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1
Mirzaeva, Saglara V. "To the Problem of Tibetan Texts from Tuvan Archives Related to Zaya pandita. Part 1." Бюллетень Калмыцкого научного центра Российской академии наук, no. 4 (December 8, 2024): 24–48. https://doi.org/10.22162/2587-6503-2024-4-32-24-48.
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This study has two parts, the first being presented in the paper. Here we consider five Tibetan-language manuscripts from the collections of the Tuvan Institute of Humanities and Applied Socio-Economic Research under the Government of the Republic of Tuva, in which colophons the name of Zaya-Pandita is mentioned. The first in this succession of reincarnations, including eight embodiments, was the renowned Buddhist scholar and translator Zaya pandita Namkha Jamtso (1599–1662), also known as creator of the Oirat todo bichig script. Research materials discussing Zaya pandita as a historical figure and Buddhist translator focus on his activity in translating from Tibetan into Mongolian and Oirat. However, there is no information on whether he wrote in Tibetan, which makes this study particularly relevant. This paper presents the transliteration and Russian translation of the following texts: “Sadhana of the Glorious Vajrabhairava” and “Sadhana of Hayagriva” (Tib. Dpal rdo rje ‘jigs byed zhes bya ba. Rta mgrin bsgrub thabs zhes bya ba bzhugs so) (inv. no. 811), three copies of the “Ritual of Taking Refuge Vow for Laymen” (Tib. Skyabs ‘gro’i dge bsnyen gyi sdom pa ‘bogs chog bzhugs so) (inv. nos. 1362, 1941, 3243), and “The Method of Offering to the Earth-Lord, the White Old Man” (Tib. Sa bdag rgan po dkar po rten ‘bul tshul zhes byas ba bzhugs so) (inv. no. 1441). It was proposed in the paper that the first Zaya pandita composed texts “Ritual of Taking Refuge Vow for Laymen” and “The Method of Offering to the Earth-Lord, the White Old Man”, while “Sadhana of Hayagriva” can be attributed to the second Zaya pandita, the contemporary of the Dzhungaria ruler Tsewang Rabdan, whose name is mentioned in the colophon of the analyzed manuscript.
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Safa, Farhana, Natalia McClellan, Sarah Bonato, Sergio Rueda, and Kelly K. O’Brien. "The Role of the Social Determinants of Health on Engagement in Physical Activity or Exercise among Adults Living with HIV: A Scoping Review." International Journal of Environmental Research and Public Health 19, no. 20 (2022): 13528. http://dx.doi.org/10.3390/ijerph192013528.
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Physical activity (PA) and exercise are an effective rehabilitation strategy to improve health outcomes among people living with HIV (PLWH). However, engagement in exercise among PLWH can vary. Our aim was to characterize the literature on the role of social determinants of health (SDOH) on engagement in PA or exercise among adults living with HIV. We conducted a scoping review using the Arksey and O’Malley Framework. We searched databases between 1996 and 2021. We included articles that examined PA or exercise among adults with HIV and addressed at least one SDOH from the Public Health Agency of Canada Framework. We extracted data from included articles onto a data extraction charting form, and collated results using content analytical techniques. Of the 11,060 citations, we included 41 articles, with 35 studies involving primary data collection 23 (66%) quantitative, 8 (23%) qualitative, and four (11%) mixed methods. Of the 14,835 participants, 6398 (43%) were women. Gender (n = 24 articles), social support (n = 15), and income and social status (n = 14) were the most commonly reported SDOH in the literature with the majority of studies addressing only one SDOH. Future research should consider the intersection between multiple SDOH to better understand their combined impact on engagement in PA or exercise among PLWH.
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Swamy, Padma, Ana C. Monterrey, Margaret S. Wood, Catherine L. Troisi, and Christopher S. Greeley. "Caregiver and Pediatric Health Care Provider Views on Social Needs Identification." Journal of Primary Care & Community Health 11 (January 2020): 215013272092308. http://dx.doi.org/10.1177/2150132720923085.
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Background: The American Academy of Pediatrics recommends that pediatricians address the social determinants of health (SDOH) through research, community partnership, and policy development. Objective: This study aimed to identify the unmet SDOH of the patients served by the Pasadena-Pediatric and Adolescent Health Center (PA-PAHC) and to understand provider perspectives on screening for SDOH. Methods: The PA-PAHC is a low-income pediatric clinic in southeast Houston. A cross-sectional survey eliciting potential SDOH concerns was administered to caregivers of children presenting for their well-child exam, along with pediatric residents and staff/faculty. Staff/faculty and residents were asked about their perceptions of SDOH screening. Statistical analysis calculated frequencies for categorical data and mean/median for continuous variables. Secondary data analysis consisted of chi-square test and logistic regression. Results: A total of 110 caregivers, 22 residents, and 21 staff/faculty participated in the study. Caregivers listed health care access the most frequently (15.5%), followed by childcare, school, and immigration status as SDOH concerns. Residents (31.8%) and staff/faculty (23.8%) also identified health care access as a concern. When comparing topic selection by survey role, there was no statistically significant difference among the 3 groups ( P = .257). Residents were more likely to indicate that screening was more time-consuming than were faculty/staff ( P = .004). Conclusion: Staff/faculty and residents agree that SDOH affect child health and screening is valuable in the patient encounter. There were no differences in the needs identified by the 3 groups. Further evaluation to assess caregiver perspectives on standardized SDOH screening versus obtaining routine social history needs to be undertaken.
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Shah, Yash B., Zachary N. Goldberg, Erika D. Harness, and David B. Nash. "Charting a Path to the Quintuple Aim: Harnessing AI to Address Social Determinants of Health." International Journal of Environmental Research and Public Health 21, no. 6 (2024): 718. http://dx.doi.org/10.3390/ijerph21060718.
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The Quintuple Aim seeks to improve healthcare by addressing social determinants of health (SDOHs), which are responsible for 70–80% of medical outcomes. SDOH-related concerns have traditionally been addressed through referrals to social workers and community-based organizations (CBOs), but these pathways have had limited success in connecting patients with resources. Given that health inequity is expected to cost the United States nearly USD 300 billion by 2050, new artificial intelligence (AI) technology may aid providers in addressing SDOH. In this commentary, we present our experience with using ChatGPT to obtain SDOH management recommendations for archetypal patients in Philadelphia, PA. ChatGPT identified relevant SDOH resources and provided contact information for local organizations. Future exploration could improve AI prompts and integrate AI into electronic medical records to provide healthcare providers with real-time SDOH recommendations during appointments.
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Pad+ma, rig 'dzin (Wanmarenzeng). "An A mdo Smyung gnas: Yo lag Tibetan Community, Thun rin (Reb gong, Tongren) City, Mtsho sngon (Qinghai) Province, PR China." ASIAN HIGHLANDS PERSPECTIVES 60 (August 19, 2021): 47–73. https://doi.org/10.5281/zenodo.5482239.
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Personal experiences, observations, preparations, daily activities, including recreational events, and interviews with locals, inform this study of a community A mdo Tibetan Smyung gnas held on the fourteenth to sixteenth days of the fourth (Chinese lunisolar calendar) in Yo lag (Zhiyue) Village, Mdo ba (Duowa) Town, Thun rin (Reb gong, Tongren) City, Mtsho sngon (Qinghai) Province, PR China during the mid-twentieth to the early twenty-first centuries. Cultural preservation is served by this study, which is also a model of how local rituals might be presented at a time of rapid cultural transformation. Why are many locals intimately and regularly involved in religious practice? As a local community member, I share my own experiences and interactions over the years with my maternal grandmother (Sgro b+ha, 1923-2010), sister (Bzung 'dus mtsho, b. 1985), sister-in-law (G.yang mo, b. 1985), and neighbor women. They are quietly confident that religious practice on sacred dates leads to an accumulation of merit. Not knowing abstract explanations for the dates' special sacredness does not minimize their belief in their importance. The women I mentioned seldom interact and exchange views with monks and other literate males who have religious ideas based on what they have read and learned in monastery-based teachings. Nevertheless, these women have sincere faith and place great value on sacred times when all positive deeds are doubled in karmic value, which they have heard repeatedly since childhood. During this time, self-restraint and austerity are believed to help attain a more positive attitude toward life and significantly contribute to a better afterlife.
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Angove, Rebekah SM, and Kathleen D. Gallagher. "Social determinants of health—to screen or not to screen? How, when, and what to do next are really the questions." Journal of Clinical Oncology 40, no. 28_suppl (2022): 169. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.169.
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169 Background: Social determinants of health (SDOH) have a considerable impact on the health outcomes of chronically ill patients. Although the implementation of social needs screening in clinical settings has been studied, patient perspectives of discussing SDOH with health care providers has not been thoroughly investigated. This study sought to explore the experience and perspectives of limited-resource patients with cancer regarding SDOH discussions. Methods: This cross-sectional analysis used data from a nationwide survey distributed in May 2022 by Patient Advocate Foundation (PAF). The survey was fielded via email to patients who received PAF services in 2020. Inclusion criteria included a valid email, aged >19 and a current or previous cancer treatment. Frequencies and percentages were calculated for categorical variables. Questions focused on individual experiences with SDOH screening, conversations and expectation around information use and assistance. Results: A total of 481 survey respondents with cancer completed the survey. Most respondents were female (73%), aged 56-75 (52%), household income < $48,000 (66%), and insured (98%); 38% were Black, Indigenous or Persons of Color (BIPOC). The most common cancer types were hematologic (42%) and breast (34%); 30% were diagnosed < 2 years prior and 82% received treatment in past 6 months. One quarter (26%) stopped or delayed care in past 12 months due to cost and 66% reported that social needs interfered with treatment in past 12 months. Two-thirds (64%) reported conversations about social needs in the past 12 months. Transportation (36%), food insecurity (32%) and personal safety were the most cited nonmedical needs. Conversations were most often initiated by nurse/PA (30%), social worker (30%) or doctor (29%) and patients reported being ‘extremely comfortable’ being asked these questions by the same providers; doctor (54%), nurse/PA (48%), social worker (46%). Over half (53%) reported comfort with SDOH information being part of their medical record; 61% wanted to be asked SDOH questions face-to-face. If a social need was identified, patients trusted patient advocacy groups (64%), social worker (61%) and charitable non-profit organizations (49%) to help them locate assistance. Only 21% indicated knowledge of availability of needs navigation services. Conclusions: Although patients are open to sharing social issues with providers, our data suggests that conversations may not be routinely initiated in clinical settings. There is also a need to increase awareness of resources in response to SDOH screening. Challenges in trust and privacy persist when disclosing this information. Achieving health equity requires culturally responsive strategies to embed screening and referrals into workflow to ensure cancer patients’ needs are identified and they are linked to appropriate nonmedical resources and services.
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Tingley, Hilary, Madeline McIntosh, McKenzie Klee, Margaret Gladman, Alison Coogan, and Andrea Madrigrano. "Abstract PO3-09-08: Using Social Determinants of Health to Improve Surgical Delays for Breast Cancer Patients at Rush University Cancer Center." Cancer Research 84, no. 9_Supplement (2024): PO3–09–08—PO3–09–08. http://dx.doi.org/10.1158/1538-7445.sabcs23-po3-09-08.
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Abstract Introduction Delays to surgery in the treatment of breast cancer can lead to worse disease specific mortality and overall survival. Previous work has shown a woman’s time to surgical treatment is influenced by income, which may be secondary to social determinants of health (SDOH) including health literacy, safety, stress, access to health care and transportation, housing, and ability to pay utilities. This study sought to evaluate a screening process for SDOH to assess and address barriers to care for women newly diagnosed with breast cancer. Methods A SDOH screening tool consisting of 7 yes/no questions was developed and used by trained breast oncology nurses via phone call made to all new patients prior to their first visit. Based on patient response, patients are provided with community resources or referred to the hospital social work team. Primary outcome included the SDOH screening results, and secondary outcome included time to surgery. Results 118 patients were screened, of which 60 patients had surgery as their first treatment and were included in this analysis. Twenty-seven patients screened positive for SDOH need. Ten patients reported &gt;3 SDOH concerns and were referred to social work. The most common concerns were food insecurity and trouble paying utilities. Of the 27 patients who screened positively, 18 identified as Black or African American, 3 were Hispanic, 1 Asian and 5 White. The mean household income for these patients based on their reported zip codes was $55,615.78. Average time to surgery for patients with a positive SDOH screen was 37.7 days and negative SDOH screen was 42 days. For patients with a positive SDOH screen, those with 2 or fewer SDOH needs had an average time to surgery of 41.9 days and those with 3 or more SDOH needs had an average 30.6 days until surgery. Discussion Patients who screened positive for SDOH need and were provided resources had a faster time to surgery than patients who initially screened negative for SDOH. Patients referred to social work had the fastest time to surgery. Early identification of SDOH is necessary for all patients to improve equity and outcomes in breast cancer treatment. Citation Format: Hilary Tingley, Madeline McIntosh, McKenzie Klee, Margaret Gladman, Alison Coogan, Andrea Madrigrano. Using Social Determinants of Health to Improve Surgical Delays for Breast Cancer Patients at Rush University Cancer Center [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-09-08.
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Zasloff, Rebecca A., Alexandra Hunter, Ayush Khanna, Huda Haque, Elizabeth R. Blackwood, and Nosayaba Osazuwa-Peters. "Abstract 4892: Tools for screening for social determinants of health in head and neck cancer: a scoping review." Cancer Research 85, no. 8_Supplement_1 (2025): 4892. https://doi.org/10.1158/1538-7445.am2025-4892.
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Abstract Methods: We conducted a systematic literature search of Medline, Embase, and Web of Science databases on July 24, 2024. The included studies were US-based, written in English, and examined a validated tool to assess SDoH among HNC patients. Tools were categorized by the five primary SDoH domains as defined by the Healthy People 2030 Initiative: Economic Stability, Education Access and Quality, Social and Community Context, Health Care Access and Quality, and Neighborhood and Built Environment. Subdomains within each primary domain were used to further categorize the included tools. Results: After screening 272 articles, 5 studies that evaluated 4 unique SDoH screening tools were included in the analysis. The number of questions in any given SDoH assessment tool ranged from 2 to 33 (mean: 16). Economic Stability (n = 3, 75%) and Health Care Access and Quality (n =2, 50%) were the only 2 SDoH domains assessed by the tools. Most tools evaluated one domain (n =3, 75%). Poverty (n = 3, 75%) and Access to Health Services (n = 2, 50%) were the most commonly assessed SDoH sub-domains. Only one study proposed a specific intervention to address SDoH. Conclusion: This review found that most SDoH screening tools in HNC care focus on assessing Economic Stability, but do not capture several other Healthy People 2030 domains. Ultimately, the limited number of validated SDoH tools fail to assess the wide-reaching spectrum of HNC patient experiences, making it difficult to comprehensively address the social needs of HNC patients. In addition to the development of tools to screen other SDoH domains, future studies are needed to integrate adequate public health interventions in order to address social need particularly among racial/ethnic minority and marginalized populations. Citation Format: Rebecca A. Zasloff, Alexandra Hunter, Ayush Khanna, Huda Haque, Elizabeth R. Blackwood, Nosayaba Osazuwa-Peters. Tools for screening for social determinants of health in head and neck cancer: a scoping review [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4892.
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Ogunrinde, Joyce. "EXPLORING CULTURALLY RESPONSIVE PHYSICAL ACTIVITY AS A RECRUITMENT AND RETENTION TOOL FOR AFRICAN AMERICAN WOMEN." Innovation in Aging 6, Supplement_1 (2022): 553–54. http://dx.doi.org/10.1093/geroni/igac059.2095.
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Abstract Physical activity (PA) is associated with lower cognitive decline and incident dementia for older adults. Yet, PA data (interventions) on older African American (AA) women, a population disproportionately affected by premature aging, are lacking. This limitation reduces the efficacy of PA to reduce cognitive decline, particularly for people of color and more so women of color whose race and gender create unique spaces for PA engagement. Although AA women desire to engage in PA, they face social, structural, and behavioral barriers to PA, challenges that parallel those faced in preventing premature aging (Li et al., 2018). Extant literature on AA women’s PA investigates social determinants of health (SDoH) and calls for more attention as to how these factors intertwine to shape these women’s PA over time (Fleury & Lee, 2006). Culturally responsive physical activity programs (CRPA) offer a framework for addressing these factors synergistically to promote PA in a way that is desirable to AA women. Specifically, CRPA provides a strength– based approach to explicate the ways PA can redress social, structural, and behavioral causes of cognitive decline and barriers to PA (cf., Joseph et al., 2020). The purpose of this poster is to explore the benefits of CRPA interventions on preventing cognitive decline. Implications include refining current models of PA as premature aging prevention measures by increasing our knowledge of the sociocultural factors shaping AA women’s aging and PA behavior and providing greater insight into the mechanisms for recruiting and retaining AA women into PA- based cognitive decline interventions.
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Nagase, T., M. Lei, F. M. Robatto, D. H. Eidelman, and M. S. Ludwig. "Tissue viscance during induced constriction in rabbit lungs: morphological-physiological correlations." Journal of Applied Physiology 73, no. 5 (1992): 1900–1907. http://dx.doi.org/10.1152/jappl.1992.73.5.1900.
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Tissue viscance (Vti), the pressure drop across the lung tissues in phase with flow, increases after induced constriction. To gain information about the possible site of response, we induced increases in Vti with methacholine (MCh) and attempted to correlate these changes with alterations in lung morphology. We measured tracheal (Ptr) and alveolar pressure (PA) in open-chest rabbits during mechanical ventilation [frequency = 1 Hz, tidal volume = 5 ml/kg, positive end-expiratory pressure (PEEP) = 5 cmH2O] under control conditions and after administration of saline or MCh (32 or 128 mg/ml) aerosols. We calculated lung elastance (EL), lung resistance (RL), Vti, and airway resistance (Raw) by fitting the equation of motion to changes in Ptr and PA. The lungs were then frozen in situ with liquid nitrogen (PEEP = 5 cmH2O), excised, and processed using freeze substitution techniques. Airway constriction was assessed by measuring the ratio of the airway lumen (A) to the ideally relaxed area (Ar). Tissue distortion was assessed by measuring the mean linear intercept between alveolar walls (Lm), the standard deviation of Lm (SDLm), and an atelectasis index (ATI) derived by calculating the ratio of tissue to air space using computer image analysis. RL, Vti, and EL were significantly increased after MCh, and Raw was unchanged. A/Ar, Lm, SDLm, and ATI all changed significantly with MCh. Log-normalized change (% of baseline) in Vti significantly correlated with A/Ar (r = -0.693), Lm (r = 0.691), SDLm (r = 0.648), and ATI (r = 0.656). Hence, changes in lung tissue mechanics correlated with changes in morphometric indexes of parenchymal distortion and airway constriction.(ABSTRACT TRUNCATED AT 250 WORDS)
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McCormack, Kara. "Abstract C005: Social determinants and environmental exposures and their localized contribution to risk of cancer mortality." Cancer Epidemiology, Biomarkers & Prevention 32, no. 1_Supplement (2023): C005. http://dx.doi.org/10.1158/1538-7755.disp22-c005.
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Abstract When considering environmental exposures and/or social determinants of health (SDOH), data are typically available by counties, zip codes or census tracts. We consider two quantitative challenges in this setting when modeling cancer outcomes. The first is that multiple, potentially highly correlated exposures may contribute to risk. The second is that the spatial correlation of such features may not follow the original models designed for disease risk mapping. While several conditional autoregressive (CAR) models are typically utilized (Besag et al. (1991), Leroux et al. (1999), Stern and Cressie (1999)), a critical drawback is that they impose a global level of autocorrelation across the study area, presuming areas nearest each other are most similar. Spatial data may actually include step changes in the risk surface, indicative of more complex patterns either due to physical barriers and/or social isolation. Thus, identifying these step changes is of interest, as they may reflect the underlying complexity of the relationship between environmental exposures, SDOH and cancer mortality. We consider a two-step model to explore how clusters of environmental exposures and SDOH may be able to identify boundaries in the risk surface of cancer outcomes. In the first step, we estimate clusters of exposures using Bayesian profile regression, a nonparametric approach based on Dirichlet process mixture methods. In the second step, we model cancer mortality using locally adaptive spatial smoothing with the clusters as dissimilarity metrics (Lee and Mitchell, 2012). Several diagnostic tools are used to assess convergence in each step. With this work, we bridge the gap between incorporating mixtures of correlated exposures with the identification of localized areas with elevated risk of cancer mortality. We apply this approach to a nationwide database of county-level breast cancer mortality, utilize environmental exposure data from the National Air Toxics Assessment and assess SDOH from the American Community Survey. Citation Format: Kara McCormack. Social determinants and environmental exposures and their localized contribution to risk of cancer mortality [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 C005.
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Alghamdi, Ahmad, and Farid Fadhillah. "Thin film composite polyelectrolyte multilayer nanofiltration membrane fabricated using spin assisted layer by layer assembly: Application of solution diffusion film model." Communications in Science and Technology 5, no. 1 (2020): 10–15. http://dx.doi.org/10.21924/cst.5.1.2020.177.
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Thin Film Composite (TFC) Polyelectrolyte Multilayer (PEM) Nanofiltration (NF) membrane consisting of multilayer of Poly(diallyl dimethyl ammonium chloride) (PDAC) and Poly(sodium 4-styrenesulfonate) (PSS) deposited on polyethersulfone (PES) support was prepared using spin-assisted layer by layer assembly (SA-LbL). This work is an effort to discover new material having better characteristics and performance than commercial polyamide (PA) NF membrane. Two main operating conditions namely temperature and salt concentration were investigated and the effect of both on membrane performance was studied. Solution-diffusion Film Model (SDFM) membrane employing two fitting parameters i.e. membrane salt permeability (PS) and stagnant layer salt permeability PS(d), was used to explain membrane transport across the membrane. The result showed an good agreement between experimental and observed rejection rate suggests PEM membrane behaves similar to typical solution diffusion-type composite membrane and SDFM can be used to predict the membrane performance and behavior.
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Ramsey-Goldman, Rosalind, Justin Arnold, Dominique Kinnett-Hopkins, et al. "IS PHYSICAL ACTIVITY (PA) BEHAVIOR ANOTHER CASUALTY OF DEPRIVED NEIGHBORHOODS IN PERSONS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)?" Journal of Rheumatology 52, Suppl 1 (2025): 122.3–123. https://doi.org/10.3899/jrheum.2025-0390.pv076.
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PV076 / #248Poster Topic:AS10 - Environment and SLEBackground/PurposeSLE, a chronic inflammatory, autoimmune disease with pervasive self-reported fatigue, negatively impacts most individuals with SLE. Because of its recognized benefits in improving oxygen capacity and endurance, physical activity (PA) is one modifiable lifestyle behavior to help reduce fatigue in patients with SLE who are typically not physically active and afraid to exercise. Recent research suggests a role for Social Determinants of Health (SDOH) in identifying environmental impact on medical care and conditions. The Area Deprivation Index (ADI), a composite score which ranks geographical areas of the US based on environmental living conditions, measures neighborhood resources and can estimate SDOH. Lupus Intervention Fatigue Trial (LIFT) is a 12-month phase II randomized, parallel group, single blind 2-arm investigator-initiated trial, comparing effectiveness of a motivational interviewing program intervention combining diet and physical activity strategies vs an educational program control arm to reduce fatigue in persons with lupus (NCT02653287). This ancillary analysis assessed the correlation between objectively measured PA behavior and ADI disadvantage of the participant’s home at the LIFT baseline visit.MethodsAll LIFT participants met criteria: ≥18 years of age, BMI: 18-40 kg/m2, ambulate household distances (50 ft), classification criteria for SLE per American College of Rheumatology (ACR) or Systemic Lupus International Collaborating Clinics (SLICC). Accelerometers were worn for 7 consecutive days during waking hours to measure daily PA minutes and were categorized as sedentary minutes (<100 counts), light PA (LPA) minutes (100-2019 counts), and moderate-vigorous PA (MVPA) minutes (2020+ counts). Valid PA monitoring was defined as at least 4 days of 10+ hours of accelerometer wear. Weekly MVPA minutes were calculated as mean daily MVPA minutes times 7. The ADI uses nine-digit zip codes to calculate a national ranking score on a scale from 0-100 (low to high deprivation rank). Descriptive statistics were calculated, and the associations between ADI and PA minutes (all categories) were estimated using Spearman correlation.ResultsAmong 160 LIFT participants, mean (SD) age was 43.3 (13) years; 92% identify as female with 52% participants self-identifying as White, 33% Black/African American, 8% Asian, 1% Hawaiian/Pacific Islander, and 5% unknown/not reported; 95% having some college education. The mean (SD) for the following were BMI 27 (5), [disease activity measure] SLEDAI 2.9 (3.1), SLICC/Damage 1.2 (1.6), and ADI 34.7 (21.4), respectively. The total PA daily mean (SD) minutes were 262.3 (83.4); mean (SD) daily minutes category were sedentary 582.8 (92.8), LPA 242.2 (75.5), and MVPA 20.1 (19.6). Thirty-two percent met PA guidelines (≥150 minutes/week of MVPA). Mean daily MVPA minutes correlated with ADI rank, r= -0.20, p= 0.01 (Table 1).Table 1.Spearman Correlations Between PA Measures and ADI in Baseline LIFT Participants (n=160)ConclusionsThis analysis documents that only 32% of LIFT participants met weekly PA guidelines of > 150 minutes of MVPA at baseline. Mean MVPA minutes were negatively correlated with ADI rank suggesting those participants living in higher ADI deprivation areas had lower MVPA minutes. Future analyses are planned to assess changes in PA between baseline & 6-month visit in the intervention and control groups in LIFT by ADI rank or if other interventions are necessary.
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Venna, Alyssia, Yves d’Udekem, and Sabrina Figueiredo. "328 Identifying barriers and facilitators influencing physical activity levels in children and adolescents with congenital heart disease (CHD): A rapid review." Journal of Clinical and Translational Science 9, s1 (2025): 101. https://doi.org/10.1017/cts.2024.959.
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Objectives/Goals: Physical activity (PA) is critical to improving the health and well-being of patients with congenital heart disease (CHD); however, rates of PA, specifically in children and adolescents with CHD, remain significantly lower than the general population. Our goal was to understand what factors influence rates of PA in children and adolescents with CHD. Methods/Study Population: A rapid review was performed in February 2024 across 5 databases: PubMed, Scopus, CINAHL, PsycINFO, and PEDRO (PROSPERO 2024 CRD42024516250). A search strategy combined all possible terms and MESH terms related to the population of interest: children or adolescents with CHD and the outcome of interest: PA levels. Descriptive analysis and concept maps were used to further describe the various barriers and facilitators to PA. Results/Anticipated Results: We identified 49 articles. Most articles were quantitative (76%) and assessed demographic influences, such as age and gender. Self-efficacy was the most common facilitator to PA, in addition to wanting to fit in and have fun. Self-imposed limitations and self-perceived barriers such as fears and anxiety, feelings of inadequacy, and lack of enjoyment were barriers to PA. Parents, teachers, and peers facilitated PA by providing support, possessing knowledge about the importance of PA, and by engaging in the activity with the child; however, these groups limited PA by showing anxiety and stress. Barriers related to social determinants of health (SDOH) include costs, lack of education, and accommodations during PA. Environmental barriers included less PA during winter, weekends, and between the hours of 15:00 and 17:00. Discussion/Significance of Impact: Identifying barriers and facilitators to PA in patients with CHD is necessary to design tailored programs that will increase PA behaviors. Future work should integrate perspectives of clinicians, patients, and families with the factors described in this review, to create programs that effectively address low PA levels in the young CHD population.
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Aroh, Adaeze, and Ifeanyi N. Madujibeya. "Abstract A089: Examining the role of Social Determinants of Health (SDoH) on adherence to cancer prevention recommendations: Evidence from a national representative sample." Cancer Epidemiology, Biomarkers & Prevention 32, no. 12_Supplement (2023): A089. http://dx.doi.org/10.1158/1538-7755.disp23-a089.
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Abstract The role of Social Determinants of Health (SDoH) on adherence to cancer prevention recommendations has not been systematically examined among adults in the United States adults despite the influential role of SDoH in shaping individuals' health behaviors and outcomes. Our purpose was to explore the effects of SDoH on adherence to cancer prevention recommendations among adults in the United States Methods: We used data from the Health Information National Trends Survey (HINTS), 6 cycle (2022). Adults aged 18 years and above were included. Adherence to cancer prevention recommendations was measured with the 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations Score. SDoH was measured based on the American Cancer society's five core SDOH domains (economic stability, social and community context, neighborhood and built environment, education access, and healthcare access). Weighted hierarchical multiple regression models were conducted using each domain of SDOH as a block, controlling for age, gender, race, selfcare efficacy, cormorbidity, cancer risk perception and belief about cancer, Jackknife replicate weights were incorporated into the analyses. Results: The sample consisted of 6252 respondents with a mean age of 55.6 (SD, 17.4) years, The estimated mean adherence rate to cancer prevention recommendations among adults in the United States was 40.4% (SD 21.8) .Adherence to cancer prevention recommendations was positively associated with having a college education compare to less than high school education (Odd Ratio [OR], 6.29, P = .019), combined household income of $75,000 and above compare to combined household income of less than $20,000 ( OR, 5.11 , P= .014) , retired compared to full-time employement ( OR, 4.87, P &lt; .001), access to health insurance compared to lack of health insurance (OR, 4.01, P= .020). These findings suggest that interventions targeting the effects of SDoH on cancer on adherence to cancer prevention recommendations may consider the socioeconomic context of targeted individuals. Such interventions should focus on addressing barriers related to education access, income stability, employment status and healthcare access. Citation Format: Adaeze Aroh, Ifeanyi N. Madujibeya. Examining the role of Social Determinants of Health (SDoH) on adherence to cancer prevention recommendations: Evidence from a national representative sample [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A089.
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Giap, Fantine, Young-Rock Hong, Julie Ann Bradley, and Oluwadamilola Temilade Oladeru. "Social determinants of health factors and palliative care services use among patients with metastatic breast cancer in Florida." Journal of Clinical Oncology 41, no. 16_suppl (2023): 1102. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.1102.
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1102 Background: ASCO recommends palliative care (PC) as an adjunct to the oncologic standard of care for patients with metastatic cancer. However, current evidence on PC utilization in patients with breast cancer and its relationship with area-level social determinants of health (SDoH) factors is limited. Therefore, we examined the associations between county-level factors and PC utilization among patients with metastatic breast cancer (mBC) in Florida. Methods: We extracted patient-level data (n = 23,539 patients diagnosed with mBC between 2012 and 2021) from the OneFlorida+ Data Trust and linked it to county-level data (67 Florida counties) from the AHRQ-SDoH Database. PC utilization since cancer diagnosis was identified using ICD-9 code V66.7 or ICD-10 code Z51.5. We assessed differences in PC utilization with county-level SDoH factors (e.g., poverty rate, transportation resource, provider supply, racial segregation) using bivariate analysis. Multivariable Poisson regression, including significant factors from bivariate analysis, was used to compare the PC utilization for the SDoH factors. Results: Our study population's overall prevalence of PC utilization was 16.1%. PC utilization was higher for patients with mBC residing in counties with a higher proportion of residents living in poverty and with a greater supply of advanced practice providers (APP: NP, PA), general surgeons, and nursing homes. Patients with mBC in counties with higher proportions of residents who identified as immigrants, with limited English proficiency, without personal transportation, and having higher racial segregation had lower PC utilization. In adjusted analysis, the supply of APP (coefficient:0.12) and nursing homes (coefficient:0.09) was associated with increased PC utilization. Conversely, racial segregation (White vs. non-White) was associated with decreased PC utilization (coefficient: -0.07). Conclusions: PC utilization among patients with mBC was associated with several SDoH at the county level. Notably, low PC utilization was associated with racial residential segregation and fewer APPs and nursing homes. Further research is needed to identify mediators in these relationships to improve PC effectiveness for patients with mBC in Florida.
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Ramirez, Amelie G., Derek Rodriguez, Cliff Despres, et al. "Abstract B147: Avanzando Equidad de Salud: Latino Cancer Health Equity Research Center." Cancer Epidemiology, Biomarkers & Prevention 33, no. 9_Supplement (2024): B147. http://dx.doi.org/10.1158/1538-7755.disp24-b147.
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Abstract South Texas (STX), spanning from San Antonio to the Texas-Mexico border, includes 25 rural counties, with 96% designated as primary care shortage areas, are notably the nation’s poorest and most medically underserved regions in the United States. Hispanic/Latinos (H/Ls) in the U.S. face challenges related to social determinants of health (SDoH), contributing to disparities in cancer prevention, diagnosis, treatment, and outcomes. H/Ls have higher risks of invasive cancers compared to peers, emphasizing the critical need to address SDoH to mitigate cancer disparities. Addressing these causes can improve access to healthcare, promote early detection, enhance patient education, and provide culturally competent care. The Avanzando Center (AC) aims to reduce health disparities across STX with community-engaged research, training, patient assessment, and advocacy that addresses the SDoH that deter Latinos from equitable access to cancer care, prevention, early detection, treatment, and improve patients’ cancer outcomes. To achieve its mission, the AC will 1) coordinate Research Scholars on SDoH-related cancer control projects, providing leadership, mentoring, and support in SDoH screening, clinical informatics, and outreach dissemination, 2) implement the SDoH Screener to screen patients at UT Health San Antonio’s Mays Cancer Center, Primary Care Center, and clinics across STX, ensuring they receive necessary support, 3) utilize the Salud America! (SA!) Latino health communications network for community education, empowering STX community members to advocate for local system and policy changes addressing structural SDoH, and 4) provide mentoring and career development in health equity (HE) and SDoH fundamentals to enhance cancer patient care and research advancements in the community. Research Scholars are actively employing interventions for 1) adolescent and young adult cancer survivors by establishing training programs for oncology providers to ensure proper guidance on vaccinations against HPV-related cancers, 2) using technology to improve treatment adherence among Latina breast cancer patients, and 3) addressing disparities in colorectal cancer screening and healthcare access among persistently impoverished populations. These studies will result in rigorous evaluation of intervention effectiveness by addressing the specific needs of cancer patients facing barriers related to SDoH and inform policy and practice initiatives to eliminate cancer as a major health concern. In addition, training and mentoring programs will enhance the knowledge and understanding of cancer care and research professionals, while the SA! Latino HE communication program to raise awareness about SDoH and cancer HE that includes blog posts featuring resources, inspirational stories, and promotional HE tools. The efforts focused on SDoH have the potential to significantly impact cancer outcomes and reduce disparities in Latino communities, ultimately advancing HE and improving overall well-being; specifically improving cancer outcomes, survivorship, and quality of life. Citation Format: Amelie G. Ramirez, Derek Rodriguez, Cliff Despres, Rebecca T. Jones, Ramon S. Cancino, Allison C. Grimes, Jonathan Gelfond, Byeongyeob Choi, Edgar Munoz, Patricia Chalela. Avanzando Equidad de Salud: Latino Cancer Health Equity Research Center [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B147.
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Odai-Afotey, Ashley, Ellana Haakenstad, Sunyi Zhang, Bridget A. Neville, Stuart Lipsitz, and Nadine J. McCleary. "Abstract 5939: Feasibility of systemic SDOH collection and associated resource utilization at a large academic cancer center." Cancer Research 82, no. 12_Supplement (2022): 5939. http://dx.doi.org/10.1158/1538-7445.am2022-5939.
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Abstract BACKGROUND: The WHO defines social determinants of health (SDoH) as “the conditions in which people are born, grow, live and age” which includes factors such as housing and food insecurity, employment, and social support and can account for 30-55% of health outcomes. Addressing unmet SDoH needs may reduce interruptions to cancer care caused by ED visits and hospitalizations (EDH). We aimed to determine feasibility of systematic patient-reported SDoH collection at a large academic cancer center and association of unmet SDoH needs with EDH.METHODS: We conducted a cross-sectional analysis of SDoH needs among new oncology patient (pt) consults from 5/15-9/21at Dana Farber Cancer Institute (DCFI). Pts completed an intake questionnaire including demographic, disease, as well as SDOH needs on a dichotomous or 5-point Likert scale, specifically health literacy (“how confident are you in filling out medical forms?”), health numeracy (“how confident are you in understanding medical statistics?”), financial distress (“how difficult is it for you, or your family, to meet monthly payments on your/your family’s bills?”) and social isolation (“do you currently live alone?”). We ran bivariate and multivariable models on the association between demographics, SDoH and EDH within 30 days of initial oncology visit using robust generalized estimating equations controlling for clustering by consult provider. RESULTS: 125,997new consults were seen from 05/15-09//21, of which 20,913 completed the intake questionnaire and were alive at 30 days of consult. Of those pts, most were female (60%), aged 40-64 (50%), White (90%), non-Hispanic (84%), primarily English-speaking (9%) and 7% had an EDH within 30 days of their 1st outpatient visit. The most reported SDOH need was limited health numeracy (26%). In bivariate analysis, factors associated with ED visits included: limited English proficiency lung or GU/GYN cancer, living &gt; 25 mi.from DFCI, and limited health literacy and numeracy (all p&lt;0.05). Demographics associated with hospitalizations included: White race and English as primary language (EPL) (both p&lt;0.05). Multivariable analysis showed female gender (OR 1.53, p &lt; 0.01), lung (OR 3.22*) and GU/GYN (OR 2.21*) (p &lt; 0.05 for both) cancer, and living &gt; 25 mi from DFCI (OR 2.50, p &lt; 0.0001) were associated with increased likelihood of ED visit while EPL (OR 1.80, p&lt;0.05) and GU/GYN (OR 1.65, p&lt;0.01*) cancer were associated with increased likelihood of hospitalization.CONCLUSIONS: It is feasible to systematically screen for unmet SDoH which are associated with increased frequency of ED visits. Differences in characteristics associated with ED vs. hospitalization could indicate possible bias or suggest SDoH needs as a reason for avoidance of costly medical care. Further study will expand both the content and site of SDoH data collection, non-English languages used for data collection, and measure impact of resource matching to reduce disruptions to cancer care. *Compared to breast cancer Citation Format: Ashley Odai-Afotey, Ellana Haakenstad, Sunyi Zhang, Bridget A. Neville, Stuart Lipsitz, Nadine J. McCleary. Feasibility of systemic SDOH collection and associated resource utilization at a large academic cancer center [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5939.
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Alviz, Lesgui, David Tebar-García, Raquel Lopez-Rosa, et al. "Pathogenic Microenvironment from Diabetic–Obese Visceral and Subcutaneous Adipocytes Activating Differentiation of Human Healthy Preadipocytes Increases Intracellular Fat, Effect of the Apocarotenoid Crocetin." Nutrients 13, no. 3 (2021): 1032. http://dx.doi.org/10.3390/nu13031032.
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In diabetes mellitus type 2 (DM2), developed obesity is referred to as diabesity. Implementation of a healthy diet, such as the Mediterranean, prevents diabesity. Saffron is frequently used in this diet because of its bioactive components, such as crocetin (CCT), exhibit healthful properties. It is well known that obesity, defined as an excessive accumulation of fat, leads to cardiometabolic pathology through adiposopathy or hypertrophic growth of adipose tissue (AT).This is related to an impaired adipogenic process or death of adipocytes by obesogenic signals. We aimed to evaluate the effect of the pathogenic microenvironment and CCT, activating differentiation of healthy preadipocytes (PA). For this, we used human cryopreserved PA from visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) depots obtained from healthy and obese-DM2 donors. We studied the effect of a metabolically detrimental (diabesogenic) environment, generated by obese-DM2 adipocytes from VAT (VdDM) or SAT (SdDM), on the viability and accumulation of intracellular fat of adipocytes differentiated from healthy PA, in the presence or absence of CCT (1 or 10 μM). Intracellular fat was quantified by Oil Red O staining. Cytotoxicity was measured using the MTT assay. Our results showed that diabesogenic conditions induce cytotoxicity and provide a proadipogenic environment only for visceral PA. CCT at 10 μM acted as an antiadipogenic and cytoprotective compound.
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Smith, Alexandria P., Ayesha Ali, Ayako Shimada, et al. "Abstract 5859: Impact of adverse SDOH on cancer knowledge and beliefs: Analysis of a NCI-designated cancer center’s catchment area survey." Cancer Research 82, no. 12_Supplement (2022): 5859. http://dx.doi.org/10.1158/1538-7445.am2022-5859.
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Abstract Background: Social determinants of health (SDOH) are social barriers that stratify health status. Specifically, socioeconomic status, education level, minority and immigration status correlate with higher risk of onset and severity of chronic disease. We sought to understand how SDOH affect a patient’s belief regarding autonomy over cancer risk and outcomes. Methods: Data from the Sidney Kimmel Cancer Center catchment area including Delaware, Montgomery, and Philadelphia Counties in Pennsylvania; Camden and Burlington Counties in New Jersey were queried and analyzed. The survey included six cancer belief statements. Demographic characteristics of survey participants, as well as data related to cancer risk factors and beliefs were all calculated using unweighted data. Results: 1,557 adults responded to this survey. Survey participants ranged in age from 18 to 88 years old, with 49.6% of participants 40 years old and younger. 64% of respondents identified as female vs 36% male. Poverty classification was based on ASPE 2020 Poverty Guidelines given family size and income information. Based on these parameters, 21.3% of respondents were considered impoverished. Additional demographics included housing security, food security, and health literacy. Results demonstrated, impoverished respondents were more likely to disagree that behavior/lifestyle causes cancer (63.3% vs 53.3%, p&lt;0.001). Housing insecure respondents were more likely to disagree that behavior/lifestyle causes cancer (62.8% vs 54.8% p&lt;0.001). Respondents who are more food insecure were more likely to disagree that behavior/lifestyle causes cancer than those who are food secure (food last: 57.9% vs 54.5%, p&lt;0.001). Respondents who are more food insecure were more likely to agree that everything causes cancer (food last: 67.8% vs 59.2%, p&lt;0.001). Discussion: Adverse SDOH such as poverty, food insecurity, housing insecurity, and health literacy affect cancer beliefs. Overall, results demonstrated that respondents with adverse SDOH were more likely to disagree that behavior/lifestyle can cause cancer and more likely to agree that everything causes cancer. Patients with adverse SDOH may be less likely to actively engage in preventive health measures and screenings, clinical trials, and other factors known to positively impact cancer outcomes. SDOH should be evaluated on patient intake and patients should be provided with appropriate support and targeted education with broad cancer beliefs in mind. Citation Format: Alexandria P. Smith, Ayesha Ali, Ayako Shimada, Brittany C. Smith, Samantha Okere, Kamryn Hines, Amy Leader, Nicole L. Simone. Impact of adverse SDOH on cancer knowledge and beliefs: Analysis of a NCI-designated cancer center’s catchment area survey [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5859.
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Aziz-Bose, Rahela, Yael Flamand, Puja J. Umaretiya, et al. "Abstract B096: Food insecurity and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits among income-eligible US pediatric acute lymphoblastic leukemia patients enrolled on a multi-center clinical trial." Cancer Epidemiology, Biomarkers & Prevention 32, no. 1_Supplement (2023): B096. http://dx.doi.org/10.1158/1538-7755.disp22-b096.
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Abstract Background Food insecurity (FI) is an adverse social determinant of health (SDoH) prevalent among pediatric cancer patients and associated with poorer health outcomes in general pediatrics. Receipt of federal SNAP benefits reduces FI in general pediatrics, and is thus a marker of appropriate resource support to mitigate adverse SDoH. Dana-Farber Cancer Institute (DFCI) Acute Lymphoblastic Leukemia (ALL) Consortium Trial 16-001 is the first pediatric oncology clinical trial to prospectively collect parent-reported SDoH, including income, SNAP receipt, and FI. We investigated whether income-eligible pediatric ALL families were successfully receiving SNAP benefits, and whether SNAP receipt was associated with FI. Methods Secondary analysis of children aged 1-17 years with de novo ALL enrolled on the DFCI 16-001-embedded SDoH cohort study at 6 US centers from 2017-2022. We utilized parent-reported SDoH data at diagnosis (T0) and 6-mos (T1) into therapy to identify families as (1) SNAP-eligible, proxied as household income &lt;130% Federal Poverty Level based on federal guidelines; and (2) food insecure, based on validated 2-item screen. McNemar’s test compared SNAP receipt at T0 vs T1 among those eligible at both timepoints. Associations between SNAP eligibility, SNAP receipt, and FI were evaluated with chi-square tests. Results At T0, among 262 evaluable families, 21% reported FI. A total of 20% (n=53) were SNAP-eligible, of whom 60% (n=32) reported FI and 53% (n=28) were receiving SNAP. Among 28 SNAP-recipient families, 61% reported FI. Similarly, at T1, among 223 evaluable families, 25% reported FI. A total of 28% (n=62) were SNAP-eligible, of whom 58% (n=36) reported FI and 58% (n=36) were receiving SNAP. Among 36 SNAP-recipient families, 56% reported FI. A significantly higher proportion of the 33 families SNAP-eligible at both T0 and T1 were receiving SNAP at T1 (70%) compared to T0 (52%) (p=0.034). Among eligible families, SNAP receipt was not associated with lower odds of FI at T0 (OR 1.03, p=0.96) or T1 (OR 0.83, p=0.73). Discussion FI, a well-defined adverse SDoH associated with inferior health outcomes, is highly prevalent among a trial-enrolled pediatric ALL population. Despite care delivery at highly resourced centers with dedicated staff to address social needs, a substantial proportion of likely eligible families (as proxied by income) were not receiving SNAP benefits 6-mos into therapy. Further, receipt of SNAP was inadequate to ameliorate FI in this cohort, with ~60% of SNAP recipients reporting concurrent FI both at T0 and T1. Ensuring successful connection of eligible families to existing benefits is an essential first step. However, high rates of FI among SNAP recipients indicate that resource navigation, though necessary, is not sufficient to address FI for this population. These data provide immediate targets for health equity interventions—including systematic benefits navigation, direct resource provision, and policy-based approaches for benefits augmentation—to address adverse SDoH and improve cancer outcomes. Citation Format: Rahela Aziz-Bose, Yael Flamand, Puja J. Umaretiya, Lenka Ilcisin, Ariana Valenzuela, Peter D. Cole, Lisa M. Gennarini, Justine M. Kahn, Kara M. Kelly, Bruno Michon, Thai-Hoa Tran, Jennifer J. G. Welch, Lewis B. Silverman, Kira Bona. Food insecurity and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits among income-eligible US pediatric acute lymphoblastic leukemia patients enrolled on a multi-center clinical trial [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 B096.
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Zhang, Xinyuan (Cindy), Longgang Zhao, David Vlahov, Yun Chen, Tamar Taddei, and Xuehong Zhang. "Abstract 4939: Social determinants disadvantage score and risk of liver cancer in the All of Us Research Program." Cancer Research 85, no. 8_Supplement_1 (2025): 4939. https://doi.org/10.1158/1538-7445.am2025-4939.
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Abstract Background: Social determinants of health (SDOH) are crucial in shaping health outcomes, yet comprehensive studies that span all key SDOH domains (economic stability, education, healthcare access and quality, neighborhood and built environment, and social and community context) to examine their associations with liver cancer risk are sparse. We developed and validated a Social Determinants Disadvantage Score (SDDS) to address this knowledge gap. Methods: We conducted a cross-sectional analysis of 117, 783 participants from the All of Us Research Program. The SDDS was systematically constructed using validated questionnaires covering five domains recognized by the World Health Organization and U.S. Department of Health and Human Services. Each domain was dichotomized into advantage (0) or disadvantage (1), with the SDDS ranging from 0 to 5. Prevalent liver cancer, especially hepatocellular carcinoma (HCC), was identified by the Electronic Health Record. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of SDDS with HCC, adjusting for age, sex, race, ethnicity, birthplace, marital status, smoking status, and alcohol intake. Results: We identified 110 HCC cases in the participants who completed the SDOH questionnaires. Disadvantage in SDOH, as assessed by higher SDDS, was associated with a higher risk of HCC. Per unit increase in SDDS, the adjusted OR (95% CI) was 1.21 (1.02, 1.43) for HCC. The OR was 5.62 (1.95, 16.22) comparing the most disadvantaged to the most advantaged SDDS group. Strongest associations were observed for disadvantage in economic stability (OR = 2.37; 95% CI = 1.22, 4.63) and education (OR = 1.87; 95% CI = 1.08, 3.24). Conclusion: The SDDS provides a comprehensive, validated tool for assessing SDOH. Our findings highlight significant associations between social disadvantage and HCC prevalence, emphasizing the need for future longitudinal studies to inform targeted interventions. Citation Format: Xinyuan (Cindy) Zhang, Longgang Zhao, David Vlahov, Yun Chen, Tamar Taddei, Xuehong Zhang. Social determinants disadvantage score and risk of liver cancer in the All of Us Research Program [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4939.
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Adeyemi, Clementine, Louise B. Murphy, Tim Bancroft, et al. "Abstract 7382: Trends in next generation sequencing (NGS) testing by social determinants of health for metastatic cancer patients, 2016-2022." Cancer Research 85, no. 8_Supplement_1 (2025): 7382. https://doi.org/10.1158/1538-7445.am2025-7382.
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Abstract Introduction: Next Generation Sequencing (NGS) testing is a precision medicine tool that uses genomic information from patient tumors to inform treatment decisions and direct patient access to targeted therapies. Social determinants of health (SDOH) partially explain barriers to healthcare access, which can impact clinical outcomes. Real-world studies examining impact of SDOH on receipt of genomic testing are limited. Objective: To examine annual incidence rates (IR) of NGS testing overall and by SDOH indices in endometrial, lung, and colorectal cancer patients. Methods: This retrospective cohort study included patients diagnosed with advanced and recurrent endometrial cancer (aEC), metastatic non-small cell lung cancer (mNSCLC), or metastatic colorectal cancer (mCRC), from July 2016 to September 2022, in the Optum Research Database. Annual incident rates (per 365, 000 person-days) were calculated for NGS testing and stratified by 5 SDOH domains: social isolation, financial stress, food insecurity, housing insecurity, and transportation difficulty. SDOH measures were categorized as low, medium, or high unmet needs. Full-year NGS testing IRs are reported for trend analysis. Results: The study examined 14, 624 aEC, 33, 608 mNSCLC, and 20, 437 mCRC mostly White patients (69%), with median age (years): 69 aEC, 72 mNSCLC, and 70 mCRC. NGS testing rates varied across tumors during the study follow up-period with the highest overall rates observed in mNSCLC (146.9), followed by CRC (73.8) and aEC (19.3). IRs increased over time for all cancer groups (1.5X higher in 2021 than 2017 for mNSCLC, and 2X higher for aEC and mCRC). Annual NGS testing trends were similar for racial/ethnic groups in aEC and mCRC, but, Black and Hispanic mNSCLC patients had the two lowest testing rates (IR: 139.3 and 134.8 respectively) compared to White (IR: 147.3), and Asian patients (IR: 186.3). In mCRC patients, those with the highest level of unmet need had the lowest IRs for all SDOH domains except food insecurity; a similar pattern was seen in mNSCLC. Before 2019, rates were lower in aEC patients with high financial stress and food insecurity vs. with those with low unmet need; this trend reversed from 2019-2021. Changing testing trends in aEC patients may result from the issuance of a Medicare national coverage determination for NGS testing. Conclusion: NGS testing rates have increased for mCRC, mNCSLC and aEC patients since 2017, however, rates differed by level of SDOH. Targeted interventions focused on increasing NGS testing among patients with more unmet SDOH needs could be impactful. Further investigation into the social factors that influence patient access and treatment decisions may help remove existing barriers to optimal patient care. Citation Format: Clementine Adeyemi, Louise B. Murphy, Tim Bancroft, Kristin Moore, Stephanie Gallagher, Amy Nguyen, Gieira S. Jones. Trends in next generation sequencing (NGS) testing by social determinants of health for metastatic cancer patients, 2016-2022 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 7382.
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Ashing, Kimlin T., Folakemi T. Odedina, Cassandra N. Moore, et al. "Abstract A033: The iCCARE Consortium for Prostate Cancer in Black men: Creating a survivorship care plan for Black prostate cancer survivors." Cancer Epidemiology, Biomarkers & Prevention 32, no. 1_Supplement (2023): A033. http://dx.doi.org/10.1158/1538-7755.disp22-a033.
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Abstract Background: Globally, Black men suffer the greatest prostate cancer (CaP) burden. Blacks are diagnosed more at advanced stages of CaP, greater morbidity and mortality and poorer survivorship outcomes. Blacks are exposed to adverse, discriminatory societal determinants. How these determinants impact the CaP disparities, in particular survivorship and health related quality of life inequities are understudied. Studies examining patient-reported outcomes of Black CaP survivors reveal heightened negative HRQOL sequelae, and depression, family, work and living situation instability due to cancer treatment and societal determinants of health (SDOH). SDOH is used mostly in Public Health to predict population health risk and outcomes, but rarely integrated into HRQOL research and practice. This project is novel by incorporating SDOH into the assessment and relief of HRQOL threats. Despite the Black CaP disparities in survivorship, there remains unacceptable lack of focus and prioritization to provide comprehensive relief. Methods: In response to this noticeable scientific gap, our requisite multidisciplinary investigatory team including Survivor-Advocate Investigators joins forces to achieve the study goal. We are employing community engaged research practice to create a CaP survivorship care plan (SCP) template targeted to Blacks. Our SCP will provide a comprehensive best-practice roadmap to document medical information with treatment history and status, along with relevant resources and health advisories to provide relief for unfavorable sequalae due to cancer and its treatments as well as improve quality of life for CaP survivors. We are building upon the Science of Survivorship, and Contextual Socioecological and the Behavioral Precision Medicine Models with full survivor-advocate partnership to create the SCP. This project to develop a SCP template employs an informative consensus panel to inform the initial SCP. Results: Based on advocate-survivor input and guidance, the SCP will include resources and tools focused on SDOH, treatment adherence, treatment side effects and symptom relief, co-occurring chronic conditions, cardio-protective strategies, and physical, emotional and social wellbeing towards improving in patient outcomes and HRQOL in Black CaP survivors. Data from the Engagement Core and Survivor-Advocate Community Advisory Board, and the preliminary SCP CaP for Black men will be presented at the meeting. Conclusion: Our Consortium builds upon the work of the multidisciplinary PIs, and provide team science approach with robust scientific methods to better understand and address the HRQOL needs of Black CaP survivors. Importantly, this research will make available a patient-centered SCP for CaP survivors, focused on Black men. The iCCaRE Consortium will use this SCP_CaP to inform the development of Artificial Intelligence interventions addressing medical, follow-up care, surveillance, social and emotional support, SDOH and health advisories that will be deployed on popular mobile platforms for greater reach and on-demand use. Citation Format: Kimlin T. Ashing, Folakemi T. Odedina, Cassandra N. Moore, Che Ngufor, Getachew A. Dagne, Fornati Bedell, Diana Londoño, John McCall, Arnold Merriweather, JoAnne S. Oliver, Rotimi Rotimi Oladapo. The iCCARE Consortium for Prostate Cancer in Black men: Creating a survivorship care plan for Black prostate cancer survivors [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 A033.
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Swaminathan, Padmapriya, McKenna Deaton, Crystal Hattum, et al. "Abstract 6160: Mutational signatures and their associations with social determinants of health." Cancer Research 84, no. 6_Supplement (2024): 6160. http://dx.doi.org/10.1158/1538-7445.am2024-6160.
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Abstract Introduction: Mutational signatures, or unique patterns of genetic mutations due to exogenous and endogenous mutational processes, are being continuously identified through the analysis of cancer patients’ genomes. While cancer research has developed and mortality rates have declined, disparities in cancer outcomes have widened. Social determinants of health (SDOH), such as access to health care, education, and economic stability are essential to addressing health equity. While much research is ongoing regarding the identification and etiology of mutational signatures, little work has been published regarding the associations of these signatures with SDOH. Therefore, this study proposes an exploration into the relationships between the presence of mutational signatures and SDOH within an adult pan-cancer patient population. Methods: Variant calls from whole exome sequencing for each patient was used to infer the presence of 58 single base substitution (SBS) mutational signatures. Descriptive statistics were calculated for 455 unique patients. Previously documented associations between primary diagnosis site and distinct signatures were used to validate the predicted signatures in the patient population. Signature profiles were then linked to 208 patient health records with complete SDOH. Logistic regression predicting the presence of each signature was modeled for these patients. Full models for each signature included age, gender, Rural-Urban Commuting Area (RUCA) code, tobacco and alcohol usage, education, income, housing condition, and access to healthcare. Stepwise selection was used to determine significant variables. Results: The most common signatures in the complete population (n = 455) were SBS1 (clock-like; 98%) and SBS39 (95%), followed by SBS5 (clock-like; 38%) and SBS22 (aristolochic acid exposure; 36%). However, SBS24 (aflatoxin exposure; p = .019) and SBS7a (UV exposure; p = .002) were significantly more common in lung and skin cancer patients respectively. Each patient had 4.1 signatures on average, with a range of 2-7. The average number of signatures per patient varied significantly by primary diagnosis (ANOVA p = .014). Patients with a vulva/vagina (4.8) or bladder/urinary tract (4.9) diagnosis had the highest number of signatures while those with a liver (3.3) or kidney (3.6) diagnosis had the lowest. Logistic regression models for the population with SDOH (n = 208) showed poor housing condition was associated with SBS4 (tobacco smoking; p = 0.091). Any issue in accessing healthcare was associated with SBS13 (AID/APOBEC; p = 0.114) and SBS21 (MMR; p = 0.076). Greater rurality was associated with SBS16 (p = .144) and SBS21 (p = .107). The relationship was inverse for SBS1 (p = .121). Conclusion: Multiple significant relationships between different SDOH and mutational signatures was revealed, pointing the need to extend this research to larger patient populations with diverse SDOH. Citation Format: Padmapriya Swaminathan, McKenna Deaton, Crystal Hattum, Benjamin Solomon, William Spanos, David Starks, Rachel Elsey, Casey Williams, Tobias Meissner. Mutational signatures and their associations with social determinants of health [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6160.
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Cohen, Camryn Mae, Kassandra I. Alcaraz, and Avonne E. Connor. "Abstract LB332: Social determinants of health and telehealth receipt among US cancer survivors." Cancer Research 85, no. 8_Supplement_2 (2025): LB332. https://doi.org/10.1158/1538-7445.am2025-lb332.
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Abstract Background: Following the COVID-19 pandemic, telehealth has risen as a popular alternative to in-person healthcare visits in the United States. Telehealth serves as a promising tool for reducing disparities in access to care, particularly for cancer survivors who experience adverse social conditions and require frequent contact with the healthcare system. Whether experiencing adverse social determinants of health (SDOH) is associated with receipt of telehealth among cancer survivors is unknown. Methods: We utilized cross-sectional data from the National Cancer Institute’s 2022 Health Information National Trends Survey (HINTS 6). Experiencing at least one adverse SDOH was defined as a household member experiencing at least one of the following in the past 12 months: cutting or skipping meals because there was not enough money for food; unable to afford to eat balanced meals; worried about being forced to move due to eviction or foreclosure; or lack of reliable transportation keeping someone from medical appointments, work, or getting things needed for daily living. A survey-weighted multivariable logistic regression model was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for the association between adverse SDOH and telehealth receipt in the past 12 months (yes/no) among cancer survivors. Estimates were adjusted for time since diagnosis (&lt;1, 2-5, 6-10, 11+ years), age at diagnosis (18-49, 50-64, 65-74, 75+ years), body mass index (&lt;18.5, 18.5-24.9, 25-29.9, 30+), census region (Northeast, Midwest, South, West), sex (male, female), race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other), smoking status (never, former, current), and a derived comorbidity index (0, 1-2, 3+ of the following conditions: diabetes, high blood pressure, heart condition, lung disease, depression). Results: Of the 900 cancer survivors, 392 (47%) received telehealth. Survivors over the age of 75 years were significantly less likely than 18-49-year-old survivors to receive telehealth (aOR: 0.30 (0.11-0.78, p=0.015). Survivors reporting at least one adverse SDOH were more likely to receive telehealth than survivors reporting no adverse SDOH (70% vs. 43%; OR: 3.07, 1.61-5.83, p=0.001); however, there was no significant difference after adjusting for covariates (aOR: 2.15 (0.96-4.79, p=0.061). The most significant variable associated with receiving telehealth was reporting 1-2 comorbidities: aOR: 2.34 (1.29-4.25, p=0.006) or 3+ comorbidities: aOR: 3.31 (1.44-7.59, p=0.006), compared to reporting no comorbid conditions. Conclusions: Cancer survivors experiencing adverse SDOH and with multiple comorbidities may be more likely to receive telehealth. Future research should explore the role of telehealth in cancer survivorship, particularly for individuals experiencing adverse SDOH. Citation Format: Camryn Mae Cohen, Kassandra I. Alcaraz, Avonne E. Connor. Social determinants of health and telehealth receipt among US cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_2):Abstract nr LB332.
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Torres, Paola, Carolina Bujanda, Celeste Charchalac-Zapeta, et al. "Abstract A025: Empowering Latinas to obtain genetic services: Comparing precision cancer prevention strategies." Cancer Epidemiology, Biomarkers & Prevention 32, no. 12_Supplement (2023): A025. http://dx.doi.org/10.1158/1538-7755.disp23-a025.
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Abstract Purpose: Precision cancer prevention strategies are critical for addressing the complex interplay of adverse social determinants of health (SDOH) and elevated biological risks for breast cancer (BC) among Latinas and other marginalized communities. FQHC-community-academic partnerships may have particularly high potential for operationalizing these strategies and reducing population-level disparities through enhancing genetic counseling and testing (GCT) and subsequent cascade testing/personalized care. Objective: To present emerging results from a RCT comparing the effectiveness of two precision cancer prevention strategies on increasing GCT among Latinas and networks with elevated biological and adverse SDOH risks. Methods: Latinas Lideres en Salud (LaLiSa) is an ongoing RCT is situated in a 14-site federally qualified health center (FQHC) in Chicago. This unique FQHC has a comprehensive GCT program, as part of its integration with an academic medical center. Eligibility criteria for patients include: 1) identification as Latina, Hispanic, Chicana, etc.; 2) age of 18+ years old; 3) personal or family history of BC or related cancers (e.g., ovarian); 4) no previous GCT uptake; and, 5) no prior volunteerism. Patients are randomly assigned to participate in one of two 3-week phone-based interventions from a community agency. Both interventions offer personalized BC education, SDOH screening and navigation, and free/low-cost GCT services. “Educate” offers education on risk reduction (diet, exercise). “Empower” offers skills training on sharing precision cancer prevention information with family and other network members, who can also be eligible for SDOH navigation and GCT services. Data collection includes two surveys (baseline, post-intervention) for relevant covariates and use of study/navigation records for GCT uptake. Results: Of 299 patients approached, 89 participants have enrolled in the RCT (42 educate, 45 empower), with 89% retention. Approximately 55% are 50+ years old, 85% prefer Spanish, 65% have less than a high school education, and 64% have Medicaid/Medicare. For BC and SDOH risks, 17% are cancer survivors, 81% have financial stress and 42% have other competing SDOH risks (intimate partner violence, housing instability, transit instability). No significant arm differences exist. About 76% have initiated GCT referrals and 43% of participants have received GCT services, including 70% who have been identified as having elevated hereditary risk. Empower participants have been more likely to obtain GCT services than Educate participants, (51% vs. 33%, aOR = 5.44, 95%CI[1.45, 20.40], p=.01) after adjusting for age and self-reported social desirability. Discussion: Emerging data suggest the feasibility of precision cancer prevention strategies through FQHC-community-academic partnerships. Empower approaches may be more effective for enhancing at-risk Latinas’ GCT uptake than Educate approaches, when combined with SDOH navigation and free/low-cost GCT services. Limitations concern generalizability due a small, non-probability based sample. Citation Format: Paola Torres, Carolina Bujanda, Celeste Charchalac-Zapeta, Juanita Arroyo, Pamela Ganschow, Vivian Pan, Nathan Stackhouse, Sage J. Kim, Araceli Lucio, Yamilé Molina. Empowering Latinas to obtain genetic services: Comparing precision cancer prevention strategies [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A025.
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Guadamuz, Jenny, Ronac Mamtani, Xiaoliang Wang, et al. "Abstract A049: Racial/ethnic and socioeconomic inequities in clinical trial participation among US community oncology patients, 2011-2021." Cancer Epidemiology, Biomarkers & Prevention 32, no. 1_Supplement (2023): A049. http://dx.doi.org/10.1158/1538-7755.disp22-a049.
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Abstract Introduction: While oncology clinical trials disproportionately recruit from academic medical centers, most patients receive care in the community setting. However, there is limited information regarding clinical trial participation rates, including inequities by race/ethnicity and the social determinants of health (SDoH), in community practices. Here we assessed factors associated with clinical study drug (CSD, proxy for trial participation) receipt among patients diagnosed with 21 common cancers in community practices. Methods: This retrospective study used the nationwide Flatiron Health electronic health record-derived de-identified database of patients with cancer. The cohort included patients (≥ 18 years) diagnosed with cancer (initial, advanced, or metastatic diagnosis; depending on the cancer type) between January 2011 and November 2021 (follow-up through March 2022). We examined inequities in receipt of CSD after diagnosis by race/ethnicity, insurance coverage, and area-level SDoH indicators (e.g., socioeconomic status [SES] and predominant race/ethnicity [proxy for residential segregation]). SDoH indicators contextualizing where patients live were defined using Census block group/tract data from the American Community Survey (2015-2019). To evaluate factors associated with CSD receipt, we used time-to-event analysis where patients were followed from index diagnosis to their first documented receipt of CSD, death, or last recorded activity. Separate Cox proportional hazards models adjusted for clinical characteristics (i.e., age, sex, performance status, and stage) were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results: This study included 196,270 patients (median age: 69 years, 49.5% women; 75.2% non-Hispanic/Latinx [NH] White, 6.2% NH-Black, 3.3% Latinx), of whom 3.7% received CSDs. Black (2.6%, HR 0.56 [CI: 0.51- 0.62]) and Latinx patients (2.6% (HR 0.54 [CI: 0.48-0.62]) were less likely to receive CSDs than white patients (4.3%). Individual and area-level SDoH were associated with CSD receipt. For example, patients without documented insurance (2.7%, HR 0.61 [CI: 0.56-0.66]) or with Medicaid coverage (2.6%, HR 0.58 [CI: 0.52-0.65]) were less likely to receive CSDs than patients with commercial coverage (4.7%). Patients living in predominately non-white and lower SES neighborhoods were less likely to receive CSDs, as were those in neighborhoods whose residents disproportionately lacked U.S. citizenship, had limited English proficiency, and had low rates of vehicle ownership. Conclusion: There are substantial inequities in CSD receipt among patients who receive care in community cancer clinics. Black, Latinx, and uninsured patients, as well as those from historically marginalized neighborhoods were less likely to receive CSDs. Without focused policy and operational efforts to increase clinical trial enrollment of racially, ethnically, and socio-demographically diverse patient populations, clinical trials may proliferate inequities in investigational drug access and potentially cancer outcomes. Citation Format: Jenny Guadamuz, Ronac Mamtani, Xiaoliang Wang, Cleo A. Ryals, Ivy Altomare, Alemseged A. Asfaw, Wendy Camelo Castillo, Harlan Pittell, Gregory S. Calip, Somnath Sarkar. Racial/ethnic and socioeconomic inequities in clinical trial participation among US community oncology patients, 2011-2021 [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 A049.
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Takruri, Lina, Farah Abu Khadra, Toth Akos Levente, and Miklos Banhidi. "Environmental Influence on the Physical Activity and Obesity Rates of the Hungarian Adult Females: A Systematic Review." Hitit Movement Science Journal 1, no. 1 (2024): 28–53. https://doi.org/10.5281/zenodo.14713150.
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Introduction: physical inactivity is insidiously taking over people’s lives. As it interplays with improper dietary habits, obesity rates can have growing incidence. Those outcomes and health practices are influenced by the environment that adult females live at, since they are required to perform main social roles they carry during adulthood. This content analysis aims to analyse how the environment in Hungary influences their lifestyle patterns, health practices and outcomes.Methods and Objectives: the objective of this study is to analyse how social environment affect physical activity and domains of the Hungarian female adults and as a result the obesity rates among them. following the Social Determinants of Health model, a literature analysis from statistical reports and research articles was carried out in April 2024 to collect results and data related to the five determinants of health. Besides, physical activity, eating patterns, and obesity rates were collected from databases to correlate the SDOH with obesity.Results: Hungarian adult females tend to have sufficient PA level. However, obesity rates among them are considered high compared with European countries, this is due to PA domains that they tend to practice which are mainly not related to LTPA. Additionally, dietary patterns and caloric intakes were among the highest in European countries. Socio-economic status showed negative impact on their lifestyle patterns, while built environment had a positive impact.Conclusion: Interventions to enhance LTPA are needed, since it has better influence on their health outcomes and practices than other PA domains. The utilization of built environment can help to create outdoor activities with low fees to encourage Hungarian female adults to practice LTPA. Also, there should be focus on nutrition and PA guidelines in public and in working environment.
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Kim, Yoonji, Xiaoxi Meng, Jaesung Choi, et al. "Abstract 2260: Social vulnerability and epigenetic signatures in adult survivors of childhood cancer with African ancestry: An epigenome-wide association study." Cancer Research 85, no. 8_Supplement_1 (2025): 2260. https://doi.org/10.1158/1538-7445.am2025-2260.
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Abstract Background: Social determinants of health (SDOH) are increasingly recognized as critical factors in shaping long-term adverse health outcomes among childhood cancer survivors (survivors) because long-lasting toxicities from cancer treatment may be exacerbated by social adversity. Our previous epigenetic study of SDOH primarily focused on survivors of European ancestry, using measures such as educational attainment, personal income, and the Area Deprivation Index. This study aims to enhance understanding of the biological embedding of social adversity in survivors of African ancestry using the Social Vulnerability Index (SVI). The SVI provides a more comprehensive representation of SDOH, capturing neighborhood-level social vulnerabilities and aligning with the objectives of Healthy People 2030. Methods: Survivors of African ancestry from the St. Jude Lifetime Cohort were included. DNA methylation (DNAm) profiles were generated with EPIC BeadChip v1 using blood-derived DNA. SDOH factors included social vulnerability (four domains from the SVI: socioeconomic, household composition/disability, minority status/language, and housing/transportation), educational attainment, and personal income. An epigenome-wide association study (EWAS) was used to evaluate the association between DNAm at each CpG and SDOH factors, adjusting for attained age, sex, cancer treatment exposures, and leukocyte composition. Results: The study included 367 survivors (50.0% males; median age at blood draw for DNAm = 32.75 and interquartile range = 27.9-38.5 years). EWAS identified an epigenome-wide significant association between cg25793377 and overall SVI (beta=0.18, SD=0.033, p=8.73×10-8). Specifically, this association was significant for the socioeconomic domain of the SVI (beta=0.14, SD=0.035, p=8.11×10-5), but not significant for three other domains of SVI). Moreover, this CpG was not associated with personal-level SDOH factors, including educational attainment and personal income. This CpG maps to FFAR4, which encodes a G protein-coupled receptor (GPR) belonging to the rhodopsin family of GPRs and is a receptor for free fatty acids, including omega-3s, indicated in suppression of anti-inflammatory responses and insulin sensitizing; cg25793377 is also associated with protein levels in whole blood, including GZMK and TNFRSF17, both implicated in immune function and pro-inflammation. Conclusion: This study highlights the potential impact of neighborhood-level socioeconomic status in epigenome alteration among childhood cancer survivors with African ancestry, suggesting that socioeconomic vulnerability has molecular effects. These findings support the hypothesis that distal social factors become biologically embedded through epigenetic modulation, potentially influencing health trajectories in childhood cancer survivors. Citation Format: Yoonji Kim, Xiaoxi Meng, Jaesung Choi, Tiffany Eulalio, Noel-Marie Plonski, Heather Mulder, John Easton, Emily Walker, Geoff Neale, Kirsten Ness, Melissa M. Hudson, Gregory T. Armstrong, I-Chan Huang, Zhaoming Wang. Social vulnerability and epigenetic signatures in adult survivors of childhood cancer with African ancestry: An epigenome-wide association study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 2260.
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Narra, Vijeth, Alex Krule, Abdul J. Zakkar, et al. "Abstract 4925: Social determinant predictors of lung cancer incidence in diverse urban populations." Cancer Research 85, no. 8_Supplement_1 (2025): 4925. https://doi.org/10.1158/1538-7445.am2025-4925.
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Abstract Background: Lung cancer is the leading cause of cancer-related mortality globally. While screening and predictive analytics provide insights into its pathogenesis, the role of social determinants of health (SDOH), particularly in urban U.S. populations, is unexplored at the individual level. This study examines associations between SDOH factors and lung cancer within Chicago. Methods: An IRB-approved protocol was used to build a retrospective cohort of 11, 154 patients (60% African American [AA], 30% White, 10% Other) from the University of Illinois Health System. Inclusion criteria followed the U.S. Preventive Services Task Force guidelines. Twenty-three zip code-level SDOH indices (measured between 2016-2023) and patient data were analyzed using statistical analyses, including hypergeometric testing and principle component analysis. Benjamini-Hochberg correction was used for multiple hypothesis testing. Results: Non-cancer patients had less green space access than lung cancer patients (meandiff=0.93, P=0.048). Lung cancer incidence correlated with increased fine particulate matter (PM2.5) levels (meandiff=0.03, P=0.030). Men with lung cancer had lower PM2.5 exposure (meandiff=0.06, P=0.007), poverty rates (meandiff=1.73, P=0.003), and Medicaid coverage (meandiff=1.89, P=0.017) compared to women, suggesting increased sensitivity to these factors. Patients with low/normal BMI and lung cancer experienced higher food insecurity (meandiff=0.64, P=0.019) compared to those with high BMI. Among non-cancer patients, low/normal BMI individuals showed lower area deprivation scores (meandiff=1.38, P=0.001) but higher lack of vehicle access (meandiff=1.34, P=4.202e-7), lifetime inhalation cancer risks (meandiff=0.29, P=0.003), and respiratory hazards (meandiff=0.01, P=0.003) compared to high BMI individuals. AA patients experienced disproportionately adverse SDOH impacts, regardless of cancer status (P&lt;0.001). AA lung cancer patients had higher PM2.5 exposure than non-cancer AA patients (meandiff=0.03, P=0.016). AA women without lung cancer had higher PM2.5 exposure (meandiff=0.02, P=0.010), green space access (meandiff=1.02, P=0.001), and respiratory hazard risks (meandiff=0.004, P=0.028), but lower high school graduation rates (meandiff=0.401, P=0.046) compared to AA men. Conclusions: Our preliminary findings highlight the need to integrate environmental and social variables, such as PM2.5 and SDOH, into lung cancer risk frameworks.. Additional studies are also merited to investigate a mechanistic link between SDOH factors, PM2.5, and lung cancer disparities. Limitations: Patient zip codes may not reflect long-term residential histories. Minimal PM2.5 variability at the zip code level warrants higher-resolution mapping. Racial comparisons were limited to AA and White patients, prompting broader demographic inclusion in future studies. Citation Format: Vijeth Narra, Alex Krule, Abdul J. Zakkar, Mason Burrage-Burton, Farah Yousef, Vijayakrishna Gadi, Frank Weinberg, Mark Korpics, Yamilé Molina, Sage J. Kim, Margaret Geise-Wright, Zhengjia Chen, Elisabeta Marai, Ryan H. Nguyen, Ameen A. Salahudeen. Social determinant predictors of lung cancer incidence in diverse urban populations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4925.
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Sathe, Claire, David DeStephano, Anita Gul, et al. "Abstract PO1-10-03: Prevalence of and Factors Associated with Food Insecurity and Other Adverse Social Determinants of Health Among Breast Oncology Patients." Cancer Research 84, no. 9_Supplement (2024): PO1–10–03—PO1–10–03. http://dx.doi.org/10.1158/1538-7445.sabcs23-po1-10-03.
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Abstract Background: Social determinants of health (SDOH), the non-medical factors that influence health status, have a profound impact on breast cancer (BC) outcomes and contribute to survival disparities. Food insecurity (FI), defined as a lack of consistent access to adequate food resources, is a modifiable SDOH associated with treatment disruptions, medication nonadherence, and decreased quality of life. To identify at-risk patients and inform future interventions, we implemented SDOH screening of patients seen in breast oncology clinic at our urban academic medical center. Methods: Screening was conducted through an 8-item questionnaire on the electronic patient portal. The questions covered FI, housing and transportation challenges, and emergency department (ED) visits. We conducted a retrospective analysis of SDOH data collected among patients scheduled for a breast oncology appointment between 11/1/22 and 5/25/23. Any level of food hardship or concern constituted a positive FI screen. Descriptive statistics were used to determine the prevalence of FI and other SDOH, to assess differences in FI rates by age, race/ethnicity, and clinical stage, and to compare characteristics of food-insecure vs food-secure patients. We also conducted a multivariable logistic regression analysis to estimate the odds ratio (OR) and 95% confidence interval (CI) associated with sociodemographic/clinical factors and FI. Results: A total of 2,585 patients were seen in our breast oncology practice, of which 1,189 (46.0%) were screened for SDOH, including 41.2% non-Hispanic White (NHW), 9.6% non-Hispanic Black (NHB) and 21.0% Hispanic patients. Among patients who responded to each SDOH question, 15.5% (146/940) reported some level of FI; 8.7% (84/962) were unable to pay their rent or mortgage on time; for 5.8% (57/989), lack of transportation interfered with their treatment. The FI rate differed significantly by race and ethnicity: 4.5% of NHW, 15.2% of NHB, and 41.8% of Hispanic patients reported FI (p&lt; 0.001). In multivariable analysis, NHB and Hispanic patients also had significantly higher odds of FI compared to NHW patients (OR=3.68, 95% CI=1.7-7.7, p&lt; 0.001 for NHB and OR=15.0, 95% CI=8.8-27.1, p&lt; 0.001 for Hispanic patients). Patients with metastatic disease had higher rates of FI compared to other breast oncology patients (23.6% vs 14.8%, p=0.048), and a metastatic BC diagnosis was associated with over twice the odds of FI (OR=2.18, 95% CI=1.1-4.2, p=0.02). Among food-insecure patients, 41.1% were unable to pay their rent or mortgage on time and 22.6% reported transportation difficulties interfering with treatment (vs 2.6% and 2.4%, respectively, for food-secure patients (p&lt; 0.001)). Compared to food-secure patients, those who were food-insecure had significantly higher rates of self-reported ED visits in the past 12 months: 18.8% vs. 33.6% reported at least 1 ED visit, respectively, and 5.2% vs. 16.4% reported multiple ED visits, respectively (p&lt; 0.001). Conclusions: In this analysis of SDOH data among patients seen in breast oncology clinic, FI was the most common social health risk reported, with nearly a quarter of patients with metastatic BC reporting FI. Racial/ethnic minorities were also at considerably higher risk for FI. ED utilization was significantly higher among food-insecure patients. Targeted interventions to reduce FI in at-risk populations are warranted to improve clinical and healthcare utilization outcomes. Sociodemographic and Clinical Characteristics and Other Reported Social Determinants of Health Among Food-Secure vs Food-Insecure Patients Citation Format: Claire Sathe, David DeStephano, Anita Gul, Melissa Beauchemin, Justine Kahn, Melissa Accordino, Katherine Crew, Ngozika Emezienna, Dawn Hershman. Prevalence of and Factors Associated with Food Insecurity and Other Adverse Social Determinants of Health Among Breast Oncology Patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-10-03.
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Sleiman, Marcelo, Tara Suntum, Nina Kadan-Lottick, et al. "Abstract B067: A mixed-methods health services analysis of disparities and social vulnerabilities in childhood cancer survivors’ long-term follow-up care." Cancer Epidemiology, Biomarkers & Prevention 33, no. 9_Supplement (2024): B067. http://dx.doi.org/10.1158/1538-7755.disp24-b067.
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Abstract Pediatric cancer affects &gt;15,000 US children annually. Treatment advances have led to an increase in those surviving the disease, and these patients must be managed to control their long-term comorbidities. Unfortunately, a majority are nonadherent to post-treatment care guidelines and become lost to follow-up. This is especially true for those from underserved backgrounds, including survivors who are Black and Latine. To help understand this disparity, we studied the organization and delivery of pediatric cancer survivorship care at an urban comprehensive cancer center. Research included: 1) a qualitative study exploring healthcare barriers and facilitators of survivors’ adherence to long-term follow-up care, as determined by N=31 key informants (pediatric oncology care providers, administrators), and; 2) a retrospective cohort study (2007- 2020) among N&gt;350 survivors (10% Black, 28% Latine, 12% Asian; 47% from vulnerable neighborhoods) assessing social determinants of health (SDoH) and its cofactors, adjusted for vital status. Interviews were recorded, transcribed, and thematically analyzed using software (K&gt;.70). Three major themes emerged in survivors’ adherence: 1) healthcare system-level influences (69%), SDoH (25%), and intra/interpersonal factors (16%). At the system-level, informants noted opportunities to strengthen adherence, especially for survivors from underserved backgrounds, including the provision of greater social support (14%), easing appointment scheduling (11%), offering high-quality ambulatory and specialty care within the system upon entering young adulthood (12%), and cultural competency training for staff (6%). Among SDoH, informants noted transportation and geographic challenges in accessing the healthcare system (25%), insurance coverage for follow-up care (17%), and strengthening trust with marginalized communities (17%). For intra/interpersonal factors, time- and age-related changes in survivors’ medical needs were acknowledged as barriers to be overcome (28%), along with providing greater patient education (11%) and heightened salience of follow-up care (17%). Conversely, the provider-patient relationship was noted as a strength in promoting adherence (23%). Retrospective cohort results revealed that survivors’ attendance at dedicated clinics was suboptimal (52% &gt;= 2 years off-therapy), as were rates of system-wide ambulatory care encounters 3+ and 5+ years post-therapy. At the bivariate level, non-Hispanic Black survivors (68%), adolescents (58%), and those with CNS tumors (81%) had the lowest likelihood of survivorship clinic attendance (p&lt;.05)–underscoring qualitative findings on SDoH. Area-level SDoH indices were unrelated to the cohort’s adherence, highlighting qualitative findings on intra/interpersonal barriers and facilitators. These data lend insights into transformations possible within the organization and delivery of healthcare to young survivors, especially those from underrepresented backgrounds, including greater attention to SDoH and strengthening cultural competence among health system employees. Citation Format: Marcelo Sleiman Jr, Tara Suntum, Nina Kadan-Lottick, Brianna Miller, Mary R Yockel, Arnold Potosky, Chiranjeev Dash, Adil Alaoui, Burton Appel, Ken Tercyak. A mixed-methods health services analysis of disparities and social vulnerabilities in childhood cancer survivors’ long-term follow-up care [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B067.
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Austin, Jessica D., Todd Huschka, Amelia Barwise, Megan Allyse, and Sean Phelan. "Abstract A077: The role of social determinants of health on beliefs around the benefits of clinical trials." Cancer Epidemiology, Biomarkers & Prevention 32, no. 12_Supplement (2023): A077. http://dx.doi.org/10.1158/1538-7755.disp23-a077.
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Abstract Background: Individuals from diverse racial/ethnic and disadvantaged backgrounds are underrepresented in cancer clinical trials, compounding the difficulty of adequately understanding, addressing, and reversing health inequities. Social determinants of health (SDOH) factors likely contribute to disparities in cancer trial enrollment. While the presence of SDOH has shown to be associated with clinical trial participation, few studies have explored the role of SDOH in shaping beliefs around the benefits of clinical trials. Thus, this study aims to identify SDOH factors associated with beliefs around the benefits of clinical trial participation. Methods: This is a cross-sectional study of data from the Community Health Assets and Resilience Measures survey. The survey was administered in Fall 2021 to community members (N=3593; 98% &gt; 50 years of age, 68% male, 52% racial/ethnic minority) residing in three states within the Mayo Clinic catchment area. Survey items assessed SDOH factors including financial instability, childcare, transportation, food insecurity, safety, literacy, social isolation, and perceived discrimination. Participant beliefs around the benefits of clinical trial participation was measured by rating level of agreement to 4 statements: ‘People in my community can benefit from participating in clinical trials’, ‘Participation in clinical trials benefits society’, ‘Participation in clinical trials is risky’, ‘I would personally benefit’, and ‘People in my community would benefit’. Response options were dichotomized as ‘agree’ and ‘disagree’ and adjusted stepwise logistic regression analyses were performed to assess factors associated with beliefs about clinical trials. Results: Race/ethnicity was significantly associated with all beliefs with Indigenous populations being significantly more likely to agree that people in their community could benefit from clinical trials, clinical trials benefit society, participation in clinical trials is risky, and that they would personally benefit. In adjusted analyses, financial instability, food insecurity, transportation, childcare, safety, social isolation, literacy, and discrimination were significantly associated with beliefs about the benefits of clinical trial participation. Neighborhood safety was most strongly associated with the belief that ‘People in my community can benefit from participating in clinical trials’ and ‘I would personally benefit from clinical trials’. Health literacy was most strongly associated with the belief that clinical trials benefit society and the community. Finally, the experience of 'people act as if they think you are not smart' (discrimination) was most strongly associated with the belief that clinical trials are risky. Conclusion: Clinical trials are the cornerstone to advancing equitable cancer care. Innovative, multifaceted, community-driven strategies are needed that address negative beliefs around the benefits of clinical trial participation to address existing recruitment and retention shortcomings. Citation Format: Jessica D. Austin, Todd Huschka, Amelia Barwise, Megan Allyse, Sean Phelan. The role of social determinants of health on beliefs around the benefits of clinical trials [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A077.
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Lu, Kun-Han, Yi Xiao, Aamna Akhtar, et al. "Abstract 4971: Predicting lung cancer screening adherence among underserved and minoritized communities using social determinants and neighborhood factors." Cancer Research 85, no. 8_Supplement_1 (2025): 4971. https://doi.org/10.1158/1538-7445.am2025-4971.
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Abstract Purpose: Lung cancer screening (LCS) lowers cancer mortality if individuals adhere to annual scans. Minoritized communities have significantly lower adherence to LCS than non-Hispanic whites. The influence of social determinants of health (SDOH) on these disparate adherence rates are rarely evaluated. The aim of this study is to develop a machine learning (ML) model that integrates individual and neighborhood level SDOH to predict which minoritized individuals are at risk of LCS non-adherence. Methods: A total of 168 participants with high-risk smoking histories who underwent their first low dose computed tomography (LDCT) between 2017 and 2021 were enrolled. Surveys on SDOH and perceived discrimination were completed. Participants’ addresses were joined to neighborhood level SDOH data from various publicly available sources. These indices captured neighborhood socioeconomic status and segregation. Adherence rates were calculated by assessing electronic medical records to determine if participants had a second LDCT within 15 months. Participants were temporally split into training (N=125) and testing (N=43) sets with a cut-off date of June 30, 2021. A gradient boosting classifier, XGBoost, was trained to predict LCS non-adherence, incorporating variables such as sociodemographic status, perceived discrimination, previous screenings, smoking status, and geospatial indices. The SHapley Additive exPlanations (SHAP) method was used to determine the relative importance of each feature in the model’s predictions. Results: The participants represented a diverse group: Asian (26%), Black/African American (32%), and Hispanic/Latino (32%). The LCS non-adherence rates were 66% in the training set and 63% in the testing set. The XGBoost classifier achieved an Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.79 and an Area Under the Precision-Recall Curve (AUPRC) of 0.90, outperforming a simple logistic regression model (AUROC=0.63 and AUPRC=0.79). The XGBoost classifier’s performance metrics were Accuracy=0.77, Recall=0.85, Specificity=0.62, Positive Predictive Value=0.79, and Negative Predictive Value=0.71. The SHAP analysis indicated that participants with no prior history of colorectal cancer screening, who lived in areas with lower quality school systems, and with a higher percentage of individuals below the poverty line, were at a higher risk of non-adherence to LCS. Conclusions: LCS reduces lung cancer survival, but LCS adherence is significantly lower in minoritized groups. Our ML model strongly predicted LCS non-adherence based on SDOH and geospatial factors. Specific neighborhood level SDOHs predicted LCS non-adherence more strongly than individual level factors. These findings support interventions that address both individual and neighborhood-level barriers to increase LCS adherence. Citation Format: Kun-Han Lu, Yi Xiao, Aamna Akhtar, Jazma Tapia, Calvin Tribby, Jay Yang, Marta Jankowska, Chi Wah Wong, Loretta Erhunmwunsee. Predicting lung cancer screening adherence among underserved and minoritized communities using social determinants and neighborhood factors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4971.
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Barnard, Mollie, Bo Qin, Marc A. Emerson, et al. "Abstract P3-06-06: Associations between social drivers of health and breast cancer stage at diagnosis among US Black women." Clinical Cancer Research 31, no. 12_Supplement (2025): P3–06–06—P3–06–06. https://doi.org/10.1158/1557-3265.sabcs24-p3-06-06.
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Abstract Introduction: In the US, Black women who are diagnosed with breast cancer experience disproportionately high disease-specific mortality. This is, in part, because US Black women are more likely to be diagnosed with advanced-stage breast cancer. We sought to understand how social drivers of health (SDOH) relate to breast cancer diagnostic stage among US Black women. Methods: This analysis included self-identified Black or African American women diagnosed with breast cancer who were participants in the Black Women’s Health Study (BWHS; n=1,777), the Women’s Circle of Health Study (WCHS; n=1,725), or the Carolina Breast Cancer Study Phase 3 (CBCS; n=1,493). SDOH were self-reported at enrollment in WCHS and CBCS, and on pre-diagnosis questionnaires in the BWHS. Data on stage at diagnosis and tumor characteristics were abstracted from medical records and state cancer registry records. We used polytomous logistic regression adjusted for age at diagnosis, insurance status, and household income below the federal poverty line to estimate odds ratios (OR) and 95% confidence intervals (CI) for stage at diagnosis in association with each categorical SDOH exposure. Two categories of advanced stage (stage 2; stage 3 or 4) were compared to stage 1. Stages 3 and 4 were combined due to small numbers of stage 4 participants (BWHS n=75, WCHS n=50, CBCS n=109). Study-specific ORs were combined using fixed effects meta-analysis. Results: Higher odds of late stage (3 or 4) versus stage 1 cancer were significantly associated with underutilization of mammographic screening (OR=2.97, 95% CI 1.85-4.77) and household income below the federal poverty line (OR=1.90, 95% CI 1.17-3.11). ORs were above 1.0 for lack of health insurance (OR=1.48, 95% CI 0.82-2.67) and lower educational status (i.e., did not graduate from high school; OR=1.24, 95% CI 0.76-2.03) but were not statistically significant. Marital status was not associated with late stage. Discussion: SDOH that reflect economic instability and lower access to preventive healthcare were associated with later stage at diagnosis among US Black women with breast cancer. Interventions to increase screening utilization must contend with financial and insurance barriers to reduce late-stage diagnoses in this historically underserved population. Acknowledgements: The Breast Cancer Research Foundation’s Health Equity Initiative was supported by the Estée Lauder Companies Charitable Foundation. Citation Format: Mollie Barnard, Bo Qin, Marc A. Emerson, Etienne X. Holder, Elisa V. Bandera, Christine B. Ambrosone, Julie R. Palmer, Melissa A. Troester, Terry Hyslop, on behalf of the Breast Cancer Research Foundation’s Health Equity Initiative. Associations between social drivers of health and breast cancer stage at diagnosis among US Black women [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P3-06-06.
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Jones, Nehanda, Adam Blair, Elizabeth Lipschultz, Jacob Koskimaki, Brooke Smither, and Robert Miller. "Abstract P3-03-12: Social Determinants of Health (SDOH) and Z Code Utilization among Patients with Breast Cancer (BC)." Clinical Cancer Research 31, no. 12_Supplement (2025): P3–03–12—P3–03–12. https://doi.org/10.1158/1557-3265.sabcs24-p3-03-12.
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Abstract Background: Previous studies show that SDOH play an important role in BC stage, treatment, and outcomes. Disparities in BC overall survival (OS) by SDOH are well documented. Z codes were introduced into International Classification of Diseases, 10th edition in 2015 to identify reasons for clinical encounters when circumstances other than a disease or injury are recorded as diagnoses, but uptake has been slow. Herein we report Z codes Z55 – Z65, which specifically identify SDOH impacting health care utilization, for BC patients (pts) in CancerLinQ (CLQ). Methods CLQ is a health data platform representing ∼7M pts across 100+ US oncology practices and cancer centers. In this retrospective cross-sectional analysis, CLQ pts diagnosed (dx) with BC actively managed in 2021 were identified and pt diagnosis codes (PDC) evaluated. Descriptive statistics and multi-variate logistic regression analysis were performed, estimating statistically significant proportions (%) and adjusted odds ratios with corresponding 95% confidence intervals [aOR (95% CI)] for associations between independent demographic variables and Z code reporting. BC pts with &gt;1 Z code reported were compared to BC pts with no Z codes. Results We evaluated 8,134,071 BC PDC representing 236,115 BC pts actively managed in 2021. BC pts were 77% Non-Hispanic White (NHW), 16% Non-Hispanic Black (NHB), with Asian and Hispanic/Latino BC pts comprising &lt;6%. BC pts dx age &lt;40 were 3%, 12% dx age 40-49, 29% dx age 50-59, 25% dx age 70-79, with 10% dx age ≥ 80. 52% of BC pts were married, 33% divorced/widowed, with 15% single. BC pts were largely female (99%) and urban (86%). Of the BC PDC assessed, 7,069 were Z code PDC representing 7,624 BC pts, 3.2% of CLQ BC pts actively managed in 2021. Among BC pts represented, 50.9% had 1, 13.4% had 2, 6.3% had 3, 14.6% had 4, and 14.7% had 5+ Z codes reported. The 5 most frequently reported Z code groups were: Z63 (35%) - Support group & family circumstances Z59 (27%) - Housing & economic circumstances Z65 (16%) - Other psychological circumstance Z60 (11%) - Social environment Z56 (5%) - Employment NHB, Asian, and Hispanic/Latino BC PDC had greater odds of Z code reporting compared to NHW, with Hispanic/Latino BC PDC having almost 2x greater odds of Z code reporting [1.8 (1.64, 1.94)]. An inverse relationship was observed between dx age and aOR of Z code reporting, with BC PDC of pts dx age &lt;40 having the greatest odds [1.4 (1.24, 1.58)] and BC PDC of pts dx ≥80 having the lowest [0.8 (0.76, 0.92)]. Divorced/widowed PDC [1.7 (1.60, 1.78)] and single PDC [1.6 (1.53, 1.75)] BC PDC had greater odds of Z code reporting compared to married BC PDC. Rural BC PDC [0.9 (0.81, 0.94) had lesser odds of Z code reporting compared to urban BC PDC. Conclusion CLQ BC Z code utilization in 2021 (3.2%) exceeded previously reported disease-agnostic studies (1.3% - 1.9%). Z codes indicative of factors related to socioeconomic status (SES), employment, and social isolation represent 94% of all Z codes reported among BC PDC in this analysis. This finding is consistent with previous studies of SDOH among BC pts. Hispanic/Latino, divorced/widowed, and single BC PDC had the greatest odds of Z code reporting, with rural BC PDC among the lowest odds. The association of poorer quality care and survival among rural pts is well-known. Similarly, previous studies of women dx age &lt;40 experiencing negative SDOH were more likely to receive chemotherapy, less likely to take endocrine therapy if indicated, and suffered worse OS. Thus, the inverse relationship observed between dx age and Z code reporting as well as low odds of reporting in rural settings should be further studied in future analyses which include BC stage, treatment patterns, and outcomes. Greater Z code reporting by providers could uncover SDOH trends impacting BC diagnosis, healthcare utilization, treatment, and outcomes. Citation Format: Nehanda Jones, Adam Blair, Elizabeth Lipschultz, Jacob Koskimaki, Brooke Smither, Robert Miller. Social Determinants of Health (SDOH) and Z Code Utilization among Patients with Breast Cancer (BC) [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P3-03-12.
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Burke, Sara, Constantine Daskalakis, Khaldoun Hamade, Christopher McNair, and Nicole Simone. "Abstract B005: Using EMR-based SOGI data collection to identify disparities in sexual and gender minority patients with cancer." Cancer Epidemiology, Biomarkers & Prevention 33, no. 9_Supplement (2024): B005. http://dx.doi.org/10.1158/1538-7755.disp24-b005.
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Abstract Purpose/Objectives: Sexual and gender minority (SGM) patients have been suggested to face disparities in cancer screening and outcomes. Despite this, a large barrier to improving care for this population is the lack of sexual orientation and gender identity (SOGI) data available in surveillance, research, and clinical settings. This study aimed to create integrated datasets containing SOGI and clinical data from electronic medical records (EMR) to better characterize SGM cancer patients with the goal of narrowing disparities and improving cancer care by tailoring to the needs of this population. Materials/Methods: The cancer patient population was identified using Thomas Jefferson University’s Epic-based registry focused on actively managed cancer patients. Additional data elements were linked to this initial dataset: SOGI data (collected using Epic’s SOGI module), general demographics, SDOH data from Epic’s SDOH module as well as geospatially inferred SDOH information (social vulnerability index), and molecular diagnostic information. A patient was considered to be part of the SGM community if any of the following criteria were met: (i) their gender identity was listed as other than “male” or “female”; (ii) there was a difference between their sex assigned at birth, their legal sex, and/or their gender identity; (iii) their sexual orientation was marked anything other than “straight.” Logistic regression was used to compare the data for the SGM community vs. the non-SGM patients within the dataset. Results: 90,506 patients were identified from the active cancer registry with SOGI data available on 11,219 patients (471 SGM and 10,748 non-SGM patients). The SGM population was more likely to be younger and aged 18-34 (5.5% vs. 1.6%) and aged 35-70 (61.6% v 51.2%), single (33.1% vs. 17.9%), Latinx/Hispanic (6.4% vs. 5.0%), and Asian/Pacific Islander (3.2% vs. 2.5). Adjusted for sex, age, race, ethnicity, marital status, and cancer site, SGM and non-SGM patients did show differences in obesity (39.7% vs 34.4%, p=0.347) or smoking (10.8% vs 8.5%, p= 0.629) rates. SGM patients had a higher frequency of alcohol (45.3% vs 39.7%, p=0.05) and illicit drug use (13.4% vs 7.5%, p=0.014). No difference between SGM and non-SGM patients was noted in SDOH or the prevalence of genomic testing rates. Conclusions: This study demonstrates the feasibility of integrating SOGI data with other clinical data within the EMR so that researchers can understand the specific needs of the SGM cancer population. These data demonstrate that risk factors of cancer such as alcohol and drug use were significantly higher in our SGM population highlighting the need for cancer care navigators to assist in connecting patients to resources specific to their needs. Our study was limited by the small number of patients with SOGI and SDOH data. This highlights the need to increase SOGI training for providers so that a comprehensive evaluation of factors leading to health disparities in the SGM community can be discerned and cancer care can be personalized and improved. Citation Format: Sara Burke, Constantine Daskalakis, Khaldoun Hamade, Christopher McNair, Nicole Simone. Using EMR-based SOGI data collection to identify disparities in sexual and gender minority patients with cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B005.
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Plonski, Noel-Marie, Cheng Chen, Qian Dong, et al. "Abstract 3503: Racial disparity and roles of social determinants of health in epigenetic age acceleration among survivors of childhood cancer." Cancer Research 83, no. 7_Supplement (2023): 3503. http://dx.doi.org/10.1158/1538-7445.am2023-3503.
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Abstract Our published studies demonstrated that epigenetic age acceleration (EAA) is significantly higher in childhood cancer survivors than non-cancer controls. Additionally, EAA is associated with germline genetics, cancer treatments, unfavorable health behaviors, and chronic health conditions. However, our previous studies were limited to non-Hispanic whites (NHW). We aimed to investigate and compare the EAA between non-Hispanic blacks (NHB) and NHW, and evaluate the contribution of social determinants of health (SDOH) to potential racial disparity in EAA. Methylation profiling was generated using Infinium EPIC BeadChips on blood derived DNA from 460 NHB and 2,052 NHW from the St. Jude Lifetime Cohort. EAA was estimated as the residual from the fit of a simple linear regression of epigenetic age (EA, using Levine’s clock) on chronological age (CA, i.e., age at DNA sampling). Cumulative doses of chemotherapy and region-specific radiation exposures were abstracted from medical records. Educational attainment was categorized into 3 levels (&lt; high school, high school, ≥ college). Personal income was categorized into 3 levels (none, &lt; $40,000 and ≥ $40,000). For socioeconomic area deprivation index (ADI), we considered &gt;75th percentile, 40th to 75th percentile, and &lt;40th percentile as high, moderate, and low deprivation, respectively. Multivariable linear regression evaluated associations of EAA with race and SDOH adjusting for sex and cancer treatments. Mediation analysis treated SDOH as mediators, EAA as an outcome, and race as an exposure. The Pearson r between EA and CA was 0.85 and 0.58, and the age slope of EA (i.e., annual change rate of EA) was 1.21 and 0.91, for NHW and NHB, respectively. EAA was much higher in NHB (mean, 5.31; sd, 7.21) than NHW (mean, -1.19; sd, 12.48) with significance in a multivariable regression model adjusting for sex and cancer treatment (NHB vs. NHW: β = 1.90, P = 9.24×10-5). EAA was also associated with educational attainment (high school vs. &lt;high school: β = -2.84, P = 3.22×10-5; college vs. &lt;high school: β = -3.75, P = 2.03×10-7) and ADI (moderate vs. low: β= 1.07, P = 0.026; high vs. low: β = 1.58, P = 2.26×10-3), but not personal income. Notably, after adjusting for SDOH, the association between EAA and race was moderately attenuated (β = 1.50, P = 8.37×10-3). Both educational attainment (15.5%) and ADI (21.4%) mediated the association between race and EAA. We found racial disparity in EAA, with both personal and geographic SDOH as mediators of the association between race and EAA. These data indicate that changes in the social support system at both a personal and community level are needed to reduce socioeconomic disadvantage (e.g., lower education and poor living conditions) and hence the biological aging trajectory. In addition, moderate correlation between EA and CA among NHB suggests that further refined measurement of EA for NHB survivors is needed. Citation Format: Noel-Marie Plonski, Cheng Chen, Qian Dong, Na Qin, Nan Song, John Easton, Heather Mulder, Emily Walker, Geoffrey Neale, Jinghui Zhang, Kevin Krull, Kirsten K. Ness, Melissa M. Hudson, Leslie L. Robison, I-Chan Huang, Zhaoming Wang. Racial disparity and roles of social determinants of health in epigenetic age acceleration among survivors of childhood cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3503.
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Odedina, Folakemi, Che Ngufor, Arnold Merriweather, et al. "Abstract B028: A point of prostate cancer diagnosis (PPCD) Virtual Robot Assistant (ViRA) intervention for newly diagnosed Black men: An iCCaRE consortium for prostate cancer in Black men project." Cancer Epidemiology, Biomarkers & Prevention 32, no. 1_Supplement (2023): B028. http://dx.doi.org/10.1158/1538-7755.disp22-b028.
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Abstract Background: To date, the disparate burden of prostate cancer (CaP) in Black men (BM) is still poorly understood. More disconcerting is the limited access to effective, culturally tailored behavioral interventions to support BM diagnosed with CaP, especially at the point of prostate cancer diagnosis (PPCD). From the PPCD, the transition to CaP survivorship can be mentally and physically trying, especially for those lacking emotional and financial support. It is important to provide psycho-oncology support, address social determinants of health (SDOH) and make emotional support available to ethnically diverse BM at the PPCD. We are addressing the CaP disparities experienced by BM at the PPCD through the Inclusive Cancer Care Research Equity (iCCaRE) for Black Men Consortium. Aim: As part of the iCCaRE for Black men Consortium, the specific aim of our project is to develop a PPCD-based Augmented Reality (AR) intervention program, the iCCaRE PPCD Virtual Robot Assistant (ViRA). The ViRA is based on the established efficacy of six CaP care and survivorship (CaPCaS) video interventions, and will support BM at the PPCD. Methodology: The efficacy of six CaPCaS videos were established through formative research that included 17 BM in Florida. Based on pre- and post-test design, data were collected from participants using a structured survey tailored to each CaPCaS intervention: Prevention, Detection, Diagnosis, Treatment, Survivorship and Advocacy form. Following the efficacy study, the iCCaRE PPCD ViRA was proposed as one of five iCCaRE Science of Survivorship (S.O.S) projects to improve the quality of life of BM. Results: Most of the participants for the efficacy study reported that they were: US-born BM; married; college educated; earn less than $60,000; retired; have health insurance; have annual health examination; have a regular doctor; and were screened within the last year. The CaPCaS videos were found to be efficacious in improving attitude towards CaP screening, beliefs about CaP screening, perceived behavioral control and CaP knowledge. Participants also rated the quality of the videos high and expressed high satisfaction with the videos. We are currently in the development phase of the PPCD iCCaRE ViRA, which is based on behavioral science and health communications model. The ViRA will provide SDOH navigation services, psycho-oncology support and emotional support. The acceptance and usability of the iCCaRE ViRA will be established at urology clinics in Florida as part of the iCCaRE Consortium HEROICA Phase I study. We will test the central hypothesis that improving SDOH factors and CaPCaS-related factors will lead to an improvement in patient reported outcomes. Conclusion: We established the efficacy of the CaPCaS interventions in supporting BM across the CaP care continuum. The iCCaRE ViRA under development will target intervention at the PPCD and deliver a smart and connected personalized AR-enabled intervention system that will positively impact CaP diagnosis experience of BM. Citation Format: Folakemi Odedina, Che Ngufor, Arnold Merriweather, Deidre Pereira, Jennifer Crook, Fathi Parisa, Roxana Dronca, Ernest Kaninjing, Solomon Rotimi, Kimlin Ashing, Manisha Salinas, Sha’Reff Rashad, John McCall, Ebenezer Erefah, Ayinde Yahaya, Wes Sholes. A point of prostate cancer diagnosis (PPCD) Virtual Robot Assistant (ViRA) intervention for newly diagnosed Black men: An iCCaRE consortium for prostate cancer in Black men project [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 B028.
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Bournigal-Feliciano, Mariela, Marievelisse Soto-Salgado, Hilmaris Centeno-Girona, et al. "Abstract 2245: Awareness and participation in cancer-related clinical trials among gastrointestinal cancer survivors." Cancer Research 84, no. 6_Supplement (2024): 2245. http://dx.doi.org/10.1158/1538-7445.am2024-2245.
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Abstract Despite significant advances in cancer prevention, early detection, and treatment, there is a persistent disparity in cancer outcomes between diverse racial/ethnic groups and medically underserved populations in the United States (US). The underrepresentation of non-white racial/ethnic groups in clinical trials (CTs) poses a critical challenge to cancer research and effective care delivery. The Hispanic/Latino population is one of the fastest-growing ethnic groups in the US and has a high rate of gastrointestinal (GI) cancer. Although Hispanics/Latinos comprise 18.5% of the US population, they have participation rates of only 1% in CTs. We aimed to describe the awareness and participation of Hispanic/Latino GI cancer survivors in cancer-related CTs. We analyzed preliminary data from an ongoing cross-sectional study that examines the social determinants of health (SDOH) associated with participation in cancer-related CTs among GI cancer survivors. As of November 7, 2023, 57 individuals aged ≥ 21 years responded to a survey assessing their awareness and participation in CTs, and other SDOH domains. Descriptive statistics were used to describe the population, including frequencies, percentages, mean, and standard deviation. The participants’ mean age was 62.5 ± 12.3 years, and 56.1% were women. Most had more than a high school education (80.6%). Moreover, 59.7% of the participants had state-sponsored health insurance or Medicaid. Twenty-nine (50.9%) of the participants reported having heard about cancer-related CTs; however, only nine (31.0%) indicated that they knew how to participate in a cancer-related CT. Most of the participants had heard about cancer-related CTs from their doctor, nurse, or other health professionals (41.4%), their family/friends (20.7%), or social media/newspapers (20.7%). Furthermore, 13 (44.8%) had been invited to participate and 11 (84.6%) were eligible and participated in cancer-related CTs. Most of the participants who were eligible and participated in cancer-related CTs (90.9%) indicated that they participated because they knew CTs are important for the development of effective cancer treatments. Our preliminary findings show high levels of awareness among Hispanics/Latinos GI cancer survivors towards CTs; however, it is concerning that only a minority of those who were aware of CTs knew how to participate in them. More efforts are needed to assess the factors and SDOH that impact participation in cancer-related CTs among this population. Additionally, we will continue to recruit participants to assess the relationship between adverse SDOH and their willingness to participate in cancer-related CTs. Citation Format: Mariela Bournigal-Feliciano, Marievelisse Soto-Salgado, Hilmaris Centeno-Girona, Sofía Contreras-Fernández, Karina Torres-Mojica, Virginia Williams, Arnethea L. Sutton, Katherine Tossas, Robert Winn, Marcia Cruz-Correa. Awareness and participation in cancer-related clinical trials among gastrointestinal cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2245.
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Centeno-Girona, Hilmaris, Marievelisse Soto-Salgado, Stephanie Cameron-Maldonado, et al. "Abstract 4918: Impact of social drivers of health on clinical trial knowledge among Hispanic/Latino and Black cancer survivors." Cancer Research 85, no. 8_Supplement_1 (2025): 4918. https://doi.org/10.1158/1538-7445.am2025-4918.
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Introduction: Despite significant advancements in cancer treatment, disparities in clinical trial (CT) participation persist among minority populations, such as Hispanic/Latino (H/L) and Black women (BW). Social drivers of health (SDoH) can influence health outcomes and health care decisions, like CT participation. This study assessed the association between SDoH and CT knowledge among H/L and BW cancer survivors in Puerto Rico and in Virginia, United States. Methodology: This cross-sectional study included H/L gastrointestinal (GI) cancer survivors from Puerto Rico and BW with breast or gynecological cancers from Virginia, aged 21+ years. Participants completed an interviewer-administered questionnaire to assess their awareness, knowledge, and participation in cancer-related CTs and SDoH. A logistic regression model was used to estimate the odds ratios and 95% confidence intervals (CI) for CT knowledge and associated factors. As reported in the literature, significant variables (p &lt; 0.05) and other relevant variables were included in the multivariate logistic regression model. Results: As of November 11, 2024, 285 H/L and BW cancer survivors completed the questionnaire. Women accounted for 78% of the sample, and the mean age of study participants was 55 years (SD: 11.8). Over half of the participants (52%) had breast or gynecological cancer, whereas 47% reported GI cancer. While most study participants were aware of CTs (64%) and 80% accurately identified the correct definition, only 26% reported ever participating in a cancer-related CT. Logistic regression models showed that participants with lower educational attainment, those unemployed, and those with another type of transportation rather than their own transportation were significantly more likely to have lower CT knowledge than their counterparts (p&lt;0.05). However, participants who reported an income between $20,000-$74,999 and those who perceived discrimination in medical settings were more likely to have higher CT knowledge than their counterparts (p&lt;0.05). After adjusting for age, sex, educational attainment, employment, and health literacy, participants who reported an income between $20,000-$74,999 (OR: 3.43, 95%CI: 1.39-8.50) and those who perceived at least one type of discrimination in medical settings (OR: 2.44, 95%CI: 1.17-5.09) were more likely to have higher CT knowledge than their counterparts. Conclusion: While CT awareness was relatively high, low CT participation was observed among H/L and BW cancer survivors. Understanding factors that impact CT participation is important for developing targeted interventions to improve CT participation and reduce health disparities among these underserved populations. Acknowledgments: Research supported by an AACR grant, Social Determinants of Health, Grant Number: 23-01-SDoH. Citation Format: Hilmaris Centeno-Girona, Marievelisse Soto-Salgado, Stephanie Cameron-Maldonado, Arnethea L. Sutton, Katherine Y. Tossas, Robert A. Winn, Marcia R. Cruz-Correa. Impact of social drivers of health on clinical trial knowledge among Hispanic/Latino and Black cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4918.
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Aklilu, Bathsheba, Erica Tate, and Cathy Samayoa. "Abstract 4976: Examining the association between chronic inflammation, stress, and resilience factors among diverse breast cancer survivors using the NIH All of Us dataset." Cancer Research 85, no. 8_Supplement_1 (2025): 4976. https://doi.org/10.1158/1538-7445.am2025-4976.
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Abstract Breast cancer disparities exist by race and ethnicity, including disparities in age at diagnosis, quality of life, and health outcomes. These disparities may be influenced by chronic stress, exacerbated by unique challenges that extend beyond disease management, such as the effects of psychosocial stress and social determinants of health (SDOH) on chronic inflammation. Elevated C-reactive protein (CRP) levels, a marker of chronic inflammation, are implicated in worse health outcomes. Understanding how stress and SDOH interact to influence CRP and other inflammatory biomarkers is critical for addressing disparities in survivorship care. However, most studies lack adequate representation of racial and ethnic minorities; thus, factors associated with chronic inflammation among diverse breast cancer survivors remain unknown. This study aims to investigate factors associated with chronic inflammation among diverse breast cancer survivors using the NIH All of Us research dataset. Using Python, a programming language available within the NIH All of Us research program dataset, we examined CRP and additional inflammatory biomarkers and their relationships with stress, economic, social, and environmental factors. Economic and environmental factors included income, housing security, and neighborhood characteristics. Social and psychological factors included social support, the Perceived Stress Scale (PSS), and the Everyday Discrimination Scale (EDS). Multivariate analyses were conducted to evaluate associations between stress, resilience, SDOH, and inflammation, with stratification by age, BMI, and allostatic load. Preliminary findings reveal significant racial and ethnic disparities in CRP levels. Black and Hispanic breast cancer survivors exhibited the highest CRP levels. We identified 3,110 participants with breast cancer in the All of Us research program dataset. Of those, 7.2% were African American or Black, 2.2% were Asian, and 6.7% were Hispanic. We hypothesize that inflammation will be higher among racial and ethnic minorities, as well as among women with higher levels of stressors, such as low income and increased PSS and EDS scores. Furthermore, we expect inflammation to be negatively associated with resilience factors, such as increased social support and greater neighborhood safety. This study will identify factors associated with chronic inflammation among diverse breast cancer survivors and provide a deeper understanding of the biological mechanisms driving breast cancer health inequities. Citation Format: Bathsheba Aklilu, Erica Tate, Cathy Samayoa. Examining the association between chronic inflammation, stress, and resilience factors among diverse breast cancer survivors using the NIH All of Us dataset [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4976.
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Velazquez-Villarreal, Enrique I., and Ei-Wen Yang. "Abstract 1115: PM-AI agent: A conversational artificial intelligence system for precision medicine and advancing health equity through integrative clinical, genomic and social determinants of health data analysis." Cancer Research 85, no. 8_Supplement_1 (2025): 1115. https://doi.org/10.1158/1538-7445.am2025-1115.
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Abstract Introduction: The integration of clinical, genomic, and social determinants of health (SDoH) data is essential for advancing precision medicine. However, significant challenges remain due to the complexity of cancer research workflows, the technical expertise required, and the pressing need to address cancer health disparities. To overcome these barriers, we developed the Precision Medicine AI Agent (PM-AI)—an innovative conversational AI system that enables users to conduct integrative data analyses through natural language inquiries. Methods: PM-AI leverages large language models (LLMs) to convert user instructions into executable code and autonomously analyze local stored datasets. The system performs advanced tasks such as subset comparisons, clinical prevalence studies using odds ratio tests, and survival analyses that provide survival curves and hazard ratios. Additionally, PM-AI delivers detailed analytic reports with actionable insights to support decision-making. To validate its utility, PM-AI was applied to a case-control study using data from TCGA and cBioPortal (including the AACR GENIE dataset). The study examined RAS mutations and their impact on the response to FOLFOX (folinic acid, 5-fluorouracil, and oxaliplatin) in colorectal cancer patients. Notably, the analysis incorporated race, ethnicity, and SDoH data, adhering to NASEM recommendations for population descriptors in genomics research, ensuring equitable and representative insights. Results: PM-AI successfully compared FOLFOX-treated patients with or without RAS mutations and revealed a significant difference in progression-free survival. The result show that KRAS mutations predict a poorer response to FOLFOX and an increased risk of recurrence. These findings were consistent with those reported in the literature, validating PM-AI’s independent analytical capabilities. Conclusion: The development of PM-AI represents a transformative advancement in precision medicine research, addressing key challenges in the integration of clinical, genomic, population-specific variables (race, ethnicity, etc.), and SDoH, into analytical pipelines. By eliminating the need for programming, PM-AI bridges domain expertise with autonomous workflows, empowering researchers across disciplines. Its versatility in handling cross-domain datasets highlights its adaptability to diverse precision medicine applications. Overall, PM-AI ensures equitable and actionable insights, positioning this advance AI system as a scalable tool for advancing precision medicine and promoting health equity in cancer research. Citation Format: Enrique I. Velazquez-Villarreal, Ei-Wen Yang. PM-AI agent: A conversational artificial intelligence system for precision medicine and advancing health equity through integrative clinical, genomic and social determinants of health data analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 1115.
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Mehta, Akhil, Eric Lau, Gayathri Nagaraj, and Hamid Mirshahidi. "Abstract 3662: Association of US county-level social vulnerability index (SVI) with breast and colon cancer screening rates." Cancer Research 82, no. 12_Supplement (2022): 3662. http://dx.doi.org/10.1158/1538-7445.am2022-3662.
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Abstract Introduction: Whether social determinants of health (SDOH) affect US breast and colon cancer screening rates remains unclear. That said, in 2011 the CDC began recording a social vulnerability index (SVI) for all US counties. SVI was designed to capture four SDOH: socioeconomic status (SES), household composition and disability, minority status and language, and housing type and transportation. This retrospective study sought to determine the association of county-level SVI with breast and colon cancer screening rates. Methods: We used publicly available data from the CDC 2018 SVI database to collect SVI scores for every US county. SVI scores range from 0.1 to 1. A lower score indicates low vulnerability, while a higher score suggests high vulnerability. SVI scores were merged with publicly available data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) and National Health Interview Survey (NHIS) containing county modeled estimates for breast and colon cancer screening rates. Counties were then divided into &lt; 50th percentile and &gt;= 50th percentile for breast and colon cancer screening. SVI scores and their four SDOH were compared between groups. Statistical significance between groups was assessed at an alpha less than 0.5. Linear regression was used to identify the association between high county-level SVI and the probability of being &gt;= 50th percentile in breast and colon cancer screening. Results: This study involved 3,109 counties. Compared to counties &gt;= 50th percentile in breast cancer screening (n = 1543), those &lt; 50th percentile (n = 1566) were significantly worse off in SES (0.60 ± 0.27 vs. 0.41 ± 0.27), household composition and disability (0.58 ± 0.28 vs. 0.42 ± 0.28), minority status and language (0.51 ± .30 vs. 0.49 ± .28), housing type and transportation (0.53 ± 0.29 vs. 0.46 ± 0.28), and overall SVI (0.58 ± 0.28 vs. 0.42 ± 0.27) (p &lt; .0001). Likewise, compared to counties &gt;= 50th percentile in colon cancer screening (n = 1548), those &lt; 50th percentile (n = 1561) were also significantly worse off in SES (0.63 ± 0.27 vs. 0.38 ± 0.25), household composition and disability (0.59 ± 0.27 vs. 0.41 ± 0.27), minority status and language (0.54 ± .30 vs. 0.45 ± .27), housing type and transportation (0.54 ± 0.29 vs. 0.46 ± 0.28), and overall SVI (0.61 ± 0.28 vs. 0.39 ± 0.27) (p &lt; .0001). High SVI counties compared with low SVI counties were significantly less likely to be &gt;= 50th percentile in breast cancer and colon cancer screening, OR 0.24 (95% CI 0.20 - 0.29) and 0.14 (95% CI 0.12 - 0.18). Finally, county-level SVI percentile correlated negatively with breast and colon cancer screening rates, Pearson coefficient -0.35 and -0.46. Conclusions: This study highlights the significant impact of US county-level SVI on breast and colon cancer screening rates, signaling the need for more effective intervention strategies and allocation of resources to help improve SDOH for our country's most vulnerable citizens. Citation Format: Akhil Mehta, Eric Lau, Gayathri Nagaraj, Hamid Mirshahidi. Association of US county-level social vulnerability index (SVI) with breast and colon cancer screening rates [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3662.
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Tang, Weizhou, Yanyuan Wu, and Jaydutt Vadgama. "Abstract B150: Social determinants of health and comorbidities increasing inflammation cytokines related to breast cancer in African American and Latinx women." Cancer Epidemiology, Biomarkers & Prevention 33, no. 9_Supplement (2024): B150. http://dx.doi.org/10.1158/1538-7755.disp24-b150.
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Abstract Introduction: Comorbidities such as obesity, Type-2 diabetes (T2D), and hypertension (HTN) are highly prevalent among under-resourced African Americans (AA) and Latinx, and they are associated with breast cancer (BC) risks and outcomes. Social determinants of health (SDOH) also have been found related to BC incidence, stage, and survival. In addition, elevated inflammatory cytokines may be an underlying factor in comorbidities that contribute to tumorigenesis and adverse cancer outcomes. Limited research has been conducted to explore the process and associations among SDOH, comorbidities, and inflammation cytokines related to BC. The purpose of this study was to fill this research gap using a sample recruited from AA and Latinx communities. Methods: This was a cross-sectional study conducted in South LA. A total of 570 AA and Latinx women with or without BC were recruited. A panel of 19 cytokines from serum samples were measured by Luminex assay. Demographic information, body mass index, comorbidities, and diagnosis/stage of BC were collected from patients’ medical records. SDOH factors were selected from the social vulnerability index (e.g., percentage of persons in poverty, unemployed, with no high school diploma) obtained through Geographic Information Systems. Chi-square tests, independent sample Mann-Whitney U tests, and Cox regression were employed to examine the associations between BC diagnosis/stages, comorbidities, and cytokines. Path analyses were adopted to further explore the associations between SDOH, comorbidities, and cytokines. Results: Among the 570 women, 45.79% had a diagnosis of BC. Over half (50.97%) had ER/PR+, HER2-, and 27.80% had triple negative BC. Results from Chi-square tests showed that a higher percentage of women with obesity (p=.001), HTN (p&lt;.0001), and T2D (p=.024) had a BC diagnosis than those without the comorbidity. Women with obesity had significantly higher levels of Leptin, VEGFα, and MIP1b; women with HTN had significantly higher levels of VEGFα and MIP1b; and women with T2D had significantly higher levels of Leptin and TGFβ1/β2. Leptin was found significantly higher in ER/PR+ BC (p&lt;.0001) and VEGFα was significantly higher in triple negative BC (p=.001). Increasing VEGFα and TGFβ1/β2 reduced BC disease-free survival significantly. The path model showed community poverty and education level did not affect TGFβ1/β2 directly but were indirectly associated with them through obesity and T2D status (p&lt;.01). Community poverty level was indirectly associated with the level of MIP1b through HTN status (p&lt;.01). Conclusions: To eliminate breast cancer disparities, effective interventions are needed that account for the social and community contexts in which women live and are treated. Interventions that target comorbidities of T2D, HTN, and obesity are important to reduce the disparities. Citation Format: Weizhou Tang, Yanyuan Wu, Jaydutt Vadgama. Social determinants of health and comorbidities increasing inflammation cytokines related to breast cancer in African American and Latinx women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B150.
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Islam, Jessica Yasmine, Jennifer McGee, Yi Guo, et al. "Abstract 744: Treatment inequities among patients diagnosed with Hodgkin's lymphoma with and without HIV (2018-2019): an analysis of the US National Cancer Database." Cancer Research 83, no. 7_Supplement (2023): 744. http://dx.doi.org/10.1158/1538-7445.am2023-744.
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Abstract Background: People living with HIV (PLWH) with Hodgkin’s lymphoma(HL) have similar response and survival rates to people without HIV when standard of care therapies are given. However, PLWH with HL are less likely to receive cancer treatment for unclear reasons. Our objective was to examine the role of social determinants of health(SDOH) with non-receipt of cancer treatment among PLWH with HL. Methods: Using the U.S. National Cancer Database, we identified 11,517 persons aged 18-90 years, diagnosed with HL (ICD-O-3 codes; C770-779) between 2018-2019. Most patients were diagnosed with classical HL(9650; n=4534, 39%) or nodular sclerosis classical Hodgkin’s lymphoma (9663; n=4725, 41%). As per NCCN guidelines, receipt of first-line treatment was defined as receiving any chemotherapy, radiotherapy or a combination of both. We compared treatment receipt by HIV status and associations of SDOH (e.g., zip-code median household income) with non-receipt of treatment among those with and without HIV. Using multivariable logistic regression, we evaluated the association of treatment receipt with HIV status after adjustment for age, sex, and stage at diagnosis. We stratified this model by zip-code level income, education and race/ethnicity to evaluate the role of SDOH in this exposure-outcome relationship. For each model, we calculated cluster-robust standard errors to account for non-independence within clusters at the facility level to adjust for correlated patient characteristics within hospitals. Results: Our sample (n=11,517) included 60% adults aged 50 years or below, 55% men, 71% NH-White and 14% NH-Black. About one-third were treated at an academic/research program and 57% were privately insured. PLWH included 6% of the population. Overall, 12% did not receive first-line recommended treatment and were less likely to receive treatment compared to those without HIV (13% vs. 9%, p=0.012). We identified the following characteristics amongst PLWH to be more likely not to receive treatment compared to those without HIV, persons who were: aged 40 years or younger(13% vs. 6%, p=0.001), male(15% vs. 9%, p&lt;0.001), NH-White(13% vs. 8%) and NH-Black(14% vs. 11%) persons(p&lt;0.001), persons residing in areas with lower levels of educational attainment (20% vs. 10%, p&lt;0.001) and low income areas (14% vs 9%, p&lt;0.001), and were Medicaid insured (17% vs. 8%, p&lt;.001). Stratifying by area-level education, this association persisted among those residing in areas with lower levels of education and income. Conclusion: PLWH with HL were less likely to receive cancer treatment and continue to experience inequities in cancer treatment receipt, with SDOH playing a potential role in inequitable cancer care delivery. Citation Format: Jessica Yasmine Islam, Jennifer McGee, Yi Guo, Marlene Camacho-Rivera, Lubomir Sokol, Susan T. Vadaparampil, Gita Suneja. Treatment inequities among patients diagnosed with Hodgkin's lymphoma with and without HIV (2018-2019): an analysis of the US National Cancer Database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 744.
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Odedina, Folakemi T., Che Ngufor, Arnold Merriweather, et al. "Abstract 2230: Connecting Black men to point of prostate cancer diagnosis (PPCD) support using precision intervention based on Virtual Reality Assistant (ViRA)." Cancer Research 84, no. 6_Supplement (2024): 2230. http://dx.doi.org/10.1158/1538-7445.am2024-2230.
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Abstract Background: The point of prostate cancer (CaP) diagnosis (PPCD) instantly leads to a life changing experience for Black men, with diverse emotional reactions that includes fear, denial, overwhelmingness, cancer fatalism etc. Black men diagnosed with CaP expressed several needs at the PPCD, including time to reflect on the diagnosis, being comfortable, emotional support, psycho-oncology support and social determinants of health (SDOH) navigation. Given that Black men are diverse in terms of their needs at the PPCD, precision intervention is needed to support them. Aim: The aim was to develop, implement, and establish the acceptance and usability of a Virtual Reality Assistant (ViRA) that will provide precision intervention tailored to the needs of Black men at the PPCD. This study is one of the five iCCaRE for Black Men projects focused on survivorship care. Methodology: The development of the ViRA was guided by CaP survivors through qualitative study. Reflective, analytic, and interpretive memos were used to generate action plans for the development of the ViRA. Based on a comprehensive PPCD ViRA intervention guide created by the team, the ViRA prototype was developed with mobile immersive technologies that integrated SDOH navigation, standard CaP psycho-oncology support and emotional support. The goal was to have the intervention personalized to everyone based on participant-provided information. Alpha testing of the ViRA is ongoing and will be completed on November 20, 2023. Participants are three prostate cancer survivors and three clinicians. The assessments will confirm the accuracy of the ViRA predictions and the functionality of the ViRA. Results: We developed the ViRA SDOH screening and navigation tool to identify participants’ needs and appropriately connect them with relevant support services and resources in their communities. The emotional support intervention was based on four CaP survivors as virtual reality avatars, providing empathetic rapport through self-disclosure and sharing of survivorship stories in different settings (home, clinic, barbershop etc). The psycho-oncology support intervention was developed with the guidance of a psycho-oncologist, with her avatar providing psychoeducation about the PPCD experience, reify and concretize the PPCD experience, and foster hope using the basic tenets of Problem-Solving Therapy. The results of the alpha testing and the modified ViRA will be presented during the conference. Conclusion: Meeting the needs of Black men at the PPCD requires a personalized and decentralized approach, which would allow Black men to access support anywhere. The presentation will unveil the iCCaRE ViRA, a smart and connected personalized AR-enabled intervention that will deliver SDOH navigation, CaP psycho-oncology support and emotional support tailored to the needs of Black men. Citation Format: Folakemi T. Odedina, Che Ngufor, Arnold Merriweather, Deidre Pereira, Roxana Dronca, Ernest Kaninjing, Kimlin Ashing, Solomon Rotimi, Vinessa Gordon, iCCaRE for Black Men Consortium. Connecting Black men to point of prostate cancer diagnosis (PPCD) support using precision intervention based on Virtual Reality Assistant (ViRA) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2230.
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Iasiello, John A., Arvind Rajan, Emmanuel Zervos, Alexander A. Parikh, and Rebecca A. Snyder. "Abstract B105: Patient-reported access to telehealth: An important and unmeasured social determinant of health." Cancer Epidemiology, Biomarkers & Prevention 32, no. 1_Supplement (2023): B105. http://dx.doi.org/10.1158/1538-7755.disp22-b105.
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Abstract Background: The recent COVID-19 pandemic expanded opportunities for remote oncology telehealth visits. However, reliable internet connectivity, digital literacy, and patient comfort with virtual medical visits may differ among patients, especially socially disadvantaged groups. The primary aim of this study was to identify patient demographics and social determinants of health (SDOH) which might limit access to remote telehealth services. Methods: First, a retrospective analysis was performed of composite administrative data of all patient visits to a large regional cancer center over the COVID-19 pandemic (3/2020-4/2022). Second, a prospective, cross-sectional study was conducted of patients with known or suspected malignancy presenting to the same center over six-months (11/2021-5/2022). Participants were asked a standard set of survey questions regarding telehealth accessibility during an in-person clinic visit. Demographics and SDOH were abstracted from the electronic health record (EHR). Results: Although Black patients comprised 43% (n=9,021) of all patient visits (n=20,953), the proportion of telehealth visits conducted among Black patients (29%; n=889) was significantly lower compared to White patients (71%, n=2,142, p&lt;0.0001). Within the cross-sectional study cohort (n=149), 51% (n=76) were Black, 39% (n=58) resided in a rural county, and 8.7% (n=13) were uninsured or Medicaid-insured. Black participants were more likely to self-report lack of internet access (73.7% vs. 90.4%, p&lt;0.01) and were less likely to report having access to or actively using a patient portal in the EHR compared to White patients (47.4% and 79.5%, respectively; p&lt;0.001). Rates of self-reported access to video-capable devices (82.9% vs. 90.4%) and confidence in conducting video visits without assistance (59.2% vs. 68.5%) were similar among Black and White patients (p&gt;0.05). The most common self-identified challenge to telehealth usage among both races was limited digital literacy. Conclusions: Black patients disproportionally under-participated in telehealth visits, suggesting underlying structural disparities in access to digital care. A greater proportion of Black participants self-reported lack of internet access and access to a patient portal to the EHR compared to White patients. Ensuring equal internet access and digital literacy will be critical to reduce further disparities in cancer care among racial minorities. Citation Format: John A. Iasiello, Arvind Rajan, Emmanuel Zervos, Alexander A. Parikh, Rebecca A. Snyder. Patient-reported access to telehealth: An important and unmeasured social determinant of health [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 B105.
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Friedler, Haley, Meghan Tierney, Melinda Baker, et al. "Abstract PO5-19-04: EVOLVE: An Ambispective, Patient-Centered, Real-World Early-Stage Breast Cancer Study in the United States." Cancer Research 84, no. 9_Supplement (2024): PO5–19–04—PO5–19–04. http://dx.doi.org/10.1158/1538-7445.sabcs23-po5-19-04.
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Abstract Background: While survival for patients with early breast cancer (eBC) has greatly improved with earlier detection and modern treatments, the risk of recurrence and long-term/late treatment-related adverse events (AEs) remain concerns for many patients. Contemporary real-world data are needed to understand current diagnostic pathways, treatment patterns and toxicities, quality of life, and patient experience to better characterize eBC care and knowledge gaps and establish important hypotheses to test in prospective trials, with the ultimate goal to improve both treatment and outcomes for patients with eBC. Study design: PicnicHealth and AstraZeneca are collaborating to build a real-world observational eBC cohort composed of de-identified medical records data supplemented with patient-reported outcomes (PROs), including patient-reported social determinants of health (SDoH). Patients recruited from multiple channels, such as digital marketing and community partnerships, will consent to participate and sign HIPAA authorization for PicnicHealth to collect their medical records from all providers and sites of care in the United States. All available retrospective medical records in any format will be retrieved, and records will continue to be collected for patients prospectively following enrollment. Disease-specific information will be abstracted using PicnicHealth’s human-in-the-loop machine learning abstraction platform. Patients will have access to their records in the form of a searchable and shareable digital timeline. Additional data, including but not limited to symptoms, quality of life and treatment experience will be collected through surveys. The first patient was enrolled in May 2023. Patients will be followed for ≥8 years or until withdrawal or death, whichever occurs first. Eligibility criteria: Patients with stage I-III breast cancer diagnosed ≤3 years before enrollment, who onboard to the PicnicHealth platform, consent to participate, sign HIPAA authorization for medical record collection, and provide ≥1 provider/care site for record retrieval will be included in the cohort. Specific aims: The cohort aims to generate contemporary real-world data relevant to understanding demographic and clinical characteristics, SDoH, diagnostic/testing pathways, treatment patterns, and clinical outcomes, including AEs and AE management. Specifically, demographic and SDoH differences in management, outcomes, and the patient experience during and following eBC diagnosis and treatment will be evaluated. The cohort design and the data collected will evolve as the eBC landscape evolves to continuously address new research questions around diagnosis, management, outcomes, and patient experience. Statistical methods: The demographics, SDoH, clinical characteristics, treatments, healthcare resource utilization, eBC outcomes, such as recurrence and progression, and patient experience will be summarized for the cohort overall and by pre-determined subgroups using descriptive statistics. Additional analyses include, but are not limited to, evaluating the impact of key exposures, such as SDoH, on treatment and diagnostic pathways, treatment compliance, clinical outcomes, and PROs. All analyses will be prespecified in study-specific statistical analysis plans. Present accrual and target accrual: At least 3,000 patients will be enrolled in the PicnicHealth eBC Cohort. As of July 2023, 843 patients have onboarded to the PicnicHealth platform and will be screened for eligibility into the eBC registry cohort. Contact information for people with a specific interest in the study: For additional information, please contact breastcancer@picnichealth.com. Citation Format: Haley Friedler, Meghan Tierney, Melinda Baker, Gillian Hanson, Josefa Briceno, Karen Smith, Michele Baber, Kara Glover, Xiaoqing Xu, Kellie Ryan, Zulikhat Segunmaru, Clara Lam, Maryam Lustberg, N. Lynn Henry, Rachel Greenup, Marianna Chavez, Joseph Unger, Alice Ho, Deborah Collyar. EVOLVE: An Ambispective, Patient-Centered, Real-World Early-Stage Breast Cancer Study in the United States [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-19-04.