Hispanic Cancer Survivors Research Articles

Exploring disparities in healthcare utilization, cancer care experience, and beliefs about cancer among asian and hispanic cancer survivors.

Significant disparities exist in cancer detection, treatment, and outcomes for racial/ethnic minoritized groups in the US. The objective of this study was to explore racial/ethnic disparities in healthcare utilization, cancer care experiences, and beliefs about cancer in patients diagnosed with cancer among diverse racial/ethnic groups in the US. Data from the Health Information National Trends Survey -Surveillance, Epidemiology, and End Results (HINTS-SEER 2021) were analyzed for 1,108 cancer survivors. Bivariate analysis of the study variables with race/ethnicity were conducted with weighted analysis from STATA version 17.Sampling weights using svy was conducted. Racial/ethnic differences in healthcare utilization remained significant when controlling for the confounding factors. Asians and Hispanics were less likely to have a regular healthcare provider compared to non-Hispanic whites (NHW) (aOR = 3.31, p = .003; aOR = 2.17, p = .014; respectively). Asians were less likely than NHW to have had healthcare provider visits in the past 12months (aOR = 4.89, p = .011). There were no statistically significant differences between racial/ethnic groups in the cancer care experiences. Racial/ethnic differences in fatalistic beliefs about cancer were not significant in the final multivariate model; however, being older (β = -.41, p = .033), and having a higher education level (β = -1.23, p < .001), were associated with lower level of fatalistic beliefs about cancer. The findings suggest tailored approaches to improve healthcare utilization rates among racial/ethnic minoritized groups and highlight the need for increased research and clinical practice efforts to address racial/ethnic disparities in the cancer care continuum.

Abstract B015: Disparities in cancer risk behaviors, cannabis use and adverse childhood experiences among cancer survivors

Abstract Introduction. Adults who report Adverse Childhood Experiences (ACEs) are more likely to engage in health-risk behaviors. While previous research has explored the associations between ACEs and health-risk behaviors in the general population, studies focusing on cancer survivors are lacking. We examined the association between cannabis use, alcohol consumption, and smoking by race and ACEs among cancer survivors. Methods. Using cross-sectional data from the 2020 Behavioral Risk Factor Surveillance System, we analyzed 7,896 cancer survivors aged ≥18. We categorized the main exposure, ACEs, based on severity into four categories: zero, one, two to three, and ≥four, derived from questions assessing exposure to eight types of ACEs before the age of 18. The outcome measures were cannabis use (yes or no) and cancer risk behaviors: smoking status (current/former smoker or never smoker), binge alcohol use (yes or no). Binge drinking was defined as males consuming five or more drinks on one occasion and females consuming four or more drinks on one occasion. Weighted multivariable logistic regression models examined association between ACE and the outcomes; cannabis use, binge alcohol use and smoking adjusting for sociodemographic factors. Results. In this sample of cancer survivors, 44.1%, 22.7%, 20.2%, and 13.0% reported having experienced zero, one, two to three, and ≥four ACEs, respectively. Personal history of cannabis use was reported by 6.0% of respondents, current/former smokers by 43.4%, and binge alcohol use by 6.2%. In the adjusted models, cancer survivors with one ACE (aOR: 1.55, 95% CI: 0.92–2.60), two to three ACEs (aOR: 2.56, 95% CI: 1.57–4.27), or ≥four ACEs (aOR: 4.10, 95% CI: 2.54–6.64) had higher odds of cannabis use compared to those with zero ACEs. Similarly, cancer survivors with one ACE (aOR: 1.53, 95% CI: 0.99–2.39), two to three ACEs (aOR: 2.18, 95% CI: 1.36–3.48), or ≥four ACEs (aOR: 2.08, 95% CI: 1.25–3.48) had higher odds of binge drinking compared to those with zero ACEs. Finally, cancer survivors with one ACE (aOR: 1.40, 95% CI: 1.12–1.74), two to three ACEs (aOR: 1.94, 95% CI: 1.54–2.44), or ≥four ACEs (aOR: 3.06, 95% CI: 2.29–4.08) had higher odds being current/former smoker compared to those with zero ACEs. In terms of racial differences, the adjusted models indicated that Hispanic cancer survivors had higher odds of cannabis use (aOR: 2.49, 95% CI: 1.13–5.48) compared to Whites, but lower odds of smoking (aOR: 0.47, 95% CI: 0.28–0.80) compared to Whites. Conclusion. ACEs are strong predictors of adult cannabis use and cancer risk behaviors such as binge drinking and smoking. Therefore, individuals with a history of ACEs may represent an important target group for preventive interventions aimed at reducing these risks. Citation Format: Oluwole A. Babatunde, Melanie S. Jefferson, Swann Adams, Chanita Hughes Halbert, Nosayaba Osazuwa-Peters, Eric Adjei Boakye. Disparities in cancer risk behaviors, cannabis use and adverse childhood experiences among cancer survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B015.

Hispanic Cancer Survivors Exposed to Multiple Natural Disasters: Pre-Post-Disaster Changes in Anxiety, Depression, PTSD, Perceived Stress, and Physical Symptom Burden.

Studies evaluating the effects of natural disasters on cancer outcomes are scarce, especially among USA ethnic minority groups, and none have focused on the effects of concurrent natural disasters and the COVID-19 pandemic. The goal of this secondary data analysis is to explore the impact of concurrent exposure to COVID-19 and earthquakes on psychological distress and symptom burden among Puerto Rican cancer survivors. This secondary data analysis (n = 101) was part of a longitudinal case-control cohort study (n = 402) aimed at describing unmet psychological needs among Puerto Rican cancer patients and non-cancer subjects previously exposed to Hurricane María in 2017. The research team pooled data from participants (cancer survivors and non-cancer group) from their baseline assessments and from follow-up assessments conducted during January-July 2020 (earthquake and the lockdown period). A descriptive, paired t-test, non-parametric mean rank test, and two-sided Pearson correlation analyses were performed. Psychological distress and cancer symptom burden diminished over time. Resilience was significantly correlated with all the psychological and symptom burden variables during both pre- and post-earthquake and COVID-19 assessment periods. The results support the role of resilience, social support, and post-traumatic growth as potential protective factors preventing psychological distress and diminishing cancer symptom burden among cancer survivors exposed to natural disasters and the COVID-19 pandemic.

Exploration of Stress and Inflammatory Biomarkers Among Non-Hispanic Black and Hispanic Cancer Survivors.

To evaluate associations among social determinants of health (SDOH), stress, interleukin-6 (IL-6), and quality of life among non-Hispanic Black and Hispanic cancer survivors. Individuals who had completed cancer treatment and did not identify as White (N = 46) were recruited through community partnerships in western Massachusetts and a state cancer registry. This descriptive cross-sectional study used questionnaires and morning salivary samples to collect data between June 2022 and September 2023. Most participants were breast cancer survivors, were female, identified as African American or Black, and reported moderate levels of stress and low physical activity. Cortisol levels were higher among African American or Black participants, those with lower body mass index, and those with less consumption of fruit and vegetables. Higher symptom experience was associated with higher IL-6 levels. No associations were identified between IL-6 and cortisol or perceived stress and cortisol levels. Incorporating SDOH in self-reported outcomes, including health behaviors and associated biologic indicators, can facilitate early identification and interventions to improve symptom experience and health outcomes of cancer survivors.

Familism, family cohesion, and health-related quality of life in Hispanic prostate cancer survivors.

Familism, the cultural value that emphasizes feelings of loyalty and dedication to one's family, has been related to both positive and negative outcomes in Hispanic cancer survivors. One potential source of observed inconsistencies may be limited attention to the family environment, as familism may be protective in a cohesive family whereas it can exacerbate distress in a conflictive family. The current study explored the associations of familism with general and disease-specific health-related quality of life (HRQoL) in Hispanic men who completed prostate cancer (PC) treatment, and whether family cohesion may help explain these relationships. Hispanic men treated for localized PC (e.g., radiation, surgery) were enrolled in a randomized controlled stress management trial and assessed prior to randomization. Familism (familial obligation) was assessed using Sabogal's Familism Scale and family cohesion was measured using the Family Environment Scale (ranging from high to low). The sexual, urinary incontinence, and urinary obstructive/irritative domains of the Expanded Prostate Cancer Index Composite - Short Form measured disease-specific HRQoL. The physical, emotional, and functional well-being subscales of the Functional Assessment of Cancer Therapy - General captured general HRQoL. Hierarchical linear regression and the SPSS PROCESS macro were used to conduct moderation analyses, while controlling for relevant covariates. Participants were 202 older men on average 65.7 years of age (SD = 8.0) who had been diagnosed with PC an average of 22 months prior to enrollment. Familism was not directly associated with general and disease-specific HRQoL. Moderation analyses revealed that greater familism was related to poorer urinary functioning in the incontinence (p = .03) and irritative/obstructive domains (p = .01), and lower emotional well-being (p = .02), particularly when family cohesion was low. These findings underscore the importance of considering contextual factors, such as family cohesion, in understanding the influence of familism on general and disease-specific HRQoL among Hispanic PC patients. The combined influence of familism and family cohesion predicts clinically meaningful differences in urinary functioning and emotional well-being during the posttreatment phase. Culturally sensitive psychosocial interventions to boost family cohesion and leverage the positive impact of familistic attitudes are needed to enhance HRQoL outcomes in this population.

African American and Hispanic Cancer Survivors' and Caregivers' Experiences in Nebraska.

Racial and ethnic minority populations experience poorer cancer outcomes compared to non-Hispanic White populations, but qualitative studies have typically focused on single subpopulations. We explored experiences, perceptions, and attitudes toward cancer care services across the care continuum from screening through treatment among African American and Hispanic residents of Nebraska to identify unique needs for education, community outreach, and quality improvement.We conducted four focus groups (N = 19), April-August 2021 with people who were aged 30 or older and who self-identified as African American or Hispanic and as cancer survivors or caregivers. Sessions followed a structured facilitation guide, were audio recorded and transcribed, and were analyzed with a directed content analysis approach.Historical, cultural, and socioeconomic factors often led to delayed cancer care, such as general disuse of healthcare until symptoms were severe due to mistrust and cost of missing work. Obstacles to care included financial barriers, transportation, lack of support groups, and language-appropriate services (for Hispanic groups). Knowledge of cancer and cancer prevention varied widely; we identified a need for better community education about cancer within the urban Hispanic community. Participants had positive experiences and a sense of hope from the cancer care team.African American and Hispanic participants shared many similar perspectives about cancer care. Our results are being used in collaboration with national and regional cancer support organizations to expand their reach in communities of color, but structural and cultural barriers still need to be addressed.

Cultural and linguistic adaptation of a telephone-based cognitive-behavioral therapy (CBT) intervention to treat depression and anxiety in Hispanic cancer survivors

Purpose/Objectives The purpose of this study was to transcreate a manualized cognitive-behavioral therapy (CBT) intervention to address depression and anxiety among Hispanic cancer survivors. Design/Research Approach Stakeholders reviewed the CBT workbook for language, content, and cultural relevance. We designed semi-structured interview guides to elicit intervention feedback. Sample/Participants Stakeholder participants were Hispanic cancer survivors (n = 4), bilingual mental health providers (n = 2), and oncology professionals (n = 4). Methods Transcreation was conducted by initial translation of the workbook followed by incorporation of stakeholder feedback. A bilingual (Spanish and English) interviewer conducted stakeholder interviews. The study team discussed themes/suggestions before refining the workbook. Findings Stakeholders reported enthusiasm for the intervention. We gathered significant feedback regarding wording, images, and resources for the workbook. Conclusion Development of culturally appropriate mental health resources for Hispanic cancer survivors is critical. Implications for Psychosocial Providers or Policy By broadening research on psychosocial care to the Hispanic population, we increase the reach of evidence-based psychological care. Future research should fully evaluate the adapted CBT intervention among Hispanic survivors.

Healthy Behaviors Among Non-Hispanic Black and Hispanic People Affected by Cancer During the Posttreatment Survivorship

Background There are disparities in health behaviors across racial and ethnic groups. However, limited studies focus on cancer survivors’ experiences developing and maintaining healthy behaviors, particularly in non-Hispanic Black (NHB) and Hispanic people. Objective This study aimed to understand the experiences of NHB and Hispanic people affected by cancer in developing and maintaining positive health behaviors beyond a cancer diagnosis. Methods The data were collected in a mixed-method study through semistructured interviews with 29 NHB and Hispanic cancer survivors between June and October 2022. Conventional content analysis was used. Results The lived experiences of cancer survivors were narrated in 3 themes: impact of a cancer diagnosis on oneself, facilitators and barriers to health and health behaviors, and utilization of available sources for health. Facilitators and barriers to health and health behaviors were further explored as biological (eg, symptoms, comorbidities), behavioral (eg, help-seeking behavior, sleep pattern), physical/built (eg, available sources, neighborhood), and sociocultural environment (eg, income, transportation, knowledge, culture, upbringing, household and community composition, social and family network), and healthcare system–related factors (eg, insurance coverage, personal preferences, perceived discrimination, and stigma). Conclusion Non-Hispanic Black and Hispanic people, specifically those living in disadvantaged neighborhoods with limited sources or where they feel discriminated and stereotyped, those with limited income and transportation, and those with physical, social, or mental health problems, seemed to have challenges prioritizing health behaviors and maintaining healthy living. Implications for Practice Biological, behavioral, and psychosocial determinants of health behaviors should be addressed through multilevel collaborations among different levels of partners.

Abstract A002: Alcohol use patterns and patient-provider discussions about alcohol use among cancer survivors: Differences by race and ethnicity in the National Survey of Drug Use and Health

Abstract Background: Alcohol is a leading modifiable risk factor for cancer risk and recurrence. The American Cancer Society recommends abstaining from alcohol for cancer prevention and advises that those who choose to drink should limit their intake. Healthcare providers are uniquely positioned to counsel cancer survivors about alcohol’s harms. Prior research has revealed stark differences in heavy drinking among cancer survivors by race and ethnicity. We build on this work by examining the prevalence of multiple alcohol use patterns, alcohol screening, and patient-provider discussions about alcohol by race and ethnicity among a cancer survivor population. Methods: We conducted a cross-sectional study using data from the National Survey on Drug Use and Health (NSDUH) 2015-2019. Eligible respondents included adults (18+ years) who reported a prior cancer diagnosis. Outcomes included alcohol use patterns (lifetime abstention, alcohol use and binge drinking in the past 30 days), alcohol screening in the past year, and report of an in-person alcohol discussion with a healthcare provider in the past year. We estimated the adjusted prevalence of these outcomes by race and ethnicity from marginal effects of logistic regression models that accounted for sociodemographic characteristics (i.e., age, gender, educational attainment, household income) and health insurance type. Models included cluster, strata, and weight variables to account for the complex survey design and nonresponse bias. Results: The unweighted analytic sample size included 6,240 cancer survivors – 431 identified as Black, Non-Hispanic; 461 identified as Hispanic, and 5,348 identified as White, Non-Hispanic. Though not statistically significant, adjusted binge drinking prevalence was highest among Black, Non-Hispanic survivors (17.3% [95% CI: 11.6 – 23.0]) followed by White survivors (13.4% [95% CI: 12.2 – 14.6]) and Hispanic survivors (13.1% [95% CI: 9.8 – 16.4]). Significant differences in adjusted binge drinking prevalence by race and ethnicity were found for binge drinking among current drinkers – Black (41.4% [95% CI: 30.7 – 52.1]), Hispanic (31.7% [95% CI: 22.6 – 40.8]), White (26.7% [95% CI: 24.6 – 28.8]). No significant differences were found for alcohol screening prevalence by race and ethnicity. Black (44.7% [955 CI: 36.4 – 53.0]) and Hispanic (48.8% [95% CI: 40.1 – 57.6%]) cancer survivors were less likely than White survivors (56.9% [95% CI: 54.9 – 59.0]) to report an in-person provider discussion about alcohol. Conclusions: There is a significant racial disparity in problematic drinking between Black, Hispanic, and White cancer survivors, with higher proportions of Black and Hispanic survivors reporting binge drinking than their White peers. Yet, Black and Hispanic cancer survivors are less likely to have an in-person discussion with a provider about alcohol use compared with White cancer survivors. Black and Hispanic cancer survivors may not be receiving important messages about alcohol’s harms from their providers, who could be important sources of this information. Citation Format: Naomi K. Greene, David Dean Jr. Alcohol use patterns and patient-provider discussions about alcohol use among cancer survivors: Differences by race and ethnicity in the National Survey of Drug Use and Health [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 A002.

Abstract A105: Healthy behaviors among non-Hispanic Black and Hispanic people affected by cancer during the post-treatment survivorship

Abstract Background: Racial and ethnic minoritized people, historically experience inequities, are disproportionately affected by suboptimal body weight, diet, and sedentary lifestyle. However, limited studies focus on cancer survivors' experiences developing and maintaining healthy behaviors, particularly in Non-Hispanic Black (NHB) and Hispanic people. Objective. This study aimed to understand the experiences of NHB and Hispanic people affected by cancer in developing and maintaining positive health behaviors beyond a cancer diagnosis. Methods. The data was collected in a mixed-method study through semi-structured interviews with 29 NHB and Hispanic cancer survivors between June- October 2022. Conventional content analysis was used. Results. The lived experiences of cancer survivors were narrated in three themes; 1- Impact of a cancer diagnosis on oneself, 2- Facilitators and Barriers to health and health behaviors, and 3- Utilization of available sources for health. Facilitators and barriers to health and health behaviors were further explored as biological (e.g., symptoms, comorbidities), behavioral (e.g., help-seeking behavior, sleep pattern), physical/built environment (e.g., available sources, neighborhood), and sociocultural environment (e.g., income, transportation, knowledge, culture, upbringing, household and community composition, social and family network), and healthcare system-related factors (e.g., insurance coverage, personal preferences, perceived discrimination, and stigma). Conclusion. NHB and Hispanic people affected by cancer, specifically those living in disadvantaged neighborhoods with limited sources or where they feel discriminated and stereotyped, those with limited income and transportation, and those with physical, social, or mental health problems, appeared to have challenges prioritizing health behaviors and maintaining healthy living. Implications for Practice. Biological, behavioral, and psychosocial determinants of health behaviors should be addressed through multilevel collaborations among different levels of partners. Keywords. Cancer survivorship, health behaviors, racial disparities, non-Hispanic Black and Hispanic people Citation Format: Memnun Seven, Ann Marie Moraitis, Marilyn J. Hammer, Jessica Pearlman, Allecia Reid, Susan Sturgeon, Jennifer Wenzel. Healthy behaviors among non-Hispanic Black and Hispanic people affected by cancer during the post-treatment survivorship [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 A105.

Feasibility and Acceptability of a Text Message Intervention to Promote Adherence to Nutrition and Physical Activity Guidelines in a Predominantly Hispanic Sample of Cancer Survivors and Their Informal Caregivers: Results from a Pilot Intervention Trial.

Hispanic cancer survivors face unique barriers to meeting American Cancer Society (ACS) nutrition and physical activity guidelines, which reduce the risk of cancer recurrence and mortality and improve quality of life. This pilot intervention trial evaluated the feasibility and acceptability of a two-week ACS guideline-based nutrition and physical activity text message intervention in a predominantly Hispanic sample of cancer survivors and their informal caregivers. A mixed methods approach was used to assess feasibility and acceptability of the intervention. Feasibility and acceptability were measured by meeting a-priori cut-offs of >80% for recruitment, retention, and text message response rate. Participants also completed a semi-structured exit interview by telephone that assessed intervention components. Thirteen cancer survivors and six caregivers (n = 19) participated in this pilot study; 78% self-identified as Hispanic. Mean time since treatment completion for survivors was 11.9 years (SD 8.4), and 67% had breast cancer. Cancer survivors had a higher acceptability rate for physical activity (94%) compared to nutrition messages (86%), whereas equal acceptability rates were observed for both types of messages among caregivers (91%). Texting interventions are a feasible, acceptable, and a cost-effective strategy that have the potential to promote lifestyle behavior change among Hispanic cancer survivors and caregivers.

Participation in and Satisfaction with a Community-Based Physical Activity Program Among Hispanic Cancer Survivors.

The objective of this study was to explore the experience of Hispanic cancer survivors participating in Active Living After Cancer (ALAC), a community-based physical activity program. We analyzed participation and satisfaction data from 250 participants who completed the program from 2017 to 2020 (55% Hispanic, 28% Black, 14% non-Hispanic White). Using a hybrid coding approach, open-text survey comments responses from Hispanic participants (n = 138) were qualitatively analyzed and key themes developed to better contextualize the quantitative results. Quantitative analysis revealed that Hispanic participants attended an average of 9.44 out of 12 sessions. There were no differences in attendance by race/ethnicity; however, Hispanic participants reported significantly higher overall satisfaction ratings than non-Hispanic White participants (4.93 vs 4.65 on a 5-point scale). Open-ended comments indicated that Hispanic ALAC participants experience collective efficacy, self-efficacy, and self-regulation, through observational learning enabled by program facilitation. The ALAC program is highly acceptable and relevant to Hispanic cancer survivors and will inform the continued expansion of other community-based survivorship programs for Hispanic communities throughout Texas.

Abstract 751: Disparities in physician office visit wait time among US cancer survivors

Abstract Background: Disparities are well-documented in the time spent seeking medical care in the US. Studies have found that minority populations are likely to have longer wait times securing healthcare access and higher total time spent at clinic visits. However, this relationship has not been previously examined among the cancer survivor population, which constitutes about 17 million people in the US. Methods: Study data were derived from the 2018 National Health Interview Survey, a nationally representative survey of US adults. Study sample was restricted to cancer survivors (n=2,940; N=23,310,174). The primary outcome of this study was reports of prolonged wait times during doctor office visits. Weighted multivariable logistic regression were used to estimate adjusted associations between prolonged wait times during doctor office visits and sociodemographic and behavioral characteristics of cancer survivors. All analyses were conducted using STATA version 14.2. Results: Respondents who identified as Black/African American were almost 3 times more likely than their White counterparts to report prolonged wait times during doctor office visits (aOR 2.65, 95% CI; 1.296, 5.419). Similarly, respondents who identified as Hispanic were almost 3 times more likely than non-Hispanic respondents to report prolonged wait times during doctor office visits (aOR 2.604, 95% CI; 1.347, 5.035). Respondents in the $50,000 - $74,999 income bracket were less likely to report prolonged wait times during doctor office visits than respondents who earned less than $35,000 (aOR: 0.50, 95% CI, 0.276, 0.916). Conclusion: Black/African American and Hispanic cancer survivors had increased odds of reporting prolonged wait times during doctor office visits. Disparities in cancer health and survivorship are well documented among racial minorities. Addressing disparities in healthcare experiences and access will be crucial in dispelling existing cancer health disparities. Citation Format: Onyema Chido-Amajuoyi, Ikenna Nnamani, Owhofasa Agbedia. Disparities in physician office visit wait time among US cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 751.

Racial/Ethnic Disparity in the Relationship of Mental and Physical Health With Colorectal Cancer Screening Utilization Among Breast and Prostate Cancer Survivors.

We examined colorectal cancer (CRC) screening utilization among non-Hispanic White, non-Hispanic Black (NHB), non-Hispanic other (NHO)/Hispanic cancer survivors. We also determined whether experiencing poor physical and/or mental health affects CRC screening utilization in breast and prostate cancers across different racial/ethnic groups. Data from years 2016, 2018, and 2020 of the Behavioral Risk Factor Surveillance System on 3,023 eligible treatment-utilizing cancer survivors with complete treatment were used. We performed descriptive statistics and multivariable logistic regression to examine the mentioned association. Among 3,023 eligible survivors, 67.7% of NHO/Hispanic survivors demonstrated lower CRC screening use compared with non-Hispanic White (82%) and NHB (89%) survivors (P < .001). In multivariable analysis, having frequent (14-30 days) poor mental health was associated with lower odds of receiving CRC screening among NHB (odds ratio [OR], 0.32; 95% CI, 0.11 to 0.95) and NHO/Hispanic (OR, 0.39; 95% CI, 0.18 to 0.81) survivors. Similar results in physical health were also found in NHB (OR, 0.34; 95% CI, 0.13 to 0.91) and NHO/Hispanic (OR, 0.22; 95% CI, 0.05 to 0.91) groups. Among those experienced both frequent poor mental and physical health, NHB/NHO/Hispanic were less likely to be screened for CRC (OR, 0.05; 95% CI, 0.02 to 0.10). NHO/Hispanic survivors demonstrated lower CRC screening use. Frequent poor mental and/or physical health was strongly associated with lower CRC screening use among NHB and NHO/Hispanic survivors. Our study suggests that cancer survivorship care considering mental and physical health status may improve adherence to CRC screening recommendation (for secondary cancer prevention) for NHB, NHO, and Hispanic survivors.

Prevalence of Financial Toxicity Among Hispanic Cancer Survivors: A Nationally Representative Pan-Cancer Analysis.

Prevalence of Financial Toxicity Among Hispanic Cancer Survivors: A Nationally Representative Pan-Cancer Analysis.

Abstract A035: Examining the health-related quality of life of U.S. Hispanic cancer survivors

Abstract Introduction By 2030, Hispanic survivors will likely constitute 20% of the survivor population (4 million people). Compared to non-Hispanic Whites, Hispanic cancer survivors experience worse health-related quality of life (HRQOL) across multiple domains including worse physical, psychological, and social wellbeing. Few studies have examined predictors of HRQOL in a population-based sample of Hispanic cancer survivors. We examined demographic, acculturation, and cancer clinical factors associated with HRQOL in early cancer survivorship. Methodology Utilizing data from the Measuring Your Health (MY-Health) study, which recruited cancer patients from 4 SEER cancer registries between 2010 and 2013, we conducted a secondary analysis of Hispanic survivors who responded to the baseline survey (administered ~9 months after diagnosis; n=908). We examined sample characteristics of the sample, including English language comfort, country of birth, and years in the US. We measured HRQOL outcomes (physical and mental health summary measures, pain interference, anxiety, depression, fatigue, and physical function) using PROMIS® measures validated in English and Spanish. We dichotomized PROMIS scores for clinically relevant symptoms in a cancer population. We conducted linear and logistic regressions examining HRQOL associated with covariates including demographic and cancer characteristics, spirituality, and acculturation factors. Preliminary Results Survivors had a mean age of 60 years, 58% were foreign born, 61% were female, 56% married, 68% had early-stage cancer, 31% had breast cancer, and 23% had prostate cancer. Some survivors reported preferring communicating in English (57%) and those who immigrated to the US had a mean of 30 years in the US. Preliminary results show that this population may be experiencing worse physical and mental health (mean = 43.68 and 47.11; lower scores mean worse health), anxiety, fatigue, and pain (52.7, 53.4, 55.2; high scores mean worse anxiety, fatigue, pain) than national averages (score of 50). Multivariable results are forthcoming. Conclusions In a large and diverse sample of Hispanic cancer survivors, we found survivors report worse quality of life across multiple domains compared to the general population’s self-reported HRQOL. Few interventions have been developed to improve HRQOL for diverse groups of Hispanic cancer survivors. Elucidating factors that affect outcomes can help clarify how to structure interventions to reduce HRQOL disparities in this understudied group of cancer survivors. Citation Format: Manami Bhattacharya, Kristi D. Graves, Roxanne Jensen. Examining the health-related quality of life of U.S. Hispanic cancer survivors [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A035.

Social risk factors among individuals with a history of cancer during the COVID-19 pandemic.

PurposeThe coronavirus disease (COVID-19) pandemic and its economic consequences may disproportionately impact cancer survivors and their overall health-related quality of life. The objective of this study was to examine whether cancer survivors experienced higher levels of financial strain or food insecurity compared to those without a history of cancer.MethodsKaiser Permanente Research Bank (KPRB) study participants were invited to complete a series of electronic surveys starting April 2020 to assess the impact of the COVID-19 pandemic. Participants who completed the initial survey and one follow-up survey were included. The odds of financial strain and food insecurity in those with and without a history of cancer were estimated using multinomial logistic regression.ResultsCancer survivors (n = 16,231) had lower odds of reporting “somewhat hard” (AOR = 0.77) and “very hard” (AOR = 0.67) financial strain, and food insecurity “sometimes” (AOR = 0.70) and “often” (AOR = 0.55) compared to those with no history of cancer (n = 88,409). Non-Hispanic (NH) Black and Hispanic cancer survivors had higher odds compared to NH Whites of reporting financial strain and food insecurity. Smokers and those with multiple comorbidities had higher odds of reporting financial strain and food insecurity among cancer survivors.ConclusionsWhile cancer survivors overall did not report greater financial strain or food insecurity than individuals without a history of cancer, subsets of cancer survivors are experiencing greater social risks during the pandemic and should be prioritized for screening for social risk factors.Implications for Cancer SurvivorsIncorporating screening for social risk factors into care coordination workflows for subsets of cancer survivors should be a priority.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11764-022-01235-7.

Cardiovascular Health Among Cancer Survivors. From the 2019 Behavioral Risk Factor Surveillance System Survey

With increasing prevalence, there is a growing population living with cardiovascular (CV) disease and cancer who are concurrently or at risk for developing these 2 disease states. We examined CV conditions and CV risk factors in cancer survivors in a cross-sectional analysis, using data from the 2019 Behavioral Risk Factor Surveillance System. Cancer survivors are more likely than participants without a cancer history to have multiple risk factors that increase their risk for CV disease and other chronic illnesses, including cigarette smoking, physical inactivity, and obesity. In contrast, cancer survivors are less likely to be heavy drinkers or to not consume fruits and vegetables. The odds of having a heart attack, coronary heart disease (CHD), diabetes, and hypertension were generally higher among cancer survivors. In multivariable analysis, the adjusted odds of having a heart attack, CHD, diabetes, hypertension, or high cholesterol were higher among cancer survivors than among participants without a history of cancer. Although the odds of obesity and physical inactivity were generally higher among cancer survivors across all socioeconomic status groups, the odds of having a heart attack or CHD were particularly high among Black and Hispanic cancer survivors and among younger participants. The odds of having diabetes were also higher among Black and Hispanic cancer survivors. In conclusion, cancer survivors are more likely than participants without a cancer history to have multiple risk factors that increase their risk of CV disease and other chronic illnesses, and they have a higher prevalence of heart attack, CHD, diabetes, and hypertension. Of particular concern are the higher prevalence of heart attack, CHD, and diabetes among Black and Hispanic cancer survivors.

Financial toxicity in Hispanic cancer survivors: A nationally representative pancancer analysis.

6528 Background: A cancer diagnosis can pose a significant financial burden to patients and their families, both during and after treatment. Financial toxicity has long-term consequences, with cancer being the most commonly cited reason for medical cost-associated bankruptcy in the United States. We used nationally representative survey data to assess financial toxicity in cancer survivors, with a focus on Hispanic patients given known disparities in socioeconomic and cancer outcomes. Methods: 2013-2018 data from the National Health Interview Survey (NHIS) was used to select individuals aged 18 years old and older who reported any previous diagnosis of cancer. Financial toxicity was defined as unmet healthcare need, health care unaffordability, and/or general financial stress. Individuals were disaggregated by race/ethnicity, and patients who self-identified as Hispanic were further classified by country of origin. Survey-adjusted percentages characterize the cohort. Multivariable logistic regression generated adjusted odds ratios (aORs) with 95% CI for each category of financial toxicity, with non-Hispanic White (NHW) used as reference. Results: Hispanic patients in aggregate had the highest prevalence of all 3 categories of financial toxicity when compared to other racial/ethnicity groups (35% unmet healthcare need, 61% healthcare unaffordability, 61% financial stress). Mexican (aOR: 2.53 95%CI: 1.82–3.52), Cuban/Cuban-American (aOR: 1.97 95%CI: 1.17–3.34), and patients of Central/South American heritage (aOR: 2.61 95%CI: 1.67–4.10) were more likely to have healthcare unaffordability. Unmet healthcare needs were higher in Mexican patients (aOR: 1.43 95%CI: 1.03-1.99) and patients of Cuban descent (aOR: 1.96 95%CI: 1.07-3.58). Financial stress was highest among patients of Central/South American heritage (aOR: 4.20 95%CI: 2.50-7.05) and Mexican patients (aOR: 1.84 95%CI: 1.27-2.66). Mediator analyses further revealed that disparities persisted even after adjusting for socioeconomic status in Mexican patients (healthcare unaffordability - aOR: 1.65 95%CI: 1.14-2.40) and patients of Central/South American heritage (healthcare unaffordability – aOR: 1.99 95%CI: 1.23-3.21; general financial stress – aOR: 2.97 95%CI: 1.71 – 5.17). Conclusions: Our study highlights significant disparities in the financial impact of cancer treatments on Hispanic patients. Disaggregation by Hispanic country of origin illustrates differences within the Hispanic and Hispanic-American population and reveals specific groups that may be at particular risk of financial harm. Targeted interventions to improve health care access and affordability are needed to increase equity and improve outcomes.

Impact of circuit, interval-based exercise on insulin resistance and adiponectin among minority cancer survivors.

12059 Background: Hispanic and Black adults have a heightened risk of metabolic syndrome compared to non-Hispanic white adults, increasing the risk of cardiovascular disease, diabetes, and co-morbid outcomes. Further, Hispanic and Black adults are more likely to be sedentary and obese than non-Hispanic white adults, leading to an increased risk of insulin resistance and poor metabolic health. Exercise improves cardiometabolic health, including insulin sensitivity and adiponectin, however few studies have focused on minority cancer survivors. The aim of our (NCT03284346) was to determine whether a 4-month circuit-based aerobic and resistance exercise intervention can improve insulin resistance and adiponectin levels in breast, prostate, and colorectal Hispanic and Black cancer survivors. Methods: Overweight or obese (BMI &gt; 25.0 kg/m2), sedentary breast, prostate or colorectal cancer survivors who self-identified as Hispanic or Black were randomized to exercise (n = 30) or usual care (n = 10). Survivors in the 4-month supervised exercise intervention participated in a thrice weekly, circuit, interval-based moderate-vigorous aerobic (65-85% of VO2max) and resistance (65-85% of 1-repetition maximum). Insulin resistance, assessed by Homeostasis Model of Assessment (HOMA-IR), and adiponectin levels were collected at baseline and post-intervention from fasting blood sample collection. Repeated-measures analysis of variance and t-tests were performed to assess within- and between-group differences. Results: The study sample was 66 ± 10.4 years old, Hispanic (55%), Black (45%), overweight (78%), and female (60%). Adherence to the intervention was 90% and post-intervention outcome measures were available on 100% of participants. Post-intervention, insulin resistance (within group mean difference: -3.2, p &lt; 0.01; between group mean difference: -4.5, p &lt; 0.01) and adiponectin levels (6.1 ug/mg, p &lt; 0.01; 8.6 ug/mg, p &lt; 0.01) significantly improved in the exercise group when compared to baseline and to usual care, respectively. Conclusions: A circuit, interval-based aerobic and resistance exercise intervention improved insulin resistance and adiponectin levels in breast, prostate, and colorectal minority cancer survivors. Accessible exercise interventions for minority cancer survivors may be effective to mitigate metabolic dysregulation and co-morbid conditions in survivorship and support cardiometabolic health. Clinical trial information: NCT03284346.