Disparities In Cancer Diagnosis Research Articles

A consensus-based classification workflow to determine genetically inferred ancestry from comprehensive genomic profiling of patients with solid tumors.

Disparities in cancer diagnosis, treatment, and outcomes based on self-identified race and ethnicity (SIRE) are well documented, yet these variables have historically been excluded from clinical research. Without SIRE, genetic ancestry can be inferred using single-nucleotide polymorphisms (SNPs) detected from tumor DNA using comprehensive genomic profiling (CGP). However, factors inherent to CGP of tumor DNA increase the difficulty of identifying ancestry-informative SNPs, and current workflows for inferring genetic ancestry from CGP need improvements in key areas of the ancestry inference process. This study used genomic data from 4274 diverse reference subjects and CGP data from 491 patients with solid tumors and SIRE to develop and validate a workflow to obtain accurate genetically inferred ancestry (GIA) from CGP sequencing results. We use consensus-based classification to derive confident ancestral inferences from an expanded reference dataset covering eight world populations (African, Admixed American, Central Asian/Siberian, European, East Asian, Middle Eastern, Oceania, South Asian). Our GIA calls were highly concordant with SIRE (95%) and aligned well with reference populations of inferred ancestries. Further, our workflow could expand on SIRE by (i) detecting the ancestry of patients that usually lack appropriate racial categories, (ii) determining what patients have mixed ancestry, and (iii) resolving ancestries of patients in heterogeneous racial categories and who had missing SIRE. Accurate GIA provides needed information to enable ancestry-aware biomarker research, ensure the inclusion of underrepresented groups in clinical research, and increase the diverse representation of patient populations eligible for precision medicine therapies and trials.

34 Use of health services and cancer screening among immigrant cancer survivors with second primary cancer

OBJECTIVES/GOALS: Due to clinical advances, cancer survivors are living longer but have an increased risk of a second primary cancer (SPC). This cross-sectional study aims to examine SPC prevalence in immigrant women and compare healthcare use (HCU) and cancer screening in immigrants with SPC versus (1) immigrants with a single cancer and (2) US-born women with SPC. METHODS/STUDY POPULATION: The study population will include adult women with breast/gynecologic primary cancer (PC) from the 2005, 2008, 2010, 2013, and 2015 National Health Interview Survey. First-generation immigrant or US-born status will be defined by region of birth. SPC includes diagnosis with a second cancer type ≥1 year after the initial PC diagnosis. We will compare the prevalence of ≥1 SPC in immigrant and US-born women. To evaluate HCU and cancer screening differences, we will assess sociodemographic and socioeconomic factors, risk behaviors, length of US residence, and citizenship status with descriptive statistics. In regression analyses, we will compare number of provider visits and cancer screening rates in immigrant women with SPC versus immigrants with PC alone and US-born women with SPC after matching by age and PC type. RESULTS/ANTICIPATED RESULTS: Disparities in cancer diagnosis, quality of care, receipt of recommended treatment, and screening rates among immigrants in the US are well documented. Therefore, we hypothesize that immigrant cancer survivors will have similar or higher rates of SPC compared to women born in the US with variations based on health status. We further hypothesize that immigrants with SPC will report lower rates of HCU after diagnosis of their first cancer and cancer screening compared to US-born women. However, we expect that immigrants with SPC will report similar or higher rates of HCU and cancer screening compared to immigrant women with PC alone. DISCUSSION/SIGNIFICANCE: To our knowledge, this study will be the first to describe SPC among immigrant cancer survivors in the US. This research will inform interventions to improve cancer care delivery and ultimately reduce SPC in immigrants with cancer.

Cancer in the time of COVID: Trends in presentation, staging, and demographic disparities in breast, uterus, and gynecologic cancers at an NCORP site.

e18809 Background: COVID-19 shutdowns decreased access to preventive care with disparate impacts on minority patients. Racial disparities in cancer diagnosis, treatment, and survival have been studied and seen in the US. Methods: All new pathologically confirmed breast, uterus, ovary, cervix, vulvar, and vaginal cancer diagnoses at an NCORP site from 01/01/2018 to 12/31/2021 were examined for trends in stage of presentation and demographics. COVID-19 shutdown was defined as 3/15/2020 to end of study period. Categorical analysis of stage by tumor type was performed using chi square tests. Demographics were analysed using Analysis of Variance tests. Results: 2173 cases were included: 1267 cases pre-shutdown, 906 post. 1583 patients identified as White, 442 as Black, 62 as Asian, 47 as Hispanic, and 39 as Other. Breast (N = 1285) and uterine cancers (N = 396) were analyzed in greater depth due to larger numbers of cases. No significant shifts were seen in the racial breakdown of new cancer diagnoses across all examined types. No significant shifts were seen in the stage at time of diagnosis. There was a decrease in new diagnoses per day post COVID with 1.58 diagnoses per day pre-shutdowns compared to 1.38 post. Breast cancer data was notable for significant differences in age of diagnoses across racial and ethnic groups: from 54 in Hispanic patients to 63 in White Patients. No significant shifts in age of diagnosis were seen. No significant difference of stage of presentation existed at any stage of diagnosis. Number of cases per day for all stages decreased post shutdowns. Largest differences were seen in stage 1A (0.62 pre, 0.43 post; -31%) and stage 1B (0.11 pre, 0.06 post; -43%). Stage 0 cases demonstrated a smaller decrease post COVID in rate of cases per day (0.19 pre, 0.16 post; -17%). Later stages beyond 1 were analyzed in aggregate due to low numbers of cases and demonstrated a decrease in presentations per day (0.09 pre, 0.07 post; -24%). Uterus cancer showed no significant difference in stage post shutdown. Diagnoses per day did not change post shutdown. Decreases in early presentations (stage 1 and 2) and increases in late presentations (stage 3 and 4) were seen, but findings were not significant and few cases were available for analysis. No shift in percentages of new diagnoses in racial and ethnic minorities were seen. Conclusions: COVID-19 shutdowns did not significantly alter stage of presentation or demographics of patients presenting with new cancer diagnoses at this NCORP site. Underlying disparities in age of presentation by racial groups were seen. Decreased numbers of new cancer diagnoses per day were seen post-shutdowns while incidence of cancer in the US is increasing overall, suggesting some patients with cancer in our community went undiagnosed and may present later or at a later stage, though future longitudinal research is needed.

Racial Disparities in Newly Diagnosed Hematological Malignancies in the United States during the COVID-19 Pandemic, January 2020 to March 2021

Background: Recent evidence in solid cancers indicates a significant decline in newly diagnosed cancer patients during the COVID-19 pandemic. However, there is little research on such trends in hematological cancers. Additionally, segmentation of such trends by race has been largely unexplored. Our research deals with these gaps in the literature. Methods: We used ConcertAI's oncology EMR database of clinical data from CancerLinQ DiscoveryTM. We chose a subset of patients who were newly assigned International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes associated with the 21 most prevalent hematological malignancies between January 2019 to March 2021. These malignancies were rolled up into three major blood disorders: leukemia, lymphoma, and myeloma. Monthly diagnosis averages and total counts were evaluated for four periods: pre-pandemic (January 2019 to February 2020), pandemic period 1 (March to May 2020), pandemic period 2 (June to October 2020), and pandemic period 3 (November 2020 to March 2022). We chose these periods based on the published literature. We conducted two sets of chi-squared statistical tests. First, we compared the trends across pandemic periods for each hematological cancer group. Second, we compared Black versus White cancer diagnosis counts between pre-pandemic and pandemic period 3. Results were considered statistically significant at P < 0.05. Analyses were performed using Python 3.9. Results: The table below is the result of our first analysis. It shows the mean as well as the total number of newly diagnosed patients, segmented by race and time period. Compared to the pre-pandemic period, mean monthly patient numbers dropped during the pandemic for all cancer types. The pre-pandemic period saw a mean monthly diagnosis of 3645 patients, pandemic period 1 had 2295 patients, pandemic period 2 had 2523 patients, and pandemic period 3 had 2410 patients. The figure below represents our second analysis, where we found that racial disparities in hematologic cancer diagnosis among White and Black patients improved during the COVID-19 pandemic. Compared to Whites, the percentage of Black patients diagnosed increased from 21.0% pre-pandemic to 23.8% (P=0.01) in pandemic period 3 in myeloma, from 13.6% to 14.7% (P=0.02) in leukemia, and from 11.0% to 12.3% (P=0.01) for lymphoma. Conclusion: Our results showed an overall decline in the diagnosis of hematological malignancies during the COVID-19 pandemic. However, we also found a statistically significant increase in the cancer diagnosis among Black populations. We know from the literature that Blacks were disproportionately affected by COVID-19, resulting in higher rates of hospitalization. We hypothesize that such increased hospitalization led to increased access to cancer diagnosis resources and as a result, higher rates of incidental findings of cancer among Blacks. This suggests the importance of increasing access to improve racial disparities in cancer diagnosis. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Muslim Women and Disparities in Cancer Diagnosis: A Retrospective Study

Muslim women often find their religious customs at odds with their healthcare needs, such as regular gynecological check-ups and cervical cancer screenings, especially before marriage. Religious beliefs may also affect beliefs about gender roles, illness and death, affecting seeking healthcare services. This retrospective study explored the differences in care-seeking related to cancer between Muslim women and the general female population at the Virginia Commonwealth University in the United States between 2010 and 2019. There were major differences in insurance status between the two cohorts. Muslim women were less likely to have government-sponsored health insurance and were much more likely to be uninsured than non-Muslim women. We also found that preventable female cancers were more prevalent among Muslim women than among non-Muslim women and was also diagnosed at more advanced stages.

Male patients with TERT mutation may be more likely to benefit from immunotherapy, especially for melanoma.

Genomic mutation may be key factors for sex-biased disparities in cancer diagnosis, prognosis and prediction of treatment response. Current study has revealed that sex-based dimorphism on the efficacy of immune checkpoint inhibitors (ICIs) in various cancers and confirmed that male patients can benefit more from immunotherapy. However, only a subset of male patients responds well to ICIs. Therefore, biomarkers are desperately needed to identify the group of patients who may be more likely to benefit from ICIs. With the availability of the cBioPortal database, we identified that TERT mutation may serve as a sex-specific cancer biomarker and TERT mutation frequency of melanoma was higher in male patients. Notably, we found that male patients with TERT mutation may be more likely to benefit from immunotherapy (p = 0.006), especially for melanoma (p < 0.001). Therefore, our research provides a possible direction for the exploration of immunotherapy prediction biomarkers based on sex difference.

Socioeconomic and Other Demographic Disparities Predicting Survival among Head and Neck Cancer Patients.

BackgroundThe Institute of Medicine (IOM) report, “Unequal Treatment,” which defines disparities as racially based, indicates that disparities in cancer diagnosis and treatment are less clear. While a number of studies have acknowledged cancer disparities, they have limitations of retrospective nature, small sample sizes, inability to control for covariates, and measurement errors.ObjectiveThe purpose of this study was to examine disparities as predictors of survival among newly diagnosed head and neck cancer patients recruited from 3 hospitals in Michigan, USA, while controlling for a number of covariates (health behaviors, medical comorbidities, and treatment modality).MethodsLongitudinal data were collected from newly diagnosed head and neck cancer patients (N = 634). The independent variables were median household income, education, race, age, sex, and marital status. The outcome variables were overall, cancer-specific, and disease-free survival censored at 5 years. Kaplan-Meier curves and univariate and multivariate Cox proportional hazards models were performed to examine demographic disparities in relation to survival.ResultsFive-year overall, cancer-specific, and disease-free survival were 65.4% (407/622), 76.4% (487/622), and 67.0% (427/622), respectively. Lower income (HR, 1.5; 95% CI, 1.1–2.0 for overall survival; HR, 1.4; 95% CI, 1.0–1.9 for cancer-specific survival), high school education or less (HR, 1.4; 95% CI, 1.1–1.9 for overall survival; HR, 1.4; 95% CI, 1.1–1.9 for cancer-specific survival), and older age in decades (HR, 1.4; 95% CI, 1.2–1.7 for overall survival; HR, 1.2; 95% CI, 1.1–1.4 for cancer-specific survival) decreased both overall and disease-free survival rates. A high school education or less (HR, 1.4; 95% CI, 1.0–2.1) and advanced age (HR, 1.3; 95% CI, 1.1–1.6) were significant independent predictors of poor cancer-specific survival.ConclusionLow income, low education, and advanced age predicted poor survival while controlling for a number of covariates (health behaviors, medical comorbidities, and treatment modality). Recommendations from the Institute of Medicine’s Report to reduce disparities need to be implemented in treating head and neck cancer patients.

Disparities in psychological distress impacting lesbian, gay, bisexual and transgender cancer survivors.

Recent studies have highlighted disparities in cancer diagnosis between lesbian, gay, bisexual and transgender (LGBT) and heterosexual adults. Studies have yet to examine disparities between LGBT and heterosexual cancer survivors in prevalence of psychological distress. Data for the current study were drawn from the LIVESTRONG dataset, a US national survey that sampled 207 LGBT and 4899 heterosexual cancer survivors (all cancer types, 63.5% women, mean age 49) in 2010. Symptoms of psychological distress were assessed with dichotomous yes/no items in three symptom clusters (depression related to cancer, difficulties with social relationships post-cancer, fatigue/energy problems). We selected a sample of 621 heterosexual survivors matched by propensity score to the 207 LGBT survivors and assessed disparities in count of symptoms using Poisson regression. We also performed subgroup analyses by self-reported sex. Relative to heterosexuals, LGBT cancer survivors reported a higher number of depression and relationship difficulty symptoms. Exploratory analyses revealed that disparities in number of symptoms were visible between gay, bisexual, and transgender versus heterosexual men but not between lesbian, bisexual, and transgender versus heterosexual women. This study highlights several disparities in psychological distress that exist between LGBT and heterosexual survivors. A need remains for interventions tailored to LGBT survivors and for studies examining disparities within subgroups of LGBT survivors.

Survival and Disease Characteristics of Multiple Myeloma in a Rural Population

BackgroundMany studies have examined the disparities in cancer diagnosis, treatment and survival among different subgroups classified based on race, socioeconomic status and age. Not as many studies have examined disease characteristics in rural populations, perhaps because of the lack of a consensus in the United States regarding the definition of "rural". In these few studies, many disparities were reported in association with rural residence such as lower levels of utilization of cancer screening tests, lower likelihood of receiving guideline-appropriate therapy and shorter survival.ObjectivesTo examine multiple myeloma disease characteristics and survival in rural patients of southern New Mexico in comparison to their urban counterparts.MethodsPatients presented to Memorial Medical Center (MMC) and its associated cancer center from January 2003 to December 2013 with multiple myeloma were enrolled in the study. Demographic and clinical data were collected. The charts were also examined for evidence of offering or discussing Autologous Stem Cell Transplant (ASCT) as a treatment option with patients, and whether it was actually performed. Patient staging at diagnosis according to International Staging System (ISS) for myeloma was determined, if possible. Urban vs. rural classification was based on the Rural-Urban Commuting Area codes (RUCA) version 2.0; a census tract-based classification scheme that utilizes the standard bureau of census urban definition in combination with work commuting information. Categorization D of RUCA was chosen. It defines urban as all places that have 30% or more of their workers going to a Census Bureau-defined Urbanized Area.ResultsA total of 87 patients were initially enrolled in the study. Four patients were excluded because sufficient evidence to establish the diagnosis could not be verified. Two additional patients who had solitary plasmacytoma with no evidence of systemic involvement were excluded as well. Patients were classified based on their residence at the time of diagnosis as rural (29 patients) and non-rural (52 patients).There was no difference between the mean age at diagnosis between the two groups with mean being 66.20 for non-rural group and 67.77 for the rural group. The type of heavy chain protein was generally similar for both groups with 55.74 % of patients diagnosed with Immunoglobulin G heavy chain disease. The average duration of initial presenting symptom prior to diagnosis was 7.36 weeks for the whole sample, 13.6 week for the rural group, and 4.56 weeks for the non rural group, which suggests that non-rural patients were more likely to seek medical attention sooner than their rural counterparts (p=0.0037). Tobacco consumption was higher among patients in the rural group compared to non-rural group. Nearly half (47.37%) of rural patients were diagnosed at stage 3 according to ISS staging system, while only 31.03% of non-rural patients were diagnosed at the same stage. Rural patients were more likely to be diagnosed at a more advanced disease stage (p=0.063). The nature of the chief presenting problem was generally similar in both groups with the exception of the higher likelihood of patients in non-rural group to be diagnosed at an asymptomatic stage. In the whole sample, 33.33% of patients had evidence of being offered or educated about ASCT as a treatment option, and 18.52% of patients actually receiving it. There was no different between the two groups in this regard. Median survival time for the whole sample was 57 months. Patients in the rural group had a median survival of 39.03 months (95% CI 18.96- 57.99), while non-rural patients had a median survival of 68.99 months (95% CI 25.95-90.02) ( p<0.001). Log-rank test for equality of survivor function showed survival benefit in favor of the non-rural group (p=0.07).DiscussionTo our knowledge, this is the 1st US based study that examine rural-urban difference in survival of multiple myeloma patients. Our results showed that rural patients of southern New Mexico state had longer period of symptoms prior to diagnosis, were diagnosed at a more advanced stage and had worse survival compared to their non-rural counterparts. This is perhaps a result of many challenges that face health care in rural population. It is recommended to encourage the efforts aiming to enhance health care services in rural areas, to minimize the disparities in health care between rural and urban populations. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Disparities in Cancer Diagnosis, Treatment, and Survival Between African-American and Other Population Groups

Disparities in Cancer Diagnosis, Treatment, and Survival Between African-American and Other Population Groups

Effect of socioeconomic status and race on outcome after radical prostatectomy for localized prostate cancer

5061 Background: In the US, profound social disparities in cancer diagnosis, treatment and mortality have been demonstrated in various cancers. We sought to evaluate the impact of socioeconomic status (SES) on utilization and cancer specific survival (CSS) after radical prostatectomy (RP) for Gleason <7, localized prostate cancer. Methods: The California Cancer Registry (CCR) is a population-based registry that has collected cancer incidence data for the entire population of California since 1988. We evaluated the association between SES and CSS for men who underwent initial RP for localized, Gleason score <7 prostate cancer in California from 1996 to 2005. SES status was defined using a residential block group method and ranked into quintiles. Survival was analyzed using Cox proportional hazards models. Results: Between 1996 and 2005, 123,836 men were diagnosed with localized, Gleason score <7 prostate cancer. Of these men, 39,192 (32%) underwent RP as initial therapy. Men of lower SES were less likely to undergo RP for localized prostate cancer than men of higher SES. For men who underwent RP (n = 39,192), the risk of death from prostate cancer declined 51% from the lowest quartile of SES to the highest quartile of SES (P for linear trend = 0.0003). Adjustment for race produced nearly identical results. (see table) Conclusions: Men of lower SES are less likely to undergo RP in the management of localized prostate cancer. Even when RP is performed, men with lower SES still have an increased cancer specific mortality when compared to men of higher SES. Quintile of SES Percent of patients undergoing RP HR for death from prostate cancer HR for death from prostate cancer–adjusted for race 1 (lowest) 27.4 1.00 (referent) 1.00 (referent) 2 29.2 0.74(0.46–1.18) 0.67(0.42–1.08) 3 30.1 0.72(0.46–1.13) 0.63(0.40–0.99) 4 32.2 0.48(0.30–0.76) 0.40(0.25–0.66) 5 (highest) 35.3 0.49(0.32–0.76) 0.41(0.26- 0.65) No significant financial relationships to disclose.

Medicaid, Medicare, and the Michigan Tumor Registry: A Linkage Strategy

The study of health outcomes and the reduction in health disparities is at the forefront of the nation's health care agenda. A theme in the disparities literature is the call for a data infrastructure that can track progress toward goals aimed at reducing differences in health outcomes. This article describes a strategy for linking Medicaid, Medicare, and Michigan Tumor Registry data for the purposes of studying disparities in cancer diagnosis, quality of care, and survival. The authors review their procedures for ensuring that a correct match between files occurred and offer guidance for merging and assessing the quality of these complex linked data sets. A cohort of 113,604 subjects (90%) from a population of 125,900 subjects was correctly linked from the Michigan Tumor Registry to Medicare and Medicaid files. Using probabilistic and deterministic methods, the prediction rate of the Medicaid match to the Michigan Tumor Registry was 93%. Approximately 13% of the subjects were dually eligible for Medicare and Medicaid. An expansive data set reflecting the Medicare and Medicaid medical service utilization and outcomes for a cohort of individuals age 65 years and older when diagnosed with cancer was created. This data set serves as a cornerstone of a health outcomes data infrastructure. The methodology described may serve as a model for other researchers seeking to create a similar data set in their state.

Disparities in cancer diagnosis and survival.

Concern has been raised over the disproportionate cancer mortality among minority and low-income persons. The current study examined differences in disease stage at the time of diagnosis and subsequent survival for patients who are medically indigent compared with the rest of the population of cancer patients in Michigan. The authors linked three Michigan statewide data bases: the Cancer Registry, Medicaid enrollment files, and death certificates. The analysis focused on female breast, cervix, lung, prostate, and colon carcinoma, and differences were analyzed in the incidence, disease stage at the time of diagnosis, and survival between younger women and older women who were either insured or not insured by Medicaid. To estimate the risk of late stage diagnosis and death, the authors used logistic regression, controlling for age, race, and Medicaid enrollment. Ordered logit models also were used as a refinement of disease stage prediction. Medically indigent persons had a disproportionately larger share of cancer. Persons age < 65 years who were insured by Medicaid had the greatest risk of late stage diagnosis and death across all five disease sites analyzed. African-American women had a greater risk of death from breast carcinoma compared with other women independent of Medicaid status. No interaction effects were found between age, race, and/or gender and Medicaid enrollment. The results of this study showed that the disparities in cancer outcomes may be greater than previously thought and are consistent across disease sites. If advancements made in cancer control are to be shared by the low-income population, then improvements clearly are needed in cancer prevention, early detection, and treatment for the poor.