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e24064 Background: The number of cancer survivors in the United States (U.S.) is projected to exceed 20 million by 2024. More and more U.S. states are legalizing marijuana use for both recreational and medicinal purposes. This study estimated the prevalence of marijuana use by state among adult cancer survivors. Methods: U.S nationally representative, cross-sectional data from the 2018-2019 Behavioral Risk Factor Surveillance System Survey (BRFSS) Marijuana Use module were used. A total of 13,174 cancer survivors in 17 states was included. Analyses were weighted to account for BRFSS’s complex survey design with results generalizable to 5.7 million cancer survivors. The outcome variable was marijuana use in the past 30 days. Weighted prevalence estimates were computed. Weighted, multivariable logistic regression model estimated the association between state and marijuana use, adjusting for sociodemographic, health, and healthcare factors. Analyses were performed in January 2021. Results: The prevalence of past-month marijuana use among adult cancer survivors in these states was 9.2%. States varied widely in terms of the prevalence of marijuana use. Marijuana use was higher among those who resided in Guam (15.9%), followed by New Hampshire (13.1%), and lowest for those in Puerto Rico (3.3%) ( p< 0.0001). In the adjusted models, compared with the adult cancer survivors residing in California, those living in Maryland, Minnesota, North Dakota, Ohio, South Carolina, Tennessee, Utah, West Virginia, and Wyoming were significantly less likely to use marijuana. Conclusions: Nearly 9% of adult cancer survivors used marijuana, and those who resided in Guam, New Hampshire, Florida, and California are at higher risk for marijuana use. Given the increasing number of cancer survivors and the proliferation of marijuana legalization, identifying high-risk cancer survivors for marijuana use and informing physicians and patients about safe uses and doses and the potential adverse effects of marijuana use is critical.

12088 Background: Cancer survivors experiencing adverse effects from their cancer and treatment report decreased symptom burden with marijuana use. An increasing number of U.S. states have legalized marijuana use for both medical and recreational purposes. This study aimed to assess the prevalence of current marijuana use and to identify the factors associated with its use among US adults with cancer living in 17 U.S. states and territories. Methods: Data from the 2018-2019 Behavioral Risk Factor Surveillance System Marijuana Use module were analyzed. In 2018, 13 states (California, Florida, Idaho, Maryland, Minnesota, Montana, New Hampshire, North Dakota, Ohio, South Carolina, Tennessee, West Virginia, and Wyoming) and 2 territories (Guam and Puerto Rico) participated in the optional marijuana use module. In 2019, 12 states (California, Idaho, Illinois, Maryland, Minnesota, New Hampshire, North Dakota, South Carolina, Tennessee, Utah, West Virginia, and Wyoming) and 1 territory (Guam) participated in the optional marijuana use module. The analytic sample included 13,174 adults with cancer. The analysis was weighted to account for BRFSS’s complex survey design. The primary outcome was current marijuana use (in the past 30-days). Multivariable logistic regression was used to identify demographic, socioeconomic, clinical, and behavioral factors associated with marijuana use among US adults with cancer. Results: Overall, 9.2% of adult cancer survivors (n = 13,174; weighted 5.7 million; 37.9% men) reported marijuana recently current use, 51.3% of whom used it for medical reasons only, with 65.2% reporting smoking as the main method of administration. Adult cancer survivors were significantly more like to use marijuana if they were younger (odds ratio [OR] for 55-64 versus 18-44 years old: 0.60; 95% CI: 0.38-0.93; P < 0.01); male (OR for female versus male: 0.65; 95% CI: 0.48-0.87; P < 0.01); non-Hispanic Black race/ethnicity (OR: 2.00; 95% CI: 1.21-3.33; P < 0.01); having depression (OR: 1.58; 95% CI: 1.17-2.14; P < 0.01) and current (OR: 3.23; 95% CI: 2.20-4.74; P < 0.01) or former tobacco smoker (OR: 2.40; 95% CI: 1.70-3.38; P < 0.01) and binge drinker (OR: 2.25; 95% CI: 1.53-3.29; P < 0.01). Conclusions: Among a large cohort of US adults with cancer, marijuana use was commonly reported and certain subgroups were at higher risk for marijuana use. Health professionals should identify the risk factors for elevated marijuana use, especially as more states legalize medical and recreational marijuana use despite uncertain health risks.

1586 Background: The number of cancer survivors in the United States is projected to exceed 20 million by 2024. Survivors are at risk of developing a second primary neoplasm (SPN) – a leading cause of survivor death. We described the risk of developing a SPN among survivors of common cancers (smoking-related vs non-smoking-related) in the United States. Methods: We identified patients aged ≥18 years who were diagnosed with a primary cancer from the 10 sites with highest survival rates and stratified as smoking-related (urinary bladder, kidney & renal pelvis, uterine cervix, oral cavity & pharynx, and colon & rectum) and non-smoking related (prostate, thyroid, breast, corpus & uterus, and non-Hodgkin lymphoma) from Surveillance, Epidemiology, and End Results (2000-2015). SPN was defined as the first subsequent primary cancer occurring ≥2 months after first cancer diagnosis. Excess SPN risk was quantified using standardized incidence ratios (SIRs) stratified by sex. Results: A cohort of 2,908,349 patients (50.1% female) was identified and 260,267 (9.0%) developed SPN (7.6% of females and 10.3% of males). All index cancer sites were associated with a significant increase in SPN risk for females and males (except prostate cancer). Index smoking-related cancers (SIR range 1.20 – 2.17 for females and 1.12 – 1.91 for males) had higher increased risk of SPN than non-smoking-related cancers (SIR range 1.08 – 1.39 for females and 0.55 – 1.38 for males) relative to the general population. Conclusions: Nearly 10% of cancer survivors developed an SPN, and those with smoking-related cancers had higher risk. Given the increasing number of cancer survivors and importance of SPN as a cause of cancer death, these findings can improve secondary prevention and surveillance guidelines. [Table: see text]