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Crop coefficients and reference crop evapotranspiration must be determined in order to estimate irrigation water requirements for any crop and improve irrigation scheduling and water management. The objective of this study is to evaluate the crop water requirements of cotton using the FAO-56 Penman-Monteith Method with dual crop coefficients. Meteorological data for the Unchadi Section Command Area of Shetrunji Right Bank Main Canal, such as maximum and minimum temperatures, mean relative humidity, sunlight hours, and wind speed, are used to calculate reference crop evapotranspiration. The MABIA method in WEAP (Water Evaluation And Planning) software uses the dual-Kc approach to calculate crop evapotranspiration or crop water requirement, which is described in FAO Irrigation and Drainage Paper No. 56, whereby the Kc value is divided into a ‘basal’ crop coefficient (Kcb) and a separate component (Ke) representing evaporation from the soil surface. The basal crop coefficient represents actual ET conditions when the soil surface is dry but sufficient root zone moisture is present to support full transpiration. Cotton crop water requirement (ETc) using is found about 940.93 mm during the growing season in region. This result can be useful for agricultural planning and efficient irrigation management for cotton cultivation in Unchadi Section Command Area of Shetrunji Right Bank Main Canal.

537 Background: Current guidelines advise that individuals with estrogen receptor-positive (ER+) breast cancer (BC) undergo 5 years of endocrine therapy with consideration of up to 10 years of extended endocrine therapy (EET). The relative benefit of EET beyond 5 years is minimal for many patients, yet a significant group of patients at higher risk of late recurrence may benefit. EndoPredict is a gene expression assay to stratify those with high versus low BC recurrence risk and is validated to predict early and late distant metastasis up to 15 years using an EPclin score. In the prospective EXET study we evaluated adherence to EndoPredict test results when making decisions regarding EET. Methods: Patients with prior ER+, human epidermal growth factor 2 negative (HER2-) BC diagnosis and 4-6.5 years of endocrine therapy underwent EndoPredict testing. To evaluate the impact on decision making for EET, chart review was performed at or after test results were clinically disclosed. Univariable analysis was used for EPclin risk classification (high, low), multivariable analysis was used to evaluate the EPclin score with clinical variables and Firth logistic regression was used to assess the association of a given variable with the therapy decision. Results: The cohort consisted of 411 patients with an average age of 62 years (range 27, 90), 107 received adjuvant chemotherapy (26%), and 71 were lymph node positive (17.3%). The rate of EET was significantly different for those with low-risk scores (EPclin Score ≤ 3.3) compared to high-risk scores (EPclin Score > 3.3; OR 8.5×10-4 [95% CI 6.8×10-6, 6.0×10-3], p-value 5.7×10-68). All patients with high-risk scores received EET. Within the low-risk group, those treated with adjuvant chemotherapy and those who were lymph node positive chose to extend endocrine therapy at higher rates. The EPclin score provided significant information in predicting EET status, even when accounting for clinical variables such as node status, tumor grade, age at diagnosis, adjuvant chemotherapy status and tumor stage (EPclin Score OR 20.2 [10.1, 44.0]; p-value=3.1 × 10-25). Conclusions: Even after adjusting for other clinical factors, EndoPredict is a significant predictor of clinical decision on EET. High adherence to EndoPredict test results in EET decision making was noted in our study. Clinical trial information: NCT04016935. [Table: see text]

e18522 Background: The COVID-19–associated global pandemic has brought many public and population health issues to light. A glaring issue is the disparities among and differences in susceptibility of diverse ethnicities. Viral infection is not the only area of healthcare facing this issue: disparities in prevalence, biology, prognosis, and outcomes of cancer exist, often based on socioeconomics and social determinants of health (SDoH). CHD have been debated and discussed at several levels, from local counties to the congress to the Centers for Medicare and Medicaid Services. Amid the debates and recommendations, it has been difficult to carve out a clear path forward. The complex factors involved include access to care because of financial challenges, biological and genetic factors, impact of SDoH, and access to screening, NGS testing, and clinical trials. CHD may contribute to almost 34% of deaths among adult cancer patients and additional spending of $230 billion. Addressing CHD could result in an indirect savings of as much as $1 trillion over 3 years (AACR, CDR, 2020). A comprehensive approach is needed to generate a groundswell of resources. This should include support for public policies aimed at improving understanding of the issue by all parts of the ecosystem (pharma, researchers, government agencies, physicians), adequate funding for federal and local initiatives, considerations of health in community planning and development, and collection of real-world data and evidence. At Carolina Blood and Cancer Care (CBCCA), the team decided to study this issue and initiate solutions one step at a time. Methods: CBCCA prioritized solutions in 5 categories. The top priority was to address issues impacting patients: access to care, NGS testing, cancer screening, SDoH, and clinical trial access. To address access to care issue (financial constraints), 2.5 FTEs (full-time equivalents) were allocated to carry out needs assessments and identify resources, including Medicaid eligibility, dual eligibility, other foundations, and sources for free drugs. A not-for-profit entity, No One Left Alone, was started to address CHD. Results: During 2021 CBCCA physicians saw 1787 unique cancer patients (both established and new). Of these, 319 needed IV anticancer treatment and an additional 104 needed oral oncolytics. Fifty-three could not pay for their cancer treatment. Another 101 patients needed assistance for out-of-pocket costs. Financial counselors procured free drugs worth $1,633,588 and an additional $135,931 in cash assistance for high out-of-pocket costs. The pharmacy team raised $253,218 for 64 patients (374 transactions) for out-of-pocket costs. As a result, not a single patient was left without treatment. Conclusions: Financial toxicity was addressed by allocating 0.5 FTE per oncologist to ensure access to care. In the next phase, CBCCA will address access to NGS testing.

e18519 Background: CHD may result from multiple factors, including access to care, screening, and clinical trials; limited uptake of biomarker and next-generation sequencing (NGS) testing; and unfavorable social determinants of health. CHD may contribute to almost 34% of deaths among adult cancer patients and additional spending of $230 billion. Addressing CHD could result in an indirect savings of as much as $1 trillion over 3 years (AACR, CDR, 2020). Biomarker testing enables the option of targeted treatment, providing better outcomes and reduced toxicity. The NGS testing rate is very low in some regions and among minority populations, and underuse worsens disparities. Carolina Blood and Cancer Care Associates (CBCCA) has created best practices to improve biomarker testing and provide standard-of-care treatment in advanced cancer. Methods: As a part of a pledge to decrease CHD, CBCCA partnered with 2 national NGS testing vendors to create a RWE registry to identify appropriate patients and provide access to NGS biomarker tests for somatic mutations, including whole exome sequencing (WES). Liquid biopsy was made available when tissue was unavailable. Results: CBCCA has 1 suburban and 1 rural location, with an ethnically diverse population. Regular care was provided for 1466 of the 1786 unique cancer patients seen in 2021, and 442 participated in a RWE registry. Nonparticipants were survivors having routine follow-up care (n = 512), patients with early-stage or noninvasive disease (510), or patients who refused testing because they were responding to ongoing treatment or had reservations. NGS testing was obtained for 354 patients, 31% of whom were members of ethnic minority groups. Liquid biopsy was used for 133 samples, and the remaining 221 were analyzed with somatic NGS panels or WES. Of the liquid biopsies, 24 patients had actionable mutations; an additional 52 had findings of germline implications. Actionable mutations that could be treated with an FDA-approved drug were identified using tissue-based NGS testing in 38 pt. In tissue-based testing, WES detected more results with germline implications, compared to somatic testing alone. Another 64 tests found mutations treatable with an approved drug in another tumor type. The NGS and biomarker testing rate (either tissue or liquid biopsy) was 84% of eligible pt. Of the patients tested with NGS, clinically actionable variants that could be treated with an approved agent were found in 23% (same tumor type) and 28% (another tumor type). Another 40% of patients had results with germline implications, of which P53 deletion was the most common finding. Conclusions: It is feasible to increase the NGS testing rate in appropriate situations. In this study, actionable mutations impacting treatment selection were found in up to 25% of patients where targeted therapy could be offered.

e18539 Background: Social determinants of health (SDOH) influence outcomes of oncologic care and more data are needed to understand these factors in underserved communities. At the same time, disparities in access to genomic tests and genomic databases that overrepresent European ancestry may contribute to disparities in precision oncology. We established a prospective study incorporating SDOH assessments and whole exome sequencing for advanced cancer patients in underserved communities. Methods: In this ongoing multi-center, prospective, observational study involving community oncology practices in underserved communities, patients with advanced cancers received whole exome/whole transcriptome sequencing and hereditary cancer testing (Sema4, Stamford, CT). Patients also completed an enrollment questionnaire focused on SDOH. The study began enrollment in July 2021 at a community practice in South Carolina and has expanded to a second practice in North Carolina as of February 2022. This report describes demographic and SDOH characteristics of patients enrolled at the first site between 7/2021-2/2022. Results: A total of 161 enrolled patients have completed baseline demographics. SDOH data are available for 148 (91.9%) patients. The cohort was predominantly female (N = 99, 61.5%), with 34 (21.1%) patients reporting Black race, and a mean age of 65.5 years (s.d. 14.2). Three patients (0.02%) reported Hispanic ethnicity. The most common cancer types in the cohort were breast (N = 37, 23.0%), chronic lymphocytic leukemia (N = 18, 11.2%), colorectal (N = 13, 8.1%), myelodysplastic syndrome (N = 12, 7.5%), and non-small cell lung cancer (N = 11, 6.8%). In terms of SDOH factors, 64 (43.2%) patients reported household incomes < $25,000 and the majority reported household incomes < $50,000 (N = 93, 57.8%). A minority of patients had 4-year college degrees or higher (N = 36, 24.3%); the highest educational attainment was high school graduate for most (N = 70, 47.3%). Household income < $50,000 was associated with financial and food insecurity: patients from lower-income households were more likely to report being worried about being able to pay bills often/always (19.4% vs. 0%, Fisher’s exact p = 0.03) and were more likely to have either worried about running out of food (18.3% vs. 0%, Fisher’s exact p = 0.02) or to have run of out of food (15.1% vs. 0%, Fisher’s exact p = 0.02) in the past 12 months. Conclusions: Among advanced cancer patients in an underserved community, lower household income was associated with both financial and food insecurity. This ongoing observational study will integrate SDOH, genomic characteristics, and clinical outcomes from a diverse cohort of patients seen in community oncology practices.