White Survivors Research Articles

Alcohol and cannabis use associated with cardiometabolic biomarkers among "All of Us" cancer survivors.

Cancer survivors are at increased risk for cardiometabolic comorbidities following cancer treatment which may be further exacerbated by cannabis and alcohol use. We aimed to examine the direct relationships of cannabis, alcohol, and the co-use of both substances with cardiometabolic risk factors and to explore disparities by race/ethnicity and sex. Cross-sectional data were extracted from adult cancer survivors in the "All of Us" from 2018-2022. Cannabis use was defined as occasional or frequent/regular cannabis use (vs never) in the past three months and hazardous alcohol intake (AUDIT-C >3 for females, AUDIT-C >4 for males) vs non-hazardous in the past year, respectively. Co-use was defined as participants who engaged in regular cannabis and hazardous alcohol intake. We identified binary cardiovascular, immune, and metabolic systems biomarkers, with high values defined by clinically established cutoffs or >75th percentile. We used multivariable logistic regression adjusting for socio-demographic and clinical factors. In our sample (N=7,054), 7.6% were Hispanic, 6.2% were Black, and 86.2% were White cancer survivors. Less than 5% of Hispanic and White survivors reported substance co-use compared to 7% of Black survivors. Compared to never users, co-users were 1.58(95% CI=1.14-2.19) more likely to have high blood pressure. No significant associations were found between co-use and immune biomarkers or sex differences. Co-use of cannabis and hazardous alcohol may worsen high blood pressure in survivors, who are at higher risk for cardiometabolic comorbidities. The study investigates substance use and cardiometabolic biomarkers, urging more research on their effects on cancer survivors.

Racial and ethnic disparities in mental health among breast cancer patients and survivors in the United States.

To decompose the mental health disparities between breast cancer patients and survivors (hereafter survivors) of racial and ethnic minority groups and non-Hispanic White survivors into the contributions of individual-, interpersonal-, community-, and societal-level determinants. We used data from the 2010-2020 Medical Expenditure Panel Survey Household Component (MEPS-HC). Our primary outcome was whether the person had mental health conditions or not. We employed the Kitagawa-Oaxaca-Blinder (KOB) method to understand to what extent the differences in outcomes were explained by the differences in the determinants between non-Hispanic Black or Hispanic breast cancer survivors and non-Hispanic White survivors. We also bifurcated the Hispanic sample analysis by the US-born status (and county of origin). Confidential geographic identifiers are utilized to supplement the MEPS-HC data with information on community characteristics and local healthcare resources. The prevalence of mental health conditions among non-Hispanic Black and Hispanic breast cancer survivors was 26.1% (95% CI: 20.4, 31.7) and 28.3% (95% CI: 21.9, 34.6), respectively. These rates were higher than those for their non-Hispanic White counterparts, 19.7% (95% CI: 17.4, 21.9). In our KOB model, the disparity between non-Hispanic Black and White survivors was fully explained by differences in education, health, and family structure, with community- and societal-level determinants playing no significant role. Conversely, our KOB model did not explain any of the overall differences between Hispanic and non-Hispanic White survivors. However, for foreign-born Hispanic survivors, the disparity was fully explained by a combination of individual- and societal-level determinants. Our findings, which identify specific individual-, interpersonal-, and societal- determinants that were associated with racial and ethnic differences in mental health, can be used by clinicians and policymakers to proactively address racial and ethnic disparities in health.

Abstract B149: Investigating Disparities in Cost-Associated Barriers to Medication Adherence in Breast Cancer Survivors in the National Institutes of Health All of Us Research Program

Abstract Purpose: Medication adherence (e.g., endocrine therapy, antihypertensives) during survivorship remains suboptimal. Racial disparities in medication adherence continue to persist, yet reasons for this disparity are not fully understood. This study aimed to assess racial differences in cost-associated barriers to medication adherence. Methods: This cross-sectional analysis utilized data from the National Institutes of Health All of Us Research Program. Cohort eligibility included identifying as Black/African American or White, being at least 18 years old, and having a diagnosis of breast cancer. Survivors must have completed the Healthcare Access and Utilization survey, a validated assessment of factors impacting healthcare behaviors. Comparisons between patient characteristics (e.g., age, annual income, marital status, employment, education, etc.) and survey responses were analyzed by race using Pearson’s chi-square tests. Univariable and multivariable logistic regression models were fitted to investigate the unadjusted and adjusted associations of cost-related barriers to medication adherence and race. Results: Among the 1,840 breast cancer survivors included in this cohort, the mean age was 63.8 (standard deviation (sd) = 10.4). The majority of survivors were White (94.3%) (5.7% Black), married (58.9%) and unemployed (57.4%). The mean score for racial discrimination in healthcare was 10.3 (sd = 3.8) (range = 7 - 35). Most survivors did not report any cost-related barriers to adherence (74.9%); however, 19.5% of survivors asked their doctor for lower cost medication to save money. When compared with White survivors, a higher proportion of Black survivors reported that they could not afford prescription medicines (6.5% vs. 12.4%). In the multivariable model, no significant association by race was observed (p=0.387). Survivors who reported annual household income levels above $50k were less likely to report cost-reported barriers when compared to survivors who reported a household income of <$25k (p<0.001). Each one-point increase in perceived discrimination in healthcare increased the odds of reporting a cost-related barrier to adherence by a factor of 1.10 (95% confidence interval: 1.07, 1.13). Conclusions: Although racial differences were not noted for overall cost-related barriers, results highlight a need to understand nuanced differences in perceived cost-related barriers to adherence and how survivors navigate those differences. Further research is needed to understand providers’ roles in encouraging medication adherence and how discrimination in healthcare may serve as a barrier to adherence. Citation Format: Arnethea L. Sutton, Jian He, Lakeshia Cousin, Keesha Powell-Roach, Mandy J. Hill, Wendy Bottinor. Investigating Disparities in Cost-Associated Barriers to Medication Adherence in Breast Cancer Survivors in 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 B149.

Abstract C036: Prevalence of and racial/ethnic differences in hearing and balance problems in a multiethnic cohort of patients with breast cancer

Abstract Background: Patients with breast cancer face many health issues during the cancer care continuum. Chemotherapy and radiotherapy can cause hearing and balance problems, e.g., tinnitus, hearing loss, and vertigo or persistent dizziness, negatively affecting patients’ health outcomes and quality of life. Hearing loss is more prevalent among cancer survivors than in the general population. However, little attention has been paid to tinnitus, hearing loss, and vertigo specifically among breast cancer patients and survivors, and it is unclear whether these symptoms vary across racial/ethnic groups. Methods: Between July and September 2023, we surveyed patients enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort about whether they experienced tinnitus, hearing loss, and/or vertigo. Racial/ethnic groups included Asian or Pacific Islander (API), Black, Hispanic, and White. To examine racial/ethnic differences in hearing and balance problems, we fit separate multivariable logistic regression models, controlling for sociodemographic and clinicopathologic factors. Adjusted odds ratios (AOR) and 95% CIs were calculated. Results: Of 1,462 patients, the mean age was 54.2 years (SD 11.4), with a median duration from diagnosis to survey of 8.2 years (IQR: 5.0-12.4). Most were White (69.8%), followed by Black (22.7%), API (3.8%), and Hispanic (3.7%); and 46.0% received chemotherapy. Overall, 15.1%, 13.6%, and 7.7% reported experiencing tinnitus, hearing loss, and vertigo, respectively. Similar prevalences of these symptoms were observed among survivors who had received chemotherapy. By race/ethnicity, 16.1% of Black patients reported experiencing tinnitus compared to 15.6% of White, 9.4% of Hispanic, and 3.8% of API patients (P=.050). White patients reported a higher proportion of hearing loss (15.5%) than Hispanic (14.8%), Black (8.0%), and API (7.8%) patients (P=.004). A higher percentage of Black patients (13.2%) reported experiencing vertigo than White (6.5%), Hispanic (5.7%), and API (1.9%) patients (P=.001). After adjusting for demographic and clinical characteristics, Black patients had lower odds of experiencing hearing loss than White patients (AOR 0.39, 95% CI: 0.20-0.75). Compared with White patients, Black patients had greater odds of experiencing vertigo (AOR 1.80, 95% CI: 1.01-3.21). Due to limited power, we did not observe statistically significant differences in vertigo or hearing loss between API or Hispanic survivors and White survivors and in tinnitus across racial/ethnic groups. Older age and longer duration from diagnosis to survey were associated with greater odds of tinnitus or hearing loss. Conclusions: In this multiethnic cohort, hearing and balance problems were prevalent and varied by race/ethnicity among breast cancer patients. Our findings suggest that oncology programs should consider routine screening for these symptoms, encourage patient-provider discussion to identify unmet needs, and address racial/ethnic disparities to improve hearing and balance-related quality of life of breast cancer survivors. Citation Format: Jincong Q. Freeman, Fangyuan Zhao, Wenji Guo, Rita Nanda, Olufunmilayo I. Olopade, Jayant M. Pinto, Megan J. Huisingh-Scheetz, Dezheng Huo. Prevalence of and racial/ethnic differences in hearing and balance problems in a multiethnic cohort of patients with 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 C036.

Abstract B014: Cannabis use among cancer survivors and its association with cardiometabolic risk factors: Findings from the All of Us Research Program

Abstract Purpose: Cannabis use has been linked to alleviating symptoms such as sleep issues, mental health, and physical problems resulting from cancer treatment among cancer survivors. However, in the US general population, evidence suggests that an increase in cannabis use increases the risk for cardiovascular disease including high blood pressure, type 2 diabetes, and high cholesterol. This is even more alarming since users who have been diagnosed with cancer have an even greater independent risk of cardiovascular events due to the toxicities of cancer therapeutic drugs. Given the US trend in cannabis legalization and decriminalization and the limited knowledge of the association between cannabis use and cardiometabolic biomarkers among cancer survivors, we aim to assess the independent associations between cannabis use and several cardiometabolic biomarkers and explore racial/ethnic and sex differences among a sample of cancer survivors from the All of Us (AoU) Program. Methods: Cross-sectional cannabis data and cardiometabolic risk factor biomarkers were obtained from adult cancer survivors in the AoU Research Program from 2018-2022. Cannabis use was defined as never use (in a lifetime or past three months), occasional use (twice or monthly in the past three months), and frequent/regular use (weekly or daily). Cardiometabolic outcomes included cardiovascular (e.g., systolic, diastolic blood pressure, hypertension), immune (i.e., White Blood Cell [WBC] counts, C-reactive protein [CRP]), and metabolic systems biomarkers (e.g. waist-to-hip ratio, lipids, HbA1c), were dichotomized from continuous values to elevated vs normal where high values, defined by clinically established cutoffs or >75th percentile, represented elevated biomarkers. Multivariable logistic regression and stratified models if interactions were statistically significant, adjusting for treatment, smoking, hazardous alcohol use, and sociodemographic variables were used. Results: Our cohort (N=6,985) consisted of 7.6% Hispanic, 6.2% Black, and 86.2% White survivors. Overall, 8.2% of survivors reported occasional and frequent/regular cannabis use, with Black survivors (9.7%) reporting a greater proportion of frequent/regular use compared to White (3.2%) and Hispanic (4.7%) survivors. Similarly, female (2.8%) survivors reported a lower frequency of frequent/regular cannabis use compared to male (4.2%) survivors. Compared to never users, frequent/regular users were 3.35(95% CI=1.10-10.53) times as likely to report elevated WBC count. No significant associations were found between cannabis use and CRP, cardiovascular, and metabolic systems biomarkers. Similarly, no race/ethnicity or sex (both pinteraction > 0.05) differences were found in the cannabis and WBC association. Conclusion: Our results underscore that more frequent cannabis use may have a detrimental effect on immune risk factors like WBC counts among survivors. Being that high WBC may be predictive of cardiovascular diseases and mortality, future studies should explore the longitudinal effects of cannabis use on WBC. Citation Format: Angel Arizpe, Claudia M. Toledo-Corral, Carol Y. Ochoa-Dominguez, Stephanie Navarro, Sue E. Kim, Albert J. Farias. Cannabis use among cancer survivors and its association with cardiometabolic risk factors: Findings from the 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 B014.

Abstract C062: Racial and ethnic disparities in risk of second primary non-breast cancer in breast cancer survivors

Abstract Purpose: Disparities in cancer outcomes are multifactorial and are attributed to differences in access to care, socioeconomic status, tumor characteristics, treatment, family history, and comorbidity burden. Studies evaluating disparities in breast cancer outcomes have mostly been restricted to Black and White patients. Additionally, whether racial and ethnic disparities affect the risk of second primary cancer in breast cancer survivors, remains under-studied. We evaluated disparities in risk of second primary non-breast cancer in a racially and ethnically diverse cohort of breast cancer survivors treated at an integrated healthcare system. Methods: This retrospective cohort study included 37,222 breast cancer patients (aged ≥18 years) diagnosed between 2008-2020 at Kaiser Permanente Southern California (KPSC). Data on tumor characteristics, cancer treatments and sociodemographic variables were extracted from KPSC’s cancer registry and electronic health records. Patients were followed electronically from breast cancer diagnosis until they developed second primary non-breast cancer, died, disenrolled from the health plan, or reached study’s end (12/31/2021), whichever occurred first. Cox proportional hazards regression was used to report the association [Hazard Ratio (95% Confidence Interval)] between race and ethnicity and second primary non-breast cancer. Results: More than half of the study cohort consisted of non-Hispanic White survivors (51.2%), followed by 20.9% Hispanic survivors, 13.9% Asian/Pacific Islander (API) survivors, 12.7% non-Hispanic Black survivors, and 1.3% survivors of other/mixed races. Overall, 55.7% and 23.9% were diagnosed with local and regional breast cancer, respectively. During a median follow-up of 5.2 years, 4.6% survivors developed second primary non-breast cancers. In the multivariable model adjusted for sociodemographic characteristics, breast tumor characteristics, and breast cancer treatments, Hispanic and API survivors were 25% and 28% less likely to develop second primary cancer compared to White survivors [adjusted HR (95%CI): 0.75 (0.65-0.86)] and 0.72 (0.61-0.86), respectively]. We did not find an increased risk in Black survivors compared to White survivors [adjusted HR (95%CI): 0.91 (0.78-1.04)]. However, factors related to higher risk of second primary non-breast cancers were older age at breast cancer diagnosis, smoking, and higher comorbidity burden. Conclusion: Interestingly, risk of second primary non-breast cancer was lower in Hispanic and API survivors compared to White survivors in this insured cohort. Next steps will include examining which lifestyle factors (e.g. less smoking), or if pharmacological management of modifiable comorbidities might have played a role in the decreased risks seen in these two racial and ethnic groups. Citation Format: Amrita Mukherjee, Zheng Gu, Lie H. Chen, Reina Haque. Racial and ethnic disparities in risk of second primary non-breast cancer in breast cancer survivors [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 C062.

Rape victim advocates’ perceptions of a racial bias in the #MeToo movement

While applauded as important for survivors, the #MeToo movement is criticized for ignoring survivors of color. Interviews with 41 rape victim advocates reveal that they perceive a racial bias in the movement. Eighteen advocates note that an African American woman started the movement, but it did not garner attention until taken over by White survivors and celebrities. Advocates perceive that the movement does not give victims of color a voice, and they are not believed (15 advocates discuss). According to 13 advocates, the movement reflects societal racial bias and blame of survivors of color. Understanding advocates’ perceptions could improve the recognition and inclusion of survivors of color, not only by the #MeToo movement but also in general sexual victimization awareness.

Hypertension Prevalence, Treatment, and Control 90 Days After Acute Stroke Among Mexican American and Non-Hispanic White Adults.

High blood pressure (BP) increases recurrent stroke risk. We assessed hypertension prevalence, treatment, control, medication adherence, and predictors of uncontrolled BP 90 days after ischemic or hemorrhagic stroke among 561 Mexican American and non-Hispanic White (NHW) survivors of stroke from the BASIC (Brain Attack Surveillance in Corpus Christi) cohort from 2011 to 2014. Uncontrolled BP was defined as average BP ≥140/90 mm Hg at 90 days poststroke. Hypertension was uncontrolled BP or antihypertensive medication prescribed or hypertension history. Treatment was antihypertensive use. Adherence was missing zero antihypertensive doses per week. We investigated predictors of uncontrolled BP using logistic regression adjusting for patient factors. Median (interquartile range) age was 68 (59-78) years, 64% were Mexican American, and 90% of strokes were ischemic. Overall, 94.3% of survivors of stroke had hypertension (95.6% Mexican American versus 92.0% non-Hispanic White; P=0.09). Of these, 87.9% were treated (87.3% Mexican American versus 89.1% non-Hispanic White; P=0.54). Among the total population, 38.3% (95% CI, 34.4%-42.4%) had uncontrolled BP. Among those with uncontrolled BP prescribed an antihypertensive, 84.5% reported treatment adherence (95% CI, 78.8%-89.3%). Uncontrolled BP 90 days poststroke was less likely in patients with stroke who had a primary care physician (adjusted odds ratio [aOR], 0.45 [95% CI, 0.24-0.83]; P=0.01), greater stroke severity (aOR per-1-point-higher National Institutes of Health Stroke Scale score, 0.96 [95% CI, 0.93-0.99]; P=0.02), or more depressive symptoms (aOR per-1-point-higher Personal Health Questionnaire Depression Scale-8 score, 0.95 [95% CI, 0.92-0.99] among those with a history of hypertension at baseline; P=0.009). Greater than one third of survivors of stroke have uncontrolled BP at 90 days poststroke in this population-based study. Interventions are needed to improve BP control after stroke.

Disparities in self-reported pain control among cancer survivors.

151 Background: Cancer survivors often suffer from chronic pain. However, not all patients have access to medication and other pain management strategies, making pain control challenging. We aim to determine the association of sociodemographic factors with self-reported pain control in cancer survivors with cancer-related chronic pain. Methods: A cross-sectional analysis was conducted using data from the 2022 Behavioral Risk Factor Surveillance System survey. Cancer survivors who self-reported physical pain from cancer or treatment were included. Non-melanoma skin cancer survivors were excluded. The outcome of interest was pain control. Univariate analysis with chi-square and multivariable logistic regression were used to determine the sociodemographic characteristics associated with pain control. Models were adjusted for age, sex, marital status, income, insurance coverage, BMI, smoking status, and cancer site. Results: 1,670 cancer survivors with self-reported cancer-related chronic pain were identified. 9.2% were aged < 40, 61.5% were female, and 71.6% were non-Hispanic white. 97.2% were insured, 50.5% earned ≥ $50,000, and 27.6% were college graduates. 29.8% of survivors reported a history of breast cancer, followed by melanoma (6.3%), and lung cancer (6.1%). Young adults (age 18-39) reported significantly lower pain control compared to older survivors (52% vs. 77.7%, p <0.001). Non-Hispanic Black survivors reported the highest rates of pain control, followed by non-Hispanic white, and Hispanic survivors (87.7% vs. 77.5% vs. 60.6%, respectively, p= 0.013). Employed survivors reported significantly higher pain control than those out of the workforce (83.2% vs. 73.7%, p= 0.008, respectively). College graduates reported better pain control than those without a college degree (82.9% vs. 74.7%, p=0.009, respectively). There was no significant association between pain control and insurance coverage or income. On multivariate analysis, young adults had lower pain control than older adults (OR: 0.454; 95% CI: 0.219-0.942). Compared to non-Hispanic white survivors, being Hispanic was associated with worse pain control (OR: 0.324; 95% CI: 0.142-0.737); no significant association was found for non-Hispanic Black survivors (OR: 1.964; 95% CI: 0.851-4.631). Employment was associated with better pain control (OR: 1.997; 95% CI: 1.235-3.231). College degree attainment was not significantly associated with pain control on multivariate analysis (OR: 1.414; 95% CI: 0.934-2.142). Conclusions: Age, race/ethnicity and employment were associated with pain control among cancer survivors. Young adults, Hispanic and unemployed survivors were most likely to have poor pain control. Further research should elucidate the factors driving these relationships in order to achieve more equitable pain management in this population.

Racial differences in treatment adherence and response to acupuncture and cognitive behavioral therapy for insomnia among Black and White cancer survivors.

Racial disparities in sleep are well-documented. However, evidence-based options for addressing these disparities are lacking in cancer populations. To inform future research on sleep interventions, this study aims to understand racial differences in treatment responses to acupuncture and cognitive behavioral therapy for insomnia (CBT-I) among Black and White cancer survivors. We conducted a secondary analysis of a comparative effectiveness trial evaluating acupuncture versus CBT-I for insomnia in cancer survivors. We compared insomnia severity, sleep characteristics, and co-morbid symptoms, as well as treatment attitudes, adherence, and responses among Black and White participants. Among 156 cancer survivors (28% Black), Black survivors reported poorer sleep quality, longer sleep onset latency, and higher pain at baseline, compared to White survivors (all p < 0.05). Black survivors demonstrated lower adherence to CBT-I than White survivors (61.5% vs. 88.5%, p = 0.006), but their treatment response to CBT-I was similar to white survivors. Black survivors had similar adherence to acupuncture as white survivors (82.3% vs. 93.4%, p = 0.16), but they had greater reduction in insomnia severity with acupuncture (-3.0 points, 95% CI -5.4 to 0.4, p = 0.02). This study identified racial differences in sleep characteristics, as well as treatment adherence and responses to CBT-I and acupuncture. To address racial disparities in sleep health, future research should focus on improving CBT-I adherence and confirming the effectiveness of acupuncture in Black cancer survivors.

Race and Ethnicity, Socioeconomic Factors, and Epigenetic Age Acceleration in Survivors of Childhood Cancer

Current research in epigenetic age acceleration (EAA) is limited to non-Hispanic White individuals. It is imperative to improve inclusivity by considering racial and ethnic minorities in EAA research. To compare non-Hispanic Black with non-Hispanic White survivors of childhood cancer by examining the associations of EAA with cancer treatment exposures, potential racial and ethnic disparity in EAA, and mediating roles of social determinants of health (SDOH). In this cross-sectional study, participants were from the St Jude Lifetime Cohort, which was initiated in 2007 with ongoing follow-up. Eligible participants included non-Hispanic Black and non-Hispanic White survivors of childhood cancer treated at St Jude Children's Research Hospital between 1962 and 2012 who had DNA methylation data. Data analysis was conducted from February 2023 to May 2024. Three treatment exposures for childhood cancer (chest radiotherapy, alkylating agents, and epipodophyllotoxin). DNA methylation was generated from peripheral blood mononuclear cell-derived DNA. EAA was calculated as residuals from regressing Levine or Horvath epigenetic age on chronological age. SDOH included educational attainment, annual personal income, and the socioeconomic area deprivation index (ADI). General linear models evaluated cross-sectional associations of EAA with race and ethnicity (non-Hispanic Black and non-Hispanic White) and/or SDOH, adjusting for sex, body mass index, smoking, and cancer treatments. Adjusted least square means (ALSM) of EAA were calculated for group comparisons. Mediation analysis treated SDOH as mediators with average causal mediation effect (ACME) calculated for the association of EAA with race and ethnicity. Among a total of 1706 survivors including 230 non-Hispanic Black survivors (median [IQR] age at diagnosis, 9.5 [4.3-14.3] years; 103 male [44.8%] and 127 female [55.2%]) and 1476 non-Hispanic White survivors (median [IQR] age at diagnosis, 9.3 [3.9-14.6] years; 766 male [51.9%] and 710 female [48.1%]), EAA was significantly greater among non-Hispanic Black survivors (ALSM = 1.41; 95% CI, 0.66 to 2.16) than non-Hispanic White survivors (ALSM = 0.47; 95% CI, 0.12 to 0.81). Among non-Hispanic Black survivors, EAA was significantly increased among those exposed to chest radiotherapy (ALSM = 2.82; 95% CI, 1.37 to 4.26) vs those unexposed (ALSM = 0.46; 95% CI, -0.60 to 1.51), among those exposed to alkylating agents (ALSM = 2.33; 95% CI, 1.21 to 3.45) vs those unexposed (ALSM = 0.95; 95% CI, -0.38 to 2.27), and among those exposed to epipodophyllotoxins (ALSM = 2.83; 95% CI, 1.27 to 4.40) vs those unexposed (ALSM = 0.44; 95% CI, -0.52 to 1.40). The association of EAA with epipodophyllotoxins differed by race and ethnicity (β for non-Hispanic Black survivors, 2.39 years; 95% CI, 0.74 to 4.04 years; β for non-Hispanic White survivors, 0.68; 95% CI, 0.05 to 1.31 years) and the difference was significant (1.77 years; 95% CI, 0.01 to 3.53 years; P for interaction = .049). Racial and ethnic disparities in EAA were mediated by educational attainment (<high school vs ≥college, ACME = 0.13; high school vs ≥college, ACME = 0.07; mediation = 22.71%) and ADI (ACME = 0.24; mediation = 22.16%). In this cross-sectional study of childhood cancer survivors, race and ethnicity moderated the association of EAA with epipodophyllotoxin exposure and racial and ethnic differences in EAA were partially mediated by educational attainment and ADI, indicating differential treatment toxic effects by race and ethnicity. These findings suggest that improving social support systems may mitigate socioeconomic disadvantages associated with even greater accelerated aging and reduce health disparities among childhood cancer survivors.

Personalized risk assessment of new onset depression in long-term cancer survivors.

e13798 Background: Advances in cancer detection and treatment have improved long-term survival. It is critical to understand the impact that experiencing cancer has on psychological health, given that the prevalence of depression in long-term survivors is higher than in the general population. Our aim was to develop a risk prediction model to identify long-term (5-year) survivors at high risk of developing depression. Methods: We conducted a retrospective study of the SEER-Medicare database beneficiaries with localized breast, prostate, colon, or rectal cancer diagnosed between 2003-2011 who had survived at least 5 years since diagnosis. We required Part D coverage in the breast cohort to account for adjuvant endocrine therapy. Our primary outcome was the cumulative incidence of depression between 5-10 years after diagnosis, which was defined using a claims-based algorithm as a single or recurrent episode of major depressive disorder, recent episode of bipolar I disorder, or dysthymic disorder. For each cancer site, we constructed restricted mean survival time models, a non-parametric method that yields time ratios; a time ratio (TR) &lt; 1 indicates shorter mean time to event (TTE). Results: Our cohort consisted of 80,579 survivors. The cumulative incidence of depression occurring between 5-10 years after diagnosis was 16.9% for breast cancer, 7.8% for prostate cancer, 10.6% for colon cancer, and 8.6% for rectal cancer. The cumulative incidence of new onset depression increased over time and was 7.2% vs. 13.9% among survivors diagnosed before and after 2008, respectively. Compared with patients age &lt; 70 at diagnosis, patients aged 75 and older exhibited 5-10% shorter mean TTE across breast, prostate, and colon cancer. There was no association between Non-Hispanic (NH) Black race or Hispanic ethnicity and depression compared with NH White survivors. Asian survivors were at lower risk of developing depression. Disease specific factors, including stage, grade, hormone receptor status (breast), or PSA (prostate), did not predict depression in long-term survivors. Receipt of treatment in the 3-5 years after initial diagnosis was associated with moderately greater risk for all survivors, with the shortest mean TTE among breast cancer survivors (TR=0.91, 95% CI=0.85-0.97). Across all cohorts, the greatest predictor of depression was a prior history of depression. The incidence of depression in long-term survivors was 42% in patients with a prior history of depression vs. 8% among survivors without a prior history of depression. Conclusions: Diagnoses of depression increased in cancer patients since 2008 and were associated with prior history of depression, advanced age, census tract poverty, and continued treatment 3 years after diagnosis. Treatment type and disease specific factors were not strong predictors of depression.

African American patients have a higher probability of cognitive impairment after incident stroke: An analysis of national electronic health record data

BackgroundCognitive impairment (CI) and stroke are diseases with significant disparities in race and geography. Post stroke cognitive impairment (PSCI) can be as high as 15–70 % but few studies have utilized large administrative or electronic health records (EHR) to evaluate trends in PSCI. We utilized an EHR database to evaluate for disparities in PSCI in a large sample of patients after first recorded stroke to evaluate for disparities in race. MethodsThis is a retrospective cohort analysis of Cerner Health Facts® EHR database, which is comprised of EHR data from hundreds of hospitals/clinics in the US from 2009–2018. We evaluated patients ≥40 years of age with a first time ischemic stroke (IS) diagnosis for PSCI using ICD9/10 codes for both conditions. Patients with first stroke in the Cerner database and no pre-existing cognitive impairment were included, we compared hazard ratios for developing PSCI for patient characteristics ResultsA total of 150,142 IS patients with follow-up data and no pre-existing evidence of CI were evaluated. Traditional risk factors of age, female sex, kidney injury, hypertension, and hyperlipidemia were associated with PSCI. Only African American stroke survivors had a higher probability of developing PSCI compared to White survivors (HR 1.347, 95 % CI (1.270, 1.428)) and this difference was most prominent in the South. Among those to develop PSCI, median time to documentation was 1.8 years in African American survivors. ConclusionIn a large national database, African American stroke survivors had a higher probability of PSCI five years after stroke than White survivors.

Systemic DNA Damage and Repair Activity Vary by Race in Breast Cancer Survivors.

Non-Hispanic Black breast cancer survivors have poorer outcomes and higher mortality rates than White survivors, but systemic biological mechanisms underlying these disparities are unclear. We used circulating leukocytes as a surrogate for measuring systemic mechanisms, which might be different from processes in the target tissue (e.g., breast). We investigated race-based differences in DNA damage and repair, using a novel CometChip assay, in circulating leukocytes from breast cancer survivors who had completed primary cancer therapy and were cancer free. We observed novel race-based differences in systemic DNA damage and repair activity in cancer survivors, but not in cells from healthy volunteers. Basal DNA damage in leukocytes was higher in White survivors, but Black survivors showed a much higher induction after bleomycin treatment. Double-strand break repair activity was also significantly different between the races, with cells from White survivors showing more sustained repair activity compared to Black leukocytes. These results suggest that cancer and cancer therapy might have long-lasting effects on systemic DNA damage and repair mechanisms that differ in White survivors and Black survivors. Findings from our preliminary study in non-cancer cells (circulating leukocytes) suggest systemic effects beyond the target site, with implications for accelerated aging-related cancer survivorship disparities.

Racial/Ethnic Disparities: Discrimination's Impact on Health-Related Quality of Life-An All of Us Cancer Survivors' Cross-sectional Study.

Discrimination is associated with worse mental and physical health outcomes. However, the associations among cancer survivors are limited. We examined whether discrimination is associated with HRQoL and whether adjusting for it reduces racial/ethnic disparities in HRQoL among cancer survivors. Cross-sectional data from adult cancer survivors who completed surveys on discrimination in the medical settings (DMS), everyday perceived discrimination (PD), and HRQoL in the "All of Us" Program from 2018 to 2022 were assessed. We created a binary indicator for fair-to-poor vs. good-to-excellent physical health and mental health. PD and DMS scores were a continuous measure with higher scores reflecting more discrimination. Multivariable logistic regression models tested whether DMS and PD are associated with HRQoL and whether they differently affect the association between race/ethnicity and HRQoL. The sample (N = 16,664) of cancer survivors was predominantly White (86%) and female (59%), with a median age of 69. Every 5-unit increase in DMS and PD scores was associated with greater odds of fair-to-poor physical health (DMS: OR [95%CI] = 1.66 [1.55, 1.77], PD: 1.33 [1.27, 1.40]) and mental health (DMS: 1.57 [1.47, 1.69], PD: 1.33 [1.27, 1.39]). After adjusting for DMS or PD, Black and Hispanic survivors had a decreased likelihood of fair-to-poor physical health and mental health (decrease estimate range: - 6 to - 30%) compared to White survivors. This effect was greater for Black survivors when adjusting for PD, as the odds of fair-to-poor mental health compared to White survivors were no longer statistically significant (1.78 [1.32, 2.34] vs 1.22 [0.90, 1.64]). Experiences of discrimination are associated with lower HRQoL and reducing it may mitigate racial/ethnic disparities in HRQoL.

Abstract 6297: “They should get a cardiologist to be a part of the team when you first go”: A qualitative analysis of racial differences in the cancer care experience amongst breast cancer patients receiving cardiotoxic therapy

Abstract Background: Black breast cancer survivors are up to three times more likely to develop cancer therapy-related cardiac dysfunction (CTRCD) when compared to White survivors. Reasons behind this disparity are not fully understood, and studies examining these disparities have been limited. One contributor may be variations in communications about CTRCD risk and risk prevention strategies between providers and patients by race and ethnicity. This study assessed racial differences in Black versus White breast cancer patients with provider communication regarding cardiotoxic treatments. Methods: Study participants were recruited from a comprehensive cancer center. Eligibility included identifying as a Black/African American or White woman, a diagnosis of stage I-III breast cancer, and receipt of anthracyclines and/or trastuzumab. Semi-structured interviews were conducted with survivors. Interviews were audio-recorded, transcribed, and were reconciled using Dedoose. Results: Interviews were conducted with 16 survivors (8 Black, 8 White) with a median age at diagnosis of 53 years. Prior to starting treatment, 100% of white survivors reported that a provider discussed CTRCD risk, however only 75% black survivors reported CTRCD discussion. Although all women received information on prevention strategies including exercise and nutrition, there were differences in timing of information delivered. Black women desired to have information at the beginning of treatment, but no White women mentioned a desire to receive information earlier. A greater proportion of White women reported engaging in prevention strategies such as exercising and eating healthy during treatment. In terms of knowledge gained, 75% of White Women reported being satisfied with the information given regarding cardiotoxic risk and prevention whereas only 45% of Black women reported being satisfied.As 65% of Black women (vs. White) reported being less than satisfied with the information given, Black women were also more likely to recommend access to additional resources. For example, one Black woman suggested that “they [care team] should get a cardiologist to be a part of the team when they first go. Conclusion &amp; Implications: Fewer Black women reported being satisfied with their medical visits regarding CTRCD risk and prevention strategies. Racial differences in assessments of these experiences highlight opportunities to develop culturally-tailored communication interventions to reduce racial disparities in CTRCD; however, future research is needed to assess interpersonal aspects of care during the receipt of cardiotoxic treatment. Citation Format: Ashley Turner, America Vijil, Sara Gómez-Trillos, Victoria Williams, Paulette Omeaku, Susan Hong, Arnethea L. Sutton. “They should get a cardiologist to be a part of the team when you first go”: A qualitative analysis of racial differences in the cancer care experience amongst breast cancer patients receiving cardiotoxic therapy [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 6297.

Abstract 3474: Racial disparities in receipt of surveillance mammography after breast cancer diagnosis

Abstract Background: The 5-year survival rate for breast cancer (BC) stands at an estimated 91%, with approximately 3.8 million BC survivors in the U.S. This large population of breast cancer survivors remains at risk of loco-regional recurrence, with variations noted across racial groups. White survivors face a locoregional breast cancer recurrence rate of 1.8%, whereas Black, Asian, and Hispanic survivors experience higher rates of 3.9%, 3.6%, and 3.1%, respectively. Notably, Black BC survivors with recurrent breast cancer exhibit a median survival time of 1.8 years compared with 3.6 years observed for White BC survivors. Current recommendations from the U.S. Preventative Services Task Force and the American College of Radiology advocate for surveillance through annual mammography and routine clinical visits following breast-conserving surgery and lumpectomies. However, there are gaps in the data available regarding disparities in the utilization of surveillance mammography by race/ethnicity. Thus, the goal of this study is to estimate race/ethnic disparities in surveillance mammography utilization and its impact on survival among breast cancer survivors at a large comprehensive cancer center. Methods: A retrospective cohort study of female breast cancer survivors ≥19 years diagnosed and/or treated at the Duke Cancer Institute (DCI) between 2014 and 2022 was conducted. Data was abstracted on patient socio-demographics, cancer type (invasive ductal and ductal in situ carcinomas) and utilization of surveillance mammography within 2-5 years post initial breast cancer diagnosis. Chi-squared testing will be used to analyze rates of mammography surveillance receipt among different races presenting with BC at DCI. Kaplan-Meier estimates will be used for analysis on survival. Results: A total of 10,904 women with a mean age of 43.7 years were included in the study. The study cohort is comprised of 69% non-Hispanic (NH) White, 24% NH Black, 2.2% Hispanic, 0.5% NH Native American, 1% NH other, and 3.2% NH Asian women. There were 1,791 cases of ductal in situ carcinomas and 9,113 invasive ductal carcinoma cases. NH Black women had the lowest 5-year relative survival rate (81.5%) of all represented racial groups: NH White 89.1%, Hispanic 95.3%, NH Native 87.8%, Asian 97.9%, and NH Other 88.0%. Ongoing analysis will be completed to estimate disparities in the use of post-treatment surveillance mammography amongst breast cancer survivors. Conclusions: This study will inform efforts to increase post-treatment surveillance and improve adherence to survivorship guidelines with the ultimate goal of reducing mortality disparities among breast cancer survivors. Citation Format: Jasmine G. Wilkerson, Frances Wang, Yadurshini Raveendran, Tomi Akinyemiju. Racial disparities in receipt of surveillance mammography after breast cancer diagnosis [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 3474.

Community resource facilitation use by ethnic minority groups with traumatic brain injury in the Midwestern United States

ABSTRACT Objective This study surveyed the use of community-based resource facilitation (RF) services by ethnic minority survivors of traumatic brain injury (TBI) living in the Midwestern United States. Method Past records of RF use by survivors of TBI were reviewed. Demographics and patterns of RF use across 3 ethnic groups were documented. Reported barriers to community integration related to ethnic identity were identified using Chi-square test of independence. Results Ethnic minority survivors were less likely to use RF services than white survivors. Caucasian women and men utilized RF services at similar rates, whereas more African American men and Latina women used RF services. Caucasians received information about RF from a greater variety of sources than ethnic minority survivors. Ethnic identity was significantly associated with greater reported needs for TBI awareness. Conclusions A pattern of differential RF use by survivors from ethnic minority groups was noted, suggesting potential socio-cultural influences on help-seeking behavior after TBI. These factors should be considered to develop more accessible and equitable strategies of RF service referral and support. Future investigations of cultural perspectives of TBI and injury-related services may improve understanding of the likelihood and necessity of community-based RF service use by diverse populations.

Disparities in Cardiovascular Disease-Related Outcomes Among Cancer Survivors in the United States: A Systematic Review of the Literature

Cancer and cardiovascular disease (CVD) are major causes of morbidity and mortality in the United States (US). Cancer survivors have increased risks for CVD and CVD-related mortality due to multiple factors including cancer treatment-related cardiotoxicity. Disparities are rooted in differential exposure to risk factors and social determinants of health (SDOH), including systemic racism. This review aimed to assess SDOH's role in disparities, document CVD-related disparities among US cancer survivors, and identify literature gaps for future research. Following the Peer Review of Electronic Search Strategies (PRESS) guidelines, MEDLINE, PsycINFO, and Scopus were searched on March 15, 2021, with an update conducted on September 26, 2023. Articles screening was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, a pre-defined Population, Exposure, Comparison, Outcomes, and Settings (PECOS) framework, and the Rayyan platform. A modified version of the Newcastle-Ottawa Scale was used to assess the risk of bias, and RAW Graphs for alluvial charts. This review is registered with PROSPERO under ID #CRD42021236460. Out of 7,719 retrieved articles, 24 were included, and discussed diverse SDOH that contribute to CVD-related disparities among cancer survivors. The 24 included studies had a large combined total sample size (n=7,704,645; median=19,707). While various disparities have been investigated, including rural-urban, sex, socioeconomic status, and age, a notable observation is that non-Hispanic Black cancer survivors experience disproportionately adverse CVD outcomes when compared to non-Hispanic White survivors. This underscores historical racism and discrimination against non-Hispanic Black individuals as fundamental drivers of CVD-related disparities. Stakeholders should work to eliminate the root causes of disparities. Clinicians should increase screening for risk factors that exacerbate CVD-related disparities among cancer survivors. Researchers should prioritise the investigation of systemic factors driving disparities in cancer and CVD and develop innovative interventions to mitigate risk in cancer survivors.

Abstract A002: Alcohol use patterns and patient-provider discussions about alcohol use among cancer survivors: Differences by race and ethnicity in the National Survey of Drug Use and Health

Abstract Background: Alcohol is a leading modifiable risk factor for cancer risk and recurrence. The American Cancer Society recommends abstaining from alcohol for cancer prevention and advises that those who choose to drink should limit their intake. Healthcare providers are uniquely positioned to counsel cancer survivors about alcohol’s harms. Prior research has revealed stark differences in heavy drinking among cancer survivors by race and ethnicity. We build on this work by examining the prevalence of multiple alcohol use patterns, alcohol screening, and patient-provider discussions about alcohol by race and ethnicity among a cancer survivor population. Methods: We conducted a cross-sectional study using data from the National Survey on Drug Use and Health (NSDUH) 2015-2019. Eligible respondents included adults (18+ years) who reported a prior cancer diagnosis. Outcomes included alcohol use patterns (lifetime abstention, alcohol use and binge drinking in the past 30 days), alcohol screening in the past year, and report of an in-person alcohol discussion with a healthcare provider in the past year. We estimated the adjusted prevalence of these outcomes by race and ethnicity from marginal effects of logistic regression models that accounted for sociodemographic characteristics (i.e., age, gender, educational attainment, household income) and health insurance type. Models included cluster, strata, and weight variables to account for the complex survey design and nonresponse bias. Results: The unweighted analytic sample size included 6,240 cancer survivors – 431 identified as Black, Non-Hispanic; 461 identified as Hispanic, and 5,348 identified as White, Non-Hispanic. Though not statistically significant, adjusted binge drinking prevalence was highest among Black, Non-Hispanic survivors (17.3% [95% CI: 11.6 – 23.0]) followed by White survivors (13.4% [95% CI: 12.2 – 14.6]) and Hispanic survivors (13.1% [95% CI: 9.8 – 16.4]). Significant differences in adjusted binge drinking prevalence by race and ethnicity were found for binge drinking among current drinkers – Black (41.4% [95% CI: 30.7 – 52.1]), Hispanic (31.7% [95% CI: 22.6 – 40.8]), White (26.7% [95% CI: 24.6 – 28.8]). No significant differences were found for alcohol screening prevalence by race and ethnicity. Black (44.7% [955 CI: 36.4 – 53.0]) and Hispanic (48.8% [95% CI: 40.1 – 57.6%]) cancer survivors were less likely than White survivors (56.9% [95% CI: 54.9 – 59.0]) to report an in-person provider discussion about alcohol. Conclusions: There is a significant racial disparity in problematic drinking between Black, Hispanic, and White cancer survivors, with higher proportions of Black and Hispanic survivors reporting binge drinking than their White peers. Yet, Black and Hispanic cancer survivors are less likely to have an in-person discussion with a provider about alcohol use compared with White cancer survivors. Black and Hispanic cancer survivors may not be receiving important messages about alcohol’s harms from their providers, who could be important sources of this information. Citation Format: Naomi K. Greene, David Dean Jr. Alcohol use patterns and patient-provider discussions about alcohol use among cancer survivors: Differences by race and ethnicity in the National Survey of Drug Use and Health [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 A002.