Cooperation between PRMT1 and PRMT6 drives lung cancer health disparities among Black/African American men

Lung cancer is the third most common cancer with Black/AA men showing higher risk and poorer outcomes than NHW men. Lung cancer disparities are multifactorial, driven by tobacco exposure, inequities in care access, upstream health determinants, and molecular determinants including biological and genetic factors. Elevated expressions of protein arginine methyltransferases (PRMTs) correlating with poorer prognosis have been observed in many cancers. Most importantly, our study shows that PRMT6 displays higher expression in lung cancer tissues of Black/AA men compared to NHW men. In this study, we investigated the underlying mechanism of PRMT6 and its cooperation with PRMT1 to form a heteromer as a driver of lung cancer. Disrupting PRMT1/PRMT6 heteromer by a competitive peptide reduced proliferation in non-small cell lung cancer cell lines and patient-derived organoids, therefore, giving rise to a more strategic approach in the treatment of Black/AA men with lung cancer and to eliminate cancer health disparities.

Ethical, legal, and social implications (ELSI) and challenges in the design of a randomized controlled trial to test the online return of cancer genetic research results to U.S. Black women

BACKGROUND

A central challenge to precision medicine research efforts is the return of genetic research results in a manner that is effective, ethical, and efficient. Formal tests of alternate modalities are needed, particularly for racially marginalized populations that have historically been underserved in this context.

METHODS

We are conducting a randomized controlled trial (RCT) to test scalable modalities for results return and to examine the clinical utility of returning genetic research results to a research cohort of Black women. The primary aim is to compare the efficacy of two communication modalities for results return: 1) a conventional modality that entails telephone disclosure by a Board-certified genetic counselor, and 2) an online self-guided modality that entails results return directly to participants, with optional genetic counselor follow-up via telephone. The trial is being conducted among participants in the Black Women's Health Study (BWHS), where targeted sequencing of 4000 participants was previously completed.

RESULTS

Several ethical, legal, and social implications (ELSI) and challenges presented, which necessitated substantial revision of the original study protocol. Challenges included chain of custody, re-testing of research results in a CLIA lab, exclusion of VUS results, and digital literacy. Bioethical principles of autonomy, justice, non-maleficence, and beneficence were considered in the design of the study protocol.

CONCLUSION

This study is uniquely situated to provide critical evidence on the effectiveness of alternative models for genetic results return and provide further insight into the factors influencing access and uptake of genetic information among U.S. Black women.

CLINICALTRIALS

gov: NCT04407611.

Change in distress about police brutality and substance use among young people, 2017-2020

BACKGROUND

It is unknown whether increasing attention to police brutality is a source of stress associated with substance use risk among young people.

METHODS

A longitudinal racially/ethnically diverse cohort from Los Angeles, California (n = 1797) completed baseline (2017; mean age: 17.9) and follow-up (2020; mean age: 21.2) surveys assessing level of concern, worry, and stress about police brutality (range: 0 'not at all' - 4 'extremely') and past 30-day nicotine, cannabis, alcohol, other drug, and number of substances used (0-19). Regression models, adjusted for demographic characteristics and baseline substance use, evaluated whether changes in distress about police brutality from 2017 to 2020 were associated with substance use in 2020 overall and stratified by race/ethnicity.

RESULTS

Distress about police brutality increased between 2017 (mean: 1.59) and 2020 (mean: 2.43) overall. Black/African American and Hispanic/Latino respondents consistently had the highest mean distress levels at both timepoints. In the full sample, each one-unit greater increase in distress about police brutality from 2017 to 2020 was associated with 11% higher odds of cannabis use, 13% higher odds of alcohol use, and 8% higher risk of using an additional substance for the number of substances used outcome. Race/ethnicity-stratified models indicated that greater increases in distress from 2017 to 2020 was associated with substance use among Black/African American, Hispanic, and multiracial respondents in 2020, but not Asian American/Pacific Islander and White respondents.

CONCLUSIONS

Distress about police brutality may be associated with substance use, particularly among certain racial/ethnic minority young people. Further investigation of whether police brutality affects health in disparity populations is needed.

Leadership Diversity and Development in the Nation's Cancer Centers

The capacity and diversity of the oncology leadership workforce has not kept pace with the emerging needs of our increasingly complex cancer centers and the spectrum of challenges our institutions face in reducing the cancer burden in diverse catchment areas. Recognizing the importance of a diverse workforce to reduce cancer inequities, the Association of American Cancer Institutes conducted a survey of its 103 cancer centers to examine diversity in leadership roles from research program leaders to cancer center directors. A total of 82 (80%) centers responded, including 64 National Cancer Institute-designated and 18 emerging centers. Among these 82 respondents, non-Hispanic White individuals comprised 79% of center directors, 82% of deputy directors, 72% of associate directors, and 72% of program leaders. Women are underrepresented in all leadership roles (ranging from 16% for center directors to 45% for associate directors). Although the limited gender, ethnic, and racial diversity of center directors and perhaps deputy directors is less surprising, the demographics of current research program leaders and associate directors exposes a substantial lack of diversity in the traditional cancer center senior leadership pipeline. Sole reliance on the cohort of current center leaders and leadership pipeline is unlikely to produce the diversity in cancer center leadership needed to facilitate the ability of those centers to address the needs of the diverse populations they serve. Informed by these data, this commentary describes some best practices to build a pipeline of emerging leaders who are representative of the diverse populations served by these institutions and who are well positioned to succeed.

Abstract SY30-01: Translational issues in lung cancer disparities: A vision for cancer equity

Lung cancer continues to be one of the leading causes of racial disparities in cancer morbidity and mortality among adults in the United States. Over the past 20 years, efforts to address disparities in lung cancer outcomes have focused on describing racial/ethnic differences in smoking behaviors and cessation outcomes. Other research has compared racial/ethnic groups in psychosocial and geographic risk factors for smoking and barriers to cessation; self-reported perceptions of stress and neighborhood deprivation have emerged as critical determinants of persistent tobacco use and predictors of relapse in disparity populations. Considerable investments have also been made to develop novel approaches for detecting lung cancer early and therapeutic strategies for treating this disease; lung cancer screening with LDCT now has a Grade B recommendation from the US Preventive Services Task Force and screening guidelines have been revised recently to be better aligned with the smoking behaviors and disease risk profiles among smokers from disparity populations. The demonstrated ability of LDCT to reduce lung cancer mortality is a significant clinical and public health advancement because it is the only evidence-based approach for detecting lung cancer at an early stage when treatment is most likely to be curative. However, several studies have demonstrated that patients from disparity populations have reduced uptake of cancer control strategies such as LDCT because of unmet social needs and risk factors; thus, revising lung cancer screening guidelines to be more inclusive may be necessary but not sufficient for improving access among disparity populations. The purpose of this presentation is to describe the goals and objectives for translational studies that are now being conducted to enhance equity in lung cancer outcomes among disparity populations and to identify priorities for future research in lung cancer equity.

Citation Format: Chanita Hughes-Halbert. Translational issues in lung cancer disparities: A vision for cancer equity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr SY30-01.

Direct N-Glycosylation Profiling of Urine and Prostatic Fluid Glycoproteins and Extracellular Vesicles

Expressed prostatic secretions (EPS), also called post digital rectal exam urines, are proximal fluids of the prostate that are widely used for diagnostic and prognostic assays for prostate cancer. These fluids contain an abundant number of glycoproteins and extracellular vesicles secreted by the prostate gland, and the ability to detect changes in their N-glycans composition as a reflection of disease state represents potential new biomarker candidates. Methods to characterize these N-glycan constituents directly from clinical samples in a timely manner and with minimal sample processing requirements are not currently available. In this report, an approach is described to directly profile the N-glycan constituents of EPS urine samples, prostatic fluids and urine using imaging mass spectrometry for detection. An amine reactive slide is used to immobilize glycoproteins from a few microliters of spotted samples, followed by peptide N-glycosidase digestion. Over 100 N-glycan compositions can be detected with this method, and it works with urine, urine EPS, prostatic fluids, and urine EPS-derived extracellular vesicles. A comparison of the N-glycans detected from the fluids with tissue N-glycans from prostate cancer tissues was done, indicating a subset of N-glycans present in fluids derived from the gland lumens. The developed N-glycan profiling is amenable to analysis of larger clinical cohorts and adaptable to other biofluids.

Development and Evaluation of a Navigation-Based, Multilevel Intervention to Improve the Delivery of Timely, Guideline-Adherent Adjuvant Therapy for Patients With Head and Neck Cancer

PURPOSE

More than half of patients with head and neck squamous cell carcinoma (HNSCC) experience a delay initiating guideline-adherent postoperative radiation therapy (PORT), contributing to excess mortality and racial disparities in survival. However, interventions to improve the delivery of timely, equitable PORT among patients with HNSCC are lacking. This study (1) describes the development of NDURE (Navigation for Disparities and Untimely Radiation thErapy), a navigation-based multilevel intervention (MLI) to improve guideline-adherent PORT and (2) evaluates its feasibility, acceptability, and preliminary efficacy.

METHODS

NDURE was developed using the six steps of intervention mapping (IM). Subsequently, NDURE was evaluated by enrolling consecutive patients with locally advanced HNSCC undergoing surgery and PORT (n = 15) into a single-arm clinical trial with a mixed-methods approach to process evaluation.

RESULTS

NDURE is a navigation-based MLI targeting barriers to timely, guideline-adherent PORT at the patient, healthcare team, and organizational levels. NDURE is delivered via three in-person navigation sessions anchored to case identification and surgical care transitions. Intervention components include the following: (1) patient education, (2) travel support, (3) a standardized process for initiating the discussion of expectations for PORT, (4) PORT care plans, (5) referral tracking and follow-up, and (6) organizational restructuring. NDURE was feasible, as judged by accrual (88% of eligible patients [100% Blacks] enrolled) and dropout (n = 0). One hundred percent of patients reported moderate or strong agreement that NDURE helped solve challenges starting PORT; 86% were highly likely to recommend NDURE. The rate of timely, guideline-adherent PORT was 86% overall and 100% for Black patients.

CONCLUSION

NDURE is a navigation-based MLI that is feasible, is acceptable, and has the potential to improve the timely, equitable, guideline-adherent PORT.

Using a Chatbot to Assess Hereditary Cancer Risk

PURPOSE

We developed a Web-based chatbot (ItRunsInMyFamily.com) to help individuals collect their family health history (FHx) and determine their risk for hereditary cancer. The purpose of the current study was to assess the characteristics of users and identify opportunities to improve the FHx collection tool.

METHODS

During Family Health History Month (November 2019) we launched an FHx campaign using social media advertisements to raise awareness about hereditary cancers and encourage individuals in the general population to use ItRunsInMyFamily to collect their FHx. Through this campaign, we were able to gather information about users and identify opportunities to improve the tool.

RESULTS

We reached 14,140 users in November 2019 through online marketing campaigns-Facebook, Google, previous ItRuns users, and Web site marketing. Of those, 3,204 completed the full FHx assessment and received risk recommendations. The campaign targeted women between age 40 and 60 years. Users came from 3,783 counties around the United States, 48 unique cancers were reported among probands, and 79 unique cancers were reported among family members, an average of two and a half cancers per family.

CONCLUSION

Our results demonstrate that it is possible to gather FHx information at the population level, with high levels of engagement and interest in the topic. There is room for future enhancements and improvements to ItRunsInMyFamily to broaden its reach and encourage individuals to learn about and record their health information.

Abstract 2196: Prostate cancer: Immune-inflammation signature in men of African ancestry

African American (AA) men have a 2 to 3 times higher prostate cancer mortality rates than European American (EA) men. Studies suggested that tumor biology may influence racial/ethnic survival and account for 24% of the disparities in PCa that remains even when controlled for access to care and stage at presentation. Additionally, men of African ancestry from the Caribbean and South America experience incidence and mortality rates similar to AA men, suggesting a possible ancestral basis for some of these expected outcomes. No study has currently assessed whether African descent men are affected by a systemic inflammatory process with changes in the immune system that increases the risk of lethal PCa. To assess the hypothesis that African ancestry drives aggressive prostate cancer and leads to genetic alterations with upregulation of unique immune-inflammatory signatures in men of African descent, we performed a genome-wide RNA sequencing analysis. We analyzed RNA isolated from FFPE tumor tissue obtained from 15 patients who self-reported as AA and 13 patients who self-reported as EA (n=28). To verify self-reported race, we used ADMIXTURE to generate a quantitative estimate of each individual ancestral composition. Notably, 14 patients who self-reported as AA also have a predominant African ancestry, particularly from African Caribbean's subpopulation, and one patient who self-reported as AA was actually Ad Mixed American. Furthermore, we conducted a descriptive statistical analysis of the study population; patients were stratified by race and pathology stage. Our results show that AA men are diagnosed with PCa at a younger age and higher pathology stage (≥ T2), contributing to a lower survival rate in AA. Gene-level expression was measured from STAR counts using Ensembl gene annotation. The resulting datasets were analyzed for differential gene expression and enriched pathways based on the patient's ancestry, race, and Gleason Score. Our analyses reveal that interferon-inducible genes (ISG15, IFT1, STAT1) are positively enriched (p-value 0.05), while neutrophil degranulation and Interleukins genes (IL8, CXCL8, KRTs, IL6, CXCL6) are negatively enriched (p-value 0.05) in AA men. These enriched gene sets may indicate that immune/inflammatory signatures play an important role in driving aggressive prostate cancer in AA. Additionally, we run GSEA-based on the immunological signature mode and used gene ontology function in EdgeR package; both showed that immune-related signaling pathways are enriched in AA men. These findings were confirmed in other RNA-Seq data sets attained from FFPE tissues. Similar immune/inflammatory patterns were observed in AA PCa cell lines (RC). Our study provides new insight into understanding how genetic ancestry and upregulation of unique immune-inflammatory signatures may contribute to PCa racial disparities in AA men cohorts from African ancestry.

Citation Format: Isra A. Elhussin, Jason A. White, Tamaro S. Hudson, Moray J. Campbell, Chanita Hughes-Halbert, Stefan Ambs, Clayton Yates. Prostate cancer: Immune-inflammation signature in men of African ancestry [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2196.

Making the "C-ACE" for a Culturally-Informed Adverse Childhood Experiences Framework to Understand the Pervasive Mental Health Impact of Racism on Black Youth

The high prevalence and psychological impact of childhood exposure to potentially traumatic events (PTE) is a major public health concern in the United States. Considerable evidence has demonstrated the significant racial disparities that exist with respect to PTE exposure, indicating that Black youth are particularly burdened by these harmful experiences. Racism may serve a unique role in explaining why Black youth are disproportionately exposed to PTEs, and why mental health disparities are more likely to occur following such experiences. Despite clear evidence acknowledging racism as a major life stressor for Black youth, theoretical models of early childhood adversity have largely neglected the multifaceted influence of racism on mental health outcomes. Inspired by bourgeoning literature highlighting the potentially traumatic nature of racism-related experiences for Black youth, we present a culturally-informed Adverse Childhood Experiences (ACEs) model, or "C-ACE", to understand the pervasive and deleterious mental health impact of racism on Black youth. This model extends the ACE framework by noting the significance of racism as an ACE exposure risk factor, a distinct ACE category, and a determinant of post-ACE mental health outcomes among Black youth. The model acknowledges and supports the advancement of ACEs research that takes a culturally informed approach to understanding the intergenerational and multilevel impact of racism on the mental health of Black youth. Future research utilizing the proposed C-ACE model is essential for informing clinical and public health initiatives centered on reducing the mental health impact of racism-related experiences and health disparities in the United States.

Abstract PR05: Epigenetic disruption of vitamin D receptor signaling in African American prostate cancer alters circadian signaling networks

The current study aimed to define the genomic functions of the vitamin D receptor (VDR) in African American (AA) prostate cancer (PCa) compared to European American (EA) counterparts. VDR-dependent ChIP-Seq and RNA-Seq gene was undertaken in EA (non-malignant HPr1AR and malignant LNCaP) and AA (non-malignant RC43N and malignant RC43T) prostate models, combined with analyses of three PCa cohorts. In AA prostate models the VDR is highly expressed, binds more frequently, and is enriched in active and poised enhancers. Motif analyses revealed selective enrichment, including ZBTB33/KAISO in AA cells and ERG family members in EA cells and, similarly, GIGGLE analyses revealed AA VDR cistromes were significantly overlapped with core circadian rhythm transcription factors (e.g. NONO). Combining VDR-dependent ChIP-Seq and RNA-Seq established that AA cells displayed a significantly stronger transcriptional response, compared to EA cells, and was most responsive in non-malignant RC43N. For example, RC43N transcriptional responses were enriched for circadian rhythm (NES 2.7) and inflammation, whereas in RC43T the same gene networks were repressed. To reveal how VDR/1,25(OH)2D3 signaling is corrupted in AA PCa, we mined TCGA data and revealed that the BAZ1A/SMARCA5 chromatin remodeling complex was uniquely altered in TMPRSS2:ERG fusion negative AA PCa. We are currently examining the impact of BAZ1A on the 1,25(OH)2D3 responsiveness. We also identified miRNA associated with progression from HGPIN to PCa in AA men, and that ~30% were bound by VDR and regulated by 1,25(OH)2D3, although ~5% of EA progression miRNA were VDR-responsive. For example, VDR binds to miR-199b, is uniquely 1,25(OH)2D3 up-regulated in RC43N but repressed in RC43T, and associates with AA progression from HGPIN to PCa. MiR-199b regulates expression of NPAS2, a core circadian transcription factor. Finally, leveraging a previously analyzed cohort of 1,25(OH)2D3-treated PCa patients revealed that AA tumors were intrinsically more 1,25(OH)2D3-responsive than EA counterparts, reflecting the cell line analyses. 1,25(OH)2D3 regulated circadian transcriptional regulators (e.g. NOCT and MYBBP1A) and inflammatory signals. Together, these data suggest VDR transcriptional control in AA men is more dynamic than in EA men, and is primed to govern inflammatory and circadian rhythm pathways. This is frequently disrupted, including by altered BAZ1A/SMARCA5 expression and/or reduced environmental-regulated serum vitamin D3 levels, and leads to altered regulation of circadian rhythm process, and inflammatory signals. Therefore, the VDR axis lies at the cross-roads of biopsychosocial processes that contributes to PCa health disparities.

Citation Format: Manjunath Siddappa, Sajad D. Wani, Jaimie S. Gray, Mark D. Long, Hedieh Jafari, Hsuchang Wu, Honhe Wang, Rebecca Morgan, Gary Hardiman, James Marshall, Chanita Hughes-Halbert, Lara E. Sucheston-Campbell, Clayton L. Yates, Moray J. Campbell. Epigenetic disruption of vitamin D receptor signaling in African American prostate cancer alters circadian signaling networks [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 PR05.

Abstract PO-167: Area-level social deprivation and stage at diagnosis among breast cancer patients in South Carolina

Background: Cancer incidence, staging and mortality rates differ across geographic areas; however, there is a need for a better understanding of how neighborhood level socioeconomic and access to care factors impact cancer burden to tailor cancer control interventions in ways that appropriately target geographic determinants of cancer health disparities. The purpose of this study was to characterize the distribution of neighborhood deprivation in a cohort of breast cancer patients and examine the effect of social deprivation, healthcare professional shortage Area (HPSA) designation, and individual-level characteristics on breast cancer staging.

Methods: We established a retrospective cohort of breast cancer patients diagnosed from 1996 to 2015 using the South Carolina Central Cancer Registry.

Sociodemographic (e.g., race, age) and clinical variables were abstracted from the registry. We linked registry data to county-level variables to determine levels of social deprivation and residence in a health care professional shortage area using the Robert Graham Center’s Social Deprivation Index (SDI) and the Health Resources and Services Administration primary care HPSA designation. Bivariate analyses and multivariate regression analyses were used to examine associations. Results: The sample included 54,501 female breast cancer patients. Overall, the mean for SDI was 54.2 (+18.1) and the range was 76 (19-95). Approximately 44.4% of women lived in areas with high levels of social deprivation (e.g., SDI score of 52 to 95). In the logistic regression model, living in a geographic area with high social deprivation was significantly associated with African American race (OR=2.3, 95% C.I. 2.2-2.4), being unmarried (OR=1.2, 95% C.I. 1.1-1.3), and HPSA designation (OR=14.0, 95% C.I. 13.5- 14.6). Higher tumor grade (OR=1.2; 95% CI.1.2-1.3) and later stage (OR=1.1, 95% C.I. 1.1-1.2) were also significantly associated with neighborhood deprivation. Conclusion: This study shows that SDI differs by race and clinical characteristics among breast cancer patients. The SDI could be integrated into tumor registries and cancer research to understand the effects of neighborhood level variables on cancer health disparities to improve the precision of cancer control interventions that are developed to address geographic determinants.

Citation Format: Andrew B. Lawson, Chanita Hughes-Halbert, Oluwole A. Babatunde, Whitney E. Zahnd, Jan M. Eberth. Area-level social deprivation and stage at diagnosis among breast cancer patients in South Carolina [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-167.

Zonal regulation of collagen-type proteins and posttranslational modifications in prostatic benign and cancer tissues by imaging mass spectrometry

BACKGROUND

The emergence of reactive stroma is a hallmark of prostate cancer (PCa) progression and a potential source for prognostic and diagnostic markers of PCa. Collagen is a main component of reactive stroma and changes systematically and quantitatively to reflect the course of PCa, yet has remained undefined due to a lack of tools that can define collagen protein structure. Here we use a novel collagen-targeting proteomics approach to investigate zonal regulation of collagen-type proteins in PCa prostatectomies.

METHODS

Prostatectomies from nine patients were divided into zones containing 0%, 5%, 20%, 70% to 80% glandular tissue and 0%, 5%, 25%, 70% by mass of PCa tumor following the McNeal model. Tissue sections from zones were graded by a pathologist for Gleason score, percent tumor present, percent prostatic intraepithelial neoplasia and/or inflammation (INF). High-resolution accurate mass collagen targeting proteomics was done on a select subset of tissue sections from patient-matched tumor or nontumor zones. Imaging mass spectrometry was used to investigate collagen-type regulation corresponding to pathologist-defined regions.

RESULTS

Complex collagen proteomes were detected from all zones. COL17A and COL27A increased in zones of INF compared with zones with tumor present. COL3A1, COL4A5, and COL8A2 consistently increased in zones with tumor content, independent of tumor size. Collagen hydroxylation of proline (HYP) was altered in tumor zones compared with zones with INF and no tumor. COL3A1 and COL5A1 showed significant changes in HYP peptide ratios within tumor compared with zones of INF (2.59 ± 0.29, P value: .015; 3.75 ± 0.96 P value .036, respectively). By imaging mass spectrometry COL3A1 showed defined localization and regulation to tumor pathology. COL1A1 and COL1A2 showed gradient regulation corresponding to PCa pathology across zones. Pathologist-defined tumor regions showed significant increases in COL1A1 HYP modifications compared with COL1A2 HYP modifications. Certain COL1A1 and COL1A2 peptides could discriminate between pathologist-defined tumor and inflammatory regions.

CONCLUSIONS

Site-specific posttranslational regulation of collagen structure by proline hydroxylation may be involved in reactive stroma associated with PCa progression. Translational and posttranslational regulation of collagen protein structure has potential for new markers to understand PCa progression and outcomes.

Abstract C097: Navigation needs among African Americans

Abstract Introduction: Patient navigation is emerging as a strategy for addressing barriers to cancer screening among African Americans; however, navigation should address the specific needs and barriers to obtaining screening. The purpose of this study was to identify navigation needs for cancer screening in a community-based sample of African American men and women. Methods: Participants were enrolled in an observational study of community-based navigation for cancer control. Eligibility criteria were African American men and women aged 50-75 years who resided in the Philadelphia, PA metropolitan area, and had no personal history or symptoms of prostate, breast and colon cancer. The main outcome variable was navigation needs for cancer screening. The exposure variables that were assessed were socioeconomic characteristics, sociocultural factors such perceived risk of developing cancer and future temporal orientation and perceptions of social integration, and history of family members with cancer. Chi square tests and analysis of variance were utilized to assess the associations between potential factors and identified barriers. Results: A total of 268 participants were enrolled in the study and of these, 161 (60%) identified navigation needs for cancer screening: cost/lack of insurance (66, 25%), ignorance/lack of knowledge (73, 27%) and provider issues (22, 8%). The main barrier identified by participants that were younger (<56 years) was cost/lack of insurance (51%) while the main barrier identified by older participants (>56 years) was ignorance/lack of knowledge (47%), [p: 0.04]. Most participants (63%) who had a higher perception of developing breast or prostate cancer identified ignorance/lack of knowledge as barrier to screening while most participants (51%) who had a higher perception of developing colon cancer had cost/lack of insurance as barrier to colon cancer screening, [p: 0.01]. Conclusions: Findings from this study suggest that navigation for cancer screening may need to address lack of knowledge and cost/lack of health insurance. Navigation programs for cancer screening may need to address different needs depending on the age and perceived risk of participants.

Citation Format: Oluwole A Babatunde, Melanie Jefferson, Jerry C Johnson, Chanita Hughes-Halbert. Navigation needs among African Americans [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C097.

Development and Validation of Nomograms for Predicting Delayed Postoperative Radiotherapy Initiation in Head and Neck Squamous Cell Carcinoma

Importance

The standard of care for initiation of postoperative radiotherapy (PORT) in head and neck squamous cell carcinoma (HNSCC) is within 6 weeks of surgical treatment. Delays in guideline-adherent PORT initiation are common, associated with mortality, and a measure of quality care, but patient-specific tools to estimate the risk of these delays are lacking.

Objective

To develop and validate 2 nomograms (that use presurgical and postsurgical data) for predicting delayed PORT initiation.

Design, Setting, and Participants

This cohort study obtained patient data from January 1, 2004, to December 31, 2015, from the National Cancer Database. Adults aged 18 years or older with a newly diagnosed HNSCC who underwent surgical treatment and PORT at a Commission on Cancer-accredited facility were included. Data analysis was conducted from June 2, 2019, to January 29, 2020.

Exposures

Surgical treatment and PORT.

Main Outcomes and Measures

The primary outcome measure was PORT initiation more than 6 weeks after the surgical intervention. Multivariable logistic regression models were created in a random selection of 80% of the sample (derivation cohort) and were internally validated with bootstrapping, assessed for discrimination by calibration plots and the concordance (C) index, and externally validated in the remaining 20% of the sample (validation cohort).

Results

The study included 60 766 adults with HNSCC who were grouped into derivation and validation cohorts. The derivation cohort comprised 48 625 patients (mean [SD] age, 59.59 [11.3] years; 36 825 men [75.7%]) selected randomly from the full sample, whereas 12 151 patients (mean [SD] age, 59.63 [11.2] years; 9266 men [76.3%]) composed the validation cohort. The rate of PORT delay was 55.8% (n=27140) in the derivation cohort and 56.7% (n=6900) in the validation cohort. Both nomograms created to predict the risk of PORT initiation delay used variables, including race/ethnicity, insurance type, tumor site, and facility type. The nomogram based on presurgical variables included clinical stage and severity of comorbidity, whereas the nomogram with postsurgical variables included US region, length of stay, and care fragmentation between surgical and radiotherapy facilities. For the presurgical nomogram, the concordance indices were 0.670 (95% CI, 0.664-0.676) in the derivation cohort and 0.674 (95% CI, 0.662-0.685) in the validation cohort. For the nomogram with postsurgical variables, the concordance indices were 0.691 (95% CI, 0.686-0.696) in the derivation cohort and 0.694 (95% CI, 0.685-0.704) in the validation cohort.

Conclusions and Relevance

This study found that a nomogram developed with presurgical data to generate personalized estimates of PORT initiation delay may improve pretreatment counseling and the delivery of interventions to patients at high risk for such a delay. A nomogram including postsurgical data can drive institutional quality improvement initiatives and enhance risk-adjusted comparisons of delay rates across facilities.

Association of Treatment Delays With Survival for Patients With Head and Neck Cancer: A Systematic Review

Importance

Delays in the delivery of care for head and neck cancer (HNC) are a key driver of poor oncologic outcomes and thus represent an important therapeutic target.

Objective

To synthesize information about the association between delays in the delivery of care for HNC and oncologic outcomes.

Evidence Review

A systematic review of the English-language literature in PubMed/MEDLINE and Scopus published between January 1, 2007, and February 28, 2018, was performed to identify articles addressing the association between treatment delays and oncologic outcomes for patients with HNC. Articles that were included (1) addressed cancer of the oral cavity, oropharynx, hypopharynx, or larynx; (2) discussed patients treated in 2004 or later; (3) analyzed time of diagnosis to treatment initiation (DTI), time from surgery to the initiation of postoperative radiotherapy, and/or treatment package time (TPT; the time from surgery through the completion of postoperative radiotherapy); (4) included a clear definition of treatment delay; and (5) analyzed the association between the treatment time interval and an oncologic outcome measure. Quality assessment was performed using the Institute of Health Economics Quality Appraisal Checklist for Case Series Studies.

Findings

A total of 18 studies met inclusion criteria and formed the basis of the systematic review. Nine studies used the National Cancer Database and 6 studies were single-institution retrospective reviews. Of the 13 studies assessing DTI, 9 found an association between longer DTI and poorer overall survival; proposed DTI delay thresholds ranged from more than 20 days to 120 days or more. Four of the 5 studies assessing time from surgery to the initiation of postoperative radiotherapy (and all 4 studies assessing guideline-adherent time to postoperative radiotherapy) found an association between a timely progression from surgery to the initiation of postoperative radiotherapy and improved overall or recurrence-free survival. Of the 5 studies examining TPT, 4 found that prolonged TPT correlated with poorer overall survival; proposed thresholds for prolonged TPT ranged from 77 days or more to more than 100 days.

Conclusions and Relevance

Timely care regarding initiation of treatment, postoperative radiotherapy, and TPT is associated with survival for patients with HNC, although significant heterogeneity exists for defining delayed DTI and TPT. Further research is required to standardize optimal time goals, identify barriers to timely care for each interval, and design interventions to minimize delays.

The big reveal: Family disclosure patterns of BRCA genetic test results among young Black women with invasive breast cancer

Despite higher incidence and mortality of breast cancer among younger Black women, genetic testing outcomes remain severely understudied among Blacks. Past research on disclosure of genetic testing results to family members has disproportionately focused on White, educated, high socioeconomic status women. This study addresses this gap in knowledge by assessing (a) to whom Black women disclose genetic test results and (b) if patterns of disclosure vary based on test result (e.g., BRCA1/2 positive, negative, variant of uncertain significance [VUS]). Black women (N = 149) with invasive breast cancer diagnosed age ≤50 years from 2009 to 2012 received free genetic testing through a prospective, population-based study. At 12 months post-testing, women reported with whom they shared their genetic test results. The exact test by binomial distribution was used to examine whether disclosure to female relatives was significantly greater than disclosure to male relatives, and logistic regression analyses tested for differences in disclosure to any female relative, any male relative, parents, siblings, children, and spouses by genetic test result. Most (77%) women disclosed their results to at least one family member. Disclosure to female relatives was significantly greater than disclosure to males (p < .001). Compared to those who tested negative or had a VUS, BRCA1/2-positive women were significantly less likely to disclose results to their daughters (OR_{BRCA positive}  = 0.25, 95% CI = 0.07-0.94, p = .041) by 12 months post-genetic testing. Genetic test result did not predict any other type of disclosure (all ps > 0.12). Results suggest that in Black families, one benefit of genetic testing-to inform patients and their family about cancer risk information-is not being realized. To increase breast cancer preventive care among high-risk Black women, the oncology care team should prepare Black BRCA1/2-positive women to share genetic test results with family members and, in particular, their daughters.

Impact of Genetic Testing on Risk-Management Behavior of Black Breast Cancer Survivors: A Longitudinal, Observational Study

BACKGROUND

Black women are overrepresented among premenopausal breast cancer (BC) survivors. These patients warrant genetic testing (GT) followed by risk-reducing behaviors. This study documented patterns and predictors of cancer risk-management behaviors among young black BC survivors after GT.

METHODS

Black women (n = 143) with a diagnosis of BC at the age of 50 years or younger received GT. At 1 year after GT, participants reported receipt of risk-reducing mastectomy, risk-reducing salpingo-oophorectomy, mammogram, breast magnetic resonance imaging (MRI), CA125 test, and transvaginal/pelvic ultrasound. Logistic regression was used to examine predictors of BC risk management (risk-reducing mastectomy or breast MRI) and ovarian cancer risk management (risk-reducing salpingo-oophorectomy, CA125 test, or transvaginal/pelvic ultrasound).

RESULTS

Of the study participants, 16 (11%) were BRCA1/2-positive, 43 (30%) had a variant of uncertain significance, and 84 (59%) were negative. During the 12 months after GT, no women received risk-reducing mastectomy. The majority (93%) received a mammogram, and a smaller proportion received breast MRI (33%), risk-reducing salpingo-oophorectomy (10%), CA125 test (11%), or transvaginal/pelvic ultrasound (34%). Longer time since the BC diagnosis predicted lower likelihood of BC risk management (odds ratio [OR] 0.54). BRCA1/2 carrier status (OR 4.57), greater perceived risk of recurrence (OR 8.03), and more hereditary breast and ovarian cancer knowledge (OR 1.37) predicted greater likelihood of ovarian cancer risk management.

CONCLUSIONS

Young black BC survivors appropriately received mammograms and ovarian cancer risk management based on their BRCA1/2 test result. However, the low usage of MRI among BRCA1/2 carriers contrasts with national guidelines. Future research should examine barriers to MRI among black BC survivors. Finally, modifiable variables predicting risk management after GT were identified, providing implications for future interventions.

Racial disparities, cancer and response to oxidative stress

At the intersection of genetics, biochemistry and behavioral sciences, there is a largely untapped opportunity to consider how ethnic and racial disparities contribute to individual sensitivity to reactive oxygen species and how these might influence susceptibility to various cancers and/or response to classical cancer treatment regimens that pervasively result in the formation of such chemical species. This chapter begins to explore these connections and builds a platform from which to consider how the disciplines can be strengthened further.

Proceedings of the 2017 Advancing the Science of Community Engaged Research (CEnR) Conference

BACKGROUND

To address an urgent need to advance the field of community engaged research, faculty at Vanderbilt University Medical Center and Meharry Medical College organized the national meeting "Advancing the Science of Community Engaged Research (CEnR): Innovative & Effective Methods of Stakeholder Engagement in Translational Research, Washington, DC September 14-15, 2017 (See Additional file 1). These meetings brought together a diverse group of stakeholders to share community engaged research evidence and practical knowledge for implementing new and enhancing existing research programs. The conference series' goals were: 1) to expand the scientific basis for the community engaged research field by convening researchers, community partners, patient advocacy organizations, and others to share innovative methods and strategies; 2) to engage community representatives and patient advocates in the development of new approaches in community engaged research by meaningfully involving them in the planning, as speakers and presenters, and as conference participants; and 3) to catalyze innovative community engaged research using interactive meeting methods that promote learning, support collective problem solving, and encourage new conceptual frameworks. These conferences have advanced community engagement across the translational research spectrum in biomedical research. For the 2017 meeting, described here, the overarching theme was Innovative and Effective Methods of Stakeholder Engagement in Translational Research.

METHODS

The forum was attended by over 210 participants. This conference used novel approaches to fulfill its objectives of participant diversity, meaningful stakeholder engagement, and eliciting varied distinct perspectives to advance the science of community engaged research. Innovative strategies for the conference included: Think Tanks focused on emerging community engaged research topics or topics in need of urgent attention. These dynamic group sessions provided for freely sharing ideas with the purpose of creating change and facilitating new research collaborations. Learning Labs offered unique opportunities to gain practical knowledge regarding innovative methods in community engaged research. Learning Labs also facilitated the wide broadcast of locally successful engagement methods with the goal of speeding the uptake and implementation of community engaged methods. Travel Scholarships were provided for twenty community and patient representatives to participate in the conference. The lack of travel funds was a significant barrier to stakeholder participation in prior community engaged research meetings. The scholarships expanded the role of community and patient representatives in setting research priorities and promoting methods development. Meaningful Engagement meant that community members and patients participated in decision making on all aspects of the conference planning, including the selection of themes, topics, and speakers, and were fully integrated into the conference as speakers, panelists, and moderators.

CONCLUSIONS

Community and stakeholder engagement can directly impact research by enhancing clinical trial design, increasing relevance, and increasing recruitment, accrual and retention (Staley K.: Exploring Impact: Public 53 Involvement in NHS, Public Health and Social Care Research - INVOLVE.; 2009, Johnson et al Clin Transl Sci 8:388-54 390, 2015, Joosten et al Acad Med 90:1646-1650, 2015). The 2017 Advancing the Science of Community Engaged Research meeting, Innovative and Effective Methods of Stakeholder Engagement in Translational Research facilitated meaningful engagement of diverse stakeholder groups including racial and ethnic minorities, community and patient representatives, and junior investigators. Of 210 attendees, 72 completed the evaluation, and, of those, 36% self-affiliated as community members, and 21% as patient/caregiver advocacy, faith-based, or tribal organization members. This conference 1) represented a step toward expanding the scientific basis for the community engaged research (CEnR) field; 2) catalyzed innovative community engaged research; and 3) enhanced the reach and impact of the scientific developments emerging from pioneering work in community engagement.

Evaluation of a Computer-Based Decision Aid for Promoting Informed Prostate Cancer Screening Decisions Among African American Men: iDecide

PURPOSE

To evaluate the effects of iDecide on prostate cancer knowledge, informed decision-making self-efficacy, technology use self-efficacy, and intention to engage in informed decision-making among African American men.

DESIGN

One-group, pretest/posttest.

SETTING

Community settings in South Carolina.

PARTICIPANTS

African American men, ages 40 years +, without a prior prostate cancer diagnosis (n = 354).

INTERVENTION

iDecide, an embodied conversational agent-led, computer-based prostate cancer screening decision aid.

MEASURES

Prostate cancer knowledge, informed decision-making self-efficacy, technology use self-efficacy, and intention to engage in informed decision-making.

ANALYSIS

Descriptive statistics, paired t tests, general linear modeling, Spearman correlations.

RESULTS

On average, participants experienced significant improvements in their prostate cancer knowledge ( P ≤ .001), informed decision-making self-efficacy ( P ≤ .001), and technology use self-efficacy ( P ≤ .001), postintervention. Additionally, 67% of participants reported an intention to engage in informed decision-making.

CONCLUSION

Given the significant improvements across all measures, this research demonstrates that embodied conversational agent-led decision aids can be used to enhance the capacity for making informed prostate cancer screening decisions among African American men and increase their technology use self-efficacy. One critical limitation of this study is that most men had received prostate cancer screening prior to engaging in our intervention, so the implications of this intervention may be different for men who do not have a history of screening. Additionally, actual engagement in informed decision-making postintervention was not assessed.

Association of Care Processes With Timely, Equitable Postoperative Radiotherapy in Patients With Surgically Treated Head and Neck Squamous Cell Carcinoma

Importance

Delays in initiation of postoperative radiotherapy (PORT) after surgery for head and neck squamous cell carcinoma (HNSCC) are common, predominantly affect racial minorities, and are associated with decreased survival. Details regarding the care processes that contribute to timely, equitable PORT remain unknown.

Objective

To determine care processes associated with timely, equitable PORT.

Design, Setting, and Participants

This retrospective cohort study included patients 18 years or older undergoing surgery for HNSCC at the Medical University of South Carolina (MUSC), Charleston, followed by PORT (at MUSC or elsewhere) with or without chemotherapy from January 1, 2014, through December 31, 2016. Data were analyzed from September 15, 2017, through June 28, 2018.

Main Outcomes and Measures

The main outcome measure was the proportion of timely, guideline-adherent initiation of PORT (≤6 weeks postoperatively). Secondary outcome measures included care processes associated with timely PORT. The association between process variables with timely PORT was explored using multivariable logistic regression analysis. Effect modification of the association between receipt of care processes and timely PORT by race was explored using interaction effects.

Results

A total of 197 patients were included in the analysis; they were predominantly white (157 [79.7%]) and male (136 [69.0%]) with a mean age of 59 years (range, 28-89 years). Overall, 89 patients (45.2%) experienced a delay initiating PORT. African American patients had a 13.5% absolute increase in the rate of delayed PORT relative to white patients (21 of 37 [56.8%] vs 68 of 157 [43.3%]). The adjusted multivariable regression showed that the following care processes were associated with timely PORT: preoperative radiotherapy consultation (odds ratio [OR], 8.94; 95% CI, 1.64-65.53), PORT at MUSC (OR, 6.21; 95% CI, 1.85-24.75), pathology report within 7 postoperative days (OR, 4.14; 95% CI, 1.21-15.86), time from surgery to PORT referral of no longer than 10 days (OR, 12.14; 95% CI, 3.14-63.00), time from PORT referral to consultation of no longer than 10 days (OR, 10.76; 95% CI, 3.01-49.70), and time from PORT consultation to its start of no longer than 21 days (OR, 4.80; 95% CI 1.41-18.44). Analysis of interactions revealed no statistically significant differences between African American and white patients in receipt of key processes associated with timely PORT.

Conclusions and Relevance

Specific care processes are associated with guideline-adherent initiation of PORT. Novel strategies appear to be needed to ensure that these processes are performed for all patients with HNSCC, thereby facilitating timely, equitable PORT.

Research participation preferences as expressed through a patient portal: implications of demographic characteristics

Objective

As patient portals are increasingly used for research recruitment, it is important to examine the demographic makeup of research registries that are populated via portals and the factors that influence participation in these registries.

Methods

We examined the response to a routine research preference questionnaire among patients who were enrolled in a patient portal at an academic health center and characterized the sub-population that responded and was tracked in a research preferences registry. We examined the factors that influence choices in two research preferences: future contact for research opportunities and biobanking of de-identified specimens.

Results

Out of 79 834 patients to whom the questionnaire was sent, 32% responded. Of those 74% agreed to future contact and 77% to the biobank preference. We found significantly lower odds of agreement in both preferences in minority populations, especially in the population >65 years of age when stratified by race. Individuals with higher comorbidity indexes had significantly higher odds for agreement.

Discussion

The disparities in volunteerism as expressed by agreement to future contact and willingness to participate in biobanking are exacerbated by lower levels of enrollment in the patient portal by minorities, especially in the oldest age group. Future work should examine other socioeconomic factors and the differences across age groups, sicker individuals, and payer categories.

Conclusion

Although patient portals can be more efficient for recruitment, researchers have to be cognizant of, and proactively address, potential biases when recruiting participants from these registries.

Review and Comparison of Electronic Patient-Facing Family Health History Tools

Family health history (FHx) is one of the most important pieces of information available to help genetic counselors and other clinicians identify risk and prevent disease. Unfortunately, the collection of FHx from patients is often too time consuming to be done during a clinical visit. Fortunately, there are many electronic FHx tools designed to help patients gather and organize their own FHx information prior to a clinic visit. We conducted a review and analysis of electronic FHx tools to better understand what tools are available, to compare and contrast to each other, to highlight features of various tools, and to provide a foundation for future evaluation and comparisons across FHx tools. Through our analysis, we included and abstracted 17 patient-facing electronic FHx tools and explored these tools around four axes: organization information, family history collection and display, clinical data collected, and clinical workflow integration. We found a large number of differences among FHx tools, with no two the same. This paper provides a useful review for health care providers, researchers, and patient advocates interested in understanding the differences among the available patient-facing electronic FHx tools.

Future cancer research priorities in the USA: a Lancet Oncology Commission

We are in the midst of a technological revolution that is providing new insights into human biology and cancer. In this era of big data, we are amassing large amounts of information that is transforming how we approach cancer treatment and prevention. Enactment of the Cancer Moonshot within the 21st Century Cures Act in the USA arrived at a propitious moment in the advancement of knowledge, providing nearly US$2 billion of funding for cancer research and precision medicine. In 2016, the Blue Ribbon Panel (BRP) set out a roadmap of recommendations designed to exploit new advances in cancer diagnosis, prevention, and treatment. Those recommendations provided a high-level view of how to accelerate the conversion of new scientific discoveries into effective treatments and prevention for cancer. The US National Cancer Institute is already implementing some of those recommendations. As experts in the priority areas identified by the BRP, we bolster those recommendations to implement this important scientific roadmap. In this Commission, we examine the BRP recommendations in greater detail and expand the discussion to include additional priority areas, including surgical oncology, radiation oncology, imaging, health systems and health disparities, regulation and financing, population science, and oncopolicy. We prioritise areas of research in the USA that we believe would accelerate efforts to benefit patients with cancer. Finally, we hope the recommendations in this report will facilitate new international collaborations to further enhance global efforts in cancer control.

A systematic review of lifestyle counseling for diverse patients in primary care

Prior research and systematic reviews have examined strategies related to weight management, less is known about lifestyle and behavioral counseling interventions optimally suited for implementation in primary care practices generally, and among racial and ethnic patient populations. Primary care practitioners may find it difficult to access and use available research findings on effective behavioral and lifestyle counseling strategies and to assess their effects on health behaviors among their patients. This systematic review compiled existing evidence from randomized trials to inform primary care providers about which lifestyle and behavioral change interventions are shown to be effective for changing patients' diet, physical activity and weight outcomes. Searches identified 444 abstracts from all sources (01/01/2004-05/15/2014). Duplicate abstracts were removed, selection criteria applied and dual abstractions conducted for 106 full text articles. As of June 12, 2015, 29 articles were retained for inclusion in the body of evidence. Randomized trials tested heterogeneous multi-component behavioral interventions for an equally wide array of outcomes in three population groups: diverse patient populations (23 studies), African American patients only (4 studies), and Hispanic/Mexican American/Latino patients only (2 studies). Significant and consistent findings among diverse populations showed that weight and physical activity related outcomes were more amenable to change via lifestyle and behavioral counseling interventions than those associated with diet modification. Evidence to support specific interventions for racial and ethnic minorities was promising, but insufficient based on the small number of studies.

Abstract A50: An exploratory study examining the acute phase impact of resection on biological and psychological markers of stress among early stage non-small cell lung cancer patients

INTRODUCTION: Surgical resection, though the most optimal treatment for lung cancer induces immunosuppression that can lead to unfavorable outcomes such as tumor recurrence. High psychological stress and sociodemographic factors can further exacerbate outcomes. Chronic stress and sociodemographic factors are significant contributors to dysregulated psycho-immune outcomes. A paucity of literature evaluating the relationship between psychological stress and inflammation exists prospectively among lung cancer patients undergoing surgical resection and personal-level factors that are associated with these outcomes.

OBJECTIVE: To examine the relationship between levels of inflammation and psychological stress and the association between sociodemographic factors and psychological stress and inflammation before and after surgical resection for lung cancer.

METHODS: We used a prospective pre- and post-test design to study clinically recruited early stage I and II non-small cell lung cancer patients. Inflammation and psychological stress were evaluated preoperatively and 2-weeks postoperatively. Inflammatory markers interlukin-6 and C-reactive protein were assessed via venipuncture and laboratory assay testing. Psychological stress was evaluated through self-report using the 15-item Impact Events Scale to evaluate traumatic stress. A score of 30 or greater is indicative of high traumatic stress. Correlation and bivariate analyses were used to examine the association between levels of psychological stress, inflammation and sociodemographic factors.

RESULTS: Of the 21 patients who participated, the majority were smokers (87%), white (93%), married (60%), had a college education or greater (60%), and an annual household income of less than $50,000 (53%). Mean levels of psychological stress decreased and levels of inflammation increased following resection; however, overall levels of psychological stress and inflammation were low preoperatively (M=27.40) and postoperatively (M=24.13). The mean changes in stress and inflammation from pre- to postoperatively were not significant. Effect size analyses revealed a small effect between mean differences in pre- and postoperative stress and inflammation. No relationship between psychological stress and inflammation was found pre- or postoperatively. When we examined associations between levels of traumatic stress and depressive symptoms, we found that those with high stress also had high depressive symptoms. When we examined sociodemographic factors, a lower income level was significantly associated with higher baseline inflammation levels preoperatively (P=0.02).

CONCLUSIONS: This exploratory study was a necessary initial step for establishing preliminary estimates and feasibility data for a novel area of research. A more longitudinal examination among a larger diverse sample of patients is needed in order to further assess the nature and course of psychological stress and inflammation and its long-term impact on quality of life and survival. Due to the perceived self-inflicted and internal causal nature of the diagnosis of lung cancer, patients may perceive less stress and have better coping because of their smoking behavior. Future studies will include both a biological marker of stress (such as cortisol) along with self-report data to evaluate psychological stress more expansively in order to better screen for psychological and inflammatory deficits.

Citation Format: Melanie Jefferson, Marvella Ford, Heather Bonilha, Elizabeth Garrett-Mayer, Chanita Hughes-Halbert. An exploratory study examining the acute phase impact of resection on biological and psychological markers of stress among early stage non-small cell lung cancer patients. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A50.

Abstract A49: Shared decision-making about weight loss and weight maintenance among a diverse sample of obese primary care patients

Background: Obesity and excess body weight are significant clinical and public health issues that disproportionately affect racial and ethnic minorities. Weight control and management are essential to obesity prevention and reduction; racial and ethnic disparities in cancer outcomes are due in part to limited weight control/management through reduced physical activity and unhealthy dietary behaviors. Healthcare providers play an important role in helping patients perform these cancer control behaviors through effective patient-provider communication that facilitates shared decision making. However, limited empirical data are available on the extent to which shared decision making occurs among diverse patients in primary care settings within the context of cancer control behaviors.

Objective: The objective of this study was to evaluate perceptions of shared decision making about weight control and management in a racially and geographically diverse sample of primary care patients.

Methods: We conducted an observational survey study in a sample of 106 racially and ethnically diverse primary care patients from primary care practices located across the U.S. Shared-decision making (SDM) was measured by self-report using an adapted version of the Shared Decision-Making Scale that measured perceived SDM for weight control/management. Bivariate and multivariate regression analysis was used to identify sociodemographic, clinical, and psychological factors having significant independent associations with SDM.

Results: 42% of the sample were from racial/ethnic minority groups and 58% were white. In addition, the majority of participants were married (62%), had at least some college education (62%), were employed (55%), and received medical care in rural primary care practices (97%). With respect to clinical characteristics, 69% were obese, but only 55% believed they were obese or overweight. Scores for SDM ranged from 8 to 32 and the Mean (SD) was 17.1 (7.4); consistent with this, the majority of patients reported that providers were not likely to make clear that a decision needs to be made about their weight management, select a weight management option with their provider, or reach an agreement on how to proceed about their weight management. In the bivariate analyses, SDM scores where significantly higher among patients who had greater readiness to control/manage their weight (t=-2.47, p=0.02), who believed they were overweight/obese (t=-2.41, p=0.02), and were making weight loss efforts (t=-2.56, p=0.01) compared to those who were not making weight loss efforts, patients who did not believe they were obese/overweight, and those who were not ready to control/manage their weight. In the multivariate regression analysis, perceived obesity had a marginally significant positive association with SDM (p=0.08).

Conclusions: Patient perceptions of SDM was low in our sample. Greater efforts are needed to enhance SDM about weight management/control between patients and providers, particularly among those who do not believe they are overweight/obese.

Citation Format: Melanie S. Jefferson, Lashanta Rice, Kemi Chukwuka, Holly Pierce, Jodie Riley, Chanita Hughes-Halbert. Shared decision-making about weight loss and weight maintenance among a diverse sample of obese primary care patients. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A49.

Priorities and Preferences for Weight Management and Cardiovascular Risk Reduction in Primary Care

Implementing behavioral interventions for cardiovascular risk reduction and weight management is challenging in primary care. Primary care patients and providers were recruited for qualitative interviews to identify priorities and preferences for addressing weight management. Thematic analysis was used to identify relevant resources, barriers to lifestyle modification, health behavior change, and implementation of weight management strategies into care. Patients and providers prioritized increasing physical activity and healthy diets when managing chronic disease; and reported decreased patient motivation, knowledge, and limited organizational capacity and time among providers to deliver intensive interventions. Providers and patients disagreed regarding who owns accountability for weight management.

Patient participation in cancer clinical trials: A pilot test of lay navigation

BACKGROUND

Clinical trials (CT) represent an important treatment option for cancer patients. Unfortunately, patients face challenges to enrolling in CTs, such as logistical barriers, poor CT understanding and complex clinical regimens. Patient navigation is a strategy that may help to improve the delivery of CT education and support services. We examined the feasibility and initial effect of one navigation strategy, use of lay navigators.

METHODS

A lay CT navigation intervention was evaluated in a prospective cohort study among 40 lung and esophageal cancer patients. The intervention was delivered by a trained lay navigator who viewed a 17-minute CT educational video with each patient, assessed and answered their questions about CT participation and addressed reported barriers to care and trial participation.

RESULTS

During this 12-month pilot project, 85% (95% CI: 72%-93%) of patients eligible for a therapeutic CT consented to participate in the CT navigation intervention. Among navigated patients, CT understanding improved between pre- and post-test (means 3.54 and 4.40, respectively; p-value 0.004), and 95% (95% CI: 82%-98%) of navigated patients consented to participate in a CT. Navigated patients reported being satisfied with patient navigation services and CT participation.

CONCLUSIONS

In this formative single-arm pilot project, initial evidence was found for the potential effect of a lay navigation intervention on CT understanding and enrollment. A randomized controlled trial is needed to examine the efficacy of the intervention for improving CT education and enrollment.

Abstract B15: Motivation for cancer control changes among African Americans

Background: Healthy dietary behaviors are critical strategies for cancer control. Despite this, many African Americans do not meet the recommended guidelines for fruit and vegetable intake. To develop effective cancer control interventions for African Americans, it is first necessary to understand within group variation in motivations for making dietary behavior changes and identify socioeconomic, social, and clinical factors that have significant independent associations with these motivations.

Objectives: To characterize motivations for making dietary changes among African Americans and to identify socioeconomic, social, and clinical factors having significant independent associations with these intrinsic and extrinsic motivations among African American adults (n=530).

Results: The mean (SD) level for intrinsic motivation was 26.5 (3.5) whereas the mean (SD) level for extrinsic motivation was 16.1 (4.8). Increasing age (Beta=0.03, p=0.03) and membership in at least one community organization (Beta=1.20, p=0.0003) had significant independent associations in the regression model for intrinsic motivation (n=479, F=5.97, p=0.0001). Lower incomes (Beta=-1.10, p=0.02) and age (Beta=0.06, p=0.006) had significant independent associations with extrinsic motivation. None of the clinical factors were associated significantly with intrinsic and extrinsic motivation.

Conclusions: African Americans may be motivated to make dietary changes for cancer control because of intrinsic motivations. Different variables had significant independent associations with intrinsic and extrinsic motivations to make dietary changes among African Americans. It may be important to use alternative strategies to enhance these motivations as part of cancer control interventions that are developed for these individuals.

Citation Format: Melanie S. Jefferson, Vanessa Briggs, Ernestine Delmoor, LaShanta Rice, Jerry Johnson, Chanita Hughes-Halbert. Motivation for cancer control changes among African Americans. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B15.

Abstract B79: Colonoscopy screening in a community sample of African Americans

Background: Colonoscopy is an efficacious strategy for reducing morbidity and mortality from colorectal cancer. Low utilization of colonoscopy contributes to racial disparities in colorectal cancer outcomes. Predictors of colonoscopy have been examined in clinical samples, but decisions about cancer screening are made in a multidimensional context that includes social, psychological, socioeconomic factors. Evaluating the association between colonoscopy utilization and multidimensional factors in a community-based sample is needed to understand how screening decisions are made in a community context.

Objectives: To evaluate the independent associations between social, psychological, socioeconomic, and clinical factors on colonoscopy use in a community-based sample of urban African American adults.

Methods: Participants were 236 African American men and women ages 50-75 who were enrolled in a community-based navigation program for cancer control. Data on colonoscopy use and socioeconomic (e.g., income), clinical (e.g., provider communication about colonoscopy), social (e.g., neighborhood satisfaction), and psychological factors (e.g., self-efficacy) were obtained by self-report during a baseline telephone interview that was completed prior to navigation.

Results: Overall, 58% of participants reported having a colonoscopy. Factors having significant independent associations with colonoscopy included older age (OR=1.15, 95% CI=1.07, 1.24, p=0.0002), greater neighborhood satisfaction (OR=1.86, 95% CI=1.05, 3.30, p=0.03), physician recommendation (OR=12.69, 95% CI=5.33, 30.20, p=0.0001), greater self-efficacy (OR=2.60, 95% CI=1.29, 5.24, p=0.01) and higher income (OR=2.70, 95% CI=1.35, 5.37, p=0.005). Participants with greater levels of present temporal orientation were also more likely to report having a colonoscopy compared to those with lower levels (OR=1.18, 95% CI=0.99, 1.41, p=0.06)

Conclusions: Colonoscopy is sub-optimal in a community-based sample of African Americans. In addition to psychological factors, participants who were more satisfied with their neighborhood conditions and those who had greater levels of present temporal orientation were likely to have a colonoscopy. Social and cultural factors may need to be addressed to enhance colonoscopy use among African Americans.

Citation Format: Melanie S. Jefferson, Vanessa Briggs, Ernestine Delmoor, Jerry C. Johnson, Chanita Hughes-Halbert. Colonoscopy screening in a community sample of African Americans. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B79. doi:10.1158/1538-7755.DISP13-B79

Abstract C43: Health-related quality of life among younger black breast cancer survivors

Purpose: Of an estimated 3 million breast cancer survivors in the U.S, the median age at diagnosis is 61 years for all racial/ethnic groups combined. Although the overall incidence of breast cancer is lower in Black women compared to White women, they are more likely to develop and die from early onset (age 50 years or younger) aggressive disease. As a result, young Black women with invasive breast cancer may experience poorer quality of life after breast cancer diagnosis; yet, few studies have focused on this subset of younger Black breast cancer survivors. As part of an ongoing population-based case-only study to investigate etiology and outcomes of early-onset breast cancer in Black women, we sought to evaluate baseline predictors of health-related quality of life (HRQOL) at time of study entry.

Methods: Black women with invasive breast cancer at age 50 or younger diagnosed between 2009-2012 were recruited through the Florida State Cancer Registry utilizing state-mandated recruitment methods. Participants completed a comprehensive baseline questionnaire which included sociodemographic, clinical, and psychosocial characteristics. In the current study, we used multiple regression analysis to examine predictors of HRQOL measured with the FACT-G instrument. Predictors were selected based on the Contextual Model of HRQOL and included individual clinical (e.g., age at diagnosis) and psychosocial (e.g., anxiety) as well as macro/systemic (e.g., social support) level variables.

Results: This report includes the first 206 women who completed the baseline questionnaires. The mean age at diagnosis was 42.5 years (SD=6.2; range=21-50). The mean HRQOL score was 74.4 (SD=21.6; range= 25-108), which is lower than ranges reported in normative samples of both healthy females (mean: 79.6, SD=18.6; range=25-108) and cancer patients (mean: 82.1, SD=16.3; range=15-108). In bivariate analyses, HRQOL was significantly associated with 19 predictor variables (p &lt; .05). In multiple regression, these variables accounted for about 78% of the variance in HRQOL. Adjusting for other model variables, self-reported current general health (beta=.15); role limitations for moderate activities (.12) and climbing stairs (.15); and social support (.14) were significantly associated with higher HRQOL, whereas life stress (-.37) was inversely associated with HRQOL.

Conclusions: Individual-level factors such as better self-reported general health, more social support, and less stress were associated with higher HRQOL. Conversely, women with moderate role limitations reported higher HRQOL. These findings document baseline characteristics among a sample of younger Black breast cancer survivors and provide an important benchmark by which to compare subsequent changes in HRQOL in this cohort.

Citation Format: Susan T. Vadaparampil, Teri L. Malo, Chanita Hughes-Halbert, Cheryl L. Holt, Shalanda A. Bynum, Jongphil Kim, Devon Bonner, Linda Bomboka, Courtney Scherr, Kimlin Ashing, Tuya Pal. Health-related quality of life among younger black breast cancer survivors. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C43. doi:10.1158/1538-7755.DISP13-C43

Abstract A06: Effects of Integrated Risk Counseling on Cancer Prevention Behaviors

Introduction: Obesity, which has important implications for cancer risk and outcomes, is the cumulative effect of diet and physical activity behaviors. Many adults, especially those from racial and ethnic minority groups, do not meet the recommended guidelines for these behaviors. Previous research has shown that cancer risk information is effective at motivating early detection, but empirical data are not available on the effects of risk factor information on prevention behaviors.

Purpose: We conducted a randomized trial to evaluate the effects of alternate forms of risk factor education on prevention behaviors in a community-based sample of African American adults (n=212).

Methods: This study was conducted as part of an academic-community partnership; the intervention protocols were developed collaboratively by a multi-disciplinary investigative team consisting of academic and community investigators. The integrated risk counseling (IRC) protocol provided education about the overlap in behavioral risk factors for cancer and cardiovascular disease and the disease-specific (DSC) protocol only provided education about behavioral risk factors for cardiovascular disease. Elements from motivational interviewing were incorporated into IRC and DSC; interactive activities were included in both protocols to develop and enhance skills for increasing fruit and vegetable intake and physical activity. Adherence to recommendations for fruit and vegetable intake and physical activity were evaluated by self-report by telephone at baseline and at 1-month following intervention. We predicted that IRC would lead to greater adherence rates compared to DSC.

Regression analyses, using an intent-to-treat approach were conducted to evaluate adherence rates for behavioral outcomes while controlling for baseline levels.

Results: Compared to DSC, IRC was associated with increased adherence rates for fruit intake only (OR=1.85, 95% CI=0.99, 3.44, p=0.05). At baseline, 37.4% of participants who were randomized to IRC met the recommended guidelines for fruit intake, but at follow-up 57.4% were adherent. There were no significant changes in adherence rates for fruit intake among those who were randomized to DSC (31.1% versus 41.5%).

Conclusions: Our findings suggest that integrated risk factor education leads to improved behavioral prevention for some outcomes. Making multiple behavioral changes simultaneously may be particularly difficult.

Citation Format: Melanie S. Jefferson, Benita Weathers, Scarlett Bellamy, Ernestine Delmoor, Vanessa Briggs, Jerry Johnson, Rodney Rogers, Joseph Purnell, Chanita Hughes-Halbert. Effects of integrated risk counseling on cancer prevention behaviors. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A06.

Predictors of yoga use among patients with breast cancer

OBJECTIVE

Emerging research suggests that yoga may be beneficial for reducing symptoms and improving quality of life among breast cancer patients. However, very little is known about the characteristics of breast cancer patients who use yoga; thus, this study seeks to identify the sociodemographic and clinical characteristics of yoga users among this population.

DESIGN

A cross-sectional survey study was conducted.

SETTING

The study was conducted at an outpatient breast oncology clinic at a large university hospital.

PARTICIPANTS

Three hundred postmenopausal breast cancer patients currently receiving aromatase inhibitors were included in this study.

MAIN OUTCOME MEASUREMENT

Self-reported use of yoga following the cancer diagnosis was collected along with sociodemographic and clinical data. Multivariate logistic regression was used to identify independent predictors of yoga use among breast cancer patients.

RESULTS

Of 300 participants, 53 (17.7%) reported having used yoga following cancer diagnosis. White patients were significantly more likely to use yoga than nonwhite patients (P = .02). Higher education level, lower BMI (body mass index), part-time employment status, previous chemotherapy, and radiation therapy were all associated with greater yoga use (all P < .05). Controlling for other factors, greater yoga use was independently associated with higher education level (adjusted odds ratio [AOR] 2.72, 95% confidence interval [CI], 1.15-6.46), and lower BMI (AOR 0.25, 95% CI, 0.09-0.66).

CONCLUSION

Yoga use following breast cancer diagnosis was substantially higher for white patients and those with lower BMI and higher education levels. Considering its potential benefits for symptom management in cancer, more research is needed to understand the attitudes and barriers to yoga use among individuals with nonwhite race, lower education, and higher BMI level. Such investigation will help design yoga programs that are aligned to the needs of these populations.

Conference Report: Eighth Annual AACR International Conference on Frontiers in Cancer Prevention Research

The Eighth Annual Frontiers in Cancer Prevention Research meeting was held in Houston, Texas, in November 2009. This report highlights significant presentations that advance the fields of chemoprevention, clinical trial recruitment and retention, cancer screening including optical imaging, energy balance, and nutritional epidemiology, and health communications and decision making. In findings from the randomized Reduction by Dutasteride of Prostate Cancer Events trial, dutasteride reduced the risk of biopsy-detectable prostate cancer in high-risk men by 23% compared with placebo. Important clues about the dosing and window of susceptibility for supplementation with choline, vitamin D, and folate were revealed from epigenetic research that has implications for future nutritional epidemiology research. Noninvasive optical imaging techniques using endoscopic ultrasound and autofluorescence for the early detection of cancers in the lung, pancreas, and oral cavity are being studied. The report also addresses the challenges of promoting cancer prevention. Understanding how individuals process risk information and make sustained behavior changes and the effect of socioeconomic status on health disparities were identified as critical areas of research. This multidisciplinary research meeting of basic, clinical, and behavioral scientists and epidemiologists continues to play a major role in identifying the research priority areas of cancer prevention, elucidating new mechanisms of carcinogenesis for targeted chemoprevention therapies and delivering a comprehensive strategy for engaging individuals in the unifying goal to reduce cancer incidence.

Achieving healthy weight in African-American communities: research perspectives and priorities

The longstanding high burden of obesity in African-American women and the more recent, steeper than average rise in obesity prevalence among African-American children constitute a mandate for an increased focus on obesity prevention and treatment research in African-American communities. The African-American Collaborative Obesity Research Network (AACORN) was formed to stimulate and support greater participation in framing and implementing the obesity research agenda by investigators who have both social and cultural grounding in African-American life experiences and obesity-related scientific expertise. AACORN's examination of obesity research agenda issues began in 2003 in conjunction with the Think Tank on Enhancing Obesity Research at the National Heart, Lung, and Blood Institute (NHLBI). The assessment was subsequently expanded to take into account the overall NIH strategic plan for obesity research, literature reviews, and descriptions of ongoing studies. In identifying priorities, AACORN members considered the quality, quantity, focus, and contextual relevance of published research relevant to obesity prevention and treatment in African-American adults or children. Fifteen recommended research priorities are presented in five categories adapted from the NHLBI Think Tank proceedings: health effects, social and environmental context, prevention and treatment, research methods, and research training and funding. These recommendations from an African-American perspective build on and reinforce certain aspects of the NHLBI and overall NIH research agendas by providing more specific rationale and directions on areas for enhancement in the type of research being done or in the conceptualization and implementation of that research.

Patient preferences can be misleading as explanations for racial disparities in health care

Addressing racial differences in US health care is difficult, in part because the origins of these differences are complex and poorly understood and also because only some differences may represent legitimate agendas for reform. For example, racial differences that result from differences in access or from clinician prejudices are symptoms of a problem that must be addressed; in contrast, racial differences that arise from different preferences for health care might be seen as acceptable consequences of variation in personal or cultural values that are worth respecting and preserving. However, we believe that this distinction is sometimes overstated. We present several fictitious clinical stories to illustrate how what appear to be individual or cultural preferences are often substantially shaped by modifiable practices of the health care system. True differences in preference that are worthy of respect surely exist between individuals or demographic groups, but some apparent differences in preference may actually reflect problems with the health care system that are worthy of remediation. Uncovering the hidden constraints that we impose on health care choice may help us reduce unwanted disparities in health care.