Minority Cancer Patients Research Articles

Testing home-based exercise strategies in underserved minority cancer patients undergoing chemotherapy (THRIVE) trial: a study protocol.

Higher rates of physical inactivity and comorbid conditions are reported in Hispanic/Latinx and Black cancer patients receiving chemotherapy compared to their White counterparts. Despite the beneficial effect of exercise training for cancer patients, rates of participation in exercise oncology clinical trials are low among disadvantaged and racial and ethnic minority groups. Here, we will examine the effect of an exercise intervention using a novel, accessible, and cost-effective home-based exercise approach among Hispanic/Latinx and Black cancer patients receiving chemotherapy on exercise participation and cardiovascular disease risk. The THRIVE trial is an 8-month prospective, three-arm study of 45 patients who are randomized in a 1:1:1 fashion to a supervised exercise intervention (SUP), unsupervised exercise (UNSUP), or an attention control (AC) group. Eligible patients include those with breast, colorectal, or prostate cancer, who are sedentary, overweight or obese, self-identify as Hispanic/Latinx or Black, and plan to receive chemotherapy. Patients randomized to the SUP group participate in a home-based 16-week periodized aerobic and resistance exercise program performed three days per week, supervised through video conference technology. Patients randomized to the UNSUP group participate in an unsupervised 16-week, telehealth-based, periodized aerobic and resistance exercise program performed three days per week using the same exercise prescription parameters as the SUP group. Patients randomized to the AC group receive a 16-week home-based stretching program. The primary outcome is changes in minutes of physical activity assessed by 7-day accelerometry at post-intervention. Secondary outcomes include cardiovascular risk factors, patient-reported outcomes, and physical function. Outcome measures are tested at baseline, post-intervention at month 4, and after a non-intervention follow-up period at month 8. The THRIVE trial is the first study to employ a novel and potentially achievable exercise intervention for a minority population receiving chemotherapy. In addition, this study utilizes an intervention approach to investigate the biological and behavioral mechanisms underlying exercise participation in these cancer patients. Results will guide and inform large randomized controlled trials to test the effect of home-based exercise on treatment outcomes and comorbid disease risk in minority patients with cancer undergoing chemotherapy. https://classic.clinicaltrials.gov/ct2/show/NCT05327452, identifier (NCT#05327452).

Disparities in fertility preservation discussions among sexual and gender minority cancer patients and their cancer care providers

Background Cancer providers are advised to inform their reproductive aged patients about fertility preservation given the potential for treatment-related infertility. How consistently fertility preservation discussions (FPDs) occur is understudied in sexual and gender minority (SGM) cancer patients. The effects of bias and heteronormativity may reduce the rate of FPDs. We identified the frequency and correlates of FPD in a sample of SGM cancer patients. Methods Data were from the cross-sectional 2020 OUT National Cancer Survey. The sample was restricted to those diagnosed with cancer between the ages of fifteen and forty-five. FPD was measured with a single item. Multivariable logistic regression was conducted to determine factors significantly associated with FPDs. Results Average age at cancer diagnosis was 34.97 (SD = 8.34). Respondents were mostly non-Hispanic white (77.6%) and college-educated (63.4%), and 32.6% reported FPDs. In the multivariable model, identifying as lesbian (Adjusted odds ratio [aOR] = 0.49; 95% CI: 0.24-0.99), pansexual (aOR = 0.34; 95% CI:0.12-0.94), or queer (aOR = 0.24; 95% CI: 0.08-0.70) was negatively associated with FPDs compared to bisexuals. Being treated more than ten years ago (aOR = 0.47; 95% CI:0.26-0.85) was also negatively associated with FPDs. Conclusion Findings suggest potential bias against some SGM patients based on sexual orientation identity in FPDs, though changes over the past decade may have increased the frequency of FPD with patients more broadly. More research is needed to investigate why some SGM patients of reproductive age are not being counseled about fertility preservation.

Abstract 4824: Multi-level intervention to increase minority cancer patient enrollment to clinical treatment trials- Study design considerations and baseline characteristics from the ACTWONDER2S Study

Abstract Introduction: Black/African American (AA) and Hispanic cancer patients are underrepresented in cancer clinical trials (CCTs). Disparities stem from multiple factors, thus, comprehensive, multi-level interventions (MLI) are needed. Presented here is a conceptual framework for selecting the appropriate study design for MLIs using ACTWONDER2S, a multi-level intervention (MLI) aimed to increase Black/AA and Hispanic patient participation into CCTs, as an illustrative example. Baseline characteristics of the ACTWONDER2S target populations are also provided. Methods: ACTWONDER2S integrates community health educator and digital tools into an MLI targeting community residents and physicians in the Moffitt Cancer Center (MCC) catchment area, as well as MCC patients, physicians and CCT coordinators. A literature review of the relative strengths and weakness of 5 candidate designs for MLIs was conducted, and a cluster stratified randomized design was selected. Geospatial analytics were used to identify clusters of census tracts (“priority zones”) with high Black/AA and Hispanic populations for intervention deployment. Baseline characteristics of the priority zones were described using US Census data and other sources. Results: 14 priority zones were identified, which were matched on population characteristics and randomized into intervention (n=7) and control (n=7) zones. There were no statistically significant differences between the intervention and control priority zones in total population size (paired t-test p-value=0.63), proportions of Black/AA (p=0.133) and Hispanic populations p=0.17), and distance (in miles) from MCC (p=0.64). Approximately 35.8% and 16.5% of the intervention priority zones were Hispanic or Black/AA, respectively. Average distance to MCC, cancer cases, referral and CCT enrollment rates were also similar between groups. Conclusion: Decision frameworks for MLI study design selection are lacking. The framework provided here for ACTWONDER2S can be applied to other studies seeking to evaluate MLIs. Furthermore, the randomization of the priority zones produced optimal target populations for testing the efficacy of the MIL within ACTWONDER2S. Citation Format: Dana E. Rollison, Rossybelle P. Amorrortu, Lindsay N. Fuzzell, Melany A. Garcia, Elliott S. Tapia-Kwan, Yayi Zhao, Steven A. Eschrich, Bob R. Gore, Brian S. Mittman, Nathanael B. Stanley, Susan T. Vadaparampil. Multi-level intervention to increase minority cancer patient enrollment to clinical treatment trials- Study design considerations and baseline characteristics from the ACTWONDER2S Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4824.

Abstract 5538: Prevalence of factors serving as common cancer clinical trial eligibility criteria by race and ethnicity

Abstract Background: Racial/ethnic minority patients remain underrepresented in clinical trials potentially due to restrictive trial eligibility criteria that disproportionally affect minority cancer patients. Objective: To examine the prevalence of existing medical conditions and abnormal lab values that commonly serve as clinical trial eligibility criteria among cancer patients by race and ethnicity. Methods: A cross-sectional analysis was conducted among patients new to Moffitt Cancer Center in 2011-2021 with multiple myeloma (n=3,967), breast (n=14,348), lung (n=10,492), and prostate (n=7,823) cancers. Demographics, existing medical conditions, and lab values were obtained from the Electronic Health Record, whereas history of cancer and metastatic disease at diagnosis were obtained from the Cancer Registry. Prevalence of medical conditions and abnormal lab values were reported among all patients and compared by race groups (White, Black, Hispanic, and other races) using age-adjusted logistic regression. For factors with prevalence higher than 5%, stratified analysis was conducted with respect to cancer type and adjusted for multiple comparisons. Results: Compared to White patients, Black (B) and Hispanic (H) patients were found to have higher prevalence of diabetes (OR [odds ratio] = 2.26 [B]/1.40 [H]), organ transplantation (OR=1.58 [B]/1.77 [H]), hepatitis (OR=1.74 [B]/1.48 [H]), HIV (OR=4.25 [B]/1.92 [H]), and abnormal creatinine value (OR=1.77 [B]/1.23 [H]). In addition, Black patients were more likely to have hypertension (OR=1.41) while patients of other races were more likely to be diabetic (OR=1.36). Similar patterns were observed across cancer types. Conclusion: Restrictive cancer clinical trial eligibility criteria may post a structural barrier that disproportionately impact racial/ethnic minority patients. Investigators should consider leveraging real-world data to define and design appropriate trial eligibility criteria. Prevalence of factors commonly included as clinical trial eligibility by race/ethnicity. Factors All White Black Hispanic Other Prevalence (%) % % OR (95% CI) % OR (95% CI) % OR (95% CI) Diabetes 6.30 5.90 10.00 2.26 (1.97-2.58) 6.50 1.40 (1.20-1.63) 6.50 1.36 (1.07-1.70) Chronic obstructive pulmonary disease 10.30 11.40 6.20 0.61 (0.52-0.72) 6.10 0.61 (0.52-0.71) 5.90 0.57 (0.44-0.72) Hypertension 18.00 18.50 19.80 1.41 (1.27-1.55) 13.40 0.87 (0.78-0.97) 13.50 0.84 (0.71-1.00) Heart condition 3.00 3.10 2.60 1.10 (0.86-1.39) 2.00 0.80 (0.61-1.03) 1.80 0.70 (0.44-1.05) Organ transplant 0.90 0.90 1.40 1.58 (1.11-2.20) 1.50 1.77 (1.28-2.41) 0.40 0.46 (0.16-1.00) Autoimmune disease 2.50 2.60 2.10 0.84 (0.63-1.09) 1.90 0.78 (0.59-1.01) 2.20 0.90 (0.60-1.30) Hepatitis 0.70 0.70 1.20 1.74 (1.17-2.49) 1.00 1.48 (0.99-2.15) 0.40 0.60 (0.21-1.30) HIV infection 0.30 0.20 0.90 4.25 (2.62-6.74) 0.40 1.92 (1.01-3.40) 0.20 0.71 (0.12-2.30) History of any cancer 15.90 17.20 10.30 0.69 (0.60-0.78) 10.30 0.69 (0.61-0.77) 10.90 0.71 (0.59-0.85) Metastasis at diagnosis 21.20 21.40 22.60 1.13 (1.02-1.24) 19.80 0.96 (0.87-1.05) 18.60 0.88 (0.75-1.02) Abnormal neutrophil count 19.70 20.10 20.20 1.00 (0.86-1.16) 16.60 0.79 (0.67-0.93) 18.20 0.89 (0.69-1.13) Abnormal creatinine 14.00 13.50 19.30 1.77 (1.57-1.99) 14.10 1.23 (1.08-1.39) 13.40 1.13 (0.93-1.38) Abnormal glomerular filtration rate 14.00 13.50 22.40 2.32 (1.99-2.70) 11.20 1.07 (0.88-1.30) 10.10 0.91 (0.66-1.22) Abnormal bilirubin 2.40 2.50 2.40 1.02 (0.69-1.45) 2.40 1.03 (0.70-1.46) 2.40 0.99 (0.52-1.69) Abnormal aspartate aminotransferase 9.40 9.40 9.20 0.88 (0.72-1.07) 9.70 0.92 (0.76-1.12) 8.50 0.82 (0.59-1.12) Citation Format: Yayi Zhao, Rossybelle P. Amorrortu, Rachel Howard, Kedar S. Kirtane, Susan T. Vadaparampil, Dana E. Rollison. Prevalence of factors serving as common cancer clinical trial eligibility criteria by race and ethnicity. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5538.

Abstract B062: Optimizing the PRE-ACT educational intervention to promote decision making about clinical trials among racial and ethnic minorities: The role of the research navigator

Abstract Background Representation in clinical trials that reflects the growing racial/ethnic population diversity in United States is a matter of health equity. Barriers to participation are multifactorial, ranging from awareness of trials, opportunity to participate, and decision making. PRE-ACT is a web-based patient tailored educational tool, previously demonstrated in a randomized controlled trial to improve knowledge and decrease attitudinal barriers to clinical trials participation. However, PRE-ACT enrolled a predominantly white population and subgroup analysis did not show benefit among the non-white participants. The primary objective of this intervention is to improve preparation for consideration of clinical trials using tailored, patient-specific information to address barriers related to knowledge and attitudes among racial/ethnic minority cancer patients (pts). This intervention will adapt the PRE-ACT model to racial/ethnic minorities at a large hybrid academic-community practice healthcare organization (HCO) and incorporate the use of research navigators. Methods This is a prospective interventional cohort study. After IRB approval, eligible pts will be recruited from medical oncology clinics throughout the HCO, including community clinics. They must be 18 or older, have a diagnosis of cancer undergoing oncological work-up, treatment, or surveillance, self-identify with a non-white race or Hispanic ethnicity, and have a life expectancy >3 months. Self-administered surveys will collect demographics and socioeconomic status indicators. Clinical data will be obtained by chart review. A survey will assess knowledge and attitudes towards clinical trials, being administered before and after the intervention. Intervention will consist of research navigator-facilitated 30-minute tailored educational encounter including short videos and discussion based on pts’ responses from the pre-intervention survey. The primary outcome is change in knowledge and attitudes after the intervention. Secondary outcomes are clinical trials participation rates after intervention, compared to historical trends at the HCO. Chi-square test will be used for pre-post comparison using the composite posttest results as observed values and the composite pretest results as expected values; a threshold of 0.05 will be used to determine significant difference. Results This protocol is undergoing review with implementation predicted for the fall of 2022. We expect to accrue 600 patients over the span of 4 years. Conclusions Novel strategies are needed to improve access to clinical trials among racial/ethnic minorities. Understanding and addressing knowledge and attitudes towards clinical trials participation is a key step in this process. We describe a proposed adaptation to the PRE-ACT model utilizing a research navigator framework to address knowledge and attitudinal barriers to participation in clinical trials among minority patients at a large HCO. Citation Format: Annie L. Zhang, Valerie Vinson, Kevin C. Hoy Jr., Violeta Uy, Kristina Austin, Erika Trapl, Jamie Shoag, Debora Bruno. Optimizing the PRE-ACT educational intervention to promote decision making about clinical trials among racial and ethnic minorities: The role of the research navigator [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B062.

Abstract A095: Enhancing minority patient participation in tobacco cessation by a personal pathway to success program

Abstract Background: Minority cancer patients (pts) who use tobacco often decline tobacco cessation programs due to variable personal barriers and priorities. We developed a Personal Pathway to Success (PPS) program to overcome barriers and improve patient (pt) engagement. PPS allowed pts to choose cessation components they were willing to initially use. Methods: City of Hope (COH) tobacco cessation program developed a comprehensive list of evidence-based cessation services. Pts completed tobacco use and a Lifestress Scale assessing societal determinants of distress. PPS was then tailored and offered to pts to create their iquit strategy. Pts could add or delete components at any time as engaged partners in cessation care. Pts were evaluated by demographic group. Since tobacco use is associated with adverse surgical outcomes, we tested the PPS program in the preoperative anesthesia testing clinic (PATC). Results were compared by Chi square statistics. Study data collection was 9/2021 to 2/2022. Results: The components of PPS were individual cessation counseling, individual motivational counseling, nicotine replacement and cessation medications, signed personal commitment agreement, English and Spanish cessation support groups, choosing a buddy partner (family, friends or support group), lung cancer screening, letter to primary care physicians requesting assistance for non-responding pts, SmokeFree Text support, Kick It California or Asian Smokers' Quitline support, rapid action plan for relapses, 5Ds cessation and 7 self-care skills, COH relaxation and/or hypnosis videos, guidance for cinnamon stick/bubble blowing, stress management and smoking cessation apps, Tobacco Cessation as Recovery Enhancement video and audios, educational brochures, advice on vaping, assistance with internet and digital devices, family education and support, and psycho-social or substance abuse referrals. Current results are based on the initial 53 evaluable pts. 100% viewed the educational video. Only 7 pts (13%) were passive-refusal despite 3 attempts and were referred back to their attending physician for added cessation referral. 26 patients (49%) agreed to cessation counseling. Of these 88% completed the counseling. 36% of pts were minority (47% were Latinx, 21% Black/African American, and 32% Asians). All minority pts had motivational counseling. 67% of Latinx and 75% of Black pts also had cessation counseling. Abstinence was achieved by 58% of minority pts, but only 24% of Caucasian pts (p=0.015). Abstinence was achieved by 50% of pts accepting cessation counseling, and even 35% of pts who received only video and brochure education (p=0.28). Overall program metrics showed cessation counseling was increased from 8.7% pre-PPS to 49% with PPS (p<.001). Conclusions: PPS activated pts to accept tobacco cessation. Findings suggest that minority pts were more successful in abstinence compared to Caucasian pts. Offering culturally responsive cessation pre-operatively may be an opportune time (teachable moment) for cessation success, especially among ethnic minority pts. Citation Format: Cary A. Presant, Kimlin Ashing, Sophia Yeung, Jonjon Macalintal, Brenda Gascon, Argiela Sandoval, Mary Cianfrocca, Ravi Salgia, Dan Raz, Loretta Erhunmwunsee, Yuman Fong, Steven Rosen. Enhancing minority patient participation in tobacco cessation by a personal pathway to success program [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A095.

Abstract C109: Testing Home-based Exercise Strategies in Underserved Minority Cancer Patients Undergoing Chemotherapy (THRIVE) Trial: A study protocol

Abstract Background: Higher rates of physical inactivity and comorbid conditions are reported in Hispanic and Black cancer patients receiving chemotherapy, compared to their White counterparts. Despite the beneficial effect of exercise training for cancer patients, rates of participation in clinical cancer trials are low among disadvantaged and racial and ethnic minority groups. This is possibly due to more barriers and less access to exercise training. Therefore, there is a crucial need for better understanding of how to apply exercise interventions using novel, accessible, and cost-effective home-based exercise approaches for Hispanic and Black communities, particularly during chemotherapy. In this study, we will examine the effect of supervised and unsupervised exercise on minutes of physical activity among Hispanic and Black cancer patients undergoing chemotherapy for breast, colorectal, and prostate cancer. Methods: The THRIVE trial is an 8-month prospective, three-arm study of 135 patients who are randomized in a 1:1:1 fashion to a supervised exercise intervention (SUP), unsupervised exercise (UNSUP), or an attention control group. Eligible patients include those with early-stage breast, colorectal, or prostate cancer, planning to receive chemotherapy, are sedentary, overweight or obese, and self-identifying as Hispanic or Black. Patients randomized to the SUP group participate in a home-based 16-week periodized aerobic and resistance exercise program performed three days per week, supervised through video conference technology. Patients randomized to the UNSUP group participate in an unsupervised 16-week, telehealth-based, periodized aerobic and resistance exercise program performed three days per week using the same exercise prescription parameters as the SUP group. The attention control group receive a 16-week home-based stretching program. The primary outcome is changes in minutes of physical activity assessed by 7-day accelerometry at month 4. Secondary outcomes include cardiovascular risk factors, patient-reported outcomes, and physical function. Outcome measures are tested at baseline, post-intervention at month 4, and after a non-intervention follow-up period at month 8. Discussion: The THRIVE trial is the first study to employ a novel and potentially achievable exercise intervention for a minority population receiving chemotherapy. In addition, this study utilizes an intervention approach to investigate the biological and behavioral mechanisms underlying exercise participation in these cancer patients. Results from this study will guide and inform large randomized controlled trials to test the effect of home-based exercise on treatment outcomes and comorbid disease risk in minority patients with cancer undergoing chemotherapy. Citation Format: Huimin Yan, Noelle Merchant, Ashley Desameau, Cherardi NeiraViscue, Paola Gonzalo-Encabo, Dong-Woo Kang, Rebekah L. Wilson, Mary K. Norris, Danny Nguyen, Daniel Gundersen, Laura L. Hayman, Rachel A. Freedman, Timothy Rebbeck, Christina M. Dieli-Conwright. Testing Home-based Exercise Strategies in Underserved Minority Cancer Patients Undergoing Chemotherapy (THRIVE) Trial: A study protocol [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C109.

The Impact of Receiving Radiation Treatment on Financial Toxicity in Underserved Hispanic Cancer Patients with Limited English Proficiency

<h3>Purpose/Objective(s)</h3> Racial and ethnic minority cancer patients in the US are at high risk for financial toxicity (FT). Prior FT outcomes for Hispanic cancer patients is mixed, though risk factors including socioeconomic, insurance, and English language proficiency barriers may influence FT outcomes in this population, though available data are lacking for US Hispanic cancer patients with un/under-insurance and low English proficiency. Therefore, we examined factors associated with FT in Hispanic cancer patients treated with or without RT. We hypothesized that un/under-insured and Spanish-only speaking Hispanic cancer patients would have more severe FT and receipt of RT would increase FT. <h3>Materials/Methods</h3> We conducted a multi-institution survey of Hispanic cancer patients receiving ambulatory oncology care. Depending on reported language preference, respondents underwent a Spanish- or English-language version of the Economic Strain and Resilience in Cancer (ENRICh) FT measure. Respondents were categorized in 3 groups: 1) un/under-insured Spanish-only speaking Hispanics (UN-Spanish) recruited from a public hospital for medically underserved patients 2) un/under-insured English-speaking Hispanics (UN-English, n=23) from the same facility and 3) insured English-speaking Hispanics (INS-English, n=31) from an academic comprehensive cancer center. Any receipt of RT, either pre- or post-survey, was recorded. Groups were compared via Fisher exact or Mann-Whitney U tests. <h3>Results</h3> A higher likelihood of severe overall FT occurred in UN-Spanish (OR=2.73, 95% CI 0.77-9.70; borderline P=0.12) and UN-English (OR=4.13, 95% CI 1.13-15.12; P=0.03) vs. INS-English Hispanics. However, the likelihood of FT did not differ between UN-Spanish and UN-English Hispanics in both models (P=0.59 and P=0.62 respectively). UN-Spanish Hispanics frequently identified completely lacking credit, savings, or income and food insecurity as key aspects of FT. Of 77 patients, 47 (61.0%) received RT as part of their cancer treatment. UN-Spanish (9/23, 39.1%) and UN-English (13/23, 56.5%) respondents were less likely to receive radiation as part of their treatment when compared to INS-English patients (25/31, 80.7%; p = 0.007). Respondents who received radiation treatment had similar overall FT score (median 3.8) when compared to those who had not (median 5.55; p = 0.214). Respondents who had already received RT demonstrated similar overall FT score (median 3.27) when compared with those who went on to receive RT (median 4.87; p = 0.559). <h3>Conclusion</h3> In this pilot study focused on medically underserved, un/under-insured Hispanics with cancer, inadequate insurance was a key predictor of FT regardless of language. Receipt of RT did not appear to impact overall FT. However, un- and under-insured Hispanic cancer patients were less likely to receive radiation as part of their treatment course, which may reflect a disparity in access to care based on insurance status.

Prevalence and Assessment of Factors Associated with COVID-19 Vaccine Hesitancy in an Ethnic Minority Oncology Patient Population

Background: Complicating the COVID-19 pandemic are the healthcare disparities experienced by ethnic minorities, especially those with comorbidities including cancer. The introduction of COVID-19 vaccines has been instrumental in blunting the morbidity and mortality from the pandemic; however, vaccine hesitancy, particularly among ethnic minorities, has been a major concern. Thus, we sought to evaluate the knowledge and perspectives of COVID-19 and vaccines among our ethnic minority cancer patient population. Methods: Following an IRB approved protocol, questionnaires were completed by patients in a predominantly ethnic minority population at a single institution between 1 February and 30 June 2021. Included were any adult cancer patients with either a solid or hematologic malignancy. Results: Among the 84 patients that were offered the questionnaires, 52 patients responded, with a median age of 63.5 years. Overall, 36% were non-Hispanic Blacks and 30% were Hispanics; 65% were receiving active treatment for their cancer. Seventy-nine percent believed COVID-19 to be dangerous or harmful to them, 61% were concerned about the side effects, yet 65% considered COVID-19 vaccines as safe. Among the seven patients that refused the vaccine, (71%, n = 5) cited side effects and/or (57%, n = 4) believed that the vaccine was not needed. Overall, there was a significantly higher chance of being vaccinated if patients were receiving active cancer treatment, believed COVID-19 was harmful, or that the vaccine was safe, and knew COVID-19 was a virus. Conclusions: This exploratory study demonstrates that most ethnic minority cancer patients are receptive to vaccines, with a majority being vaccinated. However, we also discovered various reasons why this group of patients may not want be vaccinated, including concerns about side effects and perception that COVID-19 is not harmful. These findings can help us further understand the complex nature of vaccine hesitancy in ethnic minority cancer patients, and aid in developing future vaccine awareness strategies as the COVID-19 pandemic continues to evolve.

Abstract 3066: Functional modeling and characterization of high frequency mutations associated with gastric cancer in US racial and ethnic minority populations

Abstract Gastric cancer (GC) is the 5th most common neoplasm and the 2nd most deadly cancer worldwide, with an estimated 783,000 deaths in 2018. Furthermore, Hispanic/Latino Americans continue to be underrepresented in GC genomic studies despite being twice as likely to be diagnosed with and die from GC compared to non-Hispanic whites (NHW). In order to address this pervasive health disparity, our lab has led efforts to characterize tumor biopsies from racial/ethnic minority cancer patients to inform more effective cancer treatment and advance precision medicine among these high-risk populations. We performed whole-exome sequencing of 31 GC patient tumors with more than 60% of the samples coming from minority patients. We identified higher somatic mutation frequencies in the ARID1A, BRCA2, and APC genes compared with the TCGA GC cohort, which is made up of mostly NHW patients. To better understand the role these genes play in cancer tumorigenesis among racial/ethnic minority GC patients, our lab has established a CRISPR/Cas9 genome-editing platform in minority patient-derived organoids (mPDOs). In this study, we utilized our platform to generate mPDO models of APC-TP53 double knockouts (dKO), ARID1A-TP53 dKO, and TP53-ARID1A-BRCA2 triple knockouts in organoid lines derived from normal gastric tissue. We developed medium to select for functional mutants following organoid cell electroporation that yielded near-complete selection for the desired gene knockouts, allowing us to generate isogenic mPDO lines modeling each gene KO combination. Our organoid models will provide a critical method to elucidate therapeutic sensitivity and resistance mechanisms in minority groups towards the ultimate goal of addressing GC health disparities in US racial/ethnic minorities. Citation Format: Alexa Morales Arana, Nicole B. Halmai, Hongyong Zhang, Paul Lott, Ana Estrada-Florez, Ted W. Toal, University of California Minority Patient-DerivedXenograft (PDX) Development and Trial (UCaMP) Cent, Luis G. Carvajal-Carmona. Functional modeling and characterization of high frequency mutations associated with gastric cancer in US racial and ethnic minority populations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3066.

"Queer Insights": Considerations and Challenges for Assessing Sex, Gender Identity, and Sexual Orientation in Oncofertility Research.

This article addresses issues related to clinical and research approaches to oncofertility for adolescent and young adult (AYA) sexual and gender minority (SGM) cancer patients. Limited attention has been dedicated to understanding the extent to which oncofertility services are appropriately and equitably delivered to AYAs with diverse orientations toward sexual orientation, gender identity, and future family. Unresolved challenges to conducting research with this vulnerable population perpetuate a lack of adequate knowledge about SGM AYA oncofertility needs. Therefore, the purpose of this paper is to inform considerations of sex, gender identity, and sexual orientation for investigations that include SGM AYAs. In order to improve the knowledge base and clinical services for this population, we discuss (1) challenges to sampling this population; (2) categorization and survey logic (e.g., skip patterns) in light of fluid sexual orientation and gender identities; and (3) clinical implications of accurately assessing sex and gender for oncofertility research and practice. We also recommend strategies for producing inclusive and accurate assessments of sexual and gender identity categories in both research and clinical encounters with SGM AYAs. Incorporating "queer insights" into empirical research - that is, positioning queer theory at the center of oncofertility study design - is suggested as a future direction for oncofertility research and practice.

Assessment of COVID vaccine knowledge and hesitancy in an ethnic minority oncology patient population.

e18570 Background: Complicating the pandemic are the healthcare disparities experienced by ethnic minorities, including Black and Hispanic Americans. This is further exacerbated in those ethnic subgroups, especially if they have comorbidities, including cancer. With the introduction of COVID-19 vaccines, the shift is now focused on promoting vaccination. However, vaccine hesitancy and motives of why ethnic minority cancer patients receive or do not receive vaccines have not been explored and are the focus of this study. Methods: A cross-sectional survey was administered among cancer patients to understand the knowledge and attitude towards COVID-19 vaccines at a single institution in a predominantly ethnic minority population between February 1-June 30, 2021. The participant's inclusion criteria were &gt;18 years old and diagnosed with solid or hematologic malignancy. Descriptive statistics were used to summarize the patient characteristics, COVID-19 vaccine knowledge, and uptake motives. A composite score of COVID-19 and vaccine knowledge was derived and its role on vaccination status was assessed using a multivariable logistic regression model. Results: Of 52 patients surveyed, COVID-19 vaccination prevalence during the survey was 40.4% (95% CI: 27, 54.9). Participants' average (sd) age was 63.5 (13.6) years; 42% were male, 36% were Black, and 30% Hispanic; 65% were receiving active treatment for their cancer. Seventy-nine percent believed COVID-19 infection to be dangerous or harmful to them, 61% were concerned about the side effects of the COVID-19 vaccine, yet 65% considered vaccines safe. Those refusing the vaccine (n=7) cited side effects (71%) or believed that the vaccine was not needed (57%). Of those who were unvaccinated (n=31), 48.4% (n=15) got vaccinated post-survey. The odds of vaccination was 3.79 (1.63, 8.82) times higher with a 1 unit increase in COVID-19 knowledge score but was not significant in the multivariable model. The final model suggested that the odds of vaccination increased 2.9 times more for a 1 unit increase in vaccine knowledge score; Blacks were two times more likely to get vaccinated and those with more than high school education had a five-fold increase in vaccination. The model results are presented in Table. Conclusions: This exploratory study has demonstrated that there are multiple reasons why an ethnic minority cancer patient would be vaccinated and possible reasons why they would not. This information will become important in improving vaccine campaigns targeting these populations and ensuring their safety and protection against COVID-19.[Table: see text]

Overcoming racial disparities in cancer clinical trial enrollment of Asians and Native Hawaiians

BackgroundAsians and Native Hawaiians are two of the fastest growing minority populations in the United States, however these racial minority groups are severely underrepresented in clinical trials. This study looks at cancer clinical trial accrual among Asians and Native Hawaiians in a community-based network with a mission of increasing minority accrual to studies. MethodsThe University of Hawaii Cancer Center (UHCC) network enrolls patients to treatment and non-treatment cancer studies. Enrollment on studies opened between 2009 and 2013 were obtained from UHCC's clinical trial management system. Incidence of cancer by race was acquired from the Hawaii Tumor Registry. Enrollment fractions were compared for the most common races in the state: White, Asian (specifically Chinese, Filipino, Japanese), and Native Hawaiian. ResultsWhites comprised the largest proportion of cancer patients and participants in trials. Asians and Native Hawaiians were enrolled into cancer clinical trials at the same or higher enrollment fraction compared to Whites. Chinese, Japanese, and Native Hawaiian patients participated in treatment trials significantly more often than Whites (p < 0.05). Similarly, Chinese and Native Hawaiians enrolled in non-treatment trials at a significantly higher rate compared to Whites (p < 0.05). ConclusionsThe UHCC network has instituted many strategies to increase minority accrual that have likely led to Asian and Native Hawaiian patients participating in studies at least as often as White patients. The strategies implemented at UHCC may benefit similar communities with a high number of minority cancer patients.

Sexual Orientation and Gender Identity Data Collection in Oncology Practice: Findings of an ASCO Survey.

PURPOSE:Lack of collection of sexual orientation and gender identity (SOGI) data in oncology practices limits assessment of sexual and gender minority (SGM) cancer patients' experiences and restricts opportunities to improve health outcomes of SGM patients. Despite national calls for routine SOGI data collection, individual-level and institutional barriers hinder progress. This study aimed to identify these barriers in oncology.METHODS:An online survey of ASCO members and others assessed SOGI data collection in oncology practices, institutional characteristics related to SOGI data collection, respondents' attitudes about SOGI data and SGM patients, and respondent demographics. Logistic regression calculated adjusted odds ratios (ORs) and 95% CIs for factors associated with sexual orientation (SO) and gender identity (GI) data collection.RESULTS:Less than half of 257 respondents reported institutional SO and GI data collection (40% and 46%, respectively), whereas over a third reported no institutional data collection (34% and 32%, respectively) and the remainder were unsure (21% and 17%, respectively). Most respondents felt that knowing both SO and GI was important for quality care (77% and 85%, respectively). Collection of SO and GI was significantly associated in separate models with leadership support (ORs = 8.01 and 6.02, respectively), having resources for SOGI data collection (ORs = 10.6 and 18.7, respectively), and respondents' belief that knowing patient SO and GI is important (ORs = 4.28 and 2.76, respectively). Themes from qualitative comments mirrored the key factors identified in our quantitative analysis.CONCLUSION:Three self-reinforcing factors emerged as critical drivers for collecting SOGI data: leadership support, dedicated resources, and individual respondents' attitudes. Policy mandates, implementation science, and clinical reimbursement are strategies to advance meaningful data collection and use in clinical practice.

Family communication and coping among racial-ethnic minority cancer patients: A systematic review.

The ability to actively cope with cancer has been extensively associated with better patient-reported outcomes (PROs). This systematic review aims to synthesise the available literature assessing the experience of cancer patients from racial-ethnic minoritised groups. Given the role of sociocontextual factors, greater emphasis was placed on the relationship between family communication and cancer patients' coping within the three largest racial-ethnic minority groups in the United States. Five databases (CINAHL, MEDLINE, PsycINFO, PubMed, Web of Science) were used to search for peer-reviewed empirical studies published between 2008 and 2021, investigating family communication patterns, coping, and well-being among Black/African American, Asian, and Hispanic/Latinx cancer survivors. Short reports, chapters, abstracts/summaries, systematic reviews, and conference proceedings were excluded. This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). The Criteria for Critically Appraising Systematic Reviews and Meta-Analyses were used to assess the quality and risk of bias in the included studies. The synthesis process focused on study aims, methods, measures of interests, sample characteristics, data analysis, and study findings. A total of 117 articles were identified, of which 9 met the inclusion criteria. The selected articles were cross-sectional, implementing both quantitative and qualitative designs. Studies included breast, prostate, and mixed cancer types. Sample sizes of quantitative studies ranged from 64 to 338 respondents, while qualitative studies' samples ranged between 9 and 43 participants. Family communication and coping styles varied across minoritised groups, with open family communication contributing to effective individual and family coping. However, empirical evidence about the nature and contribution of family communication to the coping process is sparse. Future research is needed to increase knowledge and psychosocial assessment techniques and interventions targeting family communication and coping among minority communities.

The role of clinical research nurses in minority recruitment to cancer clinical trials

Clinical trials (CTs) are the established research mechanism designed to examine how new medical therapies are tested for safety and effectiveness. Specifically, non-Hispanic White patients still account for most CT participants and Black patient participation has declined over the past decade. Clinical Research Nurses (CRNs) whose scope of practice includes the recruitment of participants for CTs, have the potential to significantly increase minority patients participation in cancer clinical trials (CCTs). The aim of this phenomenological study was to describe adult oncology CRNs' lived experiences of recruiting minority cancer patients to participate in CTs. A total of 19 nurses participated in semi-structured one-to-one interviews and data analysis was based on Colaizzi's method. The role of CRNs was described as advocates who coordinate care, establish trust, and provide education for CT patients within physician-driven recruitment structures. The CRN's role was also described as self-taught or learn on the go with no formalized recruitment training and lack of robust cultural training. To achieve diverse patient enrollment in CCTs, CRNs and study staff need to receive training on culturally competent clinical research care and the diversity of CRNs and study teams must be increased. Further, meaningful federal and hospital policy change must occur so that minority patients have equitable access to novel cancer therapies and the role of the CRN is delineated from other healthcare staff to optimize research patient care.

Association of mental health diagnosis with race and all-cause mortality after a cancer diagnosis: Large-scale analysis of electronic health record data.

Disparity in mental health care among cancer patients remains understudied. A large, retrospective, single tertiary-care institution cohort study was conducted based on deidentified electronic health record data of 54,852 adult cancer patients without prior mental health diagnosis (MHD) diagnosed at the University of California, San Francisco between January 2012 and September 2019. The exposure of interest was early-onset MHD with or without psychotropic medication (PM) within 12 months of cancer diagnosis and primary outcome was all-cause mortality. There were 8.2% of patients who received a new MHD at a median of 197 days (interquartile range, 61-553) after incident cancer diagnosis; 31.0% received a PM prescription; and 3.7% a mental health-related visit (MHRV). There were 62.6% of patients who were non-Hispanic White (NHW), 10.8% were Asian, 9.8% were Hispanic, and 3.8% were Black. Compared with NHWs, minority cancer patients had reduced adjusted odds of MHDs, PM prescriptions, and MHRVs, particularly for generalized anxiety (Asian odds ratio [OR], 0.66, 95% CI, 0.55-0.78; Black OR, 0.60, 95% CI, 0.45-0.79; Hispanic OR, 0.72, 95% CI, 0.61-0.85) and selective serotonin-reuptake inhibitors (Asian OR, 0.43, 95% CI, 0.37-0.50; Black OR, 0.51, 95% CI, 0.40-0.61; Hispanic OR, 0.79, 95% CI, 0.70-0.89). New early MHD with PM was associated with elevated all-cause mortality (12-24 months: hazard ratio [HR], 1.43, 95% CI, 1.25-1.64) that waned by 24 to 36 months (HR, 1.18, 95% CI, 0.95-1.45). New mental health diagnosis with PM was a marker of early mortality among cancer patients. Minority cancer patients were less likely to receive documentation of MHDs or treatment, which may represent missed opportunities to identify and treat cancer-related mental health conditions.

Increasing underrepresented minority cancer patient enrollment into cancer clinical trials: A systematic review.

e18574 Background: Minorities continue to be underrepresented in clinical trials despite the National Institute of Health’s Revitalization Act, passed in 1993, mandating the representation of women and underrepresented minority groups in clinical trials. Studies have shown that although Blacks represent 15% and Hispanics 13% of the cancer population, their clinical trial enrollment rates in are disproportionately low at 4-6% and 3-6% respectively. We conducted a systematic review exploring interventions aimed at improving clinical trial enrollment for racial and ethnic minorities. Methods: A systematic search of PubMed, Cochrane CENTRAL, and Ovid PsycINFO was conducted for English-language studies of humans since 1993. Inclusion criteria included peer-reviewed, U.S.-based studies with interventions aimed to recruit underrepresented minority adult cancer patients into cancer clinical trials. We defined underrepresented minority groups as Black, Hispanic/Latino, Asian, American Indian/Alaska Native and Native Hawaiian/other Pacific Islander. Results: A total of 2471 titles and abstracts were identified and 2324 were excluded based on the eligibility criteria. A full text review was conducted of the remaining 147 articles, of which only 9 met criteria for our review. The interventions included patient navigation/coaching (n = 4), a clinical trial educational video (n = 2), institutional research infrastructure changes (n = 1), a relationship building and social marketing recruitment model (n = 1) and cultural competency training for providers (n = 1). Studies were conducted in a variety of practice settings including national cancer institutes and community practices. The quality of evidence was limited by the heterogeneity of study methods, patient representation and bias. Several studies had a homogeneous population of Black patients. Most studies (n = 7) were single arm trials that compared results to either historical controls or those cited in the existing literature; two studies were randomized controlled trials. A statistically significant improvement in accrual was shown in three of the patient navigation interventions, one of the clinical trial educational videos, the institutional research infrastructure change and the relationship building and social marketing recruitment model. The common threads to many of these successful interventions were support through the cancer care continuum, cultural congruency of research staff and culturally catered clinical trial educational materials. Conclusions: This systematic review illustrates several mechanisms by which to increase cancer clinical trial recruitment for cancer patients of underrepresented minority backgrounds in a variety of clinical settings. Randomized controlled trials with representation of multiple races/ethnicities are needed to further explore the benefits of these interventions.

Sexual and Gender Minority Communication Skills (SGM Comskil) Training for Oncology Clinicians: Development, Implementation, and Preliminary Efficacy.

Enhancing communicative competence of healthcare providers (HCPs) is a critical initiative for improving the healthcare experience of sexual and gender minority (SGM) cancer patients. This study presents the development, implementation, and preliminary efficacy of a new training curriculum for improving oncology HCPs' skills in providing a safe and welcoming environment for SGM cancer patients (SGM Comskil training). Thirty-three (N = 33) oncology HCPs including nurses, nurse leaders, and nurse practitioners participated in a 4.25-hour SGM Comskil Training between July and August 2019. Overall, participants reported highly favorable evaluations of the training, with more than 80% of the participants reacting positively to 12 of the 15 evaluation items assessing engagement and reflectiveness for experiential role-plays with lesbian, gay, bisexual (LGB) and transgender standardized patients (SPs), respectively. Participants also demonstrated significant improvements in SGM healthcare knowledge, self-efficacy, beliefs toward LGB and transgender persons, and SGM-sensitive language use skills following the training. Encouraged by the feasibility of conducting this experiential training with busy cancer care HCPs and the initial favorable participant evaluation of the SGM Comskil training, results clearly indicate that this training can be rolled out into clinical settings to ensure its translational potential. The next steps should assess observable changes in communication skills and SGM-sensitive language skills with SGM patients and improvements in SGM patients' healthcare experience.

COVID-19 Vaccination among minority Cancer Patients: Recommendation of the International Geriatric Radiotherapy group

COVID-19 Vaccination among minority Cancer Patients: Recommendation of the International Geriatric Radiotherapy group