Disparities In Treatment Outcomes Research Articles

The impacts of area-level social deprivation on overall survival in patients receiving immune-checkpoint inhibitors (ICI) treatments: A retrospective cohort study.

1613 Background: Despite recent advancements in ICI therapy, disparities in treatment outcomes persist, potentially influenced by social factors. We investigated the association between Area-level social deprivation (ALSD) and overall survival in patients treated with ICIs, aiming to uncover the potential socioeconomic barriers to effective cancer care. Methods: The study included newly diagnosed solid or liquid tumor patients treated with ICIs between 2012 and 2020 at the Ohio State University Comprehensive Cancer Center. Socioeconomic deprivation was defined using the Social Deprivation Index (SDI), a validated measure of disadvantage across small areas using seven components related to demographic and household characteristics. A high ALSD was defined as an SDI score above the sample’s third quartile. Crude and Adjusted Cox proportional models with robust variance to account for group clustering were used to examine the association between overall survival and ALSD. We also examined the relationship between all-cause mortality and each of the seven components of ALSD. Results: A total of 3,317 patients were included in the study with a median age of 62 years, 59.1% males and 89% White non-Hispanics. An estimated 30.7% of patients had lung cancer, 16.3% melanoma, and 10.8% head and neck cancer. Type of cancer was significantly associated with deprivation states (P <0.001). The median (interquartile range) survival time for all participants was 10.3 (3.7–22.3) months. The high ALSD group had 440/800 (55.0%) deaths over 10,999.0 person-years reported, while the low ALSD group had 1275/2517 (50.7%) deaths over 40,994.8 person-years reported – risk ratio of 1.29 (95% CI: 1.15–1.43). High ALSD was significantly associated with a higher risk of all-cause: the crude risk of all-cause mortality was 21% higher for patients in the high vs. low ALSD groups [HR: 1.21; 95% CI: 1.08–1.36]. In the fully adjusted models, high ALSD was associated with an 18% higher risk of all-cause mortality [adjusted HR: 1.18; 95% CI: 1.06–1.33] compared to low ALSD. In a sub-analysis, we limited our cohort to patients undergoing immunotherapy as first-line treatment, and low ALSD remained a significant predictor of increased risk of all-cause mortality. Area-level poverty and residing in areas with higher percentages of rented housing were the main drivers of the increased risk of all-cause mortality in patients residing in high ALSD areas. Conclusions: Patients from areas with higher levels of social deprivation had a significantly higher risk of all-cause mortality compared with their counterparts in less deprived areas. Addressing adverse social factors could expand the benefits of ICIs for everyone and help reduce disparities in cancer care. Future strategies should consider social interventions to advance equitable healthcare outcomes for all cancer patients.

Racial differences in therapies received by patients with cutaneous T cell lymphoma (CTCL): A single center retrospective cohort analysis.

e23141 Background: Black patients with cutaneous T-cell lymphoma (CTCL) have increased risk of mortality and higher rates of treatment complications compared to other racial groups, however, drivers of these disparities are poorly understood. Recent advances in novel targeted therapies, such as mogamulizumab and brentuximab vedotin (BV), have demonstrated improved survival compared to standard therapies. We aimed to identify treatment patterns and clinical outcomes in patients with mycosis fungoides and Sezary syndrome (MF/SS) to better understand potential drivers underlying these racial disparities. Methods: We performed a retrospective review of 282 patients with a histopathologic diagnosis of advanced stage MF/SS seen at the Winship Cancer Institute of Emory University from 2000-2023. Clinical data was collected from the electronic medical record and included demographics, histopathologic findings, therapies received, highest disease stage reached, and survival. Differences in baseline characteristics and treatments were assessed using univariate analysis. The association between race, insurance status, disease stage, and category of treatment was assessed using multivariable analysis of overall survival (OS). Results: The cohort was comprised of an even distribution of patients identifying as Black (50%) and white (47.5%). Median age at diagnosis was 61 years (range, 12-91), and Black patients had an earlier age of diagnosis compared to white (median 52 vs. 65.5 years, p < 0.001). The majority of patients had a pathological diagnosis of MF (79.1%). Large cell transformation was seen in 24.8%. Most common stage was stage 2b (36.2%); other stages included 3a (18.1%), 3b (4.3%), 4a1 (19.1%), 4a2 (13.1%), and 4b (9.2%). Systemic therapies were divided into three groups: standard chemotherapy, biologics (interferon, retinoids, extracorporeal photopheresis, and methotrexate), and novel agents (mogamulizumab, BV, and clinical trials). Median OS was 47.5 months (range, 2-246 months), and was greater in patients who received treatment with novel agents (hazard ratio 0.46, 95%, CI 0.29-0.73, p < 0.001). Black patients were less likely to receive photopheresis and local radiation compared to white patients (36.73% vs. 63.27% and 39.53% vs. 60.47%, p < 0.05, respectively), however, there were no differences in the receipt of novel agents by race. There were no differences in OS between Black and white patients. Conclusions: While we did find some differences in treatment patterns by race, these did not translate to a difference in outcomes. Importantly, in this cohort of patients who received similar rates of novel targeted therapies across racial groups, there were no differences in survival by race. These findings suggest that factors such as access to novel targeted therapies may play a role in the well-documented racial disparities in treatment outcomes.

Proteomic features of soft tissue tumours in adolescents and young adults

BackgroundAdolescents and young adult (AYA) patients with soft tissue tumours including sarcomas are an underserved group with disparities in treatment outcomes.MethodsTo define the molecular features between AYA and older adult (OA) patients, we analysed the proteomic profiles of a large cohort of soft tissue tumours across 10 histological subtypes (AYA n = 66, OA n = 243), and also analysed publicly available functional genomic data from soft tissue tumour cell lines (AYA n = 5, OA n = 8).ResultsBiological hallmarks analysis demonstrates that OA tumours are significantly enriched in MYC targets compared to AYA tumours. By comparing the patient-level proteomic data with functional genomic profiles from sarcoma cell lines, we show that the mRNA splicing pathway is an intrinsic vulnerability in cell lines from OA patients and that components of the spliceosome complex are independent prognostic factors for metastasis free survival in AYA patients.ConclusionsOur study highlights the importance of performing age-specific molecular profiling studies to identify risk stratification tools and targeted agents tailored for the clinical management of AYA patients.

Pharmacogenomics, Race, and Treatment Outcome in Pediatric Acute Myeloid Leukemia.

Disparities in outcomes exist between Black and White patients with acute myeloid leukemia (AML), with Black patients experiencing poorer prognosis compared with their White counterparts. To assess whether varying intensity of induction therapy to treat pediatric AML is associated with reduced disparities in treatment outcome by race. A comparative effectiveness analysis was conducted of 86 Black and 359 White patients with newly diagnosed AML who were enrolled in the AML02 trial from 2002 to 2008 or the AML08 trial from 2008 to 2017. Statistical analysis was conducted from July 2023 through January 2024. Patients in AML02 were randomly assigned to receive standard low-dose cytarabine-based induction therapy or augmented high-dose cytarabine-based induction therapy, whereas patients in AML08 received high-dose cytarabine-based therapy. Cytarabine pharmacogenomic 10-single-nucleotide variant (ACS10) scores were evaluated for association with outcome according to race and treatment arm. This analysis included 86 Black patients (mean [SD] age, 8.8 [6.5] years; 54 boys [62.8%]; mean [SD] leukocyte count, 52 600 [74 000] cells/µL) and 359 White patients (mean [SD] age, 9.1 [6.2] years; 189 boys [52.6%]; mean [SD] leukocyte count, 54 500 [91 800] cells/µL); 70 individuals with other or unknown racial and ethnic backgrounds were not included. Among all patients without core binding factor AML who received standard induction therapy, Black patients had significantly worse outcomes compared with White patients (5-year event-free survival rate, 25% [95% CI, 9%-67%] compared with 56% [95% CI, 46%-70%]; P = .03). By contrast, among all patients who received augmented induction therapy, there were no differences in outcome according to race (5-year event-free survival rate, Black patients, 50% [95% CI, 38%-67%]; White patients, 48% [95% CI, 42%-55%]; P = .78). Among patients who received standard induction therapy, those with low ACS10 scores had a significantly worse 5-year event-free survival rate compared with those with high scores (42.4% [95% CI, 25.6%-59.3%] and 70.0% [95% CI, 56.6%-83.1%]; P = .004); however, among patients who received augmented induction therapy, there were no differences in 5-year event-free survival rates according to ACS10 score (low score, 60.6% [95% CI, 50.9%-70.2%] and high score, 54.8% [95% CI, 47.1%-62.5%]; P = .43). In this comparative effectiveness study of pediatric patients with AML treated in 2 consecutive clinical trials, Black patients had worse outcomes compared with White patients after treatment with standard induction therapy, but this disparity was eliminated by treatment with augmented induction therapy. When accounting for ACS10 scores, no outcome disparities were seen between Black and White patients. Our results suggest that using pharmacogenomics parameters to tailor induction regimens for both Black and White patients may narrow the racial disparity gap in patients with AML.

Potential Disparities in Treatment Outcomes of Combination Chemoimmunotherapy in African American females with Extensive-Stage Small Cell Lung Cancer (ED-SCLC): A Case Series Analysis

Potential Disparities in Treatment Outcomes of Combination Chemoimmunotherapy in African American females with Extensive-Stage Small Cell Lung Cancer (ED-SCLC): A Case Series Analysis

Over 30 years of STEP: The Pittsburgh experience with first-episode psychosis.

For over 30 years, combined research and treatment settings in the US have been critical to conceptualizing care for first-episode psychosis (FEP). Here we describe an early example of such a context, the Services for the Treatment of Early Psychosis (STEP) clinic, which is affiliated with the University of Pittsburgh. We describe STEP's historical roots and establishment in the early 1990s; STEP's research and treatment contributions, alongside its growth and ongoing leadership. Research-based clinics, like STEP, preceded and helped pave the way for the Recovery After an Initial Schizophrenia Episode project in the US and the ensuing Coordinated Specialty Care (CSC) approach, now widely adopted in the US. Early clinic-based research at STEP helped establish protocols for psychopharmacology, the relevance of effective early treatment, including psychosocial approaches, and highlighted disparities in treatment outcomes across race/ethnicity. Multidisciplinary collaboration and dialogue with consumers contributed to early treatment, combining psychosocial and pharmacological approaches. STEP adopted CSC and is situated within a bi-state Learning Health System. STEP has retained a relatively unique 5-year treatment model and exists within continuum of care ideally suited to studying psychotic illness and treatment outcomes. STEP remains the largest academic FEP clinic in Pennsylvania. Academic FEP clinics like STEP will have a critical role within Learning Health Systems nationally to model participatory approaches, sustain early intervention treatment quality and ongoing treatment developments.

In silico analysis of overall survival with YBX1 in male and female solid tumours

The Y-box binding protein-1 (YBX1) gene codes for a multifunctional oncoprotein that is increasingly being linked to the regulations of many aspects of cancer cell biology. Disparities in treatment outcomes between male and female cancer patients are increasingly reported. This study aimed to examine the relationship between YBX1 expression and overall survival in male and female patients with solid tumours. Overall survival and YBX1 expression data for cohorts of male and female cancer patients obtained from freely available databases were analysed with a cox proportional hazard model with covariates of biological sex and YBX1 expression. Kaplan–Meier curves and Violin plots were constructed for segregated male and female cohorts. High YBX1 expression was significantly associated with poor survival in 2 female-only and 4 mixed-sex cancer sites. In female lung cancer patients, better survival and lower YBX1 expression were identified. The clinical importance of YBX1 expression in cancer ought to be evaluated in a sex-specific manner, especially in lung cancer.

Factors Associated With Racial and Ethnic Disparities in Locally Advanced Rectal Cancer Outcomes

Hispanic and non-Hispanic Black patients receiving neoadjuvant therapy and surgery for locally advanced rectal cancer (LARC) achieve less favorable clinical outcomes than non-Hispanic White patients, but the source of this disparity is incompletely understood. To assess whether racial and ethnic disparities in treatment outcomes among patients with LARC could be accounted for by social determinants of health and demographic, clinical, and pathologic factors known to be associated with treatment response. The National Cancer Database was interrogated to identify patients with T3 to T4 or N1 to N2 LARC treated with neoadjuvant therapy and surgery. Patients were diagnosed between January 1, 2004, and December 31, 2017. Data were culled from the National Cancer Database from July 1, 2022, through December 31, 2023. Neoadjuvant therapy for rectal cancer followed by surgical resection. The primary outcome was the rate of pathologic complete response (pCR) following neoadjuvant therapy. Secondary outcomes were rate of tumor downstaging and achievement of pN0 status. A total of 34 500 patient records were reviewed; 21 679 of the patients (62.8%) were men and 12 821 (37.2%) were women. The mean (SD) age at diagnosis was 59.7 (12.0) years. In terms of race and ethnicity, 2217 patients (6.4%) were Hispanic, 2843 (8.2%) were non-Hispanic Black, and 29 440 (85.3%) were non-Hispanic White. Hispanic patients achieved tumor downstaging (48.9% vs 51.8%; P = .01) and pN0 status (66.8% vs 68.8%; P = .02) less often than non-Hispanic White patients. Non-Hispanic Black race, but not Hispanic ethnicity, was associated with less tumor downstaging (odds ratio [OR], 0.86 [95% CI, 0.78-0.94]), less frequent pN0 status (OR, 0.91 [95% CI, 0.83-0.99]), and less frequent pCR (OR, 0.81 [95% CI, 0.72-0.92]). Other factors associated with reduced rate of pCR included rural location (OR, 0.80 [95% CI, 0.69-0.93]), lack of or inadequate insurance (OR for Medicaid, 0.86 [95% CI, 0.76-0.98]; OR for no insurance, 0.65 [95% CI, 0.54-0.78]), and treatment in a low-volume center (OR for first quartile, 0.73 [95% CI, 0.62-0.87]; OR for second quartile, 0.79 [95% CI, 0.70-0.90]; OR for third quartile, 0.86 [95% CI, 0.78-0.94]). Clinical and pathologic variables associated with a decreased pCR included higher tumor grade (OR, 0.58 [95% CI, 0.49-0.70]), advanced tumor stage (OR for T3, 0.56 [95% CI, 0.42-0.76]; OR for T4, 0.30 [95% CI, 0.22-0.42]), and lymph node-positive disease (OR for N1, 0.83 [95% CI, 0.77-0.89]; OR for N2, 0.73 [95% CI, 0.65-0.82]). The findings of this cohort study suggest that disparate treatment outcomes for Hispanic and non-Hispanic Black patients are likely multifactorial in origin. Future investigation into additional social determinants of health and biological variables is warranted.

Sex-specific outcomes in cancer therapy: the central role of hormones.

Sex hormones play a pivotal role in modulating various physiological processes, with emerging evidence underscoring their influence on cancer progression and treatment outcomes. This review delves into the intricate relationship between sex hormones and cancer, elucidating the underlying biological mechanisms and their clinical implications. We explore the multifaceted roles of estrogen, androgens, and progesterone, highlighting their respective influence on specific cancers such as breast, ovarian, endometrial, and prostate. Special attention is given to estrogen receptor-positive (ER+) and estrogen receptor-negative (ER-) tumors, androgen receptor signaling, and the dual role of progesterone in both promoting and inhibiting cancer progression. Clinical observations reveal varied treatment responses contingent upon hormonal levels, with certain therapies like tamoxifen, aromatase inhibitors, and anti-androgens demonstrating notable success. However, disparities in treatment outcomes between males and females in hormone-sensitive cancers necessitate further exploration. Therapeutically, the utilization of hormone replacement therapy (HRT) during cancer treatments presents both potential risks and benefits. The promise of personalized therapies, tailored to an individual's hormonal profile, offers a novel approach to optimizing therapeutic outcomes. Concurrently, the burgeoning exploration of new drugs and interventions targeting hormonal pathways heralds a future of more effective and precise treatments for hormone-sensitive cancers. This review underscores the pressing need for a deeper understanding of sex hormones in cancer therapy and the ensuing implications for future therapeutic innovations.

Racial and ethnic differences in thymic epithelial tumors: A single-institution retrospective analysis.

e20649 Background: Thymic epithelial tumors (TETs) are a rare, heterogeneous group of malignancies that arise from the thymus. While the etiology of TETs remains unknown, variation in incidence rates amongst racial/ethnic groups has raised the possibility of germline predispositions. Unfortunately, due to the rarity of this disease, there is a limited understanding of the impact of race/ethnicity on tumor characteristics and treatment outcomes for TET patients. We sought to characterize patient/tumor data and investigate treatment outcomes based on race and ethnicity. Methods: We conducted a single-institution, retrospective database analysis of TET patients evaluated at the IUSCCC from 1979 – 2021 from which clinical annotations were available for 477 thymoma and 164 thymic carcinoma (TC) patients. We identified 112 thymoma and 35 TC patients who were deemed to have sufficient data for evaluation of racial/ethnic characteristics. Demographic/clinical variables and therapeutic interventions, including treatment outcomes, were analyzed. Data was compiled and analyzed using descriptive statistics and the Kaplan Meier method for survival analysis via GraphPad Prism software. Results: Of the 112 thymoma patients, 29 thymoma patients presented with de novo metastatic disease at the time of diagnosis. The median age at the time of diagnosis of all patients revealed a statistically significant difference between White and Black TET patients (53.0 v. 42.0 years, *p = 0.0195). There was a trend towards significance when median age of diagnosis between White and Asian TET patients was compared (53.0 v. 48.0 years, p = 0.0633, NS). Advanced histologic subtypes, include B3 and TC, appeared predominantly in Asian and Black patients at 77.7% and 56.3%, respectively, compared to White patients (44.9%), though the finding was not statistically significant. No statistically significant differences between racial/ethnic groups regarding progression free survival for unresectable or metastatic disease were observed, regardless of histology. There was a non-significant difference in recurrence free survival for resectable thymoma in White (30.0 months) and Asian/Pacific Islander (47.0 months) patients compared to Black patients (24.0 months). Conclusions: Overall, this analysis suggests differences in the median age of diagnosis for patients with thymic malignancies based on race, raising the possibility of inherent biologic differences driving oncogenesis and symptoms at the time of presentation. While no statistically significant differences in treatment outcomes were found based on race and ethnicity, Black patients appeared to experience shorter times to recurrence after definitive surgery. Further studies to understand the mechanistic differences driving tumorigenesis and potential disparities in treatment outcomes are greatly needed in this rare tumor type.

It’s Time to Stop Talking About Cellular Therapy Disparities and Take Action

The cellular therapy community has long recognized inequality in access to treatment and disparities in treatment outcomes based on patient race, ethnicity, and socioeconomic status. It is no longer enough to recognize the problem exists. As the late John Lewis stated, “If you see something that is not right, not fair, not just, you have a moral obligation to do something about it.” The cellular therapy community, which includes hematopoietic cell transplantation (HCT), must advance efforts to end these inequities.

Comparison of Black and White participants with severe mental illness in response to cognitive remediation as an augmentation of vocational rehabilitation.

Despite evidence that cognitive remediation improves cognitive and employment outcomes in persons with severe mental illnesses (SMI), its effects have not been systematically compared between Black and White participants. Considering that Black adults have more negative experiences receiving mental health treatment, providers may have greater difficulty engaging and retaining Black Americans in cognitive remediation. Due to the effects of structural racism on reducing employment opportunities for Black Americans, it is unclear whether Black participants will reap the same benefits of cognitive remediation on work outcomes as White Americans. This paper addressed this question. A secondary analysis was conducted of five randomized controlled trials comparing cognitive remediation (the Thinking Skills for Work program: TSW) and vocational rehabilitation vs. vocational rehabilitation only in 137 Black and 147 White Americans (64.2% schizophrenia-schizoaffective disorder) who were followed up for two years. Comparable proportions of Black and White participants were engaged and retained in TSW (>75%). Participants who received TSW improved significantly more in cognition than those receiving vocational services alone, with no racial differences in benefit. Participants in TSW obtained more work, earned more wages, and worked more weeks than those receiving vocational services alone, with no differences between the races. The findings indicate that Black Americans with SMI receiving vocational services could be successfully engaged in and benefit from cognitive remediation, highlighting the vital role of healthcare service systems in giving credence to structural racism to more effectively mitigate racial disparities in treatment outcomes.

Prognostic Associations of Concomitant Antibiotic Use in Patients with Advanced NSCLC Treated with Atezolizumab: Sensitivity Analysis of a Pooled Investigation of Five Randomised Control Trials

Immune checkpoint inhibitors (ICIs) have been a significant milestone for the treatment of advanced non-small cell lung cancer (NSCLC). However, the efficacy of ICIs can vary substantially between patients, with disparities in treatment outcomes being potentially driving by changes in the microbiome. Antibiotics can cause dysbiosis and are hypothesised to impact the efficacy of ICIs Methods: Data were pooled from five randomised clinical control trials, IMpower130, IMpower131, IMpower150, OAK, and POPLAR, assessing atezolizumab in advanced NSCLC. Cox proportional hazard models were used to determine whether antibiotic use within 6-weeks before and after randomisation was associated with progression-free survival (PFS) and overall survival (OS) outcomes, with data further stratified by programmed death ligand-1 (PD-L1) status. Antibiotic use was significantly associated with worsened PFS (hazard ratio (HR) = 1.19 [1.08-1.30], p ≤ 0.001) and OS (HR = 1.27 [1.13-1.42], p ≤ 0.001) in patients treated with atezolizumab and those not treated with atezolizumab (PFS, HR = 1.21 [1.08-1.36] p < 0.001, OS, HR = 1.33 [1.16-1.51] p < 0.001). These associations were relatively consistent in both PD-L1 positive and PD-L1 negative. Antibiotic use within a ±6-week window was significantly associated with worse PFS and OS.

Clinician experiences on training and awareness of sexual orientation in NHS Talking Therapies Services for Anxiety and Depression

Abstract Previous research that explored sexual minority service users’ experiences of accessing NHS Talking Therapies for Anxiety and Depression Services highlighted the need for specific sexual orientation training. Inconsistent or lack of training may contribute to disparities in treatment outcomes between sexual minority service users and heterosexual service users. The aim of the study was to explore clinicians’ competencies working with sexual minority service users, their experiences of sexual orientation training, their view of current gaps in training provision, and ways to improve training. Self-reported sexual orientation competency scales and open-ended questions were used to address the aims of the study. Participants (n=83) included Psychological Wellbeing Practitioners (PWPs) and high-intensity CBT therapists (HITs). Responses on competency scales were analysed using Kruskal–Wallis tests and thematic analysis was used to analyse qualitative responses. Participants who identified as 25–29 years old had higher scores on the knowledge scale than 45+-year-olds. Bisexual participants also had higher scores on the knowledge subscale than heterosexual participants. Three over-arching themes were identified: (a) training received on sexual minority issues by Talking Therapies clinicians, (b) clinicians’ experiences of accessing and receiving sexual minority training, and (c) perceived gaps in current sexual minority training and ways to improve training. Findings were linked to previous literature and recommendations to stakeholders are made throughout the Discussion section with the view of improving sexual orientation training. Key learning aims (1) To understand current training provision of sexual orientation training across NHS Talking Therapies courses and services in England. (2) To consider clinicians’ experiences of challenges and barriers that may prevent them from accessing or implementing sexual orientation training in clinical practice. (3) To understand clinicians’ views of the current gaps in training and ways to improve training provision. (4) To make recommendations to NHS Talking Therapies for Anxiety and Depression courses and services in ways to improve training on sexual orientation to better meet the learning needs of clinicians and service users.

Disparities in substance use treatment retention: An exploration of reasons for discharge from publicly funded treatment

Although Delaware is the seventh smallest state in the country (including Washington, D.C.) in terms of population size, it has the second highest drug overdose death rate. The Delaware Division of Substance Abuse and Mental Health has increased attention in identifying disparities in treatment outcomes. We explored reasons for discharge from publicly-funded treatment in Delaware with special attention to populations at risk for health inequities, with a focus on covariates of treatment non-completion. Using secondary data collected from publicly-funded treatment providers, we analyzed data from individuals that were admitted to substance use treatment between 2015 and 2019 and had been discharged in 2019. We did this by using logistic and multinomial regression, focusing on non-completion treatment outcomes such as failure to meet requirements, loss of contact, and treatment refusal. Clients who were Black or African American, compared to white clients, were more likely to be lost contact with, administratively discharged, or marked as failing to meet treatment requirements than having a completed treatment discharge. Women were 30% less likely than men to have “failed to meet treatment requirements” compared to completing treatment. Further investigation is needed into these patterns. While treatment quality cannot be assessed using this data, the results point to a need for closer study of disparities in treatment related to race, ethnicity, gender, employment, criminal justice involvement, and type of drug used. Treatment providers should be made aware of culturally informed care, as well as client-created goals, in order to reduce disparities in exit from treatment.

THE LIVED EXPERIENCE OF INFERTILITY IN ASIAN AMERICANS: A QUALITATIVE STUDY

Patients who identify as Asian American have lower clinical pregnancy and lower live-birth rates following infertility treatment compared to their white counterparts. There are many suspected sociocultural reasons for the disparities in treatment outcomes. Our study explores the common psychosocial and cultural barriers Asian Americans face with their infertility experience.

Vitamin D insufficiency as a peripheral neuropathy risk factor in white and black patients in SWOG 0221.

12023 Background: Peripheral neuropathy (PN) is a treatment-limiting toxicity of paclitaxel. Black patients have higher rates of PN and vitamin D insufficiency, and our prior work suggests vitamin D insufficiency increases risk of paclitaxel-induced PN. The objective of this study was to validate that patients with vitamin D insufficiency have higher risk of paclitaxel-induced PN and investigate whether this explains racial disparities in PN risk. Methods: This retrospective validation study was conducted in the phase III SWOG 0221 (NCT00070564) trial comparing paclitaxel-containing chemotherapy regimens for early-stage breast cancer. Pre-treatment 25-hydroxy-vitamin D was quantified in cryopreserved serum. Males and patients who received less than a third of the paclitaxel treatment were excluded. The association between vitamin D insufficiency (≤20 ng/mL) and grade 3+ sensory PN was tested via logistic regression and then adjusted for self-reported race, age, paclitaxel schedule (QW vs Q2W), and body mass index. Results: Of the 1,116 female patients in the analysis, 169 (15.1%) experienced PN and 376 (33.7%) had vitamin D insufficiency. Vitamin D insufficiency was associated with higher PN risk (19.4% vs 13.0%, OR = 1.62, p = 0.005, Data Table). The association was borderline significant (OR = 1.44, p = 0.056) after adjustment for black race (OR = 2.41, p = 0.001), paclitaxel schedule (OR = 2.22, p &lt; 0.001), and age (OR = 1.03, p = 0.005). Compared with white patients (n = 943), black patients (n = 99) had more prevalent vitamin D insufficiency (77.8% vs 28.6%, OR = 8.72, p &lt; 0.001) and increased PN risk (29.3% vs 13.5%, OR = 2.66, p &lt; 0.001); adjusting for vitamin D insufficiency decreased but did not eliminate the higher PN risk in black patients (OR = 2.23, p = 0.002). Conclusions: Vitamin D insufficiency increases risk of paclitaxel-induced PN and partially explains the higher risk of PN in black patients. Prospective trials are needed to test whether vitamin D supplementation lessens PN and reduces disparities in treatment outcomes. [Table: see text]

861-P: Differences in Heart Failure Hospitalization Risk following Initiating SGLT2 Inhibitors vs. DPP4 Inhibitors across Race/Ethnicity and Rural/Urban Areas

Objective: Racial and rural disparities exist in the adoption of newer antidiabetic agents, including SGLT2 inhibitors. We aimed to evaluate whether the effectiveness of SGLT2 inhibitors varied across race/ethnicity and rural/urban areas. Methods: Using claims data from 15% samples of national Medicare beneficiaries, we identified individuals who had type 2 diabetes and initiated SGLT2 inhibitors or DPP4 inhibitors (as the active control) between 1/1/2017-12/31/2018. Cohort entry was the day of the first filled prescription of any SGLT2 inhibitors or DPP4 inhibitors, defined as no use of either in the prior year. The outcome was hospitalization for heart failure (HHF) . Inverse probability treatment weighting (IPTW) Cox regressions were applied, controlling for pre-exposure covariates. IPTW models were fitted separately across subgroups. Results: Cohort, mean age was 72 (SD 10) , 53% were women and 2.2% (2,577 / 116,751) experienced HHF over a median follow up of 363 days. Compared with DPP4 inhibitors, SGLT2 inhibitors were associated with a lower risk of HHF (HR, 0.73; CI, 0.65-0.80) . In the subgroup analyses, the beneficial effect of SGLT2 inhibitors vs. DPP4 inhibitors were comparable across non-Hispanic White (HR, 0.77; CI, 0.68-0.87) , non-Hispanic Black (HR, 0.67; CI, 0.49-0.91) and Hispanic (HR, 0.68; CI, 0.50-0.92) groups. SGLT2 inhibitors associated decreased risk of HHF was only seen in individuals living in urban areas (HR, 0.69; CI, 0.61-0.78) but not rural areas (HR, 0.95; CI, 0.76-1.19) . Conclusion: Use of SGLT2 inhibitors, vs. DPP4 inhibitors, was associated with a lower risk of HHF and the effectiveness were comparable across racial and ethnics groups. However, SGLT2 inhibitors’ HHF benefit appeared to have been attenuated in those living in rural areas. Future studies are warranted to understand the mechanisms underlying the potential rural-urban disparities in treatment outcomes. Disclosure J.Guo: None. Y.Li: None. J.Bian: None. D.T.Lackland: None. S.Kimmel: Other Relationship; Janssen Pharmaceuticals, Inc. D.Schatz: Advisory Panel; Abbott Diabetes, Medtronic. A.G.Winterstein: Consultant; Genentech, Inc., Research Support; Merck &amp; Co., Inc.

A systematic review of racial/ethnic disparities in pharmacotherapy and surgical treatment outcomes in peripheral arterial disease among African American/non-Hispanic Black, non-Hispanic White and Hispanic patients

BackgroundLower extremity peripheral arterial disease (PAD) is associated with significant morbidity and mortality in racial/ethnic diverse populations. However, limited data exist on treatment outcome disparities in racial/ethnic diverse populations, particularly in AA/NHB populations. ObjectiveThe aim of this systematic review is to analyze disparities in the outcomes of PAD treatments, particularly pharmacotherapy and surgery, among racial/ethnic groups in the US. MethodsA comprehensive search of original investigations pertaining to PAD treatments between 2015 and 2021 was performed. Quality assessment of the studies was also completed. ResultsFourteen studies were included. Thirteen studies reported differences in treatment outcomes for surgical intervention, and one study reported differences for concurrent surgical and pharmacotherapy. NHB and Hispanic/Latinx ethnicities were associated with decreased overall and perioperative mortality in four studies. Six studies noted increased amputation risk among racial/ethnic diverse populations. Only one study noted significant survival benefit by race/ethnicity. Three studies noted increased risk of major adverse limb events and post-operative complications. One study noted increased limb patency after intervention in racial/ethnic cohorts. Overall, all studies reported high methodological quality with adequate assessment of outcomes and follow-up of cohort. ConclusionIn this analysis, the predominant intervention reported is surgical. Overall, racial/ethnic populations are less likely to experience PAD-associated mortality but are more likely to experience adverse events. Further studies are necessary to include all racial/ethnic diverse populations in assessing PAD therapeutic intervention outcomes. Moreover, targeted public health efforts are necessary to increase PAD educational awareness, community-driven risk modification, and patient-centered care planning.

Racial disparities in frailty and geriatric assessment impairments in older adults with cancer in the Deep South: Results from the CARE Registry.

Despite recent advances in cancer, racial disparities in treatment outcomes persist, and their mechanisms are still not fully understood. The objective of this study was to examine racial differences in frailty and geriatric assessment impairments in an unselected cohort of older adults with newly diagnosed gastrointestinal (GI) malignancies. This study used data from the Cancer and Aging Resilience Evaluation Registry, a prospective cohort study that enrolled older adults (≥60 years) with GI malignancies who were presenting for their initial consultation. Participants who had a geriatric assessment completed before chemotherapy initiation and self-reported as either White or Black were included. Frailty was defined with a frailty index based on the deficit accumulation method. The differences in the prevalence and adjusted odds ratios for frailty and geriatric assessment impairments between Black and White participants were examined. Of the 710 eligible patients who were seen, 553 consented with sufficient data for analyses. The mean age at enrollment was 70 ± 7.1 years, 58% were male, and 23% were Black. Primary cancer diagnoses included colorectal cancer (32%), pancreatic cancer (27%), and hepatobiliary cancer (18%). Black participants were more likely to be frail (50.0% vs 32.7%; P < .001) and report limitations in activities of daily living (27.3% vs 14.1%; P = .001), instrumental activities of daily living (64.8% vs 47.3%; P = .002), and walking 1 block (62.5% vs 48.2%; P = .004). These associations persisted even after adjustments for age, sex, education, cancer type, cancer stage, and comorbidity. Black participants were frailer and reported more limitations in function in comparison with White participants. These findings may partially explain disparities in cancer outcomes and warrant further examination.