Disparities In Cancer Outcomes Research Articles

A qualitative approach to understanding the drivers of unequal receipt of definitive therapy for Black men with prostate cancer in Massachusetts.

Despite mandated insurance coverage since 2006 and robust health infrastructure in urban settings with high concentrations of minority patients, race-based disparities in prostate cancer (PCa) treatment persist in Massachusetts. In this qualitative study, the authors sought to identify factors driving inequities in PCa treatment in Massachusetts. Four hospitals offering PCa treatment in Massachusetts were selected using a case-mix approach. Purposive sampling was used to conduct semistructured interviews with hospital stakeholders. Additional interviews were conducted with representatives from grassroots organizations providing PCa education. Two study staff coded the interviews to identify major themes and recurrent patterns. Of the 35 informants invited, 25 participated in the study. Although national disparities in PCa outcomes were readily discussed, one half of the informants were unaware that PCa disparities existed in Massachusetts. Informants and grassroots organization representatives acknowledged that patients with PCa are willing to face transportation barriers to receive treatment from trusted and accommodating institutions. Except for chief equity officers, most health care providers lacked knowledge on accessing or using metrics regarding racial disparities in cancer outcomes. Although community outreach was recognized as a potential strategy to reduce treatment disparities and engender trust, informants were often unable to provide a clear implementation plan. This statewide qualitative study builds on existing quantitative data on the nature and extent of disparities. It highlights knowledge gaps in recognizing and addressing racial disparities in PCa treatment in Massachusetts. Improved provider awareness, the use of disparity metrics, and strategic community engagement may ensure equitable access to PCa treatment. Despite mandated insurance and urban health care access, racial disparities in prostate cancer treatment persist in Massachusetts. This qualitative study revealed that, although national disparities were acknowledged, awareness about local disparities are lacking. Stakeholders highlighted the importance of ancillary services, including translators, rideshares, and navigators, in the delivery of care. In addition, whereas hospital stakeholders were aware of collected equity outcomes, they were unsure whether and who is monitoring equity metrics. Furthermore, stakeholders agreed that community outreach showed promise in ensuring equitable access to prostate cancer treatment. Nevertheless, most interviewed stakeholders lacked clear implementation plans.

Evolution of community outreach and engagement at National Cancer Institute-Designated Cancer Centers, an evolving journey.

Cancer mortality rates have declined during the last 28 years, but that process is not equitably shared. Disparities in cancer outcomes by race, ethnicity, socioeconomic status, sexual orientation and gender identity, and geographic location persist across the cancer care continuum. Consequently, community outreach and engagement (COE) efforts within National Cancer Institute-Designated Cancer Center (NCI-DCC) catchment areas have intensified during the last 10 years as has the emphasis on COE and catchment areas in NCI's Cancer Center Support Grant applications. This review article attempts to provide a historic perspective of COE within NCI-DCCs. Improving COE has long been an important initiative for the NCI, but it was not until 2012 and 2016 that NCI-DCCs were required to define their catchment areas rigorously and to provide specific descriptions of COE interventions, respectively. NCI-DCCs had previously lacked adequate focus on the inclusion of historically marginalized patients in cancer innovation efforts. Integrating COE efforts throughout the research and operational aspects of the cancer centers, at both the patient and community levels, will expand the footprint of COE efforts within NCI-DCCs. Achieving this change requires sustained commitment by the centers to adjust their activities and improve access and outcomes for historically marginalized communities.

Scoping Review of Barriers and Facilitators to Recruitment of Black People With Cancer in Biospecimen-Based Research.

The increasing focus on precision medicine to optimize cancer treatments and improve cancer outcomes is an opportunity to consider equitable engagement of people racialized as Black or African American (B/AA) in biospecimen-based cancer research. B/AA people have the highest cancer incidence and mortality rates compared with all other racial and ethnic groups in the United States, yet are under-represented in biospecimen-based research. A narrative scoping review was conducted to understand the current literature on barriers, facilitators, and evidence-based strategies associated with the engagement of B/AA people with cancer in biospecimen research. Three comprehensive searches of MEDLINE, CINAHL, Embase, and Scopus were conducted. Of 770 studies generated by the search, 10 met all inclusion criteria for this review. The most frequently reported barriers to engagement of B/AA people in biospecimen research were lack of biospecimen research awareness, fear of medical harm, and violation of personal health information privacy, resource constraints, and medical mistrust. Key facilitators included previous exposure to research, knowledge about underlying genetic causes of cancer, and altruism. Recommended strategies to increase participation of B/AA people in biospecimen-based research included community engagement, transparent communication, workforce diversity, education and training, and research participant incentives. Inclusion of B/AA people in biospecimen-based research has the potential to advance the promise of precision oncology for all patients and reduce racial disparities in cancer outcomes.

Identifying predictors of COVID-related delays in cancer-specific medical care.

Evidence of the impact of the COVID-19 pandemic on cancer prevention and control is growing, but little is known about patient-level factors associated with delayed care. We analyzed data from a survey focused on Iowan cancer patients' COVID-19 experiences in the early part of the pandemic. Participants were recruited from the University of Iowa Holden Comprehensive Cancer Center's Patients Enhancing Research Collaborations at Holden (PERCH) program. We surveyed respondents on demographic characteristics, COVID-19 experiences and reactions, and delays in any cancer-related health care appointment, or cancer-related treatment appointments. Two-sided significance tests assessed differences in COVID-19 experiences and reactions between those who experienced delays and those who did not. There were 780 respondents (26% response), with breast, prostate, kidney, skin, and colorectal cancers representing the majority of respondents. Delays in cancer care were reported by 29% of respondents. In multivariable-adjusted models, rural residents (OR 1.47; 95% CI 1.03, 2.11) and those experiencing feelings of isolation (OR 2.18; 95% CI 1.37, 3.47) were more likely to report any delay, where experiencing financial difficulties predicted delays in treatment appointments (OR 5.72; 95% CI 1.96, 16.67). Health insurance coverage and concern about the pandemic were not statistically significantly associated with delays. These findings may inform cancer care delivery during periods of instability when treatment may be disrupted by informing clinicians about concerns that patients have during the treatment process. Future research should assess whether delays in cancer care impact long-term cancer outcomes and whether delays exacerbate existing disparities in cancer outcomes.

Abstract 6160: Mutational signatures and their associations with social determinants of health

Abstract Introduction: Mutational signatures, or unique patterns of genetic mutations due to exogenous and endogenous mutational processes, are being continuously identified through the analysis of cancer patients’ genomes. While cancer research has developed and mortality rates have declined, disparities in cancer outcomes have widened. Social determinants of health (SDOH), such as access to health care, education, and economic stability are essential to addressing health equity. While much research is ongoing regarding the identification and etiology of mutational signatures, little work has been published regarding the associations of these signatures with SDOH. Therefore, this study proposes an exploration into the relationships between the presence of mutational signatures and SDOH within an adult pan-cancer patient population. Methods: Variant calls from whole exome sequencing for each patient was used to infer the presence of 58 single base substitution (SBS) mutational signatures. Descriptive statistics were calculated for 455 unique patients. Previously documented associations between primary diagnosis site and distinct signatures were used to validate the predicted signatures in the patient population. Signature profiles were then linked to 208 patient health records with complete SDOH. Logistic regression predicting the presence of each signature was modeled for these patients. Full models for each signature included age, gender, Rural-Urban Commuting Area (RUCA) code, tobacco and alcohol usage, education, income, housing condition, and access to healthcare. Stepwise selection was used to determine significant variables. Results: The most common signatures in the complete population (n = 455) were SBS1 (clock-like; 98%) and SBS39 (95%), followed by SBS5 (clock-like; 38%) and SBS22 (aristolochic acid exposure; 36%). However, SBS24 (aflatoxin exposure; p = .019) and SBS7a (UV exposure; p = .002) were significantly more common in lung and skin cancer patients respectively. Each patient had 4.1 signatures on average, with a range of 2-7. The average number of signatures per patient varied significantly by primary diagnosis (ANOVA p = .014). Patients with a vulva/vagina (4.8) or bladder/urinary tract (4.9) diagnosis had the highest number of signatures while those with a liver (3.3) or kidney (3.6) diagnosis had the lowest. Logistic regression models for the population with SDOH (n = 208) showed poor housing condition was associated with SBS4 (tobacco smoking; p = 0.091). Any issue in accessing healthcare was associated with SBS13 (AID/APOBEC; p = 0.114) and SBS21 (MMR; p = 0.076). Greater rurality was associated with SBS16 (p = .144) and SBS21 (p = .107). The relationship was inverse for SBS1 (p = .121). Conclusion: Multiple significant relationships between different SDOH and mutational signatures was revealed, pointing the need to extend this research to larger patient populations with diverse SDOH. Citation Format: Padmapriya Swaminathan, McKenna Deaton, Crystal Hattum, Benjamin Solomon, William Spanos, David Starks, Rachel Elsey, Casey Williams, Tobias Meissner. Mutational signatures and their associations with social determinants of health [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6160.

Abstract 1304: Employing widening funds to address inequity in cancer research - example of the STEPUPIORS collaborative rectal cancer project

Abstract Introduction: Treatment of locally advanced rectal cancer (LARC) using neoadjuvant chemoradiotherapy (nCRT) improves local control and survival, but response varies. Patients treated at the Institute for Oncology and Radiology of Serbia (IORS) who undergo surgery upon complete response might be exposed to risks and poor quality of life. A consortium dedicated to redefining prognostic and predictive biomarkers in rectal cancer was formed within the framework of the STEPUPIORS Horizon Europe project. The current study evaluated whether employing collaborative widening funds might lead to sustainable strategies for cancer treatment, lowering inequity and steering societal impact, especially in countries with limited resources, using a pilot rectal cancer project. Patients and Methods: The analysis was performed in the period Oct 01, 2022, to Oct 01, 2023, with a Serbian coordinating institution and partners from Spain, Greece, and the Netherlands as expert twinning centers. RT was administered to 75 patients with LARC using volumetric modulated arc therapy-simultaneous integrated boost approach/concomitant chemotherapy (5FU/Leucovorin, week 1&5) for the first time in Serbia. A comprehensive approach towards building human capacities on biobanking, multiomics analyses and project management was developed through intensive training and expert visits. Consensus consortium decisions were reached on regular partner meetings. Results: Patients with clinical complete response (16.0%) and initially distant-located tumors were enrolled in the watch and wait approach and are under follow up. Developed pipelines for multiomics analyses led to 4 high-quality papers on new predictive biomarkers to nCRT in LARC and the deposition of omics data in open-science repositories following FAIR data principles. A first Serbian cancer biobank was successfully installed. Fifteen IORS researchers (87% female), were certified in biobanking. A grant management office was established to provide and support the sustainability of future research projects. This led to 5 new grant applications and enrollment of 1 female project member in a Masters program for Management in the Health Care System. Conclusion: This study showed that even within the first 12 months, implementation of a 3-year collaborative grant dedicated to a specific research problem, might significantly change educational and treatment strategies enabling better patient care (OCEBM level of evidence 3). The results highlight that disparities in cancer outcomes and health equity might only be addressed by progressing beyond descriptions of said outcomes and taking specific action. Systematic, long-term strategic initiatives and collaborations among relevant stakeholders and ethical, legal and societal structures are needed in more countries. Acknowledgements: Horizon Europe Project STEPUPIORS (101079217). Citation Format: Milena Cavic, Ana Djuric, Mladen Marinkovic, Aleksandra Stanojevic, Miljana Tanic, Snezana Bjelogrlic, Jelena Spasic, Ana Damjanovic, Marija Djordjic Crnogorac, Ana Vuletic, Katarina Mirjacic Martinovic, Marko Radulovic, Suzana Stojanovic-Rundic, Ana Krivokuca, Radmila Jankovic, Sergi Castellvi-Bel, Jerome Zoidakis, Remond J. Fijneman. Employing widening funds to address inequity in cancer research - example of the STEPUPIORS collaborative rectal cancer project [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1304.

Abstract 2245: Awareness and participation in cancer-related clinical trials among gastrointestinal cancer survivors

Abstract Despite significant advances in cancer prevention, early detection, and treatment, there is a persistent disparity in cancer outcomes between diverse racial/ethnic groups and medically underserved populations in the United States (US). The underrepresentation of non-white racial/ethnic groups in clinical trials (CTs) poses a critical challenge to cancer research and effective care delivery. The Hispanic/Latino population is one of the fastest-growing ethnic groups in the US and has a high rate of gastrointestinal (GI) cancer. Although Hispanics/Latinos comprise 18.5% of the US population, they have participation rates of only 1% in CTs. We aimed to describe the awareness and participation of Hispanic/Latino GI cancer survivors in cancer-related CTs. We analyzed preliminary data from an ongoing cross-sectional study that examines the social determinants of health (SDOH) associated with participation in cancer-related CTs among GI cancer survivors. As of November 7, 2023, 57 individuals aged ≥ 21 years responded to a survey assessing their awareness and participation in CTs, and other SDOH domains. Descriptive statistics were used to describe the population, including frequencies, percentages, mean, and standard deviation. The participants’ mean age was 62.5 ± 12.3 years, and 56.1% were women. Most had more than a high school education (80.6%). Moreover, 59.7% of the participants had state-sponsored health insurance or Medicaid. Twenty-nine (50.9%) of the participants reported having heard about cancer-related CTs; however, only nine (31.0%) indicated that they knew how to participate in a cancer-related CT. Most of the participants had heard about cancer-related CTs from their doctor, nurse, or other health professionals (41.4%), their family/friends (20.7%), or social media/newspapers (20.7%). Furthermore, 13 (44.8%) had been invited to participate and 11 (84.6%) were eligible and participated in cancer-related CTs. Most of the participants who were eligible and participated in cancer-related CTs (90.9%) indicated that they participated because they knew CTs are important for the development of effective cancer treatments. Our preliminary findings show high levels of awareness among Hispanics/Latinos GI cancer survivors towards CTs; however, it is concerning that only a minority of those who were aware of CTs knew how to participate in them. More efforts are needed to assess the factors and SDOH that impact participation in cancer-related CTs among this population. Additionally, we will continue to recruit participants to assess the relationship between adverse SDOH and their willingness to participate in cancer-related CTs. Citation Format: Mariela Bournigal-Feliciano, Marievelisse Soto-Salgado, Hilmaris Centeno-Girona, Sofía Contreras-Fernández, Karina Torres-Mojica, Virginia Williams, Arnethea L. Sutton, Katherine Tossas, Robert Winn, Marcia Cruz-Correa. Awareness and participation in cancer-related clinical trials among gastrointestinal cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2245.

Sleep health and quality of life in the Detroit Research on Cancer Survivors cohort.

Sleep disturbances represent a modifiable target to improve quality of life and longer-term outcomes in cancer survivors. However, the association between sleep health and overall quality of life in African American cancer survivors has been poorly assessed, a population at increased risk for morbidity and mortality. Seven hundred and eighteen Detroit Research on Cancer Survivors (ROCS) cohort participants completed a supplemental sleep survey at the time of enrollment, which included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI). Linear and logistic regression was used to evaluate the association between sleep and mental health, while block regression models were used to estimate the contribution of clustered factors to Health-Related Quality of Life (HRQOL). Nearly 60% of the cohort reported symptoms indicative of poor sleep quality on the PSQI, 15% reported excessive daytime sleepiness on the ESS, and 12% reported moderate to severe insomnia on the ISI. Survivors with elevated ISI scores reported FACT-G scores that were 17 points lower than those without symptoms of insomnia (95% CI: - 13.1, - 21.2). Poor sleep health accounted for the largest proportion of variability in FACT-G scores (R2 = 0.27) and change in R2 value (0.18) when compared to comorbidities, health behaviors, cancer-related factors, and demographics. Overall sleep health was significantly associated with poorer HRQOL and variability in FACT-G scores. Additional studies investigating a causal relationship between sleep and HRQOL are needed to determine whether sleep quality could affect disparities in cancer outcomes. Addressing sleep quality in cancer survivors may improve long-term health and HRQOL.

Reviewing the progress of cancer research in the USA

This review provides a comprehensive analysis of the progress made in cancer research within the United States. Over the past few decades, significant strides have been taken to understand the complexities of cancer, leading to breakthroughs in diagnostics, treatment modalities, and overall patient care. The review explores key themes, including advancements in genomic medicine, immunotherapy, and personalized treatment approaches. Advancements in genomic medicine have emerged as a cornerstone of cancer research, allowing for a deeper understanding of the genetic basis of various cancers. The integration of precision medicine techniques has facilitated the identification of specific genetic mutations, paving the way for targeted therapies tailored to individual patients. Genomic profiling has not only enhanced diagnostic accuracy but has also provided valuable insights into cancer heterogeneity, guiding researchers toward more effective and personalized treatment strategies. Immunotherapy has revolutionized cancer treatment by harnessing the body's immune system to target and eliminate cancer cells. The review delves into the remarkable progress in developing immune checkpoint inhibitors, adoptive cell therapies, and cancer vaccines. These innovations have shown unprecedented success in treating previously challenging malignancies, offering new hope for patients with advanced-stage cancers. The concept of personalized medicine is further explored, emphasizing the shift from a one-size-fits-all approach to tailoring treatments based on individual patient characteristics. The advent of liquid biopsies and advanced imaging techniques has enabled real-time monitoring of treatment responses, facilitating timely adjustments and improving overall patient outcomes. Despite these advancements, the review acknowledges persistent challenges, such as the need for enhanced collaboration between research institutions, the imperative for increased funding, and the importance of addressing healthcare disparities in cancer outcomes. The ongoing commitment to interdisciplinary research, translational initiatives, and a patient-centered approach is emphasized as essential for overcoming these challenges and further propelling the field of cancer research in the USA. In conclusion, this review paints a comprehensive picture of the remarkable progress in cancer research within the United States. The integration of genomic insights, immunotherapeutic breakthroughs, and personalized treatment approaches underscores a promising future for cancer patients, while acknowledging the necessity of continued efforts to address existing challenges and propel the field toward even greater advancements.

Addressing disparities in European cancer outcomes: a qualitative study Protocol of the BEACON project.

Health disparities represent a crucial factor in cancer survival rates, awareness, quality of life, and mental health of people receiving a cancer diagnosis and their families. Income, education, geographic location, and ethnicity are some of the most important underlying reasons for health disparities in cancer across Europe. Costs of healthcare, access to information, psycho-oncological support options, integration of cancer research and innovative care, and multidisciplinary cancer teams are the main target areas when it comes to addressing disparities in the cancer context. As part of the Beacon Project (BEACON), we developed a protocol for a qualitative study to explore and identify any relevant reasons for cancer inequalities and disparities in Europe. Our four stakeholders namely, cancer patients, healthcare providers, researchers, and policymakers will be recruited online, facilitated by collaborative efforts with cancer organizations from various European countries, including but not limited to Italy, Croatia, Estonia, and Slovenia. Qualitative online focus group discussions for each stakeholder will be conducted and transcribed. Subsequently, thematic analysis will be used to identify reasons and aspects that may contribute to the existing disparities in cancer outcomes at various levels of engagement and from different stakeholders' perspectives. Results from focus groups will inform a subsequent Delphi study and a SWOT analysis methodology. Although advances in medical research, cancer screening and treatment options are constantly progressing, disparities in access to and awareness of healthcare in cancer patients are even more noticeable. Thus, mapping the capacity and capability of cancer centres in the European Union, creating decision support tools that will assist the four stakeholders' information needs and improving the quality of European cancer centres will be the main objectives of the BEACON project. The current protocol will outline the methodological and practical procedures to conduct online focus group discussions with different stakeholders.

Contribution of County Characteristics to Disparities in Rural Mortality After Cancer Diagnosis

IntroductionRural disparities in cancer outcomes have been widely evaluated, but limited evidence is available to describe what characteristics of rural environments contribute to the increased risk of poor outcomes. Therefore, this manuscript sought to assess the mediating effects of county characteristics on the relationship between urban/rural status and mortality among patients with cancer, characterize county profiles, and determine at-risk county profiles alongside rural settings. MethodsPatients diagnosed with cancer between 2000 and 2016 were assessed using Surveillance, Epidemiology and End Results (SEER) data linked to the 2010 Rural-Urban Commuting Codes and 2010 County Health Rankings (CHR). There were 757,655 patients representing 596 counties (of 3143 in the US) and 12 states. Mediation analyses, conducted in 2023, estimated the direct contribution of rurality to five-year all-cause survival and the contribution of the rural effect indirectly through CHR domains. Latent class analysis and survival models identified county groupings and estimated the hazard of mortality associated with class membership. ResultsRankings for premature death, clinical care, and physical environment resulted in rural patients having 17.9%-20.2% less survival time compared to urban patients. Of this, 4.1%-12.6% of the total excess risk was mediated by these characteristics. Patients living in rural and high-risk county classes saw higher all-cause mortality than those in urban-lower risk counties (HR, 1.04, 95%CI 1.01-1.08 and 1.07, 95%CI, 1.03-1.11). ConclusionsCounties with poorer health rankings had increased mortality risks regardless of rurality; however, the poor rankings, notably health behaviors and social & economic factors, elevated the risk for rural counties.

Abstract A073: Prisma Health Cancer Institute: Racial Analysis in Cancer Patients Using Molecular, Clinical, and Demographic Data

Abstract Background: Racial disparities among cancer patients have become a national concern because of their effects on cancer prognosis This study aims to tackle these disparities by conducting a comprehensive examination of the racial composition and potential inequalities among cancer patients treated at the Prisma Health Cancer Institute. The findings from this study will be compared with national trends to provide insights into the impact of race on patient treatment outcomes. Factors such as cancer staging, histology, molecular characteristics, treatment, demographics, and lifestyle will be analyzed to gain a comprehensive understanding of their impact on patient treatment outcomes. The significance of this study lies in its potential to benefit the community served by the Prisma Health Cancer Institute. Armed with localized and targeted information about racial disparities, that allows the hospital to focus on ways to enhance patient care. Methods: The study includes 586 cancer patients diagnosed with breast (397) and lung (171) cancer between 2014 and 2022. Patients were categorized by race: Asians, African Americans, Hawaiian/Pacific Islanders, Latinos, Multi-Race, Whites, and patients with missing race information. Through the JMP software, the analysis of racial composition was performed in diagnosis distribution, cancer staging, cancer histology, smoking status, cancer molecular subtypes, and other factors. Results: In the studied group, African American males had a higher likelihood (3.17%) of breast cancer diagnosis compared to White males (0.84%). In addition, the African American population showed a greater proportion of stage IV lung cancer (11.11%) compared to the White population (4.63%). Our data for stage IV lung cancer and breast cancer in males were similar to national trends with African Americans having an increased probability of each of these characteristics. Notably, the incidence of triple-negative breast cancer was similar between African Americans (14.63%) and Whites (13.18%) in this cohort. Our data was different for triple-negative breast cancer because of the similarity found between the African American and the White population. Conclusion: This study provides a focused examination of patients treated at the Prisma Health Cancer Institute and their disease prognosis, shedding light on population differences in two highly lethal cancers. The research aims to improve treatment and care for minority patients. Findings contribute to a better understanding of racial disparities in cancer outcomes, potentially leading to targeted interventions. Also, with more education, this research has the potential to lead to better physician-patient interactions leading to more equitable healthcare. Citation Format: Brittany K Austin, Julie Martin, Jeff Edenfield, Anna Blenda. Prisma Health Cancer Institute: Racial Analysis in Cancer Patients Using Molecular, Clinical, and Demographic Data [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr A073.

Comparison of outcomes for Hispanic and non-Hispanic patients with advanced renal cell carcinoma in the International Metastatic Renal Cell Carcinoma Database.

Existing data on the impact of Hispanic ethnicity on outcomes for patients with renal cell carcinoma (RCC) is mixed. The authors investigated outcomes of Hispanic and non-Hispanic White (NHW) patients with advanced RCC receiving systemic therapy at large academic cancer centers using the International Metastatic Renal Cell Carcinoma Database (IMDC). Eligible patients included non-Black Hispanic and NHW patients with locally advanced or metastatic RCC initiating systemic therapy. Overall survival (OS) and time to first-line treatment failure (TTF) were calculated using the Kaplan-Meier method. The effect of ethnicity on OS and TTF were estimated by Cox regression hazard ratios (HRs). A total of 1563 patients (181 Hispanic and 1382 NHW) (mostly males [73.8%] with clear cell RCC [81.5%] treated with tyrosine kinase inhibitor [TKI] monotherapy [69.9%]) were included. IMDC risk groups were similar between groups. Hispanic patients were younger at initial diagnosis (median 57 vs. 59years, p=.015) and less likely to have greater than one metastatic site (60.8% vs. 76.8%, p<.001) or bone metastases (23.8% vs. 33.4%, p=.009). Median OS and TTF was 38.0months (95% confidence interval [CI], 28.1-59.2) versus 35.7months (95% CI, 31.9-39.2) and 7.8months (95% CI, 6.2-9.0) versus 7.5months (95% CI, 6.9-8.1), respectively, in Hispanic versus NHW patients. In multivariable Cox regression analysis, no statistically significant differences were observed in OS (adjusted hazard ratio [HR], 1.07; 95% CI, 0.86-1.31, p=.56) or TTF (adjusted HR, 1.06; 95% CI, 0.89-1.26, p=.50). The authors did not observe statistically significant differences in OS or TTF between Hispanic and NHW patients with advanced RCC. Receiving treatment at tertiary cancer centers may mitigate observed disparities in cancer outcomes.

Abstract A112: Approaches to addressing cancer mortality disparities in U.S. health organizations: Identifying key themes in collaborative grant projects

Abstract Background Black men and women facing cancer diagnoses are more likely than White men and women to die from their disease despite similar or lower cancer incidence rates (American Cancer Society Cancer Facts &amp; Figures for African American/Black People 2022-2024). The American Cancer Society (ACS), in partnership with Pfizer Global Medical Grants (Pfizer), provided grant funding and engagement support to 16 projects based in 12 U.S. states and the District of Columbia examining prostate or multi-site cancer disparities along the cancer care continuum. Post hoc interviews by ACS team members were conducted with researchers to identify main themes discovered during their project period. These findings were key takeaways to be utilized in future work related to cancer mortality disparity efforts. Methods From April through June 2023, 16 grant-funded project leads were invited to participate in 30-45 minute qualitative virtual interviews. These semi-structured interviews included questions related to how projects addressed racial disparities in their communities, partnerships with stakeholder groups, and resources and educational materials created. The open-ended questions were adopted to allow for project leads to share their unique perspective and project details they deemed important to address in the cancer disparities research area. Interviews were audio recorded and transcribed for accuracy. Three independent coders read and extracted important quotes to identify common themes. Results A total of 15 out of the 16 grant-funded project teams were interviewed, with one interview postponed to outside the study period. Various themes were identified among the project interviews, with most centered around interventions addressing health system on the patient- and provider- levels. The most common interventions and themes identified as ways to bridge the cancer mortality gap in Black and White people include: creating relatable and culturally adaptive educational materials, assistance with transportation and communication barriers, prioritizing patient social needs, utilizing patient navigators to supplement patient support, addressing providers’ unconscious bias and patient mistrust, incorporating artificial intelligence to streamline patient care, and organizing community partnerships to expand the reach of potential patients and encourage visitation for cancer screenings. Conclusion These post hoc interviews among grant funded projects highlighted important areas along the cancer care continuum that can be addressed and further studied as ways to decrease the cancer mortality gap between Black and White people. The public-private grants partnership between ACS and Pfizer provided a unique opportunity to explore novel interventions in the field of cancer disparities. This meaningful work can be similarly extended to other health organizations to continue the work in communities across the U.S. in an effort to eliminate racial disparities in cancer outcomes. Citation Format: Emily C. Marlow, Kristen A. Wehling, Karla L. Wysocki, Dewayne Brumlow. Approaches to addressing cancer mortality disparities in U.S. health organizations: Identifying key themes in collaborative grant projects [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A112.

Factors Associated with Self-reported COVID-19 Infection and Hospitalization among Patients Seeking Care at a Comprehensive Cancer Center.

COVID-19 infection severity differs by race and ethnicity, but its long-term effect on cancer-related outcomes is unknown. Therefore, information on COVID-19 history is critical to ascertain among new cancer patients in order to advance research on its impact on cancer outcomes and potentially related health disparities. A cross-sectional study was conducted among 16,025 new patients seeking care at Moffitt Cancer Center (MCC) between 2021 and 2022. Patient self-reported histories of COVID-19 infection and other pre-existing health conditions were obtained from electronic questionnaires administered to all new MCC patients. Associations between demographics and COVID-19 infection and hospitalization were examined. A total of 1,971 patients (12.3%) reported ever having COVID-19. Self-reported COVID-19 history was significantly more prevalent in Hispanic vs. non-Hispanic patients (OR = 1.24, 1.05-1.45) and less prevalent in Asian versus White patients (OR = 0.49, 95% 0.33-0.70). Among patients who ever had COVID-19, 10.6% reported a COVID-19-related hospitalization. Males had higher odds of a COVID-19 related hospitalization than females (OR = 1.50, 95% CI = 1.09-2.05), as did Black/African American patients (OR = 2.11, 95% CI = 1.18-3.60) and patients of races other than Black/African American and Asian (OR = 2.61, 95% CI = 1.43-4.54) compared to White patients. Hispanic patients also experienced higher odds of hospitalization (OR = 2.06, 95% CI-1.29- 3.23) compared with non-Hispanic patients of all races in a sensitivity analysis that combined race/ethnicity. Pre-existing lung and breathing problems were associated with higher odds of being hospitalized with COVID-19 (OR = 2.38, 95% CI = 1.61-3.48), but these and other health conditions did not explain the observed associations between race and COVID-19 hospitalization. Higher rates of COVID-19 hospitalization were observed among patients identifying as Black/African American or Hispanic independent of pre-existing health conditions. Future studies evaluating long-term effects of COVID-19 should carefully examine potential racial/ethnic disparities in cancer outcomes.

Evaluation of the contribution of county characteristics to the rural mortality disparity in cancer.

173 Background: Rural disparities in cancer outcomes have been widely evaluated, but limited evidence is available to characterize what characteristics of rural environments contribute to the increased risk of poor outcomes. Therefore, we propose to estimate the mediating effects of county characteristics on the relationship between urban/rural status and mortality among patients with cancer, identify county profiles, and determine problematic county profiles alongside rural settings. Methods: Patients with cancers (known to be associated with rural disparities) between 2000 and 2016 were assessed using Surveillance, Epidemiology and End Results data. We then linked these data to the 2010 County Health Rankings (CHR) which ranks US counties into quartiles within their state based on measures of health: morbidity, mortality, health behaviors, physical environment, socioeconomic status, clinical care environment. We dichotomized each domain as least healthy (quartiles 3 and 4) and most healthy (quartiles 1 and 2). Rurality was defined using the 2010 Rural-Urban Commuting Codes. Using mediation analyses, we estimated 1) the direct contribution of rurality to five-year all-cause and cancer-specific mortality and 2) the contribution of the rural effect indirectly through each CHR domain. We then used latent class analysis to identify county groupings based on rankings. Using flexible parametric survival models, we estimated the hazard of mortality associated with class membership, rurality and the interaction between rurality and class. Results: Among the 757,655 patients representing 596 counties, 51% were female, the most frequent diagnoses were breast and prostate (21%, respectively), 52% were diagnosed with localized disease, and 54% were diagnosed between 55y and 65y. When setting the mediator at least healthy (quartiles 3 and 4) premature death, clinical care, and physical environment, the rural patients had 17.9% to 20.2% less survival time compared to those in rural counties. Of this, 4.1% to 12.6% of the total excess risk was mediated by these characteristics. Three county classes were identified: Class 1 (28%) had consistently poor rankings, Class 2 (32%) had moderate rankings but poor clinical care, and Class 3 (41%) had consistently high rankings except for physical environment. Patients living in rural-high risk counties (class 1 and 2) saw higher all-cause mortality than those in urban-lower risk counties (reference class 3; HR, 1.04, 95%CI 1.01-1.08 and 1.07, 95%CI, 1.03-1.11). Conclusions: County characteristics mediated the relationship between rurality and mortality among patients with cancer. Counties with poor rankings had increased mortality risks regardless of rurality; however, the poor rankings elevated the mortality risk for those in rural counties. Access to care and physical environment may be actionable points of intervention in the pathway from rurality to mortality.

Individual-level home values and cancer mortality in a statewide registry.

Prior work assessing disparities in cancer outcomes has relied on regional socioeconomic metrics. These metrics average data across many individuals, resulting in a loss of granularity and confounding with other regional factors. Using patients' addresses at the time of diagnosis from the Ohio Cancer Incidence Surveillance System, we retrieved individual home price estimates from an online real estate marketplace. This individual-level estimate was compared with the Area Deprivation Index (ADI) at the census block group level. Multivariable Cox proportional hazards models were used to determine the relationship between home price estimates and all-cause and cancer-specific mortality. A total of 667 277 patients in Ohio Cancer Incidence Surveillance System were linked to individual home prices across 16 cancers. Increasing home prices, adjusted for age, stage at diagnosis, and ADI, were associated with a decrease in the hazard of all-cause and cancer-specific mortality (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.92 to 0.93, and HR = 0.95, 95% CI = 0.94 to 0.95, respectively). Following a cancer diagnosis, individuals with home prices 2 standard deviations above the mean had an estimated 10-year survival probability (7.8%, 95% CI = 7.2% to 8.3%) higher than those with home prices 2 standard deviations below the mean. The association between home price and mortality was substantially more prominent for patients living in less deprived census block groups (Pinteraction < .001) than for those living in more deprived census block groups. Higher individual home prices were associated with improved all-cause and cancer-specific mortality, even after accounting for regional measures of deprivation.

State Public Assistance Spending and Survival Among Adults With Cancer

Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for socioeconomically disadvantaged individuals, may improve access to care; address barriers, such as food and housing insecurity; and lead to improved cancer outcomes for marginalized populations. To determine whether state-level public assistance spending is associated with overall survival (OS) among individuals with cancer, overall and by race and ethnicity. This cohort study included US adults aged at least 18 years with a new cancer diagnosis from 2007 to 2013, with follow-up through 2019. Data were obtained from the Surveillance, Epidemiology, and End Results program. Data were analyzed from November 18, 2021, to July 6, 2023. Differential state-level public assistance spending. The main outcome was 6-year OS. Analyses were adjusted for age, race, ethnicity, sex, metropolitan residence, county-level income, state fixed effects, state-level percentages of residents living in poverty and aged 65 years or older, cancer type, and cancer stage. A total 2 035 977 individuals with cancer were identified and included in analysis, with 1 005 702 individuals (49.4%) aged 65 years or older and 1 026 309 (50.4%) male. By tertile of public assistance spending, 6-year OS was 55.9% for the lowest tertile, 55.9% for the middle tertile, and 56.6% for the highest tertile. In adjusted analyses, public assistance spending at the state-level was significantly associated with higher 6-year OS (0.09% [95% CI, 0.04%-0.13%] per $100 per capita; P < .001), particularly for non-Hispanic Black individuals (0.29% [95% CI, 0.07%-0.52%] per $100 per capita; P = .01) and non-Hispanic White individuals (0.12% [95% CI, 0.08%-0.16%] per $100 per capita; P < .001). In sensitivity analyses examining the roles of Medicaid spending and Medicaid expansion including additional years of data, non-Medicaid spending was associated with higher 3-year OS among non-Hispanic Black individuals (0.49% [95% CI, 0.26%-0.72%] per $100 per capita when accounting for Medicaid spending; 0.17% [95% CI, 0.02%-0.31%] per $100 per capita Medicaid expansion effects). This cohort study found that state public assistance expenditures, including cash assistance programs and Medicaid, were associated with improved survival for individuals with cancer. State investment in public assistance programs may represent an important avenue to improve cancer outcomes through addressing social determinants of health and should be a topic of further investigation.

Urban-Rural Differences in Receipt of Cancer Surgery at High-Volume Hospitals and Sensitivity to Hospital Volume Thresholds.

Methods for identifying high-volume hospitals affect conclusions about rural cancer care access.

Impact of Race and Area Deprivation on Triple-Negative Metastatic Breast Cancer Outcomes.

To describe area deprivation, anxiety, depression, relative dose intensity of first-line metastatic breast cancer (MBC) treatment, and survival in Black and White women who had died from triple-negative MBC, including interaction analysis. This cohort study drew from a database of women who had died from MBC (N = 53). Descriptive statistics, independent t tests, analysis of variance, and Mann-Whitney U tests were used, and effect sizes were calculated. Compared with White women, Black women reported higher anxiety and depression at MBC baseline. Black women living in areas of higher deprivation experienced shorter overall survival than White women living in similar areas (9.9 months versus 24.6 months). These results were not statistically significant, likely because of a small sample size, but were clinically meaningful. Black and low-income women with breast cancer experience inferior survival as compared with White and higher-income women. Newer explanatory models for racial disparity in cancer outcomes include the assessment of neighborhood deprivation. White women may be less affected by their neighborhood, even when living in areas of greater deprivation influencing cancer outcomes. This merits further exploration.