Self-reported Cancer History Research Articles

Relationship Between Fatalistic Cancer Beliefs and Risky Health Behaviors.

There is limited research on how fatalism influences risky health behaviors that are linked to higher cancer risks. This study investigates the relationship between risky health behaviors (tobacco smoking, electronic cigarette use, and heavy alcohol drinking) and fatalistic cancer beliefs while controlling for health care-related self-efficacy and sociodemographic and clinical factors among adults without a history of cancer. We used cross-sectional data from the 2020 Health Information National Trends Survey (HINTS) 5 Cycle 4. The study sample included noninstitutionalized adults (aged ≥18 years without a self-reported cancer history (n = 2464). The outcome variable was risky health behaviors comprised of tobacco smoking, electronic cigarette use, and heavy alcohol drinking. We combined these 3 risky behaviors into a binary variable (0, not having risky health behavior; 1, having ≥1 risky health behavior). The key independent variable was cancer fatalistic beliefs. We used descriptive statistics and multivariate logistic regression analyses. Overall, 50% of the sample were women, 64.7% of participants self-identified as non-Hispanic White, 16.4% as Hispanic, and 10.6% as non-Hispanic Black. About 43% of participants reported having at least one risky health behavior. While holding all other factors constant, each unit increase in cancer fatalism score was associated with 30.0% higher odds of increased risky health behaviors (odds ratio = 1.30, 95% confidence interval 1.04-1.62, P = .021) among adults without a history of cancer. By understanding the relationship between cancer-related fatalistic beliefs and risky health behaviors, cancer prevention outreach programs can be personalized to suit the unique needs of specific individuals and communities.

Association between comorbidity clusters and mortality in patients with cancer: A machine learning analysis of data from the US National Health and Nutrition Examination Survey 1999–2018.

11132 Background: Multimorbidity is common among patients with cancer; however, research on cancer prognosis has predominantly focused on cancers in isolation. This study identified comorbidity clusters among patients with cancer using machine learning and examine their associations with survival outcomes in a nationally representative sample of the US. Methods: This study used 10 survey cycles of the National Health and Nutrition Examination Survey from 1999 to 2018. Participants aged ≥20 years with a self-reported history of cancer were included. Comorbidities were ascertained through self-reports and quantitative measurements. Machine learning techniques, including Bernoulli mixture model and partition-based methods, were used to identify comorbidity clusters. Cox proportional hazards models were used to analyze the associations between comorbidity clusters and mortality outcomes, including all-cause mortality and cause-specific mortality (cancer, cardiovascular disease [CVD], and respiratory diseases), adjusting for relevant covariates. Results: The study included 4,390 participants. Four comorbidity clusters were identified: Low Comorbidity, Metabolic, CVD, and Respiratory. After adjusting for confounders, participants in the Respiratory Cluster had the highest risk of all-cause mortality (adjusted hazard ratio[aHR]=1.62, 95% confidence interval [CI]=1.26-2.08, p<0.001), followed by the CVD Cluster (aHR=1.50, 95%CI = 1.26-1.80, p<0.001) and the Metabolic Cluster (aHR=1.15, 95%CI=1.02-1.29, p=0.03) compared to the Low Comorbidity Cluster. The Metabolic, CVD, and Respiratory clusters were associated with higher risks of cardiovascular disease-related mortality (aHR=1.48-3.05, p<0.003), but no significant differences in cancer mortality were observed among the clusters. The effects of comorbidity clusters on all-cause mortality were modified by income-to-poverty ratio ( p for interaction=0.04), diet quality ( p for interaction=0.02), time since cancer diagnosis ( p for interaction=0.009), and cancer prognosis ( p for interaction=0.005). Conclusions: High comorbidity burden clusters showed increased all-cause and CVD-related mortality. Moreover, diet quality and socioeconomic status modified these associations. Machine learning approaches can provide valuable insights into complex multimorbidity profiles in patients with cancer. Further research is needed to deepen understanding of the relationships between multimorbidity, mortality, and cancer-specific outcomes.

Unintentional weight loss, body composition, and all-cause mortality among United States adults with cancer.

e22527 Background: While unintentional weight loss (UWL) is a common presenting symptom of malignancy, weight changes also occur regularly in patients with diagnosed cancer.UWL is often characterized by considerable muscle and fat loss and can lead to cachexia, which may increase risk of mortality. This nationally representative study aims to assess the association between UWL and mortality among adults with history of cancer and characterize differences in body composition. Methods: This was a retrospective cohort study of the National Health and Nutrition Examination Survey 1999-2018 linked to the 2019 National Death Index. We identified adults with self-reported history of cancer, excluding non-melanoma skin cancer. Weight change was determined as the difference between current weight and self-reported weight 1 year prior to interview. We categorized weight change into: UWL (unintentionally losing > 5% of weight), intention weight loss (IWL) (intentional loss > 5% weight), no weight change (NWC) (≤5% weight change), weight gain (WG) ( > 5% weight gain). We estimated risk of all-cause mortality using gender-stratified multivariable Cox regression, adjusting for demographics (age, race, income, education, insurance status), sociobehavioral factors (smoking, alcohol, nutrition, physical activity, self-reported health), comorbidities, and albumin. We additionally identified participants with cancer who had whole-body dual x-ray absorptiometry scans (2011-2018) and assessed body composition measurements including total lean mass, lean-to-fat ratio, subcutaneous fat mass, and visceral fat mass by weight change category using multivariable linear regression. Results: Among 3,153 participants (mean age 62 years, 55% women, 82% non-Hispanic White), the top four primary cancers were breast (21%), prostate (14%), melanoma (11%), and cervical (11%). Approximately 9% of men and 11% of women experienced UWL. Adults with UWL were more likely to have lower socioeconomic status, more functional limitations, and higher comorbidity burden. Across a median 7 years (IQR, 3-11y) follow-up, 22% of females and 34% of men died. Both men and women experiencing UWL had more than 2 times the risk of all-cause mortality compared to NWC (adjusted HR [95% CI]; men: 2.02 [1.47, 2.78]), women: 2.43 [1.78, 3.34]). Participants with UWL had less subcutaneous fat mass (-113g, 95% CI [-242, 16]) and visceral fat mass (-65g, 95% CI [-146, 16]) compared to NWC, though not statistically significance. Conclusions: UWL in patients with history of cancer is independently associated with more than 2 times the risk of all-cause mortality in both men and women. UWL was associated with proportional loss of both subcutaneous and visceral fat mass. Further longitudinal studies examining UWL’s impact on body composition changes and downstream outcomes by cancer type and stage are needed.

Abstract 1289: Disparities in healthcare utilization and access among female cancer survivors in Maryland

Abstract Background: Healthcare utilization can be defined as how often healthcare is used, through what venue, and if access is available. There are medically vulnerable groups of cancer survivors, such as racial/ethnic minorities and economically disadvantaged populations, that may underutilize healthcare throughout cancer survivorship compared to non-vulnerable groups. Factors associated with survivorship care access/utilization should be evaluated to identify at-risk groups and reduce risk of poor health outcomes. Among female cancer survivors in Maryland, we examined the associations between race/ethnicity, obesity, measures of economic stability, and healthcare utilization-related outcomes (including access to care providers, type of doctor provides majority of care, and unmet health care needs because of cost). Methods: Survey data were analyzed for 1,353 non-Hispanic white (NHW) and 280 non-Hispanic Black (NHB) women with a self-reported history of cancer living in Maryland who completed the Maryland Behavioral Risk Factor Surveillance Survey between 2011-2020. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the associations between independent factors and healthcare utilization outcomes. Results: On average, survivors were 66.8 (standard deviation (SD)=12.8) years of age at time of survey and 53.5 (SD=15.6) years of age at time of cancer diagnosis. Breast cancer was the most common cancer reported (58.9%). While most women reported being retired (50.6%), 30.6% reported being employed and 10% were unemployed. Most women were homeowners (81.5%) and 40.1% had household incomes >$50,000/year. Overall, race/ethnicity was not associated with any of the outcomes. Unemployed survivors (compared to employed) were 3.90 times more likely (95% CI 1.38-11.04, p=0.01) to report not being able to see a doctor because of cost. Survivors who were not homeowners (compared to homeowners) were 0.39 times less likely (95% CI 0.22-0.67, p <0.001) to report having a general/family practitioner for majority of cancer survivorship care. Survivors with household incomes ≤$50,000/year (compared to >$50,000/year) were 2.36 times more likely (95% CI 1.20-4.65, p=0.01) to not have seen a doctor in the past year. Lastly, obese survivors, compared to non-obese, were 0.25 times less likely (95% CI 0.07-0.84, p=0.02) to not have at least one healthcare provider. Conclusions: While race/ethnicity was not associated with healthcare access/utilization, our results do demonstrate various disparities in access to care and healthcare utilization during cancer survivorship by employment status, home ownership, and income. Our findings can inform interventions in collaboration with healthcare providers caring for female cancer survivors to address challenges associated with access to survivorship care among medically underserved survivors in Maryland. Citation Format: Avonne E. Connor, Mu Jin, Kala Visvanathan. Disparities in healthcare utilization and access among female cancer survivors in Maryland [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 1289.

Cardiovascular Disease Incidence and Cardiovascular Health Among Diverse Women With Breast and Gynecologic Cancers.

To examine if racial differences in cardiovascular health (CVH) are associated with cardiovascular disease (CVD) disparities among women with breast and gynecologic cancers. The sample consisted of 252 Black women and 93 White women without a self-reported history of cancer or CVD who developed a breast or gynecologic malignancy. Women who developed CVD before their cancer diagnosis were excluded. CVH was classified using metrics of the American Heart Association's Life's Simple 7 framework. Metrics were summed to create a total CVH score (0-7). Associations among race, ideal CVH (score of 5-7), and CVD incidence following cancer diagnosis were estimated with Cox proportional hazards models. Ideal CVH was similar between Black women (33%) and White women (37%). Race and CVH were not associated with CVD incidence. In a small sample of women diagnosed with breast and gynecologic cancers, racial disparities in CVH and CVD incidence were not observed. Additional investigation of potential confounders relating to social determinants of health tied to the construct of race is warranted.

Multiple Chronic Conditions and the Receipt of Cancer Survivorship Care Plans

Background: Most cancer survivors have multiple chronic conditions (MCC) that make it challenging to navigate disease management processes post cancer treatment. Objective: To examine associations between having MCC and receiving a survivorship care plan (SCP), which has potential benefits for improved follow-up care, among cancer survivors. Methods: Behavioral Risk Factor Surveillance System respondents with a self-reported history of cancer not actively receiving cancer treatment were included (N = 5449). SCP receipt was defined as being provided a written summary of cancer treatments received and instructions for follow-up care upon treatment completion. MCC was categorized as 0, 1, 2, or ≥3 based on a sum of 10 chronic conditions. Multivariable-adjusted logistic models were used to assess the association between MCC and SCP receipt. Results: Most cancer survivors were age 65 or older (59%) and female (58%). Sixty percent reported receiving an SCP and 50% had at least 2 chronic conditions. Compared to those with no chronic conditions, cancer survivors with 2 and 3 or more conditions were less likely to have received an SCP. Conclusions: Professional organizations recommend that cancer survivors receive SCPs; however, having MCC was inversely associated with SCP provision. Implications for Practice: The high necessity for SCPs among cancer survivors with MCC and the potential barriers associated with their delivery should be recognized by healthcare professionals. What is Foundational: This work highlights unmet survivorship care needs in cancer survivors with MCC. The findings emphasize the need to promote greater access to SCPs in healthcare settings that cater to cancer survivors with comorbid conditions.

Comparing Medicare plan selection among beneficiaries with and without a history of cancer.

Individuals aging into Medicare must choose among plans that vary in their scope of benefits, access to health care providers, and exposure to out-of-pocket expenses. When faced with complex coverage decisions, it is unclear whether older adults consider their experiences with prior serious illness or current medical conditions. We estimated the association between a self-reported history of cancer and initial plan selection among 3811 Health and Retirement Study participants aging into Medicare between 2008 and 2020. The proportion of individuals with and without a history of cancer who chose Medicare Advantage was similar; however, the probability of selecting traditional Medicare plus supplemental coverage was 8.03 percentage points (95% confidence interval, 2.99-13.07) higher for respondents with a history of cancer compared with those without a history of cancer. Individuals with a history of cancer may have accounted for their previous experiences with high-cost health care services and prioritized plans with robust benefits (eg, greater financial protections). Raising awareness of and enhancing educational resources could ensure that older adults select plans that meet their current and evolving health care needs.

Association between cytomegalovirus seropositivity and all-cause mortality: An original cohort study.

To examine the association between cytomegalovirus (CMV) seropositivity and all-cause mortality in a nationwide cohort of US adults. We obtained data from the National Health and Nutrition Examination Survey III (1988-1994), including 16,547 participants aged 18-90 years old with CMV serology assessments. Mortality status was ascertained until December 2019 using the National Death Index linkage data. The Cox proportional hazard model was applied to estimate the association between CMV seropositivity and mortality. During a median follow-up of 26.3 years, 6,930 deaths were recorded. CMV seropositivity was associated with a higher hazard of all-cause mortality after adjusting for attained age, sex, and ethnicity (HR: 1.22, 95% CI: 1.10, 1.36, p < 0.001). The magnitude of the association attenuated slightly after adjusting further for body mass index, family income, smoking status, diabetes, and self-reported cancer history (HR = 1.11, 95% CI: 1.00, 1.23, p = 0.04). While the association was observed for both men and women, it was only statistically significant among non-Hispanic white people (HR: 1.16, 95% CI: 1.06, 1.26, p = 0.001) but not among other ethnic populations. CMV seropositivity might be an independent risk factor for all-cause mortality among US adults. If the findings are validated in an independent population, further research is needed to unveil the biological mechanisms driving the increased mortality with CMV seropositivity.

Racial disparities in receipt of survivorship care plans among female cancer survivors in Maryland

BackgroundWith the increasing number of cancer survivors in the US, survivorship care plans (SCP) have been promoted to improve survivorship outcomes for cancer patients. Few studies have assessed if the receipt of SCPs differs by race/ethnicity. This study evaluated if racial/ethnic disparities exist in SCP receipt among female cancer survivors living in Maryland.MethodsSurvey data were analyzed for 1,353 non-Hispanic white (NHW) and 280 non-Hispanic Black (NHB) women with a self-reported history of cancer living in Maryland who completed the Maryland Behavioral Risk Factor Surveillance Survey (BRFSS) between 2011 and 2020. Multivariable logistic regression models were used to estimate prevalence odds ratios (PORs) and 95% confidence intervals (CI) for SCP receipt by race/ethnicity. Models were further stratified by demographic, cancer-related, and lifestyle factors to examine effect modification.ResultsOn average, survivors were 66.8 years of age at time of BRFSS survey and 53.5 years of age at time of cancer diagnosis. Compared with NHW survivors, NHB survivors reported higher odds of receiving a summary of cancer treatments (POR = 3.81, 95% CI: 2.27, 6.39), instructions from a doctor for follow-up check-ups (POR = 2.10, 95% CI: 1.00, 4.39), and written or printed instructions (POR = 4.74, 95% CI: 2.12, 10.61). Age at survey (&amp;lt;65 years vs. ≥65 years) (p-interaction term = 0.01) and income level (≤50k vs. &amp;gt;50k) (p-interaction term = 0.04) significantly modified the relationship between race/ethnicity and receiving SCPs.ConclusionOur findings indicate that NHB female cancer survivors in Maryland are more likely to receive SCP information compared to NHW survivors and this association is significantly modified by age at survey and income level. More research is needed at the patient-provider level to gain a better understanding of the impact of SCP delivery to minority cancer populations.

Impact of smoking status on health-related quality of life (HRQoL) in cancer survivors.

The Health-Related Quality of Life (HRQoL) often declines among cancer survivors due to many factors. Some cancer patients who smoke before the cancer diagnosis continue this harmful habit, potentially contributing to a more significant decline in their HRQoL. Therefore, this study investigates the association between smoking status and HRQoL in cancer survivors. We conducted a cross-sectional study utilizing self-reported cancer history from 39,578 participants of the Behavioral Risk Factor Surveillance System (BRFSS) database, leveraging 2016 and 2020 year questionaries. A multidimensional composite outcome was created to assess HRQoL, integrating four distinct dimensions - general health, mental health, physical health, and activity limitations. After accounting for the complex survey design, logistic regression models were used to analyze the association between smoking status and poor HRQoL, adjusting for demographic, socioeconomic, and health-related confounders. Our study found that, after adjusting for potential confounders, current smokers exhibited a significantly poorer HRQoL than never smokers (OR 1.65, 95%CI 1.40-1.93). Furthermore, former smokers showed a poorer HRQoL than never smokers; however, this association was not as strong as current smokers (OR 1.22, 95%CI 1.09-1.38). Our findings highlight the adverse association of smoking with poor HRQoL in cancer survivors, underscoring the importance of healthcare professionals prioritizing smoking cessation and providing tailored interventions to support this goal.

Non-syndromic supernumerary teeth and association with aself-reported family history of cancer.

Supernumerary teeth are an alteration of dental developmental and result in the formation of teeth above the usual number. Epidemiologic studies suggested that patients with dentofacial anomalies and their family members may present an increased risk of developing cancer, including female breast cancer and gynecologic cancers. These observations indicate that genetic alterations that result in dental anomalies may be related to cancer development. Thus, the aim of the present study was to evaluate the association between supernumerary teeth and afamily history of female breast cancer and gynecologic cancers. The diagnosis of supernumerary teeth was based on clinical and radiographic examinations. For data collection, aquestionnaire asking for information regarding ethnicity, age, gender, and self-reported family history of cancer up to the second generation was used. Statistical analysis was performed using the Χ2 test and Fisher's exact test with an established α of 5%. Atotal of 344 patients were included; 47 of them had one or more non-syndromic supernumerary teeth (not associated with any syndrome or cleft lip and palate) and 297 were control patients. Age, ethnicity, and gender distribution were not statistically different between the group with supernumerary teeth and the control group (p > 0.05). The supernumerary teeth were most commonly observed in the incisors area. Breast cancer (n = 17) was the most commonly self-reported type of cancer, followed by uterine cervical (n = 10), endometrial (n = 2), and ovarian (n = 1) cancers. Endometrial cancer was significantly associated with the diagnosis of supernumerary teeth (p = 0.017). This study suggests that patients with supernumerary teeth possess ahigher risk of having family members with endometrial cancer.

Influence of family history on penetrance of hereditary cancers in a population setting

We sought to investigate how penetrance of familial cancer syndromes varies with family history using a population-based cohort. We analysed 454,712 UK Biobank participants with exome sequence and clinical data (data collected between March 2006 and June 2021). We identified participants with a self-reported family history of breast or colorectal cancer and a pathogenic/likely pathogenic variant in the major genes responsible for hereditary breast cancer or Lynch syndrome. We calculated survival to cancer diagnosis (controlled for sex, death, recruitment centre, screening and prophylactic surgery). Women with a pathogenic BRCA1 or BRCA2 variant had an increased risk of breast cancer that was higher in those with a first-degree family history (relative hazard 10.3 and 7.8, respectively) than those without (7.2 and 4.7). Penetrance to age 60 was also higher in those with a family history (44.7%, CI 32.2-59.3 and 24.1%, CI 17.5-32.6) versus those without (22.8%, CI 15.9-32.0 and 17.9%, CI 13.8-23.0). A similar pattern was seen in Lynch syndrome: individuals with a pathogenic MLH1, MSH2 or MSH6 variant had an increased risk of colorectal cancer that was significantly higher in those with a family history (relative hazard 35.6, 48.0 and 9.9) than those without (13.0, 15.4 and 7.2). Penetrance to age 60 was also higher for carriers of a pathogenic MLH1 or MSH2 variant in those with a family history (30.9%, CI 18.1-49.3 and 38.3%, CI 21.5-61.8) versus those without (20.5% CI 9.6-40.5 and 8.3% CI 2.1-30.4), but not for MSH6 (6.5% CI 2.7-15.1 with family history versus 8.3%, CI 5.1-13.2). Relative risk increases were also observed both within and across conditions. Individuals with pathogenic cancer syndrome variants may be at a less elevated risk of cancer in the absence of a first-degree family history, so in the context of results return, family history should be considered when counselling patients on the risks and benefits of potential follow-up care. The current work is supported by the MRC (grant no MR/T00200X/1). The MRC had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Variations in the agreement of self-reported cancer: A Danish nationwide study.

Previous studies show that the agreement between self-reported and registry-documented diseases varies across diseases. Few studies have addressed these challenges across site-specific cancer diagnoses. The present study aimed to examine the sensitivity and negative predictive value (NPV) of self-reported cancer in a Danish nationwide survey among adults aged ≥16 years, using registry data as the criterion standard. Moreover, the influence of sociodemographic variables and time since diagnosis on sensitivity was explored using multiple logistic regression models. Self-reported data on cancer history of any site were derived from the Danish National Health Survey 2017 (n = 183 372). Individual-level survey data were linked to data from the Danish Cancer Registry on 10 site-specific cancer diagnoses. NPV was consistently high ≥99.5% across the included cancer diagnoses. In contrast, sensitivity varied greatly and was lowest for cancer in brain/central nervous system (CNS) among both men (25.6%) and women (23.9%) and highest for rectal cancer among men (96.9%) and for breast cancer among women (98.9%). Sensitivity was also relatively low for nonmelanoma skin cancer (41.4% among men; 44.6% among women) and urinary tract cancer (60.0% among men; 60.4% among women). When restricting diagnostic definitions for cancer in brain/CNS and urinary tract cancer to include only malignant neoplasms, sensitivity increased. For several cancer diagnoses, sensitivity decreased with increasing age and lower educational level, whereas conflicting results were observed for time from diagnosis to self-report. Future studies are encouraged to use self-reported cancer history data with caution and for example, include questions on only site-specific cancer diagnoses with high sensitivity.

Association of Medicare Program Type with Health Care Access, Utilization, and Affordability among Cancer Survivors.

The Medicare Advantage program provides care to nearly half of Medicare beneficiaries, including a rapidly growing population of cancer survivors. Despite its increased adoption, it is still unknown whether or not the program improves healthcare access, outcomes, and affordability for cancer survivors. We performed a cross-sectional study of Medicare beneficiaries aged ≥ 65 years with a self-reported history of cancer from the 2019 National Health Interview Survey. We used multivariable logistic regression to evaluate the association between Medicare program type (Medicare Advantage vs. traditional Medicare) and measures of healthcare access, acute care utilization, and affordability. We identified 4451 beneficiaries with a history of cancer, corresponding to 26.6 million weighted cancer survivors in 2019. Of the beneficiaries, 35.8% were enrolled in Medicare Advantage, whereas 64.2% were enrolled in traditional Medicare. The age, sex, racial and ethnic composition, household income, primary site of cancer, and comorbidity burden of Medicare Advantage and traditional Medicare beneficiaries were similar. In the adjusted analysis, there were no differences in healthcare access or acute care utilization between traditional Medicare and Medicare Advantage beneficiaries. However, cancer survivors enrolled in Medicare Advantage were more likely to worry about (34.3% vs. 29.4%; aOR, 1.3 (95% CI, 1.1-1.5)) or have problems paying (13.6% vs. 11.1%; aOR, 1.4 (95% CI, 1.1-1.8)) medical bills. We found no evidence that Medicare Advantage beneficiaries with cancer had better healthcare access, affordability, or acute care utilization than traditional Medicare beneficiaries did. Furthermore, Medicare Advantage beneficiaries were more likely to report financial strain and have difficulty paying for their medical bills than were those with traditional Medicare. Despite the generous benefits and attractive incentives, Medicare Advantage plans may not be more cost-effective than traditional Medicare is for cancer survivors. Our study informs ongoing congressional deliberations to re-evaluate the role of Medicare Advantage in promoting equity among beneficiaries with cancer.

Is Medicare Advantage associated with more favorable health care access, acute care utilization, and affordability among beneficiaries with cancer?

1597 Background: The Medicare Advantage (MA) program provides care to nearly half of Medicare beneficiaries, including a rapidly growing population of cancer survivors. Although MA was designed to optimize healthcare access, outcomes, and affordability, it is unknown whether these effects have been achieved in cancer survivors. Methods: We performed a cross-sectional study of Medicare beneficiaries ≥65 years with a self-reported history of cancer in the 2019 National Health Interview Survey. We used multivariable logistic regression to evaluate the association between Medicare program type (MA vs traditional Medicare, TM) and measures of healthcare access, acute care utilization, and affordability. Results: We identified 4,451 beneficiaries with a history of cancer, corresponding to 26.6 million weighted cancer survivors in 2019. Of beneficiaries, 35.8% were enrolled in MA while 64.2% were enrolled in TM. The age, sex, racial and ethnic composition, household income, primary site of cancer, and co-morbidity burden of MA and TM beneficiaries were similar. In adjusted analysis, there were no differences in health care access or acute care utilization between TM and MA beneficiaries. However, survivors enrolled in MA were more likely to worry about (34.3% vs 29.4%; aOR, 1.3 [95% CI, 1.1-1.5]) or have problems paying (13.6% vs 11.1%; aOR, 1.4 [95% CI, 1.1-1.8]) medical bills. Conclusions: MA beneficiaries with a previous cancer diagnosis more often struggle paying medical bills despite similar healthcare access and preventive care as TM. Despite generous benefits and attractive incentives for care coordination and health management, privately run MA plans may not be more cost-effective than TM for cancer survivors. Our study informs ongoing congressional deliberations to re-evaluate the role of MA in promoting equity among beneficiaries.[Table: see text]

Evaluating differences in cancer survivorship care plans experienced by cancer survivors with disabilities.

e18597 Background: Survivorship Care Plans (SCPs) are crucial elements for short- and long-term follow-up care among cancer survivors and have been endorsed by leading oncologic organizations. Yet, limited research exists about the receipt of SCPs among survivors with disabilities who may face additional barriers to access the health care services. Our study examines the association between the disability status and receipt of SCPs after completion of cancer treatment among US adult cancer survivors. Methods: This secondary analysis included cross-sectional, nationally representative, population-based data from the 2021 Behavioral Risk Factor Surveillance System. We included 2110 respondents (aged ≥ 18 years) who self-reported cancer history (other than skin cancer). Outcomes were self-reported receipt of cancer treatment summaries and follow-up care instructions after completion of the cancer treatment. The independent variable was disability status, comprised of six specific disability types (having serious difficulty with hearing, vision, cognition, mobility, self-care, and independent living). We combined disability status into four groups—as having 1) no disability; 2) one disability; 3) two disabilities; and 4) three or more disabilities. We applied recommended sample weights and conducted weighted descriptive statistics and multivariable logistic regression adjusting for self-reported individual-level factors (age, sex, race, marital status, education, health insurance, provider type who provided majority of the care). Results: Overall, 4.2% self-reported as Black, 19.5% Hispanic, 70.0% White, 59.5% women, and 54.5% aged 65+ years. A total of 20.8% of participants reported having one disability, 11.1% two disabilities, and 11.7% reported three or more disabilities. Mobility disability was the most prevalent disability type (27.0%), followed by cognition (14.8%), independent living (14.5%), hearing (12.7%), vision (9.2%), and self-care (6.5%). About 18.0% did not receive follow-up care instructions, and 41.7% did not receive treatment summaries. Overall, 52.8% of survivors reported receiving both follow-up care instructions and treatment summaries. Survivors with three or more disabilities were 0.40 (95% CI 0.27-0.88, p = 0.019) times significantly less likely to report receiving follow-up care instructions than survivors without disabilities. Survivors’ disability status was not significantly associated with reporting the receipt of cancer treatment summaries. Conclusions: Nearly half of the survivors did not receive SCP upon treatment completion, which may lead to poor treatment adherence and deterioration of health. Our findings suggest disparities in follow-up instructions based on disability status, especially for people with multiple disabilities. Effective strategies are necessary to build more equitable cancer survivorship care.

The role of financial security in loneliness or sadness among Medicare-enrolled cancer survivors during the COVID-19 pandemic

IntroductionThis study aims to estimate the relative decreased rate of financial security and increased rate of loneliness or sadness during the COVID-19 pandemic and investigate the association between financial security and loneliness or sadness among Medicare beneficiaries with a cancer history. Material and MethodsWe examined population-based, cross-sectional data from the Medicare Current Beneficiary Survey COVID-19 Winter 2021 survey. The study cohort included 1,632 Medicare beneficiaries (aged ≥65 years) with self-reported cancer history. The outcome was feelings of loneliness or sadness, and the independent variable was financial security during the 2020–2021 winter surge of COVID-19. We conducted weighted descriptive statistics, a cross-tabulation analysis, and multivariable logistic regression analyses. ResultsOverall, 18.8% of cancer survivors reported increased feelings of loneliness or sadness and 11.2% reported decreased financial security during the 2020–2021 winter surge of COVID-19. Cancer survivors who reported decreased financial security had 93% higher odds of increased feelings of loneliness or sadness compared to those who reported feeling more or about the same financial security (Adjusted odds ratio [AOR] = 1.93; 95% Confidence Interval [CI] 1.25–3.01; p <0.004). DiscussionDecreased financial security and increased feelings of loneliness or sadness were prevalent among cancer survivors. Additional screenings and interventions beyond what are currently available are needed to ease the socioeconomic vulnerabilities experienced by cancer survivors.

Racial and ethnic disparities in the perception of respect from physicians among skin cancer patients in the United States

Racial and ethnic minority groups are at increased risk of poor skin cancer outcomes. Successful patient-physician communication is linked to better health outcomes, but it is unknown whether disparities in perceived care exist among skin cancer patients. To investigate whether there are racial and ethnic disparities in the perception of physicians showing respect, listening, and explaining during clinical encounters. A cross-sectional study was conducted using data from participants with a self-reported skin cancer history from the 2008 to 2017 and 2019 Medical Expenditure Panel Survey. Race and ethnicity were self-identified. Of 5570 participants, 5263 were non-Hispanic White and 307 were racial and ethnic minority individuals. Racial and ethnic minority participants were less likely to report that their doctors show them respect, listen to, and explain to them than non-Hispanic White participants, even when adjusting for age, sex, insurance type, health status, and survey year. Among racial and ethnic minority participants, perceptions of physicians listening and explaining were strongly associated with perceived respect. Lack of disaggregated racial and ethnic subgroup analysis. Our findings suggest racial and ethnic disparities in perceived care among skin cancer patients. Future research is warranted to determine whether such perceptions contribute to disparities in skin cancer care and/or outcomes.

Abstract B116: Cognitive performance and cognitive decline following cancer among middle-aged and older adults in the study of Latinos-investigation of neurocognitive aging and HCHS/SOL

Abstract BACKGROUND: Cognitive impairment is a frequently reported side-effect of cancer therapies affecting attention, concentration, memory, and executive function. However, the long-term impacts of cancer and its treatments on cognitive function and cognitive decline in Hispanics/Latinos is unknown. Herein, we examined the associations between a self-reported history of cancer and cognitive test performance cross-sectionally and longitudinally among middle-aged and older Hispanic/Latino adults. METHODS: Participants included 9,639 Hispanic/Latino adults [mean age=56.4 (SE=0.14); 54.7% female] of diverse backgrounds [30.8% Mexican, 27.2% Cuban, and 18.1% Puerto Rican; 10.0% Central American; 9.0% Dominican; and 7% South American] from the population-based, prospective, multi-site Hispanic Community Health Study/Study of Latinos. At enrollment in 2008-2011 (Visit 1), participants self-reported their history of cancer (yes/no) and cancer site(s). Cognitive function was assessed at Visit 1 and again at a 7-year follow-up assessment (Visit 2) using the Brief-Spanish English Verbal Learning Test (BSEVLT-Sum, episodic learning; and BSEVLT-Recall, memory), the Word Fluency Test (WF, verbal fluency), and the Digit Symbol Substitution Test (DSS, processing speed and executive functioning) via the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA). Changes in cognitive test performance were calculated using survey linear regression models predicting cognitive performance at Visit 2 as a function of Visit 1 cognitive performance with adjustment for time between assessments. Test scores/changes in tests scores were standardized and averaged as composites of global cognition/cognitive change. We used survey linear regression models to estimate the adjusted associations between history of cancer and baseline and longitudinal cognitive test performance. We examined these associations overall and by sex and for the most prevalent sex-specific cancers [i.e., cervical (n=121), breast (n=115), uterine (n=67), and prostate (n=48) cancers]. RESULTS: Cross-sectionally, a history of cancer (n=546) versus no history of cancer (n=9,093) was associated with higher WF scores (β=0.13, SE=0.06; P=0.03) and global cognition (β=0.08, SE=0.04; P=0.06) among all participants overall. Among men, but not among women, a history of cancer was associated with longitudinal increases in SEVLT-Sum (β=0.29, SE=0.14; P=0.04; PInteraction=0.04), and SEVLT-Recall (β=0.36, SE=0.15; P=0.02; PInteraction=0.01) scores. Among women, a history of cervical cancer was associated with longitudinal decreases in SEVLT-Recall scores (β=-0.30, SE=0.13; P=0.03) and among men, a history of prostate cancer was associated with higher baseline WF scores (β=0.29, SE=0.12; P=0.02). CONCLUSION: Cancer or its treatments may influence long-term cognition among Hispanics/Latino cancer survivors. The potential impacts of cancer or cancer treatment on cognition may vary by sex or cancer type. Citation Format: Humberto Parada Jr., Margaret Pichardo, Linda C. Gallo, Frank J. Penedo, David J. Lee, Gregory A. Talavera, Hector M. Gonzalez. Cognitive performance and cognitive decline following cancer among middle-aged and older adults in the study of Latinos-investigation of neurocognitive aging and HCHS/SOL [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 B116.

Association between social connectedness and stress or anxiety among older cancer survivors during the 2020–2021 winter surge of the COVID-19 pandemic

IntroductionOur goal was to estimate a relative decreased rate of social connectedness to family and friends, increased rate of stress or anxiety during the 2020–2021 winter surge of the COVID-19 pandemic, and investigate the association between social connectedness and stress or anxiety among a nationally representative sample of older adults with cancer history. Materials and MethodsWe used population-based, nationally representative cross-sectional data from the Medicare Current Beneficiary Survey COVID-19 Winter 2021 Community Supplement. The study cohort included community-living Medicare beneficiaries aged 65 years and older who self-reported cancer history (other than skin cancer) (n = 1650). Sample weights were applied to account for the complex survey design, with results generalizable to 8.5 million Medicare beneficiaries with cancer history. The outcome was self-reported feelings of stress or anxiety during the 2020–2021 winter surge of the COVID-19 pandemic. The independent variable was social connectedness, defined as feeling less socially connected to family and friends during the 2020–2021 winter surge of the COVID-19 pandemic. We conducted weighted descriptive statistics and multivariable logistic regression analyses. ResultsOverall, 42.5% of beneficiaries reported decreased social connectedness to family and friends, and 37.8% reported increased feelings of stress or anxiety during the 2020–2021 winter surge of the COVID-19 pandemic. After adjusting for all covariates, participants who reported decreased social connectedness had 154% higher odds of increased feelings of stress or anxiety (adjusted odds ratio [AOD] = 2.54, 95% confidence interval [CI] = 2.00–3.20, p ≤0.001) compared to those who reported more or about the same social connectedness to family and friends. The odds of increased feelings of stress or anxiety were also higher for those who self-reported as Hispanic vs. non-Hispanic White beneficiaries (AOR = 1.35, 95% CI = 1.10–1.73, p = .016), women vs. men (AOR = 1.85, 95%CI = 1.43–2.38, p ≤0.001), and those who reported depression history vs. not reporting depression history (AOR = 2.55, 95% CI = 1.86–3.48, p ≤0.000). DiscussionAn estimated 3.6 million older adults with cancer history reported decreased social connectedness to family and friends, and 3.2 million reported increased feelings of stress or anxiety during the 2020–2021 winter surge of the COVID-19 pandemic. Identifying these adults and referring them to appropriate supportive care resources and services are essential to help them cope with negative feelings.