Community Cancer Centers Research Articles

Digitizing community resources and closed-loop referral system to identify top sought health-related social needs (HRSN) in a community cancer center.

154 Background: Prior to implementation of a digital closed-loop referral system, community resources were not centralized, and knowledge of resources varied between clinic staff within a community cancer center treating patients throughout the Willamette Valley of Oregon. Referrals to community-based organizations (CBO) were found in the electronic health record as unstructured data and were difficult to track manually. As an organization, the medical care team needed to identify top sought HRSNs to better understand health equity needs in our community. Methods: 2023 Q1: Partnered with Findhelp, a social needs closed-loop referral platform. 2023 Q2-4: Attended Findhelp train-the-trainer education and began building a customized oncology database of local, regional, and national resources. Developed a process to log community-based referrals, update the referral status, and close the referral loop within Findhelp for individual patients. Educated and trained support services staff. 2024 Q1: Utilized Findhelp data analytics to review and evaluate closed-loop referral system and top sought HRSNs. Results: We describe our results to date (Table). Conclusions: Digitizing community resources and establishing a closed-loop referral process between the community cancer center and CBOs allowed accurate data tracking and increased access to data to ensure patients’ needs were met. After eight months, financial toxicity, housing insecurity, and food insecurity were identified as the top three sought HRSNs. In the future, increased data will help evaluate gaps in resources and leverage stronger relationships with CBOs to meet patients’ HRSNs in a community cancer center. Month % Closing the Referral Loop (patients with closed-loop referrals/total patient referrals) Top Sought HRSN Needs July 2023 74% (50/68) Help pay for healthcare August 2023 68% (51/75) Help pay for healthcare September 2023 80% (59/74) Housing October 2023 67% (66/98) Help pay for healthcare November 2023 78% (51/65) Food December 2023 86% (55/64) Support/Counseling January 2024 83% (52/63) Help pay for healthcare February 2024 65% (56/86) Food

Early palliative care involvement in gastrointestinal malignancies: A community cancer center perspective.

198 Background: Early involvement of palliative care (PC) specialists enhances quality of life for patients with advanced gastrointestinal (GI) cancer. Methods: This retrospective study evaluated patients with newly diagnosed stage III and IV GI cancer seen at a large community cancer center between 10/1/22 and 9/30/23. We compared patients seen by a PC provider in clinic at least once to those without an outpatient PC visit within the one-year study period. Results: 283 patients with stage III/IV colorectal (42%), gastroesophageal (23%), pancreatic (16%), hepatobiliary (12%), and other GI cancers (8%) received care within the study period (Table). Of these, 49 (17%) had at least one PC clinic visit, and 234 (83%) had no PC visits. Patients with pancreatic (35% vs 12%) and hepatobiliary cancer (20% vs 10%) were over-represented in the group receiving PC vs those without PC, while patients with colorectal cancer were under-represented (20% vs 47%). Greater percentages of patients in the group receiving PC completed advanced care planning (ACP) documents (63% vs 24%) and died during the study period (65% vs 15%). Conclusions: A minority of patients with GI malignancies at a large community cancer center are seen by an outpatient PC provider during the first year after diagnosis. These patients are more likely to have tumor types associated with worse prognosis, to complete ACPs, and to die within one year. Broader delivery of early PC will require expanded services in community cancer centers and continued development of tools for identifying patients most likely to benefit. The distribution of gastrointestinal cancer between outpatient palliative care visit and no outpatient palliative care visit. Primary cancer PC No PC Total Colorectal 10 (20% | 8%) 110 (47% | 92%) 120 (42% | 100%) Gastroesophageal 10 (20% | 16%) 54 (23% | 84%) 64 (23% | 100%) Pancreatic 17 (35% | 39%) 27 (12% | 61%) 44 (16% | 100%) Hepatobiliary 10 (20% | 30%) 23 (10% | 70%) 33 (12% | 100%) Other GI 2 (4% | 9%) 20 (9% | 91%) 22 (8% | 100%) Total 49 (100% | 17%) 234 (100% | 83%) 283 (100% | 100%) PC: Palliative care.

Magnetic lymphatic tracing for omission of sentinel lymph node biopsies in mastectomy patients: a community cancer center experience.

Patients with ductal carcinoma in situ (DCIS) and patients undergoing risk reduction mastectomy may undergo sentinel lymph node biopsy (SLNB) at the time of mastectomy to complete axillary staging were an underlying invasive malignancy to be found on final pathology. Among patients with DCIS undergoing mastectomy, 15-29% of patients will have invasive disease on final pathology; therefore, approximately 70-85% of patients may benefit from avoiding SLNB. Superparamagnetic tracers (SPMT) have been proven to be non-inferior to the standard radioisotope and blue dye combination. SPMT remains active for several weeks, allowing a large proportion of DCIS and genetic carrier patients to potentially avoid SLNB in the setting of mastectomy. We hypothesize the use of SPMT will reduce the number of SLNB performed in patients undergoing mastectomy for DCIS and risk reduction, ultimately reducing the number of complications associated with axillary surgery. We seek to report our community cancer center's experience with SPMT and omission of SLNB in the DCIS and prophylactic mastectomy patient population. We performed a retrospective review of 52 female patients with DCIS or known genetic predisposition undergoing mastectomy. SPMT (Magtrace®, Endomag Ltd, Cambridge, UK) was injected ipsilateral to DCIS and bilaterally for prophylactic mastectomy patients. Our primary outcome was rate of return to the operating room (OR) for delayed SLNB. Secondary outcomes included post-operative complications within 30days of surgery and operative time. We compared outcomes to a control group of 28 women undergoing mastectomy for DCIS or for risk reduction who underwent SLNB at their index operation in traditional fashion. Continuous variables were reported using median and interquartile ranges (IQR) and were compared using the Mann-Whitney U test. Categorical data were reported using frequency and percent and were compared using Pearson's Chi-Square or Fisher's Exact test, as appropriate. Alpha was set to 0.05 to determine statistical significance. There was a total of 80 patients (52 SPMT, 28 control). Median age of SPMT patients was 49.5 (IQR 40-60.75) vs. 54.5 (48 - 65) in the traditional tracer group. vs. control group. 57.7% of SPMT patients underwent mastectomy for DCIS vs. 89.3% in the control group. Eight SPMT patients (15.4%) had invasive ductal carcinoma (IDC) on final pathology and seven of those patients underwent delayed SLNB (87.5%). None of the delayed SLNB were positive for metastatic disease. Rates of post-operative complications were similar between the two groups, including hematoma, seroma, and surgical site infection. OR times were also similar with median OR time 202min (min) for the SPMT group vs. 195min for the control group. Use of SPMT avoided SLNB in 84.6% of our patients. We found no difference in rates of post-operative complications or operative times in patients using SPMT for omission of SLNB at time of mastectomy compared to the control group. Our findings suggest SLNB can be avoided in a majority of patients undergoing mastectomy for DCIS or risk reduction in the setting of genetic predisposition.

Abstract A160: Navigating underserved populations across the cancer continuum: Establishing cancer support and navigation project

Abstract Background. Cancer disproportionately affects underserved communities, including those who face economic, racial, ethnic, and social barriers. These barriers contribute to delays in diagnosis and treatment, resulting in poorer outcomes. Methods. To address this gap, Cedars Sinai Cancer Center Community Outreach and Engagement (COE) has developed the Cancer Support and Navigation Project to improve cancer-related outcomes for underserved cancer patients by providing navigation that eliminates barriers to timely diagnosis and treatment of cancer. The project focuses on reducing barriers for underrepresented sexual, gender, financial, racial, and ethnic minority community members, who are either at risk of being diagnosed with cancer or those have already been diagnosed with cancer, and their loved ones, by offering tailored science-based cancer information, education, navigation, support resources, access to care and cancer support. Our project is targeting geographic areas and groups within the Los Angeles County (Catchment Area) that experience higher incidence of late-stage diagnosis such Latinx, LGBTQ+, Korean, Filipino, Black and immigrant communities. Our COE team has 3 dedicated navigators who are multi-ethnic, multi-lingual, and representative of populations with intersectional identities to provide direct services to community members. Additionally, our COE team has recruited, trained and engaged over 42 community health workers/promotoras/navigators from the community to disseminate cancer health information and navigate people through the cancer continuum. Results. We have disseminated over 1000 flyers and participated in over 100 tabling events throughout Los Angeles County. Additionally, we have developed partnership with various Federally Qualified Health Clinics, including Adventist Health White Memorial Hospital, Central Neighborhood Christian Health Center, Comprehensive Community Health Centers, Saban Community Clinic, Koryo Health Foundation. To date, COE has navigated n=733, who predominantly identify as Hispanic/Latino/a/e/x, Koreans, and LGBTQ+. Most have identified the following areas for navigation: assistance with medial-related care such as cancer screening, diagnosis, or treatment, financial, language barrier, food security and nutrition, insurance coverage, emotional/relationship, social support/isolation, mental health, behavioral, or stress, transportation, housing, and many others. Conclusion. The project's efforts have highlighted the critical importance of providing targeted navigation services to reduce cancer disparities and improve health outcomes for underserved communities. By addressing the unique needs of these populations and eliminating barriers to care, the Cancer Support and Navigation Project at Cedars Sinai Cancer Center COE has made a substantial and positive impact on the lives of many individuals and their families, paving the way for more equitable cancer care and support. Citation Format: Janeth Zelada, Emma Ngula, Min Jung Sung, Ghecemy Lopez, Reener Balingit, Zul Surani. Navigating underserved populations across the cancer continuum: Establishing cancer support and navigation project [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A160.

Abstract B024: Be your own fan: Who do you get screened for?: A culturally sensitive and community-vetted colorectal cancer awareness campaign tailored for the Filipino community in Los Angeles County

Abstract Background Colorectal cancer is the second most common cancer among Filipina women and third among Filipino men, especially in Los Angeles County with the second largest concentration of Filipinos and immigrants. Recent trends show that Filipino experience late-stage diagnosis and lower survival rates. Despite the large number of Filipinos working in healthcare industry dedicated to caring for others, many Filipinos neglect to prioritize their own health and well-being. In collaboration with the Art Center College of Design, Cedars Sinai Cancer Center Community Outreach and Engagement (COE) developed a colorectal cancer awareness campaign, "Be Your Own Fan: Who do you get screened for?" aiming to evoke emotion and prompt reflection on the importance of health through storytelling, imagery, and tailored health materials (i.e., traditional hand fan, infographics, t-shirts, tote bags, stickers, photocards). Methods To determine relevance of the health campaign, five 1 hour semi-structured focus groups were conducted both in English or Tagalog via Zoom with n=23 adults ages 18 and over who self-identify as Filipino to provide community input on appropriateness of the messaging, colors, symbols, and community engagement approach. Participants were recruited through snowball sampling at in-person community outreach events, and email distribution. Results Participants represented diverse professions such as nursing, home healthcare/caregiving, public health, and accounting. Majority were 69% middle-aged adults, 57% female, and 4% colorectal cancer survivor. Research findings show that Filipinos take pride in their traditional culture, particularly in the use of Philippine flag colors (red, blue, yellow, and white) in health materials as opposed to other hues or tints. Either English or conversational Tagalog were preferred languages since it may be challenging to represent over 100 different languages spoken by Filipinos. Lastly, featuring stories and images of trusted community figures like healthcare professionals, church and community leaders, and family members are effective in pulling the heartstrings of the Filipinos to empower them to be their own fan/advocate. With this feedback, the campaign has been revised and deployed in the community and preliminary findings with n=77 people reached indicate increased awareness on colorectal cancer and intent to get screened. Conclusion. Developing health campaigns that closely reflect the community they serve can lead to increased awareness, participation, and adherence to health recommendations and behaviors. Citation Format: Reener Balingit, Mark Bondoc, Dong Hee Kim1, Zul Surani. Be your own fan: Who do you get screened for?: A culturally sensitive and community-vetted colorectal cancer awareness campaign tailored for the Filipino community in Los Angeles County [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B024.

Abstract C007: Building capacity in health clinics and community organizations serving LGBTQ+ communities on tobacco prevention

Abstract Background. Tobacco use remains a significant public health issue, particularly among the LGBTQ+ community. Los Angeles County, which is home to the second-largest LGBTQ+ population in the US, has notably higher prevalence of tobacco use compared to the general population, partly due to targeted marketing by the tobacco industry, social stressors, and discrimination. These factors contribute to higher rates of smoking and tobacco-related health disparities; however, little is known about the capacity of community-based organizations, clinical providers, support staff, and other personnel that work closely with the LGBTQ+ community to provide smoking cessation services. Methods. Cedars Sinai Cancer Center Community Outreach and Engagement (COE) assisted in the facilitation of conducting a needs assessment, Clinical Provider and Staff Survey, to assess the opinions of clinical providers and community leaders about tobacco cessation-related topics related to 1) Building culturally competent tobacco cessation services; 2) Reducing health disparities in tobacco cessation services; 3) Improving access to care (Medicaid/Medi-Cal access and uptake) for diverse populations that are affected by tobacco-related disparities; 4) Improving the utilization of tobacco cessation services. The survey was administered online from December 2022 to April 2023 with providers throughout Los Angeles County. Results. A total of 261 surveys were collected which revealed several key issues at the organization level: they do not prioritize tobacco screening, treatment, or referrals; there is no standardized process for client management; staff have limited knowledge on tobacco prevention and patient navigation; and there is limited staff capacity and funding. To address organizational-focused barriers, COE trained 147 clinical providers and staff from 4 local health clinics and organizations and on capacity building, including the basics of tobacco, evidence-based interventions like "Ask, Advice, Refer," and lung cancer screening. Additionally, to address Client/Patient-Focused Barriers for Organizations, such as: lack of motivation to quit, low perception of the severity of smoking, and a lack of culturally competent or targeted cessation resources, COE staff assisted in navigating resources, ensuring both providers and clients were aware of and could access relevant support services. This involved sharing LGBTQ+ affirming resources, including medical care, behavioral health, and housing, and referred smokers to gender-affirming cessation support groups. Conclusion. The survey highlighted the need to enhance service delivery and support for the LGBTQ+ community. With these findings, our COE staff were able to increase organizational capacity through training and education for clinical providers and staff to enhance their knowledge and skills in tobacco cessation and share gender-affirming resources and navigation, which are crucial towards improving the overall effectiveness of tobacco cessation services for LGBTQ+ populations. Citation Format: Victor Cristanto, Alexandra Caro, Reener Balingit, Zul Surani. Building capacity in health clinics and community organizations serving LGBTQ+ communities on tobacco prevention [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C007.

Abstract C006: Understanding barriers to low HPV vaccination in the LGBTQ+ community in Los Angeles: Collecting neighborhood-level data at pride events

Abstract Background The uptake of the Human Papillomavirus vaccine and anal cancer screening remain low among LGBTQ+ communities, especially in Los Angeles County. The LA metropolitan area has the nation’s second largest LGBTQA+ community, with an estimated 523,000 persons representing intersectional identities including the racial and ethnic diversity within lesbian, gay, bisexual, transgender, non-binary and questioning. Significant barriers to vaccination and screening exist, including inadequate knowledge, reluctance to disclose personal information, fear of a cancer diagnosis, and conflicting messages. Methods Cedars Sinai Cancer Center Community Outreach and Engagement (COE) created the Transgender Research Advisory Committee (T-RAC), a subcommittee of our Community Advisory Board, and facilitated bi-directional engagement with the research team to ensure that voices of the community were included in each phase of designing an intervention to increase HPV vaccination. T-RAC has n=8 members representing LGBTQ+ patients, advocates, and community navigators and their roles include: (1) weigh in on all materials development for community audiences, recruitment and research implementation strategies; (2) review the progress of study; (3) provide guidance on developments in the community; (4) contribute to interpretation of study findings; and (5) participate in dissemination of study findings. Results With T-RAC’s advice, a needs assessment survey was developed, and data was collected at Long Beach Pride on May 2024 with N=205 survey respondents. While 82% have heard about HPV, only 48% were vaccinated with at least one dose and only 12% completed all three doses. Among those who have not completed the HPV vaccine series (n=177), 33% are in interested in getting the vaccine, 55% prefer a mobile health clinic, and 70% would be vaccinated at Pride events. Qualitative responses indicated the following barriers to getting screened: “not ready”, “need more information”, “prefer a health provider”, and “unsure about side effects”. For those interested, a mobile health clinic was available during Pride event and N=16 people were vaccinated. Conclusion More outreach, education and engagement are needed to address barriers and low uptake of the HPV vaccine among LGBTQ+. Further, this initiative has led to the application for Research Program Project Grants (P01) and plans to launch a health education initiative, EndHPV, along with continuing to make mobile health clinics available at Pride events throughout Los Angeles County. The role of T-RAC has been instrumental in catalyzing gender-affirming interventions that directly address the unique needs and challenges faced by the LGBTQ+ community and promote equitable access to services for all. Citation Format: Alex Caro, Victor Cristanto, Richard Zaldivar, Marc Goodman, Reener Balingit, Zul Surani. Understanding barriers to low HPV vaccination in the LGBTQ+ community in Los Angeles: Collecting neighborhood-level data at pride events [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C006.

Implementation and Evaluation of APOTECAchemo in a Community Cancer Center: A Comparative Study of Robotic Versus Manual Antineoplastic Preparation

Background: The ever-increasing complexity and demand for antineoplastic therapy necessitates innovative solutions to improve the accuracy and safety of drug preparation. Objective: To evaluate the utilization of an advanced robotic chemotherapy drug compounding system (APOTECAchemo) at a Community Cancer Center (CCC), examining accuracy, efficiency, and staff perceptions. Methods: This single-center, retrospective study evaluated the preparation of 7 intravenous (IV) antineoplastics at a CCC over a 1-year period. We compared manual methods with the APOTECAchemo system. The primary measure of accuracy was the absolute drug error percentage, with a comparison of pass and fail rates. Secondary endpoints included the overall use of APOTECAchemo for all IV antineoplastic preparations and average preparation times. An end-user satisfaction survey gathered feedback from pharmacists and pharmacy technicians. Results: A total of 8210 doses were prepared at the CCC, with 52.1% compounded by APOTECAchemo and 47.9% manually. Of these, the CCC prepared 5526 doses of the 7 routinely compounded antineoplastics. APOTECAchemo prepared 3851 (69.7%) doses, while manual compounding accounted for 1675 (30.3%) doses. The average absolute drug error was 1.44% (95% CI, 1.35-1.53) with robot compounding versus 1.17% (95% CI, 1.03-1.32) with manual ( P < 0.001). The overall failure rate was 0.72%. There were 25 failed doses (0.45%), with 8 (0.2%) failures attributed to APOTECAchemo and 17 (1%) to manual compounding ( P < 0.001). The average dose preparation time was longer with APOTECAchemo compared with manual methods. The end-user satisfaction survey indicated a positive reception toward APOTECAchemo. Conclusions: Our study demonstrates the successful implementation, extensive utilization, and high accuracy of both APOTECAchemo and manual compounding methods in the preparation of routinely administered antineoplastics at a CCC.

Lower survival for surgical treatment of human papillomavirus–related oropharynx cancer at community cancer centers

Abstract Background The rate of primary surgery for human papillomavirus (HPV)–related oropharynx cancer has recently declined, whereas use of transoral robotic surgery has lagged at community cancer centers. We hypothesize that differences in overall survival exist between patients undergoing surgery for HPV-related oropharynx cancer at community centers and low transoral robotic surgery volume (<15 transoral robotic surgeries per year) academic centers and high transoral robotic surgery volume (≥15 transoral robotic surgeries per year) academic centers. Methods Patients from the US National Cancer Database with a diagnosis of HPV-related oropharynx cancer from 2010 to 2019 who underwent primary surgical treatment were included. Trends in transoral robotic surgery use, rates of positive surgical margins, quality of adjuvant treatment, and 5-year overall survival were compared between community centers, low transoral robotic surgery volume academic centers, and high transoral robotic surgery volume academic centers. Results A total of 5406 patients met study criteria. A clinically and statistically significantly lower proportion of patients at community centers underwent transoral robotic surgery than at low transoral robotic surgery volume academic centers or high transoral robotic surgery volume academic centers (26.2% vs 44.0% vs 73.9%, respectively; P < .001). The rate of positive surgical margins was clinically and statistically significantly higher at community centers than at low transoral robotic surgery volume academic centers or high transoral robotic surgery volume academic centers (25.7% vs 15.3% vs 9.2%, respectively; P < .001). A greater proportion of patients undergoing adjuvant radiotherapy (RT) received prolonged courses (23.6% vs 13.1% vs 8.8%; P < .001) or excessive doses (16.5% vs 11.5% vs 8.7%; P < .001) of RT at community centers than at low transoral robotic surgery volume academic centers or high transoral robotic surgery volume academic centers, respectively. Five-year overall survival was lowest at community centers (85.2%, 95% confidence interval [CI] = 81.7% to 88.2%), intermediate at low transoral robotic surgery volume academic centers (88.9%, 95% CI = 87.2% to 90.4%), and highest at high transoral robotic surgery volume academic centers (91.4%, 95% CI = 89.5% to 92.9%; Plog-rank < .01). Conclusions Clinically and statistically significant differences in the type and quality of surgical and adjuvant treatment for HPV-related oropharynx cancer exist between facility types based on transoral robotic surgery volume. Overall survival was lowest at community centers, intermediate at low transoral robotic surgery volume academic centers, and highest at high transoral robotic surgery volume academic centers.

Comparison of surgical margins and adjuvant therapy for head and neck cancer by hospital type.

Differences in patient populations and outcomes by hospital type are becoming increasingly relevant as health care systems shift to value-based care models. There is a paucity of literature on patient-level and hospital-level differences for patients with head and neck squamous cell carcinoma (HNSCC). The objective of this study was to examine differences in patient characteristics, surgical margins, and adjuvant therapy patterns for surgically treated HNSCC across different hospital types. A statewide retrospective cohort study was conducted to examine differences in surgically treated patients with HNSCC by hospital type. A total of 579 surgically treated HNSCC patients with a mean age of 58.5 [standard deviation (SD) 10.7] years were included. There were 152 patients (26%) treated at academic hospitals, 205 (35%) at community cancer centers, and 222 (38%) at community hospitals. Patients at academic hospitals were more likely to travel farther for surgery (mean distance 43.6 miles for academic centers vs. 12.7 miles for community cancer centers vs. 12.6 miles for community hospitals; P<0.001) and have advanced T stage (T3-T4) at diagnosis (38% academic, 26% community cancer center, 26% community hospital; P=0.003). There was no significant difference in the positive surgical margin rate by hospital type (32.0% for academic hospitals, 32.1% for community cancer centers, and 35.0% for community hospitals; P=0.79). However, patients at academic hospitals were more likely to receive adjuvant chemoradiation even after adjusting for tumor stage and site [odds ratio (OR) 2.4, 95% confidence interval (CI): 1.2-5.0]. There are important patient-level and hospital-level differences for head and neck cancer management in academic versus community hospitals.

Screening log: Challenges in community patient recruitment for gynecologic oncology clinical trials

BackgroundClinical trial participation can improve overall survival and mitigate healthcare disparities for gynecologic cancer patients in low-volume community centers. This study aimed to assess the effectiveness of a centrally regulated but administratively decentralized electronic screening log system to identify eligible patients across a large catchment area for a National Cancer Institute (NCI)-designated cancer center's open clinical trials. MethodsElectronic screening log data collected between 2014 and 2021 from ten community partner sites in a single NCI-designated cancer center's catchment area were reviewed retrospectively. Clinical factors assessed included cancer site, primary versus recurrent disease status, and histology. Identification efficiency (the ratio of patients screened identified with an available trial) was calculated. Identification inefficiencies (failures to identify patients with a potentially relevant trial) were assessed, and etiologies were characterized. ResultsAcross ten community partner sites, 492 gynecologic cancer patients were screened for seven open clinical trials during the study period. This included 170 (34.5 %) ovarian cancer patients, 156 (31.7 %) endometrial cancer patients, and 119 (24.2 %) cervical cancer patients. Over 40 % had advanced stage disease, and 10.6 % had recurrent disease. Only three patients were identified as having a relevant open trial; none ultimately enrolled due to not meeting trial eligibility criteria. An additional 2–52 patients were retrospectively found to have a relevant trial available despite not being identified as such within the electronic screening log system. Up to 14.4 % of patients had one or more missing minimum data elements that hindered full evaluation of clinical trial availability. Re-screening patients when new trials open may identify 12-15 additional patients per recurrent disease trial. ConclusionsAn electronic screening log system can increase awareness of gynecologic oncology clinical trials at a NCI-designated cancer center's community partner sites. However, it is inadequate as a single intervention to increase clinical trial enrollment. Providing adequate support staff, documenting clinical factors consistently, re-screening patients at relevant intervals, and coordinating with central study personnel may increase its utility.

Sjogren's syndrome due to immune checkpoint inhibitors (ICIs): Insights from a single-institution series and systematic review of the literature.

Careful adverse event assessment and management are important when prescribing immune checkpoint inhibitors (ICIs) to cancer patients. Iatrogenic Sjogren's syndrome is a relatively rare immune-related adverse event (irAEs) that affects the moisture-producing glands. We describe a series of four patients who developed Sjogren's syndrome while being treated with ICIs at a community cancer center in Southern California, USA (1/1/2017-12/31/2023). Patient, drug and disease-related data were collected by retrospective chart review. A systematic search of the PubMed database was performed to identify similar cases in the literature (1/1/2016-12/31//2023). Of 224 cancer patients at our center treated with ICIs, four (1.8%) developed iatrogenic Sjogren's syndrome. All of our patients were male; three received PD-1 inhibitors (nivolumab, pembrolizumab) and one received the PD-L1 inhibitor atezolizumab. The median time to development of Sjogren's syndrome was 24 weeks (range, 8-36 weeks); dry mouth symptoms were more prominent than dry eye symptoms. None of the patients had elevated SS-A, SS-B or antinuclear antibodies. One patient developed multiple tooth cavities and had several extractions, due to severe xerostomia. Management of all patients was primarily symptomatic. Two cases were irreversible; one was reversible and the 4th case is undermined as he is still on ICI therapy. Our systematic review of the literature identified 80 cases in five articles. Incidence of xerostomia was twice of that of xerophthalmia. The male/female ratio was 1.5:1. SS-A, SS-B, or antinuclear antibodies were found in only 9% of patients. Steroids were reported to have had only a limited role in management. The incidence of Sjogren's syndrome due to ICIs in our center was 1.8%. Details of clinical course and management in these patients are presented. Caring for patients with ICI-related Sjogren's syndrome is facilitated by a multidisciplinary effort including oncologists, otolaryngologists, dentists, ophthalmologists and rheumatologists. Expanding the knowledge base pertaining to iatrogenic Sjogren's syndrome in patients on ICIs will be helpful in promoting early detection and treatment, and improving outcomes.

The effect of healthy eating on the development of stomach and colorectal cancer by the smoking and drinking status: Results from the Korean National Cancer Center (KNCC) community cohort study.

Determining the effect of dietary factors on cancer is a crucial issue when accounting for the effect of other major risks, such as smoking and drinking. A total of 15,563 adults from the Korean National Cancer Center Community Cohort were analyzed to determine and to compare the effect of dietary factors on stomach and colorectal cancer in overall and in the subgroup of non-smokers (or urinary cotinine concentrations <5 ng/mg) and non-drinkers with Cox proportional-hazard models. During the mean follow-up (13.7 years), 469 and 299 cases of stomach and colorectal cancer were identified, respectively. The preventive effect of vegetable, fish, and soybean/tofu intake on colorectal cancer was found in women after adjustment for smoking, drinking, BMI, and sociodemographic factors. In the subgroup analysis of non-smokers and non-drinkers, the effect on colorectal cancer was increased in women (≥1 time/week vs. almost never, vegetables: hazard ratio (HR) 0.30, 95% confidence interval (CI) 0.13-0.69; fish: HR 0.46, 95% CI 0.26-0.83), and the fresh fish intake effect on stomach cancer was newly identified in men (HR 0.36, 95% CI 0.15-0.86). These effects were more pronounced and additionally shown in other dietary factors such as soybean or tofu in women and vegetables and fish in men, when subjects with <5 ng/mg urinary cotinine concentrations applied. The protective effect of healthy eating on the risk of stomach and colorectal cancer were different by smoking and drinking status. Rigorous control of smoking and drinking effects is necessary when measuring the effect of dietary factors on cancer, properly.

The state of cancer-focused community outreach and engagement (COE): reflections of Black COE directors.

The requirement of community outreach and engagement (COE) as a major component of the National Cancer Institute (NCI) Cancer Center Support Grant has had an enormous impact on the way NCI-designated cancer centers identify, investigate, and address the needs of their catchment area (CA) communities. Given the wide-ranging diversity of our nation, COE's scope of work (SOW) is extremely demanding and complex. Yet, COE is often marginalized and viewed as void of scientific methods when, in fact, it requires specialized scientific knowledge and a broad range of proficiencies. Black COE scientific directors may be particularly attuned to this marginalization as they have often confronted workplace inequities that resemble the health inequities observed within their cancer center's CA. Thus, Black COE leaders are uniquely positioned to offer insight on the past, present, and future of COE. Key areas discussed include the low involvement of minoritized group members and those with appropriate expertise in national COE leadership; the lack of established, consistent criteria for evaluation of COE components and qualifications of evaluators; the need for substantial financial investment in COE; potential misalignment of community priorities and cancer center objectives; professional development and growth of COE staff and leaders; the expanding scope of COE across their respective cancer centers and CAs; and the need for center-wide involvement in COE and an "all-hands-on-deck" approach. These areas warrant thoughtful dialogue as COE evolves, for the benefit and success of all COE leaders. However, this dialogue must include diverse voices representing similarly diverse stakeholders at every level.

Socioeconomic disparities in survival outcomes of patients with NSCLC with brain metastases: A real-world analysis.

8569 Background: Racial and ethnic disparities have been previously reported in outcomes of metastatic cancer patients. While novel therapies have improved outcomes of NSCLC patients with brain metastases (BM), however, barriers to therapy persist, warranting updated evaluations of socioeconomic disparities in clinical outcomes. Methods: A retrospective cohort study was conducted on patients diagnosed with NSCLC BM in 2018-2020 in the National Cancer Database. Patients were classified as White, Black, American Indian, Aleutian or Pacific Islander (AAPI), or Asian. Sociodemographic and clinical outcomes were analyzed and reported using median overall survival (mOS) (95% CI). Multivariate analyses were performed using Cox proportional hazard models adjusting for sex, race, facility type, and income and reported using hazard ratios for death (HR) (95% CI). Results: 13850 patients with NSCLC BM were included: 81% (N=11123) were White, 14% (N=1914) Black, 0.5% (N=73) AAPI, 3.7% (N=508) Asian. 8% were treated in community cancer centers (CCC) and 39% in comprehensive CCCs (CCCC). 55% were Medicare-insured and 30% had annual income &gt;$74063. Compared to White, Asian patients had significantly better mOS of 29.1 months (24.57-36.5). Compared to non-Hispanic, Hispanic patients had significantly better mOS at 18.1 months (14.5-24.3). Medicaid and Medicare-insured had significantly worse outcomes vs. private-insured patients – mOS of 14.62 months (12.75-16.49) and 8.84 months (8.41-9.36) vs. 21.72 months (20.37-23.29). In multivariate analyses, compared to White, Asians had an HR of 0.61 (0.53-0.70). Hispanic had a HR of 0.77 (0.67-0.88) compared to non-Hispanic patients (P&lt;0.05). Compared to academic centers, patients treated at CCC (HR 1.42 (1.29-1.57)) and CCCC (HR 1.25 (1.19, 1.32)) had worse outcomes. Patients with higher annual income (&gt;$74063) had better outcomes compared to those with low income (&lt;$46277) (HR 0.83 (0.78-0.89), P&lt;0.002). Conclusions: Asian and Hispanic patients with NSCLC BM had better 3-year survival compared to White and non-Hispanic patients, respectively. Patients at community centers had worse outcomes than those at academic centers. Medicare-insured and Medicaid-insured patients had unfavorable outcomes. Targeted efforts are warranted to improve disparities in outcomes across racial and ethnic groups. [Table: see text]

Characterization of social determinants of health in patients considered for participation in treatment clinical trials at a community cancer center serving the Great Plains.

e13704 Background: Avera Cancer Institute, a community-based cancer network comprised of six rural cancer centers in SD and MN, provides care to a five-state region in the upper mid-west covering 72,000 square miles and offers several clinical trials to patients to offer access to advanced treatment for malignancies. Malignances are known to disproportionally affect patients that are older, rural, minorities, and have lower socioeconomic status, which are all less likely to enroll into clinical trials. Methods: Patients evaluated for participation in clinical trials from 2018-2022 were identified in an institutional database. Trial type was designated as either a treatment or nontreatment trial. Status of trial involvement was designated between enrolled or screened. Their demographic information was obtained from the electronic health record (EHR). Demographic information obtained from the EHR includes race, ethnicity, language spoken, gender, employment status, insurance type, and if they live in an urban or rural area as defined by the US Census Bureau. Clinical trial portfolio during this time includes trials for breast, gynecological, gastrointestinal, lung, and hematologic malignancies. Results: 4,397 patients were considered for participation in a clinical trial at our institution in the studied timeframe. Of these patients, 1887 were screened for treatment trials and of that group, 773 were enrolled. 35% of participants considered for clinical trials were from urban areas while 65% considered were rural. 48% of the urban population ultimately were enrolled on a clinical trial while 44% of rural population participated. Participants who lived in an urban area 25-50 miles from our study site had an enrollment rate of 49% compared to rural enrollment of 33%, from 50-100 miles rates of 53% and 37%, from 100-250 miles rates of 29% and 41%, and from greater than 250 miles rates of 44% and 33%, respectively. 99.5% of the population was non-Hispanic, 97% were White, and 99% were English speaking. 74% of the total population were female and 26% were male. Females had an enrollment rate of 51% while males had an enrollment of 29%. Patients with no insurance enrolled in trial 62% compared to 36% of those with commercial insurance The average national Area Deprivation Index percentile for screened patients was 57 vs 59 for enrolled patients. Conclusions: This retrospective study demonstrates a greater likelihood for females, urban patients, and white, English-speaking patients to enroll into clinical trials. Our data also demonstrate a preference for uninsured patients to enroll into clinical trials, possibly due to the financial benefits they may provide. Further directions include comparing our patients considered for clinical trials to all patients treated at our institution to identify potential disparities in care.

Clinical trial participation and end-of-life care among older adults: A multi-center longitudinal observational cohort analysis of 121,717 patients with cancer.

11181 Background: Patients’ access to clinical trials remains significantly disparate across the US &amp; world. Complex drivers, some rooted in evidence while others in perceptions, impact shared decision making about trial participation esp in older adults (65y+). To that end, we investigated clinical trial participation (CTP) and unplanned healthcare utilization &amp; hospice use in patients w cancer. Methods: We queried the prospective longitudinal observational cohort of all patients with cancer receiving care at any of the 323 practice locations of 14 multi-site community cancer centers across 11 US states, all within the US Oncology Network and participating in the Oncology Care Model (OCM), an alternative payment model pilot from CMS to promote quality cancer care while reducing costs. We extracted data from OCM episode claims, medical records from 7/1/17-6/30/22 and used propensity score matching by time period, age, gender, date of death, cancer type to identify matched episodes for further stratification by CTP, to compare hospice care &amp; unplanned ER utilization by non-trial usual care vs CTP. Results: Overall, 121,717 pts received cancer care across 282,604 OCM care episodes in the community during this 5-yr period. Most (94%) were older adults aged 65y+ with breast, lung, multiple myeloma being the most common cancers. Of 121,717 pts, 4800 (3.9%) participated in a cancer treatment clinical trial in at least one care episode. Analysis of the 13,260 propensity score-matched episodes (6630 usual care vs 6630 CTP) shows: 1. ER/Observation visits: Patients on clinical trials did nothave any more ER/Obs visits vs usual care (ER/Obs episodes: CTP 23.4%, usual care 22.3%, p0.11). 2. Hospitalizations: The proportion of care episodes with hospitalization was higher in CTP vs usual care (25.9% vs 21.9%, p&lt;0.001). 3. Hospice enrollment: Patients on clinical trials were no less likely to enroll in hospice &gt;3 days prior to death, compared to non-trial usual care cohort (CTP 56.8%, usual care 52.6%, OR 1.18, p 0.13). Furthermore, median duration of hospice in patients on trials was not different from usual care (CTP 8 days, usual care 9 days, p 0.16). Conclusions: Our findings show that while more hospitalizations were observed, clinical trials participation is not associated with suboptimal end of life care outcomes pertaining to hospice enrollment &amp; duration as well as unplanned ER/healthcare utilization. Further efforts to integrate access to clinical trials and evidence-based supportive/palliative care in a scalable sustainable model of goal-concordant, patient-center cancer care are ongoing. CMMI Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

Fetal adenocarcinoma: An NCDB analysis of socioeconomic and demographic factors.

e20076 Background: Fetal adenocarcinoma (FA) is a rare subtype of lung neoplasia whose structure is similar to a developing fetal lung. Chest x-ray is valuable for diagnosis as 25 - 40% of patients with FA are asymptomatic. FA is classified into low-grade and high-grade, predominantly occurring in children and older males with a smoking history. The rarity of FA suggests that evaluating its diagnostic patterns could expand awareness of its epidemiology. Impactful demographic factors of FA were established through analysis of the National Cancer Database (NCDB). Methods: The 2004 - 2020 National Cancer Database (NCDB) was utilized to perform a retrospective analysis of all 120 patients with a histologically confirmed diagnosis of FA (ICD-O-3 Code 8333). Descriptive statistics were employed to examine demographic factors, including sex, age, race, Hispanic ethnicity, urban/rural residence, Charlson-Deyo comorbidity score (CDCS), and treatment facility type. Additionally, regression analysis was utilized to demonstrate incidence trends. Exclusion criteria included missing values. Results: The NCDB identified 120 patients from 2004 - 2020. Over this time period, there was a slightly increasing incidence of patients diagnosed per year (R2 = 0.4461). Represented age at diagnosis featured negative skewness (-0.8), and the mean age was 54.4 years (95% CI = 51.2 - 57.6, SD = 17.6). Most patients were female (57%), White (76%), and non-Hispanic (95%). The vast majority of patients (85%) resided in metropolitan areas, with a slight majority of patients (53%) hailing from areas of 1 million population or more. Regions of the United States were well-represented, with a plurality of patients from the South Atlantic (21%). Most patients were diagnosed at Stage I (56%) and had a CDCS of 0 (61%). The primary tumor site was the upper lung lobes, and most (83%) patients underwent surgery as primary treatment. Multiple facility types were utilized in the care of patients, including research programs (42%), comprehensive community cancer center programs (30%), and integrated network cancer programs (25%). The 30-day mortality rate was 1%, comparable to the 90-day mortality rate of 3%. Five years after diagnosis, 60% of patients were alive. Conclusions: To the best of our knowledge, this is the first NCDB analysis to examine the sociodemographic factors concerning prognosis in patients with FA. Our results are consistent with previous studies finding that patients with low-stage FA tend to have favorable outcomes. Our study is the first documentation of location demographics of patients with FA: Most patients live in metropolitan counties along the Atlantic Coast. Future investigations on the prognostic significance of demographic and socioeconomic factors should be performed to optimize treatment approaches for improved mortality rates of diverse patients with FA.

Epidemiology and clinical management of primary penile melanoma: A review of the National Cancer Database.

e21570 Background: Primary penile melanoma (PPM) is an exceedingly rare variant of skin cancer, estimated to account for less than 0.18% of all melanomas. As the incidence of melanoma is projected to increase, it is crucial to further understand subtypes of melanoma like PPM. We sought to use the National Cancer Database (NCDB) to describe the epidemiology, clinical features, and treatment modalities of PPM. Methods: We conducted a retrospective review of adults diagnosed with malignant PPM between 2004 and 2021 using the NCDB. Demographic factors analyzed included age, year of diagnosis, insurance status, and facility type. Clinical features studied included regional lymph node examination and treatments. SPSS was utilized to calculate descriptive statistics and chi-square tests for differences between categorical variables. Results: A total of 137 patients met inclusion criteria. The median age at diagnosis was 73 years. The majority of patients were insured by Medicare (n = 86, 63%) or private insurance (n = 46, 34%). About 50% (n = 69) of patients received care at an academic institution with other popular care centers being comprehensive community cancer centers (n = 33, 24%) and integrated network cancer programs (n = 28, 20%). Of the 91 (66%) patients examined for regional lymph node metastasis, 46% (n = 42/91) tested positive. The treatments of choice were partial amputation (n = 70, 51%), excisional biopsy (n = 30, 22%), total amputation (n = 15, 11%), and local excision (n = 10, 7%). After surgical intervention, 74% of patients (n = 101) showed no residual margins. Immunotherapy treatment, which was typically used as an adjuvant (n = 21,15%), increased from 7% (n = 5) of 68 cases diagnosed between 2004 and 2012 to 32% (n = 22) of 69 cases diagnosed between 2013 and 2021 (p &lt; 0.001). Only 7% (n = 9) of patients underwent chemotherapy. Conclusions: To our knowledge, we present the largest study of PPM. Most patients were of older age, covered by Medicare, and examined for regional lymph node metastasis. In line with existing literature that demonstrates increased adoption of organ-sparing procedures over more aggressive approaches for PPM, partial amputation and excisional biopsy were the most common treatments. We observed a rise in the utilization of immunotherapy in the last decade, which is consistent with the timeline of FDA approval of several immune-based therapies for advanced melanoma. Current literature regarding immunotherapy in penile melanoma is scarce. Further research should investigate patient survival and the impact of different treatment modalities on outcomes.

A framework and process for community-engaged, mixed-methods cancer needs assessments

PurposeCommunity health needs assessments are required for most state and local public health agencies and non-profit hospitals. Typically based on community health improvement planning models, these assessments encompass overall community health and multiple diseases to inform program planning. National Cancer Institute (NCI)-designated Cancer Centers and community-based cancer-focused programs share the goal of reducing cancer burden in the catchment areas they serve. However, to date, no published models exist to guide cancer-specific needs assessments for a determined geographic area that can inform both public health and research initiatives. The purpose of this article is to outline a cancer needs assessment (CNA) framework and community-engaged, mixed-methods process, along with a case study of how we applied it in Kentucky.MethodsWe convened a steering committee of key organizational partners to provide input throughout the process. We developed a conceptual framework of multi-level determinants affecting cancer-related outcomes. We incorporated both quantitative and qualitative data gathered through a variety of means, including a novel application of group concept mapping to guide definition of priorities.ResultsThe resulting CNA has helped guide strategic planning and priorities for Kentucky’s Cancer Action Plan, Markey Cancer Center, state agencies, and community-based organizations.ConclusionThis framework and process can be used collaboratively by cancer center Community Outreach and Engagement offices, public health agencies, oncology programs, and community partners to plan impactful cancer control programs and research in their catchment areas. Universities can also use them to inform the planning of community engagement and health equity research efforts.