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Background: Poor patients often reside in neighborhoods of lower socioeconomic status (SES) with high levels of airborne pollutants. They also have higher mortality from non–small cell lung cancer (NSCLC) than those living in wealthier communities. We investigated whether living in polluted neighborhoods is associated with somatic mutations linked with lower survival rates, i.e., TP53 mutations. Methods: In a retrospective cohort of 478 patients with NSCLC treated at a comprehensive cancer center between 2015 and 2018, we used logistic regression to assess associations between individual demographic and clinical characteristics, including somatic TP53 mutation status and environmental risk factors of annual average particulate matter (PM2.5) levels, and neighborhood SES. Results: 277 patients (58%) had somatic TP53 mutations. Of those, 45% lived in neighborhoods with “moderate” Environmental Protection Agency–defined PM2.5 exposure, compared with 39% of patients without TP53 mutations. We found significant associations between living in neighborhoods with “moderate” versus “good” PM2.5 concentrations and minority population percentage [OR, 1.06; 95% confidence interval (CI), 1.04–1.08]. There was a significant association between presence of TP53 mutations and PM2.5 exposure (moderate versus good: OR, 1.66; 95% CI, 1.02–2.72) after adjusting for patient characteristics, other environmental factors, and neighborhood-level SES. Conclusions: When controlling for individual- and neighborhood-level confounders, we find that the odds of having a TP53-mutated NSCLC are increased in areas with higher PM2.5 exposure. Impact: The link between pollution and aggressive biology may contribute to the increased burden of adverse NSCLC outcomes in individuals living in lower SES neighborhoods.

Background: City of Hope (COH) is an NCCN academic cancer center in Duarte CA and delivers care in 36 geographically dispersed community sites in Los Angeles, Riverside, San Bernardino, Orange and Ventura counties. We implemented a multi-departmental tobacco use control program (TUCP) (J Clin Med 2020; 1820). In order to facilitate implementation of the TUCP, we developed a multi-level multi-departmental program of clinician/nurse tobacco cessation champions using implementation science principles. Methods: A TUCP centered in Population Science included representatives of all clinical specialties. Cancer center leadership was engaged for resource allocation, and monthly staff communications (Moonshot Shout-outs). Tobacco-using patients were referred for tobacco cessation. To incentivize and promote cessation referrals and patient participation, TUCP worked with physician leaders and nurse leaders to name a clinician and nurse in each academic center clinic and each community site as champions. Results of this program were evaluated by tobacco use assessments and clinician attitude surveys. Results: Among the 36 COH sites and the Duarte academic center, 6 sites were selected for pilot implementation of the champion program. Champions (physicians, advanced practice providers, and nurses in multiple oncology specialties) were appointed and received structured training. Champions were tasked to promote cessation referrals by clinicians and staff, provide support for any problems, meet with TUCP leaders, report barriers to effective cessation implementation, and provide assistance in prescribing tobacco control medications. Tobacco use screening was nearly universal (96%), and showed 5.87% current use overall. Among patients who were smokers, 7.92% were African American, 17.61% were Hispanic, 5.18% were Asian/Pacific Islanders, and 44.09% were non-Hispanic white. Current tobacco use was more prevalent in the community sites than in the academic center and more prevalent in minority patients in community sites. Clinician attitude surveys at the academic center versus community sites revealed similar importance of tobacco cessation, feeling that continued smoking adversely impacted treatment outcomes, referral of patients for cessation, and need for increased training in tobacco control and cessation. Clinicians at the community site with the highest rate of tobacco use and greatest percent of non-white patients, Antelope Valley, expressed the highest need for training into availability of tobacco control services and program support. Conclusions: Tobacco use is widely perceived by clinicians as an important component of cancer treatment, but requires increased resource allocation and leadership, especially at sites with higher tobacco use and greater percentage of racial/ethnic minorities, and worse social determinants of health. Among resources important for tobacco control, multi-level champions (e.g. physicians, nurses, and advanced practice providers) can help promote and implement a TUCP in both academic centers and community sites. Citation Format: Cary A. Presant, Kimlin Tam Ashing, Sophia Yeung, Jonjon Macalintal, Brian Tiep, Argelia Sandoval, Dan Raz, Ravi Salgia, Loretta Erhunmwunsee, Arya Amini, Amar Merla, Heather Graves, Ranjan Pathak, Shaira Dingal, TingTing Tan, Kelly Tarkeshian, Liana Nikolaenko, Kathleen Burns, Sagus Sampath, Beverly Laksana, Steven Rosen. Use of clinician and nurse tobacco cessation champions to implement a tobacco control program in a geographically disseminated academic center-led clinical network analyzed by patient racial/ethnic group [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-011.