NHW Patients Research Articles

Germline alterations among Hispanic men with prostate cancer.

Little is known about the true rate of pathogenic (P)/likely pathogenic (LP) germline alterations in Hispanic men with prostate cancer as most studies analyzing the prevalence of P/LP germline alterations were performed in a largely non-Hispanic white population (NHW). We performed a retrospective analysis of two separate cohorts of men with prostate cancer: (1) a multicenter cohort of 17,256 men who underwent germline testing in a CLIA-certified laboratory and (2) a single-center cohort of all men eligible for germline testing between 2018 and 2020. The proportions of P/LP alterations and variants of uncertain significance (VUS) were computed. Fisher's exact test was used to compare germline alteration rates for significance. A multivariate logistic regression was performed adjusting for demographic and clinical factors to examine factors associated with germline testing. In the multicenter cohort, the rate of P/LP germline alterations among self-reported Hispanic men was 7.1%, which was lower than self-reported NHW men (9.7% vs. 7.1%, p = 0.058), but was not statistically significant. The VUS rate was significantly higher among the Hispanic cohort (21.5% vs. 16.6%, p = 0.005). In the single-center cohort, 136 Hispanic patients were eligible for testing of which 34 underwent germline testing (26.1%, N = 34/136). Of all prostate cancer patients in the single-center cohort undergoing germline testing (n = 173), the rate of P/LP alterations in Hispanic patients was not significantly different compared to NHW patients (14.7% vs. 12.2%, p = 0.77). The rate of VUS in Hispanic patients was significantly higher than that of NHW patients (20.6% vs. 7.2%, p = 0.047). The P/LP germline alteration rate in our cohorts was similar between Hispanic and NHW men. The rate of VUS was significantly higher in Hispanic men, a consequence of undertesting in minority populations. These data support that Hispanic men with prostate cancer should be screened for germline testing similar to NHW men.

Hepatotoxicity in Adolescent and Young Adult Hispanic Patients Treated with Pediatric Regimens for Acute Lymphoblastic Leukemia

Introduction: Pediatric or pediatric-inspired regimens are used in the treatment of adolescent or young adult (AYA) patients with acute lymphoblastic leukemia (ALL). While overall survival is improved with these regimens, hepatotoxicity and metabolic complications are common adverse events related to the increased dosages of asparaginase and steroids used vs adult ALL regimens. Among ethnicities, prevalence of metabolic syndrome and hepatic steatosis is highest in the Hispanic population, which comprises ~20% of the US population and carries an increased risk of ALL. Surprisingly, there is limited literature describing hepatotoxicity in this at-risk population. Herein we describe our experience with this adverse effect in AYA Hispanic patients (<50 yrs) treated with pediatric ALL regimens at an urban academic medical center.Methods: Single-center retrospective chart review of patients with ALL treated from January 1, 2010 to May 30, 2021 at the University of Illinois at Chicago. Patients with an associated ALL diagnosis were identified through an internal pathology database. Demographic information, clinical characteristics, treatment history and complications [grade 3/4 transaminitis, development of non-alcoholic fatty liver (NAFLD) on imaging, non-alcoholic steato-hepatitis (NASH)/fibrosis/cirrhosis on biopsy, pancreatitis, treatment change or drug discontinuation secondary to hepatotoxicity] were abstracted from the EMR. Descriptive statistics were used to determine outcome frequencies.Results: We identified 33 Hispanic (n= 20) and Non-Hispanic White (NHW; n = 13) patients with either B-ALL or T-ALL, with each demographic stratified by pediatric or adult regimen therapy (Table 1). Pediatric regimens include Children's Oncology Group protocols and E1910; the adult regimen was HyperCVAD.Of 16 Hispanic patients who received pediatric regimens, 7 (44%) had pre-existing diabetes, 1 had fatty liver on baseline imaging and 1 biopsy-confirmed NASH. During treatment, 12/16 (75%) developed grade 3/4 hepatotoxicity, 11 (69%) developed mild-severe NAFLD on imaging, 2 additional patients developed cirrhosis, and 4 (25%) pancreatitis. Treatment-related adverse events prompted therapy change or drug discontinuation in 25%. Hispanic patients, (n = 4), on adult and NHW patients, (n = 7), on pediatric regimens had low rates of pre-existing comorbidities, but of the older NHW patients, (n = 6), on an adult regimen, 4/6 (67%) and 1/6 had underlying diabetes or NAFLD, respectively. We found similar high rates of grade 3/4 hepatotoxicity in Hispanics on an adult regimen (100%) and NHW patients on either a pediatric (71%) or adult regimen (50%). However, fewer patients developed NAFLD (4/17, 24%), only 1 (Hispanic) patient developed fibrosis, and none developed pancreatitis. There was no difference in mean BMI between Hispanic and NHW patients.Conclusions: While grade 3/4 transaminitis is described during ALL treatment, in this retrospective analysis we observed that Hispanic AYA patients treated on pediatric protocols frequently develop more serious complications including hepatic steatosis, cirrhosis or pancreatitis. Co-existing metabolic syndrome is associated with a higher incidence of simple steatosis (SS; 70% in obesity, 90% in diabetes), and Hispanic patients have a higher baseline SS incidence (45% in Hispanics vs 33% in NHW), which in the context of use of higher doses of steroids and asparaginase may explain their increased frequency of progression to NASH and fibrosis. As few underwent biopsy, the true incidence is likely underrepresented. Additionally, Hispanics treated on a pediatric regimen more frequently developed pancreatitis than NHW patients on the same regimen. SS is related to the accumulation of hepatic free fatty acids and triglycerides, thus patients with SS or at risk may have impaired free fatty acid metabolism that predisposes to pancreatitis with asparaginase use. Limitations of this study include a small sample size, partial availability of baseline imaging, and non-standardized radiographic interpretations of the degree of steatosis. However, our findings suggest further investigation is warranted and a multi-center study is in progress. Our study highlights the need for closer monitoring of Hispanic patients to mitigate the risk of serious liver disease with the use of curative pediatric regimens for ALL. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

PD17-06 PSA VELOCITY PREDICTS CLINICAL PROGRESSION IN AFRICAN AMERICAN AND NON-HISPANIC WHITE PATIENTS WITH LOW RISK PROSTATE CANCER UNDERGOING ACTIVE SURVEILLANCE

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (PD17)1 Sep 2021PD17-06 PSA VELOCITY PREDICTS CLINICAL PROGRESSION IN AFRICAN AMERICAN AND NON-HISPANIC WHITE PATIENTS WITH LOW RISK PROSTATE CANCER UNDERGOING ACTIVE SURVEILLANCE Juan Javier-DesLoges, Tyler Nelson, Rishi Deka, Patrick Courtney, Vinit Nalawade, Loren Mell, James Murphy, J. Kellogg Parsons, and Brent Rose Juan Javier-DesLogesJuan Javier-DesLoges More articles by this author , Tyler NelsonTyler Nelson More articles by this author , Rishi DekaRishi Deka More articles by this author , Patrick CourtneyPatrick Courtney More articles by this author , Vinit NalawadeVinit Nalawade More articles by this author , Loren MellLoren Mell More articles by this author , James MurphyJames Murphy More articles by this author , J. Kellogg ParsonsJ. Kellogg Parsons More articles by this author , and Brent RoseBrent Rose More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001999.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The utility of prostate-specific antigen velocity (PSAV) to predict clinical progression in patients with localized prostate cancer (PC) on active surveillance remains unclear, and in African American (AA) patients on active surveillance remains undefined. METHODS: We performed a cohort analysis using the national US Veterans Affairs Informatics and Computing Infrastructure (VINCI). We identified 5296 patients diagnosed with localized prostate cancer (PC) from 2001 to 2015 managed with active surveillance. Follow-up extended through March 31, 2020. We defined low-risk PC as ISUP grade group 1 (GG1) clinical tumor stage ≤ 2A, and PSA level ≤ 10 ng/dl; and active surveillance as no definitive treatment within the first year after diagnosis with at least one additional staging biopsy after diagnostic biopsy. The primary outcome was grade progression on repeat biopsy/prostatectomy defined as GG2 or GG3. The secondary outcome was incident metastases. Cumulative incidence functions and multivariable Cox proportional hazards models were used to test associations between PSAV and outcomes. RESULTS: The final cohort included 3919 Non-Hispanic White patients (NHW) (74%) and 1377 AA (26%) patients. GG2 progression on repeat biopsy occurred in 2062 (38.9%) patients, with a cumulative incidence (CI) of 43.2 % and GG3 progression occurred in 728 (13.7%) patients, with a CI of 18% at seven years. Fifty-four (0.8%) patients developed metastases, with a CI of 1.4% at ten years. In unadjusted analyses, compared to NHW patients, AA patients were significantly more likely to progress to GG2 (52.8% vs 39.8%, p<0.001), and GG3 (22.2% vs 16.8%, p=0.01). On MV analysis, PSAV was a significant predictor of GG2 (HR 1.32 [1.26-1.39]), GG3 (1.5 [1.40-1.62]), and metastases (1.38 [1.10-1.74]). A significant interaction term between race and PSAV indicated the need for different PSAV thresholds for AA and NHW men. Based on maximally selected rank statistics, optimal thresholds for separating outcomes were different in AA vs NHW men. (0.44 vs. 1.18). CONCLUSIONS: In this analysis of PSAV in low-risk prostate cancer patients on AS—to our knowledge, the largest to date for AA patients—we observed that PSAV is a robust predictor of upgrading on restaging biopsy as well as metastasis. Compared to NHW patients, AA patients were more likely to progress at lower values of PSAV and therefore merit close follow-up on active surveillance protocols. Source of Funding: Department of Defense, grant number W81XWH-17-PCRP-PRA (RD and BSR) © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e286-e287 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Juan Javier-DesLoges More articles by this author Tyler Nelson More articles by this author Rishi Deka More articles by this author Patrick Courtney More articles by this author Vinit Nalawade More articles by this author Loren Mell More articles by this author James Murphy More articles by this author J. Kellogg Parsons More articles by this author Brent Rose More articles by this author Expand All Advertisement Loading ...

P10.03 Health Insurance Coverage and Racial Disparities in Early-Stage Detection and Treatment of Lung Cancer: A Causal Mediation Analysis

Racial minority patients were more likely to be diagnosed an advanced-stage disease at presentation, and received less cancer-directed surgery and other standard care. We hypothesized that access to adequate health insurance coverage among patients with lung cancer play an important role in these racial disparities, because many previous studies have shown a significant association between lack of insurance status and poor cancer outcomes. A total of 346,733 patients with lung cancer diagnosed between 2007-2015 from the Surveillance, Epidemiology, and End Results 18 registry were enrolled in our analyses. We conducted univariate and multivariate and logistic regressions to assess the association between race and the risk of being diagnosed at advanced-stage lung cancer (AJCC stage III, or IV), receipt of cancer-direct surgery and no treatment. Mediation analyses were conducted to quantify the proportion of which health insurance coverage is a factor in these racial disparities of lung cancer outcomes. Patients from Asian or Pacific Islander, NHB, and Hispanic were more likely to present with advanced-stage lung cancer compared with NHW patients. About 10-20% of the disparity between patients from racial/ethnic minority and NHW could be explained by having no insurance or only Medicaid. Cancer-directed surgery was less conducted for racial/ethnic minorities than NHW patients. Over 30% of the effect was mediated by the insurance status for Asian or Pacific Islander and Hispanic patients. Patients from and Hispanic received significantly less treatment than NHW patients, and up to 36% and 42% of the total effect was mediated by lack of insurance or having Medicaid for NHB and Hispanic separately. Our study found that health insurance significantly affects the racial disparities of advanced-stage lung cancer detection and receipt of cancer-direct surgery and other treatment. Narrowing the racial disparities might require expansion of access to adequate insurance coverage.

Initiation and adherence to adjuvant endocrine therapy among urban, insured American Indian/Alaska Native breast cancer survivors.

It has been shown that racial/ethnic disparities exist with regard to initiation of and adherence to adjuvant endocrine therapy (AET). However, the relationship among American Indian/Alaska Native (AIAN) individuals is poorly understood, particularly among those who reside in urban areas. We evaluated whether AET initiation and adherence were lower among AIAN individuals than those of other races/ethnicities who were enrolled in the Kaiser Permanente of Northern California (KPNC) health system. We identified 23,680 patients from the period 1997 to 2014 who were eligible for AET (first primary, stage I-III, hormone receptor-positive breast cancer) and used KPNC pharmacy records to identify AET prescriptions and refill dates. We assessed AET initiation (≥1 filled prescription within 1 year of diagnosis) and AET adherence (proportion of days covered ≥80%) every year up to 5 years after AET initiation. At the end of the 5-year follow-up period, 83% of patients were AET initiators, and 58% were AET adherent. Compared with other races/ethnicities, AIAN women had the second-lowest rate of AET initiation (non-Hispanic Black [NHB], 78.0%; AIAN, 78.6%; Hispanic, 83.0%; non-Hispanic White [NHW], 82.5%; Asian/Pacific Islander [API], 84.7%), the lowest rate of AET adherence after 1 year and 5 years of follow-up (70.3% and 50.8%, respectively), and the greatest annual decline in AET adherence during the 4- to 5-year period of follow-up (a 13.8% decrease in AET adherence [from 64.6% to 50.8%]) after initiation of AET. In adjusted multivariable models, AIAN, Hispanic, and NHB women were less likely than NHW women to be AET adherent. At the end of the 5-year period, total underutilization (combining initiation and adherence) in AET-eligible patients was greatest among AIAN (70.6%) patients, followed by NHB (69.6%), Hispanic (63.2%), NHW (58.7%), and API (52.3%) patients, underscoring the AET treatment gap. Our results suggest that AET initiation and adherence are particularly low for insured AIAN women.

PSA velocity to predict clinical progression in African American and non-Hispanic White patients with low-risk prostate cancer undergoing active surveillance.

196 Background: The utility of prostate-specific antigen velocity (PSAV) to predict clinical progression in patients with localized prostate cancer (PC) on active surveillance remains unclear, and in African American (AA) patients on active surveillance remains undefined. Methods: We performed a cohort analysis using the national US Veterans Affairs Informatics and Computing Infrastructure (VINCI). We identified 5296 patients diagnosed with localized prostate cancer (PC) from 2001 to 2015 managed with active surveillance. Follow-up extended through March 31, 2020. We defined low-risk PC as ISUP grade group 1 (GG1) clinical tumor stage ≤ 2A, and PSA level ≤ 10 ng/dl; and active surveillance as no definitive treatment within the first year after diagnosis with at least one additional staging biopsy after diagnostic biopsy. The primary outcome was grade progression on repeat biopsy/prostatectomy defined as GG2 or GG3. The secondary outcome was incident metastases. Cumulative incidence functions and multivariable Cox proportional hazards models were used to test associations between PSAV and outcomes. Results: The final cohort included 3919 Non-Hispanic White patients (NHW) (74%) and 1377 AA (26%) patients. GG2 progression on repeat biopsy occurred in 2062 (38.9%) patients, with a cumulative incidence (CI) of 43.2 % and GG3 progression occurred in 728 (13.7%) patients, with a CI of 18% at seven years. Fifty-four (0.8%) patients developed metastases, with a CI of 1.4% at ten years. In unadjusted analyses, compared to NHW patients, AA patients were significantly more likely to progress to GG2 (52.8% vs 39.8%, p&lt;0.001), and GG3 (22.2% vs 16.8%, p=0.01). On MV analysis, PSAV was a significant predictor of GG2 (HR 1.32 [1.26-1.39]), GG3 (1.5 [1.40-1.62]), and metastases (1.38 [1.10-1.74]). A significant interaction term between race and PSAV indicated the need for different PSAV thresholds for AA and NHW men. Based on maximally selected rank statistics, optimal thresholds for separating outcomes were different in AA vs NHW men. (0.44 vs. 1.18). Conclusions: In this analysis of PSAV in low-risk prostate cancer patients on AS—to our knowledge, the largest to date for AA patients—we observed that PSAV is a robust predictor of upgrading on restaging biopsy as well as metastasis. Compared to NHW patients, AA patients were more likely to progress at lower values of PSAV and therefore merit close follow-up on active surveillance protocols.

Chemotherapy associated liver injury and steatosis in Hispanic patients with colorectal cancer liver metastasis

Presenter: Lucas Thornblade MD, MPH | City of Hope Cancer Center Background: Chemotherapy associated liver injury and steatosis (CALI/CASH) is common among patients with colorectal cancer liver metastasis (CRC-LM). As Hispanic patients experience high rates of non-alcoholic fatty liver disease (NAFLD), there may be a bias to avoid extended courses of chemotherapy because of a perceived risk of CALI/CASH in this population. We aimed to compare the development of CALI/CASH between Hispanic and non-Hispanic White (nHW) patients with CRC-LM. Methods: A single-center retrospective cohort study of Hispanic and nHW patients with unoperated synchronous CRC-LM between (2014-2019). Patient records were reviewed for characteristics of CALI prior to initiation of (pre-chemo) and following up to six-months of chemotherapy (post-chemo). Non-contrast CT scans were sampled by investigators for characteristics of CASH (hepatic minus splenic attenuation (HSA)), and CALI (splenic and caudate lobe hypertrophy). Results: Among 64 patients (52% Hispanic, mean age 54.7 years, 48% female, 48% obese) mean chemotherapy treatment was 6.3 months and 98% received oxaliplatin (34% received irinotecan). There were no significant differences between groups in terms of age, sex, or body mass index. Both Hispanic and nHW patients demonstrated a significant increase (p = 0.03) in mean caudate diameter (+2.3mm in Hispanics, +4.5mm in nHW) over the course of treatment. The rate of thrombocytopenia (platelets < 100k) was similar in both nHW (22.6%) and Hispanic patients (6.1%, p = 0.06) following chemotherapy. Both groups exhibited similar rates of splenic enlargement over 6 months of treatment (mean +0.74cm Hispanics, +0.62cm nHW, p = 0.79). However, we found no differences in the incidence of low-grade (HSA < 6.5, 30% Hispanics, 42% NHW, p = 0.33)) or high-grade steatosis (HSA < 3.2, 15% Hispanics, 19% NHW, p = 0.66) following chemotherapy. Conclusion: Both nHW and Hispanic patients in this study had evidence of liver injury as a result of predominantly oxaliplatin-based therapy. Despite a high rate of baseline hepatic steatosis in both groups, we did not see differential progression of steatosis as a result of chemotherapy regardless of baseline BMI or exposure to irinotecan. These findings suggest that, despite high rates of NAFLD in Hispanic patients, this should not be a reason to withhold prolonged chemotherapy for CRC-LM in this group.

Inequitable access to surveillance colonoscopy among Medicare beneficiaries with surgically resected colorectal cancer.

After colorectal cancer (CRC) surgery, surveillance with colonoscopy is an important step for the early detection of local recurrence. Unfortunately, surveillance colonoscopy is underused, especially among racial/ethnic minorities. This study assesses the association between patient and neighborhood factors and receipt of surveillance colonoscopy. This retrospective, population-based cohort study used Surveillance, Epidemiology, and End Results-Medicare linked data (2009-2014). Beneficiaries with surgically resected stage II or III CRC between the ages of 66 and 85 years were identified, and multivariable logistic regression was used to assess the effect of factors on receipt of colonoscopy. Overall, 57.5% of the patients received initial surveillance colonoscopy. After adjustments for all factors, Blacks and Hispanics had lower odds of receiving colonoscopy than non-Hispanic Whites (NHWs; 29.6% for Blacks; P = .002; 12.9% for Hispanics; P > .05). NHWs with Medicaid coverage had 35% lower odds of surveillance colonoscopy than NHWs without Medicaid coverage. Minority patients with Medicaid were more likely to receive colonoscopy than their racial/ethnic counterparts without Medicaid coverage (P > .05). Hispanics residing in neighborhoods with incomes of ≥$90,000 had significantly lower odds of surveillance colonoscopy than Hispanics residing in neighborhoods with incomes of $0 to $30,000. Receipt of initial surveillance colonoscopy remains low, and there are acute disparities between Black and NHW patients. The association between factors that assess a patient's ability to access colonoscopy and actual receipt of colonoscopy suggests inequitable access to surveillance colonoscopy within and across racial/ethnic groups.

S0216 Rates of Inflammatory Bowel Disease in Hispanics Comparable to Non-Hispanic Whites: Results of a Large Cohort Study

INTRODUCTION: Inflammatory bowel disease (IBD) has historically been believed to occur at higher rates among non-Hispanic Whites compared to other ethnicities. However, current epidemiological understanding of IBD within the United States (US) has been drawn from research consisting of primarily non-Hispanic White cohorts with scant ethnoracial diversity. Hispanics are the fastest growing and the largest minority group in the US, yet they remain grossly underrepresented in studies of IBD. With this study, we aimed to better understand the epidemiology, demographics, clinical presentation, and treatment of IBD in the Hispanic population in Los Angeles County. METHODS: Our study was based at Olive View-UCLA Medical Center (OVMC), one of three safety net hospitals that comprise the Los Angeles Department of Health Services (LADHS). We queried pathology reports from 2015 to 2018 for key terms to identify biopsy-confirmed cases of IBD (N = 170) and abstracted pertinent data from electronic health records. Incidence and prevalence for ethnicities were standardized using their respective proportions in the composition of the OVMC patient population. Statistical analyses included two-proportion t-test, analysis of variance, binomial proportion confidence interval, general linear model and logistic regression. RESULTS: Of the 170 biopsy-confirmed cases of IBD, Hispanics represented 55% of all patients. The annual incidence rate per 100,000 patients for IBD among Hispanics was 175 (95% confidence interval [CI] 127–240) vs. 113 (95% CI 62–200) among non-Hispanic Whites. The prevalence of IBD per 100,000 patient-years was 418 (95% CI 341–512) for Hispanics and 557 (95% CI 431–739) for non-Hispanic Whites. In the subset with Crohn’s disease, smoking rates were significantly lower in Hispanics as compared to non-Hispanic Whites (12.9 vs 62.9%, P = 0.033). There was no significant difference between the two ethnic groups with regard to medical treatment, IBD-related surgery, presenting symptoms, or Montreal classification of disease. CONCLUSION: To our knowledge this is the largest US-based study of Hispanics with biopsy-confirmed IBD. The findings, herein, indicate that the incidence and prevalence of IBD among Hispanics in the US is higher than previously reported and comparable to rates among non-Hispanic Whites.Table 1.: Ethnic background of patients with biopsy-confirmed IBD, Olive View-UCLA Medical Center, Los Angeles County, 2015–2018Table 2.: Demographics of Hispanic and NHW patients with biopsy-confirmed IBD, Olive View-UCLA Medical Center, Los Angeles County, 2015–2018

Abstract IA37: Survival by race and ethnicity in pediatric and adolescent patients with Hodgkin lymphoma: A report from the Children’s Oncology Group

Abstract IA37: Survival by race and ethnicity in pediatric and adolescent patients with Hodgkin lymphoma: A report from the Children’s Oncology Group

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

Abstract Introduction: Participation in cancer clinical trials (CTs) is historically low, particularly for underserved populations, including racial/ethnic minorities. Wake Forest Baptist Comprehensive Cancer Center developed a population health navigation program to improve access to cancer care and CTs among Hispanic patients through linguistically and culturally concordant navigation services. The role of the Hispanic Patient Navigator (HPN) includes educating all navigated patients about CTs. To inform expansion of the program, we sought to understand the knowledge and attitudes of underserved patients at WFBCCC regarding CTs and CT participation. Methods: Patients receiving cancer care in the adult oncology clinic at WFBCCC were purposively sampled to enroll a diverse sample with regards to race, ethnicity, insurance coverage, age, and rural-urban residence. Survey domains included CT knowledge (Ellis et al., 2016) attitudes about CTs (positive beliefs and patient involvement scored from 0-100; Jenkinson et al., 2005) and participation in clinical research as part of cancer care. ANOVA and chi-square/Fisher’s exact tests compared responses by race and ethnicity. Results: We enrolled 247 participants (85% participation); 50.6% were White, non-Hispanic (NHW), 27.1% Black, non-Hispanic (NHB), and 22.3% Hispanic, all races. The majority were female (54.5%) with a median time since cancer diagnosis of 2.8 years. Common cancer types included hematologic (36.4%), breast (20.6%), gastrointestinal (12.6%), and thoracic (9.3%). Hispanics were more likely to report less than a high school education (47.3% vs 10.4% NHW and 17.9% NHB) and not having enough money to meet the daily needs of their families (45.5% vs 13.6% NHW and 17.9% NHB), p&amp;lt;.001. NHW, NHB and Hispanic cancer patients reported similar positive attitudes about CTs (positive beliefs mean=77.7, std=17.6) and willingness to participate (patient involvement=76.7, std=18.9), p &amp;gt;.05 for both comparisons. A larger proportion of NHWs had heard of clinical trials (92.8%), compared to 79.1% NHBs, and 56.4% of Hispanics. NHWs also had greater CT knowledge (mean=3.5, 0-7 scale) than NHBs (mean=2.5), and Hispanics (mean=1.9), p&amp;lt;.0001. There was a trend towards slightly lower CT participation among Hispanic patients, with 42.4% of NHWs, 38.8% of NHBs, and 29.1% of Hispanics self-reporting participation in clinical research(p=.089). Conclusions: Results support the continued role of a HPN to provide clinical trials education to cancer patients. Although self-reported clinical trial participation was slightly lower among Hispanics, it approached 30%, and we observed concurrent increases in Hispanic patient enrollment on cancer center trials. Expansion of the population health navigator program to Black patients would provide opportunities to enhance clinical trial knowledge and participation in additional underserved patients. Citation Format: Carla Strom, Karen M. Winkfield, Janet A. Tooze, Jimmy Ruiz, Kelsey Shore, Kathryn E. Weaver. The patient experience: Clinical trial knowledge, attitudes and participation among diverse populations [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A047.

Racial comparisons in receipt of timely guideline-based colon cancer treatment in an equal-access health system.

6563 Background: Non-Hispanic Black (NHB) adults with colon cancer may have longer time-to-treatment and be less likely to receive guideline-based therapy than Whites (NHW) in the U.S. This may be largely related to racial differences in access to care and insurance coverage. This study aimed to determine whether there were racial differences in receipt of timely guideline-based colon cancer treatment in the equal-access Military Health System (MHS). Methods: Patients age 18-79 years diagnosed with colon adenocarcinoma between January 1, 1998 and December 31, 2007 were identified in linked databases from the Department of Defense Central Cancer Registry and MHS Data Repository. Odds ratios (ORs) and 95% confidence intervals (CIs) of receiving stage-specific treatment within recommended timeframes [surgery within 6 weeks of diagnosis (stages I-III); adjuvant chemotherapy within 8 weeks of surgery (stages II-III); treatment within 4 weeks of diagnosis (stage IV)] for NHB relative to NHW patients were estimated using multivariable logistic regression. Results: Patients (n = 2,170) had a mean age at diagnosis of 59.6 (SD 11.8) years and the racial distribution was 78.6% NHW and 21.4% NHB. The likelihood of receiving timely surgery between races was similar across the stage groups (I-III). NHB patients were equally likely to receive adjuvant chemotherapy as NHW patients (OR 0.90, 95% CI 0.57, 1.41) and to receive it within 8 weeks of surgery (OR 1.19, 95% CI 0.75, 1.87). The likelihood of receiving timely treatment for patients with stage IV disease was similar between races (OR 0.82, 95% CI 0.39, 1.69). The overall likelihood of receiving treatment adherent to stage-specific guidelines in the study sample was similar between NHB and NHW patients (OR 1.00, 95% CI 0.77 to 1.31). Conclusions: In the MHS population, the likelihood of receiving timely treatment adherent to recommended guidelines was similar between races. Our results support the role of equal access to medical care and insurance coverage in reducing racial disparities in colon cancer treatment.

B7-H3 expression by immunohistochemistry as a negative prognostic biomarker in colorectal carcinoma (CRC) in a racially diverse population.

e15127 Background: In CRC, utility of immunotherapy (IT) remains limited to persons with microsatellite instability–high (MSI-H) status. Immunotyping of CRC patients is critical towards further establishing IT's potential. Both incidence and survival rates for CRC in the United States vary between races due to multiple factors including genetic heterogeneity. In this study, we have profiled tumor samples in a racially diverse population for the expression of four different members of the B7 family of immune check point regulators. Methods: Tissue microarray (TMA) was generated from 208 CRC patients. Formalin fixed paraffin embedded (FFPE) tissues were utilized for immunohistochemistry (IHC) post- antigen retrieval. Antibodies specific for IHC staining were used for B7-H3 (D9M2L), PD-L1(E1L3N), B7-H4/B7x(D1M81) and HHLA2(566.1). Each specimen was scored for percent staining of tumor tissue (4 quartile groups) and for intensity (1-4x), and then an overall score (1-16) was calculated. The clinical outcome of interest was overall survival (OS), measured as time from diagnosis of metastatic cancer to death. Analysis for differences in OS was by log rank test, while differences between mean staining was by t test. Race was designated as non-Hispanic white (NHW, n = 41), non-Hispanic black (NHB, n = 84), Hispanic (n = 75), and others (8). Results: B7-H3 protein expression showed strong cytoplasmic distribution. NHB patients had a mean lower expression than NHW patients (0.19 vs 0.41, p = 0.02). Correspondingly, NHB patients had a worse OS than NHW patients (606 vs 759 days). No discernible differences were found in Hispanic patients. PD-L1 showed membranous distribution with 17% expression without significant difference among patients of different racial origin. HHLA2 was more widely expressed with about 35% staining but without statistical significance. B7-H4/B7x failed to show any expression. Conclusions: Expression of B7H3 varies among patients with differential racial backgrounds. It has the potential to be a prognostic biomarker and may be a reason for worse outcome among NHB patients in our population. Other B7 immune checkpoint markers failed to show clinical relevance.

Disparities in Cancer-Related Mortality and Long-Term Survival in Adolescent and Young Adults with Hodgkin Lymphoma: A Population-Level Analysis across the United States

Background: Hodgkin lymphoma (HL) is one of the most common, and one of the most curable cancers in adolescents and young adults (AYAs) (15-39 years). Despite excellent outcomes in the majority of patients, the burden of long-term morbidity and mortality persists. Prior analyses of patients treated for HL before the year 2000 have reported mortality rates as high as 30% by 20 years. Further, this mortality risk has historically differed across different racial and ethnic groups. Over the past decade, cooperative groups have expanded the use of risk-adapted, response-based treatment in an effort to maintain high cure rates, while simultaneously reducing the burden of late effects. We examined long-term survival in AYAs with HL treated after the year 2000.Methods: We used the National Cancer Institute Surveillance, Epidemiology, and End Results registry data for 18 regions in the United States (SEER18) to examine survival in AYAs with a confirmed diagnosis of HL between 2000 and 2015. We obtained overall and cause-specific survival estimates for each year after cancer diagnosis (up to 15 years) for each racial/ethnic group with corresponding 95% confidence intervals. From these yearly survival estimates, we calculated the percentage of deaths not attributed to HL at 10- and 15-years after cancer diagnosis.Results: The final analysis included 16,868 HL patients. Racial/ethnic subgroups included: non-Hispanic white (NHW; 11,016, 65%), Hispanic (2,753, 16%), non-Hispanic black (NHB; 2,131, 13%), and Asian/Pacific Islander (API; 968, 6%) AYAs with HL. Across the full cohort, the 10-year and 15-year overall survival probabilities were 90% (95% confidence interval [95%CI]: 89 - 91) and 87% (95% CI: 86 - 88), respectively. At 10- and 15-years, overall survival was highest for NHWs (10-year: 92%: 15-year: 88%) and APIs (91%; 86%) compared to Hispanics (87%; 85%) and NHBs (82%; 78%). Overall survival, cause-specific survival, and percentage of deaths not attributed to HL by race/ethnicity are presented in the Figure. In the first year after diagnosis, 22% of deaths were due to causes other than primary disease, with the percentage of deaths not attributed to HL higher in NHWs and APIs than Hispanics and NHBs. At most time points after cancer diagnosis, a higher proportion of NHW (vs. NHB, Hispanic and API) patients died from causes other than HL. By 10 years after diagnosis, 25% of NHW patients died due to causes other than HL, vs. 20% in API, 17% in NHB, and 15% in Hispanic patients. By 15 years, 33% of all deaths were not attributed to HL. This was observed most dramatically in the NHW cohort in whom 40% of all deaths were not HL-related, compared to 24% of deaths in the NHB cohort and 26% - 27% of deaths in the Hispanic and API groups.Conclusion: In AYAs diagnosed with HL between 2000 and 2015, NHB patients had worse survival compared with NHW and API patients. The higher probability of survival in NHW patients was accompanied by a consistently higher proportion of non-cancer related death in this cohort both 10- years and 15-years after diagnosis. Studies are needed to evaluate risk factors for both short- and long-term mortality in AYAs, and to examine how these risks differ across racial/ethnic groups. Findings also suggest that despite increasing use of response-adapted therapy over the past two decades, all AYAs with HL remain at risk of death in the decades following therapy, further highlighting the need for long-term follow-up of this at-risk patient population. DisclosuresMuffly:Adaptive Biotechnologies: Research Funding; Shire Pharmaceuticals: Research Funding.

Low Referral Rate for Genetic Testing in Racially and Ethnically Diverse Patients Despite Universal Colorectal Cancer Screening

Guidelines recommend that all colorectal tumors be assessed for mismatch repair deficiency, which could increase identification of patients with Lynch syndrome. This is of particular importance for minority populations, in whom hereditary syndromes are under diagnosed. We compared rates and outcomes of testing all tumor samples (universal testing) collected from a racially and ethnically diverse population for features of Lynch syndrome. We performed a retrospective analysis of colorectal tumors tested from 2012 through 2016 at 4 academic centers. Tumor samples were collected from 767 patients with colorectal cancer (52% non-Hispanic white [NHW], 26% African American, and 17% Hispanic patients). We assessed rates of tumor testing, recommendations for genetic evaluation, rates of attending a genetic evaluation, and performance of germline testing overall and by race/ethnicity. We performed univariate and multivariate regression analyses. Overall, 92% of colorectal tumors were analyzed for mismatch repair deficiency without significant differences among races/ethnicities. However, minority patients were significantly less likely to be referred for genetic evaluation (21.2% for NHW patients vs 16.9% for African American patients and 10.9% for Hispanic patients; P = .02). Rates of genetic testing were also lower among minority patients (10.7% for NHW patients vs 6.0% for AA patients and 3.1% for Hispanic patients; P < .01). On multivariate analysis, African American race, older age, and medical center were independently associated with lack of referral for genetic evaluation and genetic testing. In a retrospective analysis, we found that despite similar rates of colorectal tumor analysis, minority patients are less likely to be recommended for genetic evaluation or to undergo germline testing for Lynch syndrome. Improvements in institutional practices in follow up after tumor testing could reduce barriers to diagnosis of Lynch diagnosis in minorities.

Abstract 4245: Racial disparities in comorbidities, income levels, and surgical procedures observed in hispanic patients with pancreatic cancer compared to non-hispanic patients results from the national inpatient sample database

Abstract Background: Higher incidence and lower survival rates have been linked to racial/ethnic and socioeconomic (SES) disparities in patients with pancreatic cancer. However, systematic evaluation of the interaction between race/ethnicity, SES, comorbidities and type of surgical procedures to predict outcomes associated with pancreatic cancer are missing. Hence, we conducted this study to investigate these risk factors and outcomes of pancreatic cancer discharges, with a focus on Hispanic population. Methods: We surveyed Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database for year 2014 to identify patients with pancreatic cancer (ICD9: 230.9, 157.1-157.4, 157.8, 157.9). To identify racial disparities, we examined age, median household income at zipcode level, various comorbidities (e.g. alcohol abuse, diabetes, obesity, liver disease, hypertension, chronic pulmonary disease, etc.), types of surgical treatments (surgical vs non-surgical options; Whipple vs. others) as a treatment choice, and death during hospitalization. Results: From approximately 7 million records, we identified 18,069 pancreatic cancer-related discharges. The median age of patients was 68 years (range: 0 to 90 years). Compared to NHW, Hispanics had a significantly higher prevalence of diabetes (40% vs. 30%, p&amp;lt;0.001) and liver disease (8% vs. 5%, p&amp;lt;0.001), whereas no significant differences were observed for obesity, hypertension, congestive heart failure, or alcohol abuse. Majority of Hispanic patients (39%) with pancreatic cancer belonged to lowest income quartile ($1 - $39,999 per year) compared to NHW (20%), P value &amp;lt;0.001. The only two factors associated with the difference in receiving Whipple procedure were having underlying liver disease and the income level, stratified by race/ethnicity. We did not identify any factors associated with differences in mortality rates. Conclusions: We identified significant racial disparities such as higher prevalence of comorbidities, lower income levels, and different types of surgical procedures in Hispanic versus NHW patients hospitalized for pancreatic cancer. Future studies quantifying the impact of stage of illness at presentation, multiple comorbidities including smoking, rural/urban care setting, SES, insurance coverage on treatment choices and outcomes associated with pancreatic cancer in different racial/ethnic groups are needed. Citation Format: Miren Peña, Jswanth Raj Kintada, Sheetal Hegde, Sammira Rouhani, Edgar Munoz, Joel Michalek, Ali Seifi, Amelie Ramirez, Pratap A. Kumar, Dimpy Shah. Racial disparities in comorbidities, income levels, and surgical procedures observed in hispanic patients with pancreatic cancer compared to non-hispanic patients results from the national inpatient sample database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4245.

Disparities in Prostate, Lung, Breast, and Colorectal Cancer Survival and Comorbidity Status among Urban American Indians and Alaskan Natives.

Cancer is the second leading cause of death among American Indians and Alaskan Natives (AIAN), although cancer survival information in this population is limited, particularly among urban AIAN. In this retrospective cohort study, we compared all-cause and prostate, breast, lung, and colorectal cancer-specific mortality among AIAN (n = 582) and non-Hispanic white (NHW; n = 82,696) enrollees of Kaiser Permanente Northern California (KPNC) diagnosed with primary invasive breast, prostate, lung, or colorectal cancer from 1997 to 2015. Tumor registry and other electronic health records provided information on sociodemographic, comorbidity, tumor, clinical, and treatment characteristics. Cox regression models were used to estimate adjusted survival curves and hazard ratios (HR) with 95% confidence intervals (CI). AIAN had a significantly higher comorbidity burden compared with NHW (P < 0.05). When adjusting for patient, disease characteristics, and Charlson comorbidity scores, all-cause mortality and cancer-specific mortality were significantly higher for AIAN than NHW patients with breast cancer (HR, 1.47; 95% CI, 1.13-1.92) or with prostate cancer (HR, 1.87; 95% CI, 1.14-3.06) but not for AIAN patients with lung and colorectal cancer. Despite approximately equal access to preventive services and cancer care in this setting, we found higher mortality for AIAN than NHW with some cancers, and a greater proportion of AIAN cancer patients with multiple comorbid conditions. This study provides severely needed information on the cancer experience of the 71% of AIANs who live in urban areas and access cancer care outside of the Indian Health Services, from which the vast majority of AIAN cancer information comes. Cancer Res; 77(23); 6770-6. ©2017 AACR.

Risk of histologic Barrett's esophagus between African Americans and non-Hispanic whites: A meta-analysis.

Barrett's esophagus (BE) is rare in African Americans (AA). However, the risk difference magnitude in histologic BE prevalence between AA and non-Hispanic whites (nHw) has not been quantified to date. The objective of this article is to determine the degree of histologic BE risk difference between AA and nHw. PubMed, Web of Science and EMBASE were searched for studies reporting histologic BE in AA/nHw for inclusion. Pooled odds ratios (ORs) with risk estimates of histologic BE occurrence between AA/nHw were calculated along with 95% confidence intervals (CIs). Forest plots were used to quantify heterogeneity. Funnel plots and the Cochrane Collaboration Risk of Bias tool were used to assess bias risk. Eight studies reported BE histologic confirmation in AA/nHw. Analysis demonstrated a nearly 400% increased histologic BE risk in nHw patients compared to AA (OR 3.949, 95% CI 3.069-5.082). In the model without the case-control study, histologic BE risk remained elevated at approximately 360% in nHw compared to AA (OR 3.618, 95% CI 2.769-4.726). Heterogeneity was not present in either model. Risk of bias was significant. Histologic BE risk is elevated in nHw by 3.6-4 times compared to AA. Investigation into understanding any clinical, molecular or genetic mechanisms underlying this risk disparity is warranted.

Abstract C30: Mortality Differences in Younger and Older Breast Cancer Patients according to Insurance, Race/Ethnicity, and Neighborhood Socioeconomic Status in the California Cancer Registry

Abstract Introduction: In the U.S., approximately 25% of all breast cancer cases occur before the age of 50 years. Younger age at diagnosis of breast cancer is associated with lower survival when compared to older cases. Data on sociodemographic predictors of mortality in younger vs. older breast cancer patients are scarce. We assessed differences in risk of total mortality between women 50 years and younger vs. those &amp;gt;50 years, according to health insurance status, race/ethnicity, and neighborhood socioeconomic status (nSES). Methods: We used data from the population-based California Cancer Registry including invasive female breast cancer cases 18 years of age and older diagnosed between 2005 and 2012 with follow-up through December 31, 2013 and identified 145,564 women. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for total mortality for younger (≤years) and older (&amp;gt;50 years) patients. Multivariable models were stratified by stage, allowing baseline hazards to vary by stage, and adjusted for year of diagnosis, single year age, race/ethnicity, nSES, insurance status, tumor subtype, grade, histology, tumor size, lymph node status, as well as treatment modalities (surgery, chemotherapy, and radiation therapy). Results: Among 145,564 breast cancer cases, 3971 total deaths occurred in patients ≤50 years of age and 18,639 deaths in those &amp;gt;50 years. Significant interactions by age group were observed for race/ethnicity (&amp;lt;0.0001), nSES (p&amp;lt;0.0006), and health insurance (p&amp;lt;0.0001). HRs comparing mortality among black versus NHW women were greater for younger women (HR=1.33; 95% CI=1.20-1.49) than for older women (HR=1.12; 95% CI=1.06-1.19). Among older patients, lower HRs were observed for Hispanic (HR=0.87; 95% CI, 0.83-0.91) and Asian/Pacific Islander (API) women (HR=0.73; 95% CI, 0.69-0.77) compared to NHW patients, but no difference was observed among younger patients. In younger women, compared to patients with private health insurance, HRs were higher for women with public (HR=1.52; 95% CI=1.39-1.66) or no insurance (HR=1.24; 95% CI=1.14-1.35). Corresponding HRs for insurance status were lower among older patients. Conclusions: Our results show differences in total mortality associated with important sociodemographic factors comparing younger to older breast cancer patients. Specifically, higher risks of dying were observed for non-privately vs. privately insured patients and for Blacks vs. NHWs in younger compared to older women, even after accounting for clinical and other sociodemographic factors. These results suggest that access to care is possibly a more important driver in mortality outcome in younger vs. older women, and additional analyses will evaluate the extent to which treatment explains these differences. The findings are important given the higher rates of recurrence and less favorable survival in younger compared to older breast cancer patients. Citation Format: Li Tao, Scarlett Lin Gomez, Caroline Thompson, Ming-Hsiang Tsou, Joseph Gibbons, Jesse N. Nodora, Ian Komenaka, Richard Schwab, Jonathan Unkart, James Murphy, Maria Elena Martinez. Mortality Differences in Younger and Older Breast Cancer Patients according to Insurance, Race/Ethnicity, and Neighborhood Socioeconomic Status in the California Cancer Registry. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C30.

Availability of Healthcare Resources and Colorectal Cancer Outcomes Among Non-Hispanic White and Non-Hispanic Black Adults

This study aims to examine if access to healthcare, measured through the availability of medical resources at the neighborhood level, influences colorectal cancer (CRC) stage, treatment and survival using the Surveillance Epidemiology and Ends Result (SEER) dataset (November 2012), linked with the 2004 Area Resource File. A cross-sectional study was conducted to determine the association between availability of healthcare resources and CRC outcomes among non-Hispanic Black (n = 9162) and non-Hispanic White patients (n = 97,264). CRC patients were identified using the SEER*Stat program, and individual socio-demographic, clinical, and county-level healthcare access variables were obtained for each patient. Among NH-W patients, residence in counties with lower number of oncology hospitals was associated with increased odds of late stage diagnosis (OR 1.09, 95 % CI 1.04-1.14), reduced odds of receiving surgery (OR 0.83, 95 % CI 0.74-0.92) and higher hazard rates (HR 1.09, 95 % CI 1.06-1.12). There were no significant associations among NH-B patients. Increased availability of healthcare resources improves CRC outcomes among NH-W patients. However, future studies are required to better understand healthcare utilization patterns in NH-B neighborhoods, and identify other important dimensions of healthcare access such as affordability, acceptability and accommodation.