Therapeutic and persistent efficacy of doramectin against Boophilus microplus in cattle

One therapeutic and one persistent efficacy study were conducted in Brazil to evaluate doramectin at a dose rate of 200 micrograms kg-1 against induced infestations of the single host tick, Boophilus microplus. Doramectin was highly effective in eliminating established tick populations from cattle and also in preventing infestation by the parasite. In the therapeutic study, 12 calves were infested three times a week along the dorsal line with 2500 recently hatched larvae, for a total of 11 times before treatment. Animals were allocated to two groups on the basis of uniformity of established engorged tick burdens. Six calves were treated with doramectin and six received saline solution. From Day -3 to Day 21 post-treatment, individual collections of detached engorged female ticks were made from each calf. In the persistent efficacy study, 12 calves were allocated to two groups of six animals. Six calves were treated with doramectin and six received saline solution. From Day 1 to Day 17 post-treatment, each animal was infested three times a week along the dorsal line with 2500 recently hatched Boophilus microplus larvae, for a total of nine times. From Day 18 to Day 42 post-treatment, daily collections of detached engorged female ticks were made from individual animals. In the therapeutic study, efficacy (reduction of collected engorged female ticks) progressed from 51% at 24 h post-treatment (p.t.) to at least 99% at 4 days p.t., and reached 100% at 8 days p.t. With the exception of one tick that did not lay eggs, recovered from one animal at 11 days p.t., no more ticks were recovered from doramectin-treated calves for the duration of the experiment. For the first 6 days after treatment, only a few detached engorged ticks were collected from treated animals, and their oviposition and hatchability declined rapidly. In the persistent efficacy study, doramectin treatment was highly efficacious in preventing the establishment of Boophilus microplus populations for 20 days after the first ticks completed their cycle in the non-treated group. The oviposition and hatchability of the few ticks that completed their life cycle in the doramectin group were severely reduced.

Determination of amitraz in canine plasma by solid-phase microextraction-gas chromatography with thermionic specific detection

A simple and rapid analytical method is presented for the determination of amitraz in canine plasma samples using solid-phase microextraction (SPME) and gas chromatography with thermionic specific detection (GC-TSD). The best conditions for the SPME procedure were: direct extraction on a polydimethlysiloxane (PDMS) fiber with 100-microm film thickness; 400 &microl of sample plasma matrix modified with 4 ml sodium borate solution (0.01 mol l(-1), pH 6.5); extraction temperature 70 degrees C, with stirring at 2500 rpm for 45 min. The method was linear between 20 and 400 ng ml(-1) with regression coefficients corresponding to 0.998 and coefficient of the variation of the points of the calibration curve lower than 15%. The lowest limit of quantification (LOQ) for amitraz in plasma was 20 ng ml(-1). This LOQ was determined as the lowest concentration on the calibration curve in which the coefficient of variation was lower than 15%. The proposed method was applied to determine amitraz concentrations in canine plasma to look for toxicity after treatment with amitraz in a dipping bath.

Measuring the impact of outreach and enrollment strategies for public health insurance in California

OBJECTIVE AND STUDY SETTING: To evaluate the effectiveness of different approaches to outreach on public health insurance enrollment in 25 California counties with a Children's Health Initiative.

DATA SOURCE

Administrative enrollment databases.

STUDY DESIGN

The use of eight enrollment strategies were identified in each quarter from 2001 to 2007 for each of 25 counties (county quarter). Strategies were categorized as either technology or nontechnology. New enrollments were obtained for Medi-Cal, Healthy Families, and Healthy Kids. Bivariate and multivariate analyses assessed the link between each strategy and new enrollments rates of children.

DATA COLLECTION

Methods Surveys of key informants determined whether a specific outreach strategy was used in each quarter. These were linked to new enrollments in each county quarter.

PRINCIPAL FINDINGS

Between 2001 and 2007, enrollment grew in all three children's health programs. We controlled for the effects of counties, seasons, and county-specific child poverty rates. There was an increase in enrollment rates of 11 percent in periods when technology-based systems were in use compared with when these approaches were inactive. Non-technology-based approaches, including school-linked approaches, yielded a 12 percent increase in new enrollments rates. Deploying seven to eight strategies yielded 54 percent more new enrollments per 10,000 children compared with periods with none of the specific strategies.

CONCLUSIONS AND IMPLICATIONS

National health care reform provides new opportunities to expand coverage to millions of Americans. An investment in technology-based enrollment systems will maximize new enrollments, particularly into Medicaid; nontechnological approaches may help identify harder-to-reach populations. Moreover, incorporating several strategies, whether phased in or implemented simultaneously, will enhance enrollments.

A TLR4 agonist improves immune checkpoint blockade treatment by increasing the ratio of effector to regulatory cells within the tumor microenvironment

Brucella lumazine synthase (BLS) is a homodecameric protein that activates dendritic cells via toll like receptor 4, inducing the secretion of pro-inflammatory cytokines and chemokines. We have previously shown that BLS has a therapeutic effect in B16 melanoma-bearing mice only when administered at early stages of tumor growth. In this work, we study the mechanisms underlying the therapeutic effect of BLS, by analyzing the tumor microenvironment. Administration of BLS at early stages of tumor growth induces high levels of serum IFN-γ, as well as an increment of hematopoietic immune cells within the tumor. Moreover, BLS-treatment increases the ratio of effector to regulatory cells. However, all treated mice eventually succumb to the tumors. Therefore, we combined BLS administration with anti-PD-1 treatment. Combined treatment increases the outcome of both monotherapies. In conclusion, we show that the absence of the therapeutic effect at late stages of tumor growth correlates with low levels of serum IFN-γ and lower infiltration of immune cells in the tumor, both of which are essential to delay tumor growth. Furthermore, the combined treatment of BLS and PD-1 blockade shows that BLS could be exploited as an essential immunomodulator in combination therapy with an immune checkpoint blockade to treat skin cancer.

Healthcare affordability and effects on mortality among adults with liver disease from 2004 to 2018 in the United States

BACKGROUND & AIMS

Liver disease is associated with substantial morbidity and mortality, likely incurring financial distress (i.e. healthcare affordability and accessibility issues), although long-term national-level data are limited.

METHODS

Using the National Health Interview Survey from 2004 to 2018, we categorised adults based on report of liver disease and other chronic conditions linked to mortality data from the National Death Index. We estimated age-adjusted proportions of adults reporting healthcare affordability and accessibility issues. Multivariable logistic regression and Cox regression were used to assess the association of liver disease with financial distress and financial distress with all-cause mortality, respectively.

RESULTS

Among adults with liver disease (n = 19,407) vs. those without liver disease (n = 996,352), those with cancer history (n = 37,225), those with emphysema (n = 7,937), and those with coronary artery disease (n = 21,510), the age-adjusted proportion reporting healthcare affordability issues for medical services was 29.9% (95% CI 29.7-30.1%) vs. 18.1% (95% CI 18.0-18.3%), 26.5% (95% CI 26.3-26.7%), 42.2% (95% CI 42.1-42.4%), and 31.6% (31.5-31.8%), respectively, and for medications: 15.5% (95% CI 15.4-15.6%) vs. 8.2% (95% CI 8.1-8.3%), 14.8% (95% CI 14.7-14.9%), 26.1% (95% CI 26.0-26.2%), and 20.6% (95% CI 20.5-20.7%), respectively. In multivariable analysis, liver disease (vs. without liver disease, vs. cancer history, vs. emphysema, and vs. coronary artery disease) was associated with inability to afford medical services (adjusted odds ratio [aOR] 1.84, 95% CI 1.77-1.92; aOR 1.32, 95% CI 1.25-1.40; aOR 0.91, 95% CI 0.84-0.98; and aOR 1.11, 95% CI 1.04-1.19, respectively) and medications (aOR 1.92, 95% CI 1.82-2.03; aOR 1.24, 95% CI 1.14-1.33; aOR 0.81, 95% CI 0.74-0.90; and aOR 0.94, 95% CI 0.86-1.02, respectively), delays in medical care (aOR 1.77, 95% CI 1.69-1.87; aOR 1.14, 95% CI 1.06-1.22; aOR 0.88, 95% CI 0.79-0.97; and aOR 1.05, 95% CI 0.97-1.14, respectively), and not receiving the needed medical care (aOR 1.86, 95% CI 1.76-1.96; aOR 1.16, 95% CI 1.07-1.26; aOR 0.89, 95% CI 0.80-0.99; aOR 1.06, 95% CI 0.96-1.16, respectively). In multivariable analysis, among adults with liver disease, financial distress (vs. without financial distress) was associated with increased all-cause mortality (aHR 1.24, 95% CI 1.01-1.53).

CONCLUSIONS

Adults with liver disease face greater financial distress than adults without liver disease and adults with cancer history. Financial distress is associated with increased risk of all-cause mortality among adults with liver disease. Interventions to improve healthcare affordability should be prioritised in this population.

IMPACT AND IMPLICATIONS

Adults with liver disease use many medical services, but long-term national studies regarding the financial repercussions and the effects on mortality for such patients are lacking. This study shows that adults with liver disease are more likely to face issues affording medical services and prescription medication, experience delays in medical care, and needing but not obtaining medical care owing to cost, compared with adults without liver disease, adults with cancer history, are equally likely as adults with coronary artery disease, and less likely than adults with emphysema-patients with liver disease who face these issues are at increased risk of death. This study provides the impetus for medical providers and policymakers to prioritise interventions to improve healthcare affordability for adults with liver disease.

Association of the extent of therapy with prostate cancer in those receiving testosterone therapy in a US commercial insurance claims database

BACKGROUND

Conflicting evidence remains in the association of testosterone therapy (TTh) with prostate cancer (PCa). This inconsistency maybe due, in part, to the small sample sizes from previous studies and an incomplete assessment of comorbidities, particularly diabetes.

OBJECTIVE

We investigated the association of PCa with TTh (injection or gel) and different TTh doses and determined whether this association varies by the presence of diabetes at baseline in a large, nationally representative, commercially insured cohort.

DESIGN

We conducted a retrospective cohort study of 189 491 men aged 40-60 years old in the IBM MarketScan® Commercial Database, which included 1424 PCa cases diagnosed from 2011 to 2014. TTh was defined using CPT codes from inpatient and outpatient, and NDC codes from pharmacy claims. Multivariable adjusted Cox proportional hazards models were used to compute hazard ratios for patients with incident PCa.

RESULTS

We found a 33% reduced association of PCa after comparing the highest category (>12) of TTh injections with the lowest (1-2 injections) category (HR = 0.67, 95% CI: 0.54-0.82). Similar statistical significant inverse association for PCa was observed for men who received TTh topical gels (>330 vs 1- to 60-days supply). Among nondiabetics, we found significant inverse association between TTh (injection and gel) and PCa, but a weak interaction between TTh injections and diabetes (P = .05).

CONCLUSION

Overall, increased use of TTh is inversely associated with PCa and this remained significant only among nondiabetics. These findings warrant further investigation in large randomized placebo-controlled trials to infer any health benefit by TTh.

Disparities in male versus female oncologic outcomes following bladder preservation: A population-based cohort study

Introduction

In surgical series of muscle‐invasive bladder cancer (MIBC), women have higher recurrence rates, disease progression, and mortality following radical cystectomy than men. Similar reports of oncologic differences between men and women following trimodality therapy (TMT) are rare. Our hypothesis was that there would be no difference in overall survival (OS) between sexes receiving TMT.

Methods

We queried the National Cancer Database (NCDB) for patients diagnosed with clinical stage T2‐T4aN0 M0 MIBC between 2004–2016. We considered patients to have received TMT if they received 55 Gy in 20 fractions or 59.4–70.2 Gy of radiotherapy with concurrent chemotherapy following a transurethral resection of bladder tumor (TURBT). We used multivariable Cox proportional hazard models to determine whether sex was associated with risk of mortality. In addition to OS, we calculated relative survival (RS) to adjust for the fact that females generally survive longer than males.

Results

Of the patients, 1960 underwent TMT and had survival data. Less than one quarter were female. In the first year following treatment, women had worse OS and RS than men (p = 0.093 and p = 0.030, respectively). However, overall and relative survival differences between sexes were not statistically significantly different in Years 2 and later. Unlike with OS, the RS between sexes remained significant at 9 years; in multivariable analysis based on RS, women were 43% more likely to die than men (p < 0.001).

Conclusions

Women had a higher initial risk of death than men in the first year following TMT. However, long‐term survival between sexes was similar. TMT is an important treatment option in both men and women seeking bladder preservation.

Efeitos da administração epidural de amitraz, xilazina ou dimetil sulfóxido em vacas

Avaliaram-se os efeitos da injeção epidural de amitraz (0,4mg/kg), xilazina (0,05mg/kg) ou dimetil sulfóxido 10% (5,0ml) sobre a freqüência cardíaca (FC), pressão arterial sistólica (PAS), freqüência respiratória (FR), motilidade ruminal (MR), temperatura retal (TR), altura de cabeça (AC) e latência das respostas a estímulos nociceptivos nas regiões da coxa (LECC) e coroa do casco (LRRM) de vacas. Houve diminuição da FC e da MR nos grupos xilazina e amitraz. O tratamento com xilazina resultou em alterações na FR, PAS e AC. LECC e LRRM foram maiores nos tratamentos com agonistas alfa-2. Nas doses utilizadas, o amitraz aumentou a latência de resposta a estímulo nociceptivo em menor grau que a xilazina, sem induzir efeitos colaterais sistêmicos severos, em vacas.

Effect of freezing on rabbit cultured chondrocytes

This work evaluated the effect of freezing on chondrocytes maintained in culture, aiming the establishment of a cell bank for future application as heterologous implant. Chondrocytes extracted from joint cartilage of nine healthy New Zealand White rabbits were cultivated and frozen with the cryoprotector 5% dimethylsulfoxide for six months. Phenotypic and scanning electron microscopy analyses were carried out to identify morphological and functional differences between fresh and thawed cells. After enzymatic digestion, a total of 4.8x10(5)cells per rabbit were obtained. Fresh chondrocytes showed a high mitotic rate and abundant matrix was present up to 60 days of culture. Loss of phenotypic stability was notable in the thawed chondrocytes, with a low labeling of proteoglycans and weak immunostaining of type II collagen. The present study showed important loss of chondrocyte viability under the freezing conditions. For future in vivo studies of heterologous implant, these results suggests that a high number of cells should be implanted in the host site in order to achieve an adequate number of viable cells. Furthermore, the chondrocytes should be implanted after two weeks of culture, when the highest viability rate is found

Breast cancer surgical delays in a racially and ethnically diverse California cancer registry cohort

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Background: Surgical delays for invasive breast cancer have been increasing over time and are associated with an increased risk of mortality. Black and Hispanic breast cancer patients are more likely to experience surgical delays than white patients; however, surgical delays among Asian ethnic subgroups remain unstudied. Methods: We used data from the population-based California Cancer Registry to identify all females diagnosed with stage I-III invasive breast cancer from 2012-2017. Our main independent variable was patient race/ethnicity, including five Asian ethnic subgroups. Covariates captured tumor, treatment-related, and patient sociodemographic characteristics. We conducted multivariable logistic regression to determine the odds of receiving surgery within 30 and 90 days of diagnosis and multivariable Cox proportional hazards regression to determine the risk of shorter time to surgical treatment. Results: Of 106,441 breast cancer patients, 57.5% were non-Hispanic white (NHW), 20.7% were Hispanic, 5.9% were non-Hispanic black (NHB), and 12.6% were Asian (consisting of 33.7% Filipino, 24.6% Chinese, 8.1% Asian Indian or Pakistani (AIP), 7.7% Japanese, 6.7% Korean, and 19.2% other Asian (OA) patients). Compared to NHWs, Hispanics and NHBs were less likely to receive surgical treatment within 30 and 90 days of diagnosis (Hispanic, 30-day: OR = 0.94, 95% CI = 0.89-0.98; Hispanic, 90-day: 0.89, 0.85-0.92; NHB, 30-day: 0.91, 0.85-0.98; NHB, 90-day: 0.86, 0.80-0.92). However, Chinese and AIP patients were more likely than NHWs to receive surgery within 30 and 90 days of diagnosis (Chinese, 30 day: OR = 1.30, 95% CI = 1.19-1.41; Chinese 90-day: 1.26, 1.08-1.47; AIP 30-day: 1.29, 1.11-1.50; AIP 90-day: 1.34, 1.17-1.53). In addition, Koreans were more likely than NHWs to receive surgery within 90 days of diagnosis (OR = 1.26, 95% CI = 1.08-1.47). Hispanics, NHBs, and OAs were less likely to receive timely treatment compared to NHWs (Hispanic: HR = 0.95, 95% CI = 0.94-0.97; NHB: 0.91, 0.89-0.94; OA: 0.95, 0.92-0.99), while Chinese, AIP, and Korean patients were more likely to receive timely treatment compared to NHWs (Chinese: HR = 1.15, 95% CI = 1.11-1.20; AIP: 1.10, 1.04-1.17; Korean: 1.10, 1.03-1.17). Lastly, patients diagnosed in 2017 were 14% less likely to receive timely treatment than those diagnosed in 2012 (HR: 0.86, 95% CI = 0.84-0.88). Conclusions: In this population-based cohort of female breast cancer patients in California, Hispanics and NHBs continue to experience surgical treatment delays and Asian American minority subgroups experience similar delays compared to NHWs. In addition, increasing delays over time could potentially exacerbate racial/ethnic disparities in breast cancer mortality. Continued work investigating the causes of breast cancer treatment delays among Asian ethnic subgroups is necessary to fully elucidate and target racial/ethnic treatment disparities.

Evidence for racial/ethnic disparities in emergency department visits following breast cancer surgery among women in California: a population-based study

PURPOSE

Racial/ethnic disparities in breast cancer outcomes may be related to quality of care and reflected in emergency department (ED) visits following primary treatment. We examined racial/ethnic variation in ED visits following breast cancer surgery.

METHODS

Using linked data from the California Cancer Registry and California Office of Statewide Health Planning and Development, we identified 151,229 women diagnosed with stage 0-III breast cancer between 2005 and 2013 who received surgical treatment. Differences in odds of having at least one breast cancer-related ED visit within 90 days post-surgery were estimated with logistic regression controlling for clinical and sociodemographic variables. Secondary analyses examined health care-related moderators of disparities.

RESULTS

Hispanics and non-Hispanic (NH) Blacks had an increased likelihood of having an ED visit within 90 days of surgery compared to NH Whites [OR = 1.11 (1.04-1.18), p = 0.0016; OR = 1.38 (1.27-1.50), p < 0.0001, respectively]; the likelihood was reduced in Asian/Pacific Islanders [aOR = 0.77 (0.71-0.84), p < 0.0001]. Medicaid and Medicare (vs. commercial insurance) increased the likelihood of ED visit for NH Whites, and to a lesser degree for Hispanics and NH Blacks (p < 0.0001 for interaction). Receipt of surgery at an NCI-designated Comprehensive Cancer Center or at a for-profit (vs. non-profit) hospital was associated with reduced likelihood of ED visits for all groups.

CONCLUSION

Racial/ethnic disparities in ED visits following breast cancer surgery persist after controlling for clinical and sociodemographic variables. Improving quality of care following breast cancer surgery could improve outcomes for all groups.

Asian American ethnic subgroup disparities in time to surgical treatment for breast cancer in the California Cancer Registry

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Background: Health risks and outcomes among Asian American patients are not adequately understood when Asians are treated as a homogenous ethnic group. This work is the first to explore trends in time to surgical treatment for breast cancer amongst Asian American ethnic subgroups. Methods: We used data from the population-based California Cancer Registry to identify a cohort of females diagnosed with invasive breast cancer between 2012-2017 in California. Time to surgical treatment was defined as the time elapsed between definitive diagnosis of breast cancer and receipt of surgery. Covariates included individual patient sociodemographic, health history, and tumor characteristics. Multivariable logistic regression was used to determine the odds of receiving surgery within 30 and 90 days of breast cancer diagnosis and multivariable Cox proportional hazards regression was used to analyze the likelihood of shorter time to surgery. A Bonferroni corrected alpha level was used to account for multiple racial/ethnic group comparisons. Results: Of 106,441 breast cancer patients, 57% were non-Hispanic white (NHW), 21% were Hispanic, 14% were Asian (4% Filipino; 3% Chinese; 1% each of Asian Indian or Pakistani (AIP), Vietnamese, Japanese, and Korean; 3% other Asian), and 6% were non-Hispanic black (NHB). Compared to NHWs, Hispanics (OR = 0.86, 99.5% CI = 0.82-0.92) and NHBs (OR = 0.82, 99.5% CI = 0.76-0.90) were less likely to receive surgery within 30 days of breast cancer diagnosis, while Chinese (OR = 1.30, 99.5% CI = 1.17-1.45) and AIPs (OR = 1.24, 99.5% CI = 1.04-1.48) were more likely to receive surgery within 30 days. These trends persisted for Hispanic (OR = 0.87, 99.5% CI = 0.79-0.96), NHB (OR = 0.73, 99.5% CI = 0.63-0.85), and Chinese patients (OR = 1.33, 99.5% CI = 1.04-1.71) when analyzing the likelihood of receiving surgery within 90 days of diagnosis. Compared to NHWs, Hispanics (OR = 0.94, 99.5% CI = 0.92-0.97), NHBs (OR = 0.88, 99.5% CI = 0.85-0.91), and Vietnamese (OR = 0.90, 99.5% CI = 0.83-0.98) were less likely to experience shorter time to surgical treatment, while Chinese (OR = 1.15, 99.5% CI = 1.09-1.21) and AIPs (OR = 1.09, 99.5% CI = 1.01-1.18) were more likely to have shorter time to surgery. Conclusions: In this population-based study of the California Cancer Registry, trends in time to surgical treatment for breast cancer were not consistent for patients belonging to different Asian ethnic subgroups. While Chinese and AIP patients tended to receive surgery sooner than NHW patients, Vietnamese patients face a disparity in receiving timely surgical treatment relative to NHW patients. Further research is needed to fully understand and appropriately target disparities in breast cancer treatment for patients of different Asian American ethnic subgroups.

Abstract PO-145: Examining the association of wearable activity tracker usage, exercise motivation, and physical activity in a cohort of cancer survivors

Purpose With the growing availability and implementation of wearable activity trackers (WATs) as motivational tools for tracking and managing physical activity, the purpose of this study is to investigate the relationship between motivations for exercise (guilt, pressure, appearance, and enjoyment), WAT usage, and meeting the recommended amount of physical activity (&gt;= 150 minutes per week) among a cohort of cancer survivors. Methods Data on WAT users with a history of cancer diagnosis were analyzed from the National Cancer Institute’s Health Information National Trends Survey (HINTS) 5 Cycle 3. Complete survey data from a total of 608 HINTS respondents were used for analyses. Multivariate logistic regression models were used to assess motivational predictors of WAT use and examine the association between WAT use and meeting the recommended amount of physical activity. A cluster analysis was conducted using participants’ responses to identify motivational profiles that were associated with using WATs. Results After adjusting for all covariates in a multivariate logistic regression model, cancer survivors who reported not feeling any guilt as a motivation for exercise were 73% less likely to use a WAT (OR: 0.274, 95% CI: 0.139, 0.543) (p =0.0002). Three motivational profiles (autonomous with high introjected regulation, autonomous with low introjected regulation, and amotivation) emerged from the cluster analysis which differed significantly across motivation and class membership. WAT users had an increased probability of membership in the autonomous with high introjected regulation group (n = 119 86%) characterized as being motivated to exercise by guilt, appearance, and enjoyment. Additionally, after adjusting for all covariates in a multivariate logistic regression model, cancer survivors who used WATs were 1.6 times more likely to meet physical activity recommendations (&gt;=150 mins per week) compared to those who did not use WATs (OR: 1.649, 95% CI: 1.026, 2.648) (p = 0.0386). Conclusions When exercise motivations were assessed independently, only guilt was significantly associated with WAT usage among this cohort of cancer survivors. However, when assessing clusters of exercise motivations, three distinct motivational profiles emerged with distinctly different class memberships. WAT users were significantly more likely to be in a class characterized by being motivated by guilt, appearance, and enjoyment. The cluster analysis provides a unique examination on not just how a single exercise motivation influences WAT usage, but how a combination of motives can be identified. Additionally, using a WAT was significantly associated with meeting physical activity recommendations in this cohort of cancer survivors. Given the health benefits of physical activity for cancer survivors, WATs may be a useful tool for physical activity interventions aimed at increasing motivation and exercise engagement.

Citation Format: Steven De La Torre, Albert Farias, Donna Spruijt-Metz. Examining the association of wearable activity tracker usage, exercise motivation, and physical activity in a cohort of cancer survivors [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-145.

General and mental health status following colorectal cancer treatment and its association with mortality among a racially diverse population-based cohort

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Background: Patient-reported outcomes (PROs) are recognized as strong predictors of cancer prognosis, outcomes, and care. However, racial/ethnic minorities with colorectal cancer (CRC) tend to report poorer general health status (GHS) and mental health status (MHS) compared to non-Hispanic whites. The objectives of this study were to determine: (1) if there are racial/ethnic differences in GHS and MHS within 36 months of CRC diagnosis and (2) if poorer GHS and MHS in recently diagnosed CRC patients are associated with mortality. Methods: We used the population-based Surveillance, Epidemiology, and End Results (SEER)-Consumer Assessment of Healthcare Providers and Systems (CAHPS) dataset to analyze Medicare beneficiaries aged ≥65 years who were diagnosed with CRC between 1998 and 2011, received surgical resection for their tumor, and completed a CAHPS survey within 6-36 months post-diagnosis. CAHPS surveys captured patient-reported GHS and MHS on a five-point Likert scale ranging from “poor” to “excellent.” We used stepwise multivariable logistic regression to examine associations between patient race/ethnicity and fair or poor health status, adjusting for clinical and sociodemographic factors. Additionally, a multivariable Cox proportional hazards regression was used to determine the risks of mortality associated with fair or poor GHS and MHS. Results: Of 1,867 patients with CRC, 79.5% were non-Hispanic white (NHW), 6.4% were non-Hispanic black (NHB), 7.5% were Hispanic, and 6.6% were non-Hispanic Asian (NHA). In Model 1 of our stepwise logistic regression, NHB patients had higher unadjusted odds for fair or poor GHS (OR 1.56, 95% CI 1.06-2.28) compared to NHW patients while Hispanic patients had higher unadjusted odds for both fair or poor GHS (1.48, 1.04-2.11) and MHS (1.92, 1.23-3.01). In Model 2, this relationship persisted after adjusting for clinical factors, with NHB patients being more likely to report fair or poor GHS (1.62, 1.10-2.40) and Hispanic patients being more likely to report fair or poor GHS (1.49, 1.04-2.13) and MHS (1.92, 1.22-3.00). In Model 3, after adjusting for both clinical and sociodemographic factors, the association between race/ethnicity and fair or poor GHS ( p = 0.53) and MHS ( p = 0.23) no longer remained. Reporting fair or poor GHS and MHS was associated with a greater risk of mortality among all CRC patients (HR 1.52, 95% CI 1.31-1.76 and 1.62, 1.34-1.99, respectively). Conclusions: Our study illustrates that racial/ethnic differences in PROs are largely driven by sociodemographic factors as opposed to clinical factors. As fair or poor GHS and MHS shortly after diagnosis reflect a higher risk of mortality in CRC patients, efforts to understand unmet biopsychosocial concerns may help further elucidate racial differences in CRC survival that may be otherwise overlooked in standard clinical practice.

Abstract PO-007: “You people”- A qualitative analysis of black cancer patients navigating a healthcare system of discrimination

Background: Black cancer patients face significant disparities in medical care throughout the cancer care continuum. While multilevel factors contribute to these disparities including access to care, socioeconomic status and cultural factors, overt and perceived discrimination in the health care setting may likely exacerbate disparities for black cancer patients. However, little is known about how experiences of racial discrimination unfold for Black cancer patients when navigating care and the consequences of such treatment. Purpose: To explore how experiences of racial discrimination in the health care setting manifests for Black cancer patients and to understand how these experiences might contribute to disparities. Methods: We conducted semi-structured in-depth interviews with 18 Black cancer survivors, lasting between 45 – 60 minutes from 2019-20. All interviews were audio-recorded, professionally transcribed, and uploaded into Dedoose software for analysis. Two independent coders met regularly and analyzed the interview transcripts using a deductive constant comparison approach to establish and modify codes based on facets of the biopsychosocial model of stress. Results: Participants included breast, colorectal, and prostate cancer survivors aged 29 to 88 years old. Most patients expressed experiencing some form of racial discrimination, perceived more than overt when receiving medical care. Participants experienced instances of perceived discrimination from their interactions with healthcare staff, medical assistants, front desk staff, health insurance administrators, or other staff within the facility. Instances of perceived discrimination resulted in patients expressing that they did not trust their provider or was a stressor contributing to their mental well-being. Patients who experienced perceived discrimination noted “walking out” of their visit and not having their health issues addressed, demonstrating a broader link between the two factors. Patients internalized experiences of perceived discrimination, resulting in behavior changes in subsequent visits to mitigate the effects. Overt discrimination in the health care setting was rooted in stereotypes and manifested through verbal microaggressions such recollections of physicians using phrases such as “you people”. Patients still sought care when they experienced discrimination out of necessity and believing it was an inevitable part of the Black experience. Patients who had positive experiences navigating care expressed a personal relationship and emotional connection characterized by mutual respect and compassion between them and their provider. Conclusion: Themes identified in this study support possible mechanisms for discrimination in the health care setting contributing to racial health disparities in cancer care such that discrimination serves as a stressor for Black cancer patients and impacts health-seeking behaviors. Future recommendations for healthcare staff should focus on ensuring patient-centered communication and care to support this vulnerable population.

Citation Format: Elleyse Garrett, Albert Farias, Carol Ochoa, Cindy Ma, Stephanie Navarro, Paul Yoon. “You people”- A qualitative analysis of black cancer patients navigating a healthcare system of discrimination [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-007.