression to be associated with chronic lymphocytic leukemia in distinguishing prognostic groups. This finding may be a pathway of interest for further studies. RNA seq of serum gave homogeneous results, however, gene set enrichment analysis of the most differentially expressed genes within the serum showed overlap with inflammation pathways gene for upregulated DE genes and Methylation Pathway for downregulated DE genes. Further analysis on more samples from African Americans tissue and serum will be used to validate findings. Citation Format: Maxine S. Harlemon, Roni Bollag, Martha Terris, Ana Cecilia Millena, Nathan Bowen, Valerie Odero-Marah. A case and control genetic profile of tissue and serum in African American men [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 C044.

Metrics, baseline scores, and a tool to improve sponsor performance on clinical trial diversity: retrospective cross sectional study

ObjectiveTo develop a measure for fair inclusion in pivotal trials by assessing transparency and representation of enrolled women, older adults (aged 65 years and older), and racially and ethnically minoritized...

Measurement invariance of the 10-item resilience scale specific to cancer in Americans and Chinese: A propensity score–based multidimensional item response theory analysis

ObjectiveLittle is known about the measurement invariance (MI) of resilience instruments in cancer care. This study was designed to examine MI of 10-Item Resilience Scale (RS-SC-10) in Americans and Chinese with cancer using propensity score–based multidimensional item response theory (MIRT) analysis. MethodsA sample of 924 patients were enrolled in the Be Resilient to Cancer trial involving 1 hospital in America and 3 hospitals in China. Data were collected from the RS-SC-10 and Hospital Anxiety and Depression Scale. Propensity score matching and MIRT were performed to evaluate Differential Item Function. Integrated Discrimination Improvement and Net Reclassification Improvement were used to indirectly estimate the MI through incremental prediction ability of MIRT-based score over total score. ResultsRS-SC-10 retained 10 items with monotonous thresholds and its original two-factor structure. Nonuniform Differential Item Function was recognized in Item 4 (P ​= ​0.0011, Δ%β1 ​= ​4.15%) and Item 8 (P ​= ​0.0017, Δ%β1 ​= ​5.99%). Net Reclassification Improvement ranged from 9.04% to 35.01%, and Integrated Discrimination Improvement ranged from 8.82% to 20.60%. ConclusionsAlthough partial MI has been identified between Americans and Chinese, RS-SC-10 remains a critical indicator to emotional distress in cancer care.

S261 Effect of a Patient Navigator on Colonoscopy Completion in FIT Positive Patients Refractory to Initial Scheduling Attempts

Introduction: Decreased time from positive fecal immunochemical test (FIT) to colonoscopy is associated with decreased morbidity and mortality from colorectal cancer. However, colonoscopy is often delayed or forgone for a variety of reasons. Prior studies have shown that patient navigation for FIT+ patients increases the likelihood of colonoscopy completion. The purpose of this study was to evaluate the impact of a patient navigator on improvement in colonoscopy completion in Veterans who had not completed timely colonoscopy after FIT+. Methods: Patients in the Veterans Affairs Puget Sound Health Care System with FIT+ between 1/1/2020 and 6/30/2021 who had not yet completed colonoscopy were randomized in 11/2021 to: 1) navigation with a mailed letter and phone call from a trained, non-clinical staff member, 2) mailed letter only, or 3) control. The patient navigator provided basic education to the patient, elicited barriers to care, and facilitated seamless interaction with the primary care team. Demographic variables were recorded from the medical record. The Care Assessment Need (CAN) score was used to assess comorbid status. Outcomes were assessed as of 6/1/2022. Binary logistic regression and Kaplan Meier analyses were performed using SPSS. Results: 170 FIT+ patients were identified and 56, 56, and 58 patients were assigned to the Navigator, Mailed Letter, and Control groups, respectively. Patient demographics were similar between cohorts (Table). Colonoscopy completion was significantly increased in the Navigator group (p < 0.05), while the letter alone had no significant impact (Table). Navigation was also associated with improved documentation of reasons for no colonoscopy (p < 0.05). Adjusting for measured covariates, compared to the Navigator group, the odds of colonoscopy completion was significantly lower for the Mailed Letter group (OR 0.31 (CI 0.14-0.67)) and the Control group (OR 0.37 (CI 0.17-0.78)). Kaplan Meier analysis (Figure) revealed statistically significant differences in time to colonoscopy between the three groups. Conclusion: Patient navigation with a trained non-clinical staff member significantly improves colonoscopy completion following FIT+ in patients who are refractory to initial attempts at timely colonoscopy. Mailing a letter alone had no significant benefit. Further efforts are needed to ensure timely and complete diagnostic evaluation of patients with FIT+ screening. This study was sponsored by a grant from the American Cancer Society.Figure 1.: Kaplan Meier for Colonoscopy Completion Following FIT+ (p = 0.05) Table 1. - Demographic Information and Descriptive Results Overall (n = 170) Navigator (n = 56) Mailed Letter Only (n = 56) Control (n = 58) Mean Age (years) 67.3 65.8 68.6 67.5 Sex (% men) 90.1 89.3 91.1 91.4 Race (% white) 80.1 76.8 85.7 79.3 Hispanic Status (% Hispanic) 0.01 0.0 0.02 0.0 Mean CAN Score 60.0 62.2 57.7 60.0 Referral to GI Placed (%) 82.9 87.5 85.7 75.9 Colonoscopy Completed (%) 28.8 41.1 23.2 22.4 Colonoscopy Completed or Appropriate Reason for no Colonoscopy (%) 47.1 66.1 33.9 39.7 Median Days from FIT+ to Colonoscopy 211 230 235 196

Association between Dietary Anthocyanidins and Risk of Lung Cancer.

Background: Anthocyanidins are a kind of water-soluble flavonoids widely found in flowers and fruits of many plants. Although the beneficial effect of anthocyanidins in cancer prevention has been discussed, the value of anthocyanidins in lung cancer prevention requires further investigation. In this study, we aimed to explore the role of dietary anthocyanidins in the prevention of lung cancer in population-based prospective studies. Methods: Data of participants in this study were collected from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated in Cox proportional hazards regression for the association of dietary anthocyanidins and lung cancer risk. The dose-response relationship was explored between total anthocyanidins and the incidence of lung cancer. Results: A total of 97,993 participants were included in this study. The calculated HRs showed a trend that a higher quartile of total anthocyanidins indicated lower risk of lung cancer after adjusting for covariates (HRQ4vsQ1: 0.63; 95% CI: 0.55,0.73; p for trend < 0.001). A non-linear association between total anthocyanidins and lung cancer risk was found in the restricted cubic spline model. Conclusion: A protective association between dietary anthocyanidins and risk of lung cancer in Americans was investigated.

Abstract 443: Predictors of mortality in hospitalized African American COVID19 cancer patients

Abstract Background: Coronavirus disease 2019 (COVID-19) and associated outcomes manifest differently depending on patients’ background and pre-existing conditions. It remains unclear how African Americans with and without cancer have been affected. Aim: To determine epidemiological, clinical comorbidities, and laboratory test results to identify markers associated with mortality in COVID-19 cancer patients. Methods: We reviewed all COVID-19 hospitalized patient records from Dec. 2019 to Nov. 2021 at Howard University Hospital. Patients having a history of, or active cancer status were reviewed. All the clinical, treatment, lab values, and pathological data were extracted. Statistical analysis of the COVID-19 cancer patients and comparison with non-cancer COVID-19 patients were performed using univariate and multivariate analyses. Results: Out of 800 COVID-19 infected patients, a total of 49 patients were identified with different types of cancer, with both active and previous history. Females consisted of 26 cancer patients (53%). Cancer patients were older than non-cancer patients (mean age-70.6 vs. 56.3 years) and had an increased length of hospital stay (mean 13.9 vs 9.4 days). Among cancer patients, breast cancer was more prevalent in females and prostate cancer in males, (54% and 52% respectively). In both cases and controls, univariate and multivariate analyses did not show any correlation between individual symptoms or clinical comorbidities and death. Higher reduction in albumin level in cancer cases, from the time of admission to day five, was significantly associated with death during the same hospital stay compared to those who were discharged (p&amp;lt;0.001). In controls, lymphocytes count, AST, and Albumin have shown an association with increased mortality. Comparison of patients with active vs. previous cancer showed no significant difference in the clinical outcome, death vs discharge (P=0.34). Conclusion: Albumin level has shown to have an inverse relationship with clinical outcomes among all COVID infected African American patients. Reduction in Albumin level during the hospital stay, particularly in COVID-19 cancer patients should be considered as a predictor of mortality. No significant difference was noticed in the clinical outcome in patients with previous versus active cancer. Further research with a large cohort size is needed to verify and identify other predictors of outcome in COVID-19 cancer patients and develop appropriate treatment modalities. Citation Format: Suryanarayana reddy challa, Lakshmi Gayathri Chirumamilla, Nader Shayegh, Josie Z Fazzino, Adeyinka O. Laiyemo, philip Oppong-Twene, Zaki A. Sherif, Oluwabusola Olamide Lawal, Daniel Larbi, Gholamreza Oskrochi, Hassan Brim, Hassan Ashktorab. Predictors of mortality in hospitalized African American COVID19 cancer patients [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 443.

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 3587: Racial disparity in COVID-19 severity after adjusting for chronic illnesses and sociodemographic factors

Abstract Background. Research has reported that African American (AA) cancer patients with COVID-19 had a higher hospitalization rate than their white counterparts. Because the severity of COVID-19 is partly related to existing chronic diseases, one of the speculations is that racial differences in COVID-19 severity are attributable to AA cancer patients having a higher prevalence of chronic illnesses. Our study aimed to assess the impact of existing chronic diseases on the racial differences in hospitalization and length of hospitalization in COVID-19 cancer patients in Louisiana. Methods. We linked cancer cases diagnosed in 2015-2019 from the Louisiana Tumor Registry (LTR) with the statewide COVID-19 data to identify COVID-19 patients who had been previously diagnosed with cancer. We also identified chronic illnesses (i.e., heart disease, peripheral vascular and cerebrovascular diseases, pulmonary disease, renal disease, liver disease, diabetes, and others) from 2012-2020 hospital discharge data and LTR data. Age and census tract level poverty were at the time of COVID-19 diagnosis. Bivariate and multivariable logistic regressions were used to exam the association of race with hospitalization after adjusting for socio-demographic and chronic illnesses. The multivariable Poisson model was used to assess the racial disparity in length (in days) of hospitalization. Results. Of 6,518 COVID-19 cancer patients, there were 30.8% AA, 68.4% whites, and 0.8% other races. AA, male, older, residing in high poverty, and patients with chronic illnesses were more likely (P&amp;lt;0.05) to be hospitalized. The odds of hospitalization was 87.2% higher among AA patients than white patients in bivariate analysis. After adjusting for age, gender, poverty, obesity, smoking status, and chronic illnesses, the odds of hospitalization was still higher for AA than white patients (OR=1.81;95% CI: 1.55-2.09). The length of hospital stay for AA was more (P&amp;lt;0.05) than whites After adjusting for the same covariates. Conclusion. Sociodemographic factors and chronic illnesses are associated with the severity of COVID-19 among cancer patients. However, AA COVID-19 cancer patients have significantly higher odds of hospitalization and longer hospital stays even when controlling these factors. More research is warranted to determine underlying factors of the observed racial disparities. Citation Format: Xiao-Cheng Wu, Yong Yi, Lauren S. Maniscalco, Mei-Chin Hsieh, DeAnn Gruber, Lee Mendoza, Theresa Sokol, Eileen T. Mederos, Augusto Ochoa. Racial disparity in COVID-19 severity after adjusting for chronic illnesses and sociodemographic factors [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 3587.

Racial/ethnic disparities of cancer treatment disruptions among patients with breast cancer with SARS-CoV-2 infection: An analysis of the ASCO Survey on COVID-19 in Oncology Registry.

6556 Background: The COVID-19 pandemic has led to disruptions in cancer treatment delivery among breast cancer patients in the U.S. However, it is currently unknown whether racial/ethnic disparities exist in cancer treatment disruptions among patients with breast cancer and SARS-CoV-2 infection. Methods: We obtained data from the ASCO Survey on COVID-19 in Oncology Registry (March 2020-July 2021) describing breast cancer patients diagnosed with SARS-CoV-2 during their care treated at 46 practices across the US. Data included patient demographics, SARS-CoV-2 diagnosis and treatment, breast cancer characteristics, and modifications to cancer treatment plans. Breast cancer treatment delay or discontinuation (TDD) was defined as any treatment postponed more than two weeks from the originally scheduled date. We computed adjusted odds ratios (aOR) using multivariable logistic regression, accounting for non-independence of patients within hospitals to evaluate racial/ethnic disparities of TDD. Multivariable models were adjusted for age, sex, number of comorbidities, cancer extent, ECOG performance score, pandemic period based on case peaks ( &lt; 06/2020, 06-12/2020, 01-07/2021), and COVID-19 severity (death/hospitalization/ICU admission/mechanical ventilation). Results: Breast cancer patients (n = 804) with SARS-CoV-2 were mostly aged 50 years and above (75%) and urban residents (83%). The racial/ethnic makeup of the sample included: 13.3% non-Hispanic Black/African American (NH-Black), 11.7% Hispanic/Latinx, 4.9% American Indian/Alaskan Native (NH-AI/AN), 4.6% NH-Asian, and 65% NH-White. At SARS-CoV-2 diagnosis, 736 patients (91%) were scheduled to receive drug-based therapy (78%), radiation therapy (8%), or surgery (6%), of whom 39% experienced TDD. Across treatment modalities, the most commonly reported TDD reason from the clinic perspective was the patient’s COVID-19 disease (̃90%). Overall, NH-Black (62%), Hispanic/Latinx (44%), and NH-Asian (42%) adults with breast cancer and SARS-CoV-2 were more likely to experience TDD versus NH-White adults (34%) (p &lt; 0.001). In multivariable analyses, NH-Black cancer patients were more likely to experience TDD compared to NH-White patients (aOR: 3.12, 95% CI: 1.96-5.47). The data suggest Hispanic/Latinx (aOR: 1.34, 95% CI: 0.78-2.30) breast cancer patients may also experience TDD, although not statistically significant. No association was observed among NH-Asian (aOR: 1.16, 95% CI: 0.50-2.73) or NH-AI/AN (aOR: 0.64, 95% CI: 0.28-1.52) breast cancer patients with TDD. Conclusions: Black or African American breast cancer patients are more likely to experience cancer care disruptions during the pandemic. Future research should evaluate the long-term impacts of care disruptions on breast cancer outcomes among minoritized US communities.

Abstract P4-11-23: Project SOAR: The strong black woman schema in the breast cancer context

Abstract Breast cancer is a crucial problem for African American women, with marked disparities in five-year survival relative to non-Latina white women. Research also suggests that Black breast cancer survivors are disadvantaged in specific quality of life (QOL) domains (relative to non-Latina white women), persisting through two years or more. Although spiritual QOL appears more robust for Black women relative to white women, disparities include lower physical QOL, as well as more pronounced depressive symptoms, perceived stress, fear of dying, unmet supportive care needs, and financial distress, with younger Black women (&amp;lt; 50 years) particularly at risk. Additionally, African American breast cancer survivors report receiving a lack of information from their physicians during diagnosis, treatment, and follow-up care. Factors such as socioeconomic and medical characteristics only partially explain the QOL disparities. The goal of Project SOAR (Speaking Our African American Realities), a community-academic partnership, is to explore the potential relevance and influence of the Strong Black Woman schema (i.e., historically grounded expectations to prioritize caregiving over self-care, suppress emotions, present an image of strength, decline support, and strive to achieve success without adequate resources) in the breast cancer context. Three Gatherings (i.e., focus groups) were held in intimate settings (e.g., private homes) and provided an entirely Black women’s space to discuss the breast cancer experience. All participants (N = 37; age = 30-94 years) had heard of the concept of the Strong Black Woman, and the majority reported identifying with the scholarly definition of the Strong Black Woman, citing both negative and positive aspects of the schema in their breast cancer experience. Perceived negative consequences included differential treatment in the oncology setting, including a lack of empathy and expectations of Black breast cancer patients’ strength on the part of the oncologic team. Positive facets included a deep spiritual connection, a sense of resilience, and self-advocacy. Additionally, participants reported primarily approach-oriented attempts to cope with their experience (e.g., attempting self-advocacy in the oncologic setting), while also citing struggles in such coping efforts, such as feeling unheard in the medical system and a lack of belonging in the broader breast cancer community. Implications of the findings for the oncologic treatment team and enhancing the experience of Black women as breast cancer survivors will be addressed. Citation Format: Tammie Denyse, Kimberly J Martin, Yrvane K Pageot, K Denise deLuz, Jacqueline HJ Kim, Praise Owoyemi, Annette L Stanton. Project SOAR: The strong black woman schema in the breast cancer context [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-23.