Association of neighborhood gentrification with prostate cancer and immune markers in African American and European American men

BACKGROUND

Prior studies showed that neighborhood deprivation increases the risk of lethal prostate cancer. However, the role of neighborhood gentrification in prostate cancer development and outcome remains poorly understood. We examined the relationships of gentrification with prostate cancer and serum proteome-defined inflammation and immune function in a diverse cohort.

METHODS

The case-control study included 769 cases [405 African American (AA), 364 European American (EA) men] and 1023 controls (479 AA and 544 EA), with 219 all-cause and 59 prostate cancer-specific deaths among cases. Geocodes were linked to a neighborhood gentrification index (NGI) derived from US Census data. Cox and logistic regression, and MANOVA, were used to determine associations between NGI, as continuous or quintiles (Q), and outcomes.

RESULTS

Adjusting for individual socioeconomic status (SES), continuous NGI was positively associated with prostate cancer among all men (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.01-1.14). AA and low-income men experienced the highest odds of prostate cancer when residing in tracts with moderate gentrification, whereas EA men experienced reduced odds of regional/metastatic cancer with increased gentrification in SES-adjusted analyses. Continuous NGI also associated with mortality among men presenting with localized disease and low-income men in SES-adjusted Cox regression analyses. NGI was not associated with serum proteome-defined chemotaxis, inflammation, and tumor immunity suppression.

CONCLUSIONS

Findings show that neighborhood gentrification associates with prostate cancer and mortality in this diverse population albeit associations were heterogenous within subgroups. The observations suggest that changing neighborhood socioeconomic environments may affect prostate cancer risk and outcome, likely through multifactorial mechanisms.

Associations Between Cancer Risk Perceptions, Self-Efficacy, and Health Behaviors by BMI Category and Race and Ethnicity

BACKGROUND

Cancer risk perceptions and high health-related self-efficacy may impact health behaviors and reduce risk of developing obesity-related cancers. The purpose of this study was to examine whether there are differences in associations among cancer risk perceptions, health-related self-efficacy, and health behaviors between people with healthy weight (PwHW) and people with overweight or obesity (PwO/O), and whether these associations vary by race and ethnicity.

METHOD

Data from the Health Information National Trends Survey (HINTS) 5 Cycles 2 and 3 were used. Data from 6944 adults were analyzed using multivariate logistic regression to assess associations among study variables.

RESULTS

PwO/O who believed there are too many cancer prevention recommendations had lower log odds of meeting guidelines for strength training (β - 0.28; CI - 0.53 to - 0.04; p < 0.05) compared to PwHW. PwO/O who believed that obesity influences cancer risk were associated with low sedentary behavior (β 0.29; CI 0.05-0.54; p < 0.05) compared to PwHW. NHB PwO/O who held fatalistic beliefs and reported high self-efficacy ordered less food (e.g., fewer food items, foods with less calories, or smaller food sizes) compared to NHB Pw/HW (p < 0.05).

CONCLUSION

Health behavior differences in PwHW and PwO/O may be associated with differences in cancer risk beliefs and health-related self-efficacy. Findings support the need for further research considering BMI and race and ethnicity in obesity-related cancer prevention and control.

Opportunities, challenges, and future directions for simulation modeling the effects of structural racism on cancer mortality in the United States: a scoping review

PURPOSE

Structural racism could contribute to racial and ethnic disparities in cancer mortality via its broad effects on housing, economic opportunities, and health care. However, there has been limited focus on incorporating structural racism into simulation models designed to identify practice and policy strategies to support health equity. We reviewed studies evaluating structural racism and cancer mortality disparities to highlight opportunities, challenges, and future directions to capture this broad concept in simulation modeling research.

METHODS

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Articles published between 2018 and 2023 were searched including terms related to race, ethnicity, cancer-specific and all-cause mortality, and structural racism. We included studies evaluating the effects of structural racism on racial and ethnic disparities in cancer mortality in the United States.

RESULTS

A total of 8345 articles were identified, and 183 articles were included. Studies used different measures, data sources, and methods. For example, in 20 studies, racial residential segregation, one component of structural racism, was measured by indices of dissimilarity, concentration at the extremes, redlining, or isolation. Data sources included cancer registries, claims, or institutional data linked to area-level metrics from the US census or historical mortgage data. Segregation was associated with worse survival. Nine studies were location specific, and the segregation measures were developed for Black, Hispanic, and White residents.

CONCLUSIONS

A range of measures and data sources are available to capture the effects of structural racism. We provide a set of recommendations for best practices for modelers to consider when incorporating the effects of structural racism into simulation models.

Sex/gender differences in metabolic syndrome among cancer survivors in the US: an NHANES analysis

BACKGROUND

The purpose of this study was to assess the association of metabolic syndrome (MetS) and its individual components in cancer survivors (CS) by gender, in comparison to participants without a history of cancer who have at least one chronic disease (CD) and those without a chronic disease diagnosis (NCD).

METHODS

Data from participants 40 years and older (n = 12,734) were collected from the 2011 to 2018 National Health and Nutrition Examination Survey dataset. MetS was defined based on the National Cholesterol Education Program's Adult Treatment Panel III. Chi-square test and multivariate-adjusted logistic regression was used to assess group comparisons and associations respectively.

RESULTS

Compared to NCD, CS and CD men had increased odds of meeting MetS, OR 2.60 (CI 1.75-3.87) and OR 2.18 (CI 1.59-2.98) respectively. For women, CS and CD participants also had higher odds of meeting MetS criteria compared to their healthy counterparts, OR 2.05 (CI 1.44-2.93) and OR 2.14 (CI 1.63-2.81) respectively. In subgroup analysis by cancer site, CS men with a history of hematologic malignancies (OR 4.88, CI 1.30-18.37) and CS women with cervical cancer (OR 4.25, CI 1.70-10.59) had highest odds of developing MetS, compared to NCD. CS men also showed a strong association with elevated waist circumference, low high density lipoprotein-c, and elevated triglycerides, even by cancer site, but there were no consistent findings among women.

CONCLUSION

This study indicates that CS men have a strong association with MetS, especially among those with blood-related cancers.

Abstract LB157: Prevalence of metabolic syndrome among cancer survivors in the US

Background: The purpose of this study was to determine the prevalence of metabolic syndrome (MetS) and its components in cancer survivors (CS) compared to participants without a history of cancer who have at least one chronic disease (CD) and those without a chronic disease diagnosis (NCD).

Methods: Using National Health and Nutrition Examination Survey (NHANES) data from 2015 to 2018, the prevalence MetS was evaluated among participants 50 years and older (n= 5466). MetS was defined based on the National Cholesterol Education Program’s Adult Treatment Panel III. Weighted data were used to estimate the prevalence of MetS, stratified by cancer site, gender, sex, and race/ethnicity. Chi-square test and logistic regression was used to assess group comparisons and associations respectively.

Results: Prevalence of MetS was higher among CS (71.4%) and CD (75.1%) participants compared to NCD (45.7%). Compared to NCD, participants with uterine cancer (UCa) and non-melanoma skin cancer (nMSC) had higher odds of MetS, with and without adjusting for covariates (p&lt;0.05). Those with UCa had the highest odds of MetS (OR 3.49, CI 1.51 - 8.06, p&lt;0.01) among all cancer types and NCD respondents. Regarding individual components of MetS, PCa survivors had lower odds of having elevated WC (p&lt;0.01) and BrCa and UCa had higher odds of having elevated WC (p&lt;0.05) after adjusting for covariates, compared to NCD. nMSC had higher odds of reduced HDL, elevated TG, and elevated WC (p&lt;0.05) after adjusting for covariates.

Conclusions: This study indicates that UCa and nMSC survivors have a strong association with MetS. In particular, nMSC survivors demonstrated statistically significant odds of meeting 3 of the 5 risk factors for MetS after adjusting for confounding variables. A better understanding of the association between MetS, its components, and specific cancers can provide insight into providing complete clinical care to CS.

Citation Format: Adaora Ezeani, Tanya Agurs-Collins. Prevalence of metabolic syndrome among cancer survivors in the US [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 LB157.

Improving Representation of Underrepresented Minority (URM) Students in Oncology Biomedical Research Workforce: Outcome Evaluation from the ReTOOL Program

The Research Training Opportunities for Outstanding Leaders (ReTOOL) program was implemented in 2012 to increase the representation of racial and ethnic minorities in the biomedical workforce. Specifically, the ReTOOL program aims to foster the capacity for scientific research among underserved populations as well as address the cultural appropriateness of research projects. This paper describes the impact of the ReTOOL program in enhancing the research training of underrepresented minority (URM) students. Forty URM students who completed the ReTOOL program between 2012 and 2019 were invited to participate in the program evaluation. The response rate was 73% with 29 participants. Of the 29 participants, 26 trainees self-identified as Black or African-American. A structured survey developed for the program was employed for data collection, using a Likert Scale ranging from 1 to 5, with 5 being the best. The item ratings ranged from 4.45 to 4.80. Responses to open-ended questions show that ReTOOL has been instrumental in socializing and acculturating participants into the habits of scientific thinking. The combined use of quantitative and qualitative inquiry depicts that ReTOOL has been highly successful in fostering participant enrollment in advanced health-related or professional degree programs.

Abstract PO-165: Prevalence of metabolic syndrome among cancer survivors: An NHANES study

INTRODUCTION The purpose of this study was to determine the prevalence of metabolic syndrome (MetS) and its components by race and ethnicity in cancer survivors (CS) compared to participants without a self-reported history of cancer with (CD) and without (NCD) a chronic disease diagnosis. METHODS Using National Health and Nutrition Examination Survey (NHANES) data from 2015 to 2018, the prevalence of metabolic syndrome (MetS) was evaluated among respondents 50 years and older. MetS criteria was based on the 2005 National Cholesterol Education Program's Adult Treatment Panel III. MetS is diagnosed when three of the following five factors are present: low HDL, elevated triglycerides, elevated blood pressure, impaired fasting glucose, and elevated waist circumference. Weighted data were used to estimate the prevalence of metabolic syndrome, stratified by gender, sex, and race/ethnicity. Chi-square test was used to assess group comparisons respectively. RESULTS Approximately, two thirds of all respondents met the criteria for MetS, of which 37% were Non-Hispanic White (NHW), 30.2% were Non-Hispanic Blacks (NHB), and 25.7% were Hispanic or Mexican Americans (Hisp) (p&lt;0.001). Of the five factors in the MetS criteria, elevated TG (p=0.012), elevated glucose (p=0.009), and elevated blood pressure (p&lt;0.001) were significantly associated with NHW, NHB, and Hisp participants who met the MetS criteria. Among those with MetS, 61.5% of NHW, 68.0% of NHB, and 65.6% of Hisp participants had at least one chronic disease (CD), whereas 22.1% of NHW, 10.9% of NHB, and 9.3% of Hisp were cancer survivors (CS) (p&lt;0.001). Of the CS with MetS, the highest reported cancer was non-melanoma skin cancer (35.2%) in NHW, prostate cancer (39.5%) in NHB, and breast cancer (28.5%) in Hisp (p&lt;0.001). CONCLUSION Due to increasing numbers of CS, comorbidities such as MetS have become a concern for healthcare providers. A better understanding of the association between MetS, its factors, and specific cancer sites can provide insight into providing complete clinical care to CS, especially if there are differences by race or ethnicity.

Citation Format: Adaora Ezeani, Tanya Agurs-Collins. Prevalence of metabolic syndrome among cancer survivors: An NHANES study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-165.

Abstract PO-017: The association of COVID-19 and cancer screening inquiries among Spanish speakers: An examination of NCI Cancer Information Service data

The disruption of routine cancer screening during the COVID-19 pandemic is a public health priority given documented delays in the diagnosis and treatment of screening-eligible cancers, and future impacts on cancer mortality. Furthermore, COVID-19 has disproportionately affected historically underrepresented populations such as the Hispanic community, who already experience lower cancer screening rates compared to non-Hispanic whites. The purpose of this study was to examine inquiries about cancer screening among Spanish-speaking general public users before and during COVID-19, using data from the National Cancer Institute's Cancer Information Service (CIS). For this analysis, we examined cancer screening inquiries before (February 2019-March 2020) and during (March 2020-January 2021) COVID-19 among Spanish-speaking general public users. We analyzed CIS point of access (email, LiveHelp, social media, telephone), subjects of interaction, and referrals. Cancer sites with low cell sizes (e.g., lung) were combined into the category “other.” We conducted Chi-squared tests to compare counts for cancer screening inquiries before and during COVID-19 across these variables. There were 47.3% (n=691) cancer screening inquiries among English-speaking users before COVID-19 and 52.7% (n=770) during COVID-19. In comparison, among the 300 cancer screening inquiries from Spanish speakers, there were 57% (n=171) before COVID-19 compared to 43% (n=129) during COVID-19. There was a significant difference in patterns between these two groups (p&lt;.002). Cancer site inquiries among Spanish speakers included breast (n=66), general (n=108), and 17 other cancers combined (n=126). The proportion of breast and general cancer inquiries from Spanish speakers increased during COVID-19 compared to pre-COVID (p&lt;.001), whereas other cancer inquiries decreased. Additionally, Spanish-speaking telephone-based inquiries increased during COVID-19 whereas all other points of access decreased (p&lt;.001); subjects of interaction regarding general cancer questions increased, but those on finding healthcare services, screening tests, and other subjects decreased (p&lt;.01); and there was an increase in referrals to national/community organizations and to the CDC National Breast and Cervical Cancer Early Detection Program, although referrals to healthcare providers and other sources decreased during COVID-19 (p&lt;.001). We found that COVID-19 was associated with a significant decrease in cancer screening inquiries among Spanish speakers compared to English speakers using the CIS, with changes in point of access, referrals, subject of interaction, and cancer site for Spanish-speaking CIS users. It is critical to evaluate how these changes in information-seeking may affect screening behaviors post-COVID in Hispanic communities and may potentially widen existing disparities that have worsened during COVID-19. Despite overall inquiry reductions, there was an increase in some cancer screening referrals, hopefully resulting in increased screening behavior among Spanish-speaking CIS users.

Citation Format: Heather N. Platter, Adaora Ezeani, Travis Hyams, Grace C. Huang, Robin C. Vanderpool, William M.P. Klein. The association of COVID-19 and cancer screening inquiries among Spanish speakers: An examination of NCI Cancer Information Service data [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-017.

Behavioural oncology research in Africa: Lessons from the last two decades and key considerations moving forward

OBJECTIVE

To analyse the state of behavioural oncology research in Africa and outline key considerations for future research.

METHODS

Five bibliographic databases were searched to identify original English-language articles published between January 2000 and August 2020. The Behavioural Epidemiology Framework was applied to studies with data/findings from Africa to delineate their current state. Research gaps/opportunities available for behavioural oncology research in Africa were further highlighted.

RESULTS

Two hundred eighty-seven original research with findings from Africa has been published over the last two decades, with the highest contribution arising from Nigeria, Kenya, Ethiopia and South Africa. Cervical and breast cancers were the most widely investigated. Prominently studied behaviours relate to cancer screening, health literacy, lifestyle, and vaccination. Behavioural oncology literature in Africa is generally in Phases I and III and lacks in measurement studies (<2%) and studies that seek to evaluate behaviour change/health promotion interventions (<6%) or translate them into practice (13.2%).

CONCLUSION

Embracing new and progressive approaches, including methodological/analytical paradigms and implementation science is imperative to advance the frontiers of behavioural oncology research in Africa. This calls for a responsive research approach that can mobilise multidisciplinary/multilevel coalitions, ensuring a research structure that effectively integrates behavioural research and cancer prevention/control in the region.

Oncology Clinical Trials in Africa: Partnering for Quality

Oncology clinical trials are requisite for testing the safety and effectiveness of promising treatments and deciphering new knowledge into concrete benefits for patients. They present opportunities to innovate promising, novel cancer remedies. A dearth of local evidence to guide cancer treatment in Africans is creating an increased interest in oncology clinical trials to improve patient care. This is primarily because of limitations in pathology, surgery, medical oncology, radiation, and palliation that are leading to worse cancer outcomes on the continent.

Investment in oversight of Human Research Ethics committees and Medicines Regulatory Authorities in Africa has improved the potential for many countries to host clinical trials. However, the distribution of cancer trials remains poor across the continent, resulting in inadequate treatment options for patients with cancer.

There are some initiatives aimed at developing research capacity to host trials in Africa. However, there is now a need to establish strategic partnerships whose aim should be to achieve harmonized, accredited Clinical Trials Units capable of running trials to meet Good Clinical Practice standards. This article discusses what has been achieved and proposes a model for quality oversight of Clinical Trials Units in Africa.

Landscape of Oncology Clinical Trials in Africa

PURPOSE

The burden of cancer in Africa is of significant concern for several reasons, including that incidence of cancer in Africa continues to rise while Africa is also dealing with communicable diseases. To combat cancer in Africa, oncology clinical trials are needed to develop innovative interventions for cancer prevention, screening, diagnosis, treatment, and survivorship. Unfortunately, there is a paucity of clinical trials in Africa and it is difficult for African clinicians to get information on open oncology clinical trials and impossible for African patients with cancer to access this information. The primary objective of this study was to identify open oncology clinical trials in Africa.

METHODS

This project was part of a large-scale study to develop an African Virtual Platform for Oncology Clinical Trials Registry. The study was a quantitative, web-based, retrospective review of clinical trials registries.

RESULTS

A total of 109 open oncology clinical trials were identified. Most of the trials were in Egypt, South Africa, Algeria, and Kenya. The top cancer types for oncology clinical trials in Africa were breast, cervical, and lung cancers. The top sponsor of oncology clinical trials in Africa was academic institutions, especially institutions in the United States.

CONCLUSION

The paucity of clinical trials in Africa will continue to magnify the global disparities of cancer in the African population. Clinical trials are needed to ensure therapeutic interventions are safe and effective in the African population. In the era of personalized and precision health, it no longer suffices to assume that drugs developed in North America, Europe, or Asia will be effective in the African population.

Abstract PO-144: Assessment of diet and physical activity among prostate cancer survivors: Health Information National Trends Survey (HINTS)

PURPOSE: Prostate cancer (PCa) is the third most common cancer diagnosis in US men. Evidence shows that diet and physical activity may play a role in decreasing the risk of PCa progression and improving outcomes. The purpose of this study is to explore lifestyle behaviors of men with and without prostate cancer. METHODS: Data were obtained from the NCI Health Information National Trends and Survey (HINTS), a cross-sectional, nationally representative survey. Using HINTS 5 Cycles 1-3, we identified US. males &gt; 50 years of age with PCa and those without a history of cancer.

Respondents reported their height, weight, daily fruit and vegetable intake, physical activity, sedentary behavior, and strength training. Data were weighted to calculate population estimates. Statistical analysis included frequencies and multivariate logistic regression analyses to examine the independent association of demographic factors with health behaviors. SPSS Statistics Version 26 was used to analyze data.

RESULTS: The overall weighted sample was 76.1% NHW (Non-Hispanic Whites), 64.3% post high school education, 38.6% &gt;$75,000 annual income, and 65.8% were married/cohabitating. PCa survivors were older compared to men without a history of cancer. Both PCa survivors and men without a history of cancer reported a BMI &gt;25, less than 150 minutes of moderate physical activity, less than 2 cups of fruit per day, and less than 3 cups of vegetables per day. Compared to men without cancer, PCa survivors were less likely to consume 3 cups of vegetables per day (OR 0.23, 0.08 – 0.63, p &lt;0.01) and less likely to complete more than 2 days of strength training per week (OR 0.47, 0.23 – 0.99, p&lt;0.05), adjusting for age, income, and ethnicity. CONCLUSIONS: Results suggest both PCa survivors and men without cancer do not follow diet and physical activity recommendations. There is a need to develop interventions to encourage healthy behaviors, especially strength training among PCa survivors.

Citation Format: Adaora Ezeani, Tanya Agurs-Collins. Assessment of diet and physical activity among prostate cancer survivors: Health Information National Trends Survey (HINTS) [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-144.

Abstract C028: Oxidative stress-inhibiting nutrients and supplements among West African men: The CaPTC prostate cancer cohort study

Introduction One of the confirmed risk factors for prostate cancer (CaP) is race, with Black men (BM) more likely to get and die from CaP globally. Although CaP affects BM globally, little is known about CaP and its risk factors in foreign-born BM and the source population of US BM in Africa. The Prostate Cancer Transatlantic Consortium (CaPTC) studies CaP in BM globally and has an ongoing familial cohort study of West African men in the US, Nigeria and Cameroon. The CaPTC cohort data provides an opportunity to examine the impact of migration on CaP behavioral risk factors. This study focuses on oxidative stress, which has been linked to CaP. The primary objective was to examine nutrients and supplements that inhibit oxidative stress among West African men. Methods The CaPTC cohort study is a prospective, longitudinal study of West African men, between ages 35 -70. Participants were recruited from diverse community settings and clinics. Data collection included the use of structured survey for behavioral and epidemiological data, and saliva samples for biological data. For this study, the variables were: known foods with high levels of antioxidants (vitamins); and dietary polyphenols such as berries, beans, leafy vegetables and tea. Descriptive statistics was used to summarize the study results while ANOVA was used to compare study variables among West African men in the US, Nigeria and Cameroon. Results A total of 704 West African men (WAm) participated in the study, with 9% recruited in the US, 81% in Nigeria and 10% in Cameroon. Most of the participants were married (93%) and in the middle-income SES. Participants in Cameroon were older with a mean age of 53, followed by those in Nigeria (48) and participants in the US (47). WAm in Nigeria were more likely to have prostatitis compared to the other two groups. There was no differences among the three groups with respect to history of CaP and BPH. The three groups were significantly different statistically for the following food groups: (1) sweet potato, mostly consumed by WAm in Cameroon; (2) beans, mostly consumed by WAm in Nigeria; and (3) berries, mostly consumed by WAm in the US. There was no differences among the groups with respect to leafy greens, grape, tea and Vitamin E. The most popular food reported by the WAm were: beans in Nigeria and berries in the US. In Cameroon, the most popular food tied between beans and sweet potatoes. Conclusion Dietary intake of foods rich with antioxidants and polyphenols have been known to be associated with decreased risk of chronic diseases such as CaP. It is interesting to note that the WAm in the different countries consume different types of food groups rich in antioxidants. More research is needed on the antioxidant content of the food as the preparation of the meals may affect content. Also, there needs to be an emphasis on increasing these nutrient rich foods in diets of WAm, given that they are also disproportionately affected by CaP.

Citation Format: Folakemi Odedina, Adaora Ezeani, Ernest Kaninjing, Malcom Ingraham, Catherine Badejo, Anthonia Sowunmi, Omolara Fatiregun, Ayo Salako, A.A. Popoola, Mohammed Faruk, Emeka Iweala, Iya Bassey, Chidiebere Ogo, O.P. Oluwole, H.A. Nggada, Jubrin Paul, Oluwole Kukoyi, Ifeoma Okoye, Abidemi Omonisi, Iheanyi Okpala, Lasebikan Nwamaka, Adeniji Adebanji, Ruth Agaba, Toye Adeniji, Yaseen Elhag. Oxidative stress-inhibiting nutrients and supplements among West African men: The CaPTC prostate cancer cohort study [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 C028.

Abstract D034: Patient and provider concordance and trust in providers among West African Immigrants: Findings from the CaPTC Familial Cohort Study

Background Healthcare disparities among racial and ethnic groups have been well documented across all aspects of clinical healthcare, and disparities in attainment of preventive services are particularly prevalent. African immigrants may be particularly susceptible to factors that contribute to healthcare disparities but little is known about this population. The purpose of this study was to assess patient-provider concordance and trust of health care providers among West African immigrants in the US. In addition, we explored the relationship between these variables and the prostate cancer (CaP) screening behavior of participants. Methods Data collection was part of a global study of prostate cancer in West African men. A study questionnaire was used to collect data from West African male immigrants in the US between the ages of 35 and 70 years. Survey scales for this study included country of birth, years since immigration, patient–provider concordance, trust of healthcare provider, attitude and cues towards CaP screening (PSA and DRE), and CaP screening history. Results There were 38 African immigrants from Cameroon, Nigeria, Sierra Leone, and Ghana. Participants’ average age was 46.2 years and they had spent an average of 13.9 years in the US. Most of the participants (over 60%) stated that they had no preference in regards to their provider race, ethnicity or gender. Over 70% indicated that their physician was of different ethnicity and race while 50% indicated that their physician was of a different gender. Furthermore, most respondents noted that they trusted their physicians with health decisions. However, 61% and 68% of participants did not complete PSA or DRE testing, respectively. Most stated that they did not discuss the advantages or disadvantages of prostate cancer screening with their physicians, noting they mostly received cues to getting tested from reading information, radio, and/or TV. Conclusion Although health disparities can be explained by socioeconomic status such as lack of insurance and various other observable impediments to accessing health care, others barriers persist. It is important to explore other contributing factors such as patient-physician relationships. This study suggests that patient-provider concordance may not be a priority. Emphasis should be placed on encouraging physician-initiated discussion on CaP screening. Unfortunately, current physician guidelines do not stress CaP screening and fail to account for the documented increased risk and early onset of CaP in Black men.

Citation Format: Nissa Askins, Ruth Agaba, Oluwaseyi Adeniji, Adaora Ezeani, Ernest Kaninjing, Folakemi Odedina, Catherine Badejo, Anthonia Sowunmi, Omolara Fatiregun, Ayo Salako, A. A Popoola, Mohammed Faruk, Emeka Iweala, Iya Bassey, Chidiebere Ogo, O. P. Oluwole, H. A. Nggada, Paul Jibrin, Ifeoma Okoye, Abidemi Omonisi, Iheanyi Okpala, A Adeniji, Toye Adeniji. Patient and provider concordance and trust in providers among West African Immigrants: Findings from the CaPTC Familial Cohort Study [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 D034.

Abstract C024: Impact of migration on prostate health factors among West African men in US, Nigeria and Cameroon: Findings from the CaPTC familial cohort study

INTRODUCTION Prostate Cancer (CaP) disproportionately overburden men of African ancestry, especially Black men (BM). Unfortunately, few CaP studies have focused on the heterogeneity of BM within the US as well as the source population of US BM in Africa. The Prostate Cancer Transatlantic Consortium (CaPTC) team has documented differences in CaP-related behavioral factors, health-seeking behaviors and experiences between US-born and foreign-born Blacks since 2005. The CaPTC familial cohort study was developed to understand the genetic, environmental and behavioral etiology of CaP in West African men (WAm). This presentation focuses on the impact of migration on prostate health factors among WAm. Methodology The CaPTC cohort study in a longitudinal study and is still ongoing. The inclusion criteria are WAm, age 35-70 years, and residing in the US, Nigeria and Cameroon. Participants were recruited in diverse community settings. Data were collected from participants who provided informed consent using the CaPTC-AC3 Global Prostate Cancer Measure. The variables included in this presentation are general demographics, cultural beliefs and values, health beliefs, sun exposure, vitamins, body shape, and baldness. In addition, self-reported measures of prostate health were assessed. In addition to descriptive analyses, ANOVA/comparative analyses was used to examine differences among WAm in the US, Nigeria and Cameroon. Results The scales employed for the construct were highly reliable (alpha over 0.80). By December 2018, the sample size was 704 WAm with 81% recruited in Nigeria, 10% recruited in Cameroon and 9% recruited in the US. The average age was 48. Most of the WAm live in Nigeria, are married, middle-income level, Christian by faith and had never been screened for CaP. There was statistically significant differences among the WAm based on their country of residence with respect to CaP history (Nigeria), skin color (darker skin color in Cameroun), vitamin use (mostly by WAm in US), and pattern of baldness at age 30 (WAm in Nigeria). In addition, there was statistically significantly differences relative to cultural beliefs and values (cancer fatalism, religiosity, temporal orientation) and health beliefs (perceived barrier, perceived benefit). Cancer fatalism was lowest among WAm in US; religiosity was highest among WAm in Nigeria; WAm in the US were more future-oriented and WAm in Cameroun more present-oriented; perceived barrier was lowest for WAm in US; and perceived benefit highest for WAm in the US. Conclusion The increasing number of the African immigrant group in the US underscores the need to study within group difference among Blacks in the US. Unfortunately, this group is understudied and may offer a novel approach to fully understand cancer disparities in Blacks. Studying the impact of migration on CaP burden in this population provides several advantages, including identification of CaP risk factors. Our study confirms that migration impacts prostate health factors among WAm.

Note: This abstract was not presented at the conference.

Citation Format: Folakemi Odedina, Getachew Dagne, Adaora Ezeani, Ernest Kaninjing, Catherine Badejo, Anthonia Sowunmi, Omolara Fatiregun, Ayo Salako, Ademola Popoola, Mohammed Faruk, Emeka Iweala, Iya Bassey, Chidiebere Ogo, HA Nggada, Paul Jibrin, Oluwole Kukoyi, Ifeoma Okoye, Abidemi Omonisi, Iheanyi Okpala, Kayode Adeniji, Ruth Agaba, Oluwaseyi Adeniji, Desiree Rivers, Renee Reams, Clayton Yates. Impact of migration on prostate health factors among West African men in US, Nigeria and Cameroon: Findings from the CaPTC familial cohort study [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 C024.

Abstract D035: Tracking of undergraduate research trainees for continuous improvement of the ReTOOL program

Introduction With the limited progress in eliminating cancer disparities, it is important to develop a diverse oncology workforce who will effectively address cancer disparities. Implemented in 2012, the Research Training Opportunities for Outstanding Leaders (ReTOOL) Program focuses on increasing the number of underrepresented minority (URM) cancer scientists in Florida. URM undergraduate students from the state of Florida are invited to participate in a 16-week, hands-on research experience at the University of Florida (UF). Students are assigned to a UF mentor who facilitates their research training and aid their professional development through multiple scholarly activities (http://retool.cop.ufl.edu/). This project focuses on the program evaluation of the ReTOOL program. Methodology ReTOOL alumni are tracked for 10 years to provide evaluation and their career status through biannual surveys. The survey asks about their experience in participating in the program; skills gained during the program; how their participation has benefited their professional development; and their opinions about the program. Alumni respond to open-ended, Likert scale, and multiple choice questions. All open-ended questions in the 2015, 2016, and 2018 surveys were employed for this study. Data analysis comprised the use of themes to categorize the responses. Sub-theming was also used to address specifics within responses; for example, “networking” was divided into “networking among peers” and “networking among UF faculty.” Results Open-ended responses by ReTOOL alumni provided unique perspective on what makes undergraduate research training programs impactful for minority trainees. The ReTOOL alumni noted that strong partnerships with their UF mentor and lab made the program effective. Some attributes of an effective mentor included encouragement, frequent communication, and the ability to shadow in clinical settings. Trainees noted that the information presented about grant and proposal writing would provide future benefits. Understanding scientific research (e.g. ethical practices, documentation, and replication) was a gap filled through participation. Trainees noted that the resources available at UF were excellent and included state-of-the-art technology compared to technology at their home institutions. Improvement opportunities noted included communication with mentors, stipend disbursement timeline, and accommodation. Overall, alumni noted that participating in research informed their graduate school decisions and recommend participating in the program. Conclusion The responses from ReTOOL alumni aided in continuous improvement of the program and effective transplantation of the ReTOOL program at Florida A&M University. Although tracking alumni over the years could be challenging, it is worth it for effective planning of future research training programs. ReTOOL alumni achievements include doctoral degrees (PhDs and MD), publications, presentations and awards.

Citation Format: Parisa Fathi, Folakemi Odedina, Bereket Mochona, Renee Reams, Jennifer Nguyen, Nissa Askins, Ernest Kaninjing, Linda Behar-Horenstein, Debra Lyon, Merr Jennifer Markham, Adaora Ezeani. Tracking of undergraduate research trainees for continuous improvement of the ReTOOL program [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 D035.

Abstract A044: Channels and locations influencing the uptake of prostate cancer intervention trials by ethnically diverse Black men

Background Black men (BM) are statistically more likely to experience aggressive cases of prostate cancer (CaP) compared to other racial groups, but are less likely to enroll in clinical trials. Several barriers have been documented as impacting the participation of BM in clinical trials. To address these barriers, there is need for unique approaches to identify successful strategies that will facilitate the implementation of effective interventions. The overall goal of this study is to develop a tailored communication strategy for a CaP intervention trial, the MiCaP Research Digest Trial. Specifically, the primary objective was to identify the best intervention trial recruitment channels and locations for US-born BM (USBM), African-born BM (ABBM), and Caribbean-born BM (CBBM). Methods The MiCaP Research Digest Trial uses a randomized waitlist research design to evaluate the effectiveness of disseminating CaP scientific discoveries for public health and community applications. It is an ongoing trial, which started in 2017. The current study compared two channels (newspaper and radio) and four locations (churches, barber shops, community outreach events) relative to their effectiveness in recruiting BM for the trial. Study location was Orange County (FL). Recruitment efforts included newspaper stories about the study, study ad in newspaper, study ad on radio, information about study at community events and distribution of study flyers at targeted locations. Assessment focused on the following for the recruitment channels and locations: (1) reach, which was operationalized as the number of BM reached; and (2) impact, operationalized as the number of BM effectively pre-screened for the Trial. Results The study period is from May to July, 2019. Results presented are for data collected up to June 30, 2019. The reach for BM were: 30 community locations for newspaper; 27,000 people every week from the radio; 130 attendees for church events; an average of 12 customers per day for barber shops; and close to 1,200 attendees combined for the community events. The highest impact (uptake of the intervention trial) was from community events, with 8 BM recruited (6 USBM and 2 CBBM). One USBM was recruited through the newspaper and one USBBM through radio. There was no recruitment from church or the barbershop. Also, no ABBM has been recruited so far. Conclusion The reach for intervention trials does not necessarily translate to impact. Although the reach was highest for the radio, uptake of the intervention trial was highest for the community events. It was not surprising that the intervention trials uptake was highest for USBM. While 2 CBBM were recruited, recruiting ABBM continues to be challenging. Engaging ethnically-diverse BM through appropriate channels and locations is crucial to effective uptake of intervention trials.

Citation Format: Malcolm Ingraham, Folakemi Odedina, Parisa Fathi, Kim Walsh-Childers, Adaora Ezeani, Yaseen Elhag. Channels and locations influencing the uptake of prostate cancer intervention trials by ethnically diverse Black men [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 A044.

Abstract C086: The effect of length of residence in the US on risk of developing chronic disease in West African male immigrants

Background African immigrants represent one of the fastest growing groups of immigrants in the US, resulting in increased diversity of Blacks in the US. Therefore, there is a growing need to assess the healthcare needs and practices of this population. The main public health concern has been on infectious disease but priority should also focus on chronic disease. Specifically, the literature has yet to provide consistent results regarding the “healthy immigrant effect”, specifically that immigrants are in relatively better health on arrival before their health converges with native-born levels after time. Using the data collected by the Prostate Cancer Transatlantic Consortium (CaPTC), this study explores chronic disease history and healthy behaviors of male immigrants from West Africa with length of residence in the US. Methods A study questionnaire was used to collect data on West African (WA) Black men residing in Nigeria, Cameroon, and the United States. Data from 709 respondents, Black men between the ages of 35-70 years, recruited from community settings, was collected. Variables analyzed included age, education level, income, smoking and alcohol use, weight, height, physical activity levels, country of birth, country of residence, years since immigration, chronic disease history, and health insurance status. Descriptive analysis was used to determine the frequency of each condition among participants. Results There were 37 respondents, WA males, residing in the US; 26 born in Cameroon, 10 born in Nigeria, 1 born in Sierra Leone, 1 born in Ghana. The average age was 46.2 years and the average length of residency was 13.9 years. Participants were placed in two groups: length of residence in the US of less than or equal to 10 years (LT10Y) and greater than 10 years (GT10Y). This study focused on the most common chronic diseases in the US: high blood pressure (HB), high cholesterol (HC), diabetes (D), stroke/transient ischemic attack (ST), COPD, Alzheimer’s (AZ), and arthritis (AT). Although there was no statistical significant differences between participants who lived greater than 10 years in the US compared to those who resided 10 years or less, there was practical differences. For example, 39% in the LT10Y group had been diagnosed with HBP versus 42% in the GT10Y group. With larger sample size, it is likely that there may be statistical differences. There was statistical significant differences in HC diagnosis with 5% in LT10Y and 22.2% in GT10Y. The GT10Y group showed decreased alcohol use, increased frequency of physical activity, and frequent annual physician visits and had higher income and education level. Conclusion Based on our results, we found length of stay of WA Black males in the US to impact HC diagnosis, alcohol use, physical activity, and physician visits. The “healthy immigrant” phenomenon is likely to be moderated by several factors and need to be studied more among African immigrants.

Citation Format: Adaora Ezeani, Ernest Kaninjing, Folakemi Odedina, Catherine Badejo, Anthonia Sowunmi, Omolara Fatiregun, Ayo Salako, A. A. Popoola, Mohammed Faruk, Emeka Iweala, Iya Bassey, Chidiebere Ogo, O. P. Oluwole, H. A Nggada, Paul Jibrin, Oluwole Kukoyi, Ifeoma Okoye, Abidemi Omonisi, Iheanyi Okpala, Lasebikan Nwamaka, A. Adeniji, Nissa Askins, Ruth Agaba, Oluwaseyi Adeniji. The effect of length of residence in the US on risk of developing chronic disease in West African male immigrants [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 C086.

SWOT Analysis of Oncology Clinical Trials in Africa: A Town Hall Report From the Global Congress on Oncology Clinical Trials in Blacks

Cancer is rapidly becoming a public health crisis as a result of the continued growth and ageing of the global population and will greatly affect resource-limited low- to middle-income countries. It is widely acknowledged that research should be conducted within countries that will bear the greatest burden of disease, and Africa has the unparalleled opportunity to lead the way in developing clinical trials to improve the health of its countries. In 2018, the inaugural Global Congress on Oncology Clinical Trials in Blacks was organized to address the global challenges of clinical trials for oncology among black populations. During this event, researchers, scientists, and advocates participated in a town hall meeting where they explored the status of oncology clinical trials in Africa using the SWOT (strengths, weaknesses, opportunities, threats) approach. Participants discussed noteworthy successes, significant barriers, and opportunities to address gaps in developing a sustainable clinical research framework. Many comments centered on the lack of funding and inadequate infrastructure affecting most African countries. Others noted important successes, such as thriving collaborations among institutions and improved political commitment in support of clinical research. The main objectives of the town hall session were to share knowledge on and discuss advantages and disadvantages of conducting clinical research in Africa. These discussions are invaluable in developing interventions and policies that improve clinical research capabilities in Africa.