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OBJECTIVE: Research on assessing clinical communication about sexual health is limited. We compared clinical communication about sexual health across patients’ self-reports and coded dialogue in breast cancer outpatients. METHODS: 134 patients had clinic visits audio-recorded and coded for sexual health communication, and completed self-report questionnaires immediately after the visit. Associations between the self-report and dialogue were assessed using Phi coefficient. Agreements (present/absent) and discrepancies (omissions, commissions) about discussed topics were classified and discrepancies analyzed for themes. RESULTS: Sexual health was discussed in 61 of 134 patient visits (46%). Associations were significant (p

Background Sexual problems are extremely common for women after breast cancer (BC). Aim To determine, in a sample of BC outpatients, how commonly women sought help for sexual concerns, from a health care provider (HCP), from other individuals, or from alternate sources; and to examine whether help-seeking was associated with women's sexual function/activity, self-efficacy for clinical communication about sexual health, or sociodemographic/medical characteristics. Methods BC patients participating in a sexual/menopausal health communication intervention trial completed web-based baseline self-report surveys. One-way analysis of variances compared effects of the level of sexual help-seeking (none; 1 outlet; 2–3 outlets) on sexual function domains. Chi-square or t-tests compared women seeking help with those not seeking help on other study variables. Main Outcome Measures Patient-reported outcome instruments assessed sexual help-seeking (past month), sexual function and activity (PROMIS Sexual Function and Satisfaction Brief Profile Version 2.0), and self-efficacy (confidence) for communicating with their BC clinician about sexual health. Results 144 women (mean age = 56.0 years; 62% partnered; 67% white; 27% black/African American; 4% Hispanic/Latina; 15% stage IV) participated in this study. 49% of women sought help for sexual concerns, most often from intimate partners, family and/or friends (42%), followed by HCPs (24%), or online/print materials (19%); very few women (n = 4; 3%) sought help only from a HCP. Women seeking help were younger and more likely to be partnered and sexually active than those not seeking help. Sexual function was impaired for all domains but was most impaired for sexual interest. Among sexually active women, those seeking help from 2 to 3 sources reported worse sexual function in certain domains (sexual interest, lubrication, vaginal discomfort, vulvar discomfort–labial, satisfaction). Women seeking help from outlets other than HCPs had significantly lower self-efficacy than those who did not. Clinical Implications BC patients with access to a partner and who are sexually active but find sex unsatisfying, uncomfortable, or lack interest may be in particular need of sexual help. Further, women may turn to outlets other than HCPs for sexual help partly because they lack the confidence to do so with a HCP. Sexual health information should be made available to women's partners, family, and friends, so they may effectively discuss such issues if needed. Strengths & Limitations Strengths of the study included examination of a range of sexual function domains and a theoretical construct in relation to BC patients' sexual help-seeking and a medically diverse sample. Limitations include a cross-sectional design. Conclusion Women treated for BC should receive accurate and timely sexual health information.

We assessed breast cancer clinicians' perspectives on how the COVID-19 pandemic and increased use of telehealth affected their clinical communication about sexual heath.Breast cancer clinicians participating in a sexual health communication intervention study (N = 29; 76% female; 66% oncologists; 34% advanced practice clinicians) completed an online survey. Data analysis consisted of descriptive statistics and thematic analysis.All clinicians were using telehealth, with most (66%) using it for up to half of their clinic appointments. Although only 14% of clinicians reported having shorter clinic visits, 28% reported having less time to discuss sexual health; 69% reported no change; and 3% said they had more time. Forty-one percent reported sexual health was less of a priority; 55% reported no change; and 3% said it was more of a priority. Thirty-five percent reported telehealth was less conducive to discussing sexual health; 59% reported no change; and 7% reported more conducive. Qualitative analysis revealed key issues underlying the perceived impact of the pandemic on discussions of sexual health including heightened clinician discomfort discussing such issues via telehealth, the less personal nature and privacy issues in telehealth visits, increased concerns about risk of COVID-19 infection and other health concerns (e.g., missing recurrence, mental health) taking priority, and clinician-perceived patient factors (e.g., discomfort, decreased priority) in discussing sexual concerns.Pandemic-related changes in breast cancer clinicians' practice could be exacerbating challenges to discussing sexual health. Methods for integrating sexual health into cancer care are needed, regardless of the mode of delivery.

Background Black men are more likely to die of prostate cancer (PCa) compared with white men. Factors ranging from genetics to neighborhood environment contribute to these disparities. However, unlike genetics, agnostic investigations that identify candidate variables from large-scale data, and that allow for empiric investigations into differential associations between neighborhood and PCa by race/ethnicity, to the authors' knowledge have not been well explored. Thus, herein, the authors built on their previously developed, empiric neighborhood-wide association study (NWAS) in white men and conducted a NWAS in black men to determine whether findings differed by race. Methods Pennsylvania Cancer Registry data were linked to US Census data. For the NWAS in non-Hispanic black men, the authors evaluated the association between 14,663 neighborhood census variables and advanced PCa (11 high-stage and/or high-grade cases and 8632 low-stage and/or low-grade cases), adjusting for age, diagnosis year, spatial correlation, and multiple testing. Odds ratios and 95% credible intervals were reported. Replication of NWAS findings across black and white races was assessed using Bayesian mixed effects models. Results Five variables related to housing (3 variables), education (1 variable), and employment and/or transportation (1 variable) were found to be significantly associated with advanced PCa in black men compared with 17 socioeconomic variables (mostly related to poverty and/or income) in white men. The top hit in black men was related to crowding in renter-occupied housing (odds ratio, 1.10; 95% credible interval, 1.001-1.12). Nine of 22 NWAS hits (4 of 5 hits in black men) were replicated across racial/ethnic groups. Conclusions Different neighborhood variables, or "candidates," were identified across race-specific NWASs. These findings and empiric approaches warrant additional study and may inform PCa racial disparities, particularly future gene-environment studies aimed at identifying patients and/or communities at risk of advanced PCa.

Objective Sexual concerns are often unaddressed for breast cancer patients; one reason is inadequate clinician training. We examined the feasibility, acceptability, and potential benefits of a novel intervention, improving Sexual Health and Augmenting Relationships through Education (iSHARE) for breast cancer clinicians. Methods Clinicians received training in communicating about sexual concerns with breast cancer patients. Intervention feasibility and acceptability were measured through enrollment/participation and postintervention program evaluations, respectively. Intervention effects were assessed through (1) clinician self-reported beliefs about sexual health communication, assessed at baseline, post-intervention, and 1- or 6-month follow-up, (2) clinical communication coded from audio recorded, transcribed clinic encounters at preintervention or postintervention, and (3) patient satisfaction with clinical care, reported immediately after the clinic visit. Patients also reported sociodemographic characteristics and level of sexual concerns. Results Seven breast cancer clinicians enrolled (88% participation), completed the intervention, and were audio recorded in clinic encounters with 134 breast cancer outpatients (67 each at preintervention or postintervention). Program evaluations supported intervention acceptability. Effect sizes suggest iSHARE increased clinicians' self-efficacy (d = 0.27) and outcome expectancies for communicating about sexual concerns (d = 0.69) and reduced communication barriers (d = -0.14). Clinicians' sexual health communication behaviors increased from baseline to postintervention, including for raising the topic (28% vs 48%), asking questions (33% vs 45%), and offering information (18% vs 24%). Neither patient satisfaction nor duration of sexual health communication changed (mean duration less than 1 minute at both time points). Conclusions The iSHARE intervention was feasible and well received by clinicians and may change breast cancer clinicians' beliefs and communication behaviors regarding sexual health.

Objectives Breast cancer patients’ sexual health needs are frequently unmet. We examined the prevalence and content of communication about sexual health between breast cancer patients and clinicians. Methods Female breast cancer patients being seen in oncology clinic follow-up had a clinic visit audio recorded and self-reported sexual problems after the visit. Transcripts were coded for sexual health communication; data were analyzed descriptively or using Chi-square tests. Results We recorded 67 patients (81% participation rate) interacting with one of 7 cancer clinicians (5 physicians; 2 advanced practice clinicians). Approximately 1/3 of women (n = 22) reported sexual problems; sexual health communication occurred with 10/22 of those women (45%). Across all 67 patients, 27 (40%) visits contained communication about sexual health. Seventy-percent of sexual health communication was clinician-initiated. When in-depth sexual health discussions occurred, the most common topics discussed were sexual inactivity (6), body image (5), vaginal dryness (4), and safety of sexual activity (2). Conclusion Communication about sexual health was uncommon even for women reporting sexual problems and was largely initiated by clinicians. Practice implications Because women with breast cancer often do not raise sexual concerns during clinic visits, breast cancer clinicians should raise the topic of sexual health for all patients.

Background: Most breast cancer clinicians lack training to counsel patients about sexual concerns. The purpose of this study was to assess the feasibility, acceptability, and preliminary effects of a mobile learning (mLearning) intervention (improving Sexual Health and Augmenting Relationships through Education [iSHARE]) aimed at enhancing breast cancer clinicians’ knowledge of, beliefs about, and comfort with discussing patients’ sexual health concerns. Methods: Clinicians listened to a 2-part educational podcast series offering information on breast cancer–related sexual health concerns and effective communication on the topic, which consisted of interviews with expert guests. Intervention feasibility was assessed through rates of enrollment, retention, and intervention completion, with benchmarks of 40%, 70%, and 60%, respectively. Acceptability was assessed through program evaluations, with 75% of clinicians rating the intervention favorably (eg, relevance, satisfaction) signifying acceptability. Clinicians self-reported their knowledge about breast cancer–related sexual health concerns, beliefs (ie, self-efficacy for discussing sexual health concerns), and comfort with discussing sexual concerns measured at preintervention and postintervention. Qualitative analysis examined clinicians’ perceptions of lessons learned from the intervention. Results: A total of 32 breast cancer clinicians enrolled (46% of those invited; 97% of those who responded and screened eligible), 30 (94%) completed both the intervention and study surveys, and 80% rated the intervention favorably, demonstrating feasibility and acceptability. Results showed positive trends for improvement in clinician knowledge, beliefs, and comfort with discussing sexual health concerns. Clinicians reported key lessons learned, including taking a proactive approach to discussing sexual health concerns, normalizing the topic, addressing vaginal health, sending the message that help is available, and assessing sexual health concerns with patients from different backgrounds. Conclusions: Breast cancer clinicians were amenable to participating in the iSHARE intervention and found it useful. iSHARE showed promise for improving clinician’s knowledge and comfort discussing patients’ sexual health concerns. A larger trial is required to demonstrate efficacy. Future studies should also examine whether iSHARE can improve patient–clinician communication and address patients’ sexual concerns.

Despite the effectiveness of screenings in reducing colorectal cancer (CRC) mortality, ~25% of US adults do not adhere to screening guidelines. Prior studies associate socioeconomic status (SES) with low screening adherence and suggest that neighborhood deprivation can influence CRC outcomes. We comprehensively investigated the effect of neighborhood SES circumstances (nSES), individual SES, and race/ethnicity on adherence to CRC screening in a multiethnic cross-sectional study. Participant surveys assessing 32 individual-level socioeconomic and healthcare access measures were administered from 2017 to 2018. Participant data were joined with nine nSES measures from the US Census at the census tract level. Univariate, LASSO, and multivariable mixed-effect logistic regression models were used for variable reduction and evaluation of associations. The total study population included 526 participants aged 50–85, 29% of participants were non-adherent. In the final multivariable model, age (p = 0.02) and Non-Hispanic Black race (p = 0.02) were associated with higher odds of adherence. Factors associated with lower adherence were home rental (vs. ownership) (p = 0.003), perception of low healthcare quality (p = 0.006), no routine checkup within two years (p = 0.002), perceived discrimination (p = 0.02), and nSES deprivation (p = 0.02). After comprehensive variable methods were applied, socioeconomic indicators at the neighborhood and individual level were found to contribute to low CRC screening adherence.

Objective Many women with breast cancer hesitate to raise sexual concerns clinically. We evaluated a multimedia intervention to facilitate BC patients' communication about sexual/menopausal health, called Starting the Conversation (STC). Methods Female BC patients (N=144) were randomly assigned to either STC [20-minute video, workbook, and resource guide] or control [resource guide only]. Audio-recorded dialogue from patients' next oncology clinic encounter was coded for patients' sexual health communication. Self-report surveys assessed patients' beliefs about sexual health communication, self-efficacy for clinical interactions, sexual function/activity, anxiety/depression symptoms, and quality of life at baseline, post-intervention, and 2-month follow-up. T-tests or mixed-effects logistic regression compared study arms. Results Women in the STC arm were more likely to raise the topic of sexual health [51%; OR=2.62(1.02, 6.69), p=.04] and ask a sexual health question [40%; OR=2.85(1.27, 6.38), p=.01] during their clinic encounter than those in the control arm (30% and 19% for raise and ask, respectively). At follow-up, women in the STC arm showed greater improvements in sexual health communication self-efficacy (p=.009) and in anxiety symptoms (p=.03), and more women were sexually active at follow-up, compared to the control arm (OR=1.5, 70% vs. 46%, p=.04). Conclusions The STC intervention facilitated women's clinical communication about sexual health and reduced women's anxiety, possibly due to increased confidence in expressing their medical needs. Helpful information gained from clinical discussions could have improved women's willingness or ability to engage in sexual activity. Future studies should identify aspects of the clinical encounter most critical to improving women's sexual outcomes. This article is protected by copyright. All rights reserved.

BACKGROUND: Pancreatic adenocarcinoma (PCA) incidence is higher in Black compared to White patients. Beyond race, neighborhood socioeconomic status (nSES) may also inform disparities. However, these effects on metastatic pancreatic adenocarcinoma (mPCA) are not well-studied. The aim of this study was to explore whether nSES influences survival in patients with mPCA. METHODS: nSES measures were derived from U.S. census data at the census tract (CT) level. We correlated medical records of mPCA patients (diagnosed 2010-2016; n=370) to nSES measures retrospectively via a geocode derived from patient address. Multivariable cox proportional hazards models were used to identify patient-level (age, sex, race, marital status, treatment (radiation/chemo/surgery), PCA family history, stage, Jewish ancestry, tobacco use, BMI, diabetes, and statin use) and nSES measures (deprivation, racial concentration, stability, transportation access, immigration) associated with mPCA survival; P values

The purpose was to test the feasibility, acceptability, and preliminary efficacy of a 4-session couple-based Intimacy Enhancement (IE) intervention addressing breast cancer survivors' sexual concerns delivered via telephone. Twenty-nine post-treatment breast cancer survivors reporting sexual concerns and their intimate partners were randomized (2:1) to the IE intervention or to an educational control condition, both of which were delivered by trained psychosocial providers. Feasibility and acceptability were measured through recruitment, retention, session completion, and post-intervention program evaluations. Couples completed validated sexual, relationship, and psychosocial outcome measures at pre- and post-intervention. Between-group effect sizes and 95% confidence intervals were calculated using the Hedges g. Data supported intervention feasibility and acceptability. For survivors, the IE intervention had medium to large positive effects on all sexual outcomes and most psychosocial outcomes. Effects were less visible for relationship outcomes and were similar but somewhat smaller for partners. The IE intervention demonstrated feasibility, acceptability, and promise in addressing breast cancer survivors' sexual concerns and enhancing their and their partners' intimate relationships and psychosocial well-being. Implications for Psychosocial Oncology Practice The IE intervention demonstrated feasibility and acceptability, suggesting it could be well-received by breast cancer survivors with sexual concerns and their partners. Effects of the IE intervention on breast cancer survivors' sexual concerns and on their and their partners' intimate relationships and psychosocial well-being could not be attributed to therapist time and attention. Interventions that psychosocial providers can use to address breast cancer survivors' sexual concerns are important to the growing number of breast cancer survivors living for many years after their diagnosis.

Recruitment challenges hinder behavioral intervention research in cancer survivors. The purpose was to examine the reasons for declining and intervention preferences of study-eligible breast cancer survivors declining a trial of a four-session couple-based Intimacy Enhancement intervention (refusers) and explore whether refusers differed from participants on key characteristics. Partnered, post-treatment breast cancer survivors reporting sexual concerns who were eligible for but declined participation in the intervention trial were approached to complete a standardized 5-min telephone survey assessing reasons for declining and support preferences. Demographic, clinical, and sexual concerns information were collected during screening. Trial participants and refusers were compared on key variables of age, race, hormone therapy use, time since treatment, level of sexual concerns, and recruitment method using t-tests or chi-square tests. Among the 31 women who declined the trial and completed the survey, the most common reasons for declining were time commitment (74%) and partner noninterest (32%). Most (61%) reported that the telephone format played little to no role in their refusal. Eighty-one percent wanted their partners involved in a program addressing sexual concerns. The two most preferred resources were informational websites (45%) and meeting with a professional (26%). Trial participants and refusers did not differ on any key factors examined. Developing intimacy interventions that are very brief, partner-optional, or that use stepped care may bolster uptake. The methods used to examine study-eligible candidates’ needs and preferences could be employed in other health populations, thus having broader implications for research design.

Background Sexual concerns are distressing for breast cancer survivors and interfere with their intimate relationships. This study evaluates the efficacy of a four-session couple-based intervention delivered via telephone, called Intimacy Enhancement (IE). The IE intervention is grounded in social cognitive theory and integrates evidence-based techniques from cognitive behavioral couple therapy and sex therapy to address survivors’ sexual concerns and enhance their and their partners’ sexual, relationship, and psychological outcomes. Methods This trial is designed to evaluate the efficacy of the IE intervention in improving survivors’ sexual function, the primary study outcome. Secondary outcomes include survivors’ sexual distress, partners’ sexual function, and survivors’ and partners’ relationship intimacy and quality as well as psychological distress (depressive symptoms and anxiety symptoms). Additional aims are to examine whether treatment effects on patient sexual function are mediated by sexual communication and self-efficacy for coping with sexual concerns and to explore whether survivor age and race/ethnicity moderate intervention effects on survivors’ sexual function. Eligible adult female breast cancer survivors reporting sexual concerns and their intimate partners are recruited from two academic sites in the USA and are randomized to either the IE intervention or to a control condition of equal length offering education and support around breast cancer-related health topics (Living Healthy Together). The target sample size is 120 couples. Self-report outcome measures are administered to participants in both conditions at baseline (T1), post-treatment (T2), 3 months post-treatment (T3), and 6 months post-treatment (T4). Discussion Evidence-based interventions are needed to address sexual concerns for breast cancer survivors and to enhance their and their intimate partners’ sexual, relationship, and psychological well-being. This randomized controlled trial will allow us to examine the efficacy of a novel couple-based intervention delivered via telephone for breast cancer survivors experiencing sexual concerns and their intimate partners, in comparison with an attention control. Findings of this study could influence clinical care for women with breast cancer and inform theory guiding cancer-related sexual rehabilitation. Trial registration ClinicalTrials.gov, NCT03930797. Registered on 24 April 2019.

Background The decision to undergo breast reconstruction (BR) surgery after mastectomy is made during stressful circumstances. Many women do not feel well prepared to make this decision. Objective Using the Ottawa Decision Support Framework, this study aims to describe women's reasons to choose or not choose BR, BR knowledge, decisional preparedness, and decisional conflict about BR. Possible demographic, medical, BR knowledge, and attitudinal correlates of decisional conflict about BR were also evaluated. Methods Participants were 55 women with early-stage breast cancer drawn from the baseline data of a pilot randomized trial evaluating the efficacy of a BR decision support aid for breast cancer patients considering BR. Results The most highly ranked reasons to choose BR were the desire for breasts to be equal in size, the desire to wake up from surgery with a breast in place, and perceived bother of a scar with no breast. The most highly ranked reasons not to choose BR were related to the surgical risks and complications. Regression analyses indicated that decisional conflict was associated with higher number of reasons not to choose BR and lower levels of decisional preparedness. Conclusions The results suggest that breast cancer patients considering BR may benefit from decisional support. Implications for clinical practice Healthcare professionals may facilitate decision making by focusing on reasons for each patient's uncertainty and unaddressed concerns. All patients, even those who have consulted with a plastic surgeon and remain uncertain about their decision, may benefit from decision support from a health professional.

Objectives Liver cancer (LC) continues to rise, partially due to limited resources for prevention. To test the precision public health (PPH) hypothesis that fewer areas in need of LC prevention could be identified by combining existing surveillance data, we compared the sensitivity/specificity of standard recommendations to target geographic areas using U.S. Census demographic data only (percent (%) Hispanic, Black, and those born 1950–1959) to an alternative approach that couples additional geospatial data, including neighborhood socioeconomic status (nSES), with LC disease statistics. Methods Pennsylvania Cancer Registry data from 2007-2014 were linked to 2010 U.S. Census data at the Census tract (CT) level. CTs in the top 80th percentile for 3 standard demographic variables, %Hispanic, %Black, %born 1950–1959, were identified. Spatial scan statistics (SatScan) identified CTs with significantly elevated incident LC rates (p-value, Highlights • Precision Public Health calls for linking surveillance data to identify fewer neighborhoods for intervention. • Sensitivity/specificity methods can measure the utility of Precision Public Health by identifying optimal data combinations. • Select combinations of linked Census and liver cancer registry data reduced neighborhood targets more than Census data alone. • Precision Public Health improves the prioritization of liver cancer prevention efforts.

Many neighborhood socioeconomic index measures (nSES) that capture neighborhood deprivation exist but the impact of measure selection on liver cancer (LC) geographic disparities remains unclear. We introduce a Bayesian geoadditive modeling approach to identify clusters in Pennsylvania (PA) with higher than expected LC incidence rates, adjusted for individual-level factors (age, sex, race, diagnosis year) and compared them to models with 7 different nSES index measures to elucidate the impact of nSES and measure selection on LC geospatial variation. LC cases diagnosed from 2007&ndash, 2014 were obtained from the PA Cancer Registry and linked to nSES measures from U.S. census at the Census Tract (CT) level. Relative Risks (RR) were estimated for each CT, adjusted for individual-level factors (baseline model). Each nSES measure was added to the baseline model and changes in model fit, geographic disparity and state-wide RR ranges were compared. All 7 nSES measures were strongly associated with high risk clusters. Tract-level RR ranges and geographic disparity from the baseline model were attenuated after adjustment for nSES measures. Depending on the nSES measure selected, up to 60% of the LC burden could be explained, suggesting methodologic evaluations of multiple nSES measures may be warranted in future studies to inform LC prevention efforts.

IntroductionNeighborhood socioeconomic (nSES) factors have been implicated in prostate cancer (PCa) disparities. In line with the Precision Medicine Initiative that suggests clinical and socioenvironmental factors can impact PCa outcomes, we determined whether nSES variables are associated with time to PCa diagnosis and could inform PCa clinical risk assessment.Materials and methodsThe study sample included 358 high risk men (PCa family history and/or Black race), aged 35-69 years, enrolled in an early detection program. Patient variables were linked to 78 nSES variables (employment, income, etc.) from previous literature via geocoding. Patient-level models, including baseline age, prostate specific antigen (PSA), digital rectal exam, as well as combined models (patient plus nSES variables) by race/PCa family history subgroups were built after variable reduction methods using Cox regression and LASSO machine-learning. Model fit of patient and combined models (AIC) were compared; p-valuesResultsIn combined models, nSES variables were significantly associated with time to PCa diagnosis. Workers mode of transportation and low income were significant in White men with a PCa family history. Homeownership (%owner-occupied houses with >3 bedrooms) and unemployment were significant in Black men with and without a PCa family history, respectively. The 5-year predicted probability of PCa was higher in men with a high neighborhood score (weighted combination of significant nSES variables) compared to a low score (e.g., Baseline PSA level of 4ng/mL for men with PCa family history: White-26.7% vs 7.7%; Black-56.2% vs 29.7%).DiscussionUtilizing neighborhood data during patient risk assessment may be useful for high risk men affected by disparities. However, future studies with larger samples and validation/replication steps are needed.

Background: Liver cancer rates are rising, particularly in minority populations. Risk factors for liver cancer, such as alcohol/drug use, metabolic disorders, and viral hepatitis B/C (HBV/HCV), are generally modifiable through lifestyle interventions, vaccinations, and treatments. However, resources are often limited and strategies to prioritize geographic areas most in need of cancer prevention are needed. Recommendations exist to focus prevention efforts on groups with the highest rates of liver cancer, namely Hispanics, Blacks, and individuals born 1950-1959 who are at high risk for HCV. We compare the sensitivity/specificity of this approach to a dual approach that couples liver cancer disease cluster statistics with neighborhood-level demographic data to inform liver cancer prevention. Methods: Pennsylvania (PA) Liver Cancer Registry data from 2007-2014 were linked to the 2010 U.S. Census data via a geocode at the census tract level with ArcGIS software. Using the space-time scan statistic in SaTScan and relative risk estimates from BayesX, we also identified high-risk clusters or geographic areas with significantly elevated rates of incident liver cancer, adjusted for age, gender, and diagnosis year. Analyses were conducted using elliptical spatial windows and Poisson models. Census tracts in the top 80th percentile for percentage of Hispanics, Blacks or those born between 1950-1959 were also identified. The sensitivity, specificity, and positive predictive value (PPV) of a census tract being located in a high-risk cluster and/or testing positive or negative for at least one of three neighborhood variables (higher % Black, % Hispanic, 1950-1959 birth cohort) were calculated. Results: There were 9,460 cases of liver cancer diagnosed in PA. Five high-risk clusters were identified (relative risks ranged from 1.83-3.73, all p Conclusions: Coupling disease cluster statistics with neighborhood demographic data refines the identification of areas that carry a greater than expected burden of liver cancer and reduces intervention targets more than neighborhood demographics alone. However, additional analyses are needed to improve the sensitivity/specificity of this combined geospatial approach. Consideration of other patient and neighborhood level socioeconomic data is also being explored and will be presented to further inform the prioritization of liver cancer prevention efforts. This abstract is also being presented as Poster C014. Citation Format: Shannon M. Lynch, Daniel Wiese, Kristen Sorice, Minhhuyen Nguyen, Evelyn Gonzalez, Kevin Henry. Geospatial analytics and sensitivity/specificity assessments to inform liver cancer prevention [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 PR13.

e24179 Background: Many women with breast cancer (BC) lack the confidence to discuss sexual health with their clinicians. We evaluated, in a randomized controlled trial, a brief multimedia intervention designed to facilitate BC patients’ communication about sexual health. Methods: We randomly assigned BC patients to either a multimedia sexual/menopausal health communication skills intervention [ Starting the Conversation (STC), including a video, workbook, and pamphlet with local and web-based resources] or a control [resource guide only]. About 1-2 weeks after patients received materials, we audio recorded a clinic encounter with their BC provider, and subsequently coded the dialogue for patients raising the topic of sexual health or asking > 1 sexual health question. Self-report surveys administered at baseline, post-intervention, and 2-month follow-up assessed patients’ self-efficacy for discussing sexual health with their BC providers, sexual function, anxiety and depression, and quality of life. T-tests or mixed-effects logistic regression compared study arms; analyses of communication outcomes (patient raising the topic or asking a question during clinic encounter) were clustered by providers. Results: Study participants were 144 BC outpatients (82% acceptance rate; mean age = 56; 67% white; 15% metastatic; 31% active treatment). Women in the STC arm versus the control arm were more likely to raise the topic of sexual health [OR = 2.48 (1.11, 5.55), p= .03] and more likely to ask a sexual health question [OR = 2.93 (1.04, 8.26), p= .04]. Specifically, 51% of women in the STC arm raised the topic of sexual health versus 30% in the control arm and 40% of women in the STC arm asked a sexual health question versus 19% in the control arm. At 2-month follow-up, women in the STC arm showed greater improvements in self-efficacy ( p= .03) and anxiety, t(139) = 2.0, p= .04) compared to the control arm. Conclusions: STC, a brief multimedia intervention, was effective in facilitating BC patients’ communication about sexual health during routine clinic encounters and significantly reduced patients’ anxiety, possibly due to greater patient confidence in expressing their medical needs. Future studies should use longer-term follow-up and examine how sexual health communication can translate to improved patient sexual outcomes. Clinical trial information: NCT03624972 .

The goal of this study was to examine colorectal cancer (CRC) screening practices and factors associated with CRC screening among foreign-born South Asians living in the metropolitan New York-New Jersey area. Two hundred and eight men and women recruited from community settings in the New York and New Jersey metropolitan area completed a questionnaire that included demographics, CRC screening practices, health care access and practices, attitudes about the health care system, primary care physician support for CRC screening, cultural factors, and attitudes about CRC screening and CRC worry. Almost a third of the sample had not heard of any of CRC screening tests. Approximately 62 % of the sample had never had a CRC screening test and approximately 69 % of the sample was not currently on schedule with regard to CRC screening. When the relative contribution of significant correlates were evaluated, participants who had lived in the US for a longer time, who endorsed more CRC screening benefits, and who endorsed fewer CRC screening barriers were significantly more likely to have had CRC screening in the past. Participants who were more likely to use English in their daily life, who endorsed more CRC screening benefits, and endorsed fewer CRC screening barriers were more likely to be on schedule with regard to CRC screening. In conclusion, awareness of CRC screening and uptake of screening was low in this population of foreign-born South Asians. Interventions to promote CRC screening may benefit from targeting this subgroup of Asian Americans.

672 Background: PC affects 57,000 people in the U.S. annually with poor long-term outcomes. NAT for localized disease has increasingly been used but lacks robust prospective data. We investigated the disease course and outcomes for patients (pts) undergoing NAT versus upfront surgery for PC at a high-volume academic center. Methods: Utilizing our IRB-approved retrospective database of metastatic PC pts (year 2000-2017), we identified pts who presented with localized disease and were considered for surgery and present the baseline tumor and treatment characteristics here. Fisher’s exact and Wilcoxon Rank-Sum tests were used for categorical data and Kaplan Meier (KM) curves for survival data when comparing those who had upfront surgery versus surgery following NAT. Results: 352 pts with localized disease at diagnosis were included in our analysis with median age of 65 y (range 38-89) and 45% females. NAT was used in 225 (64%) pts while 109 pts (31%) had upfront surgery and 18 pts (5%) received no treatment. Adjuvant therapy was given to 77% of pts after upfront surgery and 48% of pts after surgery following NAT. NAT regimen consisted of chemotherapy (CTx) and radiation for 48%, CTx alone for 8% and radiotherapy alone for 44% of pts. Of those receiving CTx, 24% received triple agent while 51% and 25% received dual and single agent therapy. Pt factors (age, CCI, gender, BMI, smoking status, race) did not differ between those receiving upfront surgery and surgery following NAT but upfront surgery was associated with a lower stage at diagnosis (p < 0.0001). Surgical resection after NAT occurred in 79 pts (35%) with median overall survival of 26.3m vs 19.7m (p = 0.06) in those who had upfront surgery. Survival rates at year 1, 3, and 5 years were 94%, 34%, and 8% for those with NAT followed by surgery vs 76%, 17%, and 11% for those with upfront surgery (p = 0.06). Conclusions: Use of NAT is prevalent, yet only 35% of pts make it to surgical resection. Survival was improved for pts who underwent resection following NAT versus upfront, although the difference was not statistically significant. Additional research is warranted to define the optimal NAT approach for pts with borderline resectable PC.

Cancer survivors’ needs around sexual concerns are often unmet. The primary objective of this systematic review was to examine the prevalence of and factors associated with patient-provider communication about sexual concerns in cancer. Using PRISMA guidelines, we searched PubMed/MEDLINE, PsychInfo, and CINAHL databases for peer-reviewed quantitative research papers (2000–2015) in cancer samples. Search terms across three linked categories were used (sexuality, communication, and cancer). The National Comprehensive Cancer Network (NCCN) Sexual Function Guidelines were used as a framework to categorize communication reported in each study. Twenty-nine studies from 10 countries (29 % in USA) were included. Studies assessed patients only (21), providers only (4), and both (4). Communication measures differed across studies and many lacked validity data. When reported by patients or providers, the average prevalence of discussing potential treatment effects on sexual function was 50 (60 % for men and 28 % for women) and 88 %, respectively. As reported by patients or providers, respectively, assessing patients’ sexual concerns (10 and 21 %) and offering treatments (22 and 17 %) were measured in fewer studies and were reported less frequently. Both patients and providers (28 and 32 %, respectively) reported a low prevalence of other non-specific communication. Greater prevalence of communication was associated with male patient gender and more years of provider experience. Sexual issues go unaddressed for many cancer survivors, particularly women. Both patient and provider interventions are needed. Enhancing patient-provider communication about sexual concerns through evidence-based interventions could improve patient sexual function and quality of life.

232 Background: The incidence of VTE is relatively high among mPC pts, upto 57%. It is associated with higher health care burden and mortality. We evaluated the mPC pts treated at a single academic center from 2010-16 for prevalence of VTE, its impact on survival and possible risk factors. Methods: Medical charts of mPC pts treated at a single academic center were analyzed retrospectively for VTE diagnosis, overall survival and potential risk factors for VTE development. The factors considered were: age, sex, stage, body mass index, smoking status, surgery, performance status (PS), Charlson comorbidity index (CCI) and treatment. Logistic regression was used to identify the factors correlating with VTE and Cox Proportional Hazard model was used to evaluate overall survival (OS) differences between those with VTE (Gp A) and those without VTE (Gp B). Results: Out of the 439 mPC pts (52% males, 86% with PS0-1, 63% with stage IV at diagnosis), 127 (29%) were in Gp A and 312 (71%) in Gp B. The groups were well balanced with respect to all factors except age (median age 67 Gp A; 65 in Gp B, p = 0.04). 2.3 % of pts in Gp A and 4.8 % pts in Gp B were on anticoagulation for reason other than VTE treatment. Within Gp A, 55% developed VTE after diagnosis of metastasis. A clear separation of the survival curves noted beyond the median OS (9 m, P = 0.02), favoring GpB. Statistically significant factors associated with risk of VTE included advanced stage at diagnosis (P = 0.004) and worse PS (P = 0.005). Treatment regimen used and CCI didn’t correlate with the risk of development of VTE. Conclusions: The incidence rate of VTE in our patients is lower than published literature, yet the diagnosis of VTE was associated with worse OS. Most cases occurred after the diagnosis of metastatic disease. The higher use of anticoagulants for other medical causes may be contributing to a lower incidence of VTE in mPC. These findings need prospective Validation.

208 Background: Incidence rates of pancreatic adenocarcinoma (PAC) are higher in Black compared to White patients (pts). Beyond race, exposure to poor neighborhoods or social environments also contribute to cancer disparities. However, social environmental effects on PAC are not well-studied. Social environment is defined as: 1) a neighborhood’s socioeconomic conditions (SES; i.e. a combination of education, income, poverty and employment levels); 2) racial segregation (RS) or the degree of isolation/separation of race/ethnic groups in a neighborhood. The goal of our study is to investigate whether poor social environments impact survival in a clinic population with metastatic PAC. Methods: Neighborhood SES and RS measures were derived from US census data (2011-2015) at the census tract level, which is a smaller geographic area than a county. Patient (pt) addresses were used to generate a geocode that identifies the census tract or neighborhood in which a pt lives. We joined medical records of PAC pts (n = 374; diagnosed 2010-2016 at Fox Chase Cancer Center) to neighborhood measures via the geocode. Pt variables included in the analysis were: age, sex, race, marital status, treatment, PAC family history, stage, Jewish ancestry, tobacco use and Charlson comorbidity index. Multivariable cox proportional hazards models with cluster adjustments were used and variables with p-values < 0.05 were considered significant. Results: 342 PAC deaths occurred and median survival was 12m. 81% of pts were White; < 40% resided in poor social environments (i.e. low SES or high RS). In multivariable analyses stratified by RS, median survival was lower in pts from high RS (11m) vs low RS areas (13m); however, this difference was not significant (p = 0.27). Variable effects differed by high/low RS. In high RS areas, sex, surgery, chemo, diabetes and neighborhood SES were significant predictors of survival; in low RS areas, surgery, chemo, radiation, PAC family history, tobacco use, Jewish ancestry and race were significant. Conclusions: While social environment did not appear to significantly affect survival time in metastatic pts, its potential moderating (interaction) effects on variable associations with PAC warrant further investigation.