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Background Starting in 2018, national death certificates included a new racial classification system that accounts for multiple-race decedents and separates Native Hawaiian and Pacific Islander (NHPI) individuals from Asian individuals. We estimated cancer death rates across updated racial and ethnic categories, sex, and age. Methods Age-standardized US cancer mortality rates and rate ratios from 2018 to 2020 among individuals aged 20 years and older were estimated with national death certificate data by race and ethnicity, sex, age, and cancer site. Results In 2018, there were approximately 597 000 cancer deaths, 598 000 in 2019, and 601 000 in 2020. Among men, cancer death rates were highest in Black men (298.2 per 100 000; n = 105 632), followed by White (250.8; n = 736 319), American Indian/Alaska Native (AI/AN; 249.2; n = 3376), NHPI (205.6; n = 1080), Latino (177.2; n = 66 167), and Asian (147.9; n = 26 591) men. Among women, Black women had the highest cancer death rates (206.5 per 100 000; n = 104 437), followed by NHPI (192.1; n = 1141), AI/AN (189.9; n = 3239), White (183.0; n = 646 865), Latina (128.4; n = 61 579), and Asian (111.4; n = 26 396) women. The highest death rates by age group occurred among NHPI individuals aged 20-49 years and Black individuals aged 50-69 and 70 years and older. Asian individuals had the lowest cancer death rates across age groups. Compared with Asian individuals, total cancer death rates were 39% higher in NHPI men and 73% higher in NHPI women. Conclusions There were striking racial and ethnic disparities in cancer death rates during 2018-2020. Separating NHPI and Asian individuals revealed large differences in cancer mortality between 2 groups that were previously combined in vital statistics data.

PURPOSE: Sixty percent of adults have multiple chronic conditions at cancer diagnosis. These patients may require a multidisciplinary clinical team-of-teams, or a multiteam system (MTS), of high-complexity involving multiple specialists and primary care, who, ideally, coordinate clinical responsibilities, share information, and align clinical decisions to ensure comprehensive care needs are managed. However, insights examining MTS composition and complexity among individuals with cancer and comorbidities at diagnosis using US population-level data are limited. METHODS: Using SEER-Medicare data (2006-2016), we identified newly diagnosed patients with breast, colorectal, or lung cancer who had a codiagnosis of cardiopulmonary disease and/or diabetes (n = 75,201). Zaccaro's theory-based classification of MTSs was used to categorize clinical MTS complexity in the 4 months following cancer diagnosis: high-complexity (≥ 4 clinicians from ≥ 2 specialties) and low-complexity (1-3 clinicians from 1-2 specialties). We describe the proportions of patients with different MTS compositions and quantify the incidence of high-complexity MTS care by patient groups. RESULTS: The most common MTS composition was oncology with primary care (37%). Half (50.3%) received high-complexity MTS care. The incidence of high-complexity MTS care for non-Hispanic Black and Hispanic patients with cancer was 6.7% (95% CI, −8.0 to −5.3) and 4.7% (95% CI, −6.3 to −3.0) lower than non-Hispanic White patients with cancer; 13.1% (95% CI, −14.1 to −12.2) lower for rural residents compared with urban; 10.4% (95% CI, −11.2 to −9.5) lower for dual Medicaid-Medicare beneficiaries compared with Medicare-only; and 16.6% (95% CI, −17.5 to −15.8) lower for colorectal compared with breast cancer. CONCLUSION: Incidence differences of high-complexity MTS care were observed among cancer patients with multiple chronic conditions from underserved populations. The results highlight the need to further understand the effects of and mechanisms through which care team composition, complexity, and functioning affect care quality and outcomes.

Incarceration affects an increasing number of women in the United States. For current and formerly incarcerated women (justice-involved women), incarceration has implications for health, particularly the reproductive health of women, long after incarceration is over. Currently, justice-involved women have a high cervical cancer burden relative to the general population, resulting in substantial disparities in incidence and outcomes. In this article, we review the surveillance, education, and resulting policy issues that contribute to incarceration being a determinant of cervical cancer disparities and present a potential model for continuity of care to reduce such inequity.

ImportanceCancer is the second leading cause of mortality in the US. Despite national decreases in cancer mortality, Black individuals continue to have the highest cancer death rates.ObjectiveTo examine national trends in cancer mortality from 1999 to 2019 among Black individuals by demographic characteristics and to compare cancer death rates in 2019 among Black individuals with rates in other racial and ethnic groups.Design, Setting, and ParticipantsThis serial cross-sectional study used US national death certificate data obtained from the National Center for Health Statistics and included all cancer deaths among individuals aged 20 years or older from January 1999 to December 2019. Data were analyzed from June 2021 to January 2022.ExposuresAge, sex, and race and ethnicity.Main Outcomes and MeasuresTrends in age-standardized mortality rates and average annual percent change (AAPC) in rates were estimated by cancer type, age, sex, and race and ethnicity.ResultsFrom 1999 to 2019, 1 361 663 million deaths from cancer occurred among Black individuals. The overall cancer death rate significantly decreased among Black men (AAPC, −2.6%; 95% CI, −2.6% to −2.6%) and women (AAPC, −1.5%; 95% CI, −1.7% to −1.3%). Death rates decreased for most cancer types, with the greatest decreases observed for lung cancer among men (AAPC, −3.8%; 95% CI, −4.0% to −3.6%) and stomach cancer among women (AAPC, −3.4%; 95% CI, −3.6% to −3.2%). Lung cancer mortality also had the largest absolute decreases among men (−78.5 per 100 000 population) and women (−19.5 per 100 000 population). We observed a significant increase in deaths from liver cancer among men (AAPC, 3.8%; 95% CI, 3.0%-4.6%) and women (AAPC, 1.8%; 95% CI, 1.2%-2.3%) aged 65 to 79 years. There was also an increasing trend in uterus cancer mortality among women aged 35 to 49 years (2.9%; 95% CI, 2.3% to 2.6%), 50 to 64 years (2.3%; 95% CI, 2.0% to 2.6%), and 65 to 79 years (1.6%; 95% CI, 1.2% to 2.0%). In 2019, Black men and women had the highest cancer mortality rates compared with non-Hispanic American Indian/Alaska Native, Asian or Pacific Islander, and White individuals and Hispanic/Latino individuals.Conclusions and RelevanceIn this cross-sectional study, there were substantial decreases in cancer death rates among Black individuals from 1999 to 2019, but higher cancer death rates among Black men and women compared with other racial and ethnic groups persisted in 2019. Targeted interventions appear to be needed to eliminate social inequalities that contribute to Black individuals having higher cancer mortality.

Practice-based guidelines recommend HIV testing during initial invasive cervical cancer (ICC) workup. Determinants of HIV testing during diagnosis of AIDS-defining cancers in vulnerable populations, where risk for HIV infection is higher, are under-explored. We examine factors associated with patterns of HIV testing among Medicaid enrollees diagnosed with ICC. Using linked data from the New Jersey State Cancer Registry and New Jersey Medicaid claims and enrollment files, we evaluated HIV testing among 242 ICC cases diagnosed from 2012 to 2014 in ages 21–64 at (a) any point during Medicaid enrollment (2011–2014) and (b) during cancer workup 6 months pre ICC diagnosis to 6 months post ICC diagnosis. Logistic regression models identified factors associated with HIV testing. Overall, 13% of women had a claim for HIV testing during ICC workup. Two-thirds (68%) of women did not have a claim for HIV testing (non-receipt of HIV testing) while enrolled in Medicaid. Hispanic/NH-API/Other women had lower odds of non-receipt of HIV testing compared with NH-Whites (OR: 0.40; 95% CI: 0.17–0.94). Higher odds of non-receipt of HIV testing were observed among cases with no STI testing (OR: 4.92; 95% CI 2.27–10.67) and

Background: Hepatocellular carcinoma (HCC) is the primary histological subtype of liver cancer, comprising up to 75% of such cases in the U.S. People living with HIV (PLWH) have a higher risk of HCC than the general population. A higher proportion of PLWH are coinfected with hepatitis B (HBV) or hepatitis C virus (HCV) due to shared transmission modalities such as injection drug use. Highly active antiretroviral therapy has improved survival from HIV infection, creating increased opportunities to develop liver cancer due to prolonged hepatic inflammation caused by chronic infection with HBV or HCV. Methods: We used data from the HIV/AIDS Cancer Match (HACM), a population-based HIV and cancer registry linkage in the U.S. We compared HCC risk in PLWH to the general population using standardized incidence ratios (SIRs), standardized by race/ethnicity, age group, HIV transmission risk group, calendar period, and registry. SIRs were estimated by race/ethnicity, age group, HIV transmission risk group, and calendar period. Poisson regression was used to estimate incidence rate ratios (RRs) among PLWH by race/ethnicity, age group, HIV transmission risk group and calendar period. In addition, data from Symphony Health, a Texas based health aggregator of medical claims determined the prevalence of HBV and/or HCV infection among people with HCC. Adjusted odds ratios identified predictors of HBV and HCV infection in PLWH with HCC. Results: There were 1,530 incident HCC cases from 2001–2016 in PLWH during over 4 million person-years of follow up. Compared to the general population, the overall SIR was 2.92 (95% CI 2.75-3.09). The risk of HCC was strongly elevated across all racial/ethnic and age groups. Rates were highest among NH-White PLWH (SIR 3.86; 95% CI 3.48-4.27) PLWH aged 40-49 (SIR 4.81; 95% CI 4.31-5.35) or aged 20-39 (SIR 4.15; 95% CI 2.82-5.89). Among PLWH, HCC risk was similar across racial/ethnic groups but increased with age. Compared to men who had sex with men (MSM), men who injected drugs had almost 4 times the risk of HCC (RR 3.93; 95% CI 3.38-4.55) while female PWID had a 60% increased risk (RR 1.61; 95% CI 1.28-2.01), and men with other or unknown HIV transmission had a 50% increased risk (RR 1.48; 95% CI 1.27-1.73). Between 2001-2004 and 2013-2016, rates of HCC declined 16% (RR 0.84; 95% CI 0.69-1.03). Using Symphony Health data, there were a total of 146 HCC cases, 38 coinfected with HBV, 84 with HCV, and 16 triply infected cases. Compared to MSMs, persons who inject drugs (PWID) had 85% decreased odds of HBV infection (aOR 0.15; 95% CI 0.05-0.50) and 8 times the odds of HCV infection (aOR 8.03; 95% CI 2.61-24.7). Conclusions: Utilizing recently updated population-based linked-surveillance data, we found risk of HCC has declined over time among PLWH, though rates remain significantly elevated compared to the general population, with particularly high risk among people who inject drugs. Prevention and treatment of HBV and HCV are needed to reduce HCC risk in this population. Citation Format: Jennifer K. McGee-Avila, Ilona Argirion, Thomas R. O’Brien, Eric Engels, Marie-Josèphe Horner, Qianlai Luo, Meredith Shiels. Risk of hepatocellular carcinoma among people living with HIV in the United States [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C106.

There is growing evidence that shared care, where the oncologist, primary care physician, and/or other specialty physicians jointly participate in care, can improve the quality of patients' cancer care. This cross-sectional study of breast and colorectal cancer patients (N = 534) recruited from the New Jersey State Cancer Registry examined patient and health system factors associated with receipt of shared care during cancer treatment into the early survivorship phase. We also assessed whether shared care was associated with quality indicators of cancer care: receipt of comprehensive care, follow-up care instructions, and written treatment summaries. Less than two-thirds of participants reported shared care during their cancer treatment. The odds of reporting shared care were 2.5 (95% CI: 1.46-4.17) times higher for colorectal than breast cancer patients and 52% (95% CI: 0.24-0.95) lower for uninsured compared with privately insured, after adjusting for other sociodemographic, clinical/tumor, and health system factors. No significant relationships were observed between shared care and quality indicators of cancer care. Given a substantial proportion of patients did not receive shared care, there may be missed opportunities for integrating primary care and nononcology specialists in cancer care, who can play critical roles in care coordination and managing comorbidities during cancer treatment.

Purpose: HIV infection and cervical cancer disproportionately impact low-income and racial/ethnic minorities in urban areas. Few studies have examined factors associated with HIV testing during cancer diagnosis in vulnerable populations. Current National Comprehensive Cancer Network (NCCN) guidelines recommend an HIV test during initial invasive cervical cancer (ICC) workup. We examine factors associated with patterns of HIV testing among Medicaid enrollees diagnosed with ICC in New Jersey. Methods: Using linked data from the New Jersey State Cancer Registry and New Jersey Medicaid claims and enrollment files, we examined patterns of HIV and other STI testing (chlamydia, gonorrhea and syphilis) among nonelderly (ages 21-64) ICC cases diagnosed between 2012 and 2014. We evaluated two HIV testing time periods: at any point during our study period (2011-2014; pre- or post-cancer diagnosis) and during the cancer workup (6 months pre/post ICC diagnosis). Bivariate and multivariable logistic regression models were used to identify sociodemographic, clinical tumor, and area-level factors associated with patterns of HIV testing. Results: A total of 248 ICC Medicaid enrollees were included in the analytic sample, of whom 83 (33%) received an HIV test at any time. A little over a quarter (26.6%) received STI testing at any time, including 21% for chlamydia and gonorrhea testing. Of those who received any HIV testing, almost half (46%) received their HIV testing during the cancer workup. In the adjusted model, women who lacked any STI testing had higher odds of also not receiving an HIV test during initial cancer workup compared with at least one STI test pre/post cancer diagnosis (OR: 4.2; 95% CI: 1.98-8.98). Similarly, women enrolled for less than a full year prediagnosis also had higher odds of not receiving an HIV test compared to those with full-year enrollment (OR: 2.6; 95% CI: 1.02-6.94). The odds of nonreceipt of HIV testing during the cancer workup were lower among Hispanic/NH-API/Other women compared with White women (OR: 0.38; 95% CI: 0.16-0.88) and higher for those with no primary care visits post-diagnosis compared to ≥ 3 PCP visits (OR: 2.6; 95% CI: 1.07-6.53) Area-level factors (median household income and population density) were not associated with nonreceipt of HIV testing. Conclusions: Although ICC is considered an AIDS-defining cancer, more than two-thirds of women diagnosed with ICC in our study population did not receive any HIV test during the study period. Strategies to address missed opportunities for HIV testing at ICC diagnosis for vulnerable populations warrant further exploration. Additional validation of claims and patterns of testing should also be explored. Citation Format: Jennifer K. McGee-Avila, Michelle Doose, Jose Nova, Rizie Kumar, Antoinette M. Stroup, Jennifer Tsui. Patterns of HIV testing among New Jersey Medicaid enrollees diagnosed with invasive cervical cancer [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B083.