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Black women with breast cancer have a worse overall survival compared with White women; however, no difference in Oncotype DX™ (ODX) recurrence scores has been observed to explain this health disparity. Black women are also disproportionately affected by insulin resistance. We evaluated whether insulin resistance is associated with a higher ODX recurrence score and whether there is a difference between White and Black women to explain disparate clinical outcomes. A subgroup analysis of patients in a multi-institutional cross-sectional study evaluating differences in insulin resistance between White and Black women was performed. Women diagnosed with a new hormone receptor-positive, HER2/neu-negative breast cancer with an ODX recurrence score were identified. Fasting blood glucose and insulin measurements were used to calculate the homeostatic model assessment of insulin resistance (HOMA-IR) score, a method for assessing insulin resistance, and compared against ODX scores. Overall, 412 women (358 White women, 54 Black women) were identified. Compared with White women, Black women had a higher body mass index (30 vs. 26 kg/m2, p

Background: Percent density (PD) is a strong risk factor for breast cancer that is potentially modifiable by lifestyle factors. PD is a composite of the dense (DA) and nondense (NDA) areas of a mammogram, representing predominantly fibroglandular or fatty tissues, respectively. Alcohol and tobacco use have been associated with increased breast cancer risk. However, their effects on mammographic density (MD) phenotypes are poorly understood. Methods: We examined associations of alcohol and tobacco use with PD, DA, and NDA in a population-based cohort of 23,456 women screened using full-field digital mammography machines manufactured by Hologic or General Electric. MD was measured using Cumulus. Machine-specific effects were estimated using linear regression, and combined using random effects meta-analysis. Results: Alcohol use was positively associated with PD (Ptrend = 0.01), unassociated with DA (Ptrend = 0.23), and inversely associated with NDA (Ptrend = 0.02) adjusting for age, body mass index, reproductive factors, physical activity, and family history of breast cancer. In contrast, tobacco use was inversely associated with PD (Ptrend = 0.0008), unassociated with DA (Ptrend = 0.93), and positively associated with NDA (Ptrend Conclusions: These findings suggest that associations of alcohol and tobacco use with PD result more from their associations with NDA than DA. Impact: PD and NDA may mediate the association of alcohol drinking, but not tobacco smoking, with increased breast cancer risk. Further studies are needed to elucidate the modifiable lifestyle factors that influence breast tissue composition, and the important role of the fatty tissues on breast health.

Introduction: ATRi and PARPi combinations kill tumor cells via synergistic modulation of complementary DDR pathways but clinical utility is limited by overlapping toxicities. A genome-wide CRISPR-Cas9 screen identified DDR alterations that sensitize tumors to the ATRi camonsertib (cam) plus PARPi. Based on preclinical models, tolerability and efficacy of cam plus PARPi given intermittently at low doses in pts with solid tumors with DDR alterations, including BRCA-mutated PARPi-resistant cancers, was evaluated. Methods: Pts (≥ 18 yrs) with relapsed/refractory (r/r) solid tumors with DDR alterations were treated with cam plus talazoparib (tala), niraparib (nira), or olaparib (ola) in 2 phase I trials (NCT04497116, NCT04972110). An adaptive BOIN design was used to optimize dose/schedule. Endpoints were safety, recommended phase II dose (RP2D), pharmacokinetics (PK), response (RECIST v1.1 [confirmed/unconfirmed], CA 125, or PSA), clinical benefit rate (CBR; RECIST/tumor marker response or treatment duration ≥ 16 wk), and ctDNA molecular response rate (MRR; best reduction in mean variant allele frequency [mVAF] ≥ 50%). Results: As of Nov 2022, 99 pts were enrolled (61 with ≥ 3 prior lines of therapy, 36 PARPi-pretreated); 43, 27, 29 pts in tala, nira, and ola combinations, respectively. Tumors included ovarian (n=20), prostate (n=13), breast (n=17), bile duct (n=3); most common genotypes were ATM (n=26), BRCA1 (n=19), and BRCA2 (n=33). Grade 3+ toxicities included reversible myelosuppression (neutropenia, anemia, and thrombocytopenia in 35%, 28%, and 14% of pts overall; 33%, 16%, and 11% at preliminary RP2Ds), fatigue (3%), and alkaline phosphatase increase (2%). Two pts discontinued treatment due to drug-related toxicity. Forty pts remain on therapy, up to 63 wks. Preliminary RP2Ds: cam 80 mg QD (d 5-7) + tala 0.25 mg QD, 1 wk on/1 wk off; cam 80 mg QD + nira 100 mg QD, 2 d on/5 d off; cam 50 mg QD + ola 100 mg BID, 3 d on/4 d off. As of abstract submission, response rate was 13% in 85 evaluable pts; CBR was 49%. Responders included pts with ovarian (n=6), bile duct (n=2), and breast, pancreatic, and carcinoma of unknown primary (n=1 each) cancers harboring alterations in BRCA1/2 (n=9), IDH1 (n=1), and ATM (n=1). Of 30 evaluable PARPi-pretreated pts, response rate was 23% and CBR was 52%. MRR was 64% (14/22 evaluable); change in mVAF correlated with a change in target lesion size (r=0.63, P=0.001). PK of each drug in the combination was consistent with respective monotherapy PK. Conclusion: Combination of cam plus PARPi at low doses on intermittent schedules was generally well-tolerated with clinical activity in DDR-aberrant tumors, including those pretreated with PARPi. RP2D optimization and translational correlative studies are ongoing. Citation Format: Timothy A. Yap, Siddhartha Yadav, Benjamin Herzberg, Benedito A. Carneiro, Elisa Fontana, Martin Højgaard, Michael J. Pishvaian, Ruth Plummer, Theresa L. Werner, Vaibhav Sahai, Stephanie Lheureux, Elizabeth K. Lee, Niharika B. Mettu, Gregory M. Cote, Joseph D. Schonhoft, Victoria Rimkunas, Ian M. Silverman, Marisa Wainszelbaum, Gerson Peltz, Adrian J. Fretland, Kezhen Fei, Danielle Ulanet, Insil Kim, Maria Koehler, Ezra Rosen, Michael Cecchini. Safety and efficacy of three PARP inhibitors (PARPi) combined with the ataxia telangiectasia- and Rad3-related kinase inhibitor (ATRi) camonsertib in patients (pts) with solid tumors harboring DNA damage response (DDR) alterations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr CT018.

Background: High percent density (PD) is common and is among the strongest risk factors for breast cancer. The prevalence of heterogeneously dense or extremely dense breasts is between 40% to 60% of screening age women, and is estimated to account for up to one third of all breast cancer (BC) diagnoses. PD decreases with age, body mass index (BMI), number of children, and menopause; and increases with age at menarche, age at first birth, and family history of breast cancer. Of particular interest are modifiable exposures believed to alter PD, such as the use of menopausal hormone therapy (MHT), tamoxifen and alcohol that could provide opportunities for women to reduce their BC risk. The dense area (DA) of the breast appears radiopaque on a mammogram and contains greater proportions of collagen, epithelial and stromal cells compared to the nondense area (NDA), which largely consists of fatty tissue. Recent studies have shown that NDA is inversely associated with BC risk, independently of DA, suggesting that normal breast fat may play a protective role. The underlying mechanisms through which mammographic density (MD) phenotypes are associated with BC risk are poorly understood. Methods: We examined associations of alcohol and tobacco use with PD, DA and NDA in a population-based cohort of 23,456 women screened using full-field digital mammography machines manufactured by Hologic or General Electric (GE). MD measurements were obtained using Cumulus an average of 2.9 years after the survey date. Machine-specific effects were estimated using linear regression, adjusted for known biologically plausible correlates of MD, and combined using random effects meta-analysis methods. Results: Alcohol use was positively associated with PD (ptrend=0.01), unassociated with DA (ptrend=0.23), and inversely associated with NDA (ptrend=0.02) in models adjusted for age, BMI, reproductive factors, physical activity, and family history of breast cancer. In contrast, tobacco use was inversely associated with PD (ptrend=0.0008), unassociated with DA (ptrend=0.93), and positively associated with NDA (ptrend Conclusions: This study provides the strongest evidence to date that association of alcohol and tobacco use with PD result from their associations with NDA rather than DA. Impact: Alcohol consumption, and less consistently tobacco use, have been shown to increase risk of breast cancer. These findings indicate that PD and NDA may mediate the association of alcohol drinking, but not tobacco smoking, with increased breast cancer risk. Further studies are needed to elucidate the modifiable lifestyle factors that influence breast tissue composition, and the important role of the fatty tissues on breast health. Citation Format: Russell B McBride, Kezhen Fei, Joseph H Rothstein, Stacey E Alexeeff, Xiaoyu Song, Lori C Sakoda, Valerie McGuire, Ninah Achacoso, Luana Acton, Rhea Y Liang, Jafi A Lipson, Martin J Yaffe, Daniel L Rubin, Alice S Whittemore, Laurel A Habel, Weiva Sieh. Alcohol and tobacco use in relation to mammographic density in 23,456 women [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-08-01.

Background/Objectives: The incidence of Prostate cancer is increasing with age and active treatment of high-risk prostate cancer improves survival. However, it is uncertain how the age as contrasted with life expectancy impact treatment decision-making for men with clinically significant prostate cancer. The aim of this study was to determine whether age or life expectancy affected the treatment receipt. Participants: 541 men with high-risk localized prostate cancer (Gleason ≥ 8 or PSA > 20) diagnosed between 2007 and 2013 were recruited to the study. Measurements: Outcome variables included treatment underuse and type of definitive therapies such as radical prostatectomy, radiotherapy, androgen deprivation therapy and cryotherapy. Life expectancy was assessed according to Schonberg Prognostic Index. Results: Among the 541 high-risk prostate cancer patients, older men (≥65 years) received definitive therapy at similar rates as younger men (97% vs 98%; p=0.2), while younger men were more likely to accept surgery compared with older men (95% vs. 72%, p

Purpose Multiple Myeloma (MM), the second leading blood malignancy, has complex and costly disease management. We studied patterns of treatment disparities and unplanned interruptions among the MM patients after the Affordable Care Act to assess their prevalence and effect on survival. Materials and methods This retrospective study of 1002 MM patients at a tertiary referral center used standard guidelines as a reference to identify underuse of effective treatments. We used multivariate logistic regression and Cox proportionate hazard to study the prognostic effect on survival. Results Median age in the cohort was 63.0 [IQR: 14] years. Non-Hispanic White (NHW) patients were older (p = 0.007) and more likely to present with stage I disease (p = 0.02). Underuse of maintenance therapy (aOR = 1.98; 95 % CI 1.12–3.48) and interruptions in treatment were associated with race/ethnicity and insurance (aOR = 4.14; 95 % CI: 1.78–9.74). Only underuse of induction therapy was associated with overall patient survival. Conclusion Age, race, ethnicity and primary insurance contribute to the underuse of treatment and in unplanned interruptions in MM treatment. Addressing underuse causes in such patients is warranted.

Purpose: Black men are more likely to die as a result of prostate cancer than white men, despite effective treatments that improve survival for clinically significant prostate cancer. We undertook this study to identify gaps in prostate cancer care quality, racial disparities in care, and underlying reasons for poorer quality care. Methods: We identified all black men and random age-matched white men with Gleason scores ≥ 7 diagnosed between 2006 and 2013 at two urban hospitals to determine rates of treatment underuse. Underuse was defined as not receiving primary surgery, cryotherapy, or radiotherapy. We then interviewed treating physicians about the reasons for underuse. Results: Of 359 black and 282 white men, only 25 (4%) experienced treatment underuse, and 23 (92%) of these were black. Most (78%) cases of underuse were due to system failures, where treatment was recommended but not received; 38% of these men continued receiving care at the hospitals. All men with treatment underuse due to system failures were black. Conclusion: Treatment rates of prostate cancer are high. Yet, racial disparities in rates and causes of underuse remain. Only black men experienced system failures, a type of underuse amenable to health information technology–based solutions. Institutions are missing opportunities to use their health information technology capabilities to reduce disparities in cancer care.

Purpose: To implement and test a Web-based tracking and feedback (T&F) tool to close referral loops and reduce adjuvant breast cancer treatment underuse in safety-net hospitals (SNHs). Patient and Methods: We randomly assigned 10 SNHs, identified patients with new stage 1 to stage 3 breast cancer, assessed their connection with the oncologist, and relayed this information to surgeons for follow-up. We interviewed key informants about the tool’s usefulness. We conducted intention-to-treat and pre- and poststudy analyses to assess the T&F tool and implementation effectiveness, respectively. Results: Between the study start and intervention implementation, several hospitals reorganized care delivery and 49% of patients scheduled to undergo breast cancer surgery were ineligible because they already were in contact with an oncologist. One high-volume hospital closed. Despite randomization of hospitals, intervention (INT) hospitals had fewer white patients (5% v 16%; P = .0005), and more underuse (28% v 15%; P = .002) compared with usual care (UC) hospitals. Over time, INT hospitals with poorer follow-up significantly reduced underuse compared with UC hospitals (INT hospitals, from 33% to 9%, P = .001 v UC hospitals, from 15% to 11%, P = .5). There was no difference in underuse (9% at INT hospitals, 11% at UC hospitals; P = .8). Hospitals with better follow-up (odds ratio, 0.85; 95% CI, 0.73 to 0.98) had less underuse. In settings with poor follow-up and tracking approaches, key informants found the tool useful. The rapidly changing delivery landscape posed significant challenges to this implementation research. Conclusion: A T&F tool did not significantly reduce adjuvant underuse but may help reduce underuse in SNHs with poor follow-up capabilities. Inability to discern T&F effectiveness is likely due to encountered challenges that inform lessons for future implementation research.

Studies show decreased risk of breast cancer recurrence and improved survival with statin use, but data on racial disparities regarding breast cancer prognosis and statin use are lacking. Our objective was to investigate if racial disparities in breast cancer prognosis can be partially explained by differences in pre-diagnosis statin use. Patients were identified from a prospective, multicenter study examining the effects of metabolic factors on breast cancer prognosis in Black and White women. Statin use, prognosis (as measured by Nottingham Prognostic Index), anthropometric, tumor, and socio-demographic characteristics were examined. Five hundred eighty-seven women (487 White, 100 Black) with newly diagnosed primary invasive breast cancer were recruited. Obesity was more prevalent in Black women than White women (47 vs 19%, p

e18142 Background: Much of cancer health services research relies on administrative data, yet, there have been calls for more granular racial & social disparities data. Subjective SES (sSES) is associated with health status & behaviors, independent of objective SES (oSES) measures like income, education and race. We assessed the relationship between breast cancer patients’ oSES and sSES with their cancer screening and health behaviors. Methods: Data are part of a large prospective study evaluating the role of insulin resistance in women with newly diagnosed breast cancer. Patients were asked to place where they stand in their communities on the MacArthur Scale of Subjective Social Status ladder (sSES). oSES measures include race, income & education. We assessed diet, activity, breast & pap screening. Group comparisons used chi-square and t-tests as appropriate. We ran logistic multivariate models with age, race, insurance, comorbidity & income. Results: Of 1035 breast cancer patients with an average age of 58±12 yrs, 81% were White and 19% Black, 63% graduated college, 47%W & 16%B women reported an income of > $100,000/yr. The median sSES = 8; 20% had high sSES ( > 8). There were no racial differences observed in sSES (high sSES: 22% B vs 20% W; p = 0.7). More patients with high sSES graduated college (76% vs 61%, p = 0.0002) & had income > $100K/yr (62% vs 36%, p < .0001) than patients with lower sSES. Of the oSES, women with higher income were more likely to undergo both cancer screenings as compared to patients with lower income. College education did not impact cancer screenings. Black women were less likely to get pap smears. Patients with high as compared to low sSES had higher cancer screening rates and healthy behaviors. Conclusions: Income and sSES are positively associated with cancer screening and health behaviors; education & race are associated with activity & diet. Race is associated with pap screening.[Table: see text]

e18157 Background: Black women are more likely to die of breast cancer and develop more aggressive subtypes than white women. Black women are also more likely to be obese and have insulin resistance than white women. Insulin resistance has been associated with faster tumor growth but has not been studied as a potential mediator of racial disparities in women with breast cancer. We hypothesized that black women would present with more aggressive breast cancer and this would be associated with obesity and insulin resistance. Methods: We recruited 1017 (80% white, 20% black) women with new primary breast cancer, measured fasting blood glucose and insulin, body mass index (BMI), triple negative breast cancer (TNBC) & Nottingham prognostic index (NPI). We classified aggressive breast cancer as NPI > 4.4. We calculated insulin resistance scores (HOMA) and classified insulin resistance as HOMA > 2.8. Patients self-identified race. Results: Of 1017 women, average age was 58 years (SD = 12.0). 373 (37%) were stage 2+ at time of diagnosis; 19% had an NPI > 4.4. Black women presented with higher stage of cancer than white women (stage 2+: 45% vs 35%; p = 0.01), more TNBC than white women (10% vs 5%, p = 0.01), were more insulin resistant (24% vs 11%, p < .0001), had higher BMI (31.4kg/m2 vs 26.6 kg/m2; p < .0001) and NPI > 4.4 (29% vs. 17%, p = 0.0002) than white women. HOMA score was positively but not significantly associated with NPI score (r = 0.05; p = 0.1). Multivariate mediation regression model suggested that HOMA_IR does not mediate the effect from black race to higher NPI score (β = 0.01; 95%CI: -0.017 to 0.039). Conclusions: In women with newly diagnosed breast cancer, black women are more likely to be obese, have higher HOMA & NPI scores than white women. While these data are consistent with the hypothesized relationship of hyperinsulinemia promoting more aggressive breast cancer, to date, insulin resistance does not appear to mediate the effect of race and poor prognostic breast cancer.

e18140 Background: Multiple Myeloma (MM) management has significantly improved disease-free and overall (OS) survival but disparities among racial groups still exist. After the Affordable Care Act, the extent to which induction, autologous stem cell transplant (ASCT), and maintenance therapies are used are uncertain. We sought to describe underuse of induction, ASCT and maintenance in a large referral center. Methods: Between 2010 and 2014, 3101 patients were diagnosed with MM via ICD-9 code from the Data Warehouse and certified hospital tumor registry. NCCN 2014 and CMS guidelines were used to define the categories of treatment underuse, and define transplant eligibility. Demographics including insurance, Charlson Comorbidity Index and treatments received were determined via chart abstraction. To date, 393 confirmed MM from 697 charts were abstracted. Comparison by groups used Chi-square for categorical variables, t-test and ANOVA for continuous variables. Multivariate logistic regression models were applied to predict underuse of induction, harvest, ASCT, and maintenance. Results: Patients were 62 ±11.3 years-old, with no racial differences in age and insurance coverage. More minorities had Medicaid (Black [B] 13%, White [W] 7%, Hispanic [H] 25%; p = 0.001). Almost all patients (97%) received induction (B 99%, W 96%, H 100%; p = 0.3), with no difference by insurance. Among transplant eligible patients, 93% underwent harvest, 87% underwent ASCT, with no racial differences. Patients with Medicare or self-pay were less likely to undergo harvest compared to patients with Medicaid or private insurance (p = 0.01). No difference in ASCT rates by insurance were noted. B patients were less likely to receive maintenance than non-B (73% vs 86%; p = 0.03), with no difference by insurance. OS was 73%, with no racial differences. In multivariate model, older age predicted induction underuse (aOR = 1.15, 95% CI: 1.06-1.25) (c = 0.9, p = 0.005), and B patients experienced more maintenance underuse (aOR = 2.22, 95% CI: 1.09-4.54) (c = 0.61, p = 0.1), controlling for age and comorbidity. Conclusions: While there were no racial or insurance differences in access to induction therapy, fewer Black patients received maintenance therapy. Interviews are underway to understand reasons for observed differences.

e18159 Background: Care coordination affects the quality of cancer treatment. Multiple Myeloma (MM) patients frequently are cared for by local and referral center physicians. We sought to determine whether getting treated at different sites might impact on the quality of MM care. Methods: We used NCCN 2014 and CMS guidelines to define categories of treatment quality and transplant eligibility. We defined high quality MM care as: Induction for all patients with ECOG < 4; harvest & transplant for patients completing induction without progression, with albumin > 2.8, bilirubin < 3 and age ≤77 years; maintenance for transplant ineligible patients completing induction with no progression & for transplant eligible patients completing transplant with no progression; and supportive care of receiving bone targeting agents, anticoagulation and infection prophylaxis for all patients receiving MM therapy. Patients who received care with both local and referral center physicians were considered to have received care at 2 sites. We abstracted 709 charts of patients with ICD-9 diagnosis of MM from 2010-2014 for demographics, site of care and treatments received. We compared groups with chi square and multivariate logistic regression models with age, insurance, race, comorbidity and sites of care to predict care quality. Results: Of the 709, 388 had active MM. On average, patients were 62 ±11 years. Overall, 70% received care at > 1 site. Referred patients had no differences by age, comorbidity index, insurance or race. Having > 1 care site was associated with higher rates of induction and harvest. Conclusions: Historically, hand-offs in care have been associated with poorer quality. However, in a referral center, hand-offs do not negatively affect induction and harvest care quality. Patients referred to a MM center are more likely to get high quality treatments for which they are referred, but referral does not ensure receiving the full gamut of needed MM treatments.[Table: see text]

Objective To identify key organizational approaches associated with underuse of breast cancer care. Setting Nine New York City area safety-net hospitals. Study Design Mixed qualitative–quantitative, cross-sectional cohort. Methods We used qualitative comparative analysis (QCA) of key stakeholder interviews, defined organizational “conditions,” calibrated conditions, and identified solution pathways. We defined underuse as no radiation after lumpectomy in women

Purpose Because insurers use performance and quality metrics to inform reimbursement, identifying remediable causes of poor-quality cancer care is imperative. We undertook this descriptive cohort study to assess key predictors of women's perceived quality of their breast cancer care and actual guideline-concordant quality of care received. Patients and Methods We surveyed inner-city women with newly diagnosed and surgically treated early-stage breast cancer requiring adjuvant treatment who were enrolled onto a randomized controlled trial (RCT) of patient assistance to reduce disparities in care. We assessed women's perceived quality of care and perceived quality of the process of getting care, such as getting referrals, test results, and treatments; we abstracted records to determine the actual quality of care. Results Of the 374 new patients with early-stage breast cancer enrolled onto the RCT, only a slight majority of women (55%) perceived their quality of care as excellent; 88% actually received good-quality, guideline-concordant care. Excellent perceived quality (P < .001) was significantly associated with patients' perception of the quality of the process of getting care (adjusted relative risk [RR], 1.78; 95% CI, 1.65 to 1.87). Also associated with perceived quality—and mediated by race—were trust in one's physician (adjusted RR, 1.43; 95% CI, 1.16 to 1.64) and perceived racism, which affected black women more than women of other races/ethnicities (black race–adjusted RR for perceived racism, 0.33 [95% CI, 0.10 to 0.87]; black race–adjusted RR for trust, 1.61 [95% CI, 0.97 to 1.90]; c = 0.82 for the model; P < .001). Actual quality of care provided did not affect perceived quality of care received. Conclusion Patients' perceived quality of care differs from their receipt of high-quality care. Mutable targets to improve perceived quality of care include the processes of getting care and trusting their physician.

e12528Background: Perceived socioeconomic status (SES) may be an important social determinant of health, cancer risks, access to care and health outcomes. We conducted this study to assess the rela...

Purpose Little is known about why women with breast cancer who have surgery do not receive proven effective postsurgical adjuvant treatments. Methods We surveyed 258 women who recently underwent surgical treatment at six New York City hospitals for early-stage breast cancer about their care, knowledge, and beliefs about breast cancer and its treatment. As per national guidelines, all women should have received adjuvant treatment. Adjuvant treatment data were obtained from inpatient and outpatient charts. Factor analysis was used to create scales scored to 100 of treatment beliefs and knowledge, medical mistrust, and physician communication about treatment. Bivariate and multivariate analyses assessed differences between treated and untreated women. Results Compared with treated women, untreated women were less likely to know that adjuvant therapies increase survival (on a 100-point scale; 66 v 75; P < .0001), had greater mistrust (64 v 53; P = .001), and had less self-efficacy (92 v 97; P < .05); physician communication about treatment did not affect patient knowledge of treatment benefits (r = 0.8; P = .21). Multivariate analysis found that untreated women were more likely to be 70 years or older (adjusted relative risk [aRR], 1.11; 95% CI, 1.00 to 1.13), to have comorbidities (aRR, 1.10; 95% CI, 1.04 to 1.12), and to express mistrust in the medical delivery system (aRR, 1.003; 95% CI, 1.00 to 1.007), even though they were more likely to believe adjuvant treatments were beneficial (aRR, 0.99; 95% CI, 0.98 to 0.99; model c, 0.84; P ≤ .0001). Conclusion Patient knowledge and beliefs about treatment and medical mistrust are mutable factors associated with underuse of effective adjuvant therapies. Physicians may improve cancer care by ensuring that discussions about adjuvant therapy include a clear presentation of the benefits, not just the risks of treatment, and by addressing patient trust in and concerns about the medical system.

BACKGROUND Black and Hispanic women with early-stage breast cancer are more likely than white women to experience fragmented care and less likely to see medical oncologists to get effective adjuvant treatment. We implemented a tracking and feedback registry to close the referral loop between surgeons and oncologists. METHODS We compared completed oncology consultations and use of adjuvant treatment among a group of 639 women with newly diagnosed stage I or II breast cancer who had undergone surgery at one of six New York City hospitals from 1999 to 2000 with the same outcomes for a different group of 300 women with breast cancer whose surgeries occurred in 2004-2006, after the implementation of the tracking registry. Underuse of adjuvant treatment was defined as no radiotherapy after breast-conserving surgery, no chemotherapy for estrogen receptor (ER)-negative tumors, or no hormonal therapy for ER-positive tumors 1 cm or larger. We used hierarchical modeling to adjust for clustering within hospital and surgeon practice. Odds ratios were converted to adjusted relative risks (aRRs). All statistical tests were two-sided. RESULTS Implementation of the tracking and feedback registry was accompanied by a statistically significant increase in oncology consultations (83% before vs 97% after the intervention; difference = 14%; 95% confidence interval [CI] = 11% to 18%; P < .001) and decrease in underuse of adjuvant treatment (23% before vs 14% after the intervention; difference = -9%, 95% CI = -12% to -6%; P < .001). Underuse declined from 34% to 14% among black women, from 23% to 13% among Hispanic women, and from 17% to 14% among white women (chi-square of change in underuse from before to after among the three racial groups; P = .001). In multivariable models adjusting for clustering by hospital and surgeon, the intervention was associated with increased rates of oncology consultation (aRR = 1.6, 95% CI = 1.3 to 1.8), and reduced underuse of adjuvant treatment (aRR = 0.75, 95% CI = 0.6 to 0.9). Compared with the preintervention findings, minority race was no longer a risk factor for low rates of oncology consultation (aRR = 1.0, 95% CI = 0.7 to 1.3) or for underuse of adjuvant therapy (aRR = 1.0, 95% CI = 0.8 to 1.3). CONCLUSIONS A tracking and feedback registry that enhances completed oncology consultations between surgeons and oncologists also appears to reduce rates of adjuvant treatment underuse and to eliminate the racial disparity in treatment.

Despite the survival benefit associated with adjuvant chemotherapy in early-stage breast cancer, many do not complete treatment. This study identified factors associated with noncompletion of adjuvant chemotherapy among a select population of women with early-stage breast cancer. The study sample was obtained from a multicenter study designed to evaluate patient-assistance program usage among early-stage breast cancer patients requiring adjuvant therapy. In this study, 333 patients with stages I and II breast cancer undergoing surgery from October 2006 to September 2009 completed 6-month follow-up surveys assessing their experiences with care, health status, social support, self-efficacy, and treatment beliefs. In- and outpatient medical records were abstracted to assess treatment completion. Of the 333 patients, 198 initiated adjuvant chemotherapy and formed our study cohort. The study compared patients who did and did not complete adjuvant chemotherapy. The median patient age was 53 years (range 28–86 years). According to self-identification, 41 % of the patients were non-Hispanic white and 21 % were black. A total of 13 patients (7 %) did not complete adjuvant chemotherapy. In the bivariate analysis, the patients not completing chemotherapy were more likely to be black and unmarried women with low emotional social support and a poor body image after treatment. In the multivariate analysis, black race [odds ratio (OR) 5.62; 95 % confidence interval (CI) 1.63–20.36] and poor body image (OR 9.75; 95 % CI 2.12–95.95) were independently associated with noncompletion of chemotherapy. Overall chemotherapy noncompletion rates were low among women exposed to patient-assistance programs. However, poor body image and black race were independent predictors of uncompleted chemotherapy. The true impact of race in this group may result from social factors that occur more often among black women, including poor social support.

Patients with breast cancer who need adjuvant treat- ments often fail to receive them. High-quality, community-based pa- tient-assistance programs are an underused, inexpensive resource to help patients with cancer obtain needed therapy. We sought to determine whether connecting women to patient-assistance programs would reduce underuse of adjuvant therapies. Methods: We conducted a randomized trial of 374 women (190 assigned intervention (INT), 184 to usual care (UC)) with early-stage breast cancer who underwent surgery between Oc- tober 2006 and August 2009. After initial needs assessment, individualized action plans were created to connect INT patients with targeted patient-assistance programs; UC patients received an informational pamphlet. Main outcome measures were re- ceiving adjuvant treatment and obtaining help. Results: High rates of INT and UC patients received treat- ment: 87% INT versus 91% UC women who underwent lumpectomy received radiotherapy (P.39); 93% INT versus 86% UC women with estrogen receptor (ER) -negative tu- mors 1 cm received chemotherapy (P.42); 92% INT versus 93% UC women with ER-positive tumors 1c m re- ceived hormonal therapy (P.80). Many women reported needs: 63% had informational; 55%, psychosocial; and 53%, practical needs. High rates of INT patients with needs con- nected with a program within 2 weeks (92%). At 6 months, INT and UC women used patient-assistance programs at similar rates (75% v 76%; P.54). Women with informational or psychosocial needs were more likely to receive help (relative risk (RR), 1.77; 95% CI, 1.51 to 1.90 and RR, 1.37; 95% CI, 1.06 to 1.61, respectively). Conclusion: INT and UC patients received high rates of adju- vant treatment regardless of trial assignment. Patients with breast cancer who connect to relevant patient assistance pro- grams receive useful informational and psychosocial but not practical help.

107 Background: System failures, a cause of underuse in which doctors order care, patients don’t refuse but care doesn’t ensue, tend to happen more at safety net hospitals (SNH). Tracking & follow-up approaches that close referral loops in SNHs may reduce underuse. In a randomized trial, we tested a Tracking & Feedback (T&F) tool to reduce underuse of adjuvant breast cancer treatment. Methods: We recruited 5 community & 5 municipal SNHs that serve a large proportion of minorities in the NYC metropolitan area. We implemented rapid case ascertainment, a T&F tool and trained point persons at each site to determine if women with newly operated stage 1-3 breast cancer, connected with the oncologist since such connections are associated with getting treated. The tool created a daily “to do” reminder for point persons to ascertain if patients were seen by the oncologist. Point persons then relayed this information to surgeons to follow through as they deemed necessary. Underuse includes: no RT after lumpectomy or mastectomy with > 4 positive nodes; no chemo for HR- and no hormonal therapy for HR+ tumors > 1cm; no trastuzumab for Her2+ tumors. We interviewed key informants about tool usefulness. We conducted intention to treat and pre-post analyses to assess tool and implementation effectiveness, respectively. Results: Pre-intervention, despite randomizing hospitals, intervention (INT) hospitals had fewer whites (4% vs 14%; p = 0.0005), poorer follow-up approaches (0.68 vs 0.80; p = 0.07), less Medicaid & uninsured patients (36% vs 62%; p < .0001) and more underuse (28% vs 15%; p = 0.002) compared to control (CNTL) hospitals; comorbidities and stage were similar. The RCT found no difference in underuse rates (9% at INT & 11% at CNTL hospitals; p = 0.8). Because randomization did not result in equivalent distributions, we modeled pre- (N = 403) and post (N = 191) populations controlling for time period and clustering & found that hospitals with better follow-up (OR = 0.82; 95% CI: 0.71-0.96) had less underuse. In settings with poor follow-up & tracking approaches, key informants found the tool useful. Conclusions: While the RCT findings were negative, they suggest a T&F tool may help reduce underuse in SNHs with poor follow-up capabilities. Clinical trial information: NCT01544374.

Oncotype DX, a 21-gene-array analysis, can guide chemotherapy treatment decisions for women with ER+ tumors. Of 225 ER+ women participating in a patient assistance trial, 23% underwent Oncotype DX testing: 31% of whites, 21% of blacks, and 14% of Hispanics (P=0.04) were tested. Only 3 white women were treated at municipal hospitals and none was tested. 3% of women treated in municipal hospital as compared to 30% treated at tertiary referral centers were tested (P=0.001). Within tertiary referral centers, there was no racial difference in testing: 32% of whites, 29% of blacks, and 19% of Hispanics (P=0.25). Multivariate analysis (model c-statistic = 0.76;P<0.0001) revealed that women who underwent testing were more likely to have stage 1B (RR=1.70; 95% CI: 1.45–1.85) and to be treated after 2007 (RR=1.34; 95% CI: 1.01–1.65) and less likely to be treated at a municipal hospital (RR=0.20; 95% CI: 0.04–0.94). Women treated at municipal hospitals were less likely to undergo testing resulting in a misleading racial disparity that is driven by site of care. As Oncotype DX can reduce overuse of chemotherapy, it is imperative to expand testing to those who could benefit from yet experience underuse of this test, namely, women treated at safety net hospitals. This trial is registered withNCT00233077.

Women with breast cancer report needs that may interfere with their ability to obtain necessary treatments. High-quality community-based patient assistance programmes exist; however, their ability to identify and meet women's needs is unknown. We surveyed women with breast cancer attending such programmes to assess programmes' ability to identify and meet their needs. We surveyed 117 (42% minority) women utilizing nine programmes in the New York City area about expectations, needs and experiences. Ninety-two (89%) women wanted information, 102 (95%) psychosocial support and 15 (20%) practical assistance. Seventy-three per cent had all or most of their needs identified, and 74% had all or most of their needs met. Seventy per cent stated programmes met needs they were not previously aware they had. Needs identified and met were lower among minority women (57% vs. 84%; P = 0.003), those with lower income (46% vs. 79%; P = 0.02) and those in poor physical health (56% vs. 78%; P = 0.04), independent of the type of need. High-quality community-based patient assistance programmes effectively identify and meet the needs of women with breast cancer but traditionally at-risk women appear less likely to have needs identified and met. Programmes should enhance the systemization and sensitivity of needs assessments to improve women's experience with cancer.

186 Background: Prostate cancer is the most common cancer for men in the US, yet the burden of this disease falls disproportionately on African Americans (AAs). The disparity’s etiology is complex. Surgery and radiotherapy offer similar survival but historically have different rates of performance with younger and white men more likely to undergo surgery and AAs more likely to experience underuse. This study aims to examine treatment decision-making (TDM) processes for AA men from patient and physician perspectives. Methods: At 1 academic and 1 municipal urban hospital, pathology records and a tumor registry from 2007-2012 were used to identify 359 AA and 282 white men with locally advanced prostate cancer, a Gleason score of 7-10, and receipt of definitive treatment. 15/17 treating physicians of participating patients were interviewed. Underuse overall was 4%, AA had higher rate of underuse compared to whites (6% vs. 1% respectively, p = 0.0002). 14 patients with longer times between diagnosis and treatment were recruited for 4 focus groups & 2 interviews lasting 60-90 minutes eliciting perspectives on themes related to TDM. Transcripts were coded and analyzed using a grounded theory approach. Results: Preliminary analysis of patient interviews suggests that patients primarily base their treatment decisions on physician recommendations. Patients were often unaware of treatment side effects. However, some patients felt this deficit helped them decide to receive treatment, whereas if they had known about possible impotence and incontinence, they would have refused treatment. Physicians recognized that patient concerns about side effects were a critical TDM factor. Physicians attributed prolonged delays between diagnosis and treatment to waiting times for tests of possible tumor spread and medical comorbidities. Conclusions: Understanding decision making and care processes for AA men with local advanced prostate cancer is critical to reducing the treatment and outcome disparities in this population. This study identifies several patient and physician/system factors that contribute to this process. These data can help inform interventions to improve prostate cancer care for AA men.

6511 Background: Safety-net hospitals, historically at higher risk for delivering poor-quality care, provide a disproportionate amount of care to vulnerable populations. Some safety-net institution...

e12623 Background: Black women are more likely than white women to be obese, and obesity is associated with worse breast cancer outcomes. Black women are more likely to be satisfied with their body...

e16068 Background: Locally advanced prostate cancer treatment can improve survival. Yet, African American are more likely than white prostate cancer patients to go untreated. We found that 13% of b...

e17678 Background: Black men are more likely to develop and die of prostate cancer than white men. Past studies show lower rates of definitive treatment among black men. However these studies included early-stage disease for which treatments may not be beneficial. We undertook this study to assess the quality of prostate cancer treatment among men with intermediate & high risk prostate cancer who could benefit from active therapies. Methods: A Steering Committee of experts in prostate cancer care reviewed the evidence to create quality measures of proven effective treatments of intermediate & high risk prostate cancer. All black and a random sample of white men with Gleason Scores of >7, diagnosed at an inner-city academic center between 2007 and 2012, were identified from pathology and charts abstracted for clinical, pathologic and treatment data. Results: Of 289 black & 266 white men identified, average age was 60y (SD=8.5) with no racial difference in age or insurance coverage. 14% of men had D’Amico i...

e19621 Background: Women with hormone receptor positive (HR+) breast cancer can benefit from chemotherapy (CTX). Unnecessary therapy can adversely affect patient morbidity.. While tumor biology affects decision making, patient perception of cancer recurrence is also important. In this study we determine whether women with HR+ tumors (>1cm) who undergo CTX, have stronger beliefs in the efficacy of CTX than women who do not get therapy. Methods: Women participating in a Breast Cancer Patient Assistance Trial in 2006-2010 were surveyed about their cancer knowledge and beliefs about its treatment; charts were abstracted 6 months later to measure treatments received. A Nottingham Prognostic indicator (NPI), which uses stage, tumor size, and lymph node involvement was calculated. Chi-square and logistic regression analyses examined associations between receipt of CTX and tumor stage, NPI, physician recommendation, patient demographics and beliefs about CTX. Results: Women with HR+ tumors 130/211(62%) received CTX and 197/211(93%) received hormonal therapy. Gene array analysis was performed in 46/211 (22%), and of these (7/46 [15%]) had high recurrence scores and received CTX. Women treated with CTX vs those without CTX were younger (mean 52.5 yrs vs 62.3 yrs, p

e11004 Background: Beliefs about medications, more than knowledge, have been found to affect medication adherence. For breast cancer patients, at least 5 years of daily adjuvant hormonal therapy (HT) improves survival but it is often difficult for women to sustain therapy. Qualitative studies suggest women take HT to prevent breast cancer recurrence. We sought to assess whether beliefs about HT and screening were associated with ongoing HT adherence. Methods: Patients with a new early-stage breast cancer enrolled in an IRB-approved RCT to reduce disparities in care in New York City were telephone surveyed 6 months after their surgical treatment for breast cancer to assess knowledge, attitudes and beliefs about breast cancer, its treatment and prevention. Adherence was defined as a positive response to “are you now taking hormonal therapy (e.g., tamoxifen, arimidex)?” Beliefs about HT and mammogram screening were assessed. Bivariate analyses were conducted with t tests, chi square or Wilcoxon rank sum tests; multivariate analysis used a stepwise logistic regression. Results: Of 333 enrolled women, 233 were recommended to take HT. Of these, 187 (80%) women were prescribed HT and 172 (92%) were still adherent 6 months after surgery. Fifty-three percent of women were bothered by side effects but all were adherent; however, of the 15 women who stopped HT, 6 (40%) stopped due to side effects. Sixteen percent of women expressed difficulty paying for HT but all were adherent. Patients adherent to HT had stronger beliefs in both HT as treatment and prevention and in the importance of regular mammograms to stay healthy. A multivariate model including race, insurance, HT knowledge and beliefs found that only beliefs about HT and mammogram screening were associated with adherence (belief about HT: OR=1.1; 95%CI: 1.03-1.11; belief about mammogram: OR=1.55; 95% CI: 1.06-2.27) [model c=.84; p

Background. Physicians are mandated to offer treatment choices to breast cancer patients yet not all patients may want the responsibility that entails. Prior studies show that breast cancer patients who are not given enough responsibility for treatment decision-making have poorer treatment knowledge and report worse quality of care. In contrast, few studies explore potential adverse consequences for breast cancer patients who feel they are given too much responsibility for treatment decision-making. Methods. We sought to describe and compare women by degree of responsibility they felt they had for making decisions about their breast cancer treatment. Our sample includes women with early-stage breast cancer treated surgically at 8 NYC hospitals, recruited for an RCT of patient assistance to improve receipt of adjuvant treatment. In multivariable analyses, we explored the association between treatment decision-making responsibility and a) baseline knowledge of benefit of surgical and adjuvant treatments discussed with doctor and b) regret of treatment decisions after 6 months. Results. Of 368 women aged 28-89y enrolled at baseline, 72% reported a “reasonable amount,” 21% “too much,” and 7% “not enough” responsibility for treatment decision-making. The majority in the first group were White (53%), earned >$150,000/year (33%), completed college (53%), had no health literacy problems (50%), and had a great deal of self-efficacy (61%). In contrast, the majority with “not enough” responsibility were Black (42%), earned Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5497. doi:1538-7445.AM2012-5497

e11131 Background: Oncotype Dx is a 21 gene array analysis to help guide chemotherapy treatment decision-making for women with ER+ tumors. There is little data on its effect on treatment decisions ...

6035 Background: Unmet needs may affect breast cancer patients' receipt of adjuvant therapy and quality of life. High quality community-based cancer assistance programs abound that can address women's informational, psychosocial and practical needs. We identified newly diagnosed and operated breast cancer patients' needs and randomized women to high quality community-based assistance programs that can meet those needs vs. usual care. Methods: 263 (88%) women with new breast cancer operated at 8 NYC hospitals participating in the RCT completed the 6 month follow-up survey assessing functional status, treatments received, perceptions and demographics. Based on women's needs, preferred mode of receipt of help, we informed the intervention group of appropriate programs, enabled program connection, and for those unconnected at 2 weeks, identified barriers to connection and reinforced plans to connect. Controls received a pamphlet about breast cancer. Results: On average, women were 56 years old, had completed ...

6072 Background: This multicenter study examined the perception among all newly diagnosed early stage breast cancer patients as to differences in adherence to hormonal therapy was related to factor...

6537 Background: As insurers consider paying for performance and quality measures grow in importance, factors that affect patients' perceived quality of cancer care matter. Concordance by race in physician-patient relationships has been associated with patient satisfaction and use of health care, however how that is mediated is unclear. Methods: 210 of 300 eligible women stage I or II breast cancer at 1 of 8 participating NYC hospitals responded to our survey (70% response rate): 20% were African-American (AA), 40% were white, and 30% were Hispanic and 9% were other races. Trust is based on a validated scale and calibrated to a 100 point scale (Cronbach α = 0.76). Bivariate analyses and logistic models were used to identify factors associated with patient ratings of quality of care. Results: Only 55% of women rated the quality of their cancer care as excellent. AA women breast cancer patients were less likely to rate their care as excellent (p=0.004). Compared to women who didn't rate their care as excellent, those who rated it excellent had greater trust in their physician (p < 0.0001) and indicated that were treated well by their physicians' office staff (p = 0.01). Of note, AA patients had lower levels of trust (p = 0.004). Women who were of the same race as their physician did not perceive better quality of care as compared to those who were not racially concordant (p = 0.18); nor did they have higher trust in their physician (p = 0.59). Multivariate models evaluating the role of patient race, education, income, knowing which physician to talk to, how well the staff treated the patient, and racial concordance with physician, found that trust in physician was significantly associated with patient perception of excellent quality care (aRR = 1.38; 95%CI: 1.03–1.65) and being AA was associated with worse perceived quality (aRR = 0.47; 95%CI: 0.21–0.88) (model c = 0.79; p < 0.0001). Conclusions: Racial concordance between physicians and patients does not directly affect patients' perceived quality of care. However, women's trust in their physician and their perceived treatment by office staff are associated with excellent cancer care quality ratings. Efforts should be made to increase effective intercultural communication particularly among AA women in order to improve ratings of cancer care quality. No significant financial relationships to disclose.

6554 Background: As insurers consider paying for performance and quality measures grow in importance, factors that affect patients’ perceived quality of cancer care matter. We undertook this study to assess predictors of women's ratings of the quality of their breast cancer care. Methods: 210 of 300 eligible women with stage I or II breast cancer at 1 of 8 participating NYC hospitals were enrolled in our survey: 43 (20%) were African-American (AA), 85 (40%) were white, and 63 (30%) were Hispanic and 19 (9%) were other races. All patients were telephone-surveyed to assess care experiences, knowledge, attitudes & beliefs about breast cancer and its treatment. Trust is based on a validated instrument and calibrated to a 100 point scale (Cronbach α = 0.73). A scale of 5 items assessing physician communication was created and calibrated to100 points (Cronbach α = 0.83). Results: Only 55% of women rated their quality of cancer care as excellent. Compared to women who did not rate their care as excellent, those who did had greater trust in their physician (p < 0.0001), better communication with their physician (p < 0.0001), indicated that were treated well by their physicians’ office staff (p = 0.01), and knew which physician to ask when they had questions (p = 0.0001); age, education & income were not significantly related to patient report of excellent care. AA women were least likely to rate their care as excellent (p = 0.004). AA women had lower levels of trust in their physician (p = 0.02). Patients reporting greater levels of communication also had greater trust (r = 0.38; p < 0.0001). Multivariate models evaluating the role of patient race, education, income, knowing which physician to talk to and how well the staff treated the patient found that being AA (aRR = 0.47; 95% CI: 0.21–0.88), having greater trust (aRR = 1.72; 95% CI:1.49–1.85) and better communication (aRR = 1.38; 95% CI: 1.03–1.65) were significantly associated with patient perception of excellent quality care (p < 0.0001). Conclusions: Greater levels of physician communication about treatment and patient trust of their physician affect women's ratings of excellent cancer care quality. Efforts should be made to improve physician communication about treatment, particularly among AA women, to improve levels of trust and ratings of cancer care quality. No significant financial relationships to disclose.

Abstract #5098 Background: It has been well-established that survival following breast conservation surgery(BCS) vs. mastectomy(MT) is equivalent. Therefore women with early-stage breast cancer should given a choice between BCS and MT. It has recently been recognized that women who have a choice of surgery type have better short term health status. Some studies suggest that there is treatment variation according to socioeconomic status and race. But little is known about whether there is a variance in a feeling of choice based on ethnicity/race and socioeconomic status. Do these factors affect women's sense of choice in her surgical treatment? Methods: Women with a newly diagnosed Stage I/II breast cancer were identified from pathology databases of 6 participating NYC hospitals, including 3 municipal, 2 tertiary, and one community hospital. Patients were surveyed an average of 6 months after surgical treatment. Bivariate, logistic and factor analyses were conducted on the 258 participants. IRB approval was obtained at all 6 institutions. Results: Despite high rates(88%) of reported discussion of surgery types, only 55% of women felt they had a choice of surgical treatment. Women who felt they had a choice were more likely to be younger(55 vs. 61; p=0.0009), more knowledgeable about equivalent survival outcomes(24% vs. 12%, p+0.0170), and shared decision making(Cronbach α=0.79) with their physician(92% vs. 88%, p=0.0066). When taking into account the patient's stage of cancer, there was no difference in the feeling of choice based on race/ethnicity, income level, or education level. This feeling of having a choice in the surgical procedure performed was not related to type of surgery: 57% of women with mastectomy felt they had a choice, while 56% of breast conservation surgery patients felt they had a choice. Conclusions: There is a difference between mentioning treatment options during preoperative evaluations and counseling of women with newly diagnosed early-stage breast cancer, and shared decision-making. Shared-decision making is associated with a greater sense of choice, which can affect health status and may influence patients satisfaction with overall treatment. Surgeons should involve women in discussion of treatment options, regardless of education or race, as this can influence patient's sense of choice, which in turn, can affect health status. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5098.

6512 Background: Despite effective adjuvant treatment for early stage breast cancer, women do not always receive it, particularly, minority women. Adjuvant underuse occurs more commonly among women...

Background: Despite the existence of effective adjuvant treatment for early stage breast cancer, women do not always receive it, particularly, minority women. Primary treatment for breast cancer, surgery and varying combinations of radio-, chemo- and hormonal therapy, is delivered by different specialists and is often fragmented. Underuse of post-surgical adjuvant treatment occurs more commonly among women who do not see a medical oncologist despite surgeons’ referral request. To reduce underuse of adjuvant treatment due to failed connections, we tracked and fedback to surgeons information about whether their newly diagnosed breast cancer patients connected with an oncologist. Methods: We compared oncology referral rates and underuse among pre-intervention (N=677) and intervention (N=300) patients undergoing breast cancer surgery at 6 NYC hospitals. All surgeons consented to the intervention. Each surgeon chose an office person to verify eligibility and identify patient’s oncology referrals. Patients identified upcoming oncology appointment sites and times. Following scheduled visits, oncologists were called to verify patients’ connection & these data were fedback to surgeons & their office staff. Six months later, we abstracted in- & outpatient charts. We compared rates of: completed oncology consultations and underuse of radiotherapy after breast conserving surgery, of chemotherapy for ER negative and hormonal therapy for ER positive tumors >1cm between pre- and intervention women with newly diagnosed early-stage breast cancer. Results: There was a significant increase in oncology consultations completed (83% to 97%; p Conclusions: A tracking and feedback registry which closes the referral loop between surgeons and oncologists appears to improve rates of medical oncology consultation, reduces rates of adjuvant treatment underuse and eliminates the racial disparity in treatment.