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PURPOSE In the 1930s, the federally sponsored Home Owners' Loan Corporation (HOLC) used racial composition in its assessment of areas worthy of receiving loans. Neighborhoods with large proportions of Black residents weremapped in red (ie, redlining) and flagged as hazardous for mortgage financing. Redlining created a platform for systemic disinvestment in these neighborhoods, leading to barriers in access to resources that persist today. We investigated the association between residing in areaswith differentHOLC ratings and receipt of quality cancer care and outcomes among individuals diagnosed with colon cancer--a leading cause of cancer deaths amenable to early detection and treatment. METHODS Individuals who resided in zip code tabulation areas in 196 cities with HOLC rating and were diagnosed with colon cancer from 2007 to 2017 were identified from the National Cancer Database and assigned a HOLC grade (A, best; B, still desirable; C, definitely declining; and D, hazardous and mapped in red). Multivariable logistic regression models investigated association of area-level HOLC grade and late stage at diagnosis and receipt of guideline-concordant care. The product-limit method evaluated differences in time to adjuvant chemotherapy. Multivariable Cox proportional hazard models investigated differences in overall survival (OS). RESULTS There were 149,917 patients newly diagnosed with colon cancer with a median age of 68 years. Compared with people living in HOLC A areas, people living in HOLC D areas were more likely to be diagnosed with late-stage disease (adjusted odds ratio, 1.06 [95% CI, 1.00 to 1.12]). In addition, people living in HOLC B, C, and D areas had 8%, 16%, and 24% higher odds of not receiving guidelineconcordant care, including lower receipt of surgery, evaluation of ≥12 lymph nodes, and chemotherapy. People residing in HOLC B, C, or D areas also experienced delays in initiation of adjuvant chemotherapy after surgery. People residing in HOLC C (adjusted hazard ratio [aHR], 1.09 [95% CI, 1.05 to 1.13]) and D (aHR, 1.13 [95% CI, 1.09 to 1.18]) areas had worse OS, including 13% and 20% excess risk of death for individuals diagnosed with early- and 6% and 8% for late-stage disease for HOLC C and D, respectively. CONCLUSION Historical housing discrimination is associated with worse contemporary access to colon cancer care and outcomes. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID‐19) pandemic led to health care disruptions and declines in cancer diagnoses in the United States. However, the impact of the pandemic on cancer incidence rates by stage at diagnosis and race and ethnicity is unknown. This cross‐sectional study calculated delay‐ and age‐adjusted incidence rates, stratified by stage at diagnosis and race and ethnicity, and rate ratios (RRs) comparing changes in year‐over‐year incidence rates (eg, 2020 vs 2019) from 2016 to 2020 for 22 cancer types based on data obtained from the Surveillance, Epidemiology, and End Results 22‐registry database. From 2019 to 2020, the incidence of local‐stage disease statistically significantly declined for 19 of the 22 cancer types, ranging from 4% (RR = 0.96; 95%CI, 0.93‐0.98) for urinary bladder cancer to 18% for colorectal (RR = 0.82; 95%CI, 0.81‐0.84) and laryngeal (RR = 0.82; 95%CI, 0.78‐0.88) cancers, deviating from pre‐COVID stable year‐over‐year changes. Incidence during the corresponding period also declined for 16 cancer types for regional‐stage and six cancer types for distant‐stage disease. By race and ethnicity, the decline in local‐stage incidence for screening‐detectable cancers was generally greater in historically marginalized populations. The decline in cancer incidence rates during the first year of the COVID‐19 pandemic occurred mainly for local‐ and regional‐stage diseases across racial and ethnic groups. Whether these declines will lead to increases in advanced‐stage disease and mortality rates remain to be investigated with additional data years. Nevertheless, the findings reinforce the importance of strengthening the return to preventive care campaigns and outreach for detecting cancers at early and more treatable stages. [ABSTRACT FROM AUTHOR]

Despite advances in cancer control—prevention, screening, diagnosis, treatment, and survivorship—racial disparities in cancer incidence and survival persist and, in some cases, are widening in the United States. Since 2020, there's been growing recognition of the role of structural racism, including structurally racist policies and practices, as the main factor contributing to historical and contemporary disparities. Structurally racist policies and practices have been present since the genesis of the United States and are also at the root of environmental injustices, which result in disproportionately high exposure to environmental hazards among communities targeted for marginalization, increased cancer risk, disruptions in access to care, and worsening health outcomes. In addition to widening cancer disparities, environmental injustices enable the development of polluting infrastructure, which contribute to detrimental health outcomes in the entire population, and to climate change, the most pressing public health challenge of our time. In this commentary, we describe the connections between climate change and cancer through an Environmental Justice perspective (defined as the fair treatment and meaningful involvement of people of all racialized groups, nationalities, or income, in all aspects, including development, implementation, and enforcement, of policies and practices that affect the environment and public health), highlighting how the expertise developed in communities targeted for marginalization is crucial for addressing health disparities, tackling climate change, and advancing cancer control efforts for the entire population. [ABSTRACT FROM AUTHOR]

Individuals diagnosed with cancer are a vulnerable population during disasters. Emergency preparedness efforts are crucial for meeting the health and safety needs of patients, health-care professionals, health-care facilities, and communities before, during, and after a disaster. Recognizing the importance of advancing emergency preparedness expertise to cancer control efforts nationwide, especially in the era of climate change, we searched National Cancer Institute–designated cancer centers' websites to examine emergency preparedness information sharing and evidence of research efforts focused on disaster preparedness. Of 71 centers, 56 (78.9%) presented some emergency preparedness information, and 36 (50.7%) presented information specific to individuals diagnosed with cancer. Only 17 (23.9%) centers provided emergency preparedness information for climate-driven disasters. Informed by these data, this commentary describes an opportunity for cancer centers to lead knowledge advancement on an important aspect of climate change adaptation: disaster preparedness. [ABSTRACT FROM AUTHOR]

Although the association between health insurance coverage and access to care is well documented, it is unclear whether the deleterious effects of being uninsured are strictly contemporaneous or whether previous disruptions in coverage have persistent effects. This study addresses this issue using nationally representative data covering 2011–2019 to estimate the extent to which disruptions in health insurance coverage continued to be associated with poor access even after coverage was regained. Analysis was conducted in 2022. Using a nationally representative cohort of insured adults aged 18–64 years (N=39,904) and multivariable logistic regression models, the authors estimated the association between past disruptions in coverage (occurring at least 1 year before) and the risks of lacking a usual source of care provider and having unmet medical need. Among insured nonelderly adults, the risk of being without a usual source of care provider was between 18% (risk ratio=1.18; 95% CI=1.00, 1.38) and 75% higher (risk ratio=1.75; 95% CI=1.56, 1.93) than for those with continuous coverage; the risk of having unmet medical needs was between 41% (risk ratio=1.41; 95% CI=1.00, 1.83) and 66% (risk ratio=1.66; 95% CI=1.26, 2.06) higher. Longer insurance disruptions were associated with a higher risk of lacking a usual source of care provider. Previous disruptions in health insurance coverage continued to be negatively associated with access to care for more than a year after coverage was regained. Improving access to care in the U.S. may require investing in policies and programs that help to strengthen coverage continuity among individuals with insurance coverage rather than focusing exclusively on helping uninsured individuals to gain coverage. [ABSTRACT FROM AUTHOR]

98 Background: Hurricanes can disrupt cancer care and adversely affect health outcomes, especially for patients needing daily radiation therapy, which depends on stable electricity and safe facility access. Among patients diagnosed with locally advanced non-small cell lung cancer (NSCLC), disruptions in radiation can decrease survival. This study evaluates the associations of exposure to a hurricane disaster and radiation delays and total dose received among patients diagnosed with NSCLC. Methods: Patients aged ≥18 years who initiated radiation therapy for non-operable stage III NSCLC between 2004-2021 were identified from the National Cancer Database. Exposure was defined as a Federal Emergency Management Agency (FEMA) hurricane disaster declaration at the county of the treating facility during radiation treatment. Patients treated at the same facility, but at a time when no hurricane happened (i.e. unexposed) were propensity score matched in a 1:1 ratio with exposed patients on age at diagnosis, sex, lymph node involvement, comorbidity score, season, and era (radiation start year 2004 – 2009, 2010 – 2015, 2016 – 2021), to account for more active hurricane seasons in recent years. Delays in radiation treatment completion were defined as > 8 weeks between date when radiation started and ended. A two-way t-test and Mantel-Haenszel test were used to examine associations of hurricane exposure and radiation dose and treatment delays respectively. Results: 6,260 matched patients were included, of whom 3,130 were treated at facilities exposed to hurricanes during radiation and 3,130 completed treatment at the same facilities but at a time when no hurricane exposure happened. Patients treated during hurricanes had 1.95 higher odds (95% confidence interval (CI): 1.71 – 2.24) of experiencing treatment delays compared to unexposed patients (23% of exposed patients experienced delays compared to 13% of unexposed patients). Exposed patients were more likely to have received higher radiation doses compared to unexposed patients (mean 5221.81 cGy vs. 4962.75 cGy; p < 0.0001). Conclusions: Patients with locally advanced NSCLC who received radiation during a hurricane disaster were more likely to experience treatment completion delays. Patients treated during a hurricane were also more likely to receive higher total doses of radiation, possibly suggesting compensation to mitigate the detrimental biological impact of radiation delays. As severe weather events become more common, comprehensive emergency preparedness plans that incorporate evidence-based strategies for mitigating adverse effects of treatment delays are essential. [ABSTRACT FROM AUTHOR]

96 Background: Access to broadband is a social determinant of health facilitating connections with healthcare services and other resources and alleviating burdens of travel distance, time, and cost. We used nationwide data to examine the association of zip code-level broadband usage and stage at diagnosis, as well as the receipt of quality care among individuals newly diagnosed with non-small cell lung cancer (NSCLC). Methods: Individuals ≥18 years newly diagnosed with first primary NSCLC between April - December of 2019-2021, were identified from the National Cancer Database (January - March were excluded to match the COVID-19 timeframe in 2020). Broadband usage percentage (the percentage of individuals per zip code with access to fixed broadband at speeds of 25 Mbps/3 Mbps in 2020) were combined with the cohort based on individual's residential zip code. Multivariable logistic regression models examined associations between broadband usage quartiles and stage at diagnosis, as well as the receipt of guideline-concordant care based on National Comprehensive Cancer Network guidelines, including surgery and radiation, ≥10 lymph nodes sampling, chemotherapy, and neoadjuvant chemoradiation (NACR). Analyses were conducted overall and stratified by metropolitan status and year, adjusting for age group, sex, race and ethnicity, comorbidity, distance to facility, state, and zip code-level social deprivation index (SDI). Results: Cohort included 305,198 individuals newly diagnosed with NSCLC. Individuals living in areas with the highest broadband usage were more likely to be aged 65-74 years, female, non-Hispanic White, with Medicare coverage, living in metropolitan and low SDI areas. In adjusted models, individuals living in areas with the highest broadband usage were more likely to be diagnosed with stage I NSCLC (adjusted odds ratio [AOR] = 1.10, 95% confidence interval [95%CI] = 1.01-1.20) and to receive guideline-concordant NACR (AOR = 1.38, 95%CI = 1.09-1.73) compared with those living in areas with the lowest broadband usage in 2020. When stratified by metropolitan status, associations of broadband and diagnosis and receipt of NACR were only observed among individuals living in non-metropolitan areas with medium-low and medium-high broadband usage, respectively (AOR = 1.15, 95%CI = 1.01-1.32; AOR = 1.80, 95%CI = 1.25-2.58). No significant associations were identified for other care modalities or during 2019 and 2021. Conclusions: Increased access to broadband usage is associated with earlier stage NSCLC diagnosis and receiving guideline-concordant NACR in 2020. Our results suggest that increased broadband access, combined with the expansion of telehealth services during the COVID-19 pandemic, may have improved telehealth utilization throughout 2020, leading to enhanced quality of cancer care, particularly benefiting individuals residing in non-metropolitan areas. [ABSTRACT FROM AUTHOR]

50 Background: Incarceration history is linked to limited access to care, including cancer screenings. Adverse consequences may also extend to their partners due to financial burdens and social stigma. This study examined associations of individual and partner incarceration history and receipt of cancer screenings in the United States. Methods: We identified individuals aged ≥ 50 years currently living with a partner who responded to the 2014-2020 Health and Retirement Study. Incarceration history was defined from responses to the question 'Have you ever been an inmate in a jail, prison, juvenile detention center, or other correctional facility?' People were categorized into 3 groups: 1) without individual or partner incarceration history, 2) with individual incarceration history only, and 3) with partner incarceration history only. People with both individual and partner incarceration history were excluded due to small sample size. We used multivariate logistic regression models to generate prevalence ratios (PRs) comparing receipt of any breast, cervical, and colorectal cancer screenings ≤2 years among screening-eligible people (defined by the US Preventive Services Taskforce guideline) with individual or partner incarceration history to people without incarceration history, stratifying by sex and controlling for age group, race and ethnicity, educational attainment, and comorbidity. Results: Of the sample, 0.9% and 11.8% of females and males reported individual incarceration history, respectively; 11.1% and 1.0% reported partner incarceration history, respectively. Compared to females without individual or partner incarceration history, women with partner incarceration history were less likely to receive breast cancer screening (PR:0.7, 95CI: 0.5-0.9); women with individual incarceration history were less likely to receive colorectal cancer screening in the past 2 years (PR: 0.7, 95% CI: 0.5-0.9). Compared to males without individual or partner incarceration history, men with partner incarceration history were less likely to receive colorectal cancer screening (PR: 0.5, 95% CI: 0.4-0.7). Conclusions: Individual or partner incarceration history was associated with lower prevalence of cancer screening. Programs to improve access to care and cancer screening among both people with incarcerations history and their partners are warranted. Adjusted association of individual and partner incarceration history and receipt of cancer screening. Female Male No Individual or Partner History With Individual History With Partner History No Individual or Partner History With Individual History With Partner History Cancer screening Breast (n=2556) Ref. 2.0 (0.5 - 8.3) 0.7 (0.5 - 0.9) -- Cervical (n=817) 1.4 (0.4 - 5.6) 0.9 (0.6 - 1.4) Colorectal (n=2682 for female, n=2207 for male) 0.7 (0.5 - 0.9) 0.9 (0.7 - 1.0) Ref. 1.0 (0.9 - 1.2) 0.5 (0.4 - 0.7) Ref: referent group. [ABSTRACT FROM AUTHOR]

311 Background: Wildfires pose substantial health and safety threats to patients recovering from lung cancer surgery. Without specific disaster preparedness guidelines, oncologists might resort to improvisational strategies, such as increasing the length of stay (LOS), a federal care quality measure with financial implication for hospitals, to better protect the health and safety of this medically vulnerable population. Methods: Individuals aged ≥18 years who received curative-intent lobectomy or pneumonectomy for stage I-III NSCLC between 2004 and 2021 were selected from the National Cancer Database. Exposure was defined as a Federal Emergency Management Agency (FEMA) Presidential Disaster Declaration in the county of the treatment facility between date of surgery and date of discharge from the hospital. Differences in the cumulative distribution function of LOS, defined as days between date of surgery and date of discharge from the hospital, were evaluated between exposed and propensity score matched unexposed patients, who were treated at the same facility but at a time when no disasters occurred, using the product-limit method and log-rank test. In sensitivity analysis, patients with discharge date equal to date of death (in-hospital mortality) were excluded, and the association was evaluated stratified by stage. Results: Patients exposed to a wildfire disaster declaration in the county of the treating facility had longer LOS (p<0.001) than unexposed patients (9.4days compared to 7.5 days, respectively) overall and for each of the stages (I-III) for which surgery is the recommended treatment modality. In sensitivity analysis, there were no in-hospital mortality difference between exposed and unexposed patients (10.8% and 10.5%, respectively, p=0.76). Excluding patients who died in the hospital did not change the main results. Conclusions: Patients whose facility is impacted by a wildfire disaster during recovery from lung cancer surgery have longer length of stay than similar patients treated at the same facility but at times when no disaster occurred. Future studies should evaluate whether extended hospital stay improves safety and quality of surgical care. Moreover, these findings should be considered for disaster preparedness guidelines tailored to vulnerable patient population. [ABSTRACT FROM AUTHOR]