Hispanic Cancer Research Articles

Abstract C113: Endoscopic history potentially explains survival differences in Hispanics and Blacks with gastric cancer

Abstract Background: Hispanic and Black persons are at higher risk for gastric cancer (GC) in the United States, as compared to White counterparts. Economic analyses demonstrate that endoscopy for GC screening may be cost-effective in Hispanic and Black Americans, but no prevention guidelines support gastric cancer screening for these minorities in the U.S. Targeted Helicobacter pylori (H. pylori) testing and treatment may also help to prevent GC. It is unknown how common endoscopic history and H. pylori testing are among Hispanics and Blacks diagnosed with gastric cancer and how this is related to stage at diagnosis and survival. Methods: We employed SEER-Medicare data on Hispanic (n=1,428) and Black (n=1,774) patients diagnosed with GC in 2004-2013. We compared stage of disease by history of gastric imaging and H. pylori testing >18 months prior to GC diagnosis. Qualifying imaging included esophagogastroduodenoscopy, endoscopic ultrasound, upper gastrointestinal series. We tested for differences in proportions by Chi-squared tests and survival differences by log-rank test. We performed Cox regression analyses adjusting for age, sex, residence in large metropolitan areas, neighborhood poverty index, histology, and tumor location to determine the association of prior gastric imaging with survival. Results: Hispanic and Black GC patients shared similar histories of endoscopic imaging (17%, 16% respectively). Hispanics and Blacks who had a history of endoscopy were more likely to be diagnosed at Stage I (41% in both), as opposed to those without endoscopic history (26% and 29%; p<0.0001, p=0.0003 respectively). Hispanics with a history of endoscopy lived longer with GC (12 months) as opposed to those without (9 months, p=0.03), while the survival difference by endoscopic history was not significant among Black patients (9 months vs. 8 months, p=0.06). In survival analysis without adjustment for stage, endoscopic history was associated with a lower rate of death among Hispanics (HR:0.84, 95%CI: 0.72, 0.98) and in Blacks (HR:0.87, 95%CI: 0.76, 0.997). After adjustment for stage of disease, the association between endoscopy and survival disappeared (Hispanic: HR=1.01, 95% CI 0.88, 1.16; Black: HR:1.01, 95% CI 0.86, 1.18). Hispanics were more likely to be tested for H. pylori (9.9%) than Blacks (5.0%). Prevalence of stage I disease at diagnosis was not different by history of H. pylori testing in Hispanics (38% tested vs. 31% non-tested, p=0.16) nor among Blacks (30% tested vs. 28% non-tested, p=0.65). Conclusion: Endoscopic procedures and H. pylori testing are underutilized in elderly Hispanic and Black patients at risk for gastric cancer. Hispanic and Black gastric cancer patients with endoscopic history were more likely to be diagnosed with Stage I disease than those without endoscopic history, leading to a survival advantage. A prospective study examining the benefit of endoscopic screening for early detection of gastric cancer in racial and ethnic minorities at high risk for gastric cancer is warranted. Citation Format: Christie Y Jeon, Yu-Chen Lin, Bianca Luna-Lupercio, Robert Haile. Endoscopic history potentially explains survival differences in Hispanics and Blacks with gastric cancer [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 C113.

Abstract A047: The patient experience: Clinical trial knowledge, attitudes and participation among diverse populations

Abstract Introduction: Participation in cancer clinical trials (CTs) is historically low, particularly for underserved populations, including racial/ethnic minorities. Wake Forest Baptist Comprehensive Cancer Center developed a population health navigation program to improve access to cancer care and CTs among Hispanic patients through linguistically and culturally concordant navigation services. The role of the Hispanic Patient Navigator (HPN) includes educating all navigated patients about CTs. To inform expansion of the program, we sought to understand the knowledge and attitudes of underserved patients at WFBCCC regarding CTs and CT participation. Methods: Patients receiving cancer care in the adult oncology clinic at WFBCCC were purposively sampled to enroll a diverse sample with regards to race, ethnicity, insurance coverage, age, and rural-urban residence. Survey domains included CT knowledge (Ellis et al., 2016) attitudes about CTs (positive beliefs and patient involvement scored from 0-100; Jenkinson et al., 2005) and participation in clinical research as part of cancer care. ANOVA and chi-square/Fisher’s exact tests compared responses by race and ethnicity. Results: We enrolled 247 participants (85% participation); 50.6% were White, non-Hispanic (NHW), 27.1% Black, non-Hispanic (NHB), and 22.3% Hispanic, all races. The majority were female (54.5%) with a median time since cancer diagnosis of 2.8 years. Common cancer types included hematologic (36.4%), breast (20.6%), gastrointestinal (12.6%), and thoracic (9.3%). Hispanics were more likely to report less than a high school education (47.3% vs 10.4% NHW and 17.9% NHB) and not having enough money to meet the daily needs of their families (45.5% vs 13.6% NHW and 17.9% NHB), p<.001. NHW, NHB and Hispanic cancer patients reported similar positive attitudes about CTs (positive beliefs mean=77.7, std=17.6) and willingness to participate (patient involvement=76.7, std=18.9), p >.05 for both comparisons. A larger proportion of NHWs had heard of clinical trials (92.8%), compared to 79.1% NHBs, and 56.4% of Hispanics. NHWs also had greater CT knowledge (mean=3.5, 0-7 scale) than NHBs (mean=2.5), and Hispanics (mean=1.9), p<.0001. There was a trend towards slightly lower CT participation among Hispanic patients, with 42.4% of NHWs, 38.8% of NHBs, and 29.1% of Hispanics self-reporting participation in clinical research(p=.089). Conclusions: Results support the continued role of a HPN to provide clinical trials education to cancer patients. Although self-reported clinical trial participation was slightly lower among Hispanics, it approached 30%, and we observed concurrent increases in Hispanic patient enrollment on cancer center trials. Expansion of the population health navigator program to Black patients would provide opportunities to enhance clinical trial knowledge and participation in additional underserved patients. Citation Format: Carla Strom, Karen M. Winkfield, Janet A. Tooze, Jimmy Ruiz, Kelsey Shore, Kathryn E. Weaver. The patient experience: Clinical trial knowledge, attitudes and participation among diverse populations [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 A047.

Treatment challenges and support needs of underserved Hispanic patients diagnosed with lung cancer and head-and-neck cancer

Purpose: We explored the treatment challenges and support needs that Hispanic underserved lung cancer and head-and-neck cancer patients face while undergoing cancer treatment.Design: Qualitative design - ethnography.Sample: Using a sample of 29 participants, we conducted semi-structured interviews with nine lung cancer and head-and-neck cancer survivors and seven health care providers and focus group interviews with six caregivers and seven patient navigators.Method: Relevant themes were extracted with Ethnographic content analysis.Findings: Participants reported treatment challenges and support needs in four areas: medical, financial, socio-cultural, and mental health. Health care providers and navigators primarily identified medical and financial challenges that impact treatment adherence, while patients and caregivers expressed the need for support for mental health problems (i.e., depression, anxiety).Implications for psychosocial providers: Understanding the experiences of underserved Hispanic cancer survivors can aid in creating psychosocial interventions that successfully target treatment-related challenges and provide them with the support they need.

Retrospective Study of Incidence and Survival for Patients with Hematologic Malignancies Residing at the U.S./Mexico Border

Introduction: Hispanics represent the largest minority group in the United States (U.S.), with 57.5 million individuals (18% of the population). Most U.S. Hispanics are of Mexican origin (63.2%), followed by Puerto Rican (9.5%), Cuban (3.9%), Salvadoran (3.8%), and Dominican (3.3%), but distribution varies by state. The majority of Hispanics in the U.S. reside in the Southwest region, and >11 million live in the state of Texas. Cancer is the leading cause of death in the Hispanic population, accounting for 21% of deaths in people of all ages. Health disparities for Hispanic cancer patients have previously been linked to disproportionate poverty and other barriers to optimal healthcare, and in the case of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), Hispanics were found to be diagnosed younger and to have worse overall survival (OS) than Non-Hispanic whites (NHWs) (ACS. Cancer Facts & Figures for Hispanics/Latinos 2018-2020). However, little is known about incidence and survival for Hispanic blood cancer patients residing at the U.S./Mexico border. To understand the impact of Hispanic ethnicity on outcomes for blood cancer patients diagnosed in this area, we examined OS in adult patients with hematologic malignancies throughout the state of Texas compared to Texas Health Service Region (HSR) 10, encompassing El Paso County. Methods: We retrospectively reviewed data available from the Texas Cancer Registry for hematologic malignancies diagnosed in the state of Texas between 1995 and 2016, focusing our analysis on chronic and acute leukemias (both myeloid and lymphoid), myelodysplastic syndrome (MDS), and myeloproliferative neoplasms (MPNs). Survival for Hispanic and NHW groups was compared using the log-rank test, and Cox regression analyses adjusting for age and diagnosis. Differences in age at diagnosis were evaluated using t-tests and generalized linear models. Similar analyses compared Hispanic patients from HSR 10 versus Hispanic patients from the rest of Texas. Research was conducted according to a local Institutional Review Board-approved protocol in accordance with the Declaration of Helsinki. Results: Of the 69,941 cases of hematologic malignancies with available information throughout the state of Texas, 18.29% self-identified as Hispanic. Surprisingly, in unadjusted analyses, Hispanic patients had significantly better OS than NHWs diagnosed with AML (p<0.0001), MDS (p<0.0001), and chronic myeloid leukemia (CML, p<0.0001), with no significant differences in OS for patients with ALL, MPN, acute promyelocytic leukemia (APL), or chronic lymphocytic leukemia (CLL). However, Hispanic patients were diagnosed at a significantly younger age in all diseases analyzed (Table 1), possibly explaining the improved survival. After adjusting for age, ALL (HR 1.32, p<.0001), CLL (HR 1.11, p=0.002), and CML (HR 1.15, p=0.008) showed significantly worse outcomes for Hispanics, with better outcomes in MDS (HR 0.92, p=0.0004), and no significant differences for AML, APL or MPN. Running the same analyses for the entire El Paso population versus the rest of Texas, we found no significant interaction except for a suggestion of a greater ethnic disparity in CML patients from El Paso (p=0.06). We also compared Hispanic patients diagnosed in El Paso versus Hispanics from the rest of Texas. Hispanics in El Paso had a significant reduction in OS compared to Hispanics in other areas of Texas for patients with ALL (p=0.0164), AML (p<0.0001), and CML (p=0.0160), but not for patients with APL, CLL, MDS, or MPN. Again the negative effects become less marked after adjustment for age, as those diagnosed in El Paso tended to be 3 years older at diagnosis than elsewhere in Texas. In analyses adjusted for age and diagnosis, there was again a suggestion that differences between El Paso and the rest of Texas were greater in Hispanics than NHW (p=0.08). Conclusions: While Hispanic patients with AML, MDS, and CML had significantly better OS compared to NHWs in Texas as a whole, this could be explained by a significant reduction in the age of diagnosis for Hispanics. However, when comparing across Texas, El Paso Hispanics with ALL, AML, and CML have a worse prognosis than in the rest of the state. There appears to be evidence that disparities in outcome by ethnicity may be different in El Paso compared with the rest of Texas. Further study is required to identify factors responsible for the disparity in OS. Disclosures No relevant conflicts of interest to declare.

Contextual and Cultural Influences on Caregivers of Hispanic Cancer Survivors.

To discuss contextual factors (barriers to accessing health care, immigration issues, minority stress, low education/income, challenging employment environments) and cultural values (familism, espíritu, confianza, marianismo, machismo) of Hispanic caregivers that may influence the caregiving experience. Literature, research. Hispanic caregivers, like non-Hispanic caregivers, experience poor health during caregiving and have unmet needs for information and emotional support. Few evidence-based supportive care interventions are currently available, and more should be developed and tested for this growing population of Hispanic caregivers. Nurses should assess both contextual factors and cultural values as part of treatment planning for quality cancer care.

Job Market Prospects of Breast vs. Prostate Cancer Survivors in the US: A Double Hurdle Model of Ethnic Disparities

Labor market presence of cancer survivors has been significantly improved as medical technology revolutionized cancer-specific diagnoses and treatments. However, less understood are post-cancer variations in job market outcomes of racial and ethnic minorities in the US. Using a theoretical framework derived from family labor supply decision models and taking advantage of the rich data in the 2008–2014 Medical Expenditure Panel Survey (MEPS), this study employs a double-hurdle empirical model of labor force participation and hours worked to evaluate the employment decisions of Black and Hispanic cancer survivors. Hispanic and Black breast cancer survivors were less likely to be employed by 4% and 7.5%, respectively, when compared with Whites. Black prostate cancer survivors were 8% less likely to work than Whites, with nonsignificant differences between Hispanic and White prostate cancer survivors. Once employed, Black and Hispanic breast cancer survivors worked an extra 4 and 6 h than Whites, while Hispanic prostate cancer survivors worked 5 fewer weekly hours than Whites. In addition, our estimates indicate the significance of job types in labor market outcomes post-cancer. Employment of minorities in blue collar or service occupations decreased employment hours of survivors. Labor market disparities for minorities amplifies the socio-economic and familial burden of cancers. This timely work motivates informed public policy to reduce unexamined consequences of chronic conditions among minorities.

Validation of the Spanish version of the Cancer Symptom Scale in Hispanic cancer patients.

To assess the validity of the translated Spanish Cancer Symptom Scale. Instruments to facilitate comprehensive and objective assessments of the cancer symptom experience in underrepresented populations are essential. The Cancer Symptom Scale was translated into Spanish, and a back translation was conducted. During June 2016, a sample of 121 Hispanic Puerto Rican patients with any cancer diagnosis, all undergoing cancer treatments, completed four paper surveys. A subgroup of 15 patients agreed to complete the Spanish Cancer Symptom Scale a second time after a short delay of 1 to 2hours. Construct validity and reliability (internal consistency via Cronbach alpha and test-retest reliability) was evaluated. All the Intensity Items of the Spanish Cancer Symptom Scale correlated significantly with the matched items on the MD Anderson Symptom Inventory. In a subgroup of 77 participants, each Cancer Symptom Scale subscale total of scores correlated significantly with the total scores from the Functional Assessment of Cancer Therapy-General. Discriminant validity was demonstrated between those receiving chemotherapy and those from post treatment. The Spanish Cancer Symptom Scale internal consistency reliability was 0.98. The Spanish Cancer Symptom Scale has excellent evidence of validity and reliability for assessing cancer-therapy-related symptoms.

Unpacking Hispanic Ethnicity-Cancer Mortality Differentials Among Hispanic Subgroups in the United States, 2004-2014.

Introduction: National data on the epidemiology of cancer are commonly reported by broad racial/ethnic categories, such as “Hispanic.” However, few studies have disaggregated Hispanic groups and explored mortality differentials in this heterogeneous population. This paper aims to further examine cancer mortality differentials among Hispanic subgroups in the U.S.Materials and Methods: The study examined cancer deaths in the United States from 2004 to 2014 among decedents classified as Mexican, Puerto Rican, Cuban, Dominican, Central/South American and non-Hispanic white on the death certificate among those who were 20 years or older at the time of death. Data were obtained from the National Vital Statistics System. Sex-specific age-adjusted mortality rates were computed for a 10-year period and each individual year, for all cancers combined. Differences by age group, cancer sites, and age distribution were also assessed.Results: A total of 296,486 Hispanic cancer deaths were identified. Mortality rates of the Hispanic subgroups compare favorably with those of non-Hispanic whites. The mortality rates for Mexicans are very similar to those of all Hispanics combined, whereas the rates for Cuban and Puerto Ricans are higher. Dominicans and Central/South Americans had the overall lowest mortality rates. Statistically significant decreases in cancer mortality rates were noted in some sub-groups, but rates increased among Dominican women. Age-adjusted mortality rates by cancer site varied among Hispanics subgroups and gender. Among Cubans, only 5% of cancer deaths occurred before the age of 50 compared to 16% of cancer deaths among Central/South American.Conclusion: While it is common to present data on the burden of cancer among Hispanics as an aggregate group, this study illustrates that the burden of cancer varies by Hispanic subgroups. The disaggregation of Hispanics by ancestry/country of origin allows for a clearer understanding of the health status of this growing population and is needed if health disparities are to be adequately identified, understood and addressed.

Geographical, racial and socio-economic variation in life expectancy in the US and their impact on cancer relative survival.

PurposeDespite gains in life expectancy between 1992 to 2012, large disparities in life expectancy continue to exist in the United States between subgroups of the population. This study aimed to develop detailed life tables (LT), accounting for mortality differences by race, geography, and socio-economic status (SES), to more accurately measure relative cancer survival and life expectancy patterns in the United States.MethodsWe estimated an extensive set of County SES-LT by fitting Poisson regression models to deaths and population counts for U.S. counties by age, year, gender, race, ethnicity and county-level SES index. We reported life expectancy patterns and evaluated the impact of the County SES-LT on relative survival using data from the Surveillance Epidemiology and End Results (SEER) Program cancer registries.ResultsBetween 1992 and 2012, the largest increase in life expectancy was among black men (6.8 years), however there were still large geographical differences. Life expectancy was highest for Asian or Pacific Islanders (API), and lowest for American Indians and Alaskan Natives (AIAN). In 2010, life expectancies by state ranged from 73 to 82 years for white males, 78 to 86 years for white females, 66 to 75 for black males, and 75 to 81 for black females. Comparisons of relative survival using National LT and the new County SES-LT showed that relative survival using County SES-LT improved relative survival estimates for some demographic groups, particularly in low and high SES areas, among Hispanics and AIAN, and among older male cancer patients. Relative survival using County SES-LT was 7.3% and 6.7% survival points closer to cause-specific survival compared to the National LT relative survival for AIAN and Hispanic cancer patients diagnosed between ages 75 and 84 years, respectively. Importantly, the County SES-LT relative survival estimates were higher in lower SES areas and lower in higher SES areas, reducing differences in relative survival comparisons.ConclusionThe use of these new socio-economic life tables (County SES-LT) can provide more accurate estimates of relative survival, improve comparisons of relative survival among registries, better illustrate disparities and cancer control efforts, and should be used as default for cancer relative survival using U.S. data.

Examining the role of social support and spirituality on the general health perceptions of Hispanic cancer survivors.

Although cancer survival rates continue to improve, overall disparities persist for ethnic minority survivors, who have a disproportionately high risk of experiencing poor quality of life, despite documented higher levels of self-reported spirituality. Yet little is known about the relationship between spirituality and social support and health outcomes among Hispanic survivors. This study examined (1) differences between Hispanic and non-Hispanic white survivors on health, social support, and spirituality and (2) the potential mediating roles of mental health and emotional distress on general health perceptions. We analyzed data (N=7778) from the American Cancer Society's Study of Cancer Survivors-II, a national cross-sectional study of adult cancer survivors. Preliminary analysis compared sociodemographic and medical characteristics between the 2 groups to identify significant covariates. Structural equation modeling assessed whether mental health and emotional distress mediate the impact of social support and spirituality on Hispanics' general health perceptions. Overall, 693 survivors were Hispanic and 7085 were non-Hispanic whites. Hispanics reported poorer health and were more likely to have comorbid conditions such as diabetes and depression compared with non-Hispanic whites. Structural equation modeling indicated that the impact of spirituality on general health perceptions was fully mediated through mental health. Emotional distress did not have a direct effect on general health perceptions nor did it mediate effects of spirituality and social support and on general health perceptions. There was a mediated effect of social support on general health perceptions. Spirituality is an important factor in the health of Hispanic survivors. Future studies should explore the impact and effectiveness of spiritual interventions and the beneficial effect for mental health on general health perceptions.

Abstract PR03: Somatic mutations and ancestry markers in Hispanic lung cancer patients

Abstract Introduction: Hispanics are projected to constitute 23% of the U.S. population by 2050. However, large-scale sequencing projects, such as The Cancer Genome Atlas (TCGA), provide little information on this ethnic population. In fact, only seven out of over 500 lung adenocarcinoma tumors sequenced in the TCGA database are reported to be Hispanic. To address the lack of genomic data from Hispanic/Latino patients with lung cancer, the Latino Lung Cancer Registry was established to collect patient data and biospecimens from these patients. Methods: This retrospective observational study examined lung cancer tumor samples from 163 Hispanic/Latino patients, and tumor-derived DNA was subjected to targeted-exome sequencing (>1000 genes, including EGFR, KRAS, STK11, and TP53) and ancestry analysis. Mutation frequencies in this Hispanic/Latino cohort were compared with those in a similar cohort of non-Hispanic white (NHW) patients. Novel mutations in EGFR were functionally characterized, and mutation rates were correlated with ancestry, patient sex, smoking status, and tumor histology. Results: Among adenocarcinomas (n=120) in the Hispanic/Latino cohort, 31% had EGFR mutations versus 17% in the NHW control group (p < 0.001). The EGFR mutations in Hispanic/Latino patients included well-characterized activating mutations, such as L858R, and uncharacterized EGFR variants. A rare exon 19 mutation, W731R, was identified that conferred resistance to both erlotinib and AZD9291. KRAS (20% vs. 38%; p=0.002) and STK11 (8% vs. 16%; p=0.065) mutations occurred at lower frequency, and mutations in TP53 occurred at similar frequency (46% vs. 40%; p=0.355) in Hispanic/Latino and NHW patients, respectively. Within the Hispanic cohort, ancestry influenced the rate of TP53 mutations (p=0.009) and may influence the rate of EGFR, KRAS, and STK11 mutations. Conclusions: Driver mutations in Hispanic/Latino lung adenocarcinoma patients differ in frequency from those in NHWs associated with their Indigenous American ancestry. The spectrum of driver mutations needs to be further assessed in the Hispanic/Latino population. Citation Format: William D. Cress, Nicholas T. Gimbrone, Bhaswati Sarcar, Edna Gordian, Jason I. Rivera, Christian Lopez, Jamie K. Teer, Eric A. Welsh, Alberto A. Chiappori, Matthew B. Schabath, Gary W. Reuther, Pedro G. Santiago-Cardona. Somatic mutations and ancestry markers in Hispanic lung cancer patients [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr PR03.

Abstract 1905: New targeted therapeutics for gastric cancer

Abstract Gastric cancer is a health disparity with 2.3 times higher incidence rates in Hispanics than in Non-Hispanic Whites (NHWs). Very few studies have been conducted to characterize this health disparity in Hispanics; however, studies from East Asian patients, where gastric cancer is also a health disparity, have revealed that p21-activated kinases (PAKs 1,2 and 4) are biomarkers for gastric cancer. Even though inhibition of PAKs impedes gastric cancer progression, current PAK inhibitors have failed to successfully complete clinical trials. Thus, we hypothesize that the inhibition of upstream effectors of PAK, the Rho GTPases Rac and Cdc42 is a rational treatment for gastric cancers with high PAK expression. The purpose of this study is to correlate Rac/Cdc42 and PAK expression and activation with Hispanic gastric cancer malignancy, and to test the efficacy of our recently developed Rac/Cdc42 inhibitor MBQ-167 (Humphries-Bickley, et al., Mol Cancer Therap. 2017, 16:805-818). In a related Aim, to identify new targets and biomarkers for Hispanic gastric cancer, gastric cancer tissues and normal gastric mucosa from biopsies and/or surgery were collected from Puerto Rican patients for expression profiling with customized qRT-PCR arrays for mRNA and Agilent arrays for non-coding RNAs (ncRNAs), and western blotting. Western blotting of gastric cancer cell lines revealed that NCI-N87 metastatic gastric cancer cells express more PAK isoforms and phospho (active)-PAK compared to the AGS non-metastatic gastric cancer cells; accordingly, MBQ-167 reduces the viability of NCI-N87 cells without affecting AGS cells. Therefore, to test the efficacy of Rac/Cdc42 inhibition in gastric cancer, immunocompromised mice with subcutaneous tumors from GFP-NCI-N87 cells were treated 3X week with vehicle or 1mg/kg BW of MBQ-167. Tumor growth calculated by image J analysis of fluorescent digital images. A drastic reduction in NCI-N87 tumor growth was observed in the MBQ-167 treated mice with a 61% inhibition in tumor size compared to the controls, and a tumor growth delay of >90% after the second doubling time. Gene expression profiling revealed that 13 genes were overexpressed (>1.5 fold change) in Puerto Rican gastric cancer tissue in comparison to the normal gastric mucosa, including Rac1, PAK1, STAT3, KDR (VEGFR2), CXCR4, IGF1, VEGFA, and IL-6, all of which are associated with Rac/Cdc42/Pak signaling. Differential profiling using a custom-made Agilent array for ncRNAs demonstrated upregulation of a number of pro-cancer microRNAs (miRNAs) such as miR-106b and downregulation of tumor suppressors such as let-7a and miR-145, as well as upregulation of the long ncRNA CCAT2, which we have shown to be important for colon cancer malignancy. Taken together, our data show that Hispanic gastric cancers have known and novel biomarkers, and MBQ-167 is a viable targeted therapeutic option for gastric cancers with elevated Rac/Cdc42/PAK signaling. Citation Format: Jean F. Ruiz Calderon, Marcia Cruz-Correa, George A. Calin, Linette Castillo-Pichardo, Suranganie Dharmawardhane. New targeted therapeutics for gastric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1905.

Abstract C35: Examining the role of social support and spirituality on the health status of Hispanic cancer survivors

Abstract Purpose: Although overall survival rates continue to improve for many cancers, disparities persist for ethnic minorities who have a disproportionately high risk of experiencing poor mental health and quality of life. However, limited research has examined the role of social support and spirituality on the health status of Hispanic cancer survivors. This study examined differences between Hispanics and non-Hispanics on health status, emotional support, and spirituality. It also examined the role of social support and spirituality on health status of cancer survivors directly and mediated through emotional distress and mental health. Methods: We analyzed data (N=9,170) from the American Cancer Society's Study of Cancer Survivors-II (SCS-II), a national cross-sectional study of adult cancer survivors diagnosed at 2, 5, or 10 years prior to sampling. Preliminary analysis compared sociodemographic and medical characteristics between Hispanic and non-Hispanic cancer survivors to identify significant covariates of health status. We used structural equation modeling (SEM) to assess if the latent variables of mental health and emotional distress mediate the impact of social support and spirituality (also modeled as latent variables) on the health status of Hispanic cancer survivors. The final model included sociodemographic characteristics such as age and marital status, health insurance coverage, and cancer-related covariates such as time since diagnosis. Measurement models for social support, spirituality, emotional distress, and mental health were built based on literature and modified through adding meaningful error-covariances. SEM models were estimated in Mplus 7.4. Model fit was assessed using chi-square, RMSEA, TLI, and CFI. Results: Overall, 7.6% of survivors were Hispanics (n=693) and 92.4% were non-Hispanics (n=8,477). Compared to their non-Hispanic counterparts, Hispanics were significantly younger (M= 63.4 ±12.6 vs 67.7 ±11.8, p=0.002) and had lower levels of educational attainment (X2=347.7, p<0.001). The majority of participants reported currently having some form of health insurance coverage; however, Hispanic cancer survivors reported higher rates of being uninsured (6.0% vs 2.0%, p<0.001). Notable differences in cancer treatment were observed. Hispanics were more likely to undergo chemotherapy and immunotherapy and less likely to undergo surgery compared to non-Hispanics. Hispanic cancer survivors reported poorer health and were more likely to have comorbid conditions such as diabetes, depression, anxiety, and chronic back pain compared to non-Hispanics. Structural equation model (SEM) estimates indicated no direct effect of social support on health or any mediated effect of social support through neither emotional distress nor mental health on overall health among Hispanics. On the contrary, there was a small to medium total effect of spirituality on health. The impact of spirituality on health was fully mediated through mental health (total effect β=.26, p<.001) and neither the direct effect nor the mediated effect through emotional distress was statistically significant. The direct effect of spirituality on mental health was large (β=.60, p<.001). The model accounted for most of the variance in health (r-square = .71). SEM model fit indices other than chi-square were very good (RMSEA=.03, CFI=.98, TLI= .98). Conclusion: Hispanic cancer survivors were more likely to report poor health (general health, mental health, and emotional distress). Although data were cross-sectional, findings from this study suggest that the association between spirituality and health is mediated by mental health among Hispanic cancer survivors. Future studies are needed to determine if interventions to enhance spiritual well-being as a coping mechanism will have a direct impact on health of Hispanic cancer survivors. Citation Format: Carol Ochoa, Regine Haardörfer, Cam Escoffery, Kevin Stein, Kassandra I. Alcaraz. Examining the role of social support and spirituality on the health status of Hispanic cancer survivors [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C35.

Abstract IA40: Obesity in breast and ovarian cancers: Racial/ethnic disparities

Abstract IA40: Obesity in breast and ovarian cancers: Racial/ethnic disparities

Abstract A44: Establishment of patient-derived Hispanic gastric cancer xenografts to test targeted therapeutics

Abstract Gastric cancer is a health disparity with 2.3 times higher incidence rates in Hispanics than in non-Hispanic Whites (NHWs). Very few studies have been conducted to characterize this health disparity in Hispanics; however, studies from East Asian patients, in whom gastric cancer is also a health disparity, have revealed that p21-activated kinases (PAKs 1,2 and 4), which are known to regulate cancer metastasis, are biomarkers for gastric cancer. Even though inhibition of PAKs impedes gastric cancer progression, current PAK inhibitors have failed to successfully complete clinical trials. Thus, we hypothesize that the inhibition of upstream effectors of PAK, the Rho GTPases Rac and Cdc42, is a rational treatment for gastric cancers with high PAK expression. The purpose of this study is to identify the Rac/Cdc42/PAK pathway as novel biomarkers for Hispanic gastric cancer and to test targeted therapeutics in patient-derived gastric cancer xenografts (PDGCXs). To achieve this aim, gastric cancer tissues and normal gastric mucosa from biopsies and/or surgery are being collected for expression profiling with customized qRT-PCR arrays for mRNA and Agilent arrays for noncoding RNAs (ncRNAs), and Western blotting. Using immunodeficient mice, xenografts have been established from the NCI-N87 gastric cancer cell line (from ATCC) and a tumor from a 58-year-old Hispanic (Puerto Rican) female (San Juan Oncology Hospital). As demonstrated by Western blotting, compared to the AGS nonmetastatic gastric cancer cell line, the NCI-N87 metastatic gastric cancer cells express more PAK isoforms and phospho (active)-PAK. We have also shown that our recently developed Rac/Cdc42 inhibitor MBQ-167 reduces the viability of the NCI-N87 cell line (Humphries-Bickley et al., Mol Cancer Therap 2017;16:805-18). Therefore, we are currently testing the effect of MBQ-167 in SCID mice with NCI-N87 xenografts. Gene expression profiling of the gastric cancer tissue from the Hispanic patient revealed that 13 genes were overexpressed (>1.5-fold change) in gastric cancer tissue in comparison to the normal gastric mucosa, including Rac1, PAK1, STAT3, KDR (VEGFR2), CXCR4, IGF1, VEGFA, and IL-6, all of which are associated with Rac/Cdc42/Pak signaling. Differential profiling using a custom-made Agilent array for ncRNAs demonstrated upregulation of a number of procancer microRNAs (miRNAs) such as miR-106b and downregulation of tumor suppressors such as let-7a and miR-145, as well as upregulation of the long ncRNA CCAT2, which we have shown to be important for colon cancer malignancy. Overall, our data show that a number of unique and established biomarkers are present in Hispanic gastric cancer, including elevated Rac/Cdc42/PAK signaling. Therefore, treatment with drugs targeting the Rac/Cdc42/PAK pathway represents a novel therapeutic option for such gastric cancers. In conclusion, modeling gastric cancer in PDGCXs is expected to enable the testing and design of targeted and individualized treatments for Puerto Rican patients. Citation Format: Jean F. Ruiz-Calderon, Marcia Cruz-Correa, George A. Calin, Suranganie Dharmawardhane. Establishment of patient-derived Hispanic gastric cancer xenografts to test targeted therapeutics [abstract]. In: Proceedings of the AACR Special Conference: Advances in Modeling Cancer in Mice: Technology, Biology, and Beyond; 2017 Sep 24-27; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(10 Suppl):Abstract nr A44.

Initial evaluation of the validity and reliability of the culturally adapted Spanish CaSUN (S-CaSUN)

There is a dearth of knowledge and limited research on the needs of Hispanic male cancer survivors (HMCSs). There is a clear need for the development of culturally and linguistically adapted needs assessment tools that are valid and reliable for use among the growing HMCS population. Thus, the purpose of this paper is to describe the field testing and psychometric evaluation of the translated and culturally adapted Spanish Cancer Survivor Unmet Needs Measure (S-CaSUN). Hispanic male cancer survivors (n = 84) completed the Spanish CaSUN (S-CaSUN), the Hospital Anxiety and Depression Scale (HADS), and the Functional Assessment of Cancer Therapy-General Population (FACT-GP). Construct validity of the S-CaSUN was assessed by correlation analysis among aforesaid measures. A test-retest procedure with 2-week delay was used to examine reproducibility with a participant subsample (n = 50). Cronbach's alpha was computed to assess internal consistency of the S-CaSUN. Construct validity of the S-CaSUN was estimated by moderate correlation with the HADS anxiety (r = 0.55, P < 0.001) and depression scales (r = 0.60, P < 0.001) and the FACT-GP (r = - 0.62, P < 0.001). The test-retest correlation coefficient for the S-CaSUN was 0.78. Cronbach's alpha was 0.96. Field testing yielded a mean S-CaSUN score of 38.3 (SD = 26.2); all needs and positive change items were endorsed. Findings from field testing and preliminary psychometric evaluation of the S-CaSUN provide initial evidence of validity and reliability of the measure and highlight the importance of going beyond translation when adapting measures to take culture, literacy, and language into consideration. Reliable, culturally, and linguistically valid instruments facilitate identification of unique unmet needs of Hispanic cancer survivors that, in turn, can be addressed with evidence-based interventions. As cancer centers continue to develop survivorship programs, the S-CaSUN may be useful for a growing group of cancer survivors.

Recruitment, adherence, and retention methods in a culturally tailored Spanish language yoga program for overweight and obese hispanic cancer survivors and their support providers using a community engaged research approach

Integrative Oncology is an emerging field internationally that aims to amalgamate evidence-based complementary therapies with mainstream medical practices. This editorial outlines the key issues surrounding the development of Integrative Oncology for Australian cancer patients undergoing radiotherapy. Further discussion considers current research for the efficacy of concurrent CAM in the setting of radiotherapy and the numerous obstacles to a truly integrative model of cancer care in Australia; including financial/research limitations and clinician acceptance.

Anxiety and depression in Spanish-speaking Latina cancer patients prior to starting chemotherapy.

Anxiety and depression can substantially impact the life of a cancer patient, but literature on emotional distress in the Hispanic cancer population is sparse. Additionally, the influence of psychosocial variables including age, acculturation, and spiritual well-being on emotional distress in this population remains unclear. The purpose of the present report was to assess the prevalence of anxiety and depression in Spanish-speaking Latina cancer patients preparing to begin chemotherapy and to explore the predictors and correlates of these outcomes. Participants were 198 Spanish-speaking Latina cancer patients who completed measures of anxiety, depression, acculturation, and spiritual well-being prior to starting chemotherapy. Prevalence of clinically significant anxious symptomatology was 52%, and prevalence of clinically significant depressive symptomatology was 27%. Longer time since diagnosis and less acculturation predicted more severe anxiety, while longer time since diagnosis, less acculturation, and older age predicted more severe depression (Ps<.05). In multivariable analyses, only time since diagnosis emerged as a significant predictor of anxiety and depression when accounting for the influence of other variables. Greater spiritual well-being was correlated with both less severe anxiety and less severe depression (Ps<.001). The present findings document the high prevalence of emotional distress, particularly anxiety, in this patient population prior to chemotherapy initiation and identify several demographic and clinical factors associated with increased risk for heightened distress. Additionally, these findings suggest that interventions to address distress in this patient population would benefit from including components that seek to improve patients' spiritual well-being.

PD-L1 expression profile and immunotherapy (IO) experience in African American (AA) and Hispanic (H) lung cancer (LC) patients: Addressing disparities at a minority-based academic cancer center.

e18073 Background: Immune checkpoint inhibitors have changed the treatment paradigm for metastatic LC. Minority populations are under-represented in large IO clinical trials. Among 989 pts with newly diagnosed LC at Montefiore Medical Center - a community-based academic center from 2014-2015, 330 (33%) were AA and 195 (20%) were H. In line with practice-changing clinical studies, PD-L1 expression testing and IO have been incorporated into LC treatment. Methods: Pts receiving IO and/or had PD-L1 testing between 1/1/14-12/31/16 were identified from records obtained from pathology, pharmacy, oncology clinics and Clinical Looking Glass. Retrospective chart review was conducted. PD-L1 testing was performed using 22C3pharmDx IHC. Results: We identified 111 pts with LC who received IO and/or had PD-L1 testing, with a median age of 66. 55% were female. Based on race, 52 (47%) were AA, 24 (22%) were White, 26 (24%) were Other, and 9 (8%) were race unknown. Based on ethnicity, 30 (27%) were H, 73 (66%) were non-H and 8 (7%) were ethnicity unknown. 82% were former/current smokers. Adenocarcinoma was the dominant histology (60%). The majority were EGFR WT (91%) and ALK neg (98%). PD-L1 testing was performed in 67 (60%), including 32 (29%) AAs and 20 (18%) Hs. Archival tissue was used in 63%. PD-L1 TPS &gt; 50% was found in 30%, 1-49% in 24%, &lt; 1% in 37%. 62 pts received IO, including 26 (42%) AAs and 18 (29%) Hs. Nivolumab was the most commonly used agent (77%). In AAs, 8 (31%) received IO as 1st line, 13 (50%) as 2nd line, 5 (19%) as 3rd line and above. In Hs, 1 (5%) received IO as 1st line, 10 (56%) as 2nd line, 7 (39%) as 3rd line and above. Immune-related adverse events (IRAEs) were reported in 31% of AAs and 39% of Hs. Data analysis on survival is ongoing. Conclusions: Unlike the low numbers of minority pts in large clinical trials, we found no significant difference in PD-L1 testing and IO across racial and ethnic groups treated at our center. Compared to large clinical trials, we observed lower rates of IRAEs in our cohort. Our current and ongoing observations in these populations may have future implications in narrowing health disparities based on race/ethnicity.

Patterns of cancer-related health information seeking and receipt among Hispanic and non-Hispanic childhood cancer survivors.

197 Background: Because childhood cancer survivors (CCS) report a high number of unmet cancer-related information needs, knowing where CCS access information may provide insights into appropriate delivery systems to address information deficits. Active seeking of health information among CCS is associated with positive health behaviors, including adherence to follow-up care. This study examined patterns of cancer-related health information seeking as an indicator of health care engagement. Methods: Participants (N = 193) were young adult CCS diagnosed with any cancer type in Los Angeles County, 54% Hispanic, with a mean age of 19.87, and at least two years from treatment. CCS were asked where they accessed health information related to their cancer with 8 response options which were categorized into four information domains: hospital resources, social media, other survivors, and family members. Multivariable logistic regression was used to assess correlates of each information domain, including sociodemographic information, post-traumatic growth, and health care engagement, controlling for age, ethnicity, sex, education, and health insurance status. Results: Hospital resources were the most frequently endorsed information domain (65.3%), and Hispanic CCS (vs. non-Hispanic) were more likely to access this source. Online sources were more likely accessed by female CCS. Seeking information from other cancer survivors was associated with follow-up care and post-traumatic growth after cancer. Hispanic CCS were less likely to seek information from other survivors and their family than non-Hispanics. Conclusions: While CCS obtain information from a variety of sources, hospital resources were the most commonly accessed, particularly for Hispanics. Information sharing between survivors may promote positive health care engagement; however, Hispanics may be less likely to pursue this resource. Future work should address barriers Hispanic CCS face in information sharing with other cancer survivors. [Table: see text]