non-African American Patients Research Articles

Equity in oncology care: addressing disparities in cancer treatment in Georgia.

This research delves into the disparities in access to oncology care among cancer patients in Georgia, with a specific focus on the distinct challenges faced by African American (AA) individuals compared to non-African American (Non-AA) counterparts. Leveraging data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) survey and supplementary online resources, the study meticulously examines socioeconomic factors, including income, education, and insurance coverage, which significantly influence the quality of cancer care received. The analysis reveals substantial income gaps between AA and Non-AA patients, underscoring the critical implications for healthcare access. Moreover, AA patients exhibit lower rates of full insurance coverage for cancer-related treatments, posing additional barriers to comprehensive care. By investigating the intersections of race, income, and education, the research aims to pinpoint the root causes of these disparities and proposes evidence-based solutions to address the identified challenges. The ultimate objective is to contribute valuable insights that inform targeted policy recommendations and community-based interventions, fostering a more equitable landscape for oncology care in Georgia. This study seeks to amplify awareness and advocate for tangible measures, striving toward healthcare equity for all cancer patients, irrespective of their racial or socioeconomic backgrounds.

Abstract 3651: Mutational analysis and spatial phenotyping to decipher racial disparities in pancreatic adenocarcinoma

Abstract Background: Pancreatic cancer has a 5-year survival of only 12%. This is due to the lack of effective treatments and virtually no early detection methods. To compound this already poor prognosis, African Americans face a 20% higher incidence and worse mortality compared to non-African American patients. With a substantial portion of the data and tools employed for studying pancreatic cancer failing to adequately represent this demographic we aim to gain more insight into the differences associated with worse outcomes for African Americans with pancreatic cancer. To achieve this, we conducted an in-depth analysis of tumor mutational burden using whole exome sequencing and the cutting-edge PhenoCycler®-Fusion 2.0 spatial biology platform, to uncover disparities in spatial immune and metabolic phenotypes. Methods: Using an ultrahigh-plex discovery panel of markers encompassing cell lineage, immune checkpoints, tissue architecture, activation, metabolism, proliferation, and stress, we sought to analyze the differences in spatial phenotypes, cellular neighborhoods and functional pathways across the two groups. Additionally, we performed laser capture microdissection on a cohort of patients containing equal numbers of African American and non-African American pancreatic cancer samples. Tumor, stroma, and adjacent normal areas were identified by a board-certified pathologist. These annotations were used to laser capture on 10-micron sections with 7 sections for each patient. We performed whole exome sequencing on these sections and different areas and compared between groups. Results: Through our investigation using these two technologies, we can find differences in the tumor microenvironment between African Americans and non-African Americans. We can see potential associations in the increased mortality and incidence of this group while also building a foundation of racially diverse data to be used for future studies. Whole exome sequencing has revealed distinct mutational patterns among African American patients, involving common genes that exhibit unique mutation profiles when compared to those previously observed in non-African American patients. Moreover, whole-slide spatial phenotyping reveals the differential tumor-immune landscapes and the key cellular and molecular niches that contribute to tumor progression and prognosis. These findings underscore the imperative need for a more systems biology exploration of the variations within these groups, with the aim of developing more effective and personalized treatment approaches. Citation Format: Daniel James Salas-Escabillas, Ning Ma, Bassem Ben Cheikh, Aditya Pratapa, Thais Pichardo, Kyra Langley, Julie Clark, Nina Steele, Niyati Jhaveri, David Kwon, Howard C. Crawford. Mutational analysis and spatial phenotyping to decipher racial disparities in pancreatic adenocarcinoma [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 3651.

Effect of Changing Estimated Glomerular Filtration Rate Formula on Sugammadex Use and Pulmonary Complications for African American and non-African American Patients.

Sugammadex is associated with fewer postoperative pulmonary complications than is neostigmine reversal of neuromuscular blockade. However, the Food and Drug Administration-approved package insert states that its use is "not recommended" in severe renal impairment, separately defined as creatinine clearance <30 mL/min. Recently, the formula for estimating glomerular filtration rate (GFR) was updated to remove the race variable. Compared to the prior formula, the new consensus equation lowers the estimated GFR for African American patients and raises it for everyone else. We sought to determine how this change could differently impact the use of sugammadex, and thus the rate of pulmonary complications, for both African American and non-African American patients. We used Monte Carlo simulation models to estimate the difference in pulmonary complications that would be suffered by patients when the change in creatine clearance calculated from the estimated GFR (using the old race-based and new race-neutral Chronic Kidney Disease Epidemiology Collaboration formulas) crossed the 30 mL/min threshold, which would require a change in sugammadex or neostigmine use. We found that 0.22% (95% confidence interval 0.14%-0.36%) of African American patients' creatinine clearance would drop from above to below 30 mL/min making sugammadex not recommended and 0.19% (0.16%-0.22%) of non-African American patients would have creatinine clearance increase to >30 mL/min making sugammadex now recommended. Based on our model, we estimate that African American patients would suffer (count [95% confidence interval]) 3 [0.4-6] more pulmonary complications per 100,000 African American patients who received rocuronium or vecuronium through the change from sugammadex to neostigmine reversal to comply with labeling recommendations. Conversely, the same change in formulas would reduce the number of non-African American patients suffering pulmonary complications by 3 [2-4] per 100,000. The recent change in GFR formulas may potentially be associated with an increase in postoperative pulmonary complications in African American patients and a decrease in postoperative pulmonary complications in non-African American patients through GFR-driven changes in sugammadex use.

Tacrolimus Dosing Between Races in Pediatric Patients Following Heart Transplant

<h3>Purpose</h3> Limited literature is available to standardize initial pediatric tacrolimus dosing following orthotopic heart transplant (OHT), despite being a backbone of many multimodal immunosuppression regimens. There is conflicting literature regarding the impact of race, age, and weight on CYP enzyme expressions as these could contribute significantly to interpatient variability. The purpose of this research was to determine the time to therapeutic tacrolimus concentrations and significant variations in tacrolimus dose requirements between African American (AA) and Non-African American (Non-AA) pediatric OHT recipients. <h3>Methods</h3> This retrospective study evaluated tacrolimus dosing and concentrations for AA and Non-AA patients who received an OHT at Children's National Hospital. Tacrolimus dosing (mg/kg) was collected at initiation, first therapeutic concentration, and at discharge. Length of stay (LOS) following transplant was collected in both groups. <h3>Results</h3> A total of 30 patients were included in the study; n=12 AA and n=18 Non-AA. The majority of patients were between ages 7-18 years (63.3%). After tacrolimus initiation, time to achieve the first therapeutic tacrolimus concentration was similar in both groups (7 vs 6 days; p=0.36). Initial tacrolimus dosing was higher in AA population (0.07 vs 0.05 mg/kg/day; p=0.02), as was dosing when first therapeutic concentration was achieved (0.11 vs 0.06 mg/kg/day; p=0.03). Tacrolimus dosing was collected at discharge to reflect consistent therapeutic concentrations and showed higher dosing requirements in AA patients (0.14 vs 0.09 mg/kg/day; p=0.048). At the first post-operative heart catheterization, 42% of AA had rejection while 22% Non-AA had rejection; acute cellular rejection was most common (80% vs 75%). Length of hospital stay following transplant was similar in AA and Non-AA populations (20 vs 23 days; p=0.42). <h3>Conclusion</h3> African American patients required higher doses of tacrolimus at initiation, first therapeutic level, and upon discharge home. Time to therapeutic concentration was similar between both groups. Both patient populations experienced similar LOS following their transplant procedure. The majority of patients were older children, making it difficult to determine if age contributed to additional pharmacokinetic variability in tacrolimus requirements.

Cardiologists' Perspectives on BiDil and the Use of Race in Drug Prescribing.

We explored cardiologists' attitudes and prescribing patterns specific to the use of generic isosorbide dinitrate and hydralazine hydrochloride, and the fixed-dose patented drug, BiDil. Since the Food and Drug Administration approved BiDil in 2005 with an indication for self-identified black patients, disagreement about the appropriateness of race-based drugs has intensified and led to calls for providers and researchers to abandon race-based delimitations. This paper reports empirical evidence of cardiologists' views on BiDil's race-based indication and their ongoing inertia with respect to the debate about BiDil. We conducted a 2010 cross-sectional online survey of members of the Association of Black Cardiologists. Fifty-nine cardiologists responded to the survey. Most participants (62.7%) prescribed BiDil to their patients. More than 40% of respondents did not prescribe BiDil to any non-African Americans. When considering whether to prescribe BiDil, a patient's race determined by physician assessment was the third most important factor considered by participants. The majority of participants (72.7%) selected symptoms as the most important factor. Most participants (59.2%) perceived race as defining biologically distinct individuals. Respondents prescribed BiDil more often to African American patients than non-African American patients. However, they prescribed the generic components that makeup BiDil to African Americans and non-African American patients similarly. The survey provides useful findings that, when viewed within the context of ongoing debates about race-based medicine, show little progress toward appropriately utilizing BiDil to maximize health outcomes, yet, might inform the development of practical and effective guidelines concerning the use of race in medicine.

Disparities in Cancer Specific and Overall Survival Outcomes in African Americans With Renal Cell Carcinoma: Analysis From the International Marker Consortium for Renal Cancer (INMARC)

ObjectiveTo investigate association of African-American race and survival in Renal Cell Carcinoma (RCC). Patients and MethodsWe queried the International Marker Consortium for Renal Cancer database for patients who underwent partial or radical (RN) nephrectomy. The cohort was divided into African American (AA) and non-African American (NAA) patients. Primary outcome was all-cause mortality. Secondary outcome was cancer-specific mortality. Multivariable Analysis and Kaplan-Meier Analysis were used to elucidate predictive factors and survival outcomes. ResultsThree thousand eight hundred and ninety-three patients were analyzed (AA, n = 564/NAA, n = 3329). AA had greater Stage I (73.8% vs 63.9%, P <.001) and papillary RCC (29.8% vs 8.5%, P <.001). Multivariable Analysis revealed increasing age (HR = 1.03, P <.001), AA (HR = 1.24, P = .027), higher stage (HR = 1.30-3.19, P <.001), RN (HR = 2.45, P <.001), clear cell (HR = 1.23, P <.001), positive margin (HR = 1.34, P .004), and high-grade (HR = 1.58, P <.001) to be associated with worsened all-cause mortality. Increasing age (HR = 1.02, P <.001), AA (HR = 1.48, P = .025), RN (HR = 2.98, P <.001), high-grade (HR = 3.11, P <.001), and higher stage (HR = 3.03-13.2, P <.001) were predictive for cancer-specific mortality. Kaplan-Meier Analysis revealed worsened 5-year overall survival for AA in stage I (80% vs 88%, P = .001), stage III (26% vs 70%, P = .001), and stage IV (23% vs 44%, P = .009). Five-year cancer-specific survival was worse for AA in stage III (36% vs 81%, P <.001) and stage IV (30% vs 49%, P = .007). ConclusionDespite presenting with more indolent histology and lower stage, African-Americans were at greater risk for diminished survival, faring worse in overall survival for all stages and cancer-specific survival in for stage III/IV RCC. Further investigation into factors associated with these disparities is warranted.

A Review of Health Care Disparities in Head and Neck Squamous Cell Carcinomas.

Head and neck squamous cell carcinomas are aggressive cancers with significant morbidity and mortality that can be confounded by health care disparities, particularly race. This article is intended to educate and provide evidence on the status of health care disparities in head and neck squamous cell carcinomas. A review of the English-language literature was performed using Pubmed and MEDLINE. Results indicated that African American patients are diagnosed at a younger age, presented with higher tumor burden, are less likely to receive definitive cancer treatment, and have increased mortality compared with non-African American patients. Much of these differences are reversible and can be eliminated by education, instituting screening programs, and also extending health care coverage.

Abstract 10709: Findings on Cardiology Screening Parameters for Cardiac Amyloidosis Differ Between African American and Non-African American Patients

Introduction: Prior studies have shown worse outcomes for African American (AA) patients with cardiac amyloidosis as compared to Caucasians. A potential contribution of diagnostic bias to delayed diagnosis of cardiac amyloidosis in AAs has not previously been explored. Hypothesis: Standard screening parameters for cardiac amyloidosis have worse diagnostic accuracy in AA as compared to non-AA patients. Methods: Patients evaluated at our institution from 2000-2018 for suspected cardiac amyloidosis with diagnostic confirmation by cardiac biopsy were included. Demographic, clinical and laboratory parameters at the time of evaluation were obtained, and ECGs and echocardiograms were analyzed by study personnel. Each parameter was compared between the biopsy positive and biopsy negative groups separately for AA and non-AA patients. Results: Among 223 patients with suspected cardiac amyloidosis, 90 were AA (64% biopsy positive) and 133 were non-AA (51% biopsy positive). Older age, low limb lead voltage, increased relative wall thickness, and apical sparing of longitudinal strain were associated with a positive biopsy in both AAs and non-AAs. Male gender, pseudoinfarct pattern, higher E/e’, and lower voltage-to-mass ratio were associated with a positive biopsy in non-AAs (p&lt;0.05), but not in AAs. This is displayed in the figure below. Brain natriuretic peptide level and left ventricular mass index were higher in the biopsy positive patients among non-AAs, and lower in the biopsy positive patients among AAs. Conclusions: Several traditional screening parameters for cardiac amyloidosis were not discerning for the diagnosis among AAs who underwent cardiac biopsy for evaluation. The development of cardiac amyloidosis screening tools tailored to AA patients may improve clinical outcomes for AAs with cardiac amyloidosis.

M056 SUSPECTED OCRELIZUMAB-INDUCED IMMEDIATE HYPERSENSITIVITY: NEGATIVE SKIN TESTING AND DRUG PROVOCATION TEST

Ocrelizumab is a monoclonal antibody commonly used in the treatment of multiple sclerosis (MS). Hypersensitivity reactions to ocrelizumab have been reported in up to 5.6 % in non-African American patients. To date, non-irritating skin testing concentrations for ocrelizumab have not yet been established. We present a patient with negative skin testing (ST) and a negative drug provocation test (DPT) to ocrelizumab.

Characterization of the tumor immune microenvironment of triple-negative breast cancer (TNBC) patients who self-identify as African American (AA) or non-African American (NonAA).

564 Background: What tumor biological differences, if any, contribute to the higher incidence and worse prognosis of triple negative breast cancer (TNBC) in African American (AA) compared to NonAA patients are unknown. We hypothesized that differences in the tumor immune microenvironment may contribute to the outcome disparities. The purpose of this study was to characterize and compare the immune microenvironment of TNBC between patients self-identified as NonAA or AA. Methods: Formalin fixed paraffin embedded surgically resected cancer and paired normal tissues collected before any systemic therapy and the corresponding clinical data were collected for NonAA (n = 56) and AA (n = 54) stage I-III TNBC treated at Yale Cancer Center between 2000-2017. The two cohorts were matched for clinical stage, age of diagnosis, and year of diagnosis. We performed somatic and germline whole exome sequencing (WES), bulk RNA sequencing, and immunohistochemistry to assess PD-L1 expression (SP142). Stromal tumor infiltrating lymphocytes (sTILs) were assessed on H&amp;E slides. Mutation load, mutation frequencies, and gene expression differences were compared at gene and pathway level. Immune cell composition was estimated through gene expression deconvolution analyses (TIDE). Results: Tumor mutational burden was similar between the two cohorts. At gene level, few genes had significantly different somatic mutation frequencies, or differential mRNA expression between AA and NonAA samples. Pathway level alterations showed inflammation, immunity (adaptive; innate), antigen presentation, and allograft rejection pathways were more affected by somatic mutations in AA samples. The affected genes differed from cancer to cancer and were not recurrent and therefore were missed at gene level analysis. Gene set enrichment and co-expression analysis also showed higher immune related pathway expression in AA samples. Unsupervised co-expression cluster analysis confirmed coordinated overexpression of genes involved in immunity, inflammation, and cytokine/chemokine signaling in AA patients. Two immunotherapy response predictive signatures, immune inflamed and the IFNG as well as sTILs score and PD-L1 positivity were also higher in AA samples. These findings raise the possibility that immune checkpoint inhibitors might be particularly effective in AA patients. In NonAA samples, the EMT transition, angiogenesis, adipogenesis, myogenesis, fatty acid metabolism, TGFβ signaling, UV-response, and hypoxia pathways were overexpressed. TIDE analysis suggested higher levels of TAM M2, overall TIDE score, and the Immune Exclusion score in NonAA samples. Conclusions: TNBC in AA patients more frequently harbor somatic mutations in genes involved with immune functions and overexpress immune and inflammatory genes compared to NonAA patients.

OUTCOMES OF INTRAVESICAL BACILLUS CALMETTE-GUERIN IN A MULTIRACIAL COHORT WITH NON-MUSCLE-INVASIVE BLADDER CANCER.

We sought to determine if outcomes of Bacillus Calmette-Guerin (BCG) therapy in patients with non-muscle-invasive bladder cancer (NMIBC) vary by race. A retrospective chart review was conducted on 149 patients treated with BCG for intermediate- and high-risk NMIBC between 2001 and 2018, and who were followed up for cancer recurrence through March 2019.The primary outcomes were disease-free survival (DFS), low-grade disease-free survival (LGDFS), high-grade disease-free survival (HGDFS), and progression-free survival (PFS) at five years. Kaplan-Meier survival curves stratified by race (African American vs non-African American) were analyzed for all the above outcomes and multivariate Cox regression analyses were also performed to compare recurrence differences by race, after adjusting for age, sex, initial stage and grade. Of the 149 patients, 37.6% were Caucasian, 24.8% were African American, 26.8% were Hispanic, and 10.7% were of other/unknown race. Disease stage at initial presentation was 65.1% Ta, 34.9% T1, and 18.1% CIS. African American patients (N=37) did not have evidence for worse outcomes compared to non-African American patients when considering DFS (54.1% vs. 65.7%, p = 0.202), HGDFS (58.8% vs. 71.7%, p = 0.158), and PFS (83.8% vs. 92.6%, p = 0.117) at five years. Multivariate analysis did not reveal statistically significant racial differences in recurrence or progression. African Americans with NMIBC did not have worse disease recurrence and progression after receiving intravesical BCG treatment. Although there did appear to be a trend towards worse oncologic outcomes in African Americans, larger studies are needed to validate this finding.

Increased Incidence of Chronic Kidney Injury in African Americans Following Cardiac Transplantation.

This study examined whether African American race was associated with an elevated risk of chronic kidney disease (CKD) post-cardiac transplantation. CKD often occurs after cardiac transplantation and may require renal replacement therapy (RRT) or renal transplant. African American patients have a higher risk for kidney disease as well as worse post-cardiac transplant morbidity and mortality. It is unclear, however, if there is a propensity for African Americans to develop CKD after cardiac transplant. The Institutional Review Board of Columbia University Medical Center approved the retrospective study of 151 adults (57 African American and 94 non-African American) who underwent single-organ heart transplant from 2013 to 2016. The primary outcome was a decrease in estimated glomerular filtration rate (eGFR), development of CKD, and end-stage renal disease (ESRD) requiring RRT after 2years. African American patients had a significant decline in eGFR post-cardiac transplant compared to non-African American patients (- 34 ± 6 vs. - 20 ± 4mL/min/1.73m2, p < 0.0006). African American patients were more likely to develop CKD stage 2 or worse (eGFR < 90mL/min/1.73m2) than non-African American patients (81% vs. 59%, p < 0.0005). This is the first study to report that African American patients are at a significantly higher risk for eGFR decline and CKD at 2years post-cardiac transplant. Future investigation into risk reduction is necessary for this patient population.

MP68-09 DISPARITIES IN SURVIVAL OUTCOMES IN AFRICAN AMERICANS IN RENAL CELL CARCINOMA

INTRODUCTION AND OBJECTIVE: African-Americans have an increased incidence of renal cortical tumor subtypes of lower oncological potential in the setting of lower risk disease when compared to other ethno-racial groups. On the other hand, survival outcomes are similar. We investigated the impact of African-American race on functional outcomes and non-cancer mortality. METHODS: Multi-institutional (Emory, TMDU, UCSD, SLU) retrospective analysis of patients with localized renal cell carcinoma (AJCC clinical stage 1-3 RCC) who underwent partial or radical nephrectomy between 1998-2018. The cohort was divided into African-American and Non-African American subgroups for descriptive analyses. Patients were analyzed for demographics, clinical parameters, and post-surgical outcomes. Primary outcome was non-cancer mortality (NCM). Secondary outcome was eGFR decline. Multivariable logistic regression (MVA) was used to elucidate predictive factors for NCM and de novo eGFR<45 and <30 ml/min/1.73m2. Kaplan Meier Analysis (KMA) was performed to analyze 5-year freedom from non-cancer mortality. RESULTS: 3751 patients who received either partial or radical nephrectomy for renal masses were grouped into African American (AA, n=602) and Non-African American (NAA, n=3149) sub-groups for analysis. No difference was noted between groups with respect to mean tumor size (p=0.166). Risk factors for development of de novo eGFR<45 included increasing age (OR 1.059, p<0.001), AA race (OR 1.47, p=0.047, diabetes mellitus (OR 1.84, p<0.001), and radical nephrectomy (OR 3.28, p<0.001). MVA for worsened NCM demonstrated AA race (OR 1.4, p=0.013), increasing age (OR 1.05, p<0.001), and post-operative eGFR<45 (OR 2.8, p<0.001) to be independent risk factors. KMA revealed a significant difference between African-Americans and Non-African Americans in terms of 5 year NCM (AA 81% vs. NAA 88%, p<0.001). CONCLUSIONS: African Americans undergoing renal surgery for RCC appear to have poorer NCM than non-African American patients. The cause of this disparity is likely multi-faceted but may be associated with functional decline. Nephron-sparing management when feasible and appropriate should be considered in African-Americans presenting with renal cortical tumors.Source of Funding: Stephen Weissman Kidney Cancer Research Fund

Impact of oncological versus nononcological on survival outcomes in African Americans with renal cell carcinoma.

749 Background: African-Americans have an increased incidence of renal tumors of lower oncological potential when compared to other ethno-racial groups. Yet, survival outcomes are similar. We investigated the impact of African-American race on overall survival, oncological and functional outcomes, and non-cancer mortality. Methods: Multi-institutional (Emory, TMDU, UCSD) retrospective analysis of patients who underwent partial or radical nephrectomy between 1998-2018. Primary outcome was overall survival (OS). Secondary outcomes were non-cancer mortality (NCM), recurrence free survival (RFS), and eGFR decline. Multivariable logistic regression (MVA) was used to analyze OS, NCM, and RFS, and estimated glomerular filtration rate (eGFR)&lt;45 and &lt;30 ml/min/1.73m2. Results: 3632 patients were grouped into African American (AA, n=531) and Non-African American (NAA, n=3101). No difference was noted between groups with respect to mean tumor size (p=0.31). NAA had a higher proportion of metastases at presentation (9.9% vs. 7.0%, p=0.04). AA race was an independent risk factor for functional decline to de novo eGFR &lt;45 (OR=1.43, p=0.04) and de novo eGFR&lt;30 (OR 2.01, p&lt;0.001). MVA for worsened NCM demonstrated AA race (OR=1.63, p=0.02), increasing age (OR=1.05, p&lt;0.001), male sex (OR=1.56, p=0.01), and hypertension (OR=1.73, p=0.001) to be independent risk factors. Significant factors on MVA for worsened OS included increasing age (OR=1.03, p&lt;0.001), radical nephrectomy (OR=1.47, p=0.01), increasing tumor size (OR=1.11, p&lt;0.001), hypertension (OR=2.63, p&lt;0.001), high tumor grade (OR=1.97, p&lt;0.001), and post-operative eGFR &lt;45 (OR=1.50, p=0.01). MVA for worsening RFS demonstrated high tumor grade (OR=2.04, p&lt;0.001) and increasing clinical tumor size (OR=1.15, p&lt;0.001) to be independent factors. Conclusions: African Americans undergoing surgical management for RCC appear to have similar OS and RFS, but poorer NCM than non-African American patients. The cause of these disparities is multi-faceted but likely is associated with functional decline. Nephron-sparing management when feasible and appropriate should be considered in African-Americans presenting with renal cortical tumors.

722 Racial Differences in the Experience of Inflammatory Bowel Disease

INTRODUCTION: In patients with inflammatory bowel disease (IBD), disease-related worries and concerns can have a substantial impact on clinical outcomes. However, most of the existing literature addressing IBD, its treatment, and disease-related concerns is drawn from majority Caucasian populations. This study aims to compare IBD-related worries and concerns among African American (AA) and non-African American (non-AA) patients. METHODS: We performed a cross-sectional study of IBD patients receiving biologic infusion therapy at a large academic medical center using the Rating Form of IBD Patient Concerns (RFIPC, © 1991, Rome Foundation Inc). This validated tool contains 25 items that assess concerns falling within four sub-domains on a scale from 1-100: impact of disease (IOD), sexual intimacy (SI), complications of disease (CD), and body stigma (BS). Total score, sub-domain scores, and individual item scores were compared between AA and non-AA groups using linear regression analysis, adjusting for age and sex. RFIPC used with permission of Mapi Research Trust, Lyon, France: https://eprovide.mapi-trust.org. RESULTS: Of 53 patients included in this preliminary analysis, 17 were AA and 36 were non-AA. AA participants tended to be younger (35.8 vs 45.3) and more predominantly female (71% vs 42%) compared to non-AA participants. Although AA participants tended to report a greater total burden of concerns, the difference was not significant (mean difference 91.75, P 0.65). AA patients had significantly greater concern in BS (mean difference 28.09, P 0.02); while there was a trend toward higher scores in other sub-domains in the AA group, these were not significant. Type 3 fixed effects analysis revealed significant effect of age on sum score (P 0.01) and IOD (P 0.01) and of sex on SI (P 0.05) and BS (P 0.01). CONCLUSION: Our results suggest that AA patients may experience slightly more IBD-related concern than non-AA patients. Although only the difference in concerns related to body stigma was significant, there was a trend toward greater concern in all other subdomains as well as overall concern in the AA group. We predict more significant differences with continued patient enrollment. Our study highlights important issues to discuss with AA patients, particularly relating to hygiene and self-awareness. As the prevalence of IBD in African Americans continues to increase, further research in this area will facilitate delivery of optimal IBD care for this population.

Abstract 2842: Vesal Yaghoobi

Abstract Background: It has been shown that even after adjusting for clinical stage at presentation and socio-economic variables, Triple Negative Breast Cancer (TNBC) still has a worse overall outcome in African American (AA) compared to Non-African American (NAA) patients. The abundance and composition of immune cells in the tumor microenvironment is a powerful prognostic factor in TNBC. Our goal was to assess if differences exist in CD8, CD68 and PD-L1 protein expression between AA and NAA TNBC. We hypothesize that the microenvironment of African AA TNBC patients may be different than that of NAAs. Method: We selected N=43 AA and N=43 NAA TNBC samples from the Yale Pathology archives that were matched by diagnosis date. We measured CD8, CD68 and PD-L1 protein expression in both the tumor and stromal compartments in whole slides from formalin fixed paraffin embedded (FFPE) tissues using multiplexed quantitative immunofluorescence (QIF). The average of each marker expression was calculated in all Fields of View (FOV), and the top 10% brightest FOV of each slide (i.e. hotspot). Results: The frequency of macrophages, as assessed by the expression of CD68 was significantly higher in AA compared to NAA. This was seen by overall assessment for all FOV (mean NAA=2273au versus mean AA=3627au; p = 0.0052), and in hotspot FOVs (mean NAA=4858au versus mean AA=6371au; p = 0.0411), and also for assessments in tumor and stromal subcompartments. Expression of CD8 positive cytotoxic T cells was significantly lower in AA compared to NAA, but only when measuring hotspots in the tumor compartment (p=0.017). Conclusion: The significantly higher CD68 and lower CD8 expression in AA compared to NAA TNBC might contribute to a more immune attenuated microenvironment. We are currently further characterizing the macrophage polarity and the cytokine milieu of these samples. Citation Format: Vesal Yaghoobi, Vasiliki Pelekanou, Tess O'Meara, Andrea Silber, Lajos Pusztai, David Rimm. Vesal Yaghoobi [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2842.

Disparities in survival outcomes in African Americans in renal cell carcinoma: Impact of oncological versus nononcological factors.

595 Background: African-Americans have increased incidences of renal cortical tumor subtypes of lower oncological potential in the setting of lower risk disease when compared to other ethno-racial groups. However, survival outcomes are similar. We investigated the impact of African-American race on overall survival, oncological outcomes, functional outcomes, and non-cancer mortality. Methods: Multi-institutional retrospective analysis of patients who underwent partial or radical nephrectomy between 1998-2018. Primary outcome was overall survival (OS). Secondary outcomes included non-cancer mortality (NCM), recurrence free survival (RFS), and estimated glomerular filtration rate (eGFR) decline. Multivariable logistic regression (MVA) were used to elucidate predictive factors for OS, NCM, and RFS, and eGFR &lt;45 and &lt;30 ml/min/1.73m2. Results: 3,088 patients were divided into African American (AA, n=353) and Non-African American (NAA, n=2735) sub-groups. No difference was noted between groups with respect to mean tumor size (p=0.211) or metastases presence (p=0.846). African-American race was an independent risk factor for functional decline to eGFR&lt;45 (OR 4.43, p&lt;0.001) and eGFR&lt;30 (OR 5.15, p&lt;0.001). MVA for worsened NCM demonstrated African-American race (OR=1.72, p=0.042), increasing age (OR=1.03, p=0.001), radical nephrectomy (OR=2.98, p&lt;0.001), and increasing tumor size (OR=1.26, p&lt;0.001) to be independent risk factors. MVA for worsened OS included increasing age (OR=1.04, p&lt;0.001), tumor size (OR=1.182, p&lt;0.001), clear cell histology (OR=1.62, p&lt;0.001), high tumor grade (OR=2.12, p&lt;0.001), and post-operative eGFR &lt;45 (OR=2.12, p&lt;0.001). MVA for worsening RFS demonstrated high tumor grade (OR=2.38, p&lt;0.001) and increasing clinical tumor size (OR=1.152, p&lt;0.001) to be independent factors. Conclusions: African Americans undergoing renal surgery for RCC appear to have similar OS and RFS, but poorer NCM than non-African American patients. The cause of these disparities is multi-faceted and likely associated with functional decline. Nephron-sparing management should be considered in African-Americans presenting with renal cortical tumors.

A comprehensive review of chronic heart failure pharmacotherapy treatment approaches in African Americans.

Background:Our aim was to review the published literature evaluating treatment approaches for chronic heart failure (HF), notably as it relates to African American patients.Method:We undertook a comprehensive database search (1986–2017) of PubMed, EMBASE, and Ovid/MEDLINE utilizing terms ‘African American’, ‘black’, ‘chronic heart failure’, ‘heart failure’, ‘medication’, ‘chronic therapy’, and ‘clinical trials’. Additional notable studies were obtained from ClinicalTrials.gov. Studies published in English that examine treatment modalities of chronic HF in African American and non-African American patients were included.Results:Examples of current gaps worthy of investigation include whether to maximize thiazides and calcium-channel blockers prior to adding renin–angiotensin system (RAS) inhibitors or beta blockers in HF with preserved ejection fraction; whether hydralazine/isosorbide dinitrate (ISDN) should be initiated during earlier HF stages; whether to prioritize hydralazine/ISDN over other agents such as RAS inhibitors; varying response of African Americans to different agents within drug classes; and the role of mineralocorticoid receptor antagonists.Conclusion:Further studies are needed in order for consensus guidelines to clarify how best to treat this population.

RACIAL DIFFERENCES IN OUTCOMES BETWEEN AFRICAN AMERICANS AND NON-AFRICAN AMERICANS ADMITTED FOR CONGESTIVE HEART FAILURE: A NATIONWIDE ANALYSIS

Limited data is available regarding differences between African-American (AA) and non-African American (non-AA) patients admitted for CHF. The Nationwide Inpatient Sample is a validated database of discharges from a representative sampling of U.S. hospitals. We identified adult patients admitted

A Systematic Comparison of African American and Non-African American Patients on Psychosocial Aspects of Hepatitis C Infection.

The purpose of this study was to compare African American and non-African American hepatitis C virus (HCV) patients on self-reported symptoms of HCV liver disease and psychosocial characteristics commonly affected by it in a sample of 309 patients enrolled in a randomized controlled trial. African Americans (n=196) rated a higher reliance on religion/spirituality for coping with HCV compared to non-African Americans. This study's findings are a basis for encouragement of public health efforts and programs to seek partnerships with African American faith and religious communities to identify and treat undiagnosed cases of HCV and promote HCV awareness.