Impact of non-adherence to endocrine therapy on recurrence risk in older women with stage I breast cancer after breast-conserving surgery

PURPOSE

We examined the impact of non-adherence to adjuvant endocrine therapy (ET) on the risk and site of recurrence among older women with early stage, hormone receptor positive (HR+) breast cancer (EBC).

METHODS

A population-based cohort of women age ≥ 65 years with T1N0 HR + EBC who were diagnosed between 2010 and 2016 and treated with breast-conserving surgery (BCS) + ET was identified. Treatment and outcomes were ascertained through linkage with administrative databases. ET non-adherence was examined as a time-dependent covariate in multivariable cause-specific Cox regression models to evaluate its effect on the risks of ipsilateral local recurrence (LR), contralateral breast cancer, and distant metastases.

RESULTS

The population cohort includes 2637 women; 73% (N = 1934) received radiation (RT) + ET and 27% (N = 703) received ET alone. At a median follow-up of 8.14 years, the first event was LR in 3.6% of women treated with ET alone and 1.4% for those treated with RT + ET (p < 0.001); the risk of distant metastases was < 1% in both groups. The proportion of time adherent to ET was 69.0% among those treated with RT + ET and 62.8% for those treated with ET alone. On multivariable analysis, increasing proportion of time non-adherent to ET was associated with increased risk of LR ((HR = 1.52 per 20% increase in time; 95%CI 1.25, 1.85; p < 0.001), contralateral BC (HR = 1.55; 95%CI 1.30, 1.84; p < 0.001), and distant metastases (HR = 1.44; 95%CI 1.08, 1.94; p = 0.01) but absolute risks were low.

CONCLUSION

Non-adherence to adjuvant ET was associated with an increased risk of recurrence, but absolute recurrence rates were low.

Abstract P4-06-10: Is Anthracycline Chemotherapy Essential in the Treatment of Women with Breast Cancer? – A Real World Comparison in the Neoadjuvant Setting

Background: Breast cancer is the second most commonly diagnosed cancer in North American women. The administration of neoadjuvant chemotherapy (NAC) is the mainstay of treatment for individuals with high risk disease in an effort to reduce the extent of surgery, evaluate the role of additional adjuvant therapies (based on pathologic response to NAC), and improve disease-free and overall survival (OS). Anthracyclines have been shown to increase response rates leading to a greater likelihood of pathologic complete response compared to non-anthracycline regimens. However, for some individuals anthracyclines are omitted from the NAC regimen due to toxicities including greater immunosuppression, cardiac toxicity and risk of acute leukemia. We established a population-based cohort of individuals treated with NAC for breast cancer. We report the outcomes of women selected for treatment with non-anthracycline NAC compared to those treated with anthracyclines. Methods: This is a retrospective population-based cohort study using linked health administrative data held at the Institute for Clinical Evaluative Sciences (ICES) in Ontario, Canada. We identified adult women diagnosed with stage I-III breast cancer (ICD-10 C50^) between 2012 and 2020 who received NAC. Administration of at least 50% of the planned chemotherapy regimen was required. We excluded patients with bilateral breast cancer, previous malignancy and male sex. NAC regimens were classified as anthracycline and non-anthracycline-containing regimens. To address confounding between those receiving anthracycline and other regimens, we built a propensity score model including patient and disease characteristics. The association with OS was calculated using Cox proportional hazards models, and breast cancer-specific survival (BCSS) was calculated using cause-specific Cox proportional hazards models. Models were adjusted for the propensity score, radiation treatment as a time-varying covariate, age, socioeconomic status, breast cancer stage and receptor sub-type, as well as Charlson comorbidity index. Results: A total of 4,180 women were identified with a median follow up of 62 months (IQR 44 – 85). Of these, 279 (6.7%) were treated with non-anthracycline regimens compared to 3,901 treated with anthracycline. Patients who received non-anthracyclines were older (median 62 years vs. 50 years; p &lt; 0.001), and less likely to have stage III disease (33.0% vs. 48.7%; p &lt; 0.001), and harbor triple-negative breast cancer (TNBC) (14.0% vs. 24.4%; p &lt; 0.001). They were more likely to have no recorded comorbidities (89.2% vs. 96.5%; p &lt; 0.001), undergo mastectomy (82.1% vs. 71.9%; p &lt; 0.001), and sentinel lymph node biopsy (44.4% vs. 32.3%; p &lt; 0.001). After propensity score and multivariable adjustment, women selected for treatment with non-anthracycline regimens had similar OS (HR 0.85, 95% CI 0.60-1.21) and BCSS (cause-specific HR 0.76, 95% CI 0.46-1.25) compared to those treated with anthracyclines. When stratified by stage, women treated with non-anthracycline regimens did not have significantly higher incidences of breast cancer death or death from any cause (stages I, II, and III Gray’s Test p-value all &gt; 0.1). The mean OS was 7.2 years for women who received non-anthracycline regimens (95% CI 7.0 – 7.4) compared to 7.9 years for those who received anthracycline (95% CI 7.9 – 8.0) (log-rank p = 0.100). Conclusions: Women with stage I-III breast cancer treated with non-anthracycline NAC regimens are a highly selected population. These patients were older and healthier, with earlier stage disease and more favorable subtype (i.e. non-TNBC) when compared to those treated with anthracycline NAC. Our results demonstrate that women were well selected to omit anthracyclines and did not have worse survival outcomes. Further research is needed to better understand in whom anthracycline can be safely omitted.

Citation Format: Danilo Giffoni M. M. Mata, Matthew Castelo, Rinku Sutradhar, Lena Nguyen, Neil Faught, Danielle Rodin, Ezra Hahn, Omolara Fatiregun, Cindy Fong, Sabina Trebinjac, Andrea Eisen, Lawrence Paszat, Katarzyna Jerzak, Eileen Rakovitch. Is Anthracycline Chemotherapy Essential in the Treatment of Women with Breast Cancer? – A Real World Comparison in the Neoadjuvant Setting [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-06-10.

Evaluation of Three-Dimensional Conformal Radiotherapy and Intensity Modulated Radiotherapy Techniques for Left Breast Post-Mastectomy Patients: Our Experience in Nigerian Sovereign Investment Authority-Lagos University Teaching Hospital Cancer Center, South-West Nigeria

Objective

This study aimed to evaluate the dosimetric properties of treatment plans obtained from three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy techniques (IMRT) plans for left chest wall breast cancer patients.

Materials and Methods

A total of 20 patients with left-sided chest wall radiotherapy were randomly selected with the dose prescriptions: 42 Gy and 45 Gy in 15 and 18 fractions, respectively. Treatment plans were obtained using 3D-CRT and IMRT for each patient. Five to seven beams were used for IMRT, while tangential beams were used for 3D-CRT. Planning target volume, D_near-max (D₂ ), D_near-min (D₉₈ ), D_mean, Homogeneity and Conformity Indices (HI and CI) were obtained. Similarly, mean doses to organs at risk (OAR), V₅, V₁₀, V₂₀, V₂₅ were generated from the dose-volume histogram and compared.

Results

IMRT showed a significant improvement in HI compared to 3D-CRT (p<0.0001). Although there was no significant difference in sparing of the left lung between both plans for high-dose volumes (V20: 18.2 vs 30.55, p<0.0001), (V25: 11.17 vs 28.12, p<0.0001). IMRT however showed supremacy to 3D-CRT with high-dose volumes for the heart, including V20 (4.44 vs 10.29, p = 0.02), V25 (2.08 vs 8.94, p = 0.002). 3D-CRT was better than IMRT in low-dose volumes for left lung (V5: 92.23 vs 56.60, p<0.001; V10: 60.98 vs 47.20, p = 0.04) and heart (V5: 57.45 vs 30.39, p = 0.004).

Conclusion

IMRT showed better homogeneity and sparing of high-dose volumes to OAR than 3D-CRT. On the other hand, 3D-CRT showed a reduction of low-dose volumes to OARs than IMRT.

Abstract PO-135: Utility of formalin-fixed, paraffin embedded prostate biospecimens from low-resource international settings for use in next generation sequencing studies in African-descent populations

Background: Men of African ancestry experience higher burden from prostate cancer compared to men of other ancestral backgrounds. Limitations in the availability of high-quality biospecimens have hindered the inclusion of this population in genetic studies of prostate cancer. The use of formalin-fixed paraffin-embedded (FFPE) tissues represents a potential rich source of genetic material particularly in some international settings, where fresh frozen tissue is difficult to obtain. Methods: A total of 976 FFPE blocks were collected between 2002 and 2017 from six international sites in Africa and the Caribbean. Genomic DNA was checked for quality and quantity. Differences in mean quality control (QC) for pre and post pathology training were assessed using t-test. Pearson chi-square with trend analysis examined association between time-category and QC success status. Association of continuous DNA quality (Q129/Q41 ratio) and time of specimen collection was estimated with linear regression. Samples with a DNA quantity &gt;0.2µg and a Q129/Q41 ratio &gt;0.00225 were submitted for whole exome sequencing (WES). Findings: Specimens from 2002 to 2010 and 2011 to 2017 had an average total DNA yield of 1.4 μg and 2.4 ug, respectively. There was a statistical positive difference in the quality of DNA samples over time indicating an improvement in quality of specimens. For the samples Insert size, mean mapping quality and alignment error rate significantly (p≤0.05) improved for samples submitted for WES, post pathology training. Interpretation: FFPE samples from low-resource settings could potentially provide sufficient DNA for WES. Improvements in biospecimen collection for research are needed in these settings.

Citation Format: Ernest Kaninjing, Damian Francis, Katy Brignole, Keyode Adeniji, William Aiken, Cherif Dial, Mohammed Faruk, Omolara Fatiregun, Andrew Gachii, Denise Gibbs, Serigne Gueye, Maria Jackson, Mohamed Jalloh, Paul Jibrin, B. Karanam, Jyoti Kumar Shravana, Mamadou Ndoye, Ogo Chidiebere Ndukwe, John Obafunwa, Folakemi Odedina, Ademola Popoola, Camile Ragin, Jason White, Clayton Yates, Damali N. Martin. Utility of formalin-fixed, paraffin embedded prostate biospecimens from low-resource international settings for use in next generation sequencing studies in African-descent populations [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-135.

Impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria (mHealth-Cervix): Protocol for a randomised controlled trial

Background: Incidence and mortality from cervical cancer have remained high due to many obstacles facing the implementation of organized screening programs in resource-constrained countries such as Nigeria. The application of mobile technologies (mHealth) to health services delivery has the potential to reduce inequalities, empower patients to control their health, and improve the cost-effectiveness of health care delivery.

Aim: To assess the efficacy of mobile technology intervention on Pap test screening adherence compared to a control condition and also determine the factors affecting the uptake of Pap smear screening practices among women in Lagos.

Methods: This is a multi-center randomized controlled trial that will involve women aged 25 to 65 years attending the General Outpatient clinics of the two tertiary health institutions in Lagos, Nigeria between April and December 2020. At baseline, a total of 200 National Health Insurance Scheme (NHIS) enrollees will be randomized to either a text message arm or usual care (control) arm. The primary outcome is the completion of a Pap smear within 6 months of enrolment in the study. The associations between any two groups of continuous variables will be tested using the independent sample t-test (normal distribution) or the Mann-Whitney U test (skewed data) and that of two groups of categorical variables with Chi-square X ²or Fisher's exact test where appropriate. Using binary logistic regression model, we will adjust for age and other relevant sociodemographic and clinical variables and adherence to Pap test screening. Statistical significance will be defined as P-value less than 0.05.

Discussion: The mHealth-Cervix study will evaluate the impact of mobile technologies on cervical cancer screening practices in Lagos, Nigeria as a way of contributing to the reduction in the wide disparities in cervical cancer incidence through early detection facilitated using health promotion to improve Pap smear screening adherence.

Registration: PACTR202002753354517 13/02/2020

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 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.

Prevalence and Correlates of Unmet Supportive Needs of Nigerian Patients With Cancer

PURPOSE

Diagnosis and treatment of cancer are associated with significant psychological distress, and patients face a broad range of challenges that create a vacuum of unmet needs felt by patients, such as a loss of personal control and frustration. The aim of the current study was to determine the magnitude, distribution, and correlates of unmet needs in Nigerian patients with cancer.

PATIENTS AND METHODS

Using a descriptive cross-sectional approach, we assessed 205 patients with cancer who attended oncology outpatient clinics at the Lagos University Teaching Hospital. Eligible patients were administered the Supportive Care Needs Survey (SCNS) –Short Form 34 with a focus on five domains of need: psychological, health system and information, physical and daily living, patient care and support, and sexuality.

RESULTS

Mean age was 47.4 ± 12.3 years and patients were predominantly female (96.6%). The most common diagnosis was breast cancer (92.2%), and mean duration since diagnosis was 20.9 ± 21.9 months for all patients. Mean SCNS score was 83.9 ± 24.8 and at least 46% of participants indicated unmet needs in 15 items of the SCNS. The most frequent unattended needs were related to the health information (53.4%), physical and daily living (49.4%), psychological (48.5%), sexuality, and patient care and support domains. None of the factors considered—age, sex marital status, family type, educational attainment, employment status, economic status, the presence of financial support, social support, and cancer type—was significantly predictive of unmet needs in these patients (P > .05).

CONCLUSION

Nigerian patients with cancer experience considerable levels of unmet needs. These needs require urgent and long-term interventions to help patients achieve increased care satisfaction and a better quality of life.

Pattern and Predictors of Unmet Supportive Care Needs in Cancer Patients

Background: The incidence of cancers is increasing, and this is associated with an increase in the burden of the disease. Patients with cancer have to deal with reduced physical functioning, emotional instability, difficulty in concentrating, and an overall diminished feeling of well-being. This creates deficits that have not been well catered for by traditional cancer care, leading to an overall dissatisfaction with care, and a reduced quality of life. Aim: This review aims at assessing the pattern of unmet needs in cancer patients and to provide information as to the factors that influence the perception of unmet needs. Methods: Studies directly focused on unmet needs in cancer patients were retrieved from MEDLINE, PubMed, PsychINFO, Embase, and Google Scholar; from the earliest records until 2016. Unmet needs in cancer patients have been measured with a wide variety of tools, with the Supportive Care Needs Survey (SCNS) being the most commonly used as a result of its strong psychometric properties, ease of use, responsiveness, and its coverage of all the domains of unmet needs. Results: The most common unmet needs were in the domains of health system and information, psychological, and physical and daily living. These needs were influenced by sociodemographic factors such as age, sex, marital status, income level; and clinical factors such as location of cancer, stage of disease, and tumor size. Conclusion: It is clear that cancer patients experience a wide range of unmet supportive needs, for which efforts need to be desperately made to improve the supportive care services for these patients and their quality of life. While it may not be possible to meet all the needs of every cancer patient, routine and regular monitoring of unmet needs using the appropriate tools is crucial so that cancer care and other health professionals can develop, implement, and streamline specific aspects of cancer care to strategically meet the specific needs of their patients.

The Unmet Supportive Care Needs of Nigerian Patients With Cancer

Background: Cancer is an important cause of morbidity and mortality globally, and its incidence has been on the increase in Nigeria, and the rest of the world. The diagnosis and treatment of cancer is associated with significant psychological distress and patients face a broad range of challenges which create a huge vacuum of “unmet needs” that patients feel as a loss of personal control and frustration. This impacts negatively on their quality of life and other care outcomes. Aim: This study was aimed at determining the magnitude, distribution, and predictors of unmet needs in Nigerian cancer patients. Methods: Using a descriptive cross-sectional approach, 205 cancer patients attending oncology outpatient clinics at Lagos University Teaching Hospital (LUTH), Idi-Araba, were assessed for unmet needs. Eligible patients were given the self-administered Supportive Care Needs Survey - Short Form (SCNS-SF34) questionnaire with focus on five domains of need - psychological, health system and information, physical and daily living, patient care and support, and sexuality. Data analysis was carried out with SPSS version 20, and the level of significance was set at < 0.05. Results: The mean age of the 205 cancer patients was 47.4 ± 12.3 years, who are predominantly females (96.6%). The most common diagnosis was breast cancer (92.2%), and the mean duration since diagnosis was 20.9 ± 21.9 months for all the patients. The mean SCNS score was 83.9 ± 24.8, and at least 46% of the participants indicated unmet needs in 15 items of the SCNS. The most frequent unmet needs were related to the health information (53.4%), physical and daily living (49.4%), and psychological (48.5%) need domains. The most frequently met needs were in the sexuality, and patient care and support need domains. None of the factors considered (age, gender, marital status, family type, educational attainment, employment status, economic status, presence of financial support, social support, and cancer type) were significantly predictive of unmet needs in these patients ( P > 0.05). Conclusion: Nigerian cancer patients experience high levels of unmet needs, particularly in the areas of health information, physical and daily living, and psychological health. Hence, there is an urgent need to provide sustainable and long-term interventions and support for these patients to help them achieve increased care satisfaction, improved treatment outcomes, and a better quality of life.

The Burden of Comorbidities in Cancer Patients in Southwestern Nigeria

Background: Noncommunicable diseases (NCDs) in sub-Saharan Africa are a major cause of morbidity and mortality. There is especially a paucity of data on the burden of hypertension, diabetes mellitus and other NCDs coexisting with cancer in Nigerian cancer patients. Comorbidities influence the survival of patients with cancer; lead to presentation at advanced disease stages; and result in increased risk of treatment complications, higher rates of postoperative mortality, and a greater consumption of medical resources. Aim: To determine the magnitude and pattern of comorbidities in Nigerian cancer patients. Methods: This is a retrospective study, for which data were extracted from hospital records of patients presenting for oncology care between January 2015 and December 2016 in the Departments of Radiotherapy and Oncology of two tertiary health facilities in Lagos, Nigeria. Comorbidities were identified, ranked and weighted using the Charlson Comorbidity Index (CCI). Results: Eight hundred and forty-eight (848) cancer cases were identified, with breast (50.1%) and cervical (11.1%) cancers being the most prevalent. Comorbidities were present in 228 (26.9%) patients, and the most common comorbidities were hypertension (75.9%), diabetes (25.0%), and peptic ulcer disease (7.9%). Patients with prostate (41.5%), colorectal (34.0%), cervical (25.5%), nasopharyngeal (25.0%), and breast (24.0%) cancers are most likely to have comorbidities. The mean ages of patients with comorbidities and without was 60.1 ± 11.8 years and 52.5 ± 13.7 years respectively ( P < 0.0001). Hypertension-augmented CCI scores were 0 (15.6%), 1-3 (62.1%), 4-6 (21.7%), and ≥ 7 (0.6%). Patients with lower mean CCI scores were more likely to receive chemotherapy (2.2 ± 1.6 vs. 2.5 ± 1.9; P < 0.05) and/or surgery (2.1 ± 1.5 vs. 2.4 ± 1.7; P < 0.05). Conclusion: Comorbidities occur in at least one in four Nigerian cancer patients, and significantly influence the treatment outcome and prognosis of these patients. There is a need for a high index of suspicion and routine evaluation of cancer patients for comorbidities, with the aim of instituting appropriate and immediate multidisciplinary management measures where necessary.

E-Patients: Online Health Seeking Behaviour of Cancer Patients in South Western Nigeria

Background: Cancer has been reported to be one of the top three diseases that patients research on the Internet. This is because the Internet is an evolving hub of cancer information and social support for patients. With the increasing connectivity and over 92,000,000 Internet enabled devices in Nigeria, it is expected that mobile health will proliferate and this will change the way cancer patients gather health information and resources, propagating a new age of e-patients. An e-patient is a health consumer who uses the Internet as a health resource. With over 100,000 new cancer cases diagnosed yearly in Nigeria, low doctor to patient ratio, constrained consultation time and limited access to specialist care, the need to promote patients to become e-patients could efficiently empower them to become better-educated healthcare consumers. However, there is a paucity of data on how Nigerian cancer patients use the Internet. Aim: To measure the utilization rate and patient attitudes toward the Internet. Methods: This descriptive cross-sectional study was carried out among 281 cancer patients across the department of radiotherapy in three teaching hospitals in south-western Nigeria in March 2018, using a self-administered questionnaire. The analysis was done with SPSS version 20, and the level of significance was set at < 0.05. Results: The mean age for the 281 participants was 50.8±14.2 years; with the majority between 41 and 60 years (46.6%); and females (78.3%). About 67.6% owned a smartphone ( Table 1 ); and 32% possessed a personal laptop/desktop computer, or lived in households with people with smartphones (66.9%). Majority of the respondents had consistent access to the Internet (59.1%) ( Table 2 ). They also had an e-mail and social media account (52%) in order of decreasing frequency: Facebook, 52.7%; WhatsApp, 18.1%; and Instagram, 17.1% ( Fig. 1 ). At least 43.1% had searched for cancer information online with the purpose of understanding the disease better (41.6%) ( Fig. 2 ). About 45.2% of the respondents also indicated that they would be comfortable having an online medical consultation with their oncologist; however, they had not used any health/cancer app before (71.2%). Patients aged 41-60 years, married, with tertiary level of education, and monthly incomes ≤ N50,000 (∼$140) were more likely to search for cancer information online ( P < 0.05). About 56.9% of the respondents did not use the Internet for cancer information because they preferred getting information directly from doctors (43.2%), lacked the knowledge of Internet use (33.6%), and lacked access to Internet-enabled devices (20.8%). Conclusion: With more cancer patients being connected to the Internet and an increasing trend to be e-patients, there is a need to leverage technology to provide patient education, consultation, navigation and social support services.[Table: see text]

[Table: see text][Figure: see text][Figure: see text]

Abstract 403: Analysis of the functional consequences of single nucleotide polymorphisms in CYP3A4 gene to prostate cancer in men of African ancestry

Prostate cancer (CaP) is the leading cause of cancer death among Black men and its pathogenesis is linked to testosterone metabolism. CYP3A4 deactivates testosterone and the polymorphisms of its gene are known to alter testosterone metabolism. In this study, computational techniques were used to investigate the effects of nonsynonymous single nucleotide polymorphisms (nsSNPs) in the CYP3A4 gene in African Americans exome sequence. A case-control study was also carried out on 100 prostate cancer patients and 100 controls, among Yoruba men in Nigeria, to investigate the allelic variants of CYP3A4*1B (rs2740574 A&gt;G) using polymerase chain reaction restriction fragment length polymorphism. A total of 22 nsSNPs were found in CYP3A4 gene of African American; out of which, 13 mutations (Q472R, M445T, K421R, R403C, I396T, L373F, R372I, I335T, T309I, V191A, D174H, R162W and S134C) were predicted to have deleterious effects on the CYP3A4 protein. The protein structural analysis of these amino acid variants revealed that M445T mutation could result in an increased free energy with a significant (p&lt;0.05) loss of allosteric site at M445, altered metal binding, and loss of catalytic site at R446. T309I mutation which also resulted in increase free energy was found to be associated with a loss of catalytic site at E308. All the Nigerian samples were homozygous for the variant CYP3A4*1B allele. Hence, the presence of GG homologous variant in the Yoruba population of Nigeria, coupled with the computationally predicted deleterious mutations, could contribute to the high prevalence and aggression of CaP in black men. These genetic variants identified through in silico analysis can provide a better understanding of the wide range of disease susceptibility associated with this gene in Black men and aid the development of new molecular diagnostic markers for CaP particularly in men of West African ancestry.

Citation Format: Solomon O. Rotimi, Chidiebere Ndukwe Ogo, Olubanke Olujoke Ogunlana, Shalom Nwodo Chinedu, Titi Akinremi, Omolara Fatiregun, Funlayo Buraimoh, Adewunmi Alabi, Kehinde Tijani, Ayo Salako, Emmanuel Omonisi, Ruth Agaba, Folakemi Odedina. Analysis of the functional consequences of single nucleotide polymorphisms in CYP3A4 gene to prostate cancer in men of African ancestry [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 403.

Abstract 1223: Significance of GSTM1 and GSTT1 gene polymorphism to breast cancer susceptibility in Nigerian women

Human glutathione-S-transferases play a key role in the metabolism of drugs and environmental chemicals. There have been conflicting reports on the association of breast cancer susceptibility with null genotypes of glutathione-S-transferase (GST) classes of mu and theta (GSTM1 and GSTT1). However, this is the first report of the association of null genotypes of GSTs with breast cancer patients from Nigerian population. By multiplex PCR, we examined the null genotypes of GSTM1 and GSTT1 in relation to breast cancer risk in Nigerian women. The case-control study included 56 clinically diagnosed breast cancer patients and age-matched control participants. Odds ratio (OR) and 95% confidence interval (Cl) from conditional logistic regression model were used to estimate the association between GSTM1 and GSTT1 subtypes and breast cancer risk. The frequencies of GSTM1 and GSTT1 null genotypes in breast cancer (BC) patients differed from healthy controls (HC) (61% in BC vs. 39% in HC and 66% in BC vs. 34% in HC for GSTM1 and GSTT1 respectively). GSTM1 and GSTT1 null genotypes and their combinations were associated with increased breast cancer risk [OR = 3.06 (95% Cl 0.98-9.48)], [OR = 14.06 (95% Cl 3.02-70.6)] and [OR = 6.98 (95% Cl = 0.11-16.5)] respectively. The study showed an increased breast cancer risk in patients with GSTT1 homozygous gene deletions with relative risk (RR) value of 5.6 than those with GSTM1 (RR = 1.77). In conclusion, the data from our work provide evidence of increased risk of breast cancer associated with GSTM1 and GSTT1 homozygous gene deletions in women from Nigeria.

Citation Format: Olubanke O. Ogunlana, Omaghomi Ortiseweyinmi, Sadiq Ajoke, Omolara Fatiregun, Solomon O. Rotimi, Bose E. Adegboye, Emeka E. Iweala, Angie O. Igbinoba-Adebayo. Significance of GSTM1 and GSTT1 gene polymorphism to breast cancer susceptibility in Nigerian women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1223.

Innovative Breast Cancer Awareness and Advocacy Campaign

Breast cancer is a major disease in Nigeria; in 2012, 27,304 new occurrences were diagnosed, and the number of mortalities was 13,960. Greater than 70% of patients present with advanced disease, which has a poor survival outcome. The mortality rates are high mainly because of a lack of awareness about breast health, screening guidelines, and treatment centers, and because of sociocultural barriers. In Nigeria, health care professionals remain the backbone for the provision of medical information to the public. This is a study of the innovative ways that breast health and cancer awareness were promoted across communities and institutions in Lagos State, Nigeria, in 2015. Several community awareness campaigns were carried out in the forms of health talks, breast cancer screenings, radio and television interviews, and campaigns on social media. Anomalies noticed during the screenings were promptly referred to appropriate hospitals for additional treatment. The campaign culminated in the #12KLLP, or 12,000 people light Lagos pink, which was a Guinness World Record attempt for the largest human awareness ribbon formed for breast cancer. There was a total reach of 28,774,812 people across platforms: 285,318 were on social media, 3,620 were in communities, 7,466,276 were on the website, 20 million were through media events, 12,000 were through publications, 7,598 were verified participants at the Guinness World Record, and approximately 1 million were through blogs. Eighty partnerships were made with various private and government institutions to facilitate different aspects of the campaign. The community members were able to learn about the need for early detection and awareness; volunteerism and corporate social responsibility were promoted among individuals and corporate institutions.

The Impact of an educational intervention on knowledge of attention-deficit hyperactivity disorder among primary school teachers in Lagos Nigeria

Objective: Primary school teachers have been identified as important partners in the prompt recognition, referral and management of children with ADHD. However their capacity to function in these roles is hinged on their extent of knowledge about ADHD. Furthermore teachers' knowledge about ADHD may influence the education and clinical outcomes of children with ADHD. This study assessed the impact of an educational intervention program on knowledge about ADHD among primary school teachers in Lagos, Nigeria. Method: An experimental study of the impact of a brief educational intervention on ADHD literacy among primary school teachers (n=144) in Lagos, Nigeria. At baseline, knowledge about symptoms and treatment of ADHD was elicited with a vignette-based questionnaire. The intervention consisted of the administration of an educational leaflet about ADHD, designed by the American Academy of Child and Adolescent Psychiatry. One week post-intervention, the baseline assessments were repeated. Results: At baseline, 92.4% of the teachers could not recognise features of ADHD. The majority were also unaware of the role of teachers, medications and psychological interventions in the management of children with ADHD. Post-intervention, significantly greater number of respondents compared with baseline (88.0% vs. 7.6%) correctly identified symptoms of ADHD (p<0.005), and agreed that ADHD could be successfully managed with medications (63.2% vs. 9.0%; p<0.005) and psychological treatment (79.2% vs. 16.7%; p<0.005). Conclusion: A simple low-cost educational intervention is effective in improving knowledge about ADHD among primary school teachers in the shortterm. Further research is required to evaluate the impact of this intervention in the long term.