Native Hawaiians And Other Pacific Islanders Research Articles

Abstract 3472: Tailored cancer outreach efforts of a community outreach core working with Native Hawaiian and Pacific Islanders in Hawaiʻi

Abstract Background The Community Outreach Core (COC) of the Pacific Island Partnership for Cancer Health Equity (PIPCHE) aims to improve health equity for historically underserved populations including Native Hawaiians and other Pacific Islanders (NHOPIs), and Filipinos. PIPCHE is a partnership between the University of Hawai’i Cancer Center and the University of Guam whose efforts are focused in Hawaiʻi, Guam and the U.S. Affiliated Pacific Islands (USAPI). The COC directly addresses the disproportionately high rates of health disparities and cancer incidence and mortality found within NHOPIs often due to multiple complex historical, social, cultural, and environmental factors. Cancer is the second leading cause of death in Hawai’i between 2014-2018, as well as the second most common cause of death in nearly all USAPI jurisdictions. The COC uses research-tested, community-engaged approaches to modify determinants of cancer in these groups. Methods Outreach efforts have addressed NHOPI cancer inequities by raising awareness of high cancer burdens experienced by these underserved communities. Efforts include resource sharing and data collection at various venues in Hawaiʻi such as health/wellness fairs, public housing, and Pacific Islander churches. Outreach Advisory Council meetings were held biannually with community health leaders to discuss ongoing and future initiatives/resource sharing. The COC provided health providers and students with cultural competency training on more efficient strategies to work with these unique NHOPI groups. The COC provided presentations and short talks across the U.S, including a Health Providers Symposium on lung cancer across the Pacific. Outreach efforts have included tailored NCI-based Screen to Save (S2S) colorectal cancer education to NHOPIs. Results Forty-seven major outreach events were conducted from 2021 to November 2023. These include: 1 Health Providers’ Cancer Symposium, 5 Outreach Advisory Council meetings, 5 Cultural Competency trainings and class lectures, 11 conference/community and short talk presentations, and 25 community outreach events. There were 1,900 attendees reached during these regional and national outreach activities. The COC works with professional audiences at the national level to inform these groups about cancer and the health burdens of NHOPIs. A total of 97 Pacific Islanders received the S2S education and completed a pre-posttest with positive increases in means found for all 14 questions. Conclusion The PIPCHE COC has been able to reach NHOPIs though community partnerships to deliver culturally tailored cancer prevention education and efforts within Hawaiʻi, as well as shed light nationally of the cancer burdens these populations face. The S2S education has been able to raise awareness of cancer screenings and holds promise as a potential strategy to address cancer burdens of NHOPI communities. Citation Format: Mark Lee Willingham Jr., Kevin D. Cassel, Angela Sy, Munirih Taafaki, Tressa P. Diaz, Antoinette Kleiner, Angelina Mummert. Tailored cancer outreach efforts of a community outreach core working with Native Hawaiian and Pacific Islanders in Hawaiʻi [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 3472.

Data Equity for Asian American and Native Hawaiian and Other Pacific Islander People in Reproductive Health Research

(Abstracted from Obstet Gynecol 2023;142(4)) Policymakers and public health researchers often exclude Asian American and Native Hawaiian and Other Pacific Islander (NHPI) people, who make up 6.0% and 0.2% of the US population, respectively, from discussions of racial, social, and health inequity. The omission of Asian American and NHPI populations is multifactorial and includes geographic concentration in certain regions, the high number of cultural and linguistic subgroups bundled together, and the faulty assumption that these groups collectively enjoy better health outcomes than their counterparts of other races and ethnicities.

Mental health literacy in Polynesian Native Hawaiian and Other Pacific Islanders

AbstractThe high prevalence of mental health problems and underutilization of mental health treatment are more severe among the Native Hawaiian and Other Pacific Islander (NHPI) populations and remain misunderstood and understudied. Examining mental health literacy (MHL) – the knowledge and beliefs about mental disorders – aids their recognition, management, or prevention – has been shown to identify barriers to seeking and receiving care. This study aimed to assess the level of MHL in NHPIs and identify associated demographic variables. Data for this cross‐sectional study were collected from 298 US NHPIs via an online questionnaire of the Mental Health Literacy Scale (MHLS). The overall mean MHLS score was 121 (SD = 17.3), with statistically significant higher scores in female participants, >31 years old, Tongan, more educated, and with higher income. This study demonstrated that overall MHL is comparable among NHPI compared to the current literature. However, NHPI men ≤30 years old and with lower income had lower MHL, which may be linked to the mental health disparities specific to this population. Current interventions should focus on increasing knowledge of risk factors, causes, self‐treatments, and available professional help regarding mental disorders. Efforts to improve the MHL of NHPI should target men ≤30 years with lower income (<$50 000).

Intersecting Identities: A Look at How Ethnic Identity Interacts With Science Identity in Native Hawaiian and Pacific Islander Students.

Understanding the experiences of Native Hawaiian and Other Pacific Islander (NHPI) students in science courses can help us foster inclusivity and belonging for these often excluded and unacknowledged students. Using social influence theory as a framework, we investigated the intersection between ethnic-racial identity and science identity in NHPI students to better understand their experiences in undergraduate Biology courses. We collected both quantitative and qualitative data and used concurrent triangulation design in our mixed-methods approach. Quantitative data include measures of student pre- and post-course science identity, self-efficacy, alignment with science values, sense of belonging, environmental concern, strength of ethnic-racial identity, and the interaction between ethnic-racial and science identity. We measured environmental concern because NHPI cultures often have strong connections with the environment that may overlap well with environmental science values. Qualitative data included short responses to survey questions that asked students to describe the interaction between their science identity and their ethnicity. We found that NHPI and non-NHPI students do not significantly differ in any construct we measured, nor do they experience different gains across a semester when comparing pre- and post-scores. We also found that NHPI students' feelings concerning the intersection of their ethnic and science identities are varied and complex, with some students expressing feelings of conflict and many others expressing a strengthening relationship between those identities. We discuss implications for instructors and encourage them to acknowledge the community culture of wealth NHPI students bring to the classroom because of their ethnic-racial identities.

A Large National Study on Racial Disparities among Asian American, Native Hawaiian, and Other Pacific Islander Cancer Patients Who Refuse Radiation Therapy and Surgery

Asian Americans (AAs) are the only race for whom cancer is the leading cause of death in the US. Despite radiation therapy (RT) and surgery being curative treatments, prior work demonstrated AAs refuse RT/surgery at a higher rate than other races. Given AAs are often aggregated with Native Hawaiians and other Pacific Islanders (NHPIs), rates of RT/surgery refusal within this community are poorly understood. We aimed to 1) assess RT/surgery refusal on overall survival (OS) using propensity-score (PS) matched groups, 2) identify AA and NHPI populations that refuse RT/surgery and 3) determine predictors of refusing RT/surgery. A US hospital-based retrospective cohort study of the National Cancer Database was conducted. Patients included were ≥18 years old, AA by ethnogeographic region (South AA, East AA, and Southeast AA) or NHPI race, with a confirmed diagnosis of 1 of the 10 most common US cancers during 2004-2017 who were recommended for RT/surgery. Cox proportional hazard models with adjusted Hazard Ratios (aHR) assessed propensity-score matched groups (1:10) based on age, race, cancer stage, comorbidity index, rurality, facility type, facility location, and year of diagnosis. Adjusted odds ratios (aOR) were calculated and 95% confidence intervals (95% CI) for treatment refusal using logistic regression. Population heterogeneity for treatment refusal by race was assessed with likelihood ratio tests (p-heterogeneity). The cohort of 147,685 patients who met the inclusion criteria were predominantly East AA (43%), diagnosed with breast cancer (42%), and had a <2 comorbidity index (99%). Median age was 61 years. Median follow-up was 58 months. Overall, 2,888 (5%) patients refused RT, and 1,073 (1%) refused surgery. RT refusal by race was 5.7% (East AA), 7.9% (NHPI), 4.6% (South AA), and 4.6% (Southeast AA). Surgery refusal rates were 1.5% (East AA), 1.9% (NHPI), 1.1% (South AA) and 1.2% (Southeast AA). RT refusal significantly predicted poorer OS (aHR = 1.15, 95% CI = 1.06-1.25) whereas surgery refusal did not. Compared to East AA, NHPIs had a higher risk of RT refusal (aOR = 1.44, 95% CI = 1.27-1.62), whereas South AA (aOR = 0.85, 95% CI = 0.75-0.95) and Southeast AA (aOR = 0.82, 95% CI = 0.75-0.90) had a significantly lower risk (p-heterogeneity<.0001). Predictors of RT refusal were older patient age, high comorbidity index, oral cavity cancer, urban-rural residence, Midwest or West US region, and diagnosis 2011-2017. Among AA and NHPI patients with cancers in the US, RT refusal predicted poorer OS. NHPI had the highest risk of RT refusal. Given AA and NHPI are not monolithic groups, data disaggregation is necessary to understand racial/ethnic disparities for treatment refusal. Sociocultural and historical contexts of AA and NHPI populations on treatment refusal are necessary to improve cancer outcomes among these populations.

Racial Disparities in Brachytherapy Treatment among Women with Cervical and Endometrial Cancers: A United States Cohort Study between 2004 and 2017

Brachytherapy (BT) improves clinical outcomes among women with cervical and endometrial cancers. Recent trends found decreasing BT rates in the United States; however, racial/ethnic differences have not been investigated completely. Here we aim to analyze 1) variations in BT practice patterns, 2) racial differences of BT, and 3) predictors of BT by race among women with cervical and endometrial cancers in the United States. A retrospective cohort of women with endometrial and cervical cancers in the US was evaluated using the National Cancer Database, between 2004 and 2017. Primary endpoint was treatment with BT. Women ≥18 years of age were included for FIGO Stage IA-IVA, non-surgically treated cervical cancers and high intermediate risk (PORTEC-2 and GOG-99 definition) or FIGO Stage II-IVA endometrial cancers. Racial groups were in accordance with federal guidelines including Asian, American Indian and Alaska Native (AIAN), Black, Native Hawaiian and other Pacific Islander (NHPI), and White. BT practice patterns and trends over time were evaluated by race. To identify predictors of BT by race, logistic regression calculated adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) after assessing for multicollinearity. A total of 13,857 women with cervical cancer and 140,942 women with endometrial cancer were included. Median follow-up was 69 months. Median (IQR) age was 53 (43-63) years for cervical cancer and 64 (57-72) years for endometrial cancer. Most cervical cancers were Stage III (44%), squamous cell carcinoma (88%), and lymphovascular space invasion (LVSI) positive (49%). Most endometrial cancers were Stage IB (45%), endometrioid histology (82%), and LVSI-positive (50%). Between 2004 and 2017, endometrial cancer BT increased (34% to 57%). BT rates for cervical cancer ranged from 65% NHPI, 63% Asian, 62% White, 59% AIAN, and 57% Black. BT rates for endometrial cancer ranged from 26% Black, 25% White, 25% Asian, 21% AIAN, and 20% NHPI. By race, only Black women with cervical cancer were significantly less likely to receive BT (aOR = 0.8; 95% CI = 0.7-0.9), compared to White women. Only NHPI women with endometrial cancer were less likely to receive BT (aOR = 0.7; 95% CI = 0.5-1.0), compared to White women. Community cancer center treatment was the only factor associated with a decreased odds of BT for both Black women with cervical cancer (aOR = 0.7; 95% CI = 0.6-0.9) and NHPI women with endometrial cancer (aOR = 0.3; 95% CI = 0.1-0.8), compared to academic centers. In this study of women diagnosed with endometrial and cervical cancers with stages known to benefit from BT, NHPI women with endometrial cancer and Black women with cervical cancer were less likely to receive brachytherapy compared to White women. Community engagement is needed to increase BT access for patients treated at community cancer centers to ensure equitable gynecologic cancer care.

Racial Disparities in End-Stage Kidney Disease Outcomes among Asians and Native Hawaiians and Other Pacific Islanders across Geographic Residence

Introduction: While Asian and Native Hawaiian and other Pacific Islander (NHOPI) patients have a high prevalence of kidney disease risk factors, there are sparse data examining their end-stage kidney disease (ESKD) outcomes. As Hawaii has high representation of Asian and NHOPI individuals, we compared their ESKD outcomes based on residence in the mainland USA versus Hawaii/Pacific Islands (PIs). Materials and Methods: Using United States Renal Data System data, we examined the impact of geographic residence in the mainland versus Hawaii/PIs on race-mortality associations among incident ESKD patients transitioning to dialysis over January 1, 2000–December 31, 2016 using Cox regression. We examined likelihood of post-dialysis kidney transplantation using Cox models and cumulative incidence curves. Results: Compared with White patients in the mainland, Asian and NHOPI patients in the mainland had lower mortality: adjusted HRs (95% CIs) 0.67 (0.66–0.67) and 0.72 (0.70–0.73), respectively. When examining Asian and NHOPI patients in Hawaii/PIs, survival benefit was attenuated in Asian and diminished to the null in NHOPI patients (ref: mainland White patients). Cumulative incidence curves comparing Asian, NHOPI, and White patients showed Asian and NHOPI patients in the mainland had the highest likelihood of transplantation, whereas NHOPI and Asian patients in Hawaii/PIs had the lowest likelihood. Conclusion: In the mainland, Asian and NHOPI patients had lower mortality versus White patients, whereas in Hawaii/PIs, this survival benefit was diminished in Asian and mitigated in NHOPI patients. NHOPI and Asian patients in Hawaii/PIs had less transplantation versus those in the mainland. Further research is needed to uncover factors contributing to differential ESKD outcomes among Asian and NHOPI patients across geographic residence.

Data Equity for Asian American and Native Hawaiian and Other Pacific Islander People in Reproductive Health Research.

Though racial and ethnic disparities in sexual and reproductive health outcomes are receiving greater interest and research funding, the experiences of Asian American and Native Hawaiian and Other Pacific Islander (NHPI) people are often combined with those of other racial and ethnic minority groups or excluded from data collection altogether. Such treatment is often rationalized because Asian American and NHPI groups comprise a smaller demographic proportion than other racial or ethnic groups, and the model minority stereotype assumes that these groups have minimal sexual and reproductive health needs. However, Asian American and NHPI people represent the fastest-growing racial-ethnic groups in the United States, and they face disparities in sexual and reproductive health access, quality of care, and outcomes compared with those of other races and ethnicities. Disaggregating further by ethnicity, people from certain Asian American and NHPI subgroups face disproportionately poor reproductive health outcomes that suggest the need for culturally targeted exploration of the unique drivers of these inequities. This commentary highlights the evidence for sexual and reproductive health disparities both in and between Asian American and NHPI groups. We also examine the failures of national data sets and clinical studies to recruit Asian American and NHPI people in proportion to their share of the U.S. population or to consider how the cultural and experiential diversity of Asian American and NHPI people influence sexual and reproductive health. Lastly, we provide recommendations for the equitable inclusion of Asian American and NHPI people to promote and systematize the study and reporting of sexual and reproductive health behaviors and outcomes in these culturally, religiously, and historically diverse groups.

Racial Disparities in 30-day Readmissions after Surgery for Head and Neck Cancer.

Native Hawaiians and other Pacific Islanders (NHPI) patients with head and neck cancer are often aggregated with Asian individuals despite evidence of heterogeneous health outcomes and mortality. The aim of this study was to determine the association of race with unplanned 30-day hospital readmission rate after head and neck surgery across the five federally recognized racial categories. This retrospective cohort study used a national hospital-based database and included patients ≥18 years old with diagnostically confirmed, nonmetastatic head and neck cancer of any subsite treated surgically between 2004 and 2017. The primary endpoint was unplanned readmission within 30 days of discharge after primary surgery. A total of 365,834 patients were included who were predominantly White (87%), treated at academic cancer centers (47%), lower income (63%), with early-stage disease (60%), and with thyroid (47%) or oral cavity (23%) cancers. Median follow-up duration was 47 months. Of the 10,717 (3%) readmissions, 5,845 (1.6%) were unplanned. Adjusted for confounders and compared with White patients, NHPI patients had the highest likelihood of unplanned (aOR 2.07, 95%CI 1.16-3.40, p = 0.008) readmissions. Within the NHPI group, patients with lower income (aOR 4.27, 95%CI 1.28-20.4, p = 0.035) and those residing in an urban or rural area (aOR 7.42, 95%CI 1.14-49.5, p = 0.034) were more likely to be readmitted. NHPI patients with head and neck cancers experience significantly higher 30-day readmissions following definitive surgical treatment. These results highlight the importance of racial disaggregation in clinical studies. 4 Laryngoscope, 134:1282-1287, 2024.

Racial Disparities among Asian American, Native Hawaiian, and Other Pacific Islander Patients with Cancer Who Refuse Recommended Radiation Therapy or Surgery.

Despite radiation therapy (RT) and surgery being the curative treatments, prior work demonstrated that the aggregated Asian American (AA) and Native Hawaiian and Other Pacific Islanders (NHPI) population refuse RT and surgery at a higher rates than other races. Given that AA and NHPI are distinct groups, data disaggregation is necessary to understand racial and ethnic disparities for treatment refusal. We aimed to (1) compare RT and surgery refusal rates between AA and NHPI populations, (2) assess RT and surgery refusal on overall mortality, and (3) determine predictors of refusing RT and surgery using the United States (U.S.) National Cancer Database. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for treatment refusal were calculated using logistic regression. Adjusted hazard ratios (aHR) were calculated for overall survival using Cox proportional hazard models among propensity score-matched groups. The overall rate of RT refusal was 4.8% and surgery refusal was 0.8%. Compared to East AA patients, NHPI patients had the highest risk of both RT refusal (aOR = 1.38, 95%CI = 1.21-1.61) and surgery refusal (aOR = 1.28, 95%CI = 1.00-1.61). RT refusal significantly predicted higher mortality (aHR = 1.17, 95%CI = 1.08-1.27), whereas surgery refusal did not. Predictors of RT and surgery refusal were older patient age, high comorbidity index, and cancer diagnosis between 2011-2017. The results show heterogenous treatment refusal patterns among AA and NHPI populations, suggesting areas for targeted intervention.

Race and ethnicity reporting by US federal standards in high-impact phase 2/3 oncology clinical trial publications.

1595 Background: There are 5 races defined by the US Office of Management &amp; Budget (OMB): White, Black, Asian, American Indian and Alaska Native (AIAN), and Native Hawaiian and other Pacific Islander (NHPI) with Hispanic ethnicity. Despite the existing 1997 race standards, race reporting in oncology clinical trials is still dismal. Here we aim to 1) quantify cancer trial publications reporting race/ethnicity, 2) determine representation in published trials, and 3) identify geographic patterns of reporting race/ethnicity by 1st author. Methods: PubMed/Embase were queried for phase 2/3 clinical trials of the 6 most common cancers, published in 4 high-impact journals between 2012-2022, each reviewed by 2 independent reviewers. Trials were excluded for non-US 1st author and those including multiple cancers. Representation quotients (RQ) for each race were calculated by dividing the percent of clinical trial patients by the proportion of year-matched, site-specific incident cancers in the US (Cancer in North America data). RQ of 1 represents equal clinical trial representation compared to US cancer incidence. Trial characteristics were recorded. Descriptive statistics were calculated. RQ statistics were calculated using Kruskal-Wallis tests with Bonferroni Corrections ( PBC) for multiple testing. Results: Of 1,149 publications assessed, 342 were included (224 JCO, 84 NEJM, 18 Lancet, and 16 JAMA) with 258,123 patients, 60% phase 3, and 45% US Northeast 1st author. By cancer site, 31% breast, 24% lung, 18% prostate, 18% kidney/bladder, 5% colorectal, and 4% endometrial publications were included. Race was reported in 245 publications (72%) varying by journal: 81% JAMA, 78% Lancet, 72% JCO, and 67% NEJM. Specific race/ethnicity were reported in 239 publications (70%) for White, 201 (59%) for Black, 185 (54%) for Asian, 62 (18%) for Hispanic, 48 (14%) for AIAN, and 29 (9%) for NHPI patients. Among publications reporting race, RQ varied after adjusting for multiple testing ( PBC&lt;.001) with median (IQR) RQ of 1.0 (0.9-1.1) for White, 0.6 (0.1-2.7) for Asian, 0.4 (0.1-0.7) for Black, 0.0 (0.0-0.0) for AIAN, and 0.00 (0.0-0.0) for NHPI patients. Stratified by cancer, RQ significantly differed by race for all cancers ( PBC&lt;.001), except colorectal ( PBC=.004) and endometrial cancer ( PBC&gt;.99). NHPI was the only race with median RQ of 0.00 for all cancers. AIAN and NHPI race reporting by 1st author was observed most in CA, while Hispanic was observed most in TX. Conclusions: While 72% of phase 2/3 cancer clinical trials published in high-impact journals report race, 91% do not report NHPI race. Indigenous patients have the lowest reporting in cancer clinical trials. Our findings support a call to action to mandate consistent race/ethnicity reporting for publication. US clinical trialists and publishers should comply with mandated US OMB federal reporting guidelines in oncology publications.

Racial disparities in survival and stage at diagnosis among adolescent and young adult patients with cancer.

6615 Background: Adolescent and young adult (AYA) patients (15-39 years) are an underrecognized population with high risk of select malignancies. Compared to pediatric and adult patients, AYA patients have not achieved improvements in cancer survival. No studies have evaluated overall survival (OS) and stage at diagnosis among all 5 federally recognized races in the US. Here we aim to investigate OS and stage at diagnosis among AYA patients by race. Methods: A retrospective cohort study of AYA patients diagnosed between 2004-2017 was conducted with the National Cancer Database. Patients with the 10 deadliest AYA cancers with at least 6 months of follow-up were included. Primary endpoints were OS (time from diagnosis to death) and late stage at diagnosis (stage III/IV or Grade III/IV for central nervous system [CNS] cancer). Kaplan-Meier estimates and log-rank tests assessed OS. OS and late stage were evaluated by race using multivariable Cox proportional hazard (adjusted hazard ratio [aHR]) and logistic (adjusted odds ratio [aOR]) regressions, respectively, with 95% confidence intervals (95%CI). All regressions were adjusted for sociodemographic and cancer characteristics. Results: 291,899 AYA patients were included: 64% female, 65% stage I/II, and 62 month median follow-up. Cancer sites included 27% breast, 16% lymphoma, 13% melanoma, 11% testis, 9% CNS, 7% colorectal, 7% cervix, 5% sarcoma, 3% ovary, and 2% lung. Race included 82.3% Non-Hispanic White (NHW), 14.0% Black, 2.9% Asian, 0.5% American Indian and Alaska Native (AIAN), and 0.3% Native Hawaiian and other Pacific Islander (NHPI). OS differed for all cancers by race (p&lt;.0001), except for lung (p=.008), CNS (p=.32), and ovary (p=.28). OS was significantly inferior for NHPI, Black, and AIAN but superior for Asian, versus NHW (Table). NHPI had inferior OS (aHR, 95%CI) for melanoma (4.5, 2.0-10.0), colorectal (1.8, 1.3-2.4), lymphoma (1.7, 1.1-2.1), and cervix (1.6, .1-2.4) cancers. Black patients had inferior OS for melanoma (1.6, 1.2-2.2), lymphoma (1.5, 1.4-1.6), and breast (1.4, 1.3-1.4) cancers. Asian patients had superior OS for breast (0.7, 0.7-0.8) and lung (0.7, 0.6-0.9) but inferior survival for testis (1.9, 1.3-2.9) cancers. AIAN patients had inferior OS for colorectal (1.4, 1.0-1.9). Late stage at diagnosis was higher for NHPI, Black, and Asian patients, compared to NHW patients (Table). Conclusions: Both NHPI and Black AYA patients with cancer have higher risk of death and late stage disease at diagnosis, compared to NHW patients. Our data reveal racial disparities among Indigenous AYA patients masked by prior data omission. [Table: see text]

Racial Disparities in Brachytherapy Treatment among Women with Cervical and Endometrial Cancer in the United States.

Brachytherapy improves clinical outcomes among women diagnosed with cervical and endometrial cancers. Recent evidence demonstrates that declining brachytherapy boosts for women with cervical cancer were associated with higher mortality. In this retrospective cohort study, women diagnosed with endometrial or cervical cancer in the United States between 2004 and 2017 were selected from the National Cancer Database for evaluation. Women ≥18 years of age were included for high intermediate risk (PORTEC-2 and GOG-99 definition) or FIGO Stage II-IVA endometrial cancers and FIGO Stage IA-IVA-non-surgically treated cervical cancers. The aims were to (1) evaluate brachytherapy treatment practice patterns for cervical and endometrial cancers in the United States; (2) calculate rates of brachytherapy treatment by race; and (3) determine factors associated with not receiving brachytherapy. Treatment practice patterns were evaluated over time and by race. Multivariable logistic regression assessed predictors of brachytherapy. The data show increasing rates of brachytherapy for endometrial cancers. Compared to non-Hispanic White women; Native Hawaiian and other Pacific Islander (NHPI) women with endometrial cancer and Black women with cervical cancer were significantly less likely to receive brachytherapy. For both NHPI and Black women, treatment at community cancer centers was associated with a decreased likelihood of brachytherapy. The data suggest racial disparities among Black women with cervical cancer and NHPI women with endometrial cancer and emphasize an unmet need for brachytherapy access within community hospitals.

Examining the immunoepigenetic-gut microbiome axis in the context of self-esteem among Native Hawaiians and other Pacific Islanders.

Introduction: Native Hawaiian and other Pacific Islander (NHPI) populations experience higher rates of immunometabolic diseases compared to other racial-ethnic groups in Hawaii. As annual NHPI mortality rates for suicide and type 2 diabetes mellitus (T2DM) exceed those of the state as a whole, understanding the social and biological mechanisms underlying these disparities are urgently needed to enable preventive strategies. Methods: A community-based approach was used to investigate the immunoepigenetic-gut microbiome axis in an NHPI-enriched cohort of Oahu residents (N = 68). Self-esteem (SE) data was collected using a modified Rosenberg self-esteem (SE) assessment as a proxy measure for mental wellbeing in consideration for cultural competency. T2DM status was evaluated using point-of-care A1c (%) tests. Stool samples were collected for 16s-based metagenomic sequencing analyses. Plasma from blood samples were isolated by density-gradient centrifugation. Peripheral blood mononuclear cells (PBMCs) were collected from the same samples and enriched for monocytes using negative selection techniques. Flow-cytometry was used for immunoprofiling assays. Monocyte DNA was extracted for Illumina EPIC array-based methylation analysis. Results: Compared to individuals with normal SE (NSE), those with low SE (LSE) exhibited significantly higher plasma concentrations (pg/ml) of proinflammatory cytokines IL-8 (p = 0.051) and TNF-α (p = 0.011). Metagenomic analysis revealed that the relative abundance (%) of specific gut bacteria significantly differed between SE groups - some of which directly correlated with SE scores. Gene ontology analysis revealed that 104 significantly differentially methylated loci (DML) between SE groups were preferentially located at genes involved in immunometabolic processes. Horvath clock analyses indicated epigenetic age (Epi-Age) deceleration in individuals with LSE and acceleration in individuals with NSE (p = 0.042), yet was not reproduced by other clocks. Discussion: These data reveal novel differences in the immunoepigenetic-gut microbiome axis with respect to SE, warranting further investigation into its relationship to brain activity and mental health in NHPI. Unexpected results from Epi-Age analyses warrant further investigation into the relationship between biological age and disparate health outcomes among the NHPI population. The modifiable component of epigenetic processes and the gut microbiome makes this axis an attractive target for potential therapeutics, biomarker discovery, and novel prevention strategies.

Racial and Ethnic Differences in Chronic Kidney Disease and Its Risk Factors among Asian-Americans and Pacific Islanders in Hawaii

Background: Several studies suggest that Asian-American and Native Hawaiian and Other Pacific Islander (NHOPI) racial/ethnic groups have a heightened risk of chronic kidney disease (CKD), but provide limited inference due to the aggregation of these groups into a single racial/ethnic category. We thus examined the association of granularly defined racial/ethnic groups with specific CKD indicators among a diverse group of participants from the National Kidney Foundation of Hawaii’s Kidney Early Detection Screening (KEDS) Program. Methods: Among 1,243 participants enrolled in 19 KEDS screening events over 2006–2009, we examined the association between Asian-American and NHOPI groups and specific CKD indicators, defined as self-reported CKD, microalbuminuria, and macroalbuminuria, using multivariable logistic regression. We then examined associations of race/ethnicity with various CKD risk factors. Results: The most predominant racial/ethnic groups were White (22.0%), Multiracial (18.9%), Japanese (19.2%), Filipino (13.4%), NHOPI (8.4%), and Chinese (4.5%) participants. NHOPI and Chinese participants had a higher risk of microalbuminuria (adjusted ORs [aORs] [95% CIs] 2.48 [1.25–4.91] and 2.37 [1.07–5.27], respectively), while point estimates for all other minority groups suggested higher risk (reference: Whites). NHOPI participants also had a higher risk of macroalbuminuria and self-reported CKD. While most minorities had a higher risk of diabetes and hypertension, NHOPI and Multiracial participants had a higher risk of obesity, whereas the East Asian groups had a lower risk. Conclusions: In this community-based cohort, compared with Whites, Asian-Americans had a higher risk of early CKD indicators, whereas NHOPIs had a higher risk of more severe CKD indicators. Further studies are needed to elucidate the distinct pathways leading to CKD across diverse racial/ethnic groups in Hawaii.

Racial Disparities in Patient-Provider Communication During Telehealth Visits Versus Face-to-face Visits Among Asian and Native Hawaiian and Other Pacific Islander Patients With Cancer: Cross-sectional Analysis.

Telehealth visits increase patients' access to care and are often rated as "just as good" as face-to-face visits by oncology patients. Telehealth visits have become increasingly more common in the care of patients with cancer since the advent of the COVID-19 pandemic. Asians and Pacific Islanders are two of the fastest growing racial groups in the United States, but there are few studies assessing patient satisfaction with telemedicine among these two racial groups. Our objective was to compare satisfaction with communication during telehealth visits versus face-to-face visits among oncology patients, with a specific focus on Asian patients and Native Hawaiian and other Pacific Islander (NHOPI) patients. We surveyed a racially diverse group of patients who were treated at community cancer centers in Hawaii and had recently experienced a face-to-face visit or telehealth visit. Questions for assessing satisfaction with patient-physician communication were adapted from a previously published study of cancer survivors. Variables that impact communication, including age, sex, household income, education level, and cancer type and stage, were captured. Multivariable logistic models for patient satisfaction were created, with adjustments for sociodemographic factors. Participants who attended a face-to-face visit reported higher levels of satisfaction in all communication measures than those reported by participants who underwent a telehealth encounter. The univariate analysis revealed lower levels of satisfaction during telehealth visits among Asian participants and NHOPI participants compared to those among White participants for all measures of communication (eg, when asked to what degree "[y]our physician listened carefully to you"). Asian patients and NHOPI patients were significantly less likely than White patients to strongly agree with the statement (P<.004 and P<.007, respectively). Racial differences in satisfaction with communication persisted in the multivariate analysis even after adjusting for sociodemographic factors. There were no significant racial differences in communication during face-to-face visits. Asian patients and NHOPI patients were significantly less content with patient-physician communication during telehealth visits when compared to White patients. This difference among racial groups was not seen in face-to-face visits. The observation that telehealth increases racial disparities in health care satisfaction should prompt further exploration.

Food Group, Macronutrient Intake, and Metabolic Status in the US-Affiliated Pacific’s Children’s Healthy Living (CHL) Program

The Children's Healthy Living study provided dietary intake information for understudied Native Hawaiian and Other Pacific Islander (NHOPI) young children. Our objective was to describe food group and macronutrient intakes of NHOPI children in the US-Affiliated Pacific region (USAP), overall and by jurisdiction, income level, and metabolic status. We evaluated 2-8-y-olds (n=3520) in a cross-sectional cluster sampled study using 2 d of dietary records completed by caregivers using provided tools, quantified by a specially developed food composition table and compared with US dietary recommendations. Overweight and obesity (OWOB) and acanthosis nigricans (AN) assessment (metabolic status) was completed by trained evaluators using standard tools. Demographic data were collected by questionnaire. Regression analysis identified differences in dietary component means by jurisdiction, World Bank income groups (WBIGs), and metabolic status, adjusted for age and sex. Few children met US recommendations for vegetable (2.4%) and milk (4.1%) food groups. US macronutrient recommendations were generally met. Food group and macronutrient intakes were significantly different by jurisdiction and WBIG. Means for food groups, except meats, and macronutrients, except protein, were higher in overweight/obese (OWOB) compared with healthy-weight children. Grain intake of 7.25 (SE: 0.08) oz was higher (P<0.05) and milk intake of 0.90 (SE: 0.05) cups was lower (P<0.05) in children with OWOB compared with those without OWOB [grains: 7.17 (SE: 0.07) oz; and milk: 0.96 (SE: 0.04) cups]. Monounsaturated fat intake of 11.68 (SE: 0.10) % energy was higher in those with OWOB, compared with healthy-weight children [11.56 (SE: 0.08) % energy, P<0.05]. Young children's diets in the USAP did not meet milk, vegetable, or fruit intake recommendations. There was variability in dietary patterns across the USAP and by WBIG. Grain intake and monounsaturated fat intake were lower and milk intake was higher in children with better metabolic status.

Assessing Cancer Disparities among Pacific Islanders with Metastatic Cancer for Survival, Time-to-Metastasis, and Time-to-Radiotherapy Using a Novel Informatics Consult Approach

<h3>Purpose/Objective(s)</h3> Native Hawaiians and Other Pacific Islanders (NHPI) are 1 of 5 federally defined races, yet are often excluded in oncology research. NHPI patients have higher mortality for multiple cancers when properly disaggregated, however appropriate statistical methods and databases are limited to compare outcomes among small samples, masking NHPI cancer disparities. This study aims to evaluate 1) overall survival (OS) 2), time-to-metastasis (TTM) and 3) time-to-RT (TTR) among NHPI patients using a high dimensionality propensity score matching approach. <h3>Materials/Methods</h3> NHPI patients diagnosed with the 13 most common cancers were identified at a single, large tertiary hospital, between 2015-2022, with at least 6-month follow-up. A randomized matching cohort of non-NHPI (White, Black, and Asian) were selected to control for demographic, clinical, and treatment characteristics. An advanced cohort informatics consult for high dimensionality propensity score matching was used to control for pre-treatment differences and adjust for confounders to compare OS, TTM (diagnosis-to-metastasis), and TTR (diagnosis-to-RT) between NHPI and non-NHPI. RT analysis included stereotactic body RT (SBRT), stereotactic radiosurgery (SRS), intensity modulated RT (IMRT), and brachytherapy. Cox proportional hazard regression calculated hazard ratios (HR) and 95% confidence intervals (95%CI). <h3>Results</h3> Of 24,357 NHPI patients, 539 (2.2%) were diagnosed with a common cancer. A randomized cohort of 69,690 non-NHPI patients with cancer were identified. Compared to non-NHPI, NHPI patients were significantly more often female (63% <i>v</i> 53%), younger (mean age 59 <i>v</i> 64 years), higher BMI (31 <i>v</i> 27), and diabetic (22% <i>v</i> 12%). Mortality was higher in NHPI patients compared to non-NHPI patients (11.5% v 7.7% mortality) with a HR of 1.71 (95%CI=1.01-2.90). More NHPI presented with metastatic disease (17%) compared to non-NHPI (15%). On a subset analysis of patients not diagnosed with metastatic disease at presentation, consisting of 447 NHPI and 59,351 non-NHPI patients, TTM was significantly faster for NHPI patients (125 days; HR=1.48 [95%CI=1.07-2.07]) compared to non-NHPI (284 days). NHPI patients had significantly higher rates of all RT (18% vs 14%), but no difference in SBRT/SRS (3.6% vs 2.2%), brachytherapy (2.7% v 1.5%), and IMRT (6.3% v 5.4%), compared to non-NHPI patients. There were also no differences in TTR with any RT modality. <h3>Conclusion</h3> Using a novel informatics consult approach with high dimensionality propensity analysis, NHPI patients with common cancers were found to have worse survival at a large tertiary cancer center, compared to non-NHPI patients. NHPI had more rapid onset of metastasis, despite no differences in time to radiation. Strategies are needed to improve outcomes for NHPI patients with metastatic disease despite having timely treatment.

A National Cancer Disparities Analysis of Pacific Islanders Who Decline Radiation Therapy and Impacts on Overall Survival

<h3>Purpose/Objective(s)</h3> Native Hawaiians and Other Pacific Islanders (NHPI) face significant cancer health disparities. Declining cancer treatment is complex and associated with inferior outcomes. Understanding populations that decline radiation therapy (RT) may provide insight into improving cancer disparities. We investigated 1) whether NHPI decline RT at higher rates than other races, 2) the impact of declining RT on overall survival (OS), and 3) the factors associated with declining RT. <h3>Materials/Methods</h3> A retrospective cohort study of the National Cancer Database was conducted using a US hospital-based population including patients ≥18 years old with diagnostically confirmed lung, breast, prostate, rectal, liver, or endometrial cancer, diagnosed between 2004-2017. All patients were offered cancer RT. Declining treatment was defined as RT "recommended by the patient's physician, but was refused by the patient, the patient's family member, or the patient's guardian." Binomial logistic regression compared patients who declined RT versus accepted RT reported as odds ratios (OR) with 95% confidence intervals (95%CI). Cox proportional hazard models assessed OS with hazards ratios (HR). Analyses were adjusted for patient factors (age, urban/rural, income, education, comorbidities) and cancer characteristics (stage, pathology, treatment facility). A P<.05 threshold was used for co-variable selection into multivariable models. <h3>Results</h3> Of 5,229,314 patients eligible, 2,441,471 patients had a documented recommendation for RT. Median follow-up was 55 months. Patients were most often female (67%), white (84%), from metropolitan areas (84%), and insured by Medicare/Medicaid (52%). Cancer types included breast (53%), lung (19%), prostate (18%), rectal (5%), endometrial (4%), and liver (<1%) cancers, of which most (72%) were early-stage disease. 120,291 patients (5%) were documented as declining RT. Compared to white patients, the racial group with the highest risk for declining RT was NHPI (adjusted OR [aOR]=1.52, 95%CI=1.35-1.72), Table. Declining RT among NHPI was associated with poor OS (adjusted HR [aHR]=1.58, 95%CI=1.28-1.95), compared to NHPI patients who accepted RT. Factors associated with NHPI declining RT included patient age (aOR=1.04 per year, 95%CI=1.02-1.05), having any co-morbidities (aOR=1.62, 95%CI=1.28-2.05), breast cancer (aOR=1.82, 95%CI=1.2-2.85), and treatment at either a comprehensive community cancer center (aOR=1.55, 95%CI=1.20-2.01) or an integrated cancer center (aOR=1.89, 95%CI=1.30-2.72). <h3>Conclusion</h3> NHPI patients who decline RT have poor survival outcomes. Understanding NHPI patient perspectives and perceptions may elucidate interventions to mitigate these disparities. Investigating the intersection of culture and healthcare perceptions among NHPI patients is warranted.

Performance of Society of Thoracic Surgeons and EuroSCORE II pre-surgical mortality risk score for cardiac surgery in a large majority-minority population

Abstract Background Pre-surgical mortality risk scores are important tools for pre-operative assessment. The Society of Thoracic Surgeons (STS) and EuroSCORE II (ES) scores were derived from predominantly white populations; their utility in minority populations is understudied. Purpose To compare the performance of STS and ES in a large majority-majority population. Methods We used cardiac surgery registry data from a tertiary care, 500-bed, university-affiliated hospital. For each patient, STS and ES risk of mortality were calculated. We measured model performance by discrimination (ROC-AUC) and calibration (O/E ratios). We compared performance by racial subgroups, and explored differences in risk stratification by race and risk category by measuring risk reclassification if ES were used instead of STS. Results From 2009–20, 4061 patients underwent CABG (68%), valve (18%), or CABG/valve (7%) surgery. Of these, 51% were Asian (n=2076), 24% Native Hawaiian and other Pacific Islander (NHPI) (n=977), 23% White (n=919) and 3% Other (n=79). Overall, STS underestimated (O/E: 1.09) and ES overestimated (O/E: 0.55) mortality risk. STS had better discrimination (ROC-AUC: 0.83 vs 0.77). STS model calibration was better among Asians (O/E: 1.03) than NHPI (O/E: 1.22) and Whites (O/E: 1.14). ES calibration was poor overall (Asian O/E: 0.58, NHPI O/E: 0.54, White O/E: 0.50). Discrimination was similar in STS (Asian AUC: 0.83, NHPI AUC: 0.85, White AUC: 0.86) and ES (Asian AUC: 0.77, NHPI AUC: 0.77, White AUC: 0.81), although it did perform better for White patients. Of patients defined as Low Risk by STS, 31% were reclassified as Intermediate or High Risk by ES. Of patients defined as High Risk by STS, 27% were downgraded to Intermediate or Low Risk by ES. This differed by race. For Asians, 28% at Low Risk and 31% at High Risk by STS were reclassified when using ES. For NHPI, 36% at Low Risk and 22% of High Risk by STS were reclassified by ES. For Whites, 31% at Low Risk and 19% of High Risk by STS were reclassified by ES. Conclusion The choice of pre-surgical risk score can impact estimates of pre-cardiac surgery risk of mortality. While STS performs better than ES in our majority minority population, there are significant differences by race. Funding Acknowledgement Type of funding sources: None.