Primary Race Research Articles

Telomere length and cognitive function among middle-aged and older participants from communities underrepresented in aging research: A preliminary study.

Accelerated biological aging is a plausible and modifiable determinant of dementia burden facing minoritized communities, but is not well-studied in these historically underrepresented populations. Our objective was to preliminarily characterize relationships between telomere length and cognitive health among American Indian/Alaska Native (AI/AN) and Black/African American (B/AA) middle-aged and older adults. This study included data on telomere length and cognitive test performance from 187 participants, enrolled in one of two community-based cognitive aging cohorts and who identified their primary race as AI/AN or B/AA. Nested multivariable regression models revealed preliminary evidence for associations between telomere length and cognitive performance, and these associations were partially independent of chronological age. Small sample size limited estimate precision, however, findings suggest future work on telomere length and cognitive health in underrepresented populations at high risk for dementia is feasible and valuable as a foundation for social and behavioral intervention research.

Specializing When It Counts: Comparing the Dose-Time Effect of Distance Variety between Swimming and Track Running.

To conduct a longitudinal retrospective analysis, explore the relationship between success at peak performance age and the number of different race distances athletes competed in each year (within-sport distance variety), and compare the dose-time effect of this distance variety throughout the development process between male swimmers and track runners. Male swimmers (n = 6033) and track runners (n = 19,278) still competing at peak performance age were ranked, and the number of different race distances was extracted retrospectively for each year until early junior age (13-14-year-old category) from the databases of the European Aquatics and World Athletics federations. Firstly, correlation analysis determined the relationship between ranking at peak performance age and distance variety. Secondly, Poisson distribution provided the probability and dose-time effect of distance variety for becoming an international-class athlete at peak performance age. Generally, correlation analysis revealed low coefficients (r ≤ 0.22) but significant effects (p < 0.001) for larger distance variety and success at peak performance age. Poisson distribution revealed the highest probability of becoming an international-class swimmer when competing in 2-4 race distances at junior age, depending on the primary race distance. The dose-time effect indicated a gradual reduction in the number of race distances as athletes approached peak performance age, narrowing down to 1-2, 2-3, and 3-4 distances for sprint, middle-, and long-distance races, respectively. Track runners exhibited a lower distance variety than swimmers, with a consistent optimum of 1-2 race distances across the age groups. The present findings including data of the most combined race distances for each primary race distance and a comparison between swimming and track running provide new background information to challenge traditional training regimes and help establish new strategies for long-term athlete development.

The Clinical, Genomic, and Transcriptomic Landscape of BRAF Mutant Cancers.

BRAF mutations are classified into four molecularly distinct groups, and Class 1 (V600) mutant tumors are treated with targeted therapies. Effective treatment has not been established for Class 2/3 or BRAF Fusions. We investigated whether BRAF mutation class differed according to clinical, genomic, and transcriptomic variables in cancer patients. Using the AACR GENIE (v.12) cancer database, the distribution of BRAF mutation class in adult cancer patients was analyzed according to sex, age, primary race, and tumor type. Genomic alteration data and transcriptomic analysis was performed using The Cancer Genome Atlas. BRAF mutations were identified in 9515 (6.2%) samples among 153,834, with melanoma (31%), CRC (20.7%), and NSCLC (13.9%) being the most frequent cancer types. Class 1 harbored co-mutations outside of the MAPK pathway (TERT, RFN43) vs. Class 2/3 mutations (RAS, NF1). Across all tumor types, Class 2/3 were enriched for alterations in genes involved in UV response and WNT/β-catenin. Pathway analysis revealed enrichment of WNT/β-catenin and Hedgehog signaling in non-V600 mutated CRC. Males had a higher proportion of Class 3 mutations vs. females (17.4% vs. 12.3% q = 0.003). Non-V600 mutations were generally more common in older patients (aged 60+) vs. younger (38% vs. 15% p < 0.0001), except in CRC (15% vs. 30% q = 0.0001). Black race was associated with non-V600 BRAF alterations (OR: 1.58; p < 0.0001). Class 2/3 BRAFs are more present in Black male patients with co-mutations outside of the MAPK pathway, likely requiring additional oncogenic input for tumorigenesis. Improving access to NGS and trial enrollment will help the development of targeted therapies for non-V600 BRAF mutations.

Association Between Social Determinants of Health, Distance from Treatment Center, and Treatment Type with Outcomes in Human Papillomavirus Associated Oropharyngeal cancer

ObjectivesSocial determinants of health (SDOH) can influence access to cancer care, clinical trials, and oncologic outcomes. We investigated the association between SDOH, distance from treatment center, and treatment type with outcomes in human papillomavirus associated oropharyngeal squamous cell carcinoma [HPV(+)OPSCC] patients treated at a tertiary care center. Study designRetrospective review. MethodsHPV(+)OPSCC patients treated surgically from 2006 to 2021 were selected from our departmental Oropharyngeal Cancer RedCap database. Demographic data, treatment, and oncologic outcomes were extracted. Distance was calculated in miles between the centroid of each patient zip code and our hospital zip code (zipdistance). Results874 patients (89 % male; mean age: 58 years) were identified. Most patients (96 %) reported Non-Hispanic White as their primary race. 204 patients (23 %) had a high-school degree or less, 217 patients (25 %) reported some college education or a 2-year degree, 153 patients (18 %) completed a four-year college degree, and 155 patients (18 %) had post-graduate degrees. Relative to those with a high-school degree, patients with higher levels of education were more likely to live further away from our institution (p < 0.0001). Patients who received adjuvant radiation therapy elsewhere lived, on average, 104 miles further away than patients receiving radiation at our institution (Estimate 104.3, 95 % CI 14.2–194.4, p-value = 0.02). In univariable Cox PH models, oncologic outcomes did not significantly differ by zipdistance. ConclusionsEducation level—and access to resources—varied proportionally to a patient’s distance from our center. Patients travelling further distances for surgical management of OPSCC were more likely to pursue adjuvant radiation therapy at an outside institution. Distance traveled was not associated with oncologic outcomes. Breaking down barriers to currently excluded populations may improve access to clinical trials and improve oncologic outcomes for diverse patient populations.

Abstract B085: Associations of African genetic ancestry and neighborhood social environment with cancer-specific mortality in the Multiethnic Cohort

Abstract Importance: Evaluating contributions of both genetic and social environmental factors to cancer mortality in Black populations is necessary for prioritizing interventions to reduce racial disparities and inequities. We examined multilevel associations of African genetic ancestry (AGA) and the neighborhood social environment with cancer-specific mortality in Black participants in the Multiethnic Cohort Study. Methods: From 1993 through 1996, participants who self-identified as Black as their primary race, and were aged 45-75 years residing in Los Angeles County completed baseline demographic, clinical, and lifestyle questionnaires to enroll into the Multiethnic Cohort Study. Residential addresses were collected and geocoded to the nearest parcel, and deaths were ascertained over follow-up through December 31, 2019. For this prospective study, we analyzed data on participants with genetic ancestry data and geocoded addresses (n=10,722). Global African and European genetic ancestry was estimated using approximately 21,000 ancestry specific markers, from which AGA was estimated for each participant against the 1000 Genomes referent panel (K=2). A neighborhood socioeconomic status (nSES) index and the Index of Concentration at Extremes (ICE) capturing spatial social polarization based on income and racial composition were computed from the 1990 decennial Census and linked to residential census tracts at baseline. Cancer-specific mortality was assigned based on ICD-09 and ICD-10 codes. We estimated subdistribution hazard ratios (SHR) from Fine-Gray competing risks models adjusted for birth cohort, sex, smoking, marital status, education, body mass index (BMI), BMI at age 21, history of hypertension, physical activity, diet quality, and nSES or African ancestry. Results: There were 1,715 cancer deaths over 226,327 person-years of follow-up. Mean age was 61.1 (SD=8.9) years, mean AGA was 76% (SD=15%). Most participants identified as Black (94%) while others reported mixed (White, Hispanic, or Asian) heritage. Higher AGA was associated with lower individual education and nSES (Both P&amp;lt;0.001). AGA was not associated with cancer mortality (SHR for 10% increase: 1.02, 95% CI: 0.99-1.06). Comparing quintile 5 to 1, there were inverse but not statistically significant associations of nSES (SHR: 0.88, 95% CI: 0.71-1.09, P trend=0.34), ICE Income (SHR: 0.92, 95% CI: 0.73-1.16, P trend=0.36), and racialized income ICE (SHR: 0.81, 0.58-1.13, P trend=0.033) with cancer mortality. Associations of AGA and nSES with cancer mortality did not vary across strata of the other exposure. Conclusions and Relevance: In this large prospective study of Black participants, after accounting for sociodemographic, lifestyle, and comorbidity-related factors, there were few associations between either genetic factors or social environment with cancer mortality. Additional studies in cohorts of Black adults residing in other geographic contexts, with additional measures of social determinants of health such as health care access, are needed to further evaluate these findings. Citation Format: Hari S. Iyer, Scarlett L. Gomez, Chidinma Opara, Nur Zeinomar, Loic LeMarchand, Christopher Haiman, Lynne Wilkens, Salma Shariff-Marco, David V. Conti, Iona Cheng, Timothy R. Rebbeck. Associations of African genetic ancestry and neighborhood social environment with cancer-specific mortality in the Multiethnic Cohort [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B085.

Abstract 4252: CCNE1 amplification in high-grade serous ovarian cancer: analysis of the GENIE database

Abstract Background: High-grade serous ovarian cancer (HGSOC) is the most common histological subtype of ovarian cancer as well as the most lethal. A primary oncogenic driver in a subset of HGSOC patients, CCNE1 amplification is associated with poorer outcomes and resistance to standard treatment. This study aims to investigate the copy number gain of CCNE1 and the genetic mutations associated with CCNE1 amplification using a large cohort of clinico-genomic data. Methods: We queried the American Association of Cancer Research-Genomics Evidence Neoplasia Information Exchange (GENIE) registry database v12.1 for patients with HGSOC. We studied CCNE1 amplification and the clinical, demographic, and genetic mutation associations. Results: A total of 3297 HGSOC samples were extracted from the registry. The mean age of patients at sequencing was 62 ± 10 years. Out of 2416 samples profiled for copy number alterations, CCNE1 amplification was found in 13.6%, being the most commonly amplified gene, followed by AGO2 (11.7%) and MYC (9.7%). Co-amplification between CCNE1 and AKT2 was demonstrated. Between the 397 samples with CCNE1 amplification and 2088 without, the genes that were more frequently mutated in the CCNE1 amplified group were AKT2 (20.4% vs 3.2%, p&amp;lt;0.001), KRAS (11.3% vs 4.3%, p&amp;lt;0.001), BRD4 (8.0% vs 4.4%, p = 0.006), and ERBB2 (7.9% vs 4.0%, p = 0.003). Other genes were less frequently mutated in the CCNE1 amplified cohort such as NF1 (7.6 % vs 12.9%, p = 0.009), BRCA1 (3.7% vs 10.0%, p&amp;lt;0.001), BRCA2 (2.7% vs 7.4%, p = 0.003), RB1 (2.7% vs 6.4%, p = 0.013), and PTEN (1.2% vs 4.0%, p = 0.02). Frequencies of MYC, PIK3CA, KMT2D, CDK12, and TSC2 mutations were similar between the two groups. TP53 was mutated in 100% of samples. There were no significant differences between the two groups in primary race or total mutation count, and mean age at sequencing was similar. Conclusion: Somatic sequencing is warranted to identify patients of this subset of HGSOC, and understanding the co-amplifications and co-mutations is essential so that they are targeted for optimal survival outcomes. Citation Format: Ashaar Al-Akhras, Shaden Tashtoush, Alina Ghazou. CCNE1 amplification in high-grade serous ovarian cancer: analysis of the GENIE database. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4252.

Inpatient Understanding of Their Care Team and Receipt of Mixed Messages: a Two-Site Cross-Sectional Study.

Patient understanding of their care, supported by physician involvement and consistent communication, is key to positive health outcomes. However, patient and care team characteristics can hinder this understanding. We aimed to assess inpatients' understanding of their care and their perceived receipt of mixed messages, as well as the associated patient, care team, and hospitalization characteristics. We administered a 30-item survey to inpatients between February 2020 and November 2021 and incorporated other hospitalization data from patients' health records. Randomly selected inpatients at two urban academic hospitals in the USA who were (1) admitted to general medicine services and (2) on or past the third day of their hospitalization. Outcome measures include (1) knowledge of main doctor and (2) frequency of mixed messages. Potential predictors included mean notes per day, number of consultants involved in the patient's care, number of unit transfers, number of attending physicians, length of stay, age, sex, insurance type, and primary race. A total of 172 patients participated in our survey. Most patients were unaware of their main doctor, an issue related to more daily interactions with care team members. Twenty-three percent of patients reported receiving mixed messages at least sometimes, most often between doctors on the primary team and consulting doctors. However, the likelihood of receiving mixed messages decreased with more daily interactions with care team members. Patients were often unaware of their main doctor, and almost a quarter perceived receiving mixed messages about their care. Future research should examine patients' understanding of different aspects of their care, and the nature of interactions that might improveclarity around who's in charge while simultaneously reducing the receipt of mixed messages.

Ninety Percent or Greater Tumor Necrosis Is Associated With Survival and Social Determinants of Health in Patients With Osteosarcoma in the National Cancer Database.

The histologic response of osteosarcoma to chemotherapy is commonly cited as a prognostic factor and typically graded as the percent necrosis of the tumor at the time of surgical resection. Few studies, to our knowledge, have examined the relationship of tumor necrosis relative to other factors. Existing studies are limited by prolonged enrollment periods or analysis of patient subsets without the strongest predictor of mortality: metastasis at diagnosis. Additionally, the definitive threshold value for a good histologic response is commonly set at more than 90% tumor necrosis with little evidence; some authors advocate other values. (1) Are there alternative cutoff values for a good response to chemotherapy in a large, national cohort of contemporarily treated patients with osteosarcoma? (2) How does the association of histologic response to survival in osteosarcoma compare with other clinicopathologic factors? (3) What patient and clinical factors are associated with the histologic response? We identified 2006 patients with osteosarcoma diagnosed between 2010 and 2015 in the National Cancer Database (NCDB), a registry that includes 70% of all new cancers diagnosed in the United States with 90% follow-up. Patients were excluded for missing documentation of percent tumor necrosis (21% [425 of 2006]) or if definitive resection was not performed (< 1% [1 of 2006]). A total of 1580 patients were included in the analysis, with a mean follow-up duration of 37 ± 22 months. A Kaplan-Meier survival analysis, stratified by the percent tumor necrosis after chemotherapy, was performed for the 5-year period. Other covariates examined were sex, race, socioeconomic score composite, insurance type, Charlson/Deyo score, distance from the hospital, and location (metropolitan, urban, or rural). Clinical and sociodemographic data including patient-identified race from the patient's medical record is input into the NCDB by certified registrars. The NCDB only allows coding of one primary race for each patient; thus, most of our patients were grouped as White or Black race and the remaining were grouped as Other for our analysis. A multiple Cox regression analysis was performed to evaluate the effect of percent necrosis compared with other demographic, clinicopathologic, and treatment effects on survival. Finally, a multiple logistic regression analysis was performed to assess demographic and clinicopathologic characteristics associated with percent necrosis. Five-year overall survival for patients with histologic gradings of 90% to 94% necrosis (70% [95% confidence interval (CI) 60.6% to 79.7%) and 95% to 100% necrosis (74% [95% CI 68% to 80.3%) was not different between groups (p = 0.47). A comparison of histologic responses below 90% necrosis found no difference in survival between patients with decreasing histologic response (p > 0.05). Necrosis of less than 90% was associated with worse survival (HR 2.00 [95% CI 1.58 to 2.52]; p < 0.001 compared with more than 90% necrosis), and factors most associated with poor survival were metastasis (HR 2.85 [95% CI 2.27 to 3.59]; p < 0.001) and skip metastasis at the time of diagnosis (HR 2.52 [95% CI 1.64 to 3.88]; p < 0.001). On multivariate analysis, adjusting for demographic, clinicopathologic, and treatment factors, social determinants of health were negatively associated with percent necrosis of 90% or more, including uninsured status (OR 0.46 [95% CI 0.23 to 0.92]; p = 0.02 compared with private insurance) and lower socioeconomic status composite (OR for the lowest first and second quartiles were 0.63 [95% CI 0.44 to 0.90]; p = 0.01 and 0.70 [95% CI 0.50 to 0.96]; p = 0.03, respectively). Race other than White or Black (OR 0.61 [95% CI 0.40 to 0.94]; p = 0.02 compared with White race) was also negatively associated with percent necrosis of more than 90% after controlling for available covariates. This study suggests that a cutoff of 90% necrosis provides the best prognostic value for patients with osteosarcoma undergoing chemotherapy. Other threshold values did not show different survival benefits. Sociodemographic factors were associated with histologic response less than 90%. These associations must be carefully understood not as cause and effect but likely demonstrating the effects of health disparities and access to care. Although we controlled for multiple variables in our analysis, broad variables such as race may have been associated with histologic response due to unaccounted confounders. Medical providers should be aware of these associations to ensure equitable access and delivery of care because access to care may be responsible for these associations. Future studies should examine potential drivers of this observation, such as a delay in presentation or deviation from standard of care practices. Level III, therapeutic study.

Primary language, race, and location of care as main determining factors of decision to opt out of personalized breast cancer risk assessment.

e18567 Background: Personalized breast cancer risk assessment (CRA) and genetic counseling/testing for women have been shown to improve interventional and clinical outcomes. However, despite CRA being routinely offered to all women at our institution, not all women choose to opt into the program. This study evaluated the demographic distribution of patients that opted out of the CRA to identify potential components influencing this substantial decision. Methods: Our medical center, located in four urban and suburban locations, piloted a clinical framework to provide CRA to all women between the ages of 25 and 75 with a qualifying mammogram. In this single institution retrospective study, we analyzed differences among patients who opted out of the program between July 20, 2020 and July 19, 2021. Data elements extracted from the electronic medical record include race, primary language, location of care, and decision to partake in CRA. Overall Chi-square tests and all pairwise comparisons with Bonferroni correction were used to statistically determine the impact of various demographics on opting out. Results: 18726 women met criteria for inclusion and 2717 (14.5%) declined CRA. Within their respective racial groups, 122 (17.6%) Asian, 1175 (16.3%) Black, 455 (14.2%) Hispanic, 112 (15%) Other, and 853 (12.4%) White opted out. Within their identified primary language, 2370 (13.7%) English, 231 (23.1%) Spanish, 35 (19.7%) Bilingual, and 81 (35.2%) Other opted out. Based on their setting of care, 837 (16.8%) Location A, 1436 (14.2%) Location B, 270 (13.8%) Location C, and 174 (10.6%) Location D opted out. The differences between demographics and opting out were statistically significant for all analyses (p &lt; .0001). Results shown in Table below. Conclusions: The main variables mediating the decision to opt out of CRA are a non-English primary language, non-White race, and location of care, potentially due to inadequate interpretation services, barriers to education, and staffing shortages. Thus, these women are less likely to receive genetic counseling/testing or supplemental screening. Our study is the first to investigate the factors contributing to the uptake of risk assessment. Further study is needed to determine the clinical impact of this striking disparity.[Table: see text]

D-29 | Arrhythmia Prevalence and Mortality by Primary Malignancy, Race and Income Disparities, and Respiratory Illness Season: Propensity Score Adjusted Machine Learning Analysis of Over 100 Million Hospitalizations and 3 Years

D-29 | Arrhythmia Prevalence and Mortality by Primary Malignancy, Race and Income Disparities, and Respiratory Illness Season: Propensity Score Adjusted Machine Learning Analysis of Over 100 Million Hospitalizations and 3 Years

Race and insurance status outcome disparities following splenectomy in trauma patients are reduced in larger hospitals. A cross-sectional study

BackgroundSplenectomy, still a commonly performed treatment for splenic injury in trauma patients, has been shown to have a high rate of complications. The purpose of this study was to identify predictors, including race and insurance status, associated with adverse outcomes post-splenectomy in trauma patients. We discuss possible explanations and methods for reducing these disparities. MethodsThe American College of Surgeons – Trauma Quality Improvement Program (ACS-TQIP) participant user database was queried from 2010 to 2015 and patients who underwent total splenectomy were identified. All mechanisms of injury, including both blunt and penetrating trauma, were included. Patients with advance directives limiting care or aged under 18 were excluded. Propensity score matching was used to control for age, preexisting medical conditions, and the severity of the traumatic injury. A chi-squared test was used to find significant associations between available predictors and outcomes for this cross-sectional study. ResultsThe post-splenectomy mortality rate was 9.2% (n = 1047), 8.0% (n = 918) of patients had three or more complications, and 20.3% (n = 2315) had major complications. A primary race of white (OR 0.7, 95% Confidence Interval (CI) 0.6–0.9, p < 0.01) and private insurance (OR 0.5, 95%CI 0.4–0.6, p < 0.01) were associated with lower risks of mortality A primary race of neither Black nor white (OR 1.3, 95%CI 1.03–1.7, p = 0.03) and a lack of health insurance (“self-pay”) (OR 1.6, 95%CI 1.3–1.9, p < 0.01) were both correlated with mortality. When limited to hospitals of 600+ beds, there were no associations between race and mortality. ConclusionThe post-splenectomy mortality rate after trauma remains high. In U.S. trauma centers, a primary race of Black and payment status of “self-pay” are associated with adverse outcomes after splenectomy following a traumatic injury. These disparities are reduced when limiting analysis to larger hospitals. Efforts to reduce disparities in outcomes among trauma patients requiring a splenectomy should focus on improving resource availability and quality in smaller hospitals.

No Differences Between White and Non-White Patients in Terms of Care Quality Metrics, Complications, and Death After Hip Fracture Surgery When Standardized Care Pathways Are Used.

No Differences Between White and Non-White Patients in Terms of Care Quality Metrics, Complications, and Death After Hip Fracture Surgery When Standardized Care Pathways Are Used.

Bootstrap Liberalism: Texas Political Culture in the Age of FDR by Sean P. Cunningham

Reviewed by: Bootstrap Liberalism: Texas Political Culture in the Age of FDR by Sean P. Cunningham Boris Heersink (bio) Bootstrap Liberalism: Texas Political Culture in the Age of FDR. By Sean P. Cunningham. (Lawrence: University Press of Kansas, 2022. Pp. ix, 312. $37.95 cloth; $28.49 ebook) In Bootstrap Liberalism: Texas Political Culture in the Age of FDR, historian Sean P. Cunningham engages with the puzzle of the massive popularity Franklin Delano Roosevelt and the New Deal enjoyed in Texas in the context of the long-standing perception of this state as the center of individualism and conservatism. How did voters with [End Page 205] a seemingly genuine belief in “conservative, rugged individualism, self-help, and limited government” end up supporting FDR in landslide numbers in each election between 1932 and 1944 (p. 2)? Conservatism was a major force in the Texas Democratic Party before, during, and after the New Deal. In 1928, Republican nominee Herbert Hoover won Texas by a small margin, as Democratic nominee Al Smith’s Catholicism and opposition to Prohibition resulted in a good number of Democratic politicians in the state bolting the ticket and openly supporting Hoover. But with the economic crash of 1929 and Hoover’s dramatic drop in popularity, these “Hoovercrats” quickly rejoined the Democratic side and fully backed Roosevelt in 1932. Importantly, Cunningham shows that these conservative Democrats generally were enthusiastic supporters of FDR throughout his first term and reelection effort. With the early New Deal benefitting local farmers and steering clear of racial and civil rights issues, conservatives—like Rep. Marvin Jones—were happy to tie themselves to FDR and celebrate the New Deal as “a new day and a new economic order for the American people” (p. 63). After 1936, however, unity dissolved, and the Texas Democratic Party split into roughly two factions. One consisted of true believers in the New Deal (such as Representatives Maury Maverick and Lyndon B. Johnson), who remained supportive of FDR until his death in 1945. The other faction united conservatives of different kinds, who became increasingly (and vocally) critical of the size and role of the federal government and FDR’s role as president and party leader. Cunningham carefully charts how these two camps battled each other in primaries and at state party conventions. In these clashes, both sides saw defeats and victories. Yet, after the conclusion of a nomination fight, Texas voters consistently voted the Democratic nominee—regardless of faction—into office in landslide victories. While much of this may have been the simple consequence of Texas (and the South in general) representing a de-facto single party system, Bootstrap Liberalism argues convincingly that it was also the product of the similar ways in which both conservatives and liberals presented [End Page 206] their politics to voters. Both sides claimed to represent the forgotten workingman in Texas and argued their policies would help voters achieve their goals. This approach may have allowed self-identified conservative voters to embrace the New Deal and incorporate it into their existing individualistic worldview. At the same time, Cunningham’s account also shows how such similar marketing likely confused voters. For example, Cunningham presents reports that some of rural voters in the 1942 senate primary race supported populist conservative W. Lee “Pappy” O’Daniel—who was increasingly anti-FDR, anti-New Deal, and anti-union—because they believed he would be a pro-labor ally to the president. Bootstrap Liberalism presents a fascinating insight into the workings of Texas politics in the FDR era—charting the clashes between leading Texas politicians of this period such as Maury Maverick, LBJ, “Pappy” O’Daniel, and James “Pa” and Miriam “Ma” Ferguson and spotlighting the importance of how an “individualist” presentation of the New Deal may have played a role in its popularity in Texas and—possibly—other traditionally conservative states as well. Boris Heersink BORIS HEERSINK is an assistant professor in the department of political science at Fordham University. He is the co-author of Republican Party Politics and the American South, 1865–1968 and the author of National Party Organizations and Party Brands in American Politics: The Democratic and Republican National Committees, 1912–2016. Copyright © 2022 Kentucky Historical...

Abstract P1-21-07: Implications for chronoradiobiology: Differential effect of radiation response for breast cancer patients with brain metastases depending on treatment time

Abstract Purpose/Objectives: Circadian clock dysregulation has been implicated in cancer risk such that The World Health Organization classifies circadian disruption as a probable carcinogen following several reports of night shift workers with an increased risk of breast cancer. There are studies which outline a link between time of day a patient receives radiation therapy and toxicity from their radiation treatment. In order to ascertain if chronomodulation should be considered for radiation toxicity and survival outcome improvements, we sought to assess if time of day for radiation treatment delivery affected outcomes for breast cancer patients with brain metastases. Materials/Methods: Retrospective data was collected for patients with a primary diagnosis of breast cancer with brain metastases who were treated with whole brain radiotherapy between 2015 and 2021. Eligible patients were included if ≥80% of their total dose was delivered either before or after 12:00 noon as documented by treatment times in the electronic medical record and if outcome data was available. Information including sex, age, performance status, control of primary disease, extracranial metastases, radiation dose, race, height, weight, BMI, and zip code were collected. Whole brain radiation was delivered to a median dose of 3000 cGy. Patients were eligible to be included in the analysis since ≥80% of their total dose was delivered either before or after 12:00 noon. A survival analysis was performed using a log-rank test to compare Kaplan-Meier curves between groups. Results: Between 2015 and 2021, 46 breast cancer patients with brain metastases were treated with whole brain radiation with ≥80% of their total dose was delivered. either before or after 12:00 noon. Patient characteristics were evenly split between those treated predominantly in the morning or afternoon with regards to age, extracranial disease, race and BMI at time of brain metastases diagnosis however 97.83% were female. The overall breakdown of race was 65.5% white, with 34.8% identifying as black or African American, Hispanic, or unknown. The average survival time for patients treated in the morning was 293 days compared to the afternoon patients which averaged 168 days. Kaplan meier curve showed statistically significant improvement in survival for the group that received ≥80% of treatments in the morning (p=0.0048). Conclusions: Survival was significantly improved in patients with breast cancer and brain metastases who received whole brain radiation in the morning compared to the afternoon. Limitations of our study include a low sample size due to our stringent criteria for inclusion in analysis but further investigation using a multi-center approach is warranted. Circadian effects on tumors or their environment, potentially through melatonin related signaling should be further evaluated. Future investigation in methods to entrain the circadian clock to harness positive chronobiological impact on tumors including pharmacologic intervention in an attempt to improve radiation outcomes and or toxicity and continued research is warranted. Citation Format: Lauren Matlack, Joseph Lombardo, Nicolas Nelson, Alexandria Smith, Wenyin Shi, Nicole Simone. Implications for chronoradiobiology: Differential effect of radiation response for breast cancer patients with brain metastases depending on treatment time [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-21-07.

Fighting to Preserve a Nation's Soul: America's Ecumenical War on Poverty

Fighting to Preserve a Nation's Soul: America's Ecumenical War on Poverty

STAYING IN THEIR LANES: ISSUE OWNERSHIP IN THE 2016 AND 2020 U.S. PRESIDENTIAL CAMPAIGNS ON FACEBOOK AND TWITTER

Prior research has identified issue-ownership across partisan lines, with Republicans seen to focus on issues such as taxes and national defense, and Democrats more likely to focus on social issues and welfare. Given the complexities of the primary race, with candidates aiming to differentiate themselves within their own party, we ask whether the candidates in both parties engage in creating “lanes” by owning specific policy topics. Use supervised machine-learning and a lexicon approach to classify candidate posts on twelve different political topics, we analyze Facebook and Twitter messages from 17 Republicans and 19 Democrats during the 2016 and 2020 U.S. Presidential Elections. We find that Democrats are more likely to post about the issues on social media, and Republicans and Democrats talk about significantly different topics. We also find that candidates of both parties tended to advocate for the issues they cared about, rather than attack opponents on issues.

Abstract 686: Longitudinal analysis of the indirect burden of prostate cancer management on paid and unpaid work: Data from CaPSURE database

Abstract Introduction: For clinically localized prostate cancer (PCa) men must choose between various management options [radical prostatectomy (RP), external beam radiation therapy (EBRT), brachytherapy (BT, with or without EBRT), or active surveillance/watchful waiting (AS/WW)] but little is known about the long-term, indirect impact of management on paid work, unpaid responsibilities, and general health up to 10 years after initial management. Methods: We identified men diagnosed with PCa managed with RP, EBRT, BT, or AS/WW in a longitudinal, observational study of 43 primarily community-based US urology practices with available work type including paid work (full-time, part-time) or unpaid work (retired, on leave/unemployed, disabled, unspecified). Work type, weeks of work missed, general health, and number of clinic visits annually were collected via surveys administered prior to treatment and at 1,3,5 and 10 years after treatment. Using multivariate repeated measures generalized estimating equation modeling we examined the association between primary treatment, work type (paid vs unpaid), race, income, and time since treatment with work weeks missed over time and SF-36 General Health after adjustments for clinicodemographics. Results:6,673 men were identified. Mean age of 64.4 years (standard deviation 8.3). Most were insured (54% private, 43% Medicare, 3% Veteran's), white (90%, 7% Black, 1% Latino) with low- (60%) or intermediate-risk (32%) disease by CAPRA. Most had paid work (44%) or were retired (45%) and underwent RP (62%, 14% BT, 14% EBRT, 10% AS/WW). Median 5.3 weeks missed in first year (IQR 1.6-12.2) with up to 2.1 weeks missed at all other time points. AS/WW (RR 0.62, 95% CI 0.51-0.74) conferred lowest risk of missed weeks [BT (RR 0.70, 95% CI 0.61-0.80), EBRT (RR 0.72, 95% CI 0.62-0.83)] compared to RP. Black patients had lower risk of reporting missed weeks (vs white, RR 0.68, 95% CI 0.55-0.83); job status was not associated. SF-36 General Health declined across 10 years after treatment after adjustments, with RP and BT having better scores than AS/WW and EBRT. Conclusions: Nearly one-quarter of men with PCa reported missed work weeks due to PCa management, up to 10 years after treatment, irrespective of job status. Relative to other treatment types, AS/WW had the lowest risk of missed weeks, independent of job status, although long-term general health scores declined more than with RP or BT. In carefully selected men with PCa, management with AS/WW can confer a lower risk of missed work but the long-term impact of PCa management on QoL and work, irrespective of job type, should be considered when counseling about making treatment decisions. Citation Format: Samuel L. Washington, Peter E. Lonergan, Janet E. Cowan, Shoujun Zhao, Scott Greenberg, Jeanette M. Broering, Nynikka R. Palmer, Matthew R. Cooperberg, Peter R. Carroll. Longitudinal analysis of the indirect burden of prostate cancer management on paid and unpaid work: Data from CaPSURE database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 686.

Cancer inpatient malnutrition risk, documentation, and ICD-10 coding in an academic medical center.

12107 Background: Malnutrition (MN) is common in hospitalized cancer patients but often underdiagnosed. We evaluated the prevalence of MN risk, dietitian documented MN (DDMN), and physician coded malnutrition (PCMN) in a consecutive cohort of cancer inpatients in an academic, community-based medical center. Methods: Electronic medical records (EMR) were reviewed for inpatients with a solid tumor diagnosis staged I-IV and admitted to Atrium Health Carolinas Medical Center at least once between 1/1/2016 to 5/21/2019. All data were collected from the first admission EMR encounter closest to the cancer diagnosis date. High MN risk was a score ≥2 on the Malnutrition Screening Tool (MST) completed by an RN at admission. Registered Dietitian (RD) assessments were reviewed for DDMN and grade (mild, moderate, severe). PCMN diagnosis was based on MN ICD-10 codes extracted from the medical coder’s discharge summary. Multivariate logistic regression models identified associations between clinic-demographic factors and the prevalence of DDMN and PCMN with stepwise selection. Results: N=5,143; 48% females. Median age 63 (range 18-102) years. 70% White; 24% Black, 3% Latino. Most common cancers: thoracic 19% and digestive system (14% other, 11% colorectal). 28% had known stage IV disease. The MST was completed in 79%. Among those with MST ≥2 (N=1,005; 25%), DDMN and PCMN prevalence was 30% and 22%, respectively. In the entire cohort, 8% had DDMN; 7% PCMN; 4% both. Prevalence of MN risk, DDMN, and PCMN by cancer site are in the Table. DDMN (N=420) was mild 2%, moderate 16%; severe 66%; unspecified 16%. On discharge, PCMN (N=360) was mild 10%; moderate 0%; severe 69%; unspecified 21%. Male gender (OR 1.27 [1.01, 1.59]), Black race (OR 1.57 [1.25, 1.98]), stage IV disease (v. I-III) (OR 3.08 [2.49, 3.82]), and primary site were all independent predictors of DDMN (all p&lt;0.05); Black race (OR 1.46 [1.14, 1.87]), stage IV disease (OR 2.70 [2.15, 3.39]), and primary site were independent predictors of PCMN (all p&lt;0.05). Conclusions: 25% of cancer inpatients were at high risk for MN. Primary site, disease stage, and race were independent predictors of a greater risk. MN appears to be under-diagnosed compared to population studies. This is the first study to report the prevalence of MN in a large cancer inpatient database with a representative population.[Table: see text]

Discrepancies in response and immune-related adverse events (irAE) of anti-PD-1 monotherapy between races and primary sites in patients (pts) with advanced nonacral cutaneous melanoma (NACM).

9530 Background: Ultraviolet (UV)-induced high tumor mutation burden (TMB) of NACM is associated with response to anti-PD-1 monotherapy (aPD-1). Anatomic location of the primary lesion (reflecting UV exposure) and race (reflecting eumelanin level) may serve as surrogates for TMB and be associated with varying response and irAE patterns. Methods: Pts with advanced NACM receiving aPD-1 between 2009-2019 were retrospectively analyzed from 5 institutions in the US, Australia and China. Best response, survival (PFS and OS), and organ/system-specific irAEs were compared by race (Caucasian [C] vs non-Caucasian [NC]) and primary anatomic site. Results: Among 697 patients, 616 were C, 81 were NC. Complete response rate (CRR) was 24.8% (95%CI, 21.4-28.4) and 2.6% (95%CI, 0.3-9.1) and ORR was 54.9% (95%CI, 50.9-58.9) and 15.6% (95%CI, 8.3-25.6) in C and NC, respectively (both P&lt;.001). Median PFS was 16.5 (95%CI, 12.0-23.1) and 5.2 (95%CI, 3.6-7.6) months, median OS was 60.5 (95%CI, 49.9-not reached [NR]) and 29.2 (95%CI, 17.9-NR) months, in C and NC, respectively (P&lt;.001 and =.04). In multivariate analyses, C had significantly higher CRR (OR 13.4, 95%CI 3.1-57.4), ORR (OR 10.6, 95%CI 4.6-24.5), and longer PFS (HR 0.5, 95%CI 0.4-0.7) than NC. Compared to a head primary site, NACM from less UV-exposed regions had significantly lower CRR (upper trunk, OR 0.6, 95%CI 0.4-0.96; lower limb, OR 0.5, 95%CI 0.2-0.9), ORR (lower limb, OR 0.6, 95%CI 0.3-0.9) and poorer PFS (perineum/buttock, HR 2.1, 95%CI 1.2-3.5; lower limb, HR 1.6, 95%CI 1.2-2.2) and OS (perineum/buttock, HR 3.8, 95%CI 2.2-6.8; lower limb, HR 1.7, 95%CI 1.2-2.4). Overall irAE incidence was similar between C and NC but irAE subtypes varied. C had significantly higher incidence of GI (12.2%, 95%CI 9.5-15.3% vs 1.2%, 95%CI, 0.03-6.7%, P=.001), respiratory (10.3%, 95%CI 7.8-13.2% vs 0, P&lt;.001) and grade 3/4 (15.4%, 95%CI 12.4-18.8% vs 6.2%, 95%CI 2.0-13.8%, P=.03) irAEs; and lower incidence of endocrine (13.8%, 95%CI 10.9-17.0% vs 32.1%, 95%CI 22.2-43.4%, P&lt;.001) and liver (4.8%, 95%CI 3.2-7.1% vs 13.6%, 95%CI, 7.0-23.0%, P=.005) irAEs. IrAEs did not vary by primary NACM site. Conclusions: Race and primary site are independently correlated with distinct response and survival outcomes in pts with advanced NACM receiving aPD-1. IrAE subtypes vary by race although overall irAE incidence does not.

Partisanship, Impeachment, and the Democratic Primaries: American Political Discourse, January - February 2020

Partisanship, Impeachment, and the Democratic Primaries: American Political Discourse, January - February 2020