Racial Differences In Receipt Research Articles

Comparing Black and White Patients in Treatment of Advanced Prostate Cancer and Survival in an Equal Access Health System.

Racial disparities in prostate cancer treatment and survival in the U.S. have been attributed to differences in access to care and medical insurance. We aimed to compare treatment and survival of advanced prostate cancers between White and Black men in the equal access Military Health System (MHS). We accessed the MilCanEpi database to study a cohort of non-Hispanic White and Black men diagnosed with stage III or IV prostate cancer between 1998 and 2014 in the MHS. The racial groups were compared in receiving curative treatment of radical prostatectomy (RP) only, RP with (neo)adjuvant radiation or hormone therapy, radiation only, or combination radiation and hormone therapy; and overall survival using multivariable regression models. The study included 1476 White and 531 Black men. Overall, there was no racial difference in receiving any curative treatment (AOR = 0.85, 95% CI = 0.67, 1.08 for Black vs. White). By treatment type, Black men were statistically as likely to receive RP only (AOR = 0.87, 95% CI = 0.67, 1.14), radiation only (AOR = 0.81, 95% CI = 0.49, 1.34), or combination radiation and hormone therapy (AOR = 1.12, 95% CI = 0.71, 1.78) but statistically less likely to receive RP with (neo)adjuvant treatment (AOR = 0.56, 95% CI = 0.37, 0.86) relative to no curative treatment compared to White men. The difference in RP with (neo)adjuvant treatment was also statistically significant among patients with stage III tumors, but not stage IV. Survival was similar overall (AHR = 1.12, 95% CI = 0.88, 1.42 for Black vs. White) and when evaluated by tumor stage. In the MHS, the overall likelihood to receive any treatment for advanced prostate cancers and survival was similar between races, which might result from universal health care. Racial differences in receipt of RP with (neo)adjuvant treatment, especially for patients with stage III prostate cancer, may be related to factors other than access to care and warrants further research.

Abstract 4820: Comparison of Black and White patients in treatment for papillary thyroid cancer in an equal access health system

Abstract Introduction: In the U.S., Black patients with papillary thyroid cancer (PTC) are less likely to receive treatment than non-Hispanic White patients. Access to care and insurance status may be related to these disparities. We aimed to compare Black and White patients in receipt of cancer care for PTC in the equal access Military Health System. Materials and Methods: We used the MilCanEpi database to identify a cohort of men and women aged 18 or older who were diagnosed with PTC between January 1, 1998 and December 31, 2014. Patients were assessed for treatment by surgery (e.g., lobectomy, thyroidectomy), adjuvant radioactive iodine (RAI), or active surveillance. Treatment appropriate for risk status (low-risk or high-risk) was compared between non-Hispanic White and Black patients using multivariable logistic regression and expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Results: Among 3,511 patients with PTC, 65.0% White and 65.5% Black received surgical treatment (aOR 0.97, 95% CI 0.80-1.18 for Black vs. White). For patients with low-risk PTC, overall receipt of either surgery or active surveillance (aOR 0.86, 95% CI 0.67-1.10 for Black vs. White) was similar between races. For patients with high-risk PTC, overall receipt of surgery (aOR 1.19, 95% CI 0.71-2.01) or adjuvant RAI (aOR 1.44, 95% CI 0.60-3.44) was similar for Black compared to White patients. Conclusions: In an equal access health system, there were no overall racial differences in receipt of surgical treatment for PTC. Further, in analysis by risk status, there were no significant racial differences in receipt of active surveillance for low-risk PTC nor receipt of adjuvant RAI for high-risk PTC. This suggests the role of access to care in reducing racial disparities in treatment for PTC observed in the general U.S. population. Funding and Acknowledgement: The authors thank the Joint Pathology Center (JPC) for providing the DoD cancer registry data and the Defense Health Agency (DHA) for providing the MHS data repository (MDR) data. This project was supported by the Murtha Cancer Center Research Program (MCCRP) of the Department of Surgery, Uniformed Services University of the Health Sciences (USUHS) under the auspices of the Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF, Inc.), grant numbers HHU0001-16-2-0014 and HU0001-18-2-0032 awarded to C.S. Disclaimer: The contents of this abstract are the sole responsibility of the authors and do not necessarily reflect the views, assertions, opinions, or policies of the Uniformed Services University of the Health Sciences, the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense, or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. government. Citation Format: Yvonne L. Eaglehouse, Sarah Darmon, Craig D. Shriver, Kangmin Zhu. Comparison of Black and White patients in treatment for papillary thyroid cancer in an equal access health system [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4820.

Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study

ObjectiveTo characterize racial differences in receipt of low value care (services that provide little to no benefit yet have potential for harm) among older Medicare beneficiaries overall and within health...

Examining racial differences in treatment and survival among patients with Paget’s disease of the breast

BackgroundThe objective of this study was to evaluate racial differences in treatment (ie, surgery, chemotherapy, and radiation) and survival among patients with Paget’s disease of the breast in the Surveillance, Epidemiology and End Result program. MethodsWomen >18 years old diagnosed with localized or regional Paget’s disease between January 1, 2010 to December 31, 2016 in the Surveillance, Epidemiology and End Result program were included. The cohort was divided into Black and White patients. Univariable analysis compared the groups. Using propensity score matching, Black and White patients were nearest matched (1:2) on age at diagnosis; Surveillance, Epidemiology and End Result summary stage; surgery; chemotherapy; and year of diagnosis. The log-rank test evaluated the matched sample's overall survival and disease-specific survival. ResultsOf the 1,181 patients, the racial distribution was 1,049 (88.8%) White and 132 (11.2%) Black. A higher percentage of Black women were Medicaid insured (Black 25.8% vs White 11.1%), lived in neighborhoods with low socioeconomic status (Black 53.0% vs White 25.4%), and had regional disease than White women (Black 41.7% vs White 29%). There were no racial differences in receipt of radiation therapy (P = .90), breast surgery (P = .23), or axillary surgery (P = .25). Black patients were more likely to receive chemotherapy (Black 34.8% vs White 26.3% P = .038). In the propensity matched cohort, Black patients had a worse overall survival (P < .005) and disease-specific survival (P = .05) than White patients. ConclusionIn this cohort of patients with Paget’s disease, despite differences in sociodemographic factors, there were no disparities in locoregional treatment. However, on matched analysis, Black patients had a worse overall survival and disease-specific survival than their White counterparts.

Racial disparities in follow-up care of early-stage lung cancer survivors.

12025 Background: Follow-up care and surveillance in lung cancer survivors is essential formanagement of treatment- and disease-related symptoms as well as for the early detection of cancer recurrence. To investigate if race impacts receipt of follow-up care in lung cancer survivors, we conducted a cross-sectional study in lung cancer survivors recruited through the New Jersey State Cancer Registry (NJSCR). Methods: Between May 2019 and December 2019, survivors of early-stage NSCLC were identified and recruited from the NJSCR. Participants were eligible if they had surgery for stage I or II NSCLC between 2014 and 2017 and, completed all treatment at least one year prior to enrollment. Eligible participants were asked to complete a paper survey questionnaire and medical record release form sent to them by mail. The survey had questions about demographics, smoking, cancer history and treatment, quality of life, follow-up care, barriers to care and informational needs. Study measures were compared between the groups using t-test or chi-square test as applicable. Results: Of the 482 survivors contacted, 23% (n = 114) mailed back the survey questionnaire. Of the 112 survivors who returned a completed survey; 78 (70%) were non-Hispanic (NH) Whites and 34 (30%) were NH Blacks. Mean age was 67 years, 61% were female, 92% had cancer in remission. 82% of participants reported receiving a surveillance scan (CT or PET) within one year of completing the study survey. More NH White survivors received a scan within a year compared to NH Black survivors (89% vs 64%; p = 0.006). Also, 88% of survivors reported that they were informed of the need for follow-up care by their provider with more NH White survivors reporting receiving this information (94%) compared to NH Blacks (71%; p = 0.002). About 57% of the survivors reported receiving a written treatment summary and 92% reported being seen by a physician within the past year; no racial differences in these measures were noted.There was also no racial difference in receipt of age-appropriate cancer screening; 66% and 80% reported receiving regular colon and breast cancer screening, respectively. A significantly higher percentage of NH Blacks reported currently smoking compared to NH Whites (16% vs 12%). The most significant barriers to care for both populations were concern for out-of-pocket costs (26% NH Whites, 19% NH Blacks), non-coverage of test (14% NH Whites, 10% NH Blacks) and lack of insurance (8% NH Whites, 16% NH Blacks). Conclusions: Significant racial disparity was identified between NH Blacks and NH Whites in receipt of surveillance scans, guidance about follow-up care and smoking cessation. The most significant barriers to follow-up care was lack of insurance in NH Blacks and financial concerns about cost and coverage of tests in NH Whites. Future interventions to increase survivorship care should target these specific needs in survivor populations.

Racial disparities in low-value surgical care and time to surgery in high-volume hospitals.

The objective of this study is to examine racial differences in receipt of low-value surgical care and time to surgery (TTS) among women receiving treatment at high-volume hospitals. Stage I-III non-Hispanic Black (NHB) and Non-Hispanic White (NHW) breast cancer patients were identified in the National Cancer Database. Low-value care included (1) sentinel lymph node biopsy (SLNB) among T1N0 patients age ≥70 with hormone receptor-positive cancers, (2) axillary lymph node dissection (ALND) in patients meeting ACOSOG Z0011 criteria, and (3) contralateral prophylactic mastectomy (CPM) with unilateral cancer. TTS was days from biopsy to surgery. Bivariate and logistic regression analyses were used to compare the groups. Compared to NHWs, NHBs had lower rates of SLNB among women age ≥70 with small hormone-positive cancers (NHB 58.5% vs. NHW 62.2% p < .001) and CPM (NHB 26.3% vs. NHW 36%; p < .001). ALND rates for patients meeting ACOSOG Z0011 criteria were similar between both groups (p = .13). The odds of surgery >60 days were higher among NHBs (odds ratio, 1.77; 95% confidence interval, 1.64-1.91; NHW ref). NHBs treated at high-volume hospitals have higher rates of surgical delay but are less likely to undergo low-value surgical procedures compared to NHW women.

Abstract B007: Racial differences in survival among veterans and nonveteran populations with stage I non-small cell lung cancer

Abstract Purpose: Racial disparities in survival persist in patients with early-stage non-small cell lung cancer (NSCLC). Possible contributors to these disparities are stage at diagnosis, comorbidities, and socioeconomic factors. The goal of this study is to compare differences in survival between black and white patients from veteran and non-veteran populations, while accounting for treatment. Methods: Black and white men aged ≥65 years diagnosed with stage I NSCLC from 2001-2009 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and Veterans Affairs (VA) cancer registry. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for differences between black and white patients in postoperative mortality among surgery patients, 5-year overall survival (OS), and lung cancer specific survival (LCSS). Results: There were 8,744 and 7,895 patients in the SEER and VA cohorts, respectively. Overall, black patients were less likely to be treated than white patients (74% vs 85% in SEER, p&amp;lt;0.0001; 69% vs 77% in VA, p&amp;lt;0.0001), and among treated patients, to receive surgery only (47% vs 62% in SEER, p&amp;lt;0.0001; 55% vs 62%, p=0.0007 in VA). OS was worse for black compared to white patients after adjustment for demographic and clinical factors (HR: 1.17, 95% CI: 1.06-1.30 in SEER; HR: 1.08, 95% CI: 1.00-1.16 in VA). However, there was no difference in OS when also adjusting for treatment (HR: 0.99, 95% CI: 0.89-1.09 in SEER; HR: 0.97, 95% CI: 0.91-1.05 in VA). For LCSS, the HRs for black vs. white patients were 1.21 (95% CI 1.07-1.37) in SEER and 1.06 (95% CI 0.96-1.17) in VA, when adjusting for demographic and clinical factors. LCSS HRs were not statistically significant in either cohort when also adjusting for treatment (HR: 0.99, 95% CI: 0.87-1.12 in SEER; HR: 0.93, 95% CI: 0.85-1.02 in VA). Similar results were obtained when analyses were restricted to patients receiving treatment, accounting for treatment modality. Among patients receiving surgery only, adjusted OS was similar across races (HR: 1.11, 95% CI: 0.91-1.36 in SEER; HR: 1.08, 95% CI: 0.95-1.23 in VA). There was no significant difference in postoperative 30-day survival in black vs. white patients (HR: 1.57, 95% CI: 0.99-2.49 in SEER; HR: 1.10, 95% CI: 0.71-1.70 in VA), nor in postoperative 90 day survival (HR: 1.28, 95% CI: 0.87-1.89 in SEER; HR: 0.90, 95% CI: 0.63-1.29 in VA). Conclusion: Among older stage I NSCLC patients, no significant racial differences in overall or lung cancer survival were detected in VA or SEER cohorts when accounting for treatment, despite observing racial differences in receipt of treatment in both populations. This suggests that survival disparities are significantly reduced when black and white patients receive similar treatment, even in populations covered by different health care systems. Effort to facilitate stage appropriate treatment in minority patients should be initiated. Citation Format: Naomi D. Alpert, Christina D. Williams, Thomas Redding, A. Jasmine Bullard, Raja Flores, Emanuela Taioli. Racial differences in survival among veterans and nonveteran populations with stage I non-small cell lung cancer [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B007.

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

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

Race and Time to Receipt of Androgen Deprivation Therapy Among Men With Metastatic Prostate Cancer

BackgroundThe Medicare Modernization Act (MMA) drastically reduced reimbursement for androgen deprivation therapy (ADT) in 2005. One unintended consequence of the MMA may be an increase in the racial disparities in receipt of ADT. Given these policy changes, it becomes increasingly important to assess racial disparities in timely receipt of ADT. MethodsThe purpose of this study is to evaluate the associations between race and median time to receipt of ADT among men with metastatic prostate cancer before and after the passage of the MMA. A population-based retrospective cohort was created from the Surveillance, Epidemiology, and End Results-Medicare. ResultsA total of 1,846 African-American and 9,462 Caucasian men diagnosed with metastatic prostate cancer from 2000 through 2011 were included. An accelerated failure time regression model was used to examine factors associated with racial differences in median time to receipt of ADT. Results indicate that African-American men had a longer median time to receipt of ADT both before the MMA (Time Ratio (TR): 1.15; 95% Confidence Interval (CI) [1.05, 1.27]) and after the MMA (TR: 1.29; 95% CI [1.10, 1.53]) as compared to Caucasian men. In addition to race, men residing in South had longer median time to receipt of ADT (TR: 1.26, 1.52; 95% CI [1.01, 1.52; 1.24, 1.87] before and after MMA, respectively) compared to the Northeast region. ConclusionConsidering the palliative benefits of ADT, it is important to develop effective strategies to address racial differences in receipt of treatment for metastatic prostate cancer.

Abstract A85: Receipt of adjuvant endometrial carcinoma treatment according to race: An NRG Oncology/Gynecologic Oncology Group 210 Study

Abstract Background: Black women diagnosed with endometrial cancer (EC) experience worse outcomes compared with white women. Differences in receipt of treatment are postulated to contribute to this disparity. While underuse of surgical treatment among black women is well documented, we know less about racial differences in adjuvant treatment. We therefore examined receipt of adjuvant treatment among black and white women in the NRG Oncology/Gynecology Oncology Group (GOG) 210 Study, a large prospective cohort of women with EC who received uniform surgical treatment but varying adjuvant therapy regimens. Methods: Our analysis included 615 black and 4,283 white women with EC who underwent either an abdominal hysterectomy or laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy and lymph node dissection. At study enrollment, women completed a questionnaire that assessed race as well as risk factors for EC. Tumor characteristics were available from surgical pathology reports and a centralized review by pathologists with expertise in gynecologic cancers. Adjuvant treatment was documented at the time of the postoperative clinical visits and was categorized as none (54.3%), radiotherapy only (16.5%), chemotherapy only (n=15.2%), and radiotherapy and chemotherapy (14.0%). We used polytomous logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between race and receipt of adjuvant therapy in the overall study population and stratified by tumor subtype (combination of histology and grade) adjusted for age, income, education, and stage. Results: Black compared with white women had higher odds of receiving combination radiotherapy and chemotherapy compared to no adjuvant therapy (OR=1.35, 95% CI=1.01-1.79) but no difference in receipt of radiotherapy only (OR=0.95, 95% CI=0.72-1.25) or chemotherapy only (OR=0.88 (0.64-1.20) was observed. In tumor-subtype stratified models, black women diagnosed with low-grade endometrioid (OR=2.04, 95% CI=1.06-3.93) or serous tumors (OR=1.81, 95% CI=1.07-3.08) had higher odds of receiving radiotherapy and chemotherapy than white women, but race was not associated with receipt of radiotherapy and chemotherapy for women with high-grade endometrioid, carcinosarcoma, mixed-cell, or clear-cell tumors. Moreover, the tumor-subtype stratified analyses revealed no racial differences in receipt of radiotherapy-only or chemotherapy-only regimens. Conclusions: In this study of women with EC who received uniform surgical treatment, we observed racial differences in receipt of some adjuvant treatment regimens but not others. Among women with indolent (i.e., low-grade endometrioid) or aggressive (i.e., serous) tumors, black women had higher odds of receiving radiotherapy and chemotherapy compared to white women. Radiotherapy and chemotherapy treatment is potentially contraindicated for women with indolent tumors, which suggests a need to understand the reasons why clinicians might overprescribe these therapies for black women. Overall, our results suggest racial differences in receipt of radiotherapy and chemotherapy, but not for other regimens. Citation Format: Ashley Felix, David Cohn, Theodore Brasky, David Mutch, William Creasman, Premal Thaker, Joan Walker, Richard Moore, Shashikant Lele, Saketh Guntupalli, Levi Downs, Christa Nagel, John Boggess, Michael Pearl, Olga Ioffe, Wei Deng, Marcus Randall, Louise Brinton. Receipt of adjuvant endometrial carcinoma treatment according to race: An NRG Oncology/Gynecologic Oncology Group 210 Study [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A85.

Abstract 4235: Race differences in treatment and survival of ovarian cancer

Abstract Black women have lower incidence rates of ovarian cancer than white women in the U.S., but their cancers are more often fatal. Factors associated with lower survival among blacks include advanced stage at diagnosis and fewer women receiving a surgery-chemotherapy sequence consistent with national guidelines for treatment of primary ovarian cancer. We examined treatment and survival among 365 white and 95 black ovarian cancer patients captured by the Hollings Cancer Center Cancer Registry in Charleston, S.C. from 2000 to 2015 with the aim of identifying factors to explain observed racial disparities. Outcomes of interest were receipt of a cytoreductive surgery-chemotherapy sequence, with or without neoadjuvant therapy, and overall survival (OS) calculated as months from diagnosis to death. We used unconditional logistic regression to estimate odds ratios (ORs) of black vs. white race associated with receipt of surgery-chemotherapy, controlling for clinical stage, histology, insurance status, smoking status, and severity of comorbidities (none, mild, moderate, moderate-severe, severe), assessed using the age-adjusted Charlson index. For survival comparisons, we plotted Kaplan-Meier curves by race and estimated the death hazard ratio (HR) using Cox proportional hazards regression. We assessed statistical interaction between race and comorbidities using −2 log likelihood tests. Age, stage and histology distributions were similar between blacks and whites; however, white women were more likely than blacks to be current or former smokers (44% vs. 32%) and to have private health insurance (38% vs. 26%), while blacks were more likely to have moderate-severe or severe comorbidities (37% vs. 30%), although differences were not statistically significant. There were significant racial differences in receipt of surgery-chemotherapy (blacks 44% vs. whites 69%, p&amp;lt;0.0001). Women who did not receive a surgery-chemotherapy sequence were 3 times more likely to be black (adjusted OR 3.13, 95% confidence interval (CI) 1.90−5.16), but the disparity was observed only in women with comorbidity as opposed to none (interaction p=0.01). Median OS was 29.3 months among black women and 49.2 months among whites (log rank p&amp;lt;0.001). The survival disadvantage among blacks persisted after controlling for treatment, comorbidities, stage, smoking, and insurance (HR 1.87, 95% CI 1.41−2.48), and no statistical interaction between race and comorbidities was evident (p=0.17). In this study, black women, particularly those with comorbidities, were significantly less likely than whites to receive a surgery-chemotherapy sequence for treatment of ovarian cancer. Black race was associated with an 87% higher fatality rate independent of treatment, stage, comorbidities, and insurance status. More research is needed to understand race-specific reasons for nonadherence to guideline based care and racial disparities in survival after ovarian cancer diagnosis. Citation Format: Janet S. Hildebrand, Kristin Wallace, Linda E. Kelemen. Race differences in treatment and survival of ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4235.

Racial Differences in Prostate Cancer Treatment: The Role of Socioeconomic Status.

This study examines whether socioeconomic status (SES), measured at both the individual and neighborhood levels, is associated with receipt of definitive treatment for localized prostate cancer and whether these associations mediate racial differences in treatment between non-Hispanic White and non-Hispanic Black men. The Philadelphia Area Prostate Cancer Access Study (P2 Access) is a mailed, cross-sectional survey of men sampled from the Pennsylvania Cancer Registry, combined with neighborhood Census data. Eight counties in southeastern Pennsylvania. 2,386 men with prostate adenocarcinoma. Receipt of definitive treatment, race, self-reported income, education, employment status, and neighborhood SES. Overall, Black and White men were equally likely to receive definitive treatment. Men living in neighborhoods with higher SES were more likely to receive definitive treatment (OR 1.57, 95%CI 1.01, 2.42). Among men who received definitive treatment, Black men were significantly less likely to receive radical prostatectomy compared with White men (OR .71, 95% CI .52, .98), as were men with some college education compared with those with a high school education or less (OR .66, 95% CI .47, .94). SES does not mediate racial differences in receipt of definitive treatment or the type of definitive treatment received, and associations with income or employment status were not significant. These results stress the importance of examining racial disparities within geographic areas and highlight the unique associations that different measures of SES, particularly neighborhood SES and education, may have with prostate cancer treatment.

(539) - Racial Differences in Receipt of Care by a Cardiologist During a Critical Heart Failure Admission

(539) - Racial Differences in Receipt of Care by a Cardiologist During a Critical Heart Failure Admission

Impact of Race on Treatment and Survival among U.S. Veterans with Early-Stage Lung Cancer

IntroductionNumerous reports suggest lower rates of surgical procedures and poorer survival for black patients with early-stage (stage I or II) NSCLC than for white patients. This study examined treatment trends among blacks and whites with early-stage NSCLC and determined whether racial disparities exist in survival among patients receiving similar treatment. MethodsA retrospective analysis of 18,466 patients in the Veteran Affairs Central Cancer Registry in whom stage I or II NSCLC was diagnosed in 2001–2010 was conducted. Patients were categorized as receiving an operation, radiation, or other/no treatment. Overall survival (OS) and lung cancer–specific survival (LCSS) were evaluated using Kaplan-Meier and multivariable Cox regression analyses. ResultsThere was a statistically significant disparity between black and white patients receiving an operation that decreased over time to similar rates (p = 0.01). No significant racial differences in receipt of radiation were noted. Race was not associated with OS among all patients (hazard ratio [HR] = 0.97, 95% confidence interval [CI]: 0.93–1.02). Among patients who received an operation, no racial difference in OS was observed (HR = 0.94, 95% CI: 0.87–1.01), but the HR for blacks versus whites was 0.90 (95% CI: 0.82–0.98) for radiation treatment and 0.89 (95% CI: 0.81–0.97) for other/no treatment. Race was not associated with LCSS among all patients combined or within each treatment category. ConclusionsA racial disparity in the rate of operation was no longer apparent at the end of the study period. There was no racial difference in OS or LCSS among all patients in this equal access health care system. Long-documented racial differences in lung cancer treatment and mortality result from disparity of access to health care and delivery of recommended treatment.

Racial differences in receipt of adjuvant hormonal therapy among Medicaid enrollees in South Carolina diagnosed with breast cancer.

Several factors contribute to the pervasive Black-White disparity in breast cancer mortality in the U.S., such as tumor biology, access to care, and treatments received including adjuvant hormonal therapy (AHT), which significantly improves survival for hormone receptor-positive breast cancers (HR+). We analyzed South Carolina Central Cancer Registry-Medicaid linked data to determine if, in an equal access health care system, racial differences in the receipt of AHT exist. We evaluated 494 study-eligible, Black (n=255) and White women (n=269) who were under 65years old and diagnosed with stages I-III, HR+ breast cancers between 2004 and 2007. Bivariate and multivariate analyses were conducted to assess receipt of ≥1 AHT prescriptions at any point in time following (ever-use) or within 12months of (early-use) breast cancer diagnosis. Seventy-two percent of the participants were ever-users (70% Black, 74% White) and 68% were early-users (65% Black, 71% White) of AHT. Neither ever-use (adjusted OR (AOR)=0.75, 95% CI 0.48-1.17) nor early-use (AOR=0.70, 95% CI 0.46-1.06) of AHT differed by race. However, receipt of other breast cancer-specific treatments was independently associated with ever-use and early-use of AHT [ever-use: receipt of surgery (AOR=2.15, 95% CI 1.35-3.44); chemotherapy (AOR=1.97, 95% CI 1.22-3.20); radiation (AOR=2.33, 95% CI 1.50-3.63); early-use: receipt of surgery (AOR=2.03, 95% CI 1.30-3.17); chemotherapy (AOR=1.90, 95% CI 1.20-3.03); radiation (AOR=1.73, 95% CI 1.14-2.63)]. No racial variations in use of AHT among women with HR+ breast cancers insured by Medicaid in South Carolina were identified, but overall rates of AHT use by these women is low. Strategies to improve overall use of AHT should include targeting breast cancer patients who do not receive adjuvant chemotherapy and/or radiation.

Racial Differences in Receipt of Chlamydia Testing Among Medicaid-Insured Women in 2013

To estimate the percentage of young, sexually active Medicaid-insured women who were tested for chlamydia by age, race/ethnicity, and history of sexually transmitted disease (STD) diagnosis. We used the medical diagnostic and procedural codes from Truven Health MarketScan Medicaid claims data from 10 states in 2012 and 2013 to estimate the rates of chlamydia testing in 2013 and previous STD diagnosis (diagnosed in 2012) among Medicaid-insured women aged 15-25 years who were sexually active in 2013. We also used a logit model to assess the association between chlamydia testing and women's age, race/ethnicity, and previous STD diagnosis. Overall, among approximately 261,000 Medicaid-insured women aged 15-25 years in 2013 who were classified as sexually active, 50.2% were tested for chlamydia in 2013. The chlamydia testing rate was 45.6% for white women and 57.5% for black women. The chlamydia testing rate was 63.5% for women diagnosed as having an STD in 2012 and 46.8% for women not diagnosed as having an STD in 2012. The chlamydia testing rate was significantly (P < 0.05) associated with previous STD diagnosis, age, and race/ethnicity in our logit model. Higher chlamydia testing rates among black women can be explained in part by higher rates of previous STD diagnoses. Our finding that black women have the highest chlamydia testing rates is encouraging, as improved access to STD prevention services among racial/ethnic minorities can help to reduce racial/ethnic disparities in STDs. However, chlamydia screening remains an underused preventive health service for young women of all racial and ethnic groups.

Abstract A91: Prevalence and effectiveness of treatment patterns for early-stage lung cancer

Abstract Background: Disparities in resection rates and survival for patients with lung cancer are well-documented. It is suggested that lower survival rates among blacks are largely due to lower rates of resection and that equivalent outcomes are possible for blacks and whites with similar treatment. The objective of this study was to determine the extent of racial variation in patterns of initial therapy and treatment-specific outcomes. Methods: We conducted a retrospective analysis of a national cohort of patients in the Veterans Affairs Central Cancer Registry diagnosed with Stage I/II non-small cell lung cancer (NSCLC) between 2001 and 2008. Descriptive and chi-square statistics were used to compare the prevalence of treatment and outcomes in Whites and Blacks. Cox proportional hazards models were used to estimate hazard ratios (HR) with 95% confidence intervals (95%CI). Results: Among 14,445 patients with stage I/II NSCLC, 57% received surgery (17% diagnosed at surgery, 40% received surgery within 6 months after diagnosis), 22% received radiation therapy and/or chemotherapy, and 21% had no treatment. The proportion of blacks and whites diagnosed at surgery was similar (both 17%), whereas the proportion of blacks receiving surgery post-diagnosis (34%) was significantly less than whites (41%) (p&amp;lt;0.0001). There was no racial difference in receipt of radiation therapy or chemotherapy among those who did not have surgery; however, blacks were more likely than whites to have no treatment (25% vs. 20%, p&amp;lt;0.0001). Among all surgical patients, rates of lobectomy, wedge resection, and pneumonectomy did not vary significantly by race, yet the frequency of other types of resection (e.g. segmentectomy) was greater among blacks (6%) than whites (4%) (p=0.0005). Approximately 17% of surgery patients had neoadjuvant or adjuvant therapy, which was similar in both race groups. Whites had a significantly greater prevalence of 90-day post-operative mortality than blacks (6% vs 3%, p&amp;lt;0.0001). Among all patients, blacks and whites had equivalent rates of 4-year survival. The adjusted HR for blacks compared to whites was 0.97 (95%CI 0.92-1.02) in the total population. Adjusted HRs also indicated no association between race and survival in each of the following treatment subgroups: diagnosed at surgery, surgery after diagnosis, and no treatment. The type of resection and the addition of neoadjuvant or adjuvant therapy did not impact the race-survival association. Black race correlated with better survival among patients receiving nonsurgical treatment (HR: 0.84, 95%CI 0.75-0.93, p=0.0007). Conclusion: Racial differences in receipt of surgery are limited to patients diagnosed prior to surgical treatment, which emphasizes the need to understand the impact of knowledge of the diagnosis on decision-making regarding surgery. The lower post-operative mortality observed among blacks is partially explained by the greater frequency of less extensive resection among blacks. Equal treatment generally confers similar outcomes in blacks and whites, and despite lower rates of post-diagnostic surgery, there were no racial differences in overall survival. There remains the need to identify factors that affect the association between race and short vs long-term clinical and patient-reported outcomes. Note: This abstract was withdrawn after the Proceedings was printed and was not presented at the conference. Citation Format: Christina D. Williams. Prevalence and effectiveness of treatment patterns for early-stage lung cancer. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A91. doi:10.1158/1538-7755.DISP13-A91

Smoking cessation among African American and white smokers in the Veterans Affairs health care system.

We examined whether a proactive care smoking cessation intervention designed to overcome barriers to treatment would be especially effective at increasing cessation among African Americans receiving care in the Veterans Health Administration. We analyzed data from a randomized controlled trial, the Veterans Victory over Tobacco study, involving a population-based electronic registry of current smokers (702 African Americans, 1569 whites) and assessed 6-month prolonged smoking abstinence at 1 year via a follow-up survey of all current smokers. We also examined candidate risk adjustors for the race effect on smoking abstinence. The interaction between patient race and intervention condition (proactive care vs. usual care) was not significant. Overall, African Americans had higher quit rates than Whites (13% vs. 9%; P < .006) regardless of condition. African Americans quit at higher rates than Whites. These findings may be a result of the large number of veterans receiving smoking cessation services and the lack of racial differences in receipt of these services as well as racial differences in smoking history, self-efficacy, and motivation to quit that favor African Americans.

Mo1609 Treatment and Survival Disparities of Locoregional Gastroesophageal Cancer in Whites, Blacks and Asian Americans: A SEER-Database Analysis

Background: Cancers that arise from the lower esophagus, esophagogastric junction and gastric cardia, so-called gastroesophageal cancers (GEC), predominantly adenocarcinomas, have trended up rapidly in incidence since the mid-1970s. Despite advances in multimodal therapies for GEC, the overall survival remains poor. African Americans have known worse outcome of GEC, however the reasons are still elusive. Studies on the outcome of GEC in the Asian Americans are sparse. Methods: In this study, we examined the racial differences in receipt of surgery and survival of locoregional GEC among whites, blacks and Asian Americans, using the latest Surveillance Epidemiology and End Results database. Subjects diagnosed with a primary GEC between 1998 and 2010 were extracted along with their demographics, tumorand therapy-related variables. Multivariate logistic regression, KaplanMeier and Cox proportional hazards regression analyses were performed to identify the factors influencing the receipt of surgery and cancer-specific survival using STATA. Results: 12,543 patients, diagnosed with primary GEC, consisting of 11,043 whites, 830 blacks and 526 Asian Americans were included. The Asian Americans had a similar surgical rate as the whites, while the black patients had lower surgical rate than whites [59% vs 80%; OR= 0.53; p<0.001], after controlling for all potential covariates. Specifically, blacks had 39% lower rate of local tumor excision, 32% less partial esophagectomy or gastrectomy, and 62% less total esophagectomy/gastrectomy compared to whites (p<0.05). Additionally, blacks were 2-fold more likely to refuse recommended surgery, and to have unknown or undocumented reasons for not receiving recommended surgery than whites (p < 0.001). The median survivals were 19, 33 and 35 months for blacks, whites and Asian Americans, respectively. Being black was associated with a HR of 1.41 for cancer-specific mortality of GEC compared to white (p < 0.001). After controlling for patient and tumor characteristics, the HR for black vs white was 1.20 (p < 0.001); further adjustment for surgery reduced the difference in hazards to a statistically insignificant value (HR=1.11, p=0.06). Surgery reduced HR of cancers at the midesophagus and lower more pronouncedly than at the cardia for blacks vs whites. In contrast, there was no difference in the survival of GEC between Asian Americans and whites. Conclusions: Blacks had markedly lower rate of surgical intervention and worse survival of locoregional GEC than whites and Asian Americans. The black-white survival differences were more profound for cancers of the midor lower esophagus than that of the cardia. Surgery diminished the survival disadvantages in blacks. More efforts are needed to promote patient education, surgeon-patient communication and close follow up for black patients to improve their survival of GEC.

Receipt of National Comprehensive Cancer Network guideline‐concordant prostate cancer care among African American and Caucasian American men in North Carolina

African Americans have a higher incidence of prostate cancer and experience poorer outcomes compared with Caucasian Americans. Racial differences in care are well documented; however, few studies have characterized patients based on their prostate cancer risk category, which is required to differentiate appropriate from inappropriate guideline application. The medical records of a population-based sample of 777 North Carolina men with newly diagnosed prostate cancer were studied to assess the association among patient race, clinical factors, and National Comprehensive Cancer Network (NCCN) guideline-concordant prostate cancer care. African Americans presented with significantly higher Gleason scores (P = .025) and prostate-specific antigen levels (P = .008) than did Caucasian Americans. However, when clinical T stage was considered as well, difference in overall risk category only approached statistical significance (P = .055). Across risk categories, African Americans were less likely to have surgery (58.1% versus 68.0%, P = .004) and more likely to have radiation (39.0% versus 27.4%, P = .001) compared with Caucasian Americans. However, 83.5% of men received guideline-concordant care within 1 year of diagnosis, which did not differ by race in multivariable analysis (odds ratio = 0.83; 95% confidence interval = 0.54-1.25). Greater patient-perceived access to care was associated with greater odds of receiving guideline-concordant care (odds ratio = 1.06; 95% confidence interval = 1.01-1.12). After controlling for NCCN risk category, there were no racial differences in receipt of guideline-concordant care. Efforts to improve prostate cancer treatment outcomes should focus on improving access to the health care system.