White Survivors Research Articles

Exploratory Examination of How Race and Criminal Record Relate to Housing Instability Among Domestic Violence Survivors.

Housing instability is a critical concern in the United States, and domestic violence (DV) survivors are a group at high risk for experiencing housing instability or of becoming unhoused. Prior research has also identified having a criminal record (CR) as being a major barrier to obtaining stable housing, and this is truer for Black and Latinx people compared to their White counterparts. No study has examined whether comparable trends exist among survivors of DV, a group also at elevated risk of having a CR, sometimes related to their experience of abuse. The current exploratory study included 305 unhoused or unstably housed female DV survivors who had sought out DV support services. Multivariate regressions explored if survivor race and CR were separately linked to greater housing instability. CR was then explored as a potential moderator in the relation between race and housing instability. Results revealed that DV survivors with a CR faced greater housing instability than those without a CR, Black and Latina survivors experienced greater housing stability than did White survivors, and CR did not moderate the relation between race and housing instability. The racial differences were unexpected and are discussed in light of methodological limitations. This is the first study to date to explore the role of CR possession on housing instability for DV survivors.

Acculturation, Mental Health, and Wellbeing Among Hispanic/Latinx Young Adult Survivors of Childhood Cancer.

Purpose: Ethnic disparities in childhood cancer survivor (CCS) mental health have been identified, although prior survivorship research has focused predominantly on non-Hispanic/Latinx (H/L) white survivors. Methods: This study examined the association of acculturation with depressive symptoms and wellbeing among 582 young adult H/L CCS recruited to a population-based study of CCS in Southern California. Results: In multivariable regression models adjusted for covariates, greater identification with both the Hispanic and Anglo cultures was positively associated with wellbeing (p = 0.007 and p < 0.0001, respectively), and Hispanic cultural identification was associated with fewer depressive symptoms (p = 0.04). Conclusions: Greater understanding of unique protective factors among minority CCS may inform tailored interventions promoting mental health.

Impact of Race, Ethnicity, and Socioeconomic Status over Time on the Long-term Survival of Adolescent and Young Adult Hodgkin Lymphoma Survivors.

Although there are growing numbers of adolescent and young adult (AYA) Hodgkin lymphoma (HL) survivors, long-term overall survival (OS) patterns and disparities in this population are underreported. The aim of the current study was to assess the impact of race/ethnicity, socioeconomic status (SES), rurality, diagnosis age, sex, and HL stage over time on long-term survival in AYA HL survivors. The authors used the Surveillance, Epidemiology, and End Results (SEER) registry to identify survivors of HL diagnosed as AYAs (ages 15-39 years) between the years 1980 and 2009 and who were alive 5 years after diagnosis. An accelerated failure time model was used to estimate survival over time and compare survival between groups. There were 15,899 5-year survivors of AYA HL identified, with a median follow-up of 14.4 years and range up to 33.9 years from diagnosis. Non-Hispanic black survivors had inferior survival compared with non-Hispanic white survivors [survival time ratio (STR): 0.71, P = 0.002]. Male survivors, older age at diagnosis, those diagnosed at higher stages, and those living in areas of higher SES deprivation had unfavorable long-term survival. There was no evidence of racial or sex-based survival disparities changing over time. Racial, SES, and sex-based disparities persist well into survivorship among AYA HL survivors. Disparities in long-term survival among AYA HL survivors show no evidence of improving over time. Studies investigating specific factors associated with survival disparities are needed to identify opportunities for intervention.

The Landscape of Perception: Racial Differences in How Disability Is Viewed Among Older-Adult Cancer Survivors.

This paper compares disability perceptions of Black with white older cancer survivors' to document racial disparities in these perceptions and the factors that contribute to them. The data are from a randomly selected tumor registry sample of 321 older adult cancer survivors from an NCI funded study. OLS regression models of disability perceptions, nested by race, examined the effects cancer and non-cancer health factors along with important covariates. Black older adult cancer survivors perceived themselves to be more disabled than did white survivors. Multivariate analyses showed a strong relationship between functional difficulties and disability perceptions for both Black and white survivors. However cancer-related factors such as continuing symptoms of the illness or treatment were relatively more important for Blacks. The findings suggest that race and cancer are both important factors in our understanding of disability in later life. These findings can then inform clinical best practices among minority older adults.

Distress Trajectories in Black and White Breast Cancer Survivors: From Diagnosis to Survivorship

BackgroundBlack breast cancer survivors have greater morbidity and mortality than White survivors. However, evidence comparing Black survivors’ psychological symptoms with their White counterparts has been mixed. Prior studies have not compared Black and White survivor’s distress-related symptom trajectories from pre- to post-treatment – the goal of the current study. MethodsAt three annual visits from shortly after diagnosis to 6 and 18 months post-treatment, 195 women (n = 163 White; n = 32 Black) reported their cancer-related distress (intrusive thoughts and avoidance), perceived stress, anxiety and depressive symptoms, fatigue, and pain. ResultsAdjusting for age, educational attainment, income, treatment type, stage at diagnosis, and physical comorbidities, Black and White breast cancer survivors had different trajectories of cancer-related distress (p = .004), intrusive thoughts about cancer diagnosis and treatment (p = .002), perceived stress (p = .04), emotional fatigue (p = .01), and vigor (p = .02). Specifically, among White women, these distress-related symptoms improved from diagnosis to 6 months post-treatment (ps < 0.0001) and then remained stable between 6 and 18 months post-treatment, whereas Black women had persistently elevated distress – even 18 months after finishing treatment. Additionally, Black women reported more avoidance of cancer-related thoughts and emotions across visits (p = .047). Race was unrelated to the trajectories of anxiety and depressive symptoms, other fatigue subscales, or pain levels (ps > 0.08). ConclusionLongitudinal assessment of the same breast cancer survivors from diagnosis to early survivorship revealed that Black and White survivors had divergent trajectories of psychological distress symptoms that were not reliably evident at a single timepoint. Overall, White women reported less psychological distress from pre- to post-treatment, but Black women’s distress remained high from diagnosis to 18 months post-treatment. If left untreated, Black women’s high distress levels may contribute to their poorer health throughout survivorship.

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

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

Racial Disparities in Sexual Assault Characteristics and Mental Health Care After Sexual Assault Medical Forensic Exams

Background: Sexual assault (SA) is common, but Black individuals might be at higher risk of SA and negative health sequalae. Racial differences in SA characteristics and health care utilization after SA are largely unknown. Materials and Methods: We reviewed medical records of 690 individuals (23.9% Black; 93.6% women) who received a SA medical forensic exam (SAMFE) at a southeastern U.S. hospital. We examined bivariate racial differences in SA characteristics and used zero-inflated Poisson regressions to estimate racial differences in mental health outpatient visits at the SAMFE hospital. Results: Among survivors of SA, Black survivors were more likely than White survivors to have been victimized by an intimate partner (odds ratio [OR] = 1.77, confidence interval [95% CI] = 1.02-3.07) and they had more post-SA outpatient mental health visits at the SAMFE hospital (incidence rate ratio [IRR] = 2.05, 95% CI = 1.70-2.47). Black survivors were less likely to report alcohol or drug use before the SA (OR = 0.42, 95% CI = 0.28-0.62). In multivariable models, Black survivors trended toward more mental health visits than White survivors (IRR = 1.63, 95% CI = 0.82-2.44), but intimate partner violence (IPV) significantly moderated that association (IRR = 0.01, 95%CI = ≤0.001-0.03). Black survivors assaulted by an intimate partner were less likely to access mental health care than White IPV survivors. Conclusions: The hospital setting of a SAMFE could be a unique opportunity to serve Black survivors and reduce racial disparities in mental health sequelae, but additional support will be needed for Black survivors experiencing IPV. An intersectional, reproductive justice framework has the potential to address these challenges.

Racial and Ethnic Disparities in Health Status, Chronic Conditions, and Behavioral Risk Factors Among Prostate Cancer Survivors, United States, 2015.

IntroductionLittle is known about perceived health status and behavioral risk factors among prostate cancer survivors. The objective of this study was to describe racial and ethnic differences in self-reported health status, chronic conditions, and selected behavioral risk factors among prostate cancer survivors in the US.MethodsWe used data from the 2015 National Health Interview Survey to calculate the prevalence of various levels of health status, chronic conditions, behavioral risk factors, and sociodemographic characteristics among prostate cancer survivors aged 50 years or older. We stratified results by race and ethnicity.ResultsOf the 317 prostate cancer survivors in our sample, 33.1% reported no physical activity, 64.2% reported being current drinkers, 26.1% characterized their drinking as moderate/heavy, 42.3% reported being former smokers, and 8.7% were current smokers. Nearly one-third (29.1%) of survivors were obese (body mass index ≥30), and 15.1% had 3 to 6 chronic conditions. A greater percentage of White (29.7%) than Black (14.2%) or Hispanic (16.3%) survivors were moderate/heavy drinkers. A greater percentage of Black (16.2%) than White (7.5%) or Hispanic (7.3%) survivors were current smokers. A greater percentage of Black (25.1%) or Hispanic (27.7%) than White (11.4%) survivors had 3 to 6 chronic conditions.ConclusionAs the population of older men increases, prostate cancer diagnoses and those surviving the disease will also increase. Significant racial and ethnic group differences in behavioral risk factors and chronic conditions exist among prostate cancer survivors. Public health could prioritize efforts to improve health behaviors among prostate cancer survivors and use targeted interventions to address disparities.

Cancer disclosure, stigma and identity: Racial differences among older adult, cancer survivors

This research examines cancer disclosure among older (60+), long-term (5+) survivors, comparing Black survivors with white survivors. 1 ““Black” and “African-American” are used interchangeably throughout this article. “Black” is capitalized because “Blacks, like Asians, Latinos, and other ‘minorities’, constitute a specific cultural group and, as such, require denotation as a proper noun. By the same token, ‘white’ is not a proper noun since whites do not constitute a specific cultural group” (Crenshaw, K. 1990, p. 1241, citing [ [34] MacKinnon C. Feminism, Marxism, Method, and the State. An Agenda for Theory, Signs. 1982; 7: 515-544 Google Scholar ], p. 516). It also examines racial differences in cancer-related stigma and the importance of identifying as a cancer survivor and how these, in turn, are related to the likelihood of disclosing their cancer history to family and friends.

Financial and Employment Impacts of Cancer and COVID-19 Among African American Cancer Survivors

Abstract Purpose: Financial hardship due to cancer is more common among African American than White survivors. The COVID-19 pandemic and its economic fallout have also disproportionately affected African Americans. The purpose of this study is to describe the financial and employment impacts of COVID-19 in a population of African American cancer survivors and to compare those impacts with those experienced after a cancer diagnosis. Methods: Results include survey data from 593 participants in the population-based Detroit Research on Cancer Survivors (ROCS) cohort who completed the ROCS enrollment survey and a supplemental questionnaire related to the impact of the COVID-19 pandemic on their financial wellbeing and employment. Most participants (96%) were not diagnosed with COVID-19 by the time they completed the supplement and reflect the societal impact of the pandemic rather than a personal COVID-19 diagnosis. Analyses compare reports of financial hardship (using assets, borrowing money, experiencing debt, decreases in income) and employment impacts (changes to work schedules, duties, hours, employment status) due to cancer and due to the COVID-19 pandemic. Results: A similar proportion of ROCS participants reported financial hardship (41% vs. 42%) and borrowing money (5% vs. 6%) related to the COVID pandemic and their cancer diagnosis, respectively. Fewer survivors reported borrowing money (9% vs. 17%; p&amp;lt;0.001) or experiencing a decrease in income due to COVID than cancer (20% vs. 28%; p = 0.001); however; more reported debt associated with COVID (30% vs. 17%; p&amp;lt;0.001). Changes to work schedules (44% vs. 36%) and hours worked (44% vs. 28%) related to the COVID pandemic and cancer were common, and not statistically different from one another. More survivors changed their work duties due to the COVID pandemic (20%) than cancer (12%; p = 0.048). Prevalence of changes to employment status were similar for cancer (6%) and COVID (11%). Conclusions: The COVID-19 pandemic was associated with similar levels of overall financial hardship, and higher prevalence of debt and some work changes, than individual cancer experiences. These additional burdens on a financially vulnerable population could exacerbate existing cancer-related inequities.

Abstract MP28: Nationwide Racial Disparities in Smoking Cessation After Stroke in the United States

Introduction: Black Americans face a higher risk of recurrent stroke than White Americans, and the reasons are unclear. Smoking after stroke is associated with a higher risk of recurrence. We investigated whether there are racial disparities in smoking cessation among stroke survivors in the United States. Methods: We performed a cross-sectional analysis of data from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, an annual, nationally representative health survey. Respondents are asked about medical conditions and health-related behaviors. We pooled data from 2013-2018, during which race and ethnicity were uniformly reported. We included respondents with prior stroke and any smoking history. The exposure was self-reported race, and the outcome was smoking cessation. We calculated the quit ratio, defined as the proportion of former smokers among ever smokers; this is a standard measure in population-based studies of smoking cessation. Survey procedures were used to estimate frequencies and summarize quit ratios by race. Multiple logistic regression was used to assess the association of Black race with smoking cessation, as compared to White race, while adjusting for age, gender, Hispanic ethnicity, education, income, health insurance, and the number of smoking-related health conditions (heart disease, lung disease, cancer) that may prompt cessation. Results: Among 4,374,011 Americans with a history of stroke and any smoking, the median age was 67 years (IQR, 58-76), and 45.7% were women; 15.4% were Black, 74.8% were White, and 9.8% reported other race. The crude quit ratio was 51.4% (95% CI, 49.0-53.7) in Black and 63.2% (95% CI, 62.4-64.1) in White stroke survivors. In unadjusted analyses, Black stroke survivors were less likely to have quit smoking than White stroke survivors (OR, 0.61; 95% CI, 0.55-0.68). This remained the case after accounting for differences in demographics and smoking-related comorbidities (OR, 0.85; 95% CI, 0.74-0.98). Conclusion: In this nationwide study, Black stroke survivors had lower smoking quit rates than White stroke survivors, even after accounting for group differences. Expanding access to smoking-cessation interventions may reduce disparities in recurrent stroke.

Exploring Differences in Perceived Satisfaction, Resilience, and Achievement Between Hispanic and Non-Hispanic White Childhood Cancer Survivors.

To address gaps in understanding disparities of posttraumatic growth among childhood cancer survivors, the aims of this study were to (1) compare satisfaction, resilience, and achievement among Hispanic and non-Hispanic White survivors; and (2) examine relationships between sociodemographic and clinical factors with satisfaction, resilience, and achievement. Survivors (N = 116) at Children's Hospital of Orange County After Cancer Treatment Survivorship Program completed the Child Health and Illness Profile-Adolescent Edition. Resilience (p = .003) and achievement (p = .005) were lower among Hispanic survivors. Resilience was positively associated with satisfaction (p < .01) and achievement (p < .01) and achievement was positively associated with years of schooling (p < .01). No differences were found between Hispanic and non-Hispanic White satisfaction scores (p = .95). Our findings suggest ethnic disparities in posttraumatic growth in childhood cancer survivors. Interventions aimed at promoting posttraumatic growth are vital to address these differences.

Atrial Cardiopathy Features Differ for Black and White Ischemic Stroke Survivors

Atrial Cardiopathy Features Differ for Black and White Ischemic Stroke Survivors

Lifestyle Challenges Among Older Female Cancer Survivors

The American Cancer Society recommends that survivors maintain a healthy lifestyle including a normal weight, being physically active, and maintaining a healthy diet to improve prognosis and health-related quality of life (HRQoL). Unfortunately, the majority of cancer survivors do not engage in a healthy lifestyle. The largest proportion of cancer survivors are older adults (≥65 years), yet they are often understudied, particularly regarding healthy lifestyles. This study sought to examine the lifestyle behaviors (maintaining healthy weight, dietary intake, physical activity) of older female cancer survivors and to identify associations with HRQoL. Older female cancer survivors (n=170) completed surveys to assess HRQoL (RAND-36), diet quality (HEI-2015), physical activity, malnutrition, and BMI. Descriptive analyses, correlations, and stepwise linear regressions were utilized. The majority of the sample (mean age=74.67±8.43 years) were white (90%), married (54.4%), college-educated (63.9%), and breast cancer survivors (67.4%). Self-reported health was very good (42.6%) and good (39.6%) and general HRQoL was 59.48±15.34 out of 100. Self-reported physical activity was low; 75.3%, 54.2%, and 68.1% reported no strenuous, moderate, and mild physical activity, respectively. Mean BMI was 27.71±6.24 with 64% of the participants being overweight or obese. Mean HEI-2015 scores were 66.39±10.00, below the “good” diet quality score of 80. Risk of malnutrition was present in 27.4% of participants. Regressions found that being White (β=-0.528, p=0.001) and lower BMI (β =-0.405, p=0.024) were significant predictors of HRQoL. Results indicate the need for tailored health coaching for older cancer survivors regarding their lifestyle behaviors to improve prognosis and HRQoL.

Abstract PO-099: Racial differences in the association of circulating inflammatory proteins with mortality from causes other than the index cancer in older adult cancer survivors in the Atherosclerosis Risk in Communities (ARIC) study

Abstract Background Inflammation is strongly hypothesized to underlie premature mortality in cancer survivors. However, little is known about racial differences in the associations of inflammatory proteins with premature mortality in cancer survivors. Methods 474 long-term (≥5 years) older adult survivors of prostate, breast, colorectal, endometrial and bladder cancers in the ARIC study were followed from visit 5 (2011-13) to December 2018. At visit 5, 5000 serum proteins were assayed using the high throughput SOMAscan technology. Using competing risks proportional hazards regression, we evaluated racial differences in the associations of 580 inflammatory proteins measured at visit 5 with deaths from causes other than the index cancer by modeling sub-distribution hazards (sHR) of deaths per log2 increase in each inflammatory protein in Black and White survivors. Models were adjusted for age, sex, race, years since cancer diagnosis, cancer/cardiovascular disease (CVD) shared risk factors such as smoking, history of CVD, diabetes, kidney function, and anti-inflammatory drug use, and included race-protein interaction terms. In a sensitivity analysis, we additionally adjusted for lifecourse SES and access to care. We accounted for multiple testing using Bonferroni correction and false discovery rate Q-values. Results Survivors were 21% Black, 56% male, had a mean age of 76.8 yrs, and median time since diagnosis of 11.4 yrs. 95 non-cancer (50% CVD) and 34 non- index cancer deaths occurred during 2740 person-years of follow-up. Thirty inflammatory proteins, 17 of these in the sensitivity analysis had significantly different (Q&amp;lt;0.05) qualitative or quantitative effects in Black and White survivors. Inflammatory proteins with the most significant racial differences in the sHR of mortality were CD69 (early activation antigen), which was associated with lower mortality in Whites (sHR per Δlog2 (95% CI): 0.47 (0.27,0.82)) and higher mortality in Blacks (2.96 (1.78,4.93), Pint = 1.24 × 10-6], and CCL18 (CC motif chemokine 18), which was associated with higher mortality in Whites (1.83 (1.02,3.28)) and lower mortality in Blacks (0.33 (0.12 0.94), Pint = 4.14 × 10-3). The differential effect of CD69 by race remained significant after Bonferroni correction in the main and sensitivity analysis. Conclusion Associations of some circulating inflammatory proteins with mortality differ in Black and White cancer survivors independent of lifestyle, medical, and social factor confounders. CD69 is upregulated by NF-κB signaling and regulates a variety of crucial immune pathways that depend on host metabolic factors. CCL18 is mainly produced by the innate immune system and genetic variations in encoding genes have been reported. Further studies are needed to evaluate whether racial differences in host metabolic factors or genetic differences modulate effects of these proteins on mortality in Black and White survivors. If confirmed these proteins may warrant focus for characterization as potential therapeutic targets. Citation Format: Chinenye C. Ugoji, Lorraine T. Dean, Alden Gross, Elizabeth A. Platz. Racial differences in the association of circulating inflammatory proteins with mortality from causes other than the index cancer in older adult cancer survivors in the Atherosclerosis Risk in Communities (ARIC) study [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-099.

Abstract PO-097: Treatment-related toxicities in Black and White women taking adjuvant endocrine therapy

Abstract Purpose: The effectiveness of adjuvant endocrine therapy (AET) to reduce morbidity and mortality among women diagnosed with hormone-receptor positive (HR+) breast cancer (BC) is well understood, yet the potential debilitating toxicities for Black survivors is not. Further, symptom toxicities impact treatment adherence. Using a mixed methods approach, this study examined patterns of reported AET- related toxicities in HR+ Black and White survivors. Methods: Study participants were enrolled in the Women’s Hormonal Initiation and Persistence study, a longitudinal observational trial of women diagnosed with HR+ breast cancer. Data regarding patient (e.g. race), medication (e.g. AET type), cancer care delivery (e.g. communication), and clinicopathologic factors (e.g., chemotherapy) were collected via surveys and medical charts. The FACT-ES assessed AET toxicity at baseline, 12 and 24 months. Primary analyses focused on the first year; secondary analyses explored changes over time. Multivariable linear regression models examined predictors of AET overall toxicity and for 5 toxicity subgroups. Focus groups with women (N=30) prescribed AET were transcribed verbatim, coded and analyzed. Results: Of the 570 participants, 28% were Black. Black women were more likely to have chemotherapy prior to starting AET but as likely as whites to have radiation. Most women (62%) were taking aromatase inhibitors (AIs). In unadjusted analyses Black women reported more overall, vasomotor, neurological, and gastrointestinal toxicities (p&amp;lt;.05). Race was insignificant in multivariable analysis. Factors associated with higher AET toxicity were higher medication concerns (ß=1.29; CI: 0.88 – 1.69; p&amp;lt;0.001), younger age (ß=-0.23; CI: -0.36 – -0.10; p&amp;lt;0.001), and lower satisfaction with care (ß=-0.24; CI: -0.48 – 0.01; p=0.041). Higher AET gynecological toxicities were associated with AI use (vs. Tamoxifen) (p=0.002) Trends of toxicities over time suggest higher overall reporting by Black women (P=0.07). Qualitative analysis revealed that most women were not prepared for AET toxicities and desired more information at the start of AET. More often than Whites, Black women reported receipt of less information from providers and emphasized that spiritual coping supported their ability to adhere to AET therapy despite toxicities. Conclusion: During the first year of AET, racial disparities in toxicity diminished when controlling for psychosocial and communication factors. Development of interventions that target these factors may enhance symptom management, self-care, and potentially adherence. Citation Format: Vanessa B. Sheppard, Arnethea L. Sutton, Reuben Retnam, Kandace P. McGuire. Treatment-related toxicities in Black and White women taking adjuvant endocrine therapy [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-097.

Abstract PO-139: Racial differences in ideal cardiovascular health and associations with racial disparities in cardiovascular disease among women with breast and gynecologic cancer

Abstract BACKGROUND: Racial disparities in cardiovascular disease (CVD) incidence among cancer survivors exist, with Black women experiencing higher morbidity and mortality than White women. Ideal cardiovascular health (CVH), a composite measure of modifiable lifestyle behaviors and biometric factors, is inversely associated with CVD. However, the extent to which racial differences in ideal CVH drive CVD disparities among women with breast and gynecologic cancers is unknown. METHODS: We included 110 White and 283 Black women of the Southern Community Cohort Study (SCCS) and without CVD or cancer at baseline who subsequently developed a breast or gynecologic malignancy, and with data available to determine CVH. Incident cancer diagnoses were ascertained via linkage with state cancer registries. The main outcome, newly diagnosed fatal or non-fatal CVD, was ascertained via linkage of the SCCS cohort with the Centers for Medicare and Medicaid Services. We categorized ideal CVH using the American Heart Association’s Life Simple 7 (LS7) framework. Body mass index, glucose (presence/absence of diabetes or medication information), cholesterol (presence/absence of hypercholesterolemia or medication information), blood pressure (hypertension presence/absence or measurement if available), smoking history, diet quality, and physical activity were dichotomized as not ideal vs. ideal based on established LS7 cut points. The resulting seven point score was categorized as inadequate (0-2), intermediate (3-4), or ideal (5-7) CVH. Cox proportional hazard regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between race, ideal CVH, and CVD incidence, adjusted for age at cancer diagnosis, SCCS enrollment year, type of cancer, and time from SCCS enrollment to cancer diagnosis. RESULTS: CVH was similar by race (p=0.90). There were also no significant differences in CVH by age at enrollment or cancer diagnosis, household income, insurance, or marital status. Women with ideal CVH were more likely to have more than a high school education than women with inadequate or intermediate CVH (p=0.03). In Cox models with incident CVD as the outcome when White women with intermediate CVH were the reference group, White women with inadequate CVH had similar CVD risk (HR=1.02) while those with ideal CVH had lower CVD risk, though not significant (HR=0.80, 95% CI 0.43-1.50). Black women with intermediate and ideal CVH had similar CVD risks as white women with intermediate CVH (HR=1.11 and HR=1.02, respectively), while Black women with poor CVH had significantly higher risk of CVD (HR=1.49, 95% CI 1.00-2.20). CONCLUSIONS: Black breast and gynecological cancer survivors, compared to White survivors, may experience elevated risk of CVD despite CVH status. Given that findings showed no differences in baseline characteristics between the Black and White survivors, further study of other potential confounders owing to the social determinants tied to the construct of race is warranted. Citation Format: Jennifer A. Sinnott, Jessica L. Krok-Schoen, Elizabeth K. Arthur, Emily Ridgway, Darrell M. Gray, Karen P. Williams, Darryl B. Hood, Joshua J. Joseph, Ashley S. Felix, Timiya S. Nolan. Racial differences in ideal cardiovascular health and associations with racial disparities in cardiovascular disease among women with breast and gynecologic cancer [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-139.

Prevalence and Predictors of Neurocognitive Impairment in Long-Term Survivors of Childhood Hodgkin Lymphoma: A Report from the Childhood Cancer Survivor Study

Background: Long-term survivors of childhood Hodgkin lymphoma (HL) are at significant risk for cardiovascular, pulmonary, and endocrine morbidity in addition to subsequent cancers. Emerging evidence suggests that HL survivors may also experience persistent neurocognitive impairment, however the prevalence of neurocognitive impairment has not been well characterized. Further, little work has been done to examine how specific treatments or comorbidities are associated with these impairments. Methods: The current study included 1,760 survivors (52.0% female, mean[sd] 37.5 [6.0] years old, 23.6 [4.7] years from diagnosis) of childhood Hodgkin lymphoma and 3,180 sibling controls (54.5% female, 33.2 [8.5] years old) from the Childhood Cancer Survivor Study. Participants completed questionnaires assessing four domains of neurocognitive impairment (task efficiency, emotional regulation, organization, and memory). Impairment for each domain was defined as a score worse than the 90th percentile of community controls. Treatment exposures were abstracted from the medical record. Second malignancies (SMN) were self-reported and subsequently confirmed by pathology findings or medical record review. Chronic health conditions were self-reported and systematically graded according to the NCI CTCAE v4.3 (Grade 1 mild, Grade 2 moderate, Grade 3 severe/disabling, Grade 4 life-threatening). Generalized estimating equations were used to calculate risk of impairment in survivors compared with siblings adjusted for age, sex, and race. Among HL survivors, multivariable log-binomial regression was used to calculate risk of impairment associated with demographic, clinical, and treatment factors. Separate models examined risk associated with Grade 2+ chronic health conditions adjusted for age, sex, and race. Results: 10.8% of HL survivors reported impaired task efficiency (vs. 7.7% in siblings), 16.6% emotional regulation (vs. 11.5% in siblings), 12.1% organization (vs. 10.3% in siblings), and 8.1% memory (vs. 5.7% in siblings). Compared with siblings, survivors reported significantly higher risk of impairment in each of the four neurocognitive domains after adjusting for age, sex, and race (Table). Female survivors had elevated risk of impairment on emotional regulation (RR [95%CI] 1.4 [1.1,1.9)) and memory (2.0 [1.3,3.0]). Compared with white survivors (91.8% of the population), non-white survivors had higher risk of impairment in task efficiency (2.1 [1.2, 3.5]) and emotional regulation (1.7 [1.0,2.7]). Current smokers (12.3%) had higher risk of impairment in task efficiency (1.9 [1.2, 3.1]), emotional regulation (2.5 [1.7,3.7]), and memory (1.7 [1.0,3.0]). Having a late-relapse (&amp;gt;5 years from diagnosis) or a second malignancy (20.0%) was associated with elevated risk of impairment in task efficiency (1.6 [1.06,2.3]). While not statistically significant, anthracycline exposure (39.8%) was associated with higher risk of impairment in task efficiency (1.3 [0.7,2.2]) and memory (1.6 [0.9,3.0]). No statistically significant associations were noted for bleomycin, corticosteroids, or chest radiation. HL survivors with pulmonary morbidity (8.5%) had a higher risk of impairment on task efficiency (1.9 [1.2,3.0]) compared to those without. Cardiovascular conditions (32.9%) were associated with elevated risk of impairment in all domains (RR range from 1.5 to 2.1, all p&amp;lt;0.05, Table). Endocrine (54.3%) and neurologic conditions (6.6%) were associated with an increased risk of task efficiency, emotional regulation, and memory impairments (RR range from 1.4 to 5.5, all p&amp;lt;0.05, Table). Conclusions: Survivors experienced significantly more neurocognitive impairment compared to sibling controls. Among survivors, potentially modifiable risk factors such as smoking and chronic health conditions were associated with neurocognitive impairment while treatment exposures showed little association. Mitigation or prevention of smoking and chronic health conditions may improve neurocognitive functioning in HL survivors Table Disclosures No relevant conflicts of interest to declare.

Spirituality and depressive symptoms in a multiethnic sample of cancer survivors.

This study aimed to (a) examine the relationships of 3 facets of spirituality (i.e., meaning, peace, faith), and their interaction, with depressive symptoms among Black, Latino, and White cancer survivors; and (b) test fear of cancer recurrence (FCR) and social support (SS) as mediators of these relationships. Data were analyzed from the American Cancer Society's Study of Cancer Survivors-I, a longitudinal population-based study of cancer survivors' quality of life. A national sample of Black (n = 194), Latino (n = 90), and White (n = 2,775) survivors of the top 10 incident cancers completed measures 1 year (Time 1, T1), 2 years (Time 2, T2), and 9 years (Time 3, T3) postdiagnosis. After controlling for T1 depressed mood and demographic and medical characteristics, T1 lower meaning and lower peace, but not faith, predicted greater depressive symptoms at T3 in the total sample. A significant interaction showed that higher faith predicted greater depressive symptoms specifically in the context of lower meaning. Race/ethnicity did not affect these relationships. FCR at T2 partially mediated the relationships of T1 meaning and peace with T3 depressive symptoms, and SS partially mediated the relationship between T1 meaning and T3 depressive symptoms. Cancer survivors with greater meaning and peace appear better able to integrate the cancer experience into their lives. An interaction between T1 meaning and faith on T3 depressive symptoms replicated previous findings. Future research should treat spirituality as a multidimensional construct and focus on identifying and influencing malleable mechanisms of the associations between spirituality and mental health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Abstract B032: Which forms of financial hardship predict financial distress among African American and white cancer survivors?

Abstract Background: Financial hardship (FH) is common among cancer survivors and prevalence is often higher in non-white survivors. It is not known whether specific forms of FH are stronger predictors of financial distress than others, or if predictors of distress differ by race. Methods: We utilized data from 500 (196 white, 304 African American) participants in the Detroit Research on Cancer Survivors pilot cohort. Adults ages 20-79 were eligible if they were diagnosed with a first primary breast, colorectal, lung, or prostate cancer since January 1, 2013; identified through the Metropolitan Detroit Cancer Surveillance System; and diagnosed/treated at the Karmanos Cancer Institute. Measures of financial hardship included decreased income, cancer-related debt, utilizing assets or borrowing money to pay for cancer care, refusing treatment or not seeing a doctor when needed due to cost, and skipping doses of prescribed medication to save money. Financial distress was measured using the validated Comprehensive Score for Financial Toxicity (COST), coded so that lower scores indicate higher distress (lower financial quality of life). We used backward selection models including demographic and socioeconomic factors to identify predictors of financial distress overall and separately for white and African American survivors. Results: COST scores were 27.3 on average (SD: 10.9; 95% CI: 26.2, 28.3; range: 0-44), and were lower (more financial distress) in African American (24.5, 95% CI: 23.1, 25.8) than white survivors (31.0, 95% CI: 29.4, 32.5; p&amp;lt;0.001). Younger age, being unmarried, lower income, not being employed, and having Medicaid coverage were all associated with higher financial distress. Debt, decreased income, utilizing assets, skipping doses of prescribed medication, and needing a doctor but not going were each independently associated with more financial distress overall (all p=0.013). Debt was associated with distress among both white and African American survivors in race-specific models (p=0.005) and decreased income was associated with distress in white (p=0.013) and marginally associated (p=0.06) in African American survivors. Not going to the doctor when needed and utilizing assets (both p&amp;lt;0.001) predicted distress among white survivors, while refusing treatment due to cost (p=0.007) and skipping doses of prescribed medication to save money (p=0.007) predicted distress in African American survivors. Not going to a doctor when needed was more common in African American survivors, but more strongly associated with distress in white survivors (p-interaction=0.024). A similar pattern was observed for utilizing assets but was only marginally significant (p=0.08). Conclusions: Several forms of financial hardship were strongly associated with financial distress after cancer, but their association with distress differed by race. Some forms of financial hardship that are more common in African American survivors are more strongly associated with financial distress among white survivors. Citation Format: Theresa A. Hastert, Amanda R. Reed, Jennifer L. Beebe-Dimmer, Terrance L. Albrecht, Julia Mantey, Tara Baird, Ann G. Schwartz. Which forms of financial hardship predict financial distress among African American and white cancer survivors? [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B032.