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BACKGROUND: Federally Qualified Health Centers (FQHCs) serve minority and low-socioeconomic populations and provide care to high-risk smokers. These centers frequently experience barriers, including low provider and medical assistant (MA) knowledge around lung cancer screening (LCS). Subsequent low LCS referral rates by providers at FQHCs limit utilization of LCS in eligible, high-risk, underserved patients. METHODS: Providers and MAs from two FQHCs participated in a LCS educational session. A pre-educational survey was administered at the start of the session and a post-educational survey at the end. The intervention included a presentation with education around non-small cell lung cancer, LCS, tobacco cessation, and shared-decision making. Both surveys were used to evaluate changes in provider and MA ability to determine eligible patients for LCS. The Pearson’s Chi-squared test with Yates’ continuity correction was used to measure the impact. RESULTS: 29 providers and 28 MAs enrolled in the study from two FQHCs. There was an improvement, P

Purpose It remains unclear why individuals living in disadvantaged neighborhoods have shorter non-small cell lung cancer (NSCLC) survival. It is possible that living in these deprived areas is linked with increased risk of developing aggressive NSCLC biology. Here, we explored the association of somatic KRAS mutations, which are associated with shorter survival in NSCLC patients, and 11 definitions of neighborhood disadvantage spanning socioeconomic and structural environmental elements. Methods We analyzed data from 429 NSCLC patients treated at a Comprehensive Cancer Center from 2015 to 2018. Data were abstracted from medical records and each patient’s home address was used to assign publicly available indices of neighborhood disadvantage. Prevalence Ratios (PRs) for the presence of somatic KRAS mutations were estimated using modified Poisson regression models adjusted for age, sex, smoking status, race/ethnicity, educational attainment, cancer stage, and histology. Results In the NSCLC cohort, 29% had KRAS mutation-positive tumors. We found that five deprivation indices of socioeconomic disadvantage were associated with KRAS mutation. A one decile increase in several of these socioeconomic disadvantage indices was associated with a 1.06 to 1.14 increased risk of KRAS mutation. Measures of built structural environment were not associated with KRAS mutation status. Conclusion Socioeconomic disadvantage at the neighborhood level is associated with higher risk of KRAS mutation while disadvantage related to built environmental structural measures was inversely associated. Our results indicate not only that neighborhood disadvantage may contribute to aggressive NSCLC biology, but the pathways linking biology to disadvantage are likely operating through socioeconomic-related stress.

BACKGROUND: Compared to women of other races who have never smoked, Black women have a higher risk of lung cancer. Whether neighborhood disadvantage, which Black women experience at higher rates than other women, is linked to never-smoking lung cancer risk remains unclear. This study investigates the association of neighborhood disadvantage and lung cancer risk in Black never-smoking women. METHODS AND MATERIALS: This research utilized data from the Black Women’s Health Study, a prospective cohort of 59,000 Black women recruited from across the US in 1995 and followed by biennial questionnaires. Associations of lung cancer incidence with neighborhood-level factors (including two composite variables derived from Census Bureau data: neighborhood socioeconomic status and neighborhood concentrated disadvantage), secondhand smoke exposure, and PM(2.5) were estimated using Fine-Gray subdistribution hazard models. RESULTS: Among 37,650 never-smokers, 77 were diagnosed with lung cancer during follow-up from 1995 to 2018. The adjusted subdistribution hazard ratio (sHR) of lung cancer incidence with ten unit increase in neighborhood concentrated disadvantage index was 1.30 (95 % CI: 1.04, 1.63, p = 0.023). Exposure to secondhand smoke at work was associated with increased risk (sHR = 1.93, 95 % CI: 1.21, 3.10, p = 0.006), but exposure to secondhand smoke at home and PM(2.5) was not. CONCLUSION: Worse neighborhood concentrated disadvantage was associated with increased lung cancer risk in Black women who never smoked. These findings suggest that non-tobacco-related factors in disadvantaged neighborhoods may be linked to lung cancer risk in Black women and that these factors must be understood and targeted to achieve health equity.

PURPOSE/OBJECTIVE(S) Cancer patients are increasingly incorporating medical marijuana into the management of treatment-related side effects. Currently however, data is limited regarding the risks and benefits of therapeutic cannabis for cancer patients. We sought to characterize radiation oncologists' practices and opinions regarding therapeutic cannabis via a nationwide survey. MATERIALS/METHODS An anonymous survey was distributed via email to 873 radiation oncologists in the American Society for Radiation Oncology member database. Radiation oncologists were asked their opinions and practices regarding the use of therapeutic cannabis for their patients. Bivariate analyses of potential predictors for responses were conducted using standard statistical techniques. RESULTS 107 radiation oncologists completed the survey. Thirty-nine percent of physicians reported having completed paperwork for medical marijuana in the past year. Seventy-one percent of respondents reported therapeutic cannabis as being effective for managing treatment-related toxicities, however only 36% reported that they would recommend it to their patients. Practicing in a state where medical marijuana is legal, and practicing for less than 5 years, were associated with being more likely to recommend therapeutic cannabis (OR = 3.79, P = 0.01 and OR = 2.68, P = 0.04, respectively). Physicians working in private practice were more likely to report a benefit of therapeutic cannabis for treatment-related toxicities than academic physicians (OR = 2.82, P = 0.02). Eighty-one percent of radiation oncologists reported that therapeutic cannabis is beneficial for patients receiving end-of-life care. Fifty-eight percent of physicians reported lacking sufficient knowledge to advise patients regarding therapeutic cannabis, and 86% of respondents were interested in learning more about therapeutic cannabis for cancer patients. CONCLUSION Although a majority of radiation oncologists believe there are benefits to therapeutic cannabis, many are hesitant to recommend for or against its use. Most radiation oncologists agree that therapeutic cannabis should play a role in supportive care for patients receiving end-of-life care. Radiation oncologists appear to be interested in learning more about how therapeutic cannabis may play a role in their patients' care.

Background: It remains unclear why African Americans (AA) have higher incidence of non-small cell lung cancer (NSCLC) and develop the disease 5 years earlier than Non-Hispanic Whites (NHW). Studies suggest that residential segregation drives NSCLC mortality disparities; however, there has been little investigation into whether residential segregation is also linked to the increased incidence of NSCLC risk among AAs. The lack of clarity regarding this link limits our understanding of possible societal determinants (SDH) related etiologies of the deadly disease. We aimed to evaluate the relationship between the isolation index – a well-known racial residential segregation metric that measures the level of exposure an average member of a specific demographic has with its own demographic – and NSCLC risk among AAs. We hypothesize that residential segregation will be associated with NSCLC risk in AAs but not in NHWs. Methods: We analyzed data from the Southern Community Cohort Study (SCCS), a large, prospective observational cohort study that recruited over 80,000 participants in the southeastern US from 2002-2009. The primary outcome is the NSCLC incidence. The SCCS is linked with cancer registries across the 12-state geographic catchment area, enabling the identification of NSCLC incidence. The isolation index was calculated using 2010 census tract data and ranges from 0 to 1, with a higher score representing higher isolation. The subdistribution hazard of NSCLC risk with the isolation index was estimated using Fine-Gray subdistribution hazard models, adjusted by demographic factors, smoking status and secondhand smoke exposure – all obtained from participant self-report surveys. Results: Of the 53,820 AA participants (mean age 50, 59% female, 37% never smokers), 1272 (2.4%) were diagnosed with NSCLC since enrollment. Of the 24,778 NHW participants (mean age 53, 61% female, 34% never smokers), 742 (3.0%) were diagnosed with NSCLC. Mean isolation index for AA = 0.71 (SD = 0.26), NHW= 0.25 (SD = 0.25). We found a significant association between residential segregation, as measured by the isolation index, and time to NSCLC in AAs. The adjusted subdistribution Hazard Ratio (sHR) of NSCLC risk for AAs with a 0.1 increase in isolation index was 1.03 (95% CI: 1.01, 1.05, p = 0.01). We did not detect a significant association in NHWs (p=0.88). The interaction between race and isolation index was not significant which may be due to lack of power. Conclusion: Our study is one of the first to document a link between racial residential segregation and NSCLC risk in AAs. This finding suggests that residential segregation, instituted and implemented by structural racism, embodies an environment that elevates NSCLC risk in AAs. Evaluation of structural racism across domains beyond segregation, in addition to the use of robust spatiotemporal methods, is required to further clarify the link with SDH, including structural racism and NSCLC risk. Such studies are essential to informing policies and interventions to improve population health and cancer prevention. Citation Format: Xiaoke Zou, Calvin Tribby, Richard Curley, Melinda Aldrich, Sophia Wang, Kimlin Ashing, Rick Kittles, Lennie Wong, Tarik Benmarhnia, Marta Jankowska, Loretta Erhunmwunsee. Residential segregation contributes to non-small cell lung cancer risk in African Americans in the southeastern US [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 C089.

Social determinants of health (SDH) are understudied in oncology yet significantly impact the quality of life of lung cancer patients and family caregivers (FCGs). Preoperative psychological distress is common for lung cancer patients and their FCGs. The purpose of this study was to determine how SDH factors influence prolonged social and environmental stressors for lung cancer surgery patients and their FCGs. Methods: This cross-sectional study evaluated the impact of SDH on psychological distress of lung cancer surgery patients and their FCGs at a comprehensive cancer center in Southern California. The 21-item Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) survey was used to measure SDH factors related to social and community context, education access and quality, healthcare access and quality, economic stability, and neighborhood and built environment. The Distress Thermometer was used to evaluate the psychological distress of participants prior to surgery (0, no distress to 10, extremely distressed). The established cut-off of 3/10 indicated a need for intervention. A two-sided Fisher's exact test, Wilcoxon rank sum test or Pearson's Chi-squared test was used based on SDH questions and p-value < 0.05 was defined as statistically significant. Results: Overall, 57% of participants (N = 152) reported psychological distress, including 55% of patients (n = 76) and 59% of caregivers (n = 76). Eighty-eight percent of participants were comfortable speaking English, 30% were from racially minoritized groups, 49% reported an annual family income between $50-$124K, and 44% interacted with their social network 5 or more times a week. Overall, 47% of participants reported experiencing some stress prior to surgery, 38% of patients and 55% of FCGs. Participants who were more likely to experience significant psychological distress prior to surgery included individuals who were more stressed (p=0.012), did not speak English (p=0.05), had a lower annual family income (p=0.032), and less interactions with their social network (p=0.028). For patients, the stress of surgery (p=0.033) and decreased communication with their social network (p=0.016) was associated with psychological distress. FCGs who spoke other languages (p=0.022), including Chinese were more likely to experience psychological distress compared to English speakers. Discussion: Lung cancer surgery patients and their FCGs experienced significant psychological distress prior to surgery due to unmet social needs. SDH may impact psychological distress differently for patients and FCGs as the impact of SDH related to social and community context (stress and social network), education access and quality (preferred language) and economic stability (annual family income) differed by group. Preoperative assessment of SDH and psychological distress should be conducted to identify dyads with unmet social needs and inform the provision of personalized interventions to improve dyadic outcomes. Citation Format: Dede K. Teteh, Xiaoke Zou, Betty Ferrell, Loretta Erhunmwunsee, Dan Raz, Rick Kittles, Susanne Montgomery, Jae Kim, Virginia Sun. Social determinants of health factors impact the psychological distress of lung cancer surgery patients and their family caregivers [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 B108.

The novel coronavirus disease of 2019 (COVID-19) disrupted the healthcare delivery landscape with dramatic impacts on cancer patients and family caregivers (FCGs). Many safety measures were implemented to provide services to patients during the pandemic. However, the impact of these measures on the experiences of lung cancer surgery patients, FCGs, and their healthcare team is not well known. Therefore, the purpose of this study was to describe the changes and experiences with surgical care delivery from the patient, FCG, and surgical team perspectives. Methods: This mixed methods study included healthcare professionals, lung cancer surgery patients, and their FCGs from an NCI-designated Comprehensive Cancer Center. Data was collected between September 2020 through February 2021 using the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences survey (patients and FCGs only). Key informant interviews with patients, FCGs, and surgical team were also conducted. Patients/FCGs were recruited from a randomized efficacy trial of a multimedia self-management intervention in lung cancer surgery. Qualitative data was analyzed using the conventional content analysis approach and demographic descriptive statistics for patients/FCGs were determined through baseline surveys from the randomized trial. Results: Our study participants (n=56) were predominantly English speaking (91%), non-Hispanic White (68%), Asian (14%), and Black (7%) lung cancer surgery patients/FCGs. Most participants achieved more than a high school diploma (77%), 33% were employed full-time, and 50% used Medicare. Providers (n=4) included a nurse practitioner and thoracic surgeons. We identified 5 constructs that were associated with cancer care delivery from perioperative to discharge: 1) increased diagnostic testing—COVID-19 test; 2) visitor restrictions increased patients/FCGs mental health distress and decreased provider-FCG shared-decision making; 3) communication barriers decreased for patients/FCGs due to use of telehealth resources (i.e., Hope Virtual, WhatsApp, FaceTime) which increased frequency of provider engagement throughout care continuum; 4) patients/FCGs concerns and lack of education of COVID-19 risk factors impacted postoperative recovery; and 5) COVD-19 “elevated” the use and need for including telemedicine in standard of care practices. Moreover, patients experienced delays in treatment, isolation, lack of social support, financial hardship, and fear of death from COVID-19. FCGs also experienced psychological distress, financial hardship, fear of contracting COVID-19, and a heightened awareness of public health safety measures. Discussion: The COVID-19 pandemic created challenges to the cancer care delivery landscape for the surgical team and impacted the psychological and financial well-being of lung cancer surgery patients and their FCGs. While the long-term effects of the pandemic is unknown, opportunities to improve patient/FCG quality of life outcomes through targeted mental health/financial toxicity interventions is warranted. Citation Format: Dede K. Teteh, Betty Ferrell, Xiaoke Zou, Loretta Erhunmwunsee, Dan Raz, Jae Kim, Virginia Sun. The impact of the COVID-19 pandemic on care delivery and quality of life in lung cancer surgery [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-093.