Racial Differences In Survival Research Articles

Racial and socioeconomic disparities in survival among patients with metastatic non-small cell lung cancer.

Immune checkpoint inhibitors have profoundly impacted survival among patients with metastatic non-small cell lung cancer. However, population-based studies evaluating this impact on survival by race and socioeconomic factors are lacking. We used the Surveillance, Epidemiology, and End Results Program-Medicare database to identify patients with metastatic non-small cell lung cancer diagnosed between 2015 and 2019. The primary study outcomes were the receipt of an immune checkpoint inhibitor and overall survival. χ2 tests and logistic regression were used to identify demographic factors associated with receipt of immune checkpoint inhibitors. The Kaplan-Meier method was used to calculate 2-year overall survival rates, and log-rank tests were used to compare survival by race and ethnicity. Of 17 134 patients, approximately 39% received an immune checkpoint inhibitor. Those diagnosed with cancer recently (in 2019); who are relatively younger (aged younger than 85 years); non-Hispanic White, non-Hispanic Asian, or Hispanic; living in high socioeconomic status or metropolitan areas; not Medicaid eligible; and with adenocarcinoma histology were more likely to receive immune checkpoint inhibitors. The 2-year overall survival rate from diagnosis was 21% for the overall population. The 2-year overall survival rate from immune checkpoint inhibitor initiation was 30%, among those who received at least 1 cycle and 11% among those who did not receive immune checkpoint inhibitors. The 2-year overall survival rates were higher among non-Hispanic White (22%) and non-Hispanic Asian (23%) patients compared with non-Hispanic Black (15%) and Hispanic (17%) patients. There was no statistically significant racial differences in survival for those who received immune checkpoint inhibitors. Immune checkpoint inhibitor utilization rates and the resulting outcomes were inferior for certain vulnerable groups, mandating the need for strategies to improve access to care.

Differences in Survival between Black and White Patients with Head and Neck Squamous Cell Carcinoma: Comparison of Data from the DOD Central Cancer Registry and SEER.

Barriers to health care access may contribute to the poorer survival of Black patients with head and neck squamous cell carcinoma (HNSCC) than their White counterparts in the U.S. general population. The Department of Defense's (DOD) Military Health System (MHS) provides universal health care access to all beneficiaries with various racial backgrounds. We compared overall survival of patients with HNSCC by race in the MHS and the general population, respectively, to assess whether there were differences in racial disparity between the two populations. The MHS patients were identified from the DOD's Central Cancer Registry (CCR) and the patients from the U.S. general population were identified from the NCI's Surveillance, Epidemiology and End Results (SEER) program. For each cohort, a retrospective study was conducted comparing survival by race. Black and White patients in the CCR cohort had similar survival in multivariable Cox regression models with a HR of 1.04 and 95% confidence interval (95% CI) of 0.81 to 1.33 after adjustment for the potential confounders. In contrast, Black patients in the SEER cohort exhibited significantly worse survival than White patients with an adjusted HR of 1.47 (95% CI = 1.43-1.51). These results remained similar in the subgroup analyses for oropharyngeal and non-oropharyngeal sites, respectively. There was no racial difference in survival among patients with HNSCC in the MHS system, while Black patients had significantly poorer survival than White patients in the general population. Equal access to health care could reduce racial disparity in overall survival among patients with HNSCC.

Racial differences in survival for early stage (T1) penile cancer: Analysis from the SEER database.

Penile cancer accounts for less than 1% of male cancers in the United States. Localized disease, particularly T1 tumors are potentially curable with local therapy. We present the racial differences in survival outcomes for T1, penile cancer from the SEER database. From 2004 to 2016 all men with T1, N0, M0 penile cancer in the SEER-18 database were included. Kaplan-Meier analysis and multivariable Cox-Regression analysis were conducted to investigate prognostic variables for cancer specific survival (CSS). A total of 4,406 men were identified with penile cancer; 1,941 men had T1 disease. The Kaplan-Meier (KM) analysis showed those with primary site surgery had better 5-year CSS compared to those without primary site surgery (P <.0001) and a significant difference in CSS based on race (P= 0.0078). On multivariable analysis, Hispanic individuals had worse CSS (HR 1.92; P = 0.0057) compared to the White men. Black men were also found to have a poor CSS however this was not statistically significant (HR 1.53, P = 0.118). Men with penile cancer who had either penectomy (HR 0.45; P = 0.006) or penile preservation surgery (HR 0.25; P< 0.001) had improved CSS. Racial disparities in CSS exist among men with in early-stage penile cancer. KM analysis showed significant differences in CSS by race and in those receiving primary site surgery. On multivariable analysis, the CSS is worse in Hispanic compared to White men. There is a trend towards worse CSS in Black men however this was not statistically significant.

Impact of endocrine therapy adherence on racial disparities in breast cancer survival.

541 Background: Black women have worse breast cancer outcomes compared to their White counterparts, even for hormone receptor positive (HR+) HER2 negative (HER2-) breast cancer (BC). This tumor type is usually treated with 5-10 years of adjuvant endocrine therapy (ET) to reduce risk of BC recurrence and improve survival. We investigated the impact of adherence to ET on racial differences in survival for HR+ HER2- BC survivors. Methods: We conducted a population-based, retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, which links demographic and clinical data with cause of death for persons with cancer and Medicare claims for covered health services. We examined 9,039 women with HR+ HER2- stage I-III BC diagnosed between 2007 and 2016, who received primary breast surgery and initiated ET. Adherence to ET was measured using the medication possession ratio (MPR), which assesses the proportion of time a patient has medication available via filled prescriptions. As in established literature, we defined ET adherence as MPR &gt; = 80%. Causal mediation analysis was performed to measure to impact of adherence on survival disparities between Black and White BC survivors. Results: Mean age at diagnosis was 72 years, 6.5% were Black, and 20.9% were dual eligible for Medicaid (a surrogate for socioeconomic hardship). Most had stage I or II breast cancer (69.3%) and mastectomy as primary surgery (69.7%). Nineteen percent received chemotherapy and 62.5% received radiation. In univariate analyses, factors associated with ET adherence were Black race (OR 0.62, 95% CI 0.54-0.75), insured by Medicaid (OR 0.72, 95% CI 0.65-0.81), being married (OR 1.14, 95% CI 1.03-1.25), and increased comorbidities (Charlson score &gt; = 2) (OR 0.88, 95% CI 0.78-0.99). Age, BC stage, type of surgery, and receipt of chemotherapy or radiation were not associated with ET adherence. In multivariable models adjusting for age, race, marital status, Medicaid eligibility, and Charlson score, Black race and Medicaid eligibility remained inversely associated with ET adherence (OR 0.70, 95% CI 0.59-0.83 and OR 0.77, 95% CI 0.69-0.87 respectively). Among those who were adherent to ET, Black women had 43% higher risk of mortality compared to White women (HR 1.43, 95% CI 1.17-1.76). In mediation analysis, 4.25% of the observed survival disparity between Black and White women can be explained by differences in ET adherence. Conclusions: We identified racial disparities in ET adherence and overall survival among women with BC. Adherence to ET accounted for a small percentage of racial disparities in survival. Further research is needed to delineate other factors contributing to ET non-adherence among Black women and to investigate additional factors contributing to known disparities in BC survival.

Abstract 4209: Cancers of unknown primary: survival by histologic type, demographic features, and treatment in the US Military Health System

Abstract Background: Cancers of unknown primary (CUP), a group of heterogenous metastatic cancers lacking a known primary site, have poor prognosis. This study compared survival by histologic type, patient characteristics, and treatment in the U.S. Military Health System (MHS), which provides universal care to its members. Methods: Patients diagnosed with CUP were identified from the U.S. Department of Defense’s Automated Central Tumor Registry. Median survival with 95% confidence intervals was calculated for demographic and treatment variables by histologic type. A multivariable accelerated failure time model estimated time ratios and 95% confidence intervals. Results: The study included 3,358 CUP patients. The most prevalent CUP in this study was well and moderately differentiated adenocarcinomas. Median survival varied by histologic type with squamous cell carcinoma having the longest at 25.1 months and poorly differentiated carcinomas having the shortest at 3.0 months. For each histologic type, survival was generally similar by sex and active-duty status. Younger patients tended to have longer survival than those aged 65 years or older. Women with well and moderately differentiated adenocarcinoma had longer survival than their male counterparts. Generally, there were no racial differences in survival except poorer survival for Blacks than Whites with other histologic types. Patents with chemotherapy and radiation treatment generally had improved survival whereas patients with squamous cell carcinoma who received chemotherapy had shorter survival than those without. Conclusion: Survival generally did not differ between racial groups, which may be related to equal healthcare access despite racial background. Further studies are warranted to better understand how survival in the MHS compares with that in the general U.S. population. Disclaimer: The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, opinions or policies of USUHS, HJF, the DoD or the Departments of the Army, Navy or Air Force. Mention of trade names, commercial products or organizations does not imply endorsement by the US Government. Citation Format: Julie A. Bytnar, Jie Lin, Joel T. Moncur, Craig D. Shriver, Kangmin Zhu. Cancers of unknown primary: survival by histologic type, demographic features, and treatment in the US Military Health System. [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 4209.

Racial differences in survival and healthcare resource utilization among Medicaid-insured adults with metastatic castration-sensitive prostate cancer.

26 Background: Racial inequalities in healthcare have long existed in the United States, with Black or African American (BAA) men having higher overall cancer death rates compared to other racial or ethnic groups. One of the greatest disparities is in prostate cancer (PC), which disproportionately affects BAA men, though when matched for stage, whether outcomes differ by race is controversial. This study assessed differences in overall survival (OS) and healthcare resource utilization (HRU) by race in Medicaid-insured patients with metastatic castration-sensitive prostate cancer (mCSPC). Methods: This retrospective longitudinal cohort study evaluated de-identified administrative claims data from the Centers for Medicare and Medicaid Services 100% Medicaid data files, from 01/01/2010 - 12/31/2018. The study included adult patients with a diagnosis for PC, ≥1 claim for androgen deprivation therapy (ADT), diagnosis of metastasis before or within 90 days after ADT, and continuous eligibility for ≥6 months pre-index (defined baseline period) and ≥3 months post-index. The date of first receipt of ADT or first receipt of novel hormonal therapy or docetaxel if initiated within 30 days before ADT defined the index date. OS and HRU were assessed from the index date to the earliest of end of continuous eligibility, data availability, or death. A multivariable Cox proportional hazards model of OS and a multivariable Poisson model of HRU were implemented and controlled for age, plan type, region, median state income, residence in a state with Medicaid expansion, index year, Charlson comorbidity index (CCI), baseline HRU, and clinical characteristics. Results: The study included 1,488 patients with mCSPC (467 [31%] BAA, 446 [30%] White [W], 219 [15%] Hispanic [H], 356 [24%] Other races [O]). H were the oldest (mean age 68 years), followed by O (67 years), W (64 years), and BAA (63 years). BAA and H had the highest CCI (0.6), followed by O (0.5), and W (0.4). Median unadjusted OS was 71.3 months in H, 57.1 months in O, 52.1 months in BAA, and 44.9 months in W. After adjustment, H had significantly lower risk of death compared to W (hazard ratio [95% confidence interval (CI)]: 0.65 [0.43, 0.96]) and BAA patients had comparable survival to W (0.91 [0.69, 1.22]). Adjusted incidence rate ratios (IRR) showed significantly lower incidence of PC-related outpatient (OP) visits for BAA as compared to W (IRR [95% CI]: 0.71 [0.55, 0.99]), per patient per year. The remaining HRU endpoints were not significantly different among racial groups. Conclusions: Among Medicaid-insured adult patients with mCSPC, H were more likely to live longer than W patients. BAA patients had similar survival and lower rates of PC-related OP visits as compared with W, which shows differential use of PC-related healthcare resources between BAA and W.

Racial differences in survival and healthcare resource utilization among Medicaid-insured adults with metastatic castration-resistant prostate cancer.

29 Background: Prostate cancer (PC) disproportionately affects Black or African American (BAA) men in the United States (US), but racial disparities in outcomes are not well understood. This study analyzed racial disparities in OS, healthcare resource utilization (HRU), and PC treatments in Medicaid-insured metastatic castration resistant PC (mCRPC) patients. Methods: This retrospective longitudinal cohort study evaluated de-identified data from the Centers for Medicare and Medicaid Services 100% Medicaid data files from 01/01/2010 – 12/31/2018. The study included adult patients with a diagnosis of PC and metastasis, and a claim for at least one of the following drugs prior to 9/30/2018, which is specific to mCRPC (date defined index): ≥1 claim for cabazitaxel, mitoxantrone, enzalutamide, radium-223, or sipuleucel-T, ≥1 claim for abiraterone acetate before June 2017, ≥1 claim for docetaxel at least 90 days after initiation of hormone therapy, or evidence of castration resistance. Patients were required to be continuously enrolled for ≥6 months pre-index (i.e., baseline period) and ≥3 months post-index. Outcomes were assessed from the index date to the earliest of end of continuous enrollment, data availability, or death. A multivariable Cox proportional hazards model of OS, and a multivariable Poisson model of HRU were implemented and controlled for age, plan type, region, median state income, residence in a state with Medicaid expansion, index year, Charlson comorbidity index, baseline HRU, baseline PC treatments, and clinical characteristics. Results: The study included 1,095 mCRPC patients (320 [29%] White [W], 278 [25%] BAA, 190 [17%] Hispanic [H], 307 [28%] Other races [O]). H had the highest mean age of 69 years, followed by 68 years for O, and 63 years for both W and BAA. Median unadjusted OS was 46.7 months in H, 40.5 months in BAA, 35.3 months in O, and 32.3 months in W. After adjustment, H had significantly lower risk of death vs. W (hazard ratio [95% confidence interval (CI)]: 0.62 [0.42, 0.90]) and BAA had comparable survival to W (0.85 [0.62, 1.16]). BAA had significantly fewer PC-related outpatient (OP) visits vs. W (adjusted incidence rate ratios [IRR] [95% CI]: 0.67 [0.48, 0.93]), but significantly more PC-related emergency room (ER) visits (5.03 [2.03, 12.47]) per patient per year. Race cohorts differed in the proportions of patients treated with novel hormonal therapy (70% W, 63% BAA, 58% H, 67% O) and chemotherapy use (29% BAA, 26% H, 24% W, 19% O). Conclusions: Among Medicaid-insured adult mCRPC patients, H were more likely to live longer than W patients, while BAA and W patients had similar OS. BAA patients had a higher rate of PC-related ER visits but fewer PC-related OP visits as compared to W, showing differential use of PC-related healthcare resources.

Investigation of racial differences in survival from non-small cell lung cancer with immunotherapy use: A Texas study.

The use of immunotherapy is associated with improved survival among patients with Non-Small Cell Lung Cancer (NSCLC) and has gained widespread use in its management. However, there is limited information on whether the survival benefits associated with immunotherapy differ among races and ethnicities. This study aimed to investigate racial differences in survival amongst patients with NSCLC who received immunotherapy as the first-line treatment in Texas. Patients with NSCLC who received immunotherapy between October 2015 to December 2018 were identified from the Texas Cancer Registry (TCR). Disease-specific survival was evaluated and compared among patients across racial/ethnic categories using the Kaplan-Meier survival analysis, log-rank test, and a multivariable Cox proportional hazard regression model following an inverse probability treatment weighting (IPTW) propensity score analysis. A total of 1453 patients were included in the analysis. Median survival (in months) was longest among Asians (34, 95% CI: 15-Not Estimable), followed by African Americans (AAs) (23, 95% CI: 15-34), Hispanics (22, 95% CI: 16-26), and Whites (19, 95% CI: 17-22). The adjusted regression estimates had no statistically significant differences in survival among AAs (aHR = 0.97; 95% CI = 0.78-1.20; P =0.77) and Hispanics (aHR = 0.96; 95% CI = 0.77-1.19, P =0.73) when compared to White patients. Asians on the other hand, had 40% reduction in mortality risk compared to Whites (aHR = 0.60; 95% CI = 0.39-0.94, P = 0.03). Our study indicated that African Americans and Hispanics do not have poorer survival compared to White patients when receiving immunotherapy as first-line treatment. Asians however had longer survival compared to Whites. Our findings suggest that existing racial disparity in NSCLC survival might be mitigated with the use of immunotherapy and should be considered in providing care to these minority groups.

Cancers of unknown primary: Survival by histologic type, demographic features, and treatment in the U.S. Military Health System

BackgroundCancers of unknown primary (CUP), a group of heterogenous metastatic cancers lacking a known primary site, have poor prognosis. This study compared survival of CUP by histologic type, patient characteristics, and treatment in the U.S. Military Health System (MHS), which provides universal care to its members. MethodsPatients histologically diagnosed with CUP were identified from the U.S. Department of Defense (DoD)’s Automated Central Tumor Registry. Median survival with 95 % confidence intervals was calculated for demographic and treatment variables by histologic type. A multivariable accelerated failure time model estimated time ratios and 95 % confidence intervals. ResultsThe study included 3358 CUP patients. The most prevalent CUP in this study was well- and moderately-differentiated adenocarcinomas. Median survival varied by histologic type with squamous cell carcinoma having the longest at 25.1 months and poorly-differentiated carcinomas having the shortest at 3.0 months. For each histologic type, survival was generally similar by sex and active-duty status although women with well- and moderately-differentiated adenocarcinoma had longer survival than their male counterparts. Younger patients tended to have longer survival than those aged 65 years or older. Generally, there were no racial differences in survival except poorer survival for Black patients than White patients in the group of other histologic types. Patients with chemotherapy and radiation treatment generally had improved survival whereas patients with squamous cell carcinoma who received chemotherapy had shorter survival than those without. ConclusionSurvival generally did not differ between racial groups, which may be related to equal healthcare access despite racial background. Further studies are warranted to better understand how survival in the MHS compares with that in the general U.S. population.

Racial Difference in Part D Enrollment and Survival Among Older Patients with Multiple Myeloma

Introduction Multiple myeloma (MM) is the second most common hematologic malignancy in the United States. African Americans (AAs) are disproportionately affected by MM.Previous studies found that among patients with MM, when having equal access to treatment, AAs had better survival than Whites. Oral agents, e.g., immunomodulatory drugs, play an active role in the treatment of both newly diagnosed and relapsed or refractory MM. For Medicare patients, these oral agents are covered by Part D only. However, little is known about the potential role of Part D enrollment in racial difference among older patients with MM. Methods Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we conducted a population-based cohort study to assess the role of part D enrollment and race in MM survival. The study included AA and White patients with first primary MM (International Classification of Diseases for Oncology-3rd edition, 9732) who 1) were diagnosed from 2007-2017, 2) ages ≥ 66 years at diagnosis, and 3) had continuous Parts A & B enrolment and were not a member of HMO from 12 months before diagnosis to end of follow-up (death or 12/31/2019, whichever came first). Patients were categorized as ever or never enrolled in Part D. We applied a published algorithm to define smoldering and symptomatic MM patients. Our outcome of interest is overall survival. Cochran-Armitage trend test was used to test trend of Part D enrollment by year of diagnosis. Kaplan-Meier curves were generated, and log-rank tests were used for comparisons across groups. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated from a multivariable Cox proportional hazards model, adjusting for demographics, comorbidities, and socioeconomic factors. All statistical tests were two-sided with a type I error of 0.05 and were performed with SAS Version 9.4. Results The final cohort included 17,097 patients with a median follow-up of 2.64 (interquartile range [IQR] 0.81-4.78) years for 3,315 AAs and 2.58 (IQR 0.70-4.72) years for 13,782 Whites. The median age of AAs was 75 ([IQR 70-80) and of Whites 76 (IQR 71-82) years. Compared with Whites, AAs were more likely to be female, younger, unmarried, diagnosed in more recent years, had a high Elixhauser score, be frail, have state buy-in, and reside in census tracts with 20-100% population below poverty (all ps<.01). However, AAs were less likely to have a diagnosis of symptomatic MM (69.0% vs 71.0%, p=0.02). During the follow-up, 85.7% AAs and 78.1% Whites were ever enrolled in Part D (p<.01). Among both races, Part D enrollment increased over years (ptrend<.01). AAs had higher Part D enrollment percentage than Whites in both smoldering MM (AAs 88.8%, Whites 84.7%, p<.01) and symptomatic MM groups (AA 84.3%, Whites 75.4%, p<.01). The median survival was 3.05 (95% CI 2.85-3.24) years for AAs and 2.86 (95% CI 2.75-2.97) years for Whites (p<.01). Smoldering MM patients who ever had Part D enrollment had highest median survival; among these patients, AA had higher median survival (5.76, 95% CI 5.39-6.62 years) than their White counterparts (4.94, 95% CI 4.71-5.15 years; Figure 1). In the multivariable models, Part D enrollees (vs non-enrollees) had better overall survival (p<.01), and the interaction term between race and Part D enrollment was statistically significant for all patients (p=0.04) and smoldering patients (p<.01). As shown in Figure 2, among patients who were ever enrolled in Part D, compared to Whites AAs had lower risk of death (HR=0.88, 95% CI 0.83-0.93, p <.01), especially among smoldering MM patients (HR=0.78, 95% CI 0.70-0.87, p<.01). However, among patients never enrolled Part D, no difference on survival (HR=0.99, 95% CI 0.89-1.11, p=0.92) was observed. Conclusions Among patients who ever enrolled in Part D, AAs, especially with smoldering MM, had better survival than Whites, yet there was no racial difference in survival among patients who never had Part D coverage. A higher percentage of Medicare Part D enrollment in AAs than that in Whites may help explain the racial difference in survival observed in MM patients. Future research is needed to evaluate patterns of MM care by both race and Part D enrollment. Acknowledgement This study was supported by grant 1U01CA265735-01. The contents are solely the responsibility of the authors and does not necessarily represent the official views of funding agency. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Racial Disparities in the Treatment of Acute Myeloid Leukemia. ELN Risk Stratification Analysis of Overall Survival According to Race

Introduction and background: Acute myeloid leukemia (AML) is a rare disease that critically disrupts the function of the bone marrow. Genetic mutations and cytogenetic changes are the main culprits of this process. As the bone marrow fails to perform its usual activity, blood production is crucially affected. Patients with AML need immediate access to medical facilities to treat such an acute disease. It has been postulated that a black population may have worse outcomes in AML. The less favorable outcome may result from miscellaneous factors, with social-economical disparities being the most important. In light of the systemic racism in health care and society in general, minorities may have less access to prime health care centers. Many studies suggest racial differences in survival among whites and black populations. But few have compared outcomes based on the ELN genetic risk stratification. It's important to realize that uneven outcomes may also result from more adverse genetic profiles in specific subgroups. In our study, we analyzed the results of the treatment of AML in a single American institution separated by race and ELN risk. Material and Methods: In this study, we retrospectively evaluated the outcomes of all patients with AML at our institution. We collected the data from patients treated with AML from June 2020 to June 2022. The most relevant information collected were: self-declared race, age, blood counts, cytogenetics, Next Generation Sequence information, Charlson Comorbidity Index(CCI), type of treatment, the best response to therapy, time to progression, and overall survival. We evaluated a total of 39 patients. Seventeen individuals were classified as adverse risk and twenty-two as an intermediate or good risk. Overall survival and statistical analysis were performed in all patients, and a special subanalysis was also done in the adverse risk group. Twenty-two patients self-declared as whites and 17 as black. Results: Among all ELN risk groups(figure 2), the estimated mean time until death was 417.21 days for blacks and 476.81 days for whites. At 400 days, the probability of survival was approximately 0.40 (or 40%) for blacks and 0.55 (or 55%) for whites. As the p-value (0.996) was greater than 0.05, we concluded that there was insignificant evidence of a difference in survival times for whites and blacks in all ELN risk groups. In a subanalysis of the ELN adverse risk population(figure 1), the estimated mean time until death was 326.00 days for non-whites and 285.96 days for whites. At 200 days, the probability of survival was approximately 0.68 (or 68%) for blacks and 0.43 (or 43%) for whites. As the p-value (0.187) was greater than 0.05, we again concluded that there was insignificant evidence of a difference in survival times for whites and blacks, even in adverse risk ELN subgroups. Conclusions and recommendations: Our study has identified no statistical difference in survival between whites and blacks in our single university institution population. Moreover, the evaluation in the adverse risk patients showed that at 200 days, the probability of survival in blacks is numerically higher than in whites. These results contradict the idea that a white population tends to have better outcomes than a black population regarding AML. The study's obvious limitation is the small sample population and the short follow-up period. Given equal access to care, as in our institution, outcomes were similar regardless of race. Further studies should be performed to evaluate the differences in outcomes among black and whites to validate our findings. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract PO-107: Racial differences in survival among advanced-stage non-small cell lung cancer patients who received immunotherapy: An analysis of the U.S. National Cancer Database (NCDB)

Abstract Background: Lung cancer is the most common cause of cancer death among men and women in the United States, with 85% of all cases characterized as non-small cell lung cancer (NSCLC). These cancers are often diagnosed at advanced stage due to inapparent clinical symptoms. In 2015, the Food and Drug Administration approved the first use of immunotherapy for NSCLC, and it has since become a standard modality for treatment among advanced-stage NSCLC patients. Although significant racial disparities have been documented in overall NSCLC survival, it is unclear whether these disparities persist upon equal utilization of immunotherapy. The purpose of this study was to evaluate the association between race and all-cause mortality among advanced-stage non-small cell lung (NSCLC) cancer patients who received immunotherapy. Methods: We obtained data from the 2016 National Cancer Database on patients diagnosed with advanced-stage (III-IV) NSCLC from 2015-2016. The NCDB is a joint project of the American Cancer Society and the Commission on Cancer of the American College of Surgeons, and captures 70% of all patients with newly diagnosed cancer in the United States. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) by race/ethnicity. Additionally, we evaluated the interaction of race/ethnicity with Charlson-Deyo comorbidity score and area-level median income using stratified models and formal tests of interaction. Results: A total of 3,068 patients were included. NH-Black patients had a lower risk of death relative to NH-White patients (HR 0.85; 95% CI 0.74, 0.98) after adjusting for sociodemographic, clinical, and treatment factors. Formal tests of interaction evaluating race with Charlson-Deyo comorbidity score and race with area-level median income were nonsignificant. However, in stratified analyses, NH-Black vs. NH-White patients had a lower risk of death in models adjusted for sociodemographic factors among those with at least one comorbidity (HR 0.76; 95% CI 0.59, 0.98), and those living in regions within the two lowest quartiles of median income (HR 0.82; 95% CI 0.69, 0.98). Conclusions: Among advanced-stage NSCLC patients who received immunotherapy, NH-Black patients experienced higher survival compared to NH-White patients. We urge the implementation of policies and interventions that seek to equalize access to care as a means of addressing differences in overall NSCLC survival by race. Citation Format: Anjali Gupta, Tomi Akinyemiju. Racial differences in survival among advanced-stage non-small cell lung cancer patients who received immunotherapy: An analysis of the U.S. National Cancer Database (NCDB) [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-107.

Racial Differences in Survival Among Advanced-stage Non-small-Cell Lung Cancer Patients Who Received Immunotherapy: An Analysis of the US National Cancer Database (NCDB).

Lung cancer is the most common cause of cancer death among men and women in the United States, with significant racial disparities in survival. It is unclear whether these disparities persist upon equal utilization of immunotherapy. The purpose of this study was to evaluate the association between race and all-cause mortality among non-small-cell lung cancer (NSCLC) patients who received immunotherapy. We obtained data from the 2016 National Cancer Database on patients diagnosed with advanced-stage (III-IV) NSCLC from 2015 to 2016. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) by race/ethnicity. A total of 2940 patients were included. Non-Hispanic (NH)-Black patients had a lower risk of death relative to NH-White patients (HR: 0.85; 95% CI: 0.73, 0.98) after adjusting for sociodemographic, clinical, and treatment factors. Formal tests of interaction evaluating race with Charlson-Deyo comorbidity score and race with area-level median income were nonsignificant. However, in stratified analyses, NH-Black versus NH-White patients had a lower risk of death in models adjusted for sociodemographic factors among those with at least 1 comorbidity (HR: 0.75; 95% CI: 0.57, 0.97), and those living in regions within the 2 lowest quartiles of median income (HR: 0.82; 95% CI: 0.68, 0.99). Among advanced-stage NSCLC patients who received immunotherapy, NH-Black patients experienced higher survival compared with NH-White patients. We urge the implementation of policies and interventions that seek to equalize access to care as a means of addressing differences in overall NSCLC survival by race.

Adherence to Endocrine Therapy and Racial Outcome Disparities in Breast Cancer.

The disparity in outcomes of breast cancer for Black compared with White women in the U.S. is well known and persistent over time, with the largest disparities appearing among women with hormone receptor-positive (HR+) cancers. The racial gap in breast cancer survival first emerged in the 1980s, a time of significantmen treatment advances in early-stage breast cancer, including the introduction of adjuvant endocrine therapy. Since that time, the gap has continued to widen despite steady advances in treatment and survival of breast cancer overall. Although advanced stage at presentation and unfavorable biology undoubtedly contribute to racial differences in survival of HR+ breast, treatment disparities are increasingly acknowledged to play a key role as well. The recent recognition of racial differences in endocrine therapy use may be a key explanatory factor in the persistent racial gap in mortality of HR+ disease, and may be a key focus of intervention to improve breast cancer outcomes for Black women. IMPLICATIONS FOR PRACTICE: Black women with hormone receptor-positive breast cancer experience the greatest racial disparity in survival among all breast cancer subtypes. This survival gap appears consistently across studies and is not entirely explained by differences in presenting stage, tumor biology as assessed by genomic risk scores, or receipt of chemotherapy. Recent research highlights lower adherence to endocrine therapy (ET) for Black women. Health systems and individual providers should focus on improving communication about the importance of ET use, sharing decisions around ET, providing appropriate support for side effects and other ET-related concerns, and equitably delivering survivorship care, including ET adherence assessment.

Socioeconomic and Racial Determinants of Brachytherapy Utilization for Cervical Cancer: Concerns for Widening Disparities.

Cervical cancer (CC) disproportionately affects minorities who have higher incidence and mortality rates. Standard of care for locally advanced CC involves a multimodality approach including brachytherapy (BT), which independently improves oncologic outcomes. Here, we examine the impact of insurance status and race on BT utilization with the SEER database. In total, 7,266 patients with stage I-IV CC diagnosed from 2007 to 2015 were included. BT utilization, overall survival (OS), and disease-specific survival (DSS) were compared. Overall, 3,832 (52.7%) received combined external beam radiation therapy (EBRT) + BT, whereas 3,434 (47.3%) received EBRT alone. On multivariate logistic regression analysis, increasing age (OR, 0.98; 95% CI, 0.98 to 0.99; P < .001); Medicaid (OR, 0.80; 95% CI, 0.72 to 0.88; P < .001), uninsured (OR, 0.67; 95% CI, 0.56 to 0.80; P < .001), and unknown versus private insurance (OR, 0.61; 95% CI, 0.43 to 0.86; P < .001); Black (OR, 0.68; 95% CI, 0.60 to 0.77; P < .001) and unknown versus White race (OR, 0.30; 95% CI, 0.13 to 0.77; P = .047); and American Joint Committee on Cancer stage II (OR, 1.07; 95% CI, 0.93 to 1.24; P = .36), stage III (OR, 0.82; 95% CI, 0.71 to 0.94; P = .006), stage IV (OR, 0.30; 95% CI, 0.23 to 0.40; P < .001), and unknown stage versus stage I (OR, 0.36; 95% CI, 0.28 to 0.45; P < .001) were associated with decreased BT utilization. When comparing racial survival differences, the 5-year OS was 44.2% versus 50.9% (P < .0001) and the 5-year DSS was 55.6% versus 60.5% (P < .0001) for Black and White patients, respectively. Importantly, the racial survival disparities resolved when examining patients who received combined EBRT + BT, with the 5-year OS of 57.3% versus58.5% (P = .24) and the 5-year DSS of 66.3% versus 66.6% (P = .53) for Black and White patients, respectively. This work demonstrates notable inequities in BT utilization for CC that particularly affects patients of lower insurance status and Black race, which translates into inferior oncologic outcomes. Importantly, the use of BT was able to overcome racial survival differences, thus highlighting its essential value.

Racial differences in survival and response to therapy in patients with metastatic colorectal cancer: A secondary analysis of CALGB/SWOG 80405 (Alliance A151931).

The objective of this study was to evaluate the association between self-identified race and overall survival (OS), progression-free survival (PFS), and response to therapy among patients enrolled in the randomized Cancer and Leukemia Group B (CALGB)/SWOG 80405 trial. Patients with advanced or metastatic colorectal cancer who were enrolled in the CALGB/SWOG 80405 trial were identified by race. On the basis of covariates (treatment arm, KRAS status, sex, age, and body mass index), each Black patient was exact matched with a White patient. The association between race and OS and PFS was examined using a marginal Cox proportional hazard model for matched pairs. The interaction between KRAS status and race was tested in the model. The association between race and response to therapy and adverse events were examined using a marginal logistic regression model. In total, 392 patients were matched and included in the final data set. No difference in OS (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.73-1.16), PFS (HR, 0.97; 95% CI, 0.78-1.20), or response to therapy (odds ratio [OR], 1.00; 95% CI, 0.65-1.52) was observed between Black and White patients. Patients with KRAS mutant status (HR, 1.31; 95% CI, 1.02-1.67), a performance statusscore of 1 (reference, a performance status of 0; HR, 1.49; 95% CI, 1.18-1.88), or ≥3 metastatic sites (reference, 1 metastatic site; HR, 1.67; 95% CI, 1.22-2.28) experienced worse OS. Black patients experienced lower rates and risk of grade ≥3 fatigue (6.6% vs 13.3%; OR, 0.46; 95% CI, 0.24-0.91) but were equally likely to be treated with a dose reduction (OR, 1.09; 95% CI, 0.72-1.65). No difference in OS, PFS, or response to therapy was observed between Black patients and White patients in an equal treatment setting of the CALGB/SWOG 80405 randomized controlled trial. Despite improvements in screening and treatment, studies have demonstrated worse outcomes in Black patients with colorectal cancer. The purpose of this study was to determine whether there was a difference in cancer-specific outcomes among Black and White patients receiving equivalent treatment on the CALGB/SWOG 80405 randomized clinical trial. In this study, there was no difference in overall survival, progression-free survival, or response to therapy between Black and White patients treated on a clinical trial. These findings suggest that access to care and differences in treatment may be responsible for racial disparities in colorectal cancer.

Racial disparities in survival outcomes following pediatric in-hospital cardiac arrest

BackgroundAmong adults with in-hospital cardiac arrest (IHCA), overall survival is lower in black patients compared to white patients. Data regarding racial differences in survival for pediatric IHCA are unknown. MethodsUsing 2000–2017 data from the American Heart Association Get With the Guidelines-Resuscitation® registry, we identified children >24 h and <18 years of age with IHCA due to an initial pulseless rhythm. We used generalized estimation equation to examine the association of black race with survival to hospital discharge, return of spontaneous circulation (ROSC), and favorable neurologic outcome at discharge. ResultsOverall, 2940 pediatric patients (898 black, 2042 white) at 224 hospitals with IHCA were included. The mean age was 3.0 years, 57% were male and 16% had an initial shockable rhythm. Age, sex, interventions in place at the time of arrest and cardiac arrest characteristics did not differ significantly by race. The overall survival to discharge was 36.9%, return of spontaneous circulation (ROSC) was 73%, and favorable neurologic survival was 20.8%. Although black race was associated with lower rates of ROSC compared to white patients (69.5% in blacks vs. 74.6% in whites; risk-adjusted OR 0.79, 95% CI 0.67−0.94, P = 0.016), black race was not associated with survival to discharge (34.7% in blacks vs. 37.8% in whites; risk-adjusted OR 0.96, 95% CI 0.80–1.15, P = 0.68) or favorable neurologic outcome (18.7% in blacks vs. 21.8% in whites, risk-adjusted OR 0.98, 95% CI 0.80–1.20, p = 0.85). ConclusionsIn contrast to adults, we did not find evidence for racial differences in survival outcomes following IHCA among children.

Racial Disparities in the Incidence and Survival of Spinal Meningioma.

Objective:Race is a significant prognostic factor in various cancers, including the breast. Its prognostic association with spinal meningioma has not been established, although the incidence of spinal meningioma varies by race. In this retrospective cohort study, we aimed to investigate the association of race with the incidence and survival of spinal meningioma among a large population sample.Materials and Methods:A comprehensive search was done in the surveillance, epidemiology, and end results database between 2000 and 2016 to identify patients with spinal meningioma. Overall and race-specific incidence were calculated. The effect of race on overall survival among these patients was determined with Kaplan–Meier curve and Cox proportional hazard models.Results:Of 3502 spinal meningioma patients, 82.6% were Caucasian, 7.7% were African-American, 8.8% were Asian/Pacific Islander and 0.7% were American Indian/Alaska Native. The overall age-adjusted incidence was 0.239/100,000; it was highest among Caucasian (0.249) and lowest among American Indian/Alaska Native patients (0.137). There was a race effect in overall survival in the unadjusted analysis with the worst overall survival reported for Caucasian patients, and the best reported for American Indian/Alaska Native patients. However, this relationship was insignificant in the adjusted analysis.Conclusions:Race was not significantly associated with overall survival among these patients. Future studies should use spinal-meningioma-specific survival as outcome to see whether there is a racial difference in survival.

Abstract PO-155: Social determinants of receptor positive breast cancer patients’ survival in Louisiana

Abstract Breast carcinoma is the most commonly diagnosed cancer in Louisiana women. Four molecular subtypes of breast cancer are classified by the presence or lack of certain hormone receptors (HR), specifically estrogen and progesterone receptors, and the Human epidermal growth factor 2 (HER2) including: Luminal A (HR+/HER2-), Luminal B (HR+/HER2+), HER2-enriched (HR-/HER2+), and Triple-Negative Breast Cancer, TNBC (HR-/HER2-). Although it is now known that genetics has a role in the risk of breast cancer incidence, other factors such as age, race, and neighborhood also have an effect on prognosis and survival. Previously we have reported that in Louisiana neighborhood concentrated disadvantage index (CDI) explained the racial disparities in TNBC stage at diagnosis and survival, but not the disparities present in incidence. The purpose of this study is to assess the association of social determinants in Luminal A, Luminal B, and HER2-enriched breast cancers patients’ survival. This population-based study used 2010-2016 breast cancer data from the Louisiana Tumor Registry (LTR) and the data of the population at risk was obtained from the US Census. To assess neighborhood environment, CDI scores were calculated based on the PhenX Toolkit Protocol. We performed regression analysis of survival data based on the cox proportional hazard models using PHREG. A total of 21,005 breast cancer patient’s data were initially screened for the study with Luminal A (14,437), Luminal B (2,345), HER2-enriched (1,089) and TNBC (3134) diagnosis. Caucasian women (White) represented 68.5%, African women (Black) represented 30.42% and “other” race represented 1.09% of the breast cancer patients. Using Wald Chi-square tests, we compared stage of diagnosis (distant, regional) and CDI among Black and White patients of all three receptor positive breast cancers. For Luminal A, stage of diagnosis, [Distant: (Pr&amp;gt;ChiSq &amp;lt;0.0001), Hazard Ratio, HR:32.4] and Regional: (Pr&amp;gt;ChiSq &amp;lt;0.0001), HR:3.56], and race (Pr&amp;gt;ChiSq &amp;lt;0.0001, HR:1.58]) were significant, but not the CDI [(Pr&amp;gt;ChiSq: &amp;lt; 0.812), HR:1.0]. For Luminal B, stage of diagnosis, [Distant: (Pr&amp;gt;ChiSq &amp;lt;0.0001), HR:30.17] and Regional: (Pr&amp;gt;ChiSq &amp;lt;0.0001), HR:4.49], and race (Pr&amp;gt;ChiSq &amp;lt;0.0065, HR:1.62]) were significant, but not the CDI [(Pr&amp;gt;ChiSq: &amp;lt; 0.288), HR:0.91]. For HER2, stage of diagnosis, [Distant: (Pr&amp;gt;ChiSq &amp;lt;0.0001), HR:14.798] and Regional: (Pr&amp;gt;ChiSq &amp;lt;0.0001), HR:2.765], was significant, but race (Pr&amp;gt;ChiSq &amp;lt;0.254, HR:1.26]) and CDI [(Pr&amp;gt;ChiSq: &amp;lt; 0.75), HR:1.0] were not. We found significant racial difference in survival in Luminal A and Luminal B breast cancer subtypes but not in HER2-enriched subtype. However, we didn’t find any significant contribution of CDI in receptor positive breast cancer patient survival. Future studies should focus on assessing the processes by which social determinants affect receptor positive breast cancer disease progression. Citation Format: Alejandra M. Rivera-Irizarry, Denise Danos, Xinnan Wang, Qiufan Fu, Xiao-Cheng Wu, Richard Scribner, Lucio Miele, Fokhrul Hossain. Social determinants of receptor positive breast cancer patients’ survival in Louisiana [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-155.

The Lack of Racial Survival Differences in Metastatic Prostate Cancer in National Cancer Data Base (NCDB): A Paradox Compared to Non-metastatic Disease

Inconsistent findings have been reported in the literature regarding racial differences in survival outcomes between African American (AA) and Caucasian American (CA) patients with metastatic prostate cancer (PCa). To address the inconsistency, the current study inquired into a national database to determine whether racial differences exist among the target population. The purpose of this research is to find out if racial differences exist in the survival outcomes between AA and CA patients with metastatic PCa. This study retrospectively reviewed PCa patient data (N = 1,319,225) from the National Cancer Database (NCDB). The data were divided into three groupings based on the metastatic status: (1) no metastasis (N = 579,202) (2) bone metastasis (N = 29,639) and (3) metastases to locations other than bone, such as brain, liver, or lung (N = 952). Survival probabilities of AA and CA PCa patients with bone metastasis were examined through parametric proportional hazards Weibull models and Bayesian survival analysis. These results were compared with patients with no metastasis or other types of metastases. No statistically supported racial disparities were observed for AA and CA men with bone metastasis (p = 0.885). Similarly, there were no racial disparities in survival for those men suffering from other metastases (liver, lung, or brain). However, racial disparities in survival was observed among the two racial groups for non-metastatic group (p<0.001) or when metastasis status was not taken into account (p<0.001). The Bayesian analysis corroborates the finding. This research supports our previous finding and reveals that there are no racial differences in survival outcomes between AA and CA patients with metastatic prostate cancer. In contrast, racial disparities in the outcome continue to exist among non-metastatic PCa patients. Further research is warranted to explain this paradox.