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Introduction: The National Cancer Institute (NCI) Center to Reduce Center Health Disparities (CRCHD) Geographic Management of Cancer Health Disparities Program (GMaP) initiated in 2009 brings together investigators, trainees, students, and community health educators to network and share information, scientific resources, and tools to promote cancer and cancer health disparities research, as well as community education outreach within and across regions. To reach their goals, CRCHD initiated 7 GMaP regional “hubs” across the United States to enhance their capacity in areas of disparities research, contribute to the next generation of researchers, and achieve measurable reductions in cancer health disparities. Each hub is led by Regional Coordinating Directors (RCDs) who facilitate connections, provide funding and training resources and “leverage the strengths of its people, programs, and resources to provide greater access to cancer information.” Methods: The GMaP Region 1 North (R1N) hub is based at the Markey Cancer Center in Lexington, Kentucky. R1N partners with Johns Hopkins University's Sidney Kimmel Comprehensive Cancer Center, the University of South Carolina, and the University of Virginia Cancer Center to serve Delaware, Kentucky, Maryland, Maine, New Hampshire, Vermont, Virginia, West Virginia, Washington, DC, and West Virginia. The overall goal of GMaP R1N is to enhance the capacity of regional cancer centers, associated academic partners, community partners, and early-stage investigators to contribute to the reduction of cancer health disparities in the region. As part of the Continuing Umbrella of Research Experiences (CURE) Program, GMaP R1N promotes the F31, K series, and Diversity Supplement funding opportunities to potential applicants. R1N implemented pilot awards and travel scholarships for CURE-eligible candidates; developed a listserv to communicate with researchers, trainees, and potential applicants; and maintains regular contact with trainees to answer questions and encourage applications for NCI CURE Program and other grant opportunities. Results: R1N awarded 11 pilot projects, 22 travel scholarships, helped identify mentors and 146 potential applicants for NCI CURE Program grants, and collaborated with points of contact (POC) at colleges and universities, including Historically Black Colleges and Universities to identify potential applicants for NCI CURE and other funding. Conclusions: Methods have been successful in increasing interest in NCI Cancer health disparities training opportunities. RCDs are critical in establishing and maintaining linkages to support mentor-mentee relationships supported by available funding mechanisms; to engage institutional support for pre- and post-award activities, especially for new investigators; and for shrinking delays in the IRB review and approval process. RCDs have identified process barriers and work with regional POCs to eliminate these barriers and increase efficiencies to further the GMaP mission. Citation Format: Marcela Blinka, Mark Cromo, Julia F. Houston, Mark Dignan, Nathan Vanderford, B. Mark Evers, Janice Bowie, Adrian Dobs, James Hebert, Tisha Felder, Roger Anderson. Results to date: Efforts to increase cancer health disparities training in Geographic Management of Cancer Health Disparities Program Region 1 North [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A068.

Background: The incidence of epithelial ovarian cancer (EOC) is lower among African-American (AA) women compared to European American (EA) women (9.8 vs. 13.0 cases/100,000), but AA women have markedly worse outcomes. The purpose of this study is to describe the health-related quality of life (HRQL) in AA women with EOC and its correlates using data from a multisite population-based case-control study of invasive EOC in AA women, the African American Cancer Epidemiology Study (AACES). Methods: 215 cases completed a first annual follow-up questionnaire, including the HRQL and psychosocial surveys Results: Higher household family income, lower phobic anxiety, higher social support, and higher leisure physical activity levels were associated with higher MCS and PCS (p < 0.01). Higher perceived discrimination was associated with both lower MCS and PCS, while higher optimism (LOTR) was associated with higher MCS. In multivariable analyses including all predictors, CCI-PA and LOTR remained significant predictors of MCS (p < 0.01), and BMI, phobic anxiety, and social support predicted PCS (p < 0.001). Conclusion: Prediagnosis characteristics and exposures of AA women with EOC are important predictors of HRQL after cancer diagnosis, and in AACES were more important than tumor characteristics. Cancer survivorship programs that enhance patients' social support and physical activity could have important benefits by reducing emotional distress and increasing perceived vitality. Citation Format: Roger T. Anderson, Fabian Camacho, Elisa Bandera, Ellen Funkhouser, Patricia Moorman, Lisa Paddock, Lauren C. Peres, Edward Peters, Sarah E. Abbott, Anthony J. Alberg, Jill Barnholtz-Sloan, Melissa Bondy, Michele L. Cote, Ann Schwartz, Paul Terry, Joellen Schildkraut. Correlates of health-related quality of life among African-American survivors of ovarian cancer: Results from the AACES Study [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C42.

Background: Under the Affordable Care Act (ACA), Medicare beneficiaries can receive annual wellness visits (AWV) to configure or update a personalized prevention plan. Previous data show the use of AWVs rose from about 7 percent overall (3.2 million visits) in 2011 to 20 percent (10.4 million visits) in 2016, but patterns of rural uptake of AWV have not been examined nor their potential to reduce rural disparities in cancer screening. Methods: We examined physician and outpatient claims for rural and urban beneficiaries enrolled in Medicare 5% FFS (“Fee for Service”) from 2011-2014 among beneficiaries with >1 year prior enrollment. Beneficiaries were classified into three groups based on previous care patterns: patients with annual health care visits but no AWV (controls); those without previous screening but who attended a subsequent AWV; and those with a previous screening episode with a subsequent AWV. Confounders considered included beneficiary race (white, black, other), gender, age category at reference, Charlson comorbidity score, reference date, National County Economic Distress from Appalachian Regional Commission, and NCHS rural urban status. Outcomes included receipt of colorectal (CRC) and breast (BC) cancer screenings, as well as a bundle of 7 recommended preventative services relating to cardiovascular disease, cancer, diabetes, and bone density. Results: Per beneficiary, AWVs were more likely to occur in metropolitan regions and regions with higher socioeconomic indices, along with individual characteristics such as white ethnicity, female gender, and older age groups. By 2014, the AWV utilization rates in metropolitan residents were 60% higher than rural residents. For both urban and rural US populations, screening access for those without an AWV was significantly lower than with an AWV. For CRC and BC screening, having an AWV was associated with a greater than two-fold increase screening compared to controls (p < .001). Only 20% of the control group had 1 of 7 possible preventive services examined compared to > 80% of the other patient groups. We examine evidence of the impact of ACA on access to screening in rural Appalachia to identify policy and implementation research solutions for the well-documented higher late-stage cancer burden in this region. Conclusions: Our findings strongly suggest that AWVs can be used to reduce disparities in preventive services, such as cancer screenings and vaccinations, especially in disadvantaged groups that tend to lack prior preventive services. However, rural beneficiaries have fewer opportunities to have an AWV. Policies to increase AWV penetration may involve increasing access through community health workers, practice-based supports, and increased financial incentives. Given the size of the screening effects found in this study together with the underutilization of AWV by rural populations, we believe policy seeking to expand the use of AWVs may help with early detection of cancer to improve survival. Citation Format: Roger T. Anderson, Fabian Camacho, Aaron Yao. Rural disparities in uptake of well visits and access to cancer screening in Medicare under the Affordable Care Act [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA28.

Introduction: Smoking in the United States has steadily declined over the past several years; however, rural Virginia Appalachian communities have a substantially higher than average smoking prevalence than the rest of the country. A major challenge in providing effective and sustainable cigarette-cessation services to Virginia Appalachia is the geographic and economic diversity of the region, combined with much of the population residing in poor, medically underserved rural areas. Previous research has suggested that community health workers (CHWs) may be valuable in regions with limited financial and medical resources by acting as a bridge between patients and providers when access is limited by distance, health care provider shortages, and cultural stigma. The purpose of this study was to assess the feasibility and success of using CHWs for smoking-cessation services in two Virginia Appalachian health care settings. Methods: Study enrollees were recruited from two sites: a local-family-owned pharmacy and a Federally Qualified Health Center (FQHC) in the Appalachian region of Virginia. Inclusion criteria were daily adult smokers (18+) who were patients at the clinic or the community pharmacy, and self-identified as ready to quit in the next 30 days. Enrollees were defined as individuals for whom a consent form and baseline assessment were completed. Enrollees were subset into a participant group defined as enrollees who completed at least the first session of the eight-session intervention plan. We used an intention-to-treat framework in calculating enrollee and participant quit rates. The program was designed to have eight sessions, with scheduling at the discretion of the CHW and participant. Sessions five and eight were to be completed by the respective health care provider for the clinic and pharmacy. Sessions one and two were completed by the CHW in person with the participant, and sessions three, four, six, and seven were completed by the CHW over the phone. During the sessions, CHWs helped participants develop skills in identifying and addressing barriers to a successful cigarette quit, providing support in adhering to their quit plan, and discussing challenges and barriers they were facing in their quit attempt. Results: Twenty-three individuals were enrolled in the study, with twenty distinguished as participants. The enrollee quit rate was 22%, with a participant quit rate of 25%. Overall, we found a statistically significant decrease in all participants' average cigarettes smoked per day over the eight sessions. Almost all participants failed to complete sessions 5 and 8 with their health care provider. All participants highly rated the program with 100% satisfaction on flexibility of scheduling, level of comfort, positivity, and helpfulness of the CHW. Conclusion: The use of CHWs in Virginia Appalachian communities within our pilot study for cigarette cessation services appears promising. Challenges were noted in attendance to sessions five and eight in the clinic setting. This may speak to the difficulty of going back to their care provider due to challenges in scheduling, concerns about cost of visit, and transportation. The flexibility of working with CHWs, in their own community, over meeting with care providers may provide a benefit to the use of CHWs in future smoking-cessation programs. Future research should explore expanded integration of CHWs into comprehensive tobacco-cessation services in health care settings including the cost-benefit analysis and sustainability of the CHW model. Citation Format: Lindsay Hauser, Catherine Labgold, Roger Anderson, Fabian Camacho. Community health worker led smoking cessation intervention in Virginia Appalachia [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B21.

Introduction: Region 1 North of the National Cancer Institute's Geographic Management of Cancer Health Disparities Program (GMaP) is based at the University of Kentucky Markey Cancer Center (UK MCC). GMaP was funded for a three-year period as a supplement to the UK MCC Cancer Center Support Grant with an overall goal to reduce cancer health disparities. Efforts to achieve this goal include enhancing the capacity of regional cancer centers, associated academic partners, community partners, and early-stage investigators to increase research on disparities by fostering collaborative research applications and facilitating the career development of the next generation of underrepresented cancer and cancer health disparities investigators. Methods: UK MCC GMaP investigators are partnering with researchers at Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, the University of Virginia Cancer Center, the University of South Carolina Cancer Prevention and Control Program, and other regional cancer center and academic partners to implement multi-faceted programming to increase and strengthen collaborative research and training efforts across the Region 1 North coverage area, which includes DC, DE, KY, ME, MD, NH, VA, VT, and WV. GMaP Region 1 North has implemented an online survey of investigators and partners throughout the region to assess their career level, research focus and interests, and readiness to submit grant applications within the next 12 months. Results: A total of 161 responses to the survey have been received. The respondents include undergraduate and graduate students, faculty members, research and administrative staff and community members. Over 70% of respondents described themselves as researchers (32% cancer center researchers) and almost 50% as mentors. The most common response categories for types of research conducted include basic science (52%), translational (44%), cancer health disparities (39%) and behavioral/population focused research (36%). Of those currently funded by extramural sources, 26% reported R01 funding and nearly all of the remaining respondents reported funding by a wide variety of other NIH mechanisms. Most (88%) respondents indicated that they are planning R01 and/or R21 applications within the next 12 months. Conclusion: The survey has provided Region 1 North investigators with a working foundation for matching mentors with underrepresented early-stage investigators for K- and R-series grant applications. Additionally, the survey results provide a tool to promote collaborative applications across regional institutions through targeted communication and media efforts. Citation Format: Mark B. Dignan, Nathan L. Vanderford, B Mark Evers, Mark Cromo, Janice Bowie, Adrian Dobs, Ashleigh Gallagher, Olive Mbah, Julia F. Houston, Neha Jaggi, Roger Anderson, James R. Hebert. Utilizing the Geographic Management of Cancer Health Disparities Program (GMaP) Region 1 North partnership survey as a tool to promote mentoring and collaborative grant applications. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A81.

Women in their reproductive years, ages 14 through 44, account for 15% of all breast cancer cases in the United States (Tomao et al, 2010). The 5-year survival rate for women diagnosed during these years is on average 85% (“Cancer Survival by Age”, 2014). Breast cancer treatment often leads to infertility (Tomao et al, 2010). Therefore, many survivors will become infertile without reaching their desired family size. Unfortunately, prior studies reveal low patient awareness of the infertility risks associated with cancer treatment until after they have completed treatment (Crawshaw et al, 2009). This suggests a potential decrease in quality of life once they enter remission. This paper outlines the process of developing a survey for original data collection among women in Pennsylvania who are registered as breast cancer survivors and who were diagnosed during their reproductive years. The central focus of the study is whether breast cancer treatment and remission is associated with a change in family size expectations among pre-menopausal women and if this is associated with the information a woman receives before she begins treatment. Additionally, we will be asking if the change in family size expectations pre and post-treatment are associated with feelings of regret, satisfaction or depression. Questions are taken largely from surveys focused on medical decision making. An original conceptual model is developed. Citation Format: Angela Gale Campbell, Marianne Hillemeier, Roger Anderson. The association between breast cancer treatment decisions, fertility and emotional well-being among premenopausal women: An original data collection. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A33.

Background: National Cancer Institute has designated Appalachia as a priority area characterized by significant disparities in cancer outcomes. However, little research focuses on the availability of cancer care resources in this region and how resource availability may relate to cancer outcomes. This paper will describe the distribution of breast cancer screening resources in Appalachia and examine the relationship between screening resources and breast cancer stage at diagnosis at the population level. Method: Early stage breast cancer as a percent of all breast cancer cases are computed based on the county-level registry data from the four Appalachian states during 2000–2008. Availability of breast cancer screening providers and facilities are estimated for these Appalachian states. Descriptive analysis, exploratory spatial data analysis, and spatial regression are conducted. Results: Appalachian counties have significantly fewer primary physicians, OB/GYN specialists, and diagnostic radiologists per capita than non-Appalachian counties. Spatial analysis demonstrates moderate clustering of scarce breast cancer screening resources and low percentages of early stage breast cancer in West Virginia and Appalachian Kentucky. Those diagnosed at early stages were 67.92% of all Appalachian cases vs. 68.34% of non-Appalachian breast cancer patients. The number of diagnostic radiologists per capita is significantly associated with the percentage of early stage breast cancer incidence when controlling for covariates such as county level poverty rates, uninsurance rate, percentage of adults with college degree, and primary care resources. Conclusions: Fewer diagnostic radiologists per capita in West Virginia and Appalachia Kentucky is associated with lower percentage of early stage breast cancer incidence in the Central Appalachia region. Public health interventions should include policies and regulations to improve breast cancer screening resources in this region. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A96.

Research Objective: Many breast cancer patients in Appalachia face unique challenges in obtaining a timely diagnosis and beginning treatment. Barriers including low socio-economic status, mountainous terrain, and fragmentation of services across cancer care providers can contribute to disparities in the receipt of needed care. As a result, a focus on maximizing efficiency and streamlining processes to minimize the time between screening, diagnosis, and treatment for breast cancer patients has become paramount. Our study aim was to examine times to diagnosis and treatment by race and state of residence for a sample of patients in the Appalachian counties of Pennsylvania, Kentucky, North Carolina, and Ohio. Study Design: Three time intervals were constructed from our data. The intervals included: (1) a time-to-diagnosis interval, consisting of the date of first breast cancer screening exam through date of confirmed diagnosis, (2) a time-to-treatment interval, consisting of the date of diagnosis through the date of first treatment, and (3) a total interval, consisting of the date of first breast cancer screening exam through the date of confirmed diagnosis. Averages for each interval were calculated to examine differences according to race and state of residence; t-tests were performed to evaluate the statistical significance of these differences. Sample: Our population is comprised of Medicare patients who were diagnosed with breast cancer in one of the Appalachian counties of PA, KY, NC, and OH from 2006–2008. Patients may have lived in counties outside Appalachia, but their diagnosis was confirmed by an organization located in an Appalachian county. Patients were then matched to cancer registry files in PA, KY, NC, and OH by a unique ID to insure the quality of the claims data. Further, we narrowed the sample to contain only patients who had definitive screening, diagnosis, and treatment dates. The final sample consisted of 6,188 patients. Results: Time-to-diagnosis interval: North Carolina (26 days) and Pennsylvania (32 days) had shorter time-to-diagnosis than did patients in Kentucky (41 days) and Ohio (43 days). No statistically significant differences were found between white (34 days) and black (37 days) patients. Time-to-treatment interval: Kentucky (17 days) experienced the shortest time-to-treatment, whereas Ohio (23 days), North Carolina (25 days), and Pennsylvania (29 days) experienced longer time from diagnosis to first treatment. Averaged over the Appalachian areas in all 4 states, black patients (31 days) had a significantly longer time-to-treatment than white (25 days) patients (p Conclusions: Our findings suggest that black patients in Appalachian areas of KY, NC, OH, and PA experience delays in treatment compared to white patients after receiving a diagnosis of breast cancer. Moreover, the differences in time-to-diagnosis and treatment across states suggest that states have varying strengths and weaknesses when looking across the entire continuum of care. Implications for Policy and Practice: Understanding the factors driving variation in diagnosis and treatment intervals among Appalachian residents with Medicare coverage is paramount. Health care provider shortages, scarcity of comprehensive cancer centers, and widespread economic disadvantage are likely to be contributing factors, and further research is needed to determine the roles each of these factors play and to identify effective policy interventions to reduce disparities. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A103.