Reduce Cancer Health Disparities Research Articles

Expanding active living after cancer to underserved cancer survivors and their caregivers.

Physical activity (PA) improves physical and psychological health in cancer survivors. This study evaluated Active Living After Cancer (ALAC), a community-based program to improve PA, physical function, and quality of life (QOL) in minority and medically underserved cancer survivors and their caregivers. Participants completed 12 weekly ALAC sessions and assessments of PA, physical functioning, and QOL at baseline and follow-up (week 12). Paired samples t-tests were used to assess changes in outcomes over time. 540 cancer survivors (M age = 61.1 years, SD = 11.3) and 87 caregivers (M age = 62.3 years, SD = 13.1) were enrolled. Most were women (91.4%), Hispanic (61.1%) or non-Hispanic Black (19.3%), and medically underserved (86.4%). The percent of cancer survivors meeting PA recommendations increased from 28.9% to 60.2% (d = 0.75), and the number of sit-to-stand repetitions in a 30-second period increased from 12.3 to 14.3 (d = 0.39) from 0-12 weeks. Cancer survivors reported significant improvements in physical (T-score Δ = 1.7, d = 0.06) and mental (T-score Δ = 2.3, d = 0.31) health-related QOL. Caregivers also improved their PA, physical function, and QOL, and there were no statistically significant differences between breast and other cancer survivors and between cancer survivors and caregivers. The ALAC program demonstrated increased PA, physical function, and QOL in medically underserved cancer survivors and their caregivers. Furthermore, ALAC was successfully implemented by community partners and serves as a good model for reaching medically underserved cancer survivors and improving survivorship. Additional efforts are warranted to further extend reach, improve cancer survivorship, and reduce cancer health disparities among underserved cancer survivors.

Abstract 3554: Using All of Us cancer data on the Researcher Workbench to advance career development

Abstract This session will provide an overview of the All of Us Research Program (All of Us) dataset, discuss a mechanism to build the capacity of research institutions using the All of Us dataset, and outline the career benefits researchers experienced from using the dataset. All of Us is building a national health dataset to accelerate medical breakthroughs. It is used by cancer researchers to advance health research and career development. This dataset is large and diverse, both in the data types available as well as the demographics of participants: as of April 2023, health data from 413,450+ participants is available to researchers, from a variety of distinct data types, including survey responses, physical measurements, electronic health records, whole genome sequencing, wearable data, and genotyping arrays, with 75% of participants self-identifying as underrepresented in biomedical research and about 45% of participants self-identifying as racial and ethnic minorities. Researchers already leverage this dataset, with All of Us data used in more than 210 publications across peer-reviewed journals. In addition, this dataset is useful for cancer researchers - All of Us EHR data indicates over 60,700 participants are diagnosed with at least one type of cancer, and more than 10% of research projects underway (725/6,945 as of September 2023) using the All of Us dataset are cancer-related, making it the top condition studied by researchers. To help build capacity at research institutions, All of Us collaborated with the NCI Center to Reduce Cancer Health Disparities (CRCHD) Partnerships to Advance Cancer Health Equity (PACHE) to develop a Notice of Special Interest (NOSI) titled Administrative Supplements to Support "All of Us" and Health Disparities-Related Pilot Research Projects at NCI CRCHD-Funded PACHE Partnerships. The focus of this NOSI was on P20 and U54 awards associated with research projects led by PACHE researchers interested in exploring the connections between social determinants of health outcomes and populations experiencing cancer health disparities. NIH awarded investigators at the following institutions: City College of New York, University of California, Irvine, and Temple University. Principal investigators of these awards will provide an overview of their work, describe how they analyze the All of Us dataset, and discuss how their use of the dataset has helped advance their career as cancer researchers: Karen Hubbard (City College of New York) Project Title: Relative and Intersectional Analysis of social determinants of Lung Cancer Risk among Black and Hispanic All of Us respondents Hannah Lui Park (University of California, Irvine) Project Title: Improving breast cancer risk assessment and prevention in Asian American women Lin Zhu (Temple University) Project Title: Elucidating the Roles of Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease among Asian American Patients with Chronic Hepatitis B Citation Format: Karriem S. Watson, Rubin Baskir, Division of Engagement and OutreachAll of Us Research Program, Karen Hubbard, Hannah L. Park, Lin Zhu. Using All of Us cancer data on the Researcher Workbench to advance career development [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 3554.

Engaging the Asian American Community to Address Cancer Burden: Experiences and Lessons Learned

Abstract: Background: Reducing cancer health disparities in Asian Americans requires orchestrated efforts and partnerships. Objectives: To describe the approach used by the University of Texas MD Anderson Cancer Center, HOPE Clinic, and Asian American organizations to understand and engage Houston's Asian American communities in cancer research, as well as to share lessons learned. Methods: The community-academic-medical partnership used community-based research principles to build the partnership, form the community advisory board, conduct a community needs assessment, and offer cancer prevention engagement and education. Results: Some lessons learned included balancing language needs with limited resources, incorporating more time and resources to conduct health research in an ethnically diverse community, and promoting awareness of research and its role in cancer prevention in Asian American communities. Conclusions: Community–academic–medical partnerships are promising ways to engage the community, draw on combined expertise, and create research and programs that are scientifically strong and meaningful to the community.

Abstract B134: The art of science: Painting a new image of genomic research in the indigenous communities of the Southwest

Abstract Introduction: The Patient Engagement-Cancer Genome Sequencing Research Center (PE-CGS; NCI U2C CA252973) based at the University of New Mexico Comprehensive Cancer Center (UNMCCC) with partners at Mayo Clinic Comprehensive Cancer Center, the Translational Genomics Research Institute, and the Black Hills for American Indian Health Research Center are developing culturally appropriate strategies and methods to address the underrepresentation of American Indians (AIs) in genomic research. Our efforts are directed towards the implementation of tailored cancer prevention, diagnosis, and treatment strategies that reduce cancer health disparities in Tribal communities. Methods: The PE-CGS Center has three units, each tasked with specific research components to engage AI participants in participatory, clinically-meaningful genomic research: 1) the Participant Engagement Unit; 2) the Genomics Characterization Unit; and 3) the Engagement Optimization Unit (EOU). The Center also has a Tribal Advisory Committee, composed of Tribal Governors, Presidents, and tribal health advocates and experts, who provide direction on all research matters. The PE-CGS EOU uses iterative rapid-cycle research techniques to optimize engagement and shares these strategies with other units for timely implementation. To date, the EOU has developed and implemented three key efforts. First, to aid in recruiting participants for the study, the EOU tailored a series (6) of participant-facing informational materials that include artwork from a local AI artist who combined her traditional and scientific knowledge to prepare complementary imagery. Second, the EOU is currently implementing a series of semi-structured discussions to document participant perceptions on criteria including engagement, communication, and education. Lastly, the EOU implemented a survey among UNMCCC providers on their return of results processes. Results: EOU discussions are ongoing and have provided important perspectives on participant satisfaction and areas for improvement. Participants have commended study staff on their efforts to make enrollment straightforward. Participants report discussing the study with family prior to enrolling, highlighting the importance of continuing to engage with the entire community on the goals of the study. The provider return of results survey is complete (n=42/62, response rate=68%); one key finding was that providers who return somatic test results rarely provide participants with a hard copy of the results or utilize complementary materials that might enhance their explanation of the test findings. Conclusion: The EOU serves an innovative function through its rapid-cycle methods to optimize participant engagement. Although participants are generally pleased with their study participation, there are numerous opportunities for improvement. The informational materials represent a novel contribution to the field of genomic research. Efforts will continue to implement optimized processes for effective engagement of AI communities in genomic research and cancer care delivery. Citation Format: Shoshana Adler Jaffe, Kendal Jacobson, Joseph Rodman, Cindy Blair, Debra MacKenzie, Mallery Quetawki, Tamar Ginossar, V. Shane Pankratz, Andrew Sussman, Ursa Brown-Glabermen, Jeffrey Trent, Cheryl Willman, Shiraz I. Mishra. The art of science: Painting a new image of genomic research in the indigenous communities of the Southwest [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B134.

Abstract B131: Social drivers of adverse health outcomes among cancer survivors

Abstract Purpose of the Study Disparities in health outcomes among cancer survivors are often driven by differences in social-ecological resources. Poor health outcomes and multiple chronic conditions often manifest as a result of shared demographic and social risk factors. The aim of this study was to examine the social drivers that predict adverse health outcomes among cancer survivors. Methods Data from the national longitudinal Population Assessment of Tobacco and Health (PATH) Study was used to examine social drivers of several adverse health outcomes: tobacco use, sleep trouble, high cholesterol, diabetes, and high blood pressure among cancer survivors enrolled in the first cohort (waves 1-3; n=1924). Social drivers included education, financial stress, poverty level, insurance status, and satisfaction with social relationships. Survey-weighted multivariable logistic regression was used to assess demographic and social drivers that predicted health outcomes among cancer survivors. Results Among the 1,924 cancer survivors, most were non-Hispanic, White (77%); 56% female; ages ranged from 18-34 (14%), 35-54 (27%), 55-64 (24%), 65+ (34%). Higher tobacco use was linked (p’s<0.05) to both demographic (males, younger) and social drivers (lower education, poverty, lack of insurance and social dissatisfaction). Trouble sleeping was associated with social drivers including financial stress (p<.001) and social dissatisfaction (p<.0001). High cholesterol was significantly associated with demographics (older age) and social drivers including lower education, access to insurance, and social dissatisfaction (p’s<.05). High blood sugar was significantly associated with demographics (older age, NH Black) and social drivers (lower education and social dissatisfaction (p’s<.05). High blood pressure was significantly associated with demographic (older age, male, NH Black) and social drivers including lower education college (p<.05) and financial stress (p<.05). Conclusions Increased recognition of the critical role of social drivers on health outcomes suggests effective interventions that are sensitive to cancer survivors’ social-ecological contexts are needed to improve health equity and reduce cancer health disparities. Citation Format: Victoria M. Telles, Mateo Banegas, David Strong. Social drivers of adverse health outcomes among cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B131.

Abstract A053: Development and evaluation of a community-informed intervention to improve clinical trial knowledge and interest: Preliminary findings

Abstract Introduction: Nationally, racial and ethnic disparities in cancer clinical trial participation exist. Black Americans are underrepresented in cancer clinical trials, with approximately 9% of clinical trial participants in studies sponsored by the National Cancer Institute (NCI) identifying as Black. As part of work supported by the NCI’s National Outreach Network, we adapted educational materials provided by the Center to Reduce Cancer Health Disparities (CRCHD) for dissemination across KCI’s catchment area. Our study aimed to increase knowledge and interest in clinical trials with a focus on concerns salient among Black Americans. Methods: We adapted a CRCHD educational PowerPoint presentation to create Project FACCTs: Facts about Cancer Clinical Trials, a multicultural online video intervention. Adaptation included input from our cancer center’s longstanding Black American community stakeholders and collaborators. who shared a preference for video format versus PowerPoint presentation and recommended inclusion of a discussion of medical mistrust as well as information on clinical trial costs. Participants were recruited through KCI clinics and community partners. Assessments, provided by the CRCHD, included an 11-item measure of clinical trial knowledge (true/false) as well as 6-item measure of clinical trials interest and attitudes, including likelihood of future participation in a trial (strongly disagree to strongly agree). Assessments were administered as pre- and post-tests. Results: The majority of our 307 participants identified as Black American (59.3%), female (76.9%), college graduates (63.5%), and had health insurance from a former or current employer (49.8%). Overall, clinical trial knowledge was relatively high at both pre-test (mean=86.7% correct) and post-test (mean=87% correct) across the entire sample. A repeated measures ANOVA revealed a statistically significant difference between Black and White participants on clinical trial knowledge from pre-test (Black: 84.5%; White: 94%) to post-test (Black: 85.4%; White: 93%) (F(1,2) =20.6, p=.01). Across the entire sample, a paired samples t-test showed that clinical trial interest increased after viewing Project FACCTs, (t (297)=-8.84, p=.01). A repeated measures ANOVA demonstrated that within groups there was statistically significant improvement in interest and attitudes towards participating in a clinical trial (F(1, 295) = 34.8 p=.01). Between groups, White participants had a higher overall score in clinical trial interest compared to Black participants (F(1, 2) =9.13, p=.01). Conclusions: Project FACCTs shows promise as a tool that can improve community members' knowledge, awareness, and interest in clinical trials. One limitation of the work reported here is that participants already had high clinical trials knowledge so the intervention’s effect on those with low knowledge is an area for future inquiry. Citation Format: Ariel Washington, Brittany Dowe, Rochelle Chapman, Maida Herrera, Madison Pavliscak, Bertram Marks, Hayley Thompson. Development and evaluation of a community-informed intervention to improve clinical trial knowledge and interest: Preliminary findings [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A053.

Abstract A056: Community scientist research advocacy program: Bridging cancer research and community advocacy

Abstract Community Scientist Research Advocacy (CSRA) programs are designed to connect researchers with community members, to effectively inform and involve the general population on clinical research. More programs like such are needing to be implemented into the community for better outcomes among cancer health disparities. The purpose of our study was to develop and evaluate a novel bi-coastal and bilingual program to inform, educate and empower community members to become cancer research advocates in Florida (FL) and California (CA). Our program was tailored for African American (AA) and Hispanic/Latino/a (H/L) adults. Primary objectives are to increase person power for cancer research advocacy and increase multi-directional communication between cancer advocates with cancer survivors, community members, academic scientists and policy makers. The CSRA program is a 13-week program implemented 100% virtual by the FL-CA Cancer Research, Education and Engagement (CaRE2) Health Equity Center, a bi-coastal partnership between the Florida A&M University, University of Florida, and University of Southern California where participants learned about cancers that disproportionately impact AA and H/L adults. Participants completed surveys at program start, midway, and end to assess knowledge gained and program evaluation, and a mentored advocacy project for community implementation. Five months after program end, we surveyed participants on impact and to provide support for their research advocacy. To date, a total of 26 adults have graduated from our program. We present data from the 2022 CSRA cohort (N = 20) that included participants from FL and CA, which are among the top five states in the U.S with the largest AA and H/L populations. Participants self-identified race, ethnicity, and gender were: 13 (68.4%) AA, 7 (26.3%) H/L, 90% female. This cohort had 90% program completion (N = 18) and 5 advocacy projects on breast cancer, lung cancer, pancreas cancer, and prostate cancer. Participant knowledge had a mean (SD) of 67.9 (7.9) at pre-survey and 71.4 (9.0) at post-survey, with a p-value of 0.2. Participants had a mean (SD) of 60.0 (14.6) at mid-survey and 68.2 (11.0) at post-survey, with a p-value of 0.13. We used a Likert scale to evaluate program expectations, which resulted in a mean (SD) of 94.0 (8.8) participants who ‘agreed’ that they were satisfied with the program at the start compared to a mean (SD) of 91.0 (12.9) of participants who ‘agreed’ that they were satisfied with the program at the end, with an overall p-value of 0.5. In conclusion, we present findings from a novel virtual CCS bi-coastal and bilingual training program tailored for AA and H/L adults that can foster multi-directional communication between cancer research advocates with multiple stakeholders to reduce cancer health disparities. We will further evaluate our program for 2023 cohort implementation. Citation Format: Brooke Hensel, Eduardo Ibarra, Carolina Aristizabal, Ileana Guzman, Rosa Barahona, Brandon Hazelton-Glenn, Ji-Hyun Lee, Zhongyue Zhang, Mariana C. Stern, Lourdes Baezconde-Garbanati, Sandra Suther, Fern Webb. Community scientist research advocacy program: Bridging cancer research and community advocacy [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A056.

Abstract A068: Educating the next generation of cancer researchers: Evaluation of a cancer research partnership training program

Abstract Introduction: The underrepresentation of minorities in cancer research hampers efforts to address disparities among minority populations. To tackle this issue, early mentorship of emerging scientists from underrepresented communities is crucial. The Synergistic Partnership for Enhancing Equity in Cancer Health (SPEECH) is a collaboration between Temple University/Fox Chase Cancer Center, Hunter College (TUFCCC/HC), and funded by the National Cancer Institute. SPEECH aims to reduce cancer health disparities through research, community outreach, and support for underrepresented investigators and students. The Research Education Core (REC) within SPEECH focuses on enhancing training and mentorship, including the Summer Cancer Research Institute (SCRI), providing opportunities for underrepresented minority students in cancer research. Procedures: We conducted a cross-sectional survey with accepted SCRI applicants (i.e., participants) and their peers whose applications to the SCRI were not accepted (non-participants) from four cohorts (2019–2022). Email invitations with a link to a REDCap survey were sent to 51 SCRI participants and 488 non-participants with the goal of investigating any differences between the two groups in knowledge and career goals. In total, 32 SCRI participants and 47 non-participants responded to the survey. One SCRI participant was excluded due to missing data, yielding 31 SCRI participants. About 70% of the participants identified as Asian, Black/African American, or multi-racial. Results: SCRI participants had significantly higher knowledge scores in health disparities (p < 0.001), cancer biology (p < 0.001), and cancer prevention (p < 0.05) than non-participants. SCRI participants also had slightly higher levels of interest in pursuing a graduate-level degree in cancer biology or cancer health disparities-related discipline (41.9% reporting “very interested”) and in pursuing a career in cancer biology or cancer health disparities (41.9% “very interested”), than the non-participants (36.2% and 36.2%, respectively), but the differences were not statistically significant. The two groups had similar rates of pursuing a career in cancer biology, cancer health disparities research, or teaching in academia. In addition, over 90% reported Of those who participated in the SCRI that they “agreed” or “strongly agreed” that the SCRI experience had a positive influence on their plans for continued education (90.3%), increased skills in cancer or cancer health disparities research (93.6%), increased skills on scientific writing (93.6%), increased skills on presenting at a conference (100%), and had a positive influence on their future career plans (90.3%). Summary: Our findings indicate that an intensive 8-week training institute can increase students’ knowledge and capacity in cancer research, demonstrating an overall positive influence of the program on students’ perceived scientific skills and future career plans. Citation Format: Lin Zhu, S.J. Dodd, Yuku Chen, Emily R. Kaminsky, Zhiqing Elaine Liu, Grace X. Ma, Olorunseun O. Ogunwobi, Carolyn Y. Fang. Educating the next generation of cancer researchers: Evaluation of a cancer research partnership training program [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A068.

Abstract A109: The growth and evolution of GMaP Region 3 Technical Training Summits

Abstract Introduction: The Geographic Management of Cancer Health Disparities Program (GMaP) is a national program funded by the National Cancer Institute’s (NCI) Center to Reduce Cancer Health Disparities with the mission to expand and diversify the pipeline of cancer researchers. GMaP Region 3 is one of seven regions, and is comprised of members from seven Southwestern US states. The University of New Mexico Comprehensive Cancer Center serves as the hub for GMaP Region 3, and has hosted three seminal training Summits. Methods: GMaP Technical Training Summits provided hands-on learning experiences for cancer health disparities (CHD) trainees and promoted collaboration among Region 3’s NCI-designated cancer centers. GMaP Region 6 collaborated with Region 3 to host the final two Summits. Each of the three Summits had differing aims, but the core goals were to strengthen grant writing skills, enhance professional development, in addition to providing opportunities for networking and mentorship. Summit activities included keynote addresses by senior researchers, many of whom are members of historically underrepresented populations, interactive grant writing sessions, and mock grant reviews. Attendee feedback was captured via REDCap surveys and qualitative experience summary reports. Results: Each Summit had increasing attendance: 2016 Summit, n=29, 2019 Summit, n=35; 2023 Summit, n=48. Summit length grew from 1 full day to 2.5 days of sessions. Although the majority of participants were from Regions 3 and 6 there were also attendees from Region 2 and 5 demonstrating the desirability of this type of intensive grant writing training. Attendees were largely satisfied with their experience and in 2023 the overall reception of the summit material was 87% positive. Attendees highlighted the benefits of receiving individualized feedback on their Specific Aims page and the ability to meet people doing similar work. Summits were described as “invigorating” and “motivational”. Participants across the years highlighted the value of hearing from influential researchers in the field and cited these keynote addresses as being “inspirational”. Challenges of hosting these Summits included logistical barriers specifically pertaining to ensuring that scholars had the financial support they needed to attend prior to each event. In addition, tailoring the Summit curriculum and coordinating appropriate speakers was an ongoing learning process. Recommendations: Grant writing is both a science and an art and many scholars, particularly those from underrepresented groups, do not have access to the focused training necessary to develop successful proposals. The GMaP Region 3 Summits provided opportunities for scholars to learn from experienced grant writers and network with their peers. Future efforts to provide tailored grant writing education to newer cancer researchers should be prioritized to support their career development and diversify the types of CHD research proposed and ultimately funded. Citation Format: Shoshana Adler Jaffe, Dolores D. Guest, John Torres, Miria Kano, Andrew Sussman, Shiraz I. Mishra. The growth and evolution of GMaP Region 3 Technical Training Summits [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A109.

State of Cancer Care in America: Achieving Cancer Health Equity Among Sexual and Gender Minority Communities.

In 2017, ASCO issued the position statement, Strategies for Reducing Cancer Health Disparities Among Sexual and Gender Minority Populations, outlining five areas of recommendations to address the needs of both sexual and gender minority (SGM, eg, LGBTQ+) populations affected by cancer and members of the oncology workforce who identify as SGM: (1) patient education and support; (2) workforce development and diversity; (3) quality improvement strategies; (4) policy solutions; and (5) research strategies. In 2019, ASCO convened the SGM Task Force to help actualize the recommendations of the 2017 position statement. The percentage of the US population who publicly identify as SGM has increased dramatically over the past few years. Although increased national interest in SGM health equity has accompanied a general interest in research, policy change, and education around diversity, equity, and inclusion, resulting from public concern over discrimination in health care against Black, Indigenous, and People of Color, this has been accompanied by a surge in discriminatory legislation directly impacting the SGM community. Although much progress has been made in advancing SGM cancer health equity since 2017, more progress is needed to reduce disparities and advance equity. The five focus areas outlined in the 2017 ASCO position statement remain relevant, as we must continue to promote and advance equity in quality improvement, workforce development, patient care, research, and SGM-affirming policies. This article reports on the progress toward reducing SGM cancer disparities and achieving equity across these five areas and identifies future directions for the work that still remains.

Health System Practices and Perspectives of Social Risk Screening in Oncology

Social risks (e.g., food insecurity) are adverse social/economic conditions associated with poor health outcomes. Among patients with cancer, presence of social risks is associated with increased late-stage diagnoses, care delays, and mortality. The purpose of this project was to assess the perspectives and practices regarding social risk screening within a large NCI-designated cancer center. Email invitations to complete a secure, online survey were distributed to oncology healthcare staff (e.g., oncologists, nurses, pharmacists, medical assistants, social workers, and patient navigators) at Moores Cancer Center between June 1, 2022 and July 31, 2022. The 6-item survey collected information on clinical role, current practices and perceived barriers to screening for social risks as part of routine care. Respondents were categorized as MD-trained providers versus non-MD clinical staff. Descriptive statistics were used, including Fisher's exact test to compare responses by respondent type (MD vs non-MD). All analyses were conducted using data management and decision management software. This project was approved by the UCSD Institutional Review Board. A total of 59 respondents completed the survey, including 20 MDs (34%) and 39 non-MD staff (66%). Overall, most respondents reported asking patients about their social risks (75%) and communicating information about patients' social risks with other healthcare staff when clinically relevant (84%). MDs were significantly more likely to agree that they ask patients about social risks when clinically relevant than non-MDs (95% vs 64%, p = 0.024). MDs were also more likely to communicate, review and use social risk information than their non-MD colleagues. The most reported barriers to integrating social risk information into clinical care, overall, included insufficient time (73%), uncertainty about who is responsible (70%), and lack of knowledge about existing tools (75%) for asking patients about social risks, as well as lack of resources to address social risks (76%). Non-MDs were more likely to cite concern that patients and families will feel uncomfortable answering questions about social risks (67% vs 20% of MDs, p = 0.003) as a barrier. Only 30% of MDs and 46% of non-MDs agreed that "asking about social risks is outside of the scope of my role" was a barrier. Most oncology providers and staff agree that obtaining social risk information is important for patient care. Developing clinic-based solutions that integrate social risk screening and referral workflows within the oncology setting is imperative to reduce cancer health disparities. Future efforts that leverage the use of electronic health records to conduct social risk screening and streamline referrals to community-based resources in oncology may improve cancer health equity.

Children's Oncology Group's 2023 blueprint for research: Germ cell tumors.

Extracranial germ cell tumors (GCT) are a biologically diverse group of tumors occurring in children, adolescents, and young adults. The majority of patients have excellent outcomes, but treatment-related toxicities impact their quality of survivorship. A subset of patients succumbs to the disease. Current unmet needs include clarifying which patients can be safely observed after initial surgical resection, refinement of risk stratification to reduce chemotherapy burden in patients with standard-risk disease, and intensify therapy for patients with poor-risk disease. Furthermore, enhancing strategies for detection of minimal residual disease and early detection of relapse, particularly in serum tumor marker-negative histologies, is critical. Improving the understanding of the developmental and molecular origins of GCTs may facilitate discovery of novel targets. Future efforts should be directed toward assessing novel therapies in a biology-driven, biomarker-defined, histology-specific, risk-stratified patient population. Fragmentation of care between subspecialists restricts the unified study of these rare tumors. It is imperative that trials be conducted in collaboration with national and international cooperative groups, with harmonized data and biospecimen collection. Key priorities for the Children's Oncology Group (COG) GCT Committee include (a) better understanding the biology of GCTs, with a focus on molecular targets and mechanisms of treatment resistance; (b) strategic development of pediatric and young adult clinical trials; (c) understanding late effects of therapy and identifying individuals most at risk; and (d) prioritizing diversity, equity, and inclusion to reduce cancer health disparities and studying the impacts of social determinants of health on outcomes.

The impact of high intensity interval training in a diverse group of cancer survivors: CAPABLE, a pilot study

PurposeGiven the well-documented benefits of regular exercise to cancer survivors, current American Cancer Society guidelines recommend that patients engage in a minimum of 150 min per week of moderate-to-vigorous physical activity with a minimum of two days of strength training. However, few survivors meet this goal, particularly among minorities. MethodsThe CAPABLE study is a single-arm, pilot exercise intervention that introduced 48 cancer survivors to a high intensity interval and strength training program three days a week for 12 weeks. We evaluated the impact of this unique training method on bodyweight, % body fat, serum markers correlated with an adverse cardiometabolic profile and health-related quality of life (HRQoL). Measures were summarized at baseline and program exit. Paired t-tests were used to assess change in each of these measures over time. ResultsWe observed losses in weight, body mass index, and % body fat, and glycosylated hemoglobin (HbA1c) levels over 12-weeks. There were also clinically meaningful improvements in reported overall HRQoL (FACTG total change +9.5 (95% CI, 4.6, 14.4)) and in each one of the individual domains (physical, social, emotional, and functional well-being). ConclusionsWe observed meaningful improvements in body composition, HbA1c and quality of life over 12 weeks among cancer survivors participating in a high-intensity interval training program. Future work will include a control arm for comparison and address barriers to participation and adherence which will be important in using this intervention and others like it to improve outcomes and reduce cancer health disparities.

Abstract 1942: Effectiveness of community outreach/engagement and faith-based strategies among African American & African Nationals to increase cancer clinical trials participation using a culturally tailored educational manual

Abstract Background: The importance of diversity in clinical trials is vital to ensure treatments and medications work and respond well for everyone. In contrast to other ethnic groups, AAs are disproportionately affected by various types of cancers in the U.S., such as prostate & pancreatic cancer, and have higher cancer mortality rates. Yet AA participation in cancer clinical trials remains extremely low. Black/African Americans make up 13.4% of the US population and have a clinical trial enrollment rate of less than 5%. In comparison, White/Caucasians make up about 67% of the US population and have a 75% enrollment rate in clinical trials and the Asian community makes up less than 6% of US population and have a 15% participation rate in clinical trials. Reported factors that have influenced Black/African American clinical trials enrollment rates are little awareness of clinical trials, religious beliefs, and access to health care barriers. Improving clinical trial participation among African Americans/African Nationals (AA/AN) is essential to reduce cancer health disparities because it gives opportunity to increased access to breakthrough cancer therapies and treatments. Methods: To address these disparities, we composed an AA/AN Clinical Trials manual to be distributed among these populations living in Los Angeles County (LAC). The AA/AN manual modules review: 1) Intro to Clinical Trials 2) Demographics 3) Types of clinical trials 4) Phases of clinical trials 5) Safety of clinical trials 6) The role of faith among AA communities and 7) Life during and after clinical trials. There is also a Call to Action to share the manual information with friends and family, to talk with one’s primary care physician and get screened, and to participate in clinical trials. The manual was culturally and linguistically adapted to deliver lay messages on clinical trials as needed, using graphs, infographics, and educational videos featuring clinical trials cancer researchers and experts. Results: 90 Churches in Los Angeles County serving AA/AN communities have been provided with avirtual copy of the Clinical Trials manual to be disseminated among their communities. Additionally, have participated in 7 major community health events in LAC to outreach and engage African American community members at which we have distributed 822 hard copy clinical trials manuals between November of 2021 and November of 2022. Conclusion: Involvement of faith-based communities in outreach and engagement strategies mayincrease cancer clinical trials participation among African American communities. The utilization of culturally sensitive and adapted educational materials may increase access to information on clinical trials and contribute to tackle clinical trials enrollment barriers affecting underserved minorities. Citation Format: Lourdes A. Baezconde-Garbanati, Carolina Aristizabal, Eduardo Ibarra, Cynthia Quince. Effectiveness of community outreach/engagement and faith-based strategies among African American & African Nationals to increase cancer clinical trials participation using a culturally tailored educational manual [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 1942.

Abstract B016: Addressing cancer clinical trials lack of enrollment among African Americans and African Nationals

Abstract Background: African Americans (AA) populations are among the most impacted by different types of cancers in the U.S. compared to other racial/ethnic groups. Among them, cancer clinical trials enrollment rates continue to be disproportionally low. Whites/Caucasian individuals comprise about 67% of the US population although having a 75% enrollment rate in clinical trials. Black/AA individuals comprise 13.4% of the US population although having a clinical trial enrollment rate of less than 5%. Participation of African Americans and African Nationals (AN) will significantly increase the state of knowledge regarding cancer treatment, survival, behavioral and pharmaceutical therapeutics, precision medicine, and increase access to the newest cancer therapies and can help improve cancer outcomes. Therefore, improving clinical trial participation among AA/AN patients is fundamental to reduce cancer health disparities. However more culturally focused information is needed addressing barrriers to clinical trials participation in these groups. Methods: We conducted 6 focus groups with 42 participants and two Town hall meetings with 120 participants targeted to AA/AN communities, where we gathered information about barriers to participation in research and clinical trials. We also reached out to 48 Black churches to discuss partnerships for dissemination and listen to concerns regarding AA participation in research. We leveraged our experience at USC NCCC where we have seen an increase of 147% in AA participation in clinical trials since 2015. Utilizing lessons learned and strategies identified we developed an AA/AN Clinical Trials Toolkit for CT outreach to inform about CT enrollment in Los Angeles County. The manual was culturally adapted to convey messages on clinical trials, using infographics and educational videos by cancer researchers, guided by persons living with cancer and other key stakeholders. Results: More than 160 stakeholders provided information in the creation of the AA/AN manual to include pastors, and other additional stakeholders. The manual was culturally adapted to convey lay messages on clinical trials addressing barriers to participation, using infographics and educational videos by cancer researchers. We found that partnering with pastors in the faith-based community was one of the most trusted ways of approaching this topic in the AA/AN community. Once the AA/AN manual was developed, stakeholders were asked to contribute to community wide dissemination and uptake. To date (6/6/2022), 62 churches in Los Angeles County serving AA/AN communities have been provided with a virtual copy of the Clinical Trials manual to be disseminated among their communities. The manual was launched and widely disseminated between November and March of 2022 and is currently available for public use. Our Tool Kit can be downloaded for free here: https://tinyurl.com/yey9hjpa Citation Format: Carolina Aristizabal, Fern Webb, Sandra Suther, Eduardo Ibarra, Cynthia Quince, Rosa Barahona, Mariana C. Stern, Lourdes A. Baezconde-Garbanati. Addressing cancer clinical trials lack of enrollment among African Americans and African Nationals [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B016.

Abstract B008: Evaluation of the NCI’s Geographic Management of Cancer Health Disparities (GMaP) program

Abstract (A) Purpose: The Geographic Management of Cancer Health Disparities Programs (GMaP) is a national program funded by the National Cancer Institute’s Center to Reduce Cancer Health Disparities (CRCHD). GMaP supports the academic and professional development of underrepresented minority (URM) scholars conducting cancer and cancer health disparities (CHDs) research and is comprised of seven regions with an academic institution or cancer center serving as the region-based “hub”. Collectively, each region enhances capacity of scholars through dispersal of pilot funding and research stimulus awards for preliminary research, technical assistance workshops and webinars, expert grant reviews, conference travel and registration support, mentor matching, and training navigation among others. Understanding the value and impact of these services for URM scholars is essential to future programmatic planning. (B) Description: The regional offices collaborated on the development and deployment of a GMaP Awardee Evaluation Survey to GMaP scholars that have received support (e.g., pilot funding, travel scholarships, expert grant reviews) over the past 10 years. The survey included demographic questions, research interests, extent of engagement, awards applied for and/or received, as well as general feedback of the value of the program. The goal of the survey was to evaluate how and through which mechanisms GMaP funding has facilitated professional development activities, in addition to understanding the value of this support to scholars. (C) Results: 190 awardees from across the country responded to the survey. The majority (61%) of respondents were new to GMaP having joined in the last three years. 71.3% were female, and represented diverse racial and ethnic backgrounds (33% were white, 28% Black or African American, 16% Asian) and 31% were of Hispanic or Latino decent. Almost half (42%) were first generation college students. Over one-third (37.2%) stated that they were early stage investigators followed by postdoctoral (22.3%). 60% stated they had received conference and travel support, 19% research stimulus awards, and 25% a pilot project award. A number of respondents indicated they had received a CURE Diversity Supplement or KOI. Comments such as, “I was able to get my dissertation research completed. Funding from GMaP was instrumental to my success”, “I hired an undergrad research assistant from an URM community and we have published 2 papers together”, and “I was able to attend the AACR conference to present my work” highlight the scholars’ perspectives when asked about the impact/value of GMaP. Here, we will present both quantitative and qualitative data from this survey. (D) Conclusions: There is a national priority to increase diversity in the biomedical research workforce, and GMaP supports these efforts through enhancing the capacity of URM cancer and CHDs researchers. The funding opportunities provided by GMaP are highly valued by URM scholars and provide support to building a strong pipeline of diverse scholars. Citation Format: Linda Fleisher, Carrie Norbeck, Miria Kano, Amy Herrera, Emily Kay, Erin Oakley, Z'kera Sims, Cassidy Kenny, Zoe Landau. Evaluation of the NCI’s Geographic Management of Cancer Health Disparities (GMaP) program [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B008.

Abstract IA001: Ending cancer as we know it – for all

Abstract Despite decades of remarkable progress in cancer research, the unfortunate truth is that the benefits of research have not reached all populations equitably. Without adequate representation, especially in therapeutic trials, cancer disparities are likely to increase as racial and ethnic populations, in particular, may not be able to fully benefit from cutting-edge treatments and the promises of precision medicine. In order to end cancer as we know it, it is essential that we advance health equity and ensure that cancer research benefits everyone affected by cancer. This requires more research to understand why disparities persist and how to properly address them, and significant efforts to overcome the structural barriers that have long stood in the way. The National Cancer Institute (NCI) has long been a leader in advancing health equity in cancer research. NCI has a rich and large health disparities portfolio, which includes the work of its Center to Reduce Cancer Health Disparities, a substantial portion of its translational research portfolio and decades of training to empower researchers from diverse populations. In recent years, NCI has expanded its efforts and launched new programs to specifically address diversity, equity and inclusion in cancer research and build a cancer research workforce that reflects the diversity of the communities it serves and produces the best science. The Cancer Moonshot, launched in 2016, has accelerated scientific discovery in cancer, fostered greater collaboration, and improved the sharing of data. In the next phase of the Moonshot, NCI is leveraging the success of the initial Moonshot to further catalyze research progress, with the aim to benefit all patients equitably. Citation Format: Douglas R. Lowy. Ending cancer as we know it – for all [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA001.

The impact of social and environmental factors on cancer biology in Black Americans.

Low socioeconomic status (SES) is associated with early onset of chronic diseases and reduced life expectancy. The involvement of neighborhood-level factors in defining cancer risk and outcomes for marginalized communities has been an active area of research for decades. Yet, the biological processes that underlie the impact of SES on chronic health conditions, such as cancer, remain poorly understood. To date, limited studies have shown that chronic life stress is more prevalent in low SES communities and can affect important molecular processes implicated in tumor biology such as DNA methylation, inflammation, and immune response. Further efforts to elucidate how neighborhood-level factors function physiologically to worsen cancer outcomes for disadvantaged communities are underway. This review provides an overview of the current literature on how socioenvironmental factors within neighborhoods contribute to more aggressive tumor biology, specifically in Black U.S. women and men, including the impact of environmental pollutants, neighborhood deprivation, social isolation, structural racism, and discrimination. We also summarize commonly used methods to measure deprivation, discrimination, and structural racism at the neighborhood-level in cancer health disparities research. Finally, we offer recommendations to adopt a multi-faceted intersectional approach to reduce cancer health disparities and develop effective interventions to promote health equity.

Breast, Colorectal, Lung, Prostate, and Cervical Cancer Screening Prevalence in a Large Commercial and Medicare Advantage Plan, 2008–2020

This study aimed to comprehensively assess breast, colorectal, cervical, lung, and prostate cancer screening rates and trends in the United States over time among individuals for whom screening is recommended by the United States Preventive Services Task Force (USPSTF). This retrospective study was conducted in two-year intervals from January 1, 2008 to February 29, 2020, using Optum’s de-identified Clinformatics® Data Mart Database, which includes Medicare Advantage and commercially insured members. Screening-eligible individuals, who had not previously had the cancer being screened and met USPSTF criteria for screening, were identified at various time points within the study timeframe for relevant screening tests within five cancer types: breast, colorectal, cervical, lung, and prostate. In the 2020 analysis period, patients who were eligible for cancer screening included: breast: 1,620,588; colorectal: 2,763,736; cervical: 1,371,506; lung: 1,491,594; prostate: 1,126,249. Breast and cervical cancer screening prevalence rates were highest (64.4% and 63.8%, respectively), followed by colorectal (29.5%), prostate (11.7%), and lung (3.8%). Black/African American individuals and Hispanics had moderately low screening rates for cervical (58.6%) and breast (61.8%) cancer, respectively; Hispanics had the lowest screening rates for prostate cancer (6.1%). Those residing in the West had lower screening rates for breast (58.9%), cervical (62.1%), and prostate (5.6%) cancer. Screening rates remained stable over time for breast, colorectal, and lung cancer, and changed significantly for cervical (-9.5%, 2012–2020) and prostate (+7.3%, 2008–2020) cancer. Real-world cancer screening rates remain suboptimal and low, and efforts to increase screening uptake and reduce cancer health disparities remain critical.

Cancer Disparities Experienced by People with Disabilities

People with disabilities, who represent a rapidly growing and seriously disadvantaged segment of the U.S. population, face unremitting barriers to equal and accessible healthcare and a high prevalence of chronic health conditions. A slowly growing body of research suggests multiple cancer-related disparities between people with and without disabilities. This commentary identifies multiple aspects of the cancer experience and highlights ways cancer is impacted by disability. This includes vulnerabilities to risk factors, barriers to accessing healthcare, and disparities in screening, diagnosis, and treatment. The authors offer six essential pathways for reducing cancer disparities faced by people with disabilities. It is clear that reducing cancer health disparities experienced by people with disabilities will require the commitment and cooperation of a wide range of stakeholders.