Social Determinants Research Articles

Sexual Abuse, Commercial Sexual Exploitation, and Cumulative Adversity Among Sexually Diverse and Non-Sexually Diverse Girls in the Juvenile Justice System

ABSTRACT Despite awareness about high rates of sexual abuse among girls in the juvenile justice system, little is known about the additional risk conferred upon sexually diverse (SD) youths, as well as the combined vulnerability of sexual abuse and commercial sexual exploitation of children (CSEC) – frequently a survival behavior amplifying disproportionate juvenile justice contact among SD and non-SD juvenile justice-involved (JJI) girls. In a sample of JJI-girls, we compared SD (n = 52) with non-SD (n = 46) JJI-girls on sexual victimization (e.g. sexual abuse occurring within different relationship-types, CSEC), and broader developmental adversity burden disadvantage (cumulative trauma/loss exposure-types) and distress (posttraumatic stress disorder [PTSD]; cumulative stressor-reactivity, grief-specific, and adversity-related symptoms), health distress/impairment, and sexual and physical health-risk indicators. While comparable on childhood sexual abuse frequency, SD JJI-girls reported greater cumulative sexual abuse severity across relationship-types, higher sexual abuse within non-familial contexts, and more CSEC involvement. They also reported more social determinants of health (e.g. trauma/loss exposure-types) and showed elevations on all health-risk indicators, and most cumulative adversity burden indicators, despite comparable PTSD severity. Our findings emphasize the need to consider multiple sexual victimization facets, including the combined vulnerability of sexual abuse and CSEC, and utilize cumulative developmental assessment approaches among youths vulnerable to maltreatment and exploitation.

Abstract A017: Social, behavioral and clinical risk factors are associated with clonal hematopoiesis

Abstract A017: Social, behavioral and clinical risk factors are associated with clonal hematopoiesis

Abstract A100: Addressing financial toxicity and associated social determinants among Hispanic cancer patients in Puerto Rico

Abstract A100: Addressing financial toxicity and associated social determinants among Hispanic cancer patients in Puerto Rico

Abstract A006: Disparities, social determinants of health, and ovarian cancer: predicting ovarian cancer using sociodemographic information and comorbidities as risk factors

Abstract A006: Disparities, social determinants of health, and ovarian cancer: predicting ovarian cancer using sociodemographic information and comorbidities as risk factors

Abstract B117: HT Helper Study: A phone application + patient navigation to improve medication adherence among Latina breast cancer patients experiencing social determinants of health

Abstract Background: Hormone therapy (HT) is highly effective for nearly all breast cancer patients with hormone receptor-positive tumors, which are about 80% of all breast cancer diagnoses. Long-term use of HT reduces cancer recurrence rates and cuts the risk of mortality nearly in half during the second decade after diagnosis. Despite proven benefits, 33% of women who are prescribed HT do not take it as prescribed by their doctor (<80% take their daily dosage). Latina patients are disproportionately affected by Social Determinants of Health (SDoH) that keep them from adhering to HT and are at higher risk of breast cancer recurrence and mortality. Objective: The goal of this 4-year randomized controlled study is to assess the effectiveness of the existing bilingual, culturally tailored, interactive HT Helper App, in combination with patient navigation (PN), on improving adherence to HT among Latina breast cancer patients experiencing SDoH barriers, i.e., income, health insurance, education, health literacy, and language, that impacts their medication adherence. This theory-based intervention will increase patient education, enhance self-efficacy, facilitate communication with the medical team and coordination of resources to address SDoH barriers and help patients develop self-care skills for optimal adherence to HT, ensuring patients the most equitable treatment outcomes possible, including improvement in quality of life, survival, and life expectancy. Study Design. The proposed study involves a parallel 3-group randomized controlled trial with 5-time assessments (baseline, 3, 6, 12, and 18 months) and will enroll 159 breast cancer patients who are prescribed HT and are attending the breast clinic at the Mays Cancer Center at UT Health San Antonio. Intervention components are based on Social Cognitive Theory and elements of Motivational Interviewing. Methods: We will compare the effectiveness of 3 groups on HT adherence: 1) the HT Helper App + PN group vs. the PN alone group vs. the usual care group, and will assess the effect of each study condition on patient self-efficacy to identify side effects, use self-care to manage side effects, and communicate with the medical team. We hypothesize that the HT Helper App + PN and the PN alone groups will have greater rates of HT adherence and higher patient self-efficacy than the usual care group, with the HT Helper App + PN achieving better results than both PN alone and the usual care groups. Conclusion: This proposed multi-level intervention involving a unique combination of mHealth technology + PN has the potential to improve adherence to HT by addressing SDoH and promote equitable breast cancer outcomes, including reduced recurrence and improved quality of life, overall survival and life expectancy among underserved Latina patients. The anticipated outcome is a scalable, evidence-based, and easily disseminated intervention with potentially broad use to patients using oral anticancer medications. Citation Format: Patricia Chalela, Vivian Cortez, Sandra Sivak, Armida Flores, Martha De La Mora, Zully Garcia, Byeongyeob Choi, Edgar Muñoz, Qurathul Ahmed, Audrey Cordova, Maria I Sung-Cuadrado, Asra Aslam, Cliff Despres, Alyssa Gonzales, Virginia G Kaklamani, Kate I. Lathrop, Marcela Mazo Canola, Devasena Inupakutika, David Akopian, Amelie G. Ramirez. HT Helper Study: A phone application + patient navigation to improve medication adherence among Latina breast cancer patients experiencing social determinants of health [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B117.

Abstract B150: Social determinants of health and comorbidities increasing inflammation cytokines related to breast cancer in African American and Latinx women

Abstract Introduction: Comorbidities such as obesity, Type-2 diabetes (T2D), and hypertension (HTN) are highly prevalent among under-resourced African Americans (AA) and Latinx, and they are associated with breast cancer (BC) risks and outcomes. Social determinants of health (SDOH) also have been found related to BC incidence, stage, and survival. In addition, elevated inflammatory cytokines may be an underlying factor in comorbidities that contribute to tumorigenesis and adverse cancer outcomes. Limited research has been conducted to explore the process and associations among SDOH, comorbidities, and inflammation cytokines related to BC. The purpose of this study was to fill this research gap using a sample recruited from AA and Latinx communities. Methods: This was a cross-sectional study conducted in South LA. A total of 570 AA and Latinx women with or without BC were recruited. A panel of 19 cytokines from serum samples were measured by Luminex assay. Demographic information, body mass index, comorbidities, and diagnosis/stage of BC were collected from patients’ medical records. SDOH factors were selected from the social vulnerability index (e.g., percentage of persons in poverty, unemployed, with no high school diploma) obtained through Geographic Information Systems. Chi-square tests, independent sample Mann-Whitney U tests, and Cox regression were employed to examine the associations between BC diagnosis/stages, comorbidities, and cytokines. Path analyses were adopted to further explore the associations between SDOH, comorbidities, and cytokines. Results: Among the 570 women, 45.79% had a diagnosis of BC. Over half (50.97%) had ER/PR+, HER2-, and 27.80% had triple negative BC. Results from Chi-square tests showed that a higher percentage of women with obesity (p=.001), HTN (p<.0001), and T2D (p=.024) had a BC diagnosis than those without the comorbidity. Women with obesity had significantly higher levels of Leptin, VEGFα, and MIP1b; women with HTN had significantly higher levels of VEGFα and MIP1b; and women with T2D had significantly higher levels of Leptin and TGFβ1/β2. Leptin was found significantly higher in ER/PR+ BC (p<.0001) and VEGFα was significantly higher in triple negative BC (p=.001). Increasing VEGFα and TGFβ1/β2 reduced BC disease-free survival significantly. The path model showed community poverty and education level did not affect TGFβ1/β2 directly but were indirectly associated with them through obesity and T2D status (p<.01). Community poverty level was indirectly associated with the level of MIP1b through HTN status (p<.01). Conclusions: To eliminate breast cancer disparities, effective interventions are needed that account for the social and community contexts in which women live and are treated. Interventions that target comorbidities of T2D, HTN, and obesity are important to reduce the disparities. Citation Format: Weizhou Tang, Yanyuan Wu, Jaydutt Vadgama. Social determinants of health and comorbidities increasing inflammation cytokines related to breast cancer in African American and Latinx women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B150.

Abstract B067: A mixed-methods health services analysis of disparities and social vulnerabilities in childhood cancer survivors’ long-term follow-up care

Abstract Pediatric cancer affects >15,000 US children annually. Treatment advances have led to an increase in those surviving the disease, and these patients must be managed to control their long-term comorbidities. Unfortunately, a majority are nonadherent to post-treatment care guidelines and become lost to follow-up. This is especially true for those from underserved backgrounds, including survivors who are Black and Latine. To help understand this disparity, we studied the organization and delivery of pediatric cancer survivorship care at an urban comprehensive cancer center. Research included: 1) a qualitative study exploring healthcare barriers and facilitators of survivors’ adherence to long-term follow-up care, as determined by N=31 key informants (pediatric oncology care providers, administrators), and; 2) a retrospective cohort study (2007- 2020) among N>350 survivors (10% Black, 28% Latine, 12% Asian; 47% from vulnerable neighborhoods) assessing social determinants of health (SDoH) and its cofactors, adjusted for vital status. Interviews were recorded, transcribed, and thematically analyzed using software (K>.70). Three major themes emerged in survivors’ adherence: 1) healthcare system-level influences (69%), SDoH (25%), and intra/interpersonal factors (16%). At the system-level, informants noted opportunities to strengthen adherence, especially for survivors from underserved backgrounds, including the provision of greater social support (14%), easing appointment scheduling (11%), offering high-quality ambulatory and specialty care within the system upon entering young adulthood (12%), and cultural competency training for staff (6%). Among SDoH, informants noted transportation and geographic challenges in accessing the healthcare system (25%), insurance coverage for follow-up care (17%), and strengthening trust with marginalized communities (17%). For intra/interpersonal factors, time- and age-related changes in survivors’ medical needs were acknowledged as barriers to be overcome (28%), along with providing greater patient education (11%) and heightened salience of follow-up care (17%). Conversely, the provider-patient relationship was noted as a strength in promoting adherence (23%). Retrospective cohort results revealed that survivors’ attendance at dedicated clinics was suboptimal (52% >= 2 years off-therapy), as were rates of system-wide ambulatory care encounters 3+ and 5+ years post-therapy. At the bivariate level, non-Hispanic Black survivors (68%), adolescents (58%), and those with CNS tumors (81%) had the lowest likelihood of survivorship clinic attendance (p<.05)–underscoring qualitative findings on SDoH. Area-level SDoH indices were unrelated to the cohort’s adherence, highlighting qualitative findings on intra/interpersonal barriers and facilitators. These data lend insights into transformations possible within the organization and delivery of healthcare to young survivors, especially those from underrepresented backgrounds, including greater attention to SDoH and strengthening cultural competence among health system employees. Citation Format: Marcelo Sleiman Jr, Tara Suntum, Nina Kadan-Lottick, Brianna Miller, Mary R Yockel, Arnold Potosky, Chiranjeev Dash, Adil Alaoui, Burton Appel, Ken Tercyak. A mixed-methods health services analysis of disparities and social vulnerabilities in childhood cancer survivors’ long-term follow-up care [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B067.

Abstract A104: EpiTracker Cancer: A new webtool to visualize disparities in cancer death rates across demographics and county-level characteristics

Abstract There are known disparities in cancer death rates in the U.S. by demographic, geographic and socioeconomic factors. While there are several widely available webtools to visualize U.S. cancer death rates, none allow for direct comparison of cancer death rates across county-level measures of social determinants of health. The National Cancer Institute has developed a new webtool, EpiTracker Cancer (https://episphere.github.io/epitracker), to allow for customizable visualization of cancer death rates across geography, demographics and county-level characteristics. Cancer death data and decedent race (i.e., American Indian and Alaska Native, Asian, Black, Native Hawaiian and Pacific Islander, White), ethnicity (Hispanic, non-Hispanic), sex, age and county of residence were ascertained from the National Center for Health Statistics (NCHS) death certificate data for 2018-2022. Counts and rates based on <10 deaths are suppressed per NCHS policy. Population data were abstracted from the U.S. Census. County-level characteristics were derived from multiple sources, and include metrics of socioeconomic status (e.g., median income, proportion with a college degree), health status (e.g., proportion who smoke, proportion who are obese), and healthcare access and utilization (e.g., proportion uninsured, proportion of women who have had a mammogram). EpiTracker Cancer is comprised of three main pages, each featuring a different type of visualization. The first page displays bar charts of age-standardized or crude death rates by cancer type, sex, race, ethnicity and age group. The second displays maps of cancer death rates at the county, state and national level. Users can generate national, state and county-level maps for each cause of cancer death that can be compared by race, ethnicity and sex, and can control how outlying rates are handled. The final visualization plots cancer death rates across quartiles, quintiles or deciles of county- level characteristics. The user can choose to display rate ratios comparing to either the highest or lowest quantile of the county-level metric. As an example, a user could visualize the association between county-level education, measured by the fraction of adults with at least some college education, and lung cancer mortality. Compared to counties in the highest quintile of educational attainment, those in the lowest quintile have lung cancer age-adjusted death rates that are 1.77- times (95%CI 1.72-1.82) higher among men and 1.56-times (95%CI 1.51-1.61) higher in women. Future iterations will include more county-level variables, death rates over time and additional visualizations, as well as user suggested improvements and innovations. Citation Format: Meredith Shiels, Lee Mason, Jonas Almeida, Sahar Behpour, Neal Freedman, Peter Kraft, Wayne Lawrence. EpiTracker Cancer: A new webtool to visualize disparities in cancer death rates across demographics and county-level characteristics [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A104.

Abstract A043: Improving our understanding of social determinants of health and neighborhood deprivation on survival in patients after radical cystectomy for urothelial carcinoma

Abstract A043: Improving our understanding of social determinants of health and neighborhood deprivation on survival in patients after radical cystectomy for urothelial carcinoma

Abstract A037: Understanding the role of neighborhood deprivation in racial and urban-rural disparities in triple negative breast cancer

Abstract Background: Triple negative breast cancer (TNBC) accounts for 15% of all breast cancers and is one of the most aggressive disease subtypes. Disparities in TNBC exist, where US Black women and women living in urban environments are more likely to be diagnosed with TNBC than their White or rural counterparts. Reasons for these disparities are not completely understood. Social determinants of health, such as the neighborhood environment, have been implicated as potential contributors to breast cancer disparities. To improve our understanding of disparities in TNBC, we examined neighborhood deprivation in relation to breast cancer subtype, according to race and rurality. Methods: We identified 40,095 non-Hispanic Black and White women diagnosed with invasive breast cancer in 2010-2017 in the Georgia Cancer Registry. Neighborhood deprivation was measured by the Neighborhood Deprivation Index (NDI), a composite measure of neighborhood poverty, income, housing, unemployment, occupation, and education derived through principal component analysis using 2011-2015 block group-level American Community Survey data. Georgia Department of Public Health data were used to measure county-level rurality. We estimated case-only multivariable odds ratios (OR) and 95% confidence intervals (CI) for the separate associations between NDI, in quintiles, and each breast cancer subtype (TNBC, ERBB2+, or luminal B vs. luminal A breast cancer), overall and according to race and rurality. Results: Of the 40,095 non-Hispanic Black (31.5%) and White (68.5%) women, 5,328 were diagnosed with TNBC, 1,926 with ERBB2+, 4,958 with luminal B, and 27,883 with luminal A breast cancer. Compared to living in the least deprived neighborhoods, living in the most deprived neighborhoods was associated with a 33% (OR= 1.33, 95% CI 1.19-1.48) increased odds of TNBC vs. luminal A breast cancer. Race and rurality did not modify the association. However, estimates were less pronounced among non-Hispanic Black (OR=1.18, 95% CI 1.00-1.39) compared to non-Hispanic White (OR=1.40, 95% CI 1.18- 1.65) women and among women living in urban (OR=1.33, 95% CI 1.18-1.50) compared to rural (OR=1.52, 95% CI 1.15-2.03) counties. Neighborhood deprivation was associated with an increase in ERBB2+ breast cancer (OR=1.19, 95% CI 1.00-1.40), which was confined to non- Hispanic White women (OR=1.29, 95% CI 1.00-1.66) and women living in urban counties (OR=1.25, 95% CI 1.04-1.52). The OR for luminal B breast cancer was 1.08 (95% CI 0.96- 1.21). Although race did not modify this relationship, an association was observed only among women living in urban counties (OR=1.14, 95% CI 1.00-1.29). Conclusions: In this population of Georgia breast cancer patients, neighborhood deprivation was associated with an increase in TNBC, regardless of race or rurality. The weaker associations among non-Hispanic Black women and women living in urban counties suggests that other factors, in addition to neighborhood deprivation, may play an important role in TNBC development among Black women and women residing in urban environments. Citation Format: Lauren E. Barber, Jasmine M. Miller-Kleinhenz, Maret L. Maliniak, Leah Moubadder, Jeffrey M. Switchenko, Lauren E. McCullough. Understanding the role of neighborhood deprivation in racial and urban-rural disparities in triple negative breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A037.

Abstract PR011: Investigating the interplay among allostatic load, social determinants of health, and treatment outcomes in chronic myeloid leukemia patients

Abstract PR011: Investigating the interplay among allostatic load, social determinants of health, and treatment outcomes in chronic myeloid leukemia patients

Abstract B170: Advancing cancer disparities research through the integration of new data: Opportunities from the National Institutes of Health All of Us Research Program

Abstract The NIH All of Us Research Program is building one of the largest, richest, and most diverse health datasets of its kind. The program aims to promote health equity across multiple health conditions including cancer by making a comprehensive and diverse dataset available to over 10,000 vetted and registered researchers on its Researcher Workbench (RW). The RW offers access to various data types including genomics, electronic health records, physical measurements, wearable data, and survey data on social determinants of health (SDOH) and self- reported cancer diagnoses. The latest data release (Q3 2024), also known as the Curated Data Repository (CDR Version 8) includes data from over 630,000 participants, with more than 80% from populations underrepresented in biomedical research (UBR). Racial, ethnic minoritized populations and other underrepresented groups are more likely to experience health-related disparities and inequities. While previous data releases included aggregate categories, new data released in CDR Version 8 considers the interplay of self-identified categories of demographic descriptors and allows the examination of comorbidities, while emphasizing the importance of identifying appropriate comparator groups in research and considering the heterogeneity that exists within and across groups. It includes a 40% increase in array data, a 67% increase in srWGS data, and a 150% increase in long-read sequences, as well as data from expanded EHR sources, DHT devices, a new Life Functioning Survey, and racial and ethnic subcategories for more than 610,000 participants. This vast and diverse dataset release enables the examination of the intersecting impact of SDOH on cancer-related outcomes both within and across racial and ethnic populations, including populations experiencing health-related disparities and inequities. The extensive data release is facilitated by a two-pronged approach: A robust community and participant engagement model and the All of Us Health Equity strategic plan (HESP). The program employs a socioecological model for participant recruitment and retention, specifically targeting UBR groups. This multi-level approach encompasses activities ranging from targeted outreach and awareness campaigns to establishing trust and fostering collaborative partnerships with communities and participants. HESP complements these efforts by promoting the integration of equity considerations across the research lifecycle through the promotion of data equity and data justice. This community engagement and equity integrated approach guarantees that participants who reflect the demographic diversity of cancer patients in the United States and territories are actively engaged in shaping and benefiting from cancer disparities research. This session will update the scientific audience on recent data expansions available to researchers, provide examples of how that data can be used to examine disparities in cancer outcomes and prevention, and demonstrate the importance of community engagement and health equity in advancing research. Citation Format: Karriem S Watson, JoAnn Smith, Nandita Rahman, Ryan Lupi, Rubin Baskir, Romuladus Azuine, Janeth Sanchez. Advancing cancer disparities research through the integration of new data: Opportunities from the National Institutes of Health All of Us Research Program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B170.

Abstract B032: Advancing the science of cancer in Latinos conference

Abstract Cancer is the leading cause of mortality within the Latino population. Projections suggest a 142% increase in cancer incidence among Latinos over the next two decades. This trend is concerning given that Latinos, the largest minority group in the United States, are expected to constitute at least 28% of the nation's populace by 2060. To address the need for enhanced comprehension of these trends and to identify equitable interventions targeting Latino health disparities, the Institute of Health Promotion Research and the Mays Cancer Center jointly established the biennial Advancing the Science of Cancer in Latinos (ASCL) Conference. The fourth ASCL Conference convened in San Antonio, TX from February 21-23, 2024. The conference objectives were twofold: 1) Examine the intersection of health equity and biological underpinnings in cancer control, prevention, and treatment; and 2) Foster collaborative initiatives among attendees aimed at addressing cancer-related health disparities within the Latino community. The 2024 conference attracted 286 participants compared to 251 attendees in 2022, encompassing guest speakers, researchers, physicians, healthcare professionals, patient advocates, researchers, and students. It comprised 23 sessions (3 keynotes, 6 plenaries, 6 breakouts, 3 general sessions, 1 special session, 1 lunch panel session) featuring insights from 51 speakers, alongside a poster session highlighting 80 research abstracts and a rapid-fire session tailored for early-career investigators. Sessions encompassed multiple topics relevant to Latino cancer research, spanning health disparities, clinical trials, survivorship, patient advocacy, climate change impacts on cancer, precision medicine, health policy and social determinants of health. A post-conference survey from a cohort of 48 respondents underscored high levels of satisfaction, with 90% expressing pronounced contentment regarding the conference experience, compared to 85% in 2022. Moreover, nearly all respondents (98%) rated the relevance of conference content to Latino cancer science as excellent, with 93% regarding the conference as an exceptional platform for information exchange, compared to 79% in 2022. Impressions regarding session quality were overwhelmingly positive, with 90% of respondents indicating a high level of satisfaction, and all survey respondents acknowledging the objectivity, balance, and absence of commercial bias in the session content. Our results showed that the resounding positivity in attendee feedback reflects the conference's success in fostering meaningful engagement among researchers committed to alleviating Latino cancer health disparities. The ASCL conference facilitated an understanding of cultural nuances and barriers specific to the Latino community, stimulating collaborative efforts aimed at enhancing Latino health outcomes. Overall, this retrospective analysis affirms the conference's success in achieving its stipulated objectives and underscores the need of having consistently coordinated research endeavors to reduce Latino health disparities. Citation Format: Amelie G. Ramirez, Rebecca T. Jones, Matthew P. Banegas, Maria C Camargo, Gerardo Colon-Otero, Cliff Despres, Laura Fejerman, Filipa Lynce, Martin Mendoza, Patricia I. Moreno, Alejandro Recio-Boiles, Barbara Segarra-Vazquez, Sandi Stanford, Mariana Stern, Katherine Y. Tossas, Edward J. Trapido, Nicolette M Orozco. Advancing the science of cancer in Latinos conference [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B032.

Abstract B136: Health related social needs of people with cancer underrepresented in clinical trials: Early experience of the Cancer Research Equity and Advocacy through Engagement Initiative (CREATE) clinical trial patient navigation program

Abstract Background: Black and African Americans (AA) remain severely underrepresented in therapeutic oncology clinical trials (TOCTs) and have the highest cancer mortality rates compared to all other groups. Racially biased clinical trial offers, poor physician-patient communication, and social determinants of health largely contribute to these racial inequities. The UNC Lineberger CREATE Clinical Trial Patient Navigation (CTPN) program was established to advance racial equity in TOCT participation. The CTPN program entails clinical trial education, facilitating communication between patients and their medical/research team, identifying barriers to clinical trial participation and connecting patients to resources to address those barriers. Here we describe the health-related social needs and referrals made to address those needs. Methods: The CTPN program employed a targeted proactive approach to reach patients with a new cancer diagnosis who self-identified as Black/African American (AA) or were insured by Medicaid. The patient navigator used the electronic medical record (EMR) to review the oncologist's schedule to identify patients meeting the above criteria. Identified patients received a letter in the mail describing the CTPN program and were offered an in-person clinic visit and/or telephone call with the patient navigator. During these encounters, the patient navigator assessed clinical trial barriers including health-related social needs and made referrals to resources to help address these needs. The CTPN program was initially launched in the thoracic oncology clinic but later became available for direct referrals from all oncology groups. Results: In the first 18 months of the CTPN program, there were 292 patient encounters among183 unique patients who received navigation services. Most patients (83%) were identified through the EMR, 79% identify as Black or AA, 64% have Medicaid. Patients had a diagnosis of lung (62%), head and neck (18%), gynecological (9%), and breast (2%) cancers. Clinical trial related barriers and health-related social needs included lack of clinical trial knowledge (68%), housing (9%), transportation (26%), financial support (18%), and family/caregiver support (14%). CTPN program materials were provided to address clinical trial informational needs (78%), and referrals were made to assist with emotional (13%), logistical (20%), and financial (21%) needs. On average, 2 referrals were made per patient encounter. Conclusion: CTPN can engage Black/AA patients with cancer using a proactive EMR approach to identify patients and may help address health-related social needs to facilitate cancer care and potential clinical trial participation. Future work will evaluate the impact of CTPN on enrollment of Black/AAs in therapeutic cancer clinical trials. Citation Format: Ashley Rankin Collins, Hayley N. Morris, Lauren N. Matthews, Omar N. Buenaventura Gomez, Marjory Charlot. Health related social needs of people with cancer underrepresented in clinical trials: Early experience of the Cancer Research Equity and Advocacy through Engagement Initiative (CREATE) clinical trial patient navigation program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B136.

Abstract C079: Investigating the interplay among allostatic load, social determinants of health, and treatment outcomes in chronic myeloid leukemia patients

Abstract This abstract is being presented as a short talk in the scientific program. A full abstract is printed in the Proffered Abstracts section (PR011) of the Conference Program/Proceedings. Citation Format: Marisol Miranda-Galvis, Muhannad Sharara, Kellen C. Tjioe, McKenzie Maloney Maloney, Vamsi Kota, Anand Jillella, Locke Bryan, Amany R. Keruakous, Jorge E. Cortes. Investigating the interplay among allostatic load, social determinants of health, and treatment outcomes in chronic myeloid leukemia patients [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C079.

Abstract B066: Empowering Black and Latine breast/ovarian cancer survivors with lower quality of life through community-based patient navigation programs

Abstract Community-based organizations (CBOs) offer essential health information and support through programming directed toward women at-risk for and surviving with breast/ovarian cancer. This includes services delivered to women of color–who are more likely to have unmet medical and psychosocial needs, and high social determinants of health burdens. Yet, little is known about the effectiveness of CBO’s programs and services on these women’s levels of empowerment (e.g., their perceived control, self-efficacy, knowledge/skills, and coping with cancer risk, treatment, and survivorship) that could impact the outcomes of their cancer care. To study this, we conducted a secondary data analysis among N=124 breast/ovarian cancer survivors identifying as Black and/or Latine participating in CBO-led cancer control activities, and assessed their care satisfaction, quality of life, patient navigation, and empowerment. Patient empowerment was high: most women of color (M age=50, 54% Black, 48% Latine) felt more informed (75%) and confident (75%) in managing their care following program engagement. Care quality was also very high (87%), and perceived as: recommendable to others (94%), helpful (91%), informative (92%), timely (90%), reliable (91%), supportive (91%), and effective (91%). Regarding care satisfaction, these underrepresented women felt supported by abundant resources (93%) and programs (95%), understood (93%), and helped (91%) by the CBOs programs. Regarding quality of life, 69% were in fair/poor health and 24% endorsed frequent mental distress–with an average of 9.1 physically unhealthy days, 9.4 mentally unhealthy days, and 7.8 activity-limited days in the past month. Disparities in empowerment were observed as a function of survivors’ navigation experiences and physical/mental well-being, as empowerment was highest among those who benefited more from patient navigation (r=.58, p<.001), and had poorer quality of life (r=-.44, p<.001). In a multivariable model controlling for satisfaction with CBO-led cancer control, both patient navigation (B=.81, SE=.13, p<.001) and quality of life (B=-.18, SE=.07, p<.005) were associated with survivors’ experience of empowerment: those who rated their patient navigation experience more highly, and those who were more impaired, felt most empowered. Community cancer control empowers Black and Latine breast/ovarian cancer survivors: addressing disparities, through programs such as patient navigation, could enhance their effectiveness, and particularly for those with lower quality of life. Behavioral and Social Science: Socioeconomic Influences Citation Format: Marcelo Sleiman Jr, Dheeraj Oruganty, Adina Fleischmann, Mingqian Liu, Sahana Arumani, Kenneth Tercyak. Empowering Black and Latine breast/ovarian cancer survivors with lower quality of life through community-based patient navigation programs [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B066.

Abstract A039: Joint roles of proteomics and neighborhood-level social determinants of metastatic prostate cancer

Abstract A039: Joint roles of proteomics and neighborhood-level social determinants of metastatic prostate cancer

Abstract A038: Uncovering the role of social determinants of health in racial disparities in cancer incidence in Alabama

Abstract A038: Uncovering the role of social determinants of health in racial disparities in cancer incidence in Alabama

Abstract B140: Further evaluation of social determinants of health including association of neighborhood disadvantage and population density with severity of activity- and mood- related interference in primary brain tumor patients

Abstract Purpose: Growing evidence links living in rural or socioeconomically disadvantaged areas with worse outcomes in cancer patients. Our previous work indicated that growing up in a rural area and experiencing food insecurity in childhood are associated with more severe activity and mood-related interference from symptoms in the primary brain tumor (PBT) population. This study investigates the association of current neighborhood deprivation and population density with activity- and mood-related interference in a cross-sectional cohort of 555 patients with a PBT enrolled in a natural history study (NCT03251989). Methods: National Area Deprivation Index (ADI) and population density were dichotomized into more (>40) and less (<40) disadvantaged and urbanized (>1,000 persons/sq mi) and non-urbanized (<1,000 persons/sq mi). Activity- and mood-related interference was stratified into none/mild (0-1) and moderate/severe (2-10). Logistic regression was used to test univariate and multivariate associations of moderate/severe activity- and mood-related interference with demographic and clinical variables. Bonferroni-Holm was implemented to adjust for multiple comparisons (p < 0.001) in univariate analyses. We used backwards elimination multivariate analyses to fit the final model. Variables were included modeling when univariate p <0.10. Results: The sample included more males (57%), median age 49 (range 18-85), living in more disadvantage neighborhoods (25%), and primarily in urbanized areas (61%). The majority (74%) had high grade tumors, most commonly glioblastoma (39%), with 49% with tumor recurrence, and 21% on active treatment. Univariate analysis showed neither ADI nor population density was significantly associated with activity-related interference (ADI OR=1.35, 95% CI [0.85, 2.13]; population density OR=1.20, 95% CI [0.80, 1.79]) or mood-related interference (ADI OR=0.85, 95% CI [0.52, 1.38]; population density OR=1.19, 95% CI [0.78, 1.81]). In the multivariate analyses tumor diagnosis (OR=0.92 CI [0.53, 1.58]) growing up in a non-urbanized area (OR=1.56 CI [1.02, 2.40]), not having enough to eat when growing up (OR=2.50 CI [1.13, 5.54], and number of surgeries (OR=1.50 CI [1.00, 2.23]) remained associated with moderate/severe activity-related interference with ADI, and similar results were found in the population density model. Tumor recurrence (OR=1.77 CI [1.17, 2.66]) and comorbidities (OR=0.53 CI [0.33, 0.85]) were associated with moderate/severe mood-related interference with ADI and similar results were found in the population density model. Conclusions: Although activity- and mood-related interference were not associated with current ADI or population density, activity-related interference was significantly related to early life social variables including growing up in a rural area and not having enough to eat growing up. This study may be foundational for future study directions exploring other social deprivation factors early life or current that contributes to more interference in the PBT population. Citation Format: Tara S. Davis, Bennett A. McIver, Kimberly Reinhart, Elizabeth Vera, Vivian A. Guedes, Macy L. Stockdill, Orieta Celiku, Terri S. Armstrong, Michelle L. Wright. Further evaluation of social determinants of health including association of neighborhood disadvantage and population density with severity of activity- and mood- related interference in primary brain tumor patients [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B140.

Incorporating Social Determinants of Health in Infectious Disease Models: A Systematic Review of Guidelines

Incorporating Social Determinants of Health in Infectious Disease Models: A Systematic Review of Guidelines