Mexico Comprehensive Cancer Center Research Articles

Abstract A111: Summertime fun: Findings from three cohorts of C-STEPS summer research trainees

Abstract Introduction: For the past three summers (2021-2023), a National Cancer Institute-funded R25 research education program has been underway at the University of New Mexico Comprehensive Cancer Center, entitled “Cancer Research—Scholarship and Training Experiences in Population Sciences” (C-STEPS). The program engages a diverse population of undergraduate students from across the nation in hands-on, mentored 10-week summer research education and training in cancer control and population science (CCPS). Methods: Using a data-driven methodology, the C-STEPS team has collected quantitative and qualitative data via REDCap surveys to evaluate program aims and student progress and ascertain how students experience the program to improve it for future cohorts. Students who decline admission are provided a one-time survey about the reasons they declined and asked to prioritize factors in their selection of summer research programs. Students enrolled in the program complete a pre- and post-program survey, pre- and post-seminar surveys, and a bi-annual alumni survey. The pre- and post-seminar surveys reflect expected competencies for each of the eight seminars that are part of the curriculum. The alumni survey captures academic accomplishments and career updates since completion of the summer program. Results: We have collected three years of pre/post-program data and pre/post-seminar data. Student knowledge, confidence, and interest in CCPS has steadily increased within each cohort across each of the three time periods: pre-program, immediately post-program, and alumni (1-3 years after the initial research experience). The pre/post seminar surveys indicated that the structure of the seminars inhibited interactions between the presenter and students and warranted change. We have administered the decliner and alumni survey twice each. Data from the decliner survey suggest that students apply to multiple programs each summer and the timeframe for notification to students about their acceptance may need to be shortened to give students more time to consider their C-STEPS offer in relation to other summer opportunities. Data from the alumni survey indicate that students continue to engage in research with their C-STEPS mentor and present the research at their home institution. Conclusion: Efforts to decrease the length of time between when a student applies and when they are notified of their acceptance are at the forefront of the refinement process for the next cohort. The seminars have been restructured to promote more student-led discussions and interactions between presenters and students. The CCPS research experiences and professional networks students develop during the summer have led to new educational and career opportunities. Initial evidence indicates that the success of C-STEPS extends well beyond the immediate one-time immersive research experience. Citation Format: Shoshana Adler Jaffe, Paige A. Lynch, Judith Sheche, Joseph Rodman, Miria Kano, Shiraz I. Mishra. Summertime fun: Findings from three cohorts of C-STEPS summer research trainees [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 A111.

Abstract IA016: Best practice strategies for SOGI data collection: Lessons learned from conducting and implementing the Ask SOGI study

Abstract Background: Collection of reliable data on Sexual Orientation and Gender Identity (SOGI) is essential for improving cancer care for Sexual and Gender Minority (SGM) populations that experience health disparities. To address gaps in reliable SOGI data collection, the National Cancer Institute (NCI) funded a series of awards to enhance sexual orientation and gender identity (SOGI) data collection at cancer centers. In August 2022, we launched the “We Ask Because We Care: Enhancing Sexual Orientation and Gender Identity Data Collection in New Mexico Cancer Center” (Ask SOGI) research intervention at the University of New Mexico Comprehensive Cancer Center (UNMCCC). Methods: Our research team used a mixed methods framework that included a cancer center-wide readiness assessment survey and focus groups to: 1) identify potential barriers to the systematic collection of patient SOGI data, incorporate National Academy of Science Engineering Medicine (NASEM) recommended SOGI measures into the UNMCCC Electronic Health Records; 2) tailor future staff/provider-cultural competency/cultural humility educational interventions, and 3) design a patient-facing “We Ask Because We Care” campaign to encourage welcoming and comfortable care for SGM patients and their informal cancer caregivers. Results: Although the study is on-going, initial survey findings suggest that staff and provider concerns regarding the appropriate method and time for asking patients about their SOGI may inhibit data collection at the cancer center. Respondents desired cancer center led education and training for staff and faculty that would include appropriate points and methods for SOGI data collection, demonstrations of SOGI integration and utilization into the electronic health record, and strategies to encourage conversational confidence so staff and providers can engage patients and their caregivers in sensitive topics. Moreover, SGM patients and caregiver focus group participant reviewers of the emerging “We Ask Because We Care” campaign were positive about the visual images, and acknowledged the importance of such efforts for creating affirmative spaces for SGM persons experiencing cancer. Conclusion: Interventions that address multilevel staff and provider, as well as patient and caregiver concerns regarding discussions of sexual orientation and gender identity data collection may increase more consistent collection of SOGI data that can be used to enhance cancer care and health disparities research. Citation Format: Miria Kano, Dolores Guest, Amy Farnbach Pearson, Mikaela Kosich, Kendal A. Jacobson, Shiraz Mishra, Andrew Sussman, Bernard Tawfik, Zoneddy Dayao, NFN Scout, Cathleen Willging. Best practice strategies for SOGI data collection: Lessons learned from conducting and implementing the Ask SOGI study [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 IA016.

Abstract B134: The art of science: Painting a new image of genomic research in the indigenous communities of the Southwest

Abstract Introduction: The Patient Engagement-Cancer Genome Sequencing Research Center (PE-CGS; NCI U2C CA252973) based at the University of New Mexico Comprehensive Cancer Center (UNMCCC) with partners at Mayo Clinic Comprehensive Cancer Center, the Translational Genomics Research Institute, and the Black Hills for American Indian Health Research Center are developing culturally appropriate strategies and methods to address the underrepresentation of American Indians (AIs) in genomic research. Our efforts are directed towards the implementation of tailored cancer prevention, diagnosis, and treatment strategies that reduce cancer health disparities in Tribal communities. Methods: The PE-CGS Center has three units, each tasked with specific research components to engage AI participants in participatory, clinically-meaningful genomic research: 1) the Participant Engagement Unit; 2) the Genomics Characterization Unit; and 3) the Engagement Optimization Unit (EOU). The Center also has a Tribal Advisory Committee, composed of Tribal Governors, Presidents, and tribal health advocates and experts, who provide direction on all research matters. The PE-CGS EOU uses iterative rapid-cycle research techniques to optimize engagement and shares these strategies with other units for timely implementation. To date, the EOU has developed and implemented three key efforts. First, to aid in recruiting participants for the study, the EOU tailored a series (6) of participant-facing informational materials that include artwork from a local AI artist who combined her traditional and scientific knowledge to prepare complementary imagery. Second, the EOU is currently implementing a series of semi-structured discussions to document participant perceptions on criteria including engagement, communication, and education. Lastly, the EOU implemented a survey among UNMCCC providers on their return of results processes. Results: EOU discussions are ongoing and have provided important perspectives on participant satisfaction and areas for improvement. Participants have commended study staff on their efforts to make enrollment straightforward. Participants report discussing the study with family prior to enrolling, highlighting the importance of continuing to engage with the entire community on the goals of the study. The provider return of results survey is complete (n=42/62, response rate=68%); one key finding was that providers who return somatic test results rarely provide participants with a hard copy of the results or utilize complementary materials that might enhance their explanation of the test findings. Conclusion: The EOU serves an innovative function through its rapid-cycle methods to optimize participant engagement. Although participants are generally pleased with their study participation, there are numerous opportunities for improvement. The informational materials represent a novel contribution to the field of genomic research. Efforts will continue to implement optimized processes for effective engagement of AI communities in genomic research and cancer care delivery. Citation Format: Shoshana Adler Jaffe, Kendal Jacobson, Joseph Rodman, Cindy Blair, Debra MacKenzie, Mallery Quetawki, Tamar Ginossar, V. Shane Pankratz, Andrew Sussman, Ursa Brown-Glabermen, Jeffrey Trent, Cheryl Willman, Shiraz I. Mishra. The art of science: Painting a new image of genomic research in the indigenous communities of the Southwest [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 B134.

Abstract A109: The growth and evolution of GMaP Region 3 Technical Training Summits

Abstract Introduction: The Geographic Management of Cancer Health Disparities Program (GMaP) is a national program funded by the National Cancer Institute’s (NCI) Center to Reduce Cancer Health Disparities with the mission to expand and diversify the pipeline of cancer researchers. GMaP Region 3 is one of seven regions, and is comprised of members from seven Southwestern US states. The University of New Mexico Comprehensive Cancer Center serves as the hub for GMaP Region 3, and has hosted three seminal training Summits. Methods: GMaP Technical Training Summits provided hands-on learning experiences for cancer health disparities (CHD) trainees and promoted collaboration among Region 3’s NCI-designated cancer centers. GMaP Region 6 collaborated with Region 3 to host the final two Summits. Each of the three Summits had differing aims, but the core goals were to strengthen grant writing skills, enhance professional development, in addition to providing opportunities for networking and mentorship. Summit activities included keynote addresses by senior researchers, many of whom are members of historically underrepresented populations, interactive grant writing sessions, and mock grant reviews. Attendee feedback was captured via REDCap surveys and qualitative experience summary reports. Results: Each Summit had increasing attendance: 2016 Summit, n=29, 2019 Summit, n=35; 2023 Summit, n=48. Summit length grew from 1 full day to 2.5 days of sessions. Although the majority of participants were from Regions 3 and 6 there were also attendees from Region 2 and 5 demonstrating the desirability of this type of intensive grant writing training. Attendees were largely satisfied with their experience and in 2023 the overall reception of the summit material was 87% positive. Attendees highlighted the benefits of receiving individualized feedback on their Specific Aims page and the ability to meet people doing similar work. Summits were described as “invigorating” and “motivational”. Participants across the years highlighted the value of hearing from influential researchers in the field and cited these keynote addresses as being “inspirational”. Challenges of hosting these Summits included logistical barriers specifically pertaining to ensuring that scholars had the financial support they needed to attend prior to each event. In addition, tailoring the Summit curriculum and coordinating appropriate speakers was an ongoing learning process. Recommendations: Grant writing is both a science and an art and many scholars, particularly those from underrepresented groups, do not have access to the focused training necessary to develop successful proposals. The GMaP Region 3 Summits provided opportunities for scholars to learn from experienced grant writers and network with their peers. Future efforts to provide tailored grant writing education to newer cancer researchers should be prioritized to support their career development and diversify the types of CHD research proposed and ultimately funded. Citation Format: Shoshana Adler Jaffe, Dolores D. Guest, John Torres, Miria Kano, Andrew Sussman, Shiraz I. Mishra. The growth and evolution of GMaP Region 3 Technical Training Summits [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 A109.

Abstract C019: Comparing the effectiveness of different community education approaches on colorectal cancer knowledge

Abstract Introduction: Colorectal cancer (CRC) incidence and mortality varies greatly among racial/ethnic groups nationally. Community outreach and education are effective strategies to enhance knowledge of CRC and have been shown to increase screening for CRC. The University of New Mexico Comprehensive Cancer Center implements Screen to Save, a community-based CRC screening initiative through the National Outreach Network Program. During the COVID-19 pandemic, restrictions on in-person engagement led to the development and implementation of alternative delivery strategies. Our site continued in-person education as possible, and added Zoom and fully self-paced via QR code options for community member participation. Very little is known regarding the effectiveness of different delivery modes. The purpose of this research is to examine the relationship between method of education session delivery and participant CRC knowledge. Methods: Participants were recruited via community organizations, Facebook advertising, and referrals from local stakeholders. Both before and after a standardized health education session, participants completed a survey assessing their knowledge of CRC risk and screening recommendations. Participant demographics were descriptively summarized. Estimates of mean changes, and 95% confidence intervals (CI), were obtained for each content delivery type. Differences in these changes were compared using ANCOVA approaches. Results: There were 239 participants who completed the educational sessions in-person (n=81), via Zoom (n=66), or using the self-paced module (n=92), Groups did not differ significantly in composition for age (p=0.72) or gender (p=0.33), but did differ in race, ethnicity, and education level (p<0. 001). Those who participated in any delivery method improved their knowledge scores by 11.6 (95% CI: 9.9-13.3) percentage points. For in-person, Zoom, and self-paced groups, the improvements were 14.1 (95% CI: 10.6-17.6, p<0.001), 11.5 (95% CI: 9.1-13.8, p<0.001), and 9.4 (95% CI: 6.7-12.1, p<0.001) percentage points, respectively. When comparing pre vs post score differences among session types while adjusting for pre scores, and for baseline differences in race, ethnicity, and education, the differences in improvement for the three different session types were not significantly different (p=0.68). For in-person, Zoom, and self-paced groups adjusted improvements were 9.2 (95% CI: 0.5-17.5), 11.1 (95% CI: 1.9-19.8), and 10.1 (95% CI: 1.5-18.3) percentage points, respectively. Conclusion: Health education sessions delivered in person, via Zoom, and by self-paced online modules are associated with increases in participant knowledge of CRC. As Cancer Centers expand community outreach and engagement to address cancer health disparities in their catchment areas, a better understanding of the relative effectiveness of different delivery strategies is needed. Further research will help to discern population characteristics predictive of different strategies and link these approaches to screening uptake. Citation Format: Lila A. Baca, Yadira Aguero, Angelica Solares, Vernon Shane Pankratz, Shiraz I. Mishra, Miria Kano, Andrew L. Sussman. Comparing the effectiveness of different community education approaches on colorectal cancer knowledge [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 C019.

Impact of audio-visual tool on patient comfort level at a comprehensive cancer center infusion suite: Preliminary results.

348 Background: Patients receiving chemotherapy often experience anxiety which may result in dissatisfaction with care and decreased adherence to treatment, subsequently leading to unfavorable outcomes. Patient education is shown to ameliorate the anxiety and improve patient comfort. However, retention of information by patients may be sub-optimal in this setting and utilization of multiple information sources may enhance patient recall. We hypothesized that a short “welcome video” on what to expect at an infusion visit, in addition to nursing- patient education would improve patient comfort level. Methods: We conducted a single center prospective pre-post study at the University of New Mexico Comprehensive Cancer Center (UNMCCC) to evaluate the impact of an educational audio-visual tool on the comfort level of patients. An introductory welcome video was developed and made available on: (i) the UNMCCC website (ii) on iPads All patients receiving infusions are asked to complete a survey prior to their infusion. In the phase 1 patients completed surveys prior to the “welcome video” being released. In the phase 2, the video has been introduced. We plan to compare the comfort level of the two populations before and after the video release. Study was reviewed and approved by University of New Mexico Health Sciences IRB. Results: In the first phase, 43 patients completed the survey. Overall, patients felt to have a good understanding of what to expect on their infusion day (average score - 8.9/10), felt somewhat nervous (average score: 3/10), and were interested to learn more about treatment side effects (average score: 5/10), on the 10-point Likert scale (1- strongly disagree, 10- strongly agree (table 1). In the phase 2, preliminary data collection on 40 surveyed patients showed that only 15% (6/40) watched the welcome video. Strategies planned to enhance access including a text message link to the video at patient registration are being implemented as we continue to collect phase 2 survey results. Conclusions: At our center, patients already demonstrate a strong sense of comprehension regarding what to anticipate on their infusion day, primarily through nursing-patient education. Our goal is to further enhance their understanding by improving the delivery of our welcome video and refining the survey questions to yield more informative insights.[Table: see text]

Unfolded Protein Response Factor ATF6 Augments T Helper Cell Responses and Promotes Mixed Granulocytic Airway Inflammation

Abstract The unfolded protein response (UPR) plays a critical role in many diseases, including airway inflammation. Several recent studies demonstrated a pathogenic role of Activating transcription factor 6a (ATF6a or ATF6), one of the essential arms of UPR, in airway structural cells. However, its role in T helper (TH) cells has not been well examined. In this study, we found that ATF6 was selectively induced by STAT6 and STAT3 in TH2 and TH17 cells, respectively. ATF6 upregulated UPR genes and promoted the differentiation and cytokine production of TH2 and TH17 cells. T cell-specific Atf6-deficiency impaired TH2 and TH17 responses in vitro and in vivo and attenuated mixed granulocytic experimental asthma. ATF6 inhibitor Ceapin A7 suppressed ATF6 downstream gene expression and TH cell cytokine expression in both murine and human memory CD4 +T cells. Administration of Ceapin A7 lessened both TH2 and TH17 responses in vivo, leading to alleviation of both airway neutrophilia and eosinophilia. Thus, our results demonstrate a novel role of ATF6 in TH2 and TH17 cell-driven mixed granulocytic airway disease, suggesting a novel option to combat steroid-resistant mixed and even T2-low endotypes of asthma through targeting ATF6. This work was supported in part by NIH grants HL148337 and AI142200 (X.O.Y.), and DK110439 and DK132643 (M.L.). We acknowledge the University of New Mexico Comprehensive Cancer Center Flow Cytometry Core supported by NIH CA118100 and the Autophagy, Inflammation, and Metabolism in Disease Center Inflammation and Metabolism Core supported by NIH GM121176

Outcomes of responders to PD-1/PD-L1 inhibitors who discontinue therapy after sustained disease control.

PD-1/PD-L1 immune checkpoint inhibitors (ICIs) are widely used in the treatment of metastatic malignancies. Judiciously balancing disease control (DC) against development of immune-related adverse events (irAE) remains a crucial aspect of treatment. The effect of treatment discontinuation after sustained disease control (SDC) is unknown. The purpose of this analysis was to evaluate outcomes of responders to ICI who discontinue treatment after a minimum of 12 months (SDC). We retrospectively reviewed the database of the University of New Mexico Comprehensive Cancer Center (UNMCCC) between 2014 and 2021 and identified patients who had received ICI. Patients with metastatic solid tumors who had stopped ICI therapy after achieving SDC [stable disease, partial response, complete response (SD, PR, CR)] were selected and outcomes reviewed from their electronic health records. We identified 204 patients who were treated with ICI for various solid cancers. Forty-four patients (21.6%) met the criteria, of whom 35 with follow-up data were included in the final analysis; including 11 melanoma, 5 non-small cell lung, 4 head & neck, 8 renal, 4 urothelial, 1 anal, 1 Merkel cell carcinoma, and 1 liposarcoma. Patients were divided into two groups: those who stopped ICI due to an irAE [irAE group, n = 14, median treatment time (MTT), 16.6 mo] and those who stopped due to other reasons (eg completion of 2 years of therapy, n = 20, non-cancer related surgery, n = 1) (non-irAE group, n = 21, MTT, 23.7 mo). Among the irAE group, the most common irAE included pneumonitis, rash, transaminitis, and fatigue. As of data cutoff date, 9 of 14 (64%) patients continued to show SDC. Only 5 of 14 (36%) patients in this group experienced progression of disease (PD), with 1 of 2 patients achieving DC (median follow-up of 19.2 mo after last dose of treatment, range 3-50.2 mo). Among the non-irAE group, 13 of 21 (62%) continued to have SDC. Eight of 21 (38%) experienced PD after stopping treatment, 7 of whom received ICI rechallenge, with 2 of 7 achieving DC (median follow-up of 22.2 mo, range 3.6-54.8 mo). At a median follow-up of 21.3 mo from stopping ICI therapy (range, 3-54.8 mo), 10 patients (71%) from the irAE group and 13 (61.9%) from the non-irAE group are in DC and have not experienced PD. We demonstrate that 22 (66%) patients experienced SDC, regardless of cancer type or development of irAE. After including patients who were re-challenged with ICI due to PD, 25 (71%) remain in DC. Future prospective malignancy-specific trials are warranted to evaluate optimal treatment duration.

Dysregulation of the PRUNE2/PCA3 genetic axis in human prostate cancer: from experimental discovery to validation in two independent patient cohorts.

We have previously shown that the long non-coding (lnc)RNA prostate cancer associated 3 (PCA3; formerly prostate cancer antigen 3) functions as a trans-dominant negative oncogene by targeting the previously unrecognized prostate cancer suppressor gene PRUNE2 (a homolog of the Drosophila prune gene), thereby forming a functional unit within a unique allelic locus in human cells. Here, we investigated the PCA3/PRUNE2 regulatory axis from early (tumorigenic) to late (biochemical recurrence) genetic events during human prostate cancer progression. The reciprocal PCA3 and PRUNE2 gene expression relationship in paired prostate cancer and adjacent normal prostate was analyzed in two independent retrospective cohorts of clinically annotated cases post-radical prostatectomy: a single-institutional discovery cohort (n=107) and a multi-institutional validation cohort (n=497). We compared the tumor gene expression of PCA3 and PRUNE2 to their corresponding expression in the normal prostate. We also serially examined clinical/pathological variables including time to disease recurrence. We consistently observed increased expression of PCA3 and decreased expression of PRUNE2 in prostate cancer compared with the adjacent normal prostate across all tumor grades and stages. However, there was no association between the relative gene expression levels of PCA3 or PRUNE2 and time to disease recurrence, independent of tumor grades and stages. We concluded that upregulation of the lncRNA PCA3 and targeted downregulation of the protein-coding PRUNE2 gene in prostate cancer could be early (rather than late) molecular events in the progression of human prostate tumorigenesis but are not associated with biochemical recurrence. Further studies of PCA3/PRUNE2 dysregulation are warranted. We received support from the Human Tissue Repository and Tissue Analysis Shared Resource from the Department of Pathology of the University of New Mexico School of Medicine and a pilot award from the University of New Mexico Comprehensive Cancer Center. RP and WA were supported by awards from the Levy-Longenbaugh Donor-Advised Fund and the Prostate Cancer Foundation. EDN reports research fellowship support from the Brazilian National Council for Scientific and Technological Development (CNPq), Brazil, and the Associação Beneficente Alzira Denise Hertzog Silva (ABADHS), Brazil. This work has been funded in part by the NCI Cancer Center Support Grants (CCSG; P30) to the University of New Mexico Comprehensive Cancer Center (CA118100) and the Rutgers Cancer Institute of New Jersey (CA072720).

Outcomes of responders to PD-1/PD-L1 inhibitors who discontinue therapy after sustained disease control.

2586 Background: PD-1/PD-L1 immune checkpoint inhibitors (ICIs) are widely used in the treatment of metastatic malignancies. Judiciously balancing disease control (DC) against development of immune-related adverse events (irAE) remains a crucial aspect of treatment. The effect of treatment discontinuation after sustained disease control (SDC) is unknown. The purpose of this analysis was to evaluate outcomes of responders to ICI who discontinue treatment after a minimum of 12 months (SDC). Methods: We retrospectively reviewed the database of the University of New Mexico Comprehensive Cancer Center between 2014 and 2021 and identified patients who had received ICI. Patients with metastatic solid tumors who had stopped ICI therapy after achieving SDC [stable disease, partial response, complete response (SD,PR,CR)] were selected and outcomes reviewed from their electronic health records. Results: We identified 204 patients who were treated with ICI for various solid cancers. Forty-four patients (21.6%) met the criteria, of whom 35 with follow-up data were included in the final analysis; including 11 melanoma, 5 non-small cell lung, 4 head & neck, 8 renal, 4 urothelial, 1 anal, 1 Merkel cell carcinoma, and 1 liposarcoma. Patients were divided into two groups: those who stopped ICI due to an irAE [irAE group, n=14, median treatment time (MTT), 16.6 mo] and those who stopped due to other reasons (eg completion of 2 years of therapy, n=20, non-cancer related surgery, n=1) (non-irAE group, n=21, MTT, 23.7 mo). Among the irAE group, the most common irAE included pneumonitis, rash, transaminitis, and fatigue. As of data cutoff date, 10 of 14 (71%) patients continued to show SDC. Only 4 of 14 (28.6%) patients in this group experienced progression of disease (PD), one of whom was re-challenged with nivolumab and achieved DC (median follow-up of 19.2 mo after last dose of treatment, range 3-50.2 mo). Among the non-irAE group, 13 of 21 (62%) continued to have SDC. Eight of 21 (38%) experienced PD after stopping treatment, 7 of whom received ICI rechallenge, with 2 of 7 achieving DC (median follow-up of 22.2 mo, range 3.6-54.8 mo). At a median follow-up of 21.3 mo from stopping ICI therapy (range, 3-54.8 mo), 10 patients (71%) from the irAE group and 13 (61.9%) from the non-irAE group are in DC and have not experienced PD. Conclusions: We demonstrate that 23 (66%) patients experienced SDC, regardless of cancer type or development of irAE. After including patients who were re-challenged with ICI due to PD, 26 (74%) remain in DC. Future prospective malignancy-specific trials such as NCT04637594 are warranted to evaluate optimal treatment duration. [Table: see text]

Abstract PO-080: Reaching the “hard to reach” sexual and gender diverse communities for population-based research in cancer prevention

Abstract Purpose Despite about 5% of the US population identifying as Sexual and Gender Diverse (SGD), there is limited research on cancer prevention and control disparities in this population. In New Mexico (NM), population-level data from the Department of Health show differences in cervical and breast cancer screening uptake based on sexual orientation, but these data do not document disparities based on gender identity and for other types of cancer, prompting us to assess cancer prevention practices among NM SGD communities. SGD communities have consistently been considered “hard to reach” and much of the extant SGD studies have been conducted in large urban cities. We present findings on how to implement innovative, multi-pronged, and systematic recruitment strategies to engage SGD communities in NM, a state that is both largely rural and racially classified as “majority-minority” state. Methods Our recruitment efforts focused on four strategies: (1) Every Door Direct Mail program (by the United States Postal Services) was used to mail flyers across targeted (based on residential areas, income below $30,000, and between ages 30-71) mailing routes across NM. (2) These routes were also targeted for study-related ads via Google, Twitter, and Facebook. (3) Email outreach was conducted with SGD-friendly businesses, state cancer coalitions, and the University of New Mexico Comprehensive Cancer Center's Office of Community Outreach and Engagement. (4) Flyers were displayed at clinical and community settings across NM. All flyers, ads, and emails contained QR codes for a pre-survey that determined eligibility for participation in the main survey (i.e. 21-80 years old, NM resident, member of SGD community). Questions on the online survey, provided in both English and Spanish, inquired about the participant's demographics, body organs, physical health, vaccination history, healthcare access, and cancer screening practices. Results A total of 27,369 flyers were distributed and 436,177 impressions were made on social media, resulting in 5,080 surveys from eligible participants. Approximately 68% heard about the study from social media, 17% from email, 16% through friends or family, and 12% from flyers. All eligible participants were then emailed three times and, in a few cases, mailed a survey. This resulted in 3,115 completed surveys. Half of respondents were between 31-40 years, 38% were Black, Hispanic, or American Indian/Alaskan Native, and 48% had an annual household income below $50,000. Eighteen percent identified as lesbian, 30% gay, 28% bisexual, and 18% queer, while 48% were cisgender men, 32% cisgender women, and 13% transgender. Approximately 44% reported residing in rural areas and responses were received from 172 unique NM zip codes. Conclusion To reach state-wide SGD communities and engage them in population-based research, innovative and systematic efforts are needed. Social media and postal flyers may provide successful recruitment opportunities with potential to use these methods for future public health interventions for these populations. Citation Format: Prajakta Adsul, Karen Quezada, Katie Myers, Talya Jaffe, Bernard Tawfik, Emily Wu, Molly McClain, Shiraz Mishra, Miria Kano. Reaching the “hard to reach” sexual and gender diverse communities for population-based research in cancer prevention [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-080.

Comparative Analysis for Effectiveness of Azacitidine Versus Decitabine in Acute Myeloid Leukemia and Myelodysplastic Syndromes in New Mexico: A Single Institution Experience

IntroductionPrognosis of acute myeloid leukemia (AML) and high-risk myelodysplastic syndromes (MDS) is still very poor due to limited treatment options. Both azacitidine (AZA) and decitabine (DEC) have to been shown to have a significant overall survival benefit in MDS patients. In recent years, both drugs are increasingly used for relapsed refractory AML as well as de novo AML in elderly patients with multiple comorbidities. However, we do not have the results of prospective clinical trials comparing AZA directly to DEC in AML or MDS patients. The goal of this study is to evaluate the overall survival and response duration of the AML and MDS patients who received at least one cycle of AZA or DEC in University of New Mexico Comprehensive Cancer Center (UNMCC).MethodsA retrospective chart review was performed to identify clinical characteristics, treatment duration and overall survival in AML and MDS patients. AML patients were risk stratified into favorable, intermediate and poor risk categories based on cytogenetics and molecular abnormalities. MDS patients were also risk stratified into low, intermediate and high-risk categories based on International Prognostic Scoring System. A majority of MDS patients in the study were in intermediate to high-risk categories. The primary patient outcome was overall survival (OS), calculated from the date of diagnosis until the date of death or lost to follow-up. Kaplan-Meier method was applied to compare OS between two groups, azacitidine-treated and decitabine-treated patients.ResultsIn this study, 60 patients (82%) received AZA and 13 patients (18%) received DEC as a treatment for either AML or MDS. Median age at diagnosis for AZA group was 69 years old and DEC group was 62 years old. There were 34 females (57%) in AZA group, compared to 6 females (46%) in DEC group. There were 22 patients with therapy related AML in both groups. DEC group had a higher proportion of patients (8 out of 13, 62%) with relapsed refractory AML, compared to only 25 out of 60 (42%) patients in AZA group with the p value of 0.229. There were 35 De novo AML and MDS patients in AZA group and 5 in DEC group.Median duration of treatment was 3.2 months and median number of treatment cycles was 4 for both groups. There was no significant difference in median overall survival between two groups (AZA 18 months vs DEC 17 months, p=0.082). The median overall survival for relapsed refractory AML in both groups was also similar (AZA 16.6 months versus DEC 18.2 months, p=0.932). However, median overall survival was significantly longer for AZA group with MDS or de novo AML patients (AZA 25 months versus DEC 3 months, p=0.001).ConclusionA significant number of patients with MDS and AML received AZA than DEC in UNMCC and it is similar to the previously reported Surveillance, Epidemiology, and End Results-Medicare database analysis which showed a majority of patients (78%) received AZA. Although we have a limited number of patients in both groups, the median overall survival for de novo AML and MDS patients is significantly higher in AZA group than DEC group. We are awaiting results from the ongoing prospective randomized clinical trials comparing azacitidine versus decitabine in AML and MDS patients to confirm these findings. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

First Person Profile: Cheryl Willman, MD: As director and CEO of the University of New Mexico Comprehensive Cancer Center, Dr. Willman has led major health equity initiatives while making pioneering discoveries in precision medicine.

First Person Profile: Cheryl Willman, MD: As director and CEO of the University of New Mexico Comprehensive Cancer Center, Dr. Willman has led major health equity initiatives while making pioneering discoveries in precision medicine.

Developing a survivorship care plan (SCP) delivery process for patients and primary care providers serving poor, rural, and minority patients with cancer.

BackgroundSurvivorship care plans (SCPs) summarize patients’ treatment and act as an education and communication tool between oncologists and primary care providers (PCPs). But creation and delivery of SCPs are challenging, labor intensive, and costly. The University of New Mexico Comprehensive Cancer Center (UNM CCC) treats a poor, rural, and minority patient population, and our purpose was to implement and evaluate a process to create and deliver SCPs to patients and PCPs.MethodsProviders placed an electronic SCP order, basic information was imported, and staff compiled treatment details. Flagged SCPs were then ready for delivery, providers approved of and delivered the SCP at the next encounter, and the SCP was sent to the PCP.ResultsBy April 2020, 283 SCPs were ordered, 241 (85.2%) were created by the designated staff, and 97 (34.2%) were given to patients after definitive therapy for breast cancer (59.1%), gynecological cancers (10.8%), prostate cancer (7.4%), colorectal cancer (5.1%), and lymphomas (4.8%). Of 97 SCPs eligible to be sent to PCPs, 75 (77.3%) were mailed or sent via EMR. Of the 41 (48.9%) SCPs sent via mail or fax, only 8 (8.3%) were received and 5 (5.2%) integrated.ConclusionsThis study shows that SCPs can be delivered to patients in a poor, rural, and minority patient population but that PCP receipt and integration of SCPs are poor. Future efforts need to ensure that an oncologist to PCP education and communication tool is able reach and be integrated by PCPs.

Targeted phage display-based pulmonary vaccination in mice and non-human primates

The extensive alveolar capillary network of the lungs is an attractive route for administration of several agents. One key functional attribute is the rapid onset of systemic action due to the absence of first-pass metabolism. Here we applied a combinatorial approach for ligand-directed pulmonary delivery as a unique route for systemic targeting in vaccination. We screened a phage display random peptide library in vivo to select, identify, and validate a ligand (CAKSMGDIVC) that specifically targets and is internalized through its receptor, α3β1 integrin, on the surface of cells lining the lung airways and alveoli and mediates CAKSMGDIVC-displaying phage binding and systemic delivery without compromising lung homeostasis. As a proof-of-concept, we show that the pulmonary delivery of targeted CAKSMGDIVC-displaying phage particles in mice and non-human primates elicit a systemic and specific humoral response. This broad methodology blueprint represents a robust and versatile platform tool enabling new ligand-receptor discovery with many potential translational applications. Cancer Center Support Grants to the University of Texas M.D. Anderson Cancer Center (CA016672), University of New Mexico Comprehensive Cancer Center (CA118100), Rutgers Cancer Institute of New Jersey (CA072720), research awards from the Gillson Longenbaugh Foundation, and National Institutes of Health (NIH) grant no. 1R01CA226537.

Abstract B015: Women in survivorship health using Project ECHO: Creating a model for navigated care transitions

Abstract There are currently over 15 million cancer survivors in the US, and this number is expected to exceed 20 million by 2026 due to population aging and growth. The majority of these patients are older; many are ethnically diverse and face unique health care challenges and comorbidities due to their cancer treatment. Despite this recognition, research clearly documents the persistence of unmet needs among cancer survivors, including less than optimal preventive and cancer surveillance screening rates. Several barriers have been identified in the effort to achieve optimal survivorship care: the current health care system is fragmented, difficult to navigate, and communication between oncologists and primary care providers is often minimal. While research has been devoted to developing integrated care models, systematic reviews conclude that no standard of care exists for survivorship models. Further, given the variability of cancer survivors in terms of health needs, socioeconomic circumstances, and health care environment, it is likely that such models will need to be adaptive. Building on prior formative research, our research team at the University of New Mexico Comprehensive Cancer Center (UNMCCC) is creating a survivorship care model for implementation. New Mexico, a large, rural, minority-majority state, with deep socioeconomic disparities that limit access to care, presents an ideal environment to address the current evidence gap in survivorship care transitions. Our developing research program features the following major components to this survivorship care model: 1) identifying risk-stratified patients at the UNMCCC and delivering a survivorship care plan; 2) using the Project ECHO telementoring platform, implement a survivorship care training curriculum with primary care providers; 3) an oncology nurse navigator based at the UNMCCC will actively navigate patients to the community-based providers; and 4) all components of the model will be assessed using implementation science research and evaluation strategies. We are in the early phases of developing and implementing this model and we will report on the content and process associated with each of the major components. Identified outcomes pertain to feasibility and acceptability of implementation, and we will categorize these using the RE-AIM and Consolidated Framework for Implementation Research frameworks. Citation Format: Andrew L. Sussman, Teresa Rutledge, Zoneddy Dayao, Miria Kano, Amy Gundelach, Stephanie McGirt, Jolene Lobo, Shiraz Mishra. Women in survivorship health using Project ECHO: Creating a model for navigated care transitions [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B015.

Pharmacist-Driven Oral Oncolytic Medication Education and Consent.

The numbers and types of oral oncolytics in oncology are expanding rapidly. Oral oncolytics have serious adverse effects, and pharmacist-driven patient education has the potential to reduce adverse events. The University of New Mexico Comprehensive Cancer Center (UNM CCC) initiated a patient education and consent process for oral oncolytics in our minority, rural, and economically disadvantaged population. The UNM CCC initiated a pharmacist-driven education and consent process from August 2016 to October 2018. The process metric measured via statistical process control charts was the percentage of patients receiving oral oncolytic therapy who were educated and consented. The balancing metric was time for benefit investigation. The intervention was pharmacy team members providing standardized education for and obtaining consent from each patient, supported by electronic medical record orders, physician education, pharmacy notifications, and hospital discharge planning. The initial monthly education and consent rate was 17.9%, followed by 45.5% the subsequent month. This quickly grew to an average of 87.0% (95% CI, 81.5% to 92.4%) for the subsequent 15 months in which control was achieved. Additional changes increased the education rate to 95.7% (95% CI, 93.4% to 98.1%). These 2 periods were statistically different (P = .0025). There was no change in time for benefit investigation (5.60 v 5.52 days; P = .75). A pharmacist-driven program for education and consent upon initiation of oral oncolytics is possible and can successfully educate a majority of patients. Future directions will include ensuring patient adherence and educating patients who fill oral oncolytic prescriptions outside UNM CCC.

Optimizing infusion wait time: Redesigning medication order verification/approval at a comprehensive cancer center.

e14042 Background: Nationwide, many cancer centers experience challenges with infusion center efficiency while maintaining high safety standards. Many factors contribute to long wait times for patients on the day of their infusion appointments. At University of New Mexico Comprehensive Cancer Center (UNMCCC), a contributing factor is the delays in verification or approval of medications. We conducted a project to improve order verification/approval workflow within a Plan-Do-Study-Act (PDSA) framework with the objective to decrease the infusion wait time. Methods: A multidisciplinary working group was formed consisting of the infusion floor physician lead, nurse lead, pharmacy lead, and analytics and process improvement leads. Upon exploring the infusion workflow database, disruptions in verification or approval of orders had a large impact on wait times. Order verification workflow was broken down into 3 steps: 1) physician assessment of patient and approval of orders, 2) infusion nurse assessment of patient, 3) pharmacist verification of order. Beginning Feb 2019, the following interventions were implemented in each section: 1) once patient was assessed by physician and orders approved, the patient was marked as “ready-to-treat”. 2) Pharmacist verified the order once “ready-to-treat” was communicated and initiated preparation of medications prior to arrival of patient to the infusion suit. 3) Infusion nurse assessment occurred once patient was seated on infusion chair. 4) Physicians were encouraged to pre-approve selected injections by the morning of patient appointment. Results: Prospective wait time was gathered for May 2019 using the real-time data available in the electronic medical record. Wait times were analyzed for patients receiving chemotherapy or flat dose injections. By marking appropriate patients “ready-to-treat” and moving pharmacist verification prior to infusion nurse assessment, there was an immediate decrease in wait time from 79 to 60 min. Selected injections which did not require mixing were pre-approved by the physician and stored in the medication dispensing system (Pyxis). This resulted in decrease in the injection wait time by 8.5 minutes, without wasting of drugs. Conclusions: Redesigning the medication order verification/approval workflow resulted in reduced wait times for patients receiving infusions or injections. We aim to further refine our PDSA cycles and ensure sustainability of change.

Streamlining survivorship care plan (SCP) creation and delivery to primary care providers in poor, rural, and minority patients.

e24181 Background: The number of cancer survivors is rapidly climbing due to increased screening and improved treatment. Survivorship Care Plans (SCPS) summarize the patients’ treatment and is a communication tool between oncologists and primary care physicians (PCP)s. Creation and delivery of the SCPs has been labor intensive and costly for many healthcare systems and a previous paper based system at our institution was ineffective. The University of New Mexico Comprehensive Cancer Center (UNMCCC) treats a unique population of lower socioeconomic status (SES) (poverty rate 19.7%), rural (22.6%) and minority (Native Americans and Hispanics constitute 10.4% and 48% of the population respectively) patients in a large rural state. Methods: Beginning March 2019, UNMCCC initiated a process for creation and delivery of SCPs through the Electronic Medical Record (EMR). EMRs are not designed to delivery SCPs to patients and PCPs, so EMR functions were creatively repurposed. Upon identification of eligible patients, providers would place an electronic SCP order through the EMR. Designated staff then partially completes the SCPs based on medical record review while the EMR imports demographics, PCP, cancer and stage. Then the EMR flags SCPs ready for delivery and the provider edits, approves and prints the SCP for the patient at the next encounter. Once printed, the EMR alerts medical records to send the SCP to the PCP via mail or EMR routing. Results: 282 SCPs were ordered, 222 (78.7%) were created and 86 (38.7%) given to patients after definitive therapy of Breast (77.9%), Colorectal (7.0%), Gynecological (9.3%) and Prostate Cancer (5.8%). Of 72 SCPs eligible to be sent to PCPs, 48 (66.7%) were successfully mailed or sent via EMR, 13 (18.1%) had PCP discrepancies, 6 (8.3%) had no PCP and 5 (6.9%) had PCPs in systems which do not accept unsolicited records. Conclusions: The UNMCCC cares for low SES, rural and minority patients and was able to create and deliver SCPs to a significant number of patients and PCPs. Future process steps will involve creating tailored SCPs for other diagnoses, resolving PCP discrepancy issues and creating an EMR alert for PCPs when they receive an SCP. Additionally, assessment of both patient and PCP perceptions is ongoing.

Oral oncolytic education and adherence monitoring in poor, rural and minority patients.

e19212 Background: Oral oncolytics therapy use has been exponentially growing over the last several years necessitating education and monitoring. Pharmacy driven interventions have been shown to increase side effects detection, mitigation and ensure adherence. The University of New Mexico Comprehensive Cancer Center (UNMCCC) treats a unique population composed of poor (poverty rate 19.7%), rural (22.6%) and minority (Native Americans and Hispanics constitute 10.4% and 48% of the population respectively). Methods: New patients starting oral oncolytics were enrolled from May 2019 to January 2020 with an initial 30-minute educational visit with a pharmacist. UNMCCC initiated a pharmacy driven process of tracking patients via phone calls to monitor compliance, early presence of adverse events and issues surrounding the administration of oral oncolytics. Phone calls were conducted monthly for three months and then spaced out depending on patient and drug characteristics. Late education occurred when the initial education was performed after the patient started chemotherapy. Late first follow-ups occurred when the follow-up date was greater thirty-eight days after the start of chemotherapy. Results: A total of 196 patients started on oral chemotherapy of which 70% (139) received education following prescription, 17% (35) received late education and 11% (22) missed education. Newly started actively monitored patients significantly increased to 196 patients by the ninth month of the program. A total of 296 follow ups calls were performed within the first three months, 41% (111) were considered late follow-up. The first, second and third call were missed in 18% (49), 14% (40) and 16% (45) of patients. Conclusions: The UNMCCC cares for poor, rural and minority based patients and was able to reach the majority of patients in a timely manner for education and adherence monitoring. Our efforts were significantly hampered by the increasing number of active patients needing monitoring as the program progressed which will require further resources including, a close collaboration between physicians and pharmacists to provide a service that was previously absent and process changes which we are addressing as our next steps.