Greater Bay Area Cancer Registry Research Articles

Patient-level factors associated with the use of active surveillance: The talking about prostate cancer cohort.

10565 Background: Talking About Prostate Cancer is a population-based cohort study on multilevel determinants of active surveillance (AS) and patient reported outcomes in a racially and ethnically diverse population of men with low-risk prostate cancer. The study includes qualitative one-on-one interviews with patients and physicians, and quantitative cross-sectional provider and longitudinal (baseline and 12-month follow-up) patient surveys to address gaps in the literature regarding patient-level factors associated with AS, particularly among understudied populations including Asian American and Hispanic patients, we assessed socio-demographic characteristics associated with receipt of AS. Methods: Men aged 40-79 diagnosed with low-risk prostate cancer from May 2018 through March 2022 were identified within 12 months of diagnosis from the population-based Greater Bay Area Cancer Registry. To expand recruitment, men were also identified from the cancer registries covering the rest of California. To ensure sufficient representation of diverse racial and ethnic groups, 20% of non-Hispanic White men were sampled, while all Asian American and Pacific Islander, Black, and Hispanic men were invited to participate. Univariable and multivariable logistic regression were used to estimate the odds ratios (OR), adjusted odds ratios (aOR), and 95% confidence intervals (CI), of receiving AS. Potential predictors included year of diagnosis, age, health insurance, usual source of care, race and ethnicity, educational attainment, employment, nativity, and language preference. Results: Among 500 men with low-risk prostate cancer, 27% went on AS, 30% underwent surgery, radiation, hormonal treatment, cryotherapy, and/or high-intensity focused ultrasound, and 43% had not yet made a treatment decision at baseline. Among those who had made a treatment decision at baseline (N = 287), 27% of Hispanic men received AS, which was the lowest proportion among the racial and ethnic groups (Black 28%; Asian 47%; White 59%). A higher proportion of coupled men (29%) received AS compared to single men (15%). Less than half of men with less than a high school education received AS. Compared to men with a high school education or less, men with a bachelor’s degree had an aOR of 2.91 (95% CI 1.10 – 8.42) and men with a graduate degree had an aOR of 4.37 (95% CI 1.50-12.76) of receiving AS. A significantly lower odds of AS was identified among Black (aOR 0.26; 95% CI 0.11-0.64) and Hispanic men (aOR 0.35; 95% CI 0.15 – 0.81) compared to non-Hispanic White men. Conclusions: We identified several significant socio-demographic differences between patients who received definitive treatment versus AS in this cohort, including race and ethnicity and educational attainment. Further study of these domains in larger, diverse samples will elucidate the strength of these associations within racial and ethnic groups.

Patient-reported supportive care needs among Asian American cancer patients

PurposeCancer is the leading cause of death for Asian Americans. However, few studies have documented supportive care needs from the perspective of Asian American cancer patients. This study describes the needs reported by Asian American patients with colorectal, liver, or lung cancer over a 6-month period during their treatment.MethodsParticipants were recruited through the Greater Bay Area Cancer Registry and from cancer care providers in San Francisco. Participants self-identified as Asian or Asian American; were age 21 or older; spoke English, Chinese, or Vietnamese; and had stage I–III colon, rectum, liver, or lung cancer. Participants were matched with a language concordant patient navigator who provided support during a 6-month period. Needs were assessed by surveys at baseline, 3, and 6 months.ResultsAmong 24 participants, 58% were 65 years or older, 42% did not complete high school, and 75% had limited English proficiency (LEP). At baseline, the most prevalent needs were cancer information (79%), nutrition and physical activity (67%), language assistance (54%), and daily living (50%). At the 3- and 6-month follow-up surveys, there was a higher reported need for mental health resources and healthcare access among participants.ConclusionIn this pilot study of Asian American cancer patients who predominantly had LEP, participants reported many needs, with cancer information and language assistance as the most prominent. The findings highlight the importance of culturally and linguistically appropriate patient navigators in addressing supportive care needs among cancer patients with LEP.Trial registrationClinicalTrials.gov identifier: NCT03867916.

Abstract PO-032: Cancer supportive care needs and resource use among Asian American cancer patients: Preliminary findings from a pilot patient navigation intervention, “Patient COUNTS”

Abstract Background: Cancer is the leading cause of death for Asian Americans. Patient navigation has shown benefits in enhancing cancer treatment outcomes and quality of life. Navigational needs in accessing cancer supportive care among Asian American cancer patients and how to address such needs, however, remain understudied. Asian Americans face unique language and cultural barriers in cancer care. We designed a culturally and linguistically-tailored pilot patient navigation intervention, Patient COUNTS, to better understand and address the needs of Asian American cancer patients. Objective: To examine cancer supportive care needs and resource use among patients, who participated in a pilot study that aimed to provide culturally and linguistically-tailored navigation for Asian American cancer patients. Methods: We recruited Asian American adults diagnosed with stage I-III colorectal, liver, or lung cancer from the Greater Bay Area Cancer Registry and San Francisco hospitals. Participants spoke English, Chinese, or Vietnamese and had not completed treatment. Participants were assigned a language-concordant patient navigator, who provided support for six months. This study describes participants' cancer supportive care needs and resource use from telephone and self-administered surveys collected at baseline, three, and six months. Participants included 24 Asian Americans with cancer who completed the baseline survey, with 18 (75%) who completed at least one of the follow-up surveys. Results: Of the study sample (n=24), 63% were men, 55% were 65 years or older, and 42% did not complete high school. A majority (75%) spoke limited English; participants' preferred language included Cantonese/Mandarin (61%), Vietnamese (26%) and English (13%). Most participants had stage I (54%) or III (42%) cancer of the lung (42%), colon (37%), or liver (21%). Across the three surveys, the most frequently reported types of needs by the 24 participants were: cancer information (83%), language translation (54%), basic resources such as financial, transportation, legal, housing, and food access resources (50%), access to healthcare (42%), and mental health (33%). Among the 18 participants who completed the three- or six-month surveys, 90% reported using one or more resources that navigators directed them to. Specifically, of the 18 patients, the most frequently used resources included healthcare (77%), basic needs (67%), language translation (56%), and mental health (28%). Conclusions: The Asian American cancer patients enrolled in Patient COUNTS, a pilot patient navigation program, had a variety of cancer supportive care needs. Findings provided preliminary support of Patient COUNTS as a promising approach to assess cancer supportive care needs and assist navigation of resources among Asian American cancer patients. These findings will inform future interventions to improve the care that Asian American cancer patients receive. Citation Format: Katarina Wang, Janice Tsoh, Carmen Ma, Ching Wong, Hoan Bui, Corina Liew, Junlin Chen, Salma Shariff-Marco, Janet N. Chu, Laura Allen, Mei-Chin Kuo, Debora L. Oh, Scarlett L Gomez, Tung T. Nguyen. Cancer supportive care needs and resource use among Asian American cancer patients: Preliminary findings from a pilot patient navigation intervention, “Patient COUNTS” [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-032.

Survival after Diffuse Large B-Cell Lymphoma Among Children, Adolescents and Young Adults in the Era of Immunotherapy: A Population-Based Study

Introduction Diffuse large B-cell lymphoma (DLBCL) is the most frequent non-Hodgkin lymphoma in adolescents and young adults (AYAs, 20-39 years [y]) and the third most common in children (0-19y). Data on outcomes for AYAs with DLBCL are scarce, but substantial survival gap has been reported, with children having better survival than AYAs, even in the modern era of treatment with immunotherapy combined with conventional chemotherapy. We aimed to investigate the influence of rituximab on the survival of children and AYAs with DLBCL in California.Methods We obtained data from the Greater Bay Area Cancer Registry, which covers 9 California counties and captures at least 98% of all cancer cases. Eligible cases were patients aged less than 39 years when diagnosed with DLBCL during 2001-2014. Facility-level reports for each patient were reviewed in order to abstract information on treatment regimens. Kaplan Meier method was used to estimate 5-year overall survival (OS). Cox proportional regression models were performed to examine the association between OS and treatment, adjusted for age at diagnosis, gender, stage at diagnosis, health insurance status, treatment facility (whether associated with NCI-designated cancer [NCIDCC]), race/ethnicity (including non-Hispanic whites [NHW], non-Hispanic blacks, Hispanics, and Asians/Pacific Islanders [API]), neighborhood socioeconomic status (nSES), and year of diagnosis. Results are presented as adjusted hazard ratios (HR) and associated 95% confidence intervals (CI). Multivariable logistic regression models were used to examine the association of receipt of rituximab with sociodemographic and clinical factors through estimation of the odds ratios (OR) and associated 95% CI.Results We obtained data on 642 patients with DLBCL (n=88, 0-19y; n=554, 20-39y). Rituximab use increased from 64% during 2001-2007 to 79% during 2008-2014. The majority of patients who received rituximab were older (20-39y, n=420, 92%, P<0.0001), of NHW race/ethnicity (n=196, 43%, P=0.09), had private insurance (n=311, 68%, P=0.49), resided in higher nSES (4th & 5th quintiles, n=291, 64%, P=0.49), and were treated at a non-NCIDCC (n=309, 68%, P=0.20). Five-year OS improved significantly over time, from 79% (2001-2007) to 87% (2008-2014), and was higher among patients aged 0-19y (91%) vs. those aged 20-39y (82%), as well as for patients who received rituximab (85%) vs. those who did not receive this treatment (77%). In multivariable-adjusted models, the risk of death was about 50% lower among patients who received rituximab compared to those who did not receive it (HR=0.52, 95% CI 0.34-0.79). Patients aged 20-39y had 2.6 times greater risk of death than those aged 0-19y (HR=2.60, 95% CI 1.23-5.50). The hazard of death was significantly higher among Hispanics (HR=1.74, 95% CI 1.09-2.77 vs. NHW), for patients who lacked health insurance (HR=2.21, 95% CI 1.21-4.02 vs. privately insured) or were publicly insured (HR=1.70, 95% CI 1.08-2.66), and for those with advanced stage at diagnosis (HR= 2.81, 95% CI 1.72-4.59 vs. localized). On a multivariable logistic regression analysis in which all variables were mutually adjusted, the odds of receipt of rituximab was significantly higher in the more recent calendar period of diagnosis (2008-2014, OR=3.58, 95% CI 2.17-5.92), among AYAs (vs. 0-19y, OR=9.57, 95% CI 5.33-17.19), among APIs (vs. NHW, OR=1.85, 95% 1.06-3.10), and for patients with advanced stage at diagnosis (vs. localized, OR=1.81, 95% CI 1.06-3.10). Insurance status, treatment facility and nSES were not associated with receipt of rituximab. In our cohort, about 14% of patients had HIV/AIDS. When we excluded these patients from the analysis, the same pattern of associations was observed, although the magnitude of some of the associations was attenuated (Table).Conclusions Our study confirms the benefit of using rituximab on the treatment of children and AYAs with DLBCL. However, the worse survival observed among AYAs and patients of Hispanic race/ethnicity are concerning and warrant further investigation.Although patients who lacked health insurance or were publicly insured had lower survival than private insured patients, insurance status, treatment facility, nSES and Hispanic race/ethnicity were not found to be associated with the receipt of rituximab. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Abstract D067: The REACT study: A feasibility study to develop and test the integration of a California Cancer Registry Early Case Ascertainment process via electronic pathology reporting with an online clinical trial matching tool

Abstract Background: Representation of diverse patient populations in prostate cancer clinical trials is essential to ensure that trial results are applicable to all affected men. However, underrepresentation among racial/ethnic minorities remains a critical problem in cancer research. Population-based cancer registries provide a potential platform to overcome problems with inclusion of diverse patient populations in clinical research if they are used as a source for recruitment. Methods: Leveraging the statewide implementation of electronic pathology (e-path) for cancer case identification, we performed a pilot feasibility study, REACT (Registry Early case Ascertainment process via e-path with an online Clinical Trial matching tool), within the Greater Bay Area Cancer Registry to (1) develop and test a process using e-path to rapidly identify new cases of advanced prostate cancer for potential enrollment into existing prostate cancer clinical trials; and (2) test the utility of an online clinical trial matching tool used in combination with e-path to improve matching of underrepresented patients into advanced prostate cancer clinical trials. All study materials were translated into Spanish, and a Spanish-speaking bilingual recruiter is one of two recruiters. This study will accrue 50 patients. Results: Thus far, a total of 224 cases were identified from 19 reporting facilities through e-path and 213 (92%) were sent invitation letters. We have initiated recruitment contact calls with N=101; of these, 11 were excluded due to physician-indicated contraindication, and 17 (17%) declined participation. To date, 12 patients have enrolled in the study, 10 of whom completed baseline surveys, and 4 subsequently completed follow-up surveys after using the online matching tool. The majority (N=7) of participants were NH White; of higher income, &amp;gt;$150,000 (N=6); and of higher education, &amp;gt;bachelor’s/associate degree (N=8). Nine participants indicated use of the internet to learn about prostate cancer and 4 found internet prostate-cancer related information very useful. Nine participants reported receipt of prostate cancer treatment in the past 3 months, 8 received hormonal therapy, 4 received radiation, and 2 received surgery. To assess research knowledge and attitudes, 7 indicated awareness of cancer clinical trials, 6 indicated interest in participating in clinical research, 7 held a positive and 3 held a neutral attitude towards cancer clinical trials, however 5 indicated that they would not participate in a randomized study. To assess utility of the matching tool, 2 indicated it increased their interest in participating in clinical trials. Discussion: As the study progresses, we will focus effort on recruitment of underserved patients. However, thus far, preliminary results indicate that e-path used in combination with an online clinical trial matching tool may serve as an important recruitment vehicle for prostate cancer clinical trials. Citation Format: Hala T Borno, Christine Duffy, Sylvia Zhang, Todd Golden, Zinnia Loya, Debby Oh, Anobel Odisho, Scarlett Lin Gomez. The REACT study: A feasibility study to develop and test the integration of a California Cancer Registry Early Case Ascertainment process via electronic pathology reporting with an online clinical trial matching tool [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D067.

Abstract B053: Factors that influence prostate cancer treatment decisions: A qualitative study among a diverse, population-based sample of men with low-risk prostate cancer in Northern California

Abstract Background: Most men diagnosed with prostate cancers of low grade and low potential for progression are expected to have comparable survival as other men their age without prostate cancer. Thus, active surveillance (i.e., closely monitoring the course of disease with the expectation to intervene given evidence of cancer progression) is universally recommended as a viable management option for men with these tumors. However, men may not be adequately informed about their treatment options; for example, there is evidence that active surveillance is less frequently discussed with underserved men, such as minorities, those of low socioeconomic status, or those with limited English proficiency. Methods: This study is the first (qualitative) phase of a sequential mixed-methods study to explore factors that influence prostate cancer treatment among a diverse group of men with low risk disease. We conducted 43 in-depth interviews with patients diagnosed within the prior 24 months with low-risk prostate cancer recruited from the Greater Bay Area Cancer Registry (13 Asian Americans, 10 African Americans, 10 Latinos, and 10 Non-Hispanic Whites). Interviews were conducted in English, Spanish, Cantonese, or Mandarin. To date, 38 interviews have been transcribed, and coded in Dedoose using 29 codes. Three study staff reviewed all interview excerpts tagged with each code to identify factors that played a role in patients’ decision-making. These factors were then incorporated into an epidemiologic survey being developed for the second (quantitative) phase of the study. Results: Themes related to treatment decision-making include: concern for and obligation to partner/family, others’ experiences with treatment, clinical factors (grade/stage), health insurance, medical mistrust, cancer-related anxiety, comorbidities, race/ethnicity/culture, and religion/spirituality. We incorporated these themes into the quantitative survey by drafting survey items on: burden on family members, experiences of family/friends with cancer, avoidance of repeated tests, anxiety related to anticipation of test results, preference for immediate action rather than waiting to see whether the cancer progresses, personality and coping preferences, cultural factors (e.g., stigma regarding cancer, norms/expectations regarding manhood), and life stage and lifestyle. Most of these items have not been included in prior surveys of prostate cancer treatment decision-making. Conclusions: We identified many novel factors influencing treatment decisions among a diverse group of prostate cancer patients in the Greater San Francisco Bay Area, illustrating how a mixed-method approach can be used to augment knowledge regarding treatment decision-making in diverse populations. Ongoing quantitative work will examine the importance of these factors among a larger study population. This work will assist providers to better support patients with low risk prostate cancer as they go through the treatment decision-making process. Citation Format: Salma Shariff-Marco, Janet Shim, Laura Allen, Mei-Chin Kuo, Kathie Lau, Todd Golden, Zinnia Loya, Alice Guan, Mindy C. DeRouen, Debora Oh, Daphne Lichtensztajn, TAP Study Team, Scarlett Lin Gomez. Factors that influence prostate cancer treatment decisions: A qualitative study among a diverse, population-based sample of men with low-risk prostate cancer in Northern California [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B053.

REACT: A feasibility study to test the integration of a cancer registry early case ascertainment process via electronic pathology reporting with an online clinical trial matching tool.

207 Background: Representation of diverse patient populations in prostate cancer clinical trials is essential to ensure results are applicable to all men. However, underrepresentation among underserved populations remains a critical problem. Population-based cancer registries provide a potential platform to overcome problems with inclusion of diverse patient populations in clinical research when used as a source for recruitment. Methods: Leveraging statewide implementation of early-case ascertainment (ECA) via electronic pathology for cancer case identification, we performed a feasibility study within the Greater Bay Area Cancer Registry to (1) test a process using ECA to identify new cases of advanced prostate cancer for potential enrollment into clinical trials and (2) test the utility of an online clinical trial matching tool to improve matching of underrepresented patients into clinical trials. All study materials were translated into Spanish, and recruiters were Spanish-speaking. Results: A total of 419 cases were identified from 19 reporting facilities through ECA and sent invitation letters; 18 cases were excluded due to physician contraindication, and 68 (16%) declined participation. All enrolled participants (N=54) completed baseline surveys. To date, 40 participants completed follow-up surveys after using the online matching tool. Most participants were White (80%), of higher income (&gt;$150,000; 41%), and college-educated (70%). Thirty-seven percent indicated awareness of cancer clinical trials, 69% stated interest in participating in clinical research, and 72% held a positive attitude towards cancer clinical trials. However, 46% indicated they would not participate in a randomized study. To assess utility of the matching tool, 65% indicated it increased their interest in participating in a clinical trial. Conclusions: ECA needs to ensure sociodemographic data are available to make it useful as a tool for clinical trials. Preliminary results indicate ECA used in combination with an online clinical trial matching tool may serve as an important recruitment vehicle for prostate cancer clinical trials.

Breast Cancer in San Francisco: Disentangling Disparities at the Neighborhood Level.

This study uses a novel geographic approach to summarize the distribution of breast cancer in San Francisco and aims to identify the neighborhoods and racial/ethnic groups that are disproportionately affected by this disease. Nine geographic groupings were newly defined on the basis of racial/ethnic composition and neighborhood socioeconomic status. Distribution of breast cancer cases from the Greater Bay Area Cancer Registry in these zones were examined. Multivariable logistic regression models were used to determine neighborhood associations with stage IIB+ breast cancer at diagnosis. Cox proportional hazards regression was used to estimate the hazard ratios for all-cause and breast cancer-specific mortality. A total of 5,595 invasive primary breast cancers were diagnosed between January 1, 2006 and December 31, 2015. We found neighborhood and racial/ethnic differences in stage of diagnosis, molecular subtype, survival, and mortality. Patients in the Southeast (Bayview/Hunter's Point) and Northeast (Downtown, Civic Center, Chinatown, Nob Hill, Western Addition) areas were more likely to have stage IIB+ breast cancer at diagnosis, and those in the East (North Beach, Financial District, South of Market, Mission Bay, Potrero Hill) and Southeast were more likely to be diagnosed with triple-negative breast cancers (TNBC). Compared with other racial/ethnic groups, Blacks/African Americans (B/AA) experienced the greatest disparities in breast cancer-related outcomes across geographic areas. San Francisco neighborhoods with lower socioeconomic status and larger minority populations experience worse breast cancer outcomes. Our findings, which reveal breast cancer disparities at sub-county geographic levels, have implications for population-level health interventions.

Patient-clinician interactions and disparities in breast cancer care: the equality in breast cancer care study.

To examine whether interpersonal aspects of patient-clinician interactions, such as patient-perceived medical discrimination, clinician mistrust, and treatment decision-making contribute to racial/ethnic/educational disparities in breast cancer care. A telephone interview was administered to 542 Asian/Pacific Islander (API), Black, Hispanic, and White women identified through the Greater Bay Area Cancer Registry, ages 20 and older diagnosed with a first primary invasive breast cancer. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated from logistic regression models that assessed associations between race/ethnicity/education, medical discrimination, clinician mistrust, and treatment decision-making with concordance to breast cancer treatment guidelines (guideline-concordant treatment) and perceived quality of care (pQoC). Approximately three-quarters of women received treatment that was guideline-concordant (76.6%) and reported that their breast cancer care was excellent (72.1%). Non-college-educated Black women had lower odds of guideline-concordant care (aOR (CI) = 0.29 (0.12-0.67)) vs. college-educated White women. Odds of excellent pQoC were lower among the following: college-educated Hispanic women (aOR (CI) = 0.09 (0.02-0.47)) and API women regardless of education (aORs ≤ 0.50) vs. college-educated White women, women reporting low and moderate levels of discrimination (aORs ≤ 0.44) vs. none, and women reporting any clinician mistrust (aOR (CI) = 0.50 (0.29-0.88)) vs. none. Disparities in guideline-concordant care and pQoC persisted after controlling for medical discrimination, clinician mistrust, and decision-making. Interpersonal aspects of the patient-clinician interaction had an impact on pQoC but not receipt of guideline-concordant treatment and did not explain disparities in either outcome. Although breast cancer survivors' interpersonal interactions with clinicians did not influence receipt of appropriate treatment, intervention strategies to improve patient-clinician relations may help attenuate disparities in survivors' pQoC.

Adoption of pediatric-inspired acute lymphoblastic leukemia regimens by adult oncologists treating adolescents and young adults: A population-based study.

Studies have demonstrated superior outcomes for adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) who are treated using pediatric versus adult therapeutic regimens. To the best of our knowledge, whether adult oncologists in the United States have adopted this approach to ALL in AYA patients is currently unknown. The objective of the current study was to provide a population-based description of ALL treatment patterns in AYA individuals over the past decade. Data regarding AYA patients aged 15 to 39 years and diagnosed with ALL between 2004 and 2014 while living in the Greater Bay Area were obtained from the Greater Bay Area Cancer Registry (GBACR). Treating facilities were designated as pediatric or adult centers; induction treatment regimens were abstracted from registry text data fields. Of 304 patients diagnosed in the GBACR catchment region, complete treatment data were available for 229 (75%). The location of care was identified for 296 patients (97%) treated at 31 unique centers. Approximately 70% of AYA patients received induction therapy at an adult treatment center. All AYA patients who were treated at pediatric centers received pediatric ALL regimens. Among AYA patients treated by adult oncologists with complete treatment data, none received a pediatric regimen before 2008. Between 2008 and 2012, while the US Adult Intergroup C10403 pediatric-inspired ALL protocol was open to accrual, 31% of AYA patients treated by adult oncologists received pediatric regimens. This rate fell to 21% from 2013 through 2014. Adult facilities treating ≥ 2 AYA patients with ALL per year captured in the GBACR were more likely to administer pediatric regimens than lower volume centers (P = .03). As of 2014, only a minority of AYA patients with ALL received pediatric ALL regimens at adult cancer centers. Cancer 2017;122-130. © 2016 American Cancer Society.

Residential cancer cluster investigation nearby a Superfund Study Area with trichloroethylene contamination.

Trichloroethylene (TCE) is an industrial solvent associated with liver cancer, kidney cancer, and non-Hodgkin's lymphoma (NHL). It is unclear whether an excess of TCE-associated cancers have occurred surrounding the Middlefield-Ellis-Whisman Superfund site in Mountain View, California. We conducted a population-based cancer cluster investigation comparing the incidence of NHL, liver, and kidney cancers in the neighborhood of interest to the incidence among residents in the surrounding four-county region. Case counts and address information were obtained using routinely collected data from the Greater Bay Area Cancer Registry, part of the Surveillance, Epidemiology, and End Results program. Population denominators were obtained from the 1990, 2000, and 2010 US censuses. Standardized incidence ratios (SIRs) with two-sided 99 % confidence intervals (CIs) were calculated for time intervals surrounding the US Censuses. There were no statistically significant differences between the neighborhood of interest and the larger region for cancers of the liver or kidney. A statistically significant elevation was observed for NHL during one of the three time periods evaluated (1996-2005: SIR = 1.8, 99 % CI 1.1-2.8). No statistically significant NHL elevation existed in the earlier 1988-1995 (SIR = 1.3, 99 % CI 0.5-2.6) or later 2006-2011 (SIR = 1.3, 99 % CI 0.6-2.4) periods. There is no evidence of an increased incidence of liver or kidney cancer, and there is a lack of evidence of a consistent, sustained, or more recent elevation in NHL occurrence in this neighborhood. This evaluation included existing cancer registry data, which cannot speak to specific exposures incurred by past or current residents of this neighborhood.

Abstract C16: Validation of a new medical discrimination scale among a diverse population of breast cancer survivors

Abstract Introduction: Experiences of medical discrimination may impact women's decisions regarding breast cancer treatment. However, measures of perceived discrimination generally are not specific to the medical context, and none are specific to breast cancer. The objective of this study was to determine the structure and psychometric properties of a 9-item scale assessing perceived discrimination among a racially/ethnically diverse sample of women receiving breast cancer care. This scale was developed based on existing measures of general discrimination and recent qualitative research with breast cancer survivors of various racial/ethnic backgrounds. Methods: Women ages 20 and older diagnosed with a first invasive primary breast cancer between 2006 and 2009 were sampled from all available case listings in the Greater Bay Area Cancer Registry. 542 of these women completed a telephone interview in English, Spanish, Mandarin, Cantonese, or Tagalog between 2011 and 2013. Women reported how often they perceived 9 types of discriminatory experiences while receiving breast cancer care using a 4-point scale (never, rarely, sometimes, often). Item-level descriptive statistics and reliability analyses were computed. A categorical confirmatory factor analysis (CCFA) was conducted to determine whether the 9 items reflected a single discrimination construct. Logistic regression was used to evaluate differential item functioning (DIF), examining whether the items performed differently by race after controlling for the level of perceived medical discrimination. A summed medical discrimination score was calculated from the items that supported the unidimensional discrimination construct according to the CCFA and did not show evidence of DIF. Correlations between the summed score and single item measures of perceived racial/ethnic discrimination and satisfaction with breast cancer care were used to assess convergent validity. Results: Reports of medical discrimination were fairly low, with no more than a third of any racial/ethnic group of women reporting discrimination on any item. As a result, responses were dichotomized into never vs. ever experiencing discrimination. A CCFA of all 9 items suggested improved model fit could be achieved by adding a correlated error term between two items with similar wording. After removing the item with the smallest factor loading from this item pair, a final CCFA produced adequate model fit (RMSEA=0.06, CFI=0.99, TLI=0.99). Standardized factor loadings ranged from 0.71-0.91. DIF analyses of the remaining 8 items indicated uniform DIF with an appreciable effect size for one item: “had to wait longer than other people to be seen by your health care team” (p&amp;lt;0.001, effect size=0.03). The final medical discrimination scale comprised 7 items and demonstrated good reliability (α=0.84). The mean summed score was 1.24 (SD=1.90; range=0.0-7.0 in total sample). Preliminary evidence of convergent validity was observed: medical discrimination scores were significantly positively correlated with mistreatment while receiving breast cancer care due to race/ethnicity (r=0.39, p&amp;lt;0.0001), and significantly negatively correlated with satisfaction with care (r=-0.42, p&amp;lt;0.0001). Conclusion: A 7-item medical discrimination scale demonstrated unidimensionality, internal reliability, convergent validity, and uniformity of responses by race for women diagnosed with breast cancer. This is the first medical discrimination scale developed for a diverse group of breast cancer patients and may be of interest to researchers and clinicians interested in how perceptions of discrimination in the medical context contribute to disparities in breast cancer care and outcomes. Citation Format: Felisa A. Gonzales, Salma Shariff-Marco, Michelle M. Langer, Bryce B. Reeve, Amani M. Nuru-Jeter, Laura A. Dwyer, Scarlett Lin Gomez. Validation of a new medical discrimination scale among a diverse population of breast cancer survivors. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C16.

Discrimination and quality of life among breast cancer survivors.

250 Background: We examined the role of race/ethnicity, education, and medical discrimination on global and breast cancer-specific (BCS) quality of life (QoL). Methods: Telephone interviews were administered to 536 Asian, Black, Hispanic and White women identified through the Greater Bay Area Cancer Registry who were aged 20+ when diagnosed with a first invasive primary breast cancer between 2006 and 2009. Women reported perceptions of discriminatory experiences while receiving breast cancer care. QoL was assessed with a single item asking about global QoL over the past 4 weeks ( “excellent” vs “less than excellent”) and a summary score for the 6-item breast cancer subscale of the FACT-B (higher scores indicated more concerns (or worse QoL)). Race/ethnicity and education were combined into an 8-category variable (4 race/ethnic groups x 2 education groups). Psychometric analyses was used to create a summed medical discrimination score using 7 items that comprised a single factor, and split into tertiles to indicate no, low, and moderate/high levels of discrimination. Main effects for race/ethnicity x education and medical discrimination were identified using logistic and linear regression models. Adjusted analyses controlled for age, marital status, health insurance, stage, histology, and tumor size. Results: In adjusted analyses, disparities across combined race/ethnicity x education groups were observed for global QoL (Wald χ2(7) = 23.32, p &lt; 0.01) but not for BCS QoL (F= 0.78, p= 0.60). Black and Asian women reported lower global QoL than college-educated White women. Medical discrimination was related to global (Wald χ2(2) = 6.98, p= 0.03) and BCS QoL (F= 6.14, p&lt; 0.01). Women reporting moderate/high levels of medical discrimination had significantly lower odds of excellent QoL (OR= 0.416, p&lt; 0.01) and more breast cancer concerns (β= 1.19, t= 3.50, p&lt; 0.001) than women reporting no discrimination. Conclusions: Medical discrimination was associated with lower global and BCS QoL. More research is needed to identify specific factors at the individual, provider, and organizational levels that contribute to perceptions of medical discrimination so that they can be addressed and QoL can be improved for breast cancer patients.

Perceptions, expectations, and attitudes about communication with physicians among Chinese American and non-Hispanic white women with early stage breast cancer.

Asian Americans have consistently reported poorer communication with physicians compared with non-Hispanic Whites (NHW). This qualitative study sought to elucidate the similarities and differences in communication with physicians between Chinese and NHW breast cancer survivors. Forty-four Chinese and 28 NHW women with early stage breast cancer (stage 0-IIa) from the Greater Bay Area Cancer Registry participated in focus group discussions or individual interviews. We oversampled Chinese women because little is known about their cancer care experiences. In both interview formats, questions explored patients' experiences and feelings when communicating with physicians about their diagnosis, treatment, and follow-up care. Physician empathy at the time of diagnosis was important to both ethnic groups; however, during treatment and follow-up care, physicians' ability to treat cancer and alleviate physical symptoms was a higher priority. NHW and US-born Chinese survivors were more likely to assert their needs, whereas Chinese immigrants accepted physician advice even when it did not alleviate physical problems (e.g., pain). Patients viewed all physicians as the primary source for information about cancer care. Many Chinese immigrants sought additional information from primary care physicians and stressed optimal communication over language concordance. Physician empathy and precise information were important for cancer patients. Cultural differences such as the Western emphasis on individual autonomy vs. Chinese emphasis on respect and hierarchy can be the basis for the varied approaches to physician communication we observed. Interventions based on cultural understanding can foster more effective communication between immigrant patients and physicians ultimately improving patient outcomes.

Chemotherapy (CTX) treatment patterns for early-stage breast cancer (ESBC): Changing use of anthracyclines (A).

1083 Background: Anthracyclines (A), given in sequence or combination, have been the mainstay of adjuvant CTX for ESBC. Recent molecular studies have questioned the value of A for ESBC. Trials for ESBC, presented primarily in 2005, have demonstrated similar or improved efficacy with non-anthracycline (NA) CTX. We sought to understand changing use of A for ESBC from 2000-2010 as reported in the population-based 9-county Greater Bay Area Cancer Registry (GBACR). Methods: Using the GBACR database, we recorded use of A or NA based CTX regimens in women with ESBC and no prior CTX from 2000-2010, and correlated type of CTX with tumor stage, receptor status, and age. We evaluated the use of A vs. NA (80% taxane-based) CTX from 2000-2005 and 2006-2010. Results: 16,476 patients (pts) met criteria for inclusion; 2,032 (12%) were excluded (missing information, or CTX not given). Pt characteristics were: median age 52 (range 21-94), stage I (25%), II (56%), and III (19%), 69% HR+. From 2000-2010, 83% received A; overall use of A decreased (87% to 57%), and use of NA increased (13% to 43%). The Table compares use of NA CTX during the two time periods by clinical variables. With short follow-up there was no difference in survival based on use of A vs. NACTX. Conclusions: Use of NA CTX significantly increased during 2006-2010; this trend was independent of age or receptor status and was more pronounced in earlier stage disease. The timing of this change correlated with the presentation of two phase III trials, emphasizing the impact of early data from phase III trials on treatment practice, and confirming results from a large claims database (Giordano). Potential outcome differences will be evaluated in NSABP-B49 and with longer follow-up of this cohort. This study was supported by the UCSF Cancer Registry and CPIC. [Table: see text]

A mixed method exploration of survivorship among Chinese American and non-Hispanic White breast cancer survivors: the role of socioeconomic well-being.

Cancer-related stress is heavily influenced by culture. This study explored similarities and differences in survivorship care concerns among Chinese American and non-Hispanic White (NHW) breast cancer survivors. A sequential, mixed-method design (inductive/qualitative research-phase I and deductive/quantitative research-phase II) was employed. Eligible women identified from the Greater Bay Area Cancer Registry were age ≥21, diagnosed with stage 0-IIa breast cancer between 2006 and 2011, and had no recurrence or other cancers. In phase I, we conducted 4 Chinese (n=19) and 4 NHW (n=22) focus groups, and 31 individual telephone interviews (18 Chinese immigrants, 7 Chinese US-born, and 6 NHW). Content analysis was conducted to examine qualitative data. In phase II, another 296 survivors (148 NHW age-matched to 148 Chinese cases) completed a cross-sectional survey. Descriptive statistics and linear regression analysis were conducted to examine quantitative data. Qualitative data revealed "socioeconomic well-being" (SWB) as a dominant survivorship concern, which was operationalized as a cancer survivor's perceived economic and social resources available to access care. Quantitative data showed that low-acculturated Chinese immigrants reported the poorest SWB, controlling for covariates. Highly acculturated Chinese immigrants and the US-born Chinese/NHW group reported similar SWB. Women who had low-income levels or chemotherapy had poorer SWB. SWB emerged as an important aspect of breast cancer survivorship. Immigration stress, cancer care costs, and cultural values all contributed to immigrants' socioeconomic distress. Immigrant and US-born breast cancer survivors experienced different socioeconomic circumstances and well-being following treatment. Our findings warrant further investigation of socioeconomic distress and survivorship outcomes.

Prediction of BRCA1 Germline Mutation Status in Women With Ovarian Cancer Using Morphology-based Criteria

Specific morphologic features that may predict BRCA1 germline mutation in ovarian cancer have neither been well described nor independently tested. We identified 5 morphologic features associated with BRCA1 mutation status in a series of 20 ovarian cancers from BRCA1 mutation carriers: (1) modified Nottingham grade 3; (2) serous/undifferentiated histology; (3) prominent intraepithelial lymphocytes; (4) marked nuclear atypia with giant/bizarre forms; and (5) abundant mitotic figures. These morphologic features were then tested on 325 ovarian tumors drawn from a population-based Greater Bay Area Cancer Registry and classified into 3 categories independent of the BRCA1 status: "Compatible with BRCA1," "Possibly compatible with BRCA1," and "Not compatible with BRCA1." All "Compatible with BRCA1" tumors were additionally investigated for presence of dominant adnexal mass, fallopian tube mucosal involvement, and uterine cornu involvement. The positive and negative predictive values for "Compatible with BRCA1" were 11/42 (26.2%) and 267/283 (94.3%), respectively, whereas combining the "Compatible with BRCA1" and "Possibly compatible with BRCA1" had positive and negative predictive values of 18/85 (21.2%) and 231/240 (96.3%), respectively. Although dominant adnexal mass and uterine cornu involvement did not add further predictive value, the likelihood of BRCA1 positivity increased to 42.9% when a tumor with "Compatible with BRCA1" histology was also associated with fallopian tube mucosal involvement. The combination of modified Nottingham grade 3 serous or undifferentiated histology, prominent intraepithelial lymphocytes, marked nuclear atypia with giant/bizarre nuclei, and high mitotic index should help to identify women for BRCA1 mutational analysis in the appropriate clinical setting. Ovarian tumors lacking this specific phenotype are unlikely to be associated with BRCA1 and should not undergo mutational analysis in the absence of other indications.

Physical distress and cancer care experiences among Chinese-American and non-Hispanic White breast cancer survivors

ObjectiveThe number of Chinese-American breast cancer survivors (BCS) is increasing as a result of increasing incidence rates. There has been little research on Chinese BCS’ follow-up cancer care. This qualitative study aims to understand how Chinese-American BCS experience and cope with physical distress relative to non-Hispanic White (NHW) survivors. MethodsSeventy-one BCS (37 Chinese immigrant, 7 US-born Chinese, 27 NHW) were recruited from the Greater Bay Area Cancer Registry to participate in focus group discussions or one-on-one interviews about their survivorship experiences. All BCS were diagnosed with breast cancer at stage 0-IIA between 2006 and 2009, and had survived for 1–4years without recurrence. Interviews were conducted in Cantonese, Mandarin, or English. Data analyses followed established qualitative methods of content analysis. ResultsBCS experienced pain and side effects from radiation, surgery, and hormonal therapy. Physical distress subsequently caused emotional concerns about recurrence or metastasis. Most BCS consulted physicians about their physical distress. Chinese immigrant BCS were less likely to have their issues resolved compared to NHW and US-born Chinese who were more likely to question physicians, ask for referrals, and make repeat attempts if their problems were not resolved. Some Chinese immigrant BCS turned to Traditional Chinese Medicine for relief or accepted the idea that physical distress was part of survivorship. ConclusionChinese immigrant BCS may be at risk for greater distress compared with US-born Chinese and NHW BCS because of cultural norms that make them less inclined to express their needs to physicians or challenge physicians when their needs are not met. Furthermore, they may express symptoms in culturally unique ways (e.g., hot–cold imbalances). Further research is needed to determine how to best improve survivorship care experiences in this understudied population, with the goal of decreasing BCS’ physical distress and improving quality of life.

Survival following Non–Small Cell Lung Cancer among Asian/Pacific Islander, Latina, and Non-Hispanic White Women Who Have Never Smoked

Lung cancer is the leading cause of cancer death among U.S. Asian/Pacific Islander (API) and Latina women despite low smoking prevalence. This study examined survival patterns following non-small cell lung cancer in a population-based sample of lung cancer cases from the San Francisco Bay Area Lung Cancer Study (SFBALCS). Women diagnosed with lung cancer from 1998 to 2003 and 2005 to 2008 and identified through the Greater Bay Area Cancer Registry were telephone-screened for eligibility for the SFBALCS. The screener data were linked to the cancer registry data to determine follow-up. This analysis included 187 non-Hispanic (NH) white, 23 U.S.-born Latina, 32 foreign-born Latina, 30 U.S.-born API, and 190 foreign-born API never-smokers diagnosed with lung cancer and followed through 2008. All-cause survival was poorer among APIs [HR=1.7 (95% CI: 1.0-2.8) among U.S.-born APIs and HR=1.2 (95% CI: 0.9-1.5) among foreign-born APIs] and Latinas [HR=2.1 (95% CI: 1.2-3.6) among U.S.-born Latinas; HR=1.4 (95% CI: 0.9-2.3) among foreign-born Latinas] relative to NH whites. These survival differences were not explained by differences in selected sociodemographic or clinical factors. Further research should focus on factors such as cultural behaviors, access to or attitudes toward health care, and genetic variations as possible explanations for these striking racial/ethnic differences. Latina and API female never-smokers diagnosed with lung cancer were up to two times more likely to die than NH whites, highlighting the need for additional research to identify the underlying reasons for the disparities and heightened clinical awareness.

Why do Asian-American women have lower rates of breast conserving surgery: results of a survey regarding physician perceptions

BackgroundUS Asian women with early-stage breast cancer are more likely to receive a modified radical mastectomy (MRM) than White women, contrary to clinical recommendations regarding breast conserving treatment (BCT).MethodsWe surveyed physicians regarding treatment decision-making for early-stage breast cancer, particularly as it applies to Asian patients. Physicians were identified through the population-based Greater Bay Area Cancer Registry. Eighty (of 147) physicians completed a questionnaire on sociodemographics, professional training, clinical practices, and perspectives on the treatment decision-making processes.ResultsThe most important factors identified by physicians in the BCT/MRM decision were clinical in nature, including presence of multifocal disease (86% identified this as being an important factor for selecting MRM), tumor size (71% for MRM, 78% for BCT), cosmetic result (74% for BCT), and breast size (50% for MRM, 55% for BCT). The most important reasons cited for the Asian treatment patterns were patient attitudes toward not needing to preserve the breast (53%), smaller breast sizes (25%), and fear and cultural beliefs (12%).ConclusionThese survey results suggest that physicians perceive major roles of both clinical and cultural factors in the BCT/MRM decision, but cultural factors may be more relevant in explaining surgical treatment patterns among Asians.