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A concerted commitment across research stakeholders is necessary to increase equity, diversity, and inclusion (EDI) and address barriers to cancer clinical trial recruitment and participation. Racial and ethnic diversity among trial participants is key to understanding intrinsic and extrinsic factors that may affect patient response to cancer treatments. This ASCO and Association of Community Cancer Centers (ACCC) Research Statement presents specific recommendations and strategies for the research community to improve EDI in cancer clinical trials. There are six overarching recommendations: (1) clinical trials are an integral component of high-quality cancer care, and every person with cancer should have the opportunity to participate; (2) trial sponsors and investigators should design and implement trials with a focus on reducing barriers and enhancing EDI, and work with sites to conduct trials in ways that increase participation of under-represented populations; (3) trial sponsors, researchers, and sites should form long-standing partnerships with patients, patient advocacy groups, and community leaders and groups; (4) anyone designing or conducting trials should complete recurring education, training, and evaluation to demonstrate and maintain cross-cultural competencies, mitigation of bias, effective communication, and a commitment to achieving EDI; (5) research stakeholders should invest in programs and policies that increase EDI in trials and in the research workforce; and (6) research stakeholders should collect and publish aggregate data on racial and ethnic diversity of trial participants when reporting results of trials, programs, and interventions to increase EDI. The recommendations are intended to serve as a guide for the research community to improve participation rates among people from racial and ethnic minority populations historically under-represented in cancer clinical trials. ASCO and ACCC will work at all levels to advance the recommendations in this publication.

The adjustments include covariates: age, HbA1c, Charlson comorbidity, finasteride use, and statin use, and propensity scores for metformin use.

The Hispanic/Latino(x) population (H/L) in the United States of America is heterogeneous and fast growing. Cancer is the number one cause of death among H/Ls, accounting for 21% of deaths. Whereas for the most common cancers, incidence rates are lower in H/Ls compared with non-H/L White (NHW) individuals, H/Ls have a higher incidence of liver, stomach, cervical, penile, and gallbladder cancers. H/L patients tend to be diagnosed at more advanced stages for breast, colorectal, prostate, and lung cancers, and melanoma compared with NHW individuals. Etiologic and cancer outcomes research among H/Ls lags other populations. In this review, we provide a summary of challenges, opportunities, and research priorities related to cancer etiology, cancer outcomes, and survivorship to make progress in addressing scientific gaps. Briefly, we prioritize the need for more research on determinants of obesity, nonalcoholic fatty liver disease and its progression to liver cancer, stomach and gallbladder cancers, and pediatric acute lymphoblastic leukemia. We emphasize the need to improve cancer screening, early detection of cancer, and survivorship care. We highlight critical resources needed to make progress in cancer epidemiologic studies among H/L populations, including the importance of training the next generation of cancer epidemiologists conducting research in H/Ls.

ObjectiveThis study examines childhood cancer survival rates and prognostic factors related to survival in the majority Hispanic population of South Texas.MethodsThe population-based cohort study used Texas Cancer Registry data (1995-2017) to examine survival and prognostic factors. Cox proportional hazard models and Kaplan-Meier survival curves were used for survival analyses.ResultsThe 5-year relative survival rate for 7,999 South Texas cancer patients diagnosed at 0–19 years was 80.3% for all races/ethnicities. Hispanic patients had statistically significant lower 5-year relative survival rates than non-Hispanic White (NHW) patients for male and female together diagnosed at age≥5 years. When comparing survival among Hispanic and NHW patients for the most common cancer, acute lymphocytic leukemia (ALL), the difference was most significant in the 15-19 years age range, with 47.7% Hispanic patients surviving at 5 years compared to 78.4% of NHW counterparts. The multivariable-adjusted analysis showed that males had statistically significant 13% increased mortality risk than females [hazard ratio (HR): 1.13, 95% confidence interval (CI):1.01-1.26] for all cancer types. Comparing to patients diagnosed at ages 1–4 years, patients diagnosed at age < 1 year (HR: 1.69, 95% CI: 1.36-2.09), at 10-14 year (HR: 1.42, 95% CI: 1.20-1.68), or at 15–19 years (HR: 1.40, 95% CI: 1.20-1.64) had significant increased mortality risk. Comparing to NHW patients, Hispanic patients showed 38% significantly increased mortality risk for all cancer types, 66% for ALL, and 52% for brain cancer.ConclusionsSouth Texas Hispanic patients had lower 5-year relative survival than NHW patients especially for ALL. Male gender, diagnosis at age

The second ASCL conference was held in February 2020, about 1 month after the first case of coronavirus disease 2019 (COVID-19) was documented in the United States and before evidence of community spread. Since then, COVID-19 has become a global pandemic that has disproportionately infected, hospitalized, and killed ethnic and racial minorities in the United States (Jacobson et al., Am J Prev Med 61(5):644–651, 2021; Moore et al., MMWR Morb Mortal Wkly Rep 69:1122–1126, 2020; Shiels et al., Ann Intern Med. https://doi.org/10.7326/m21-2134, 2021; American Cancer Society, Cancer facts & figures 2021. American Cancer Society, Atlanta, 2021). According to a report of provisional life expectancy estimates from the National Center for Health Statistics, the life expectancy for US Hispanics decreased 3 years (81.8–78.8) between 2019 and 2020. As a result, the life expectancy advantage held by Hispanics over non-Hispanic whites narrowed by 60%, suggesting poorer health and mortality outcomes for the US Hispanic population. It is estimated that 90% of this decline in the life expectancy gap is the result of mortality caused by COVID-19 (Arias et al., Provisional life expectancy estimates for 2020. National Center for Health Statistics, Hyattsville, 2021). Some speculate that this disease disparity exists because Hispanics and other underrepresented groups receive the greatest exposure to the virus. They are more likely to live in densely populated areas and multigenerational households; use public transportation; and have essential public-facing jobs in the service and healthcare sectors, where working from home is not an option (American Cancer Society, Cancer facts & figures 2021. American Cancer Society, Atlanta, 2021; Hooper et al., JAMA 323(24):2466–2467, 2020; Balogun et al., JAMA Oncol 6(10):1531–1532, 2020). If infected, they are also more likely to experience severe symptoms of COVID-19 because of comorbidities such as diabetes, obesity, cardiovascular disease, asthma, and other chronic conditions (Hooper et al., JAMA 323(24):2466–2467, 2020).

Cancer is the leading cause of death among Latinos, who have a unique demographic profile that departs from the US public health pattern. Latinos have a lower incidence than non-Latino whites for some common cancers such as breast, colorectal, lung, and prostate, yet they are disproportionately affected by some less common cancers, such as gall bladder and infection-related cancers of the liver, intrahepatic bile duct, stomach, and uterine cervix. In addition to increased incidence for some cancers, US Latinos experience other cancer disparities. For one, cancer is often diagnosed at a later stage in Latinos when the disease is more difficult to treat, perhaps the result of economic and cultural barriers to cancer care and lower use of prevention screening. Second, accurately characterizing Latino cancer risk is challenging, because Latinos are underrepresented in cancer registries, research, and clinical trials. Thus, these data do not reflect the proportion of Latinos in the US population. Compounding the problem is the fact that these data commonly consider Latinos as a single group when, in fact, Latinos are heterogeneous and may differ by genetic admixture, country of origin, nativity, degree of acculturation, and socioeconomic status—all factors that have been implicated in cancer risk. The conference, Advancing the Science of Cancer in Latinos, brought together cancer disparities researchers to discuss the latest research findings, identify knowledge gaps, and stimulate ideas for new research in cancer health disparities among Latinos. Conference topics covered the entire cancer continuum, including advances in risk assessment, primary prevention, screening, detection, diagnosis, treatment, and survivorship.

We aimed to identify subgroups of Hispanic/Latino (H/L) cancer survivors with distinct health behavior patterns and their associated sociodemographic, medical, and psychosocial characteristics.Baseline data were used from a randomized clinical trial evaluating the efficacy of an enhanced patient navigation intervention in H/L cancer survivors. Participants (n = 278) completed the Lifestyle Behavior Scale and validated questionnaires on health-related quality of life (HRQOL), supportive care needs, distress, and satisfaction with cancer care. Latent class analysis was used to determine the latent classes and associated characteristics.Three latent classes emerged: class 1 (survivors who increased health behaviors [e.g., exercising and eating healthy] since diagnosis); class 2 (no changes in health behaviors since diagnosis); and class 3 (a "mixed class," with a higher or lower engagement across various health behaviors since diagnosis). Participants in class 1 were significantly more educated and less likely to be foreign born. Participants in class 2 were significantly older and more likely to have prostate cancer. H/L cancer survivors in class 3 had a significantly lower income, were less educated, and reported greater unmet supportive care needs, more distress, and poorer HRQOL.Survivors who report engaging in health behaviors less frequently since diagnosis may be experiencing psychosocial challenges and health disparities.Hispanic/Latino cancer survivors may benefit from screening for social determinants of health and mental health needs, prompt referral to supportive care services, community resources, and public services, and participating in culturally informed psychosocial interventions to address their unique needs.

Background Gastric cancer disproportionately affects Latinos, but little is known about regional effects and risk factors. We compared primary incidence, late‐stage diagnosis, and risk factors for gastric adenocarcinoma (GCA) from 2004 to 2016 in Latinos and non‐Latinos in the United States, Texas (TX), and South Texas (STX). Methods We collected case data from Surveillance, Epidemiology, and End Results (SEER) and the Texas Cancer Registry. We generated average annual age‐adjusted incidence rates, rate ratios (RRs), and 95% confidence intervals (CIs) using SEER*Stat software and analyzed the cases by anatomic site, demographics, and county‐level risk factors using SAS 9.4. We constructed multilevel logistic regression models for late‐stage GCA, adjusting for patient‐ and county‐level characteristics. Results Latinos had higher overall GCA incidence rates in all regions, with the greatest disparities in overlap GCA in STX males (RR 4.39; 95% CI: 2.85, 6.93). There were no differences in cardia GCA rates for non‐Hispanic Whites (NHWs) and Latino women in all regions. Younger patients, patients with overlapping or not otherwise specified (NOS) lesions, and patients diagnosed during 2012–2016 had higher odds of late‐stage GCA. The stratification by location showed no differences in late‐stage disease between NHWs and Latinos. The stratification by anatomic site showed Latinos with cardia GCA were more likely to have late‐stage GCA than NHWs (OR: 1.13, p = 0.008). At the county level, higher odds of late‐stage GCA were associated with medium and high social deprivation levels in TX without STX (OR: 1.25 and 1.20, p = 0.007 and 0.028, respectively), and medium social deprivation index (SDI) in patients with NOS GCA (OR: 1.21, p = 0.01). Conclusions STX Latinos experience greater GCA disparities than those in TX and the United States. Younger age and social deprivation increase the risk for late‐stage GCA, while Latinos and women are at higher risk specifically for late‐stage cardia GCA. There is a need for population‐specific, culturally responsive intervention and prevention measures, and additional research to elucidate contributing risk factors., Latinos had higher gastric adenocarcinoma incidence than non‐Latinos in the U.S., Texas and South Texas from 2004 to 2016. Younger age and social deprivation increased risk of late‐stage diagnosis, while Latino ethnicity and female gender increased risk of late‐stage gastric adenocarcinoma of the cardia specifically.

U.S. Latinos are 1.5 times more likely to develop Alzheimer’s disease (AD) than non-Latino Whites. To raise awareness of and action around this rising public health issue, Salud America!, a nationa...

BACKGROUND: Bladder cancer (BC) poses an enormous burden on health care systems. Latinos in Texas (TX) were underrepresented in previous studies on racial/ethnic disparity of BC in the US. OBJECTIVE: To examine whether BC incidence and survival rates differ among Latinos compared to non-Latino whites (NLW) in South TX, TX, and the US SEER. METHODS: Data was collected from the US SEER Program and the Texas Cancer Registry. Annual age-specific and age-adjusted BC incidence rates and annual 5-year relative survival were calculated. RESULTS: South TX and TX had significantly lower BC incidence rates than SEER for both Latinos and NLW regardless of gender (Ps

PURPOSE: Behavioral interventions have been used with breast cancer survivors (BCS) in cancer pain management and post-treatment quality of life (QOL) studies. We studied the effects of an anti-inflammatory dietary intervention on QOL in BCS. METHODS: One hundred fifty-three overweight and obese (body mass index [BMI] ≥ 25 kg/m(2)), early stage (0-III), English-speaking BCS who had completed all cancer treatment 2 or more months prior to enrollment were recruited into a two-arm randomized controlled trial with a 2 (group) by 3 (time) repeated measures design. Intervention components included six monthly food-preparation workshops and twelve motivational interviewing telephone calls. Endpoints included the Perceived Stress Scale (PSS), the Functional Assessment of Cancer Therapy–General (FACT-G) and Breast Cancer (FACT-B), and the Center for Epidemiologic Studies Depression Scale (CES-D). Repeated measures analysis using PROC MIXED in SAS version 9.4 was used. RESULTS: On repeated measures analysis (intent to treat), there were no differences between groups on any of the QOL outcomes except the PSS total scores. These were significantly different in the intervention group (IG; n = 76) compared to control group (CG; n = 77), showing a main effect of assignment but no effect of time and no interaction effects. CONCLUSION: There was an impact on QOL as measured by the PSS between groups. The intervention reduced perceived stress at 6-month follow-up, but the effects dissipated by 12 months. Sources and stress and stress reduction should be a focus of future studies. Future research should also identify appropriate QOL measures that are sensitive to changes brought about by behavioral interventions.

Introduction Breast cancer survivorship is a life‐long process involving challenges to health‐care communities and individuals, especially Latinas. Patient Navigation has shown some success in meeting these challenges. The purpose of this study was to compare the effects of an enhanced Patient Navigation program (Intervention; PN+) vs Control (PN) over time on general cancer and breast cancer‐specific quality of life (QoL) in Latina breast cancer survivors (BCS). Methods We conducted a 2‐year, two‐arm randomized controlled trial of the “Staying Healthy” program among Latina BCS. The design compared PN+ vs PN over time. We recruited 60 patients into each study arm and randomized them by sequential numerical assignment. PN+ participants received culturally tailored educational materials and active, personalized Patient Navigation services, including phone calls, transportation, and care coordination. PN participants were navigated only upon request. Primary outcomes included general cancer (Functional Assessments of Cancer Therapy [FACTS]‐G) and breast cancer‐specific (FACT‐B) QoL. Results PN+ participants had significantly improved QoL measures compared to PN at 6‐month follow‐up on all subscales (P‐values .007‐.04) except physical well‐being (PWB; P = .11). Intervention effect size coefficient (standard error) for FACT‐G overall was 7.9 (3.1); P = .01. For FACT‐B, it was 10.9 (3.9); P = .006. Again, all subscales showed significant effects [range 1.7‐3.1 (0.8‐1.2); P‐values .006‐.04], except for PWB [1.5 (1.0); P = .16] and social/family well‐being (SWB) [2.1 (1.1); P = .06]. There were no differences between groups at baseline. Discussion Multiple cultural, psychosocial, and socioeconomic variables contributing to these intervention effects will be addressed in future studies. As the national BCS population continues to increase, more Patient Navigation‐focused partnerships among patients, health‐care professionals, research groups, and community organizations are needed to improve BCS experiences. The Staying Healthy program has the potential to serve as a national survivorship care model for improving Latina BCS QoL., We evaluated the effect of a two‐year, two‐arm randomized controlled trial (the “Staying Healthy” program) on quality of life (QoL) among Latina breast cancer survivors (BCS). The design compared enhanced Patient Navigation (Intervention; PN+) versus usual (Control; PN) over time. PN+ participants had significantly improved quality of life measures compared to PN at 6‐month follow‐up.

Summary Background Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness. Methods In this cohort study, we collected de-identified data on patients with active or previous malignancy, aged 18 years and older, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the USA, Canada, and Spain from the COVID-19 and Cancer Consortium (CCC19) database for whom baseline data were added between March 17 and April 16, 2020. We collected data on baseline clinical conditions, medications, cancer diagnosis and treatment, and COVID-19 disease course. The primary endpoint was all-cause mortality within 30 days of diagnosis of COVID-19. We assessed the association between the outcome and potential prognostic variables using logistic regression analyses, partially adjusted for age, sex, smoking status, and obesity. This study is registered with ClinicalTrials.gov, NCT04354701, and is ongoing. Findings Of 1035 records entered into the CCC19 database during the study period, 928 patients met inclusion criteria for our analysis. Median age was 66 years (IQR 57–76), 279 (30%) were aged 75 years or older, and 468 (50%) patients were male. The most prevalent malignancies were breast (191 [21%]) and prostate (152 [16%]). 366 (39%) patients were on active anticancer treatment, and 396 (43%) had active (measurable) cancer. At analysis (May 7, 2020), 121 (13%) patients had died. In logistic regression analysis, independent factors associated with increased 30-day mortality, after partial adjustment, were: increased age (per 10 years; partially adjusted odds ratio 1·84, 95% CI 1·53–2·21), male sex (1·63, 1·07–2·48), smoking status (former smoker vs never smoked: 1·60, 1·03–2·47), number of comorbidities (two vs none: 4·50, 1·33–15·28), Eastern Cooperative Oncology Group performance status of 2 or higher (status of 2 vs 0 or 1: 3·89, 2·11–7·18), active cancer (progressing vs remission: 5·20, 2·77–9·77), and receipt of azithromycin plus hydroxychloroquine (vs treatment with neither: 2·93, 1·79–4·79; confounding by indication cannot be excluded). Compared with residence in the US-Northeast, residence in Canada (0·24, 0·07–0·84) or the US-Midwest (0·50, 0·28–0·90) were associated with decreased 30-day all-cause mortality. Race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with mortality. Interpretation Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments. Funding American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research.

Given how smart phones, internet services, and social media have shown great potential for assisting smoking cessation, we constructed a Facebook chat application based on our previous work with SMS texting services. This report summarizes findings from 2,364 Spanish-speaking young adults recruited through Facebook advertising in South Texas during the 2020 New Year holiday season. Among these service users, 926 (39%) were ready to make a quit attempt, and 26 (3.1%) of those users reported that they were tobacco free 1 month later. There were no responses to a chat question survey 72 days after the dates selected for quitting. Although more research with longer follow up is needed, these findings show that social media chat applications may be helpful for at least prompting quit attempts and short-term cessation among young adult Spanish-speaking smokers. There is no evidence of an impact on long-term cessation, and more research is clearly needed.

Objective(s)Culinary education may be one way to improve children's eating behaviors. We formatively evaluated the effect of a hands-on afterschool 12-module, registered dietitian-led culinary education program on healthy eating behaviors in a predominately Hispanic/Latino, low-socioeconomic community.MethodsOf 234 children participating in the program, 77% completed both pre- and post-assessment surveys (n = 180; mean age 9.8 years; 63.3% female; 74.3% Hispanic/Latino, 88.4% receiving free/reduced lunch). In addition to program satisfaction, we assessed changes in children's self-reported fruit, vegetable, and whole-grain consumption, knowledge, and culinary skills using binary and continuous mixed effects models. We report false discovery rate adjusted p-values and effect sizes.Results95.5% of participants reported liking the program. Improved whole grain consumption had a medium effect size, while effect sizes for whole grain servings and vegetable consumption were small, but significant (all p < 0.05). Culinary skills increased between 15.1 to 43.4 percent points (all p < 0.01), with medium to large effect sizes.Conclusion(s)The program was well-received by participants. Participants reported improved eating behaviors and culinary skills after program completion. Therefore, this hands-on afterschool culinary education program can help improve healthy eating in a predominantly Hispanic/Latino, low-socioeconomic community.

In response to coronavirus disease (COVID-19) in 2020, the national Salud America! Latino health equity program at University of Texas Health San Antonio applied its digital content curation model to create and communicate culturally relevant news, stories, and data to raise immediate awareness and generate action against the pandemic’s inequitable impacts on U.S. Latinos. Digital content curation is an emerging public health communication strategy using a systematic, refined process to create tailored online and social health messages and prevent mixed messaging and information overload for an audience. Salud America! curated culturally relevant digital content to raise awareness of the pandemic’s inequitable impact on Latinos and promote solutions for health equity, with a unique combination of website blog posts exploring pandemic effects on Latinos, peer-modeled stories of people responding meaningfully to the crisis, podcast episodes and Tweetchats engaging people in COVID-19 solutions for Latinos, action tools and campaigns equipping school leaders to make grassroots changes, and supplying advocates with a local data tool on health equity identification. The digital health promotion intervention produced curated content that spiked program website traffic to record highs, revealing the model’s effectiveness in increasing exposure to culturally relevant and action-oriented information for a novel topic.

6530 Background: Only a small fraction of patients with cancer participate in treatment trials. Patients identifying as members of racial and ethnic minority groups are consistently underrepresented in these trials. A recent systematic review reported that patients, regardless of race and ethnicity, are willing to enroll in trials if asked to participate by their treating clinician. Prospective and longitudinal data and metrics at the site- and clinician-level are necessary to understand whether patients are equitably considered for clinical trials. Methods: ASCO and Association of Community Cancer Centers (ACCC) developed a self-assessment for trial sites to record and gauge the number of patients across races and ethnicities screened, offered, and enrolled into clinical trials. Research sites, from across the US, were recruited through an open call to apply to participate in the ASCO-ACCC Pilot Project. There were 65 sites assigned to this pilot study, which tested the feasibility and utility of the site assessment. Sites were asked to enter 2019 and 2020 aggregate data for each step along the clinical trial enrollment continuum by select races and ethnicities (Black, Hispanic/Latinx, White) and overall. Results: 62 of 65 sites completed the study and represented a range of settings and practice types (61% academic, 26% hospital/health system, 13% independent). Only 2 sites (3%) were able to provide the data requested at each enrollment step in the assessment (table). Sites that collected the data did not do so routinely (table) and most had to compile data through multiple sources and/or manual extraction (40-100% across enrollment steps). Sites with missing data reported they did not collect data at all (36-64% across enrollment steps), did not collect data in a systematic way (0-29% across enrollment steps), or stated it would be too burdensome to manually review charts to extract data (12-29% across enrollment steps). Conclusions: Data collection and routine evaluation of participation metrics, by race and ethnicity, are necessary to assess and monitor equity and diversity in clinical trials. Most sites in this study did not collect, or routinely collect, data for screening, offering, and consenting patients to clinical trials. Without these data, sites are unable to evaluate and monitor whether their patients have equitable access to clinical trials or establish strategies to address any inequities. ASCO and ACCC will continue to partner with sites to better understand their processes and the feasibility of collecting such data in a systematic and automated way, such as through electronic health record systems. [Table: see text]

Background Cigarette smoking and alcohol use are well known to be concomitant behaviors, but there is a lack of studies related to recruitment of smokers for mobile cessation services at places where alcohol is consumed, such as bars and clubs. Adapting recruitment strategies to expand the reach of cessation programs to where tobacco users are located may help decrease the health-equity gap in tobacco control by improving reach and enrollment of underserved smokers residing in low-income and rural areas who are not reached by traditional cessation services. Objective The purpose of this exploratory study was to assess the feasibility of direct outreach in bars, clubs, and restaurants to recruit smokers to Quitxt, our mobile smoking cessation service. Quitxt is delivered through SMS text messaging or Facebook Messenger. Methods We collaborated with an advertising agency to conduct in-person recruitment of young adult smokers aged 18-29 years, focusing on urban and rural Spanish-speaking Latino participants, as well as English-speaking rural White and African American participants. Street team members were recruited and trained in a 4-hour session, including a brief introduction to the public health impacts of cigarette smoking and the aims of the project. The street teams made direct, face-to-face contact with smokers in and near smoking areas at 25 bars, clubs, and other venues frequented by young smokers in urban San Antonio and nearby rural areas. Results The 3923 interactions by the street teams produced 335 (8.5%) program enrollments. Most participants were English speakers with a mean age of 29.2 (SD 10.6) years and smoked a mean of 8.5 (SD 6.2) cigarettes per day. Among users who responded to questions on gender and ethnicity, 66% (70/106) were women and 56% (60/107) were Hispanic/Latino. Among users ready to make a quit attempt, 22% (17/77) reported 1 tobacco-free day and 16% (10/62) reported maintaining cessation to achieve 1 week without smoking. The response rate to later follow-up questions was low. Conclusions Direct outreach in bars and clubs is a useful method for connecting young adult cigarette smokers with mobile cessation services. However, further research is needed to learn more about how mobile services can influence long-term smoking cessation among those recruited through direct outreach, as well as to test the use of incentives in obtaining more useful response rates.

BACKGROUND Cigarette smoking and alcohol use are well known to be concomitant behaviors, but there is a lack of studies related to recruitment of smokers for mobile cessation services at places where alcohol is consumed, such as bars and clubs. Adapting recruitment strategies to expand the reach of cessation programs to where tobacco users are located may help decrease the health-equity gap in tobacco control by improving reach and enrollment of underserved smokers residing in low-income and rural areas who are not reached by traditional cessation services. OBJECTIVE The purpose of this exploratory study was to assess the feasibility of direct outreach in bars, clubs, and restaurants to recruit smokers to Quitxt, our mobile smoking cessation service. Quitxt is delivered through SMS text messaging or Facebook Messenger. METHODS We collaborated with an advertising agency to conduct in-person recruitment of young adult smokers aged 18-29 years, focusing on urban and rural Spanish-speaking Latino participants, as well as English-speaking rural White and African American participants. Street team members were recruited and trained in a 4-hour session, including a brief introduction to the public health impacts of cigarette smoking and the aims of the project. The street teams made direct, face-to-face contact with smokers in and near smoking areas at 25 bars, clubs, and other venues frequented by young smokers in urban San Antonio and nearby rural areas. RESULTS The 3923 interactions by the street teams produced 335 (8.5%) program enrollments. Most participants were English speakers with a mean age of 29.2 (SD 10.6) years and smoked a mean of 8.5 (SD 6.2) cigarettes per day. Among users who responded to questions on gender and ethnicity, 66% (70/106) were women and 56% (60/107) were Hispanic/Latino. Among users ready to make a quit attempt, 22% (17/77) reported 1 tobacco-free day and 16% (10/62) reported maintaining cessation to achieve 1 week without smoking. The response rate to later follow-up questions was low. CONCLUSIONS Direct outreach in bars and clubs is a useful method for connecting young adult cigarette smokers with mobile cessation services. However, further research is needed to learn more about how mobile services can influence long-term smoking cessation among those recruited through direct outreach, as well as to test the use of incentives in obtaining more useful response rates.

When the COVID-19 pandemic began, formal frameworks to collect data about affected patients were lacking. The COVID-19 and Cancer Consortium (CCC19) was formed to collect granular data on patients with cancer and COVID-19 at scale and as rapidly as possible. CCC19 has grown from five initial institutions to 125 institutions with >400 collaborators. More than 5,000 cases with complete baseline data have been accrued. Future directions include increased electronic health record integration for direct data ingestion, expansion to additional domestic and international sites, more intentional patient involvement, and granular analyses of still-unanswered questions related to cancer subtypes and treatments.

BACKGROUND Latinx people comprise 18% of the US adult population and a large share of youth and continue to experience inequities that perpetuate health disparities. To engage Latinx people in advocacy for health equity based on this population’s heavy share of smartphone, social media, and Twitter users, Salud America! launched the #SaludTues Tweetchat series. In this paper, we explore the use of #SaludTues to promote advocacy for Latinx health equity. OBJECTIVE This study aims to understand how #SaludTues Tweetchats are used to promote dissemination of culturally relevant information on social determinants of health, to determine whether tweetchats serve to drive web traffic to the Salud America! website, and to understand who participates in #SaludTues Tweetchats and what we can learn about the participants. We also aim to share our own experiences and present a step-by-step guide of how tweetchats are planned, developed, promoted, and executed. METHODS We explored tweetchat data collected between 2014 and 2018 using Symplur and Google Analytics to identify groups of stakeholders and web traffic. Network analysis and mapping tools were also used to derive insights from this series of chats. RESULTS We conducted 187 chats with 24,609 reported users, 177,466 tweets, and more than 1.87 billion impressions using the hashtag #SaludTues during this span, demonstrating effective dissemination of and exposure to culturally relevant information. Traffic to the Salud America! website was higher on Tuesdays than any other day of the week, suggesting that #SaludTues Tweetchats acted effectively as a website traffic–driving tool. Most participants came from advocacy organizations (165/1000, 16.5%) and other health care–related organizations (162/1000, 16.2%), whereas others were unknown users (147/1000, 14.7%) and individual users outside of the health care sector (117/1000, 11.7%). The majority of participants were located in Texas, California, New York, and Florida, all states with high Latinx populations. CONCLUSIONS Carefully planned, culturally relevant tweetchats such as #SaludTues can be a powerful tool for public health practitioners and advocates to engage audiences on Twitter around health issues, advocacy, and policy solutions for Latino health equity. Further information is needed to determine the effect that #SaludTues Tweetchats have on self- and collective efficacy for advocacy in the area of Latino health equity. CLINICALTRIAL

Mobile Health (mHealth) apps are being widely used to monitor the health of patients with chronic medical conditions with the proliferation and the increasing use of smartphones. Mobile devices have limited computation power and energy supply which may lead to either delayed alarms, shorter battery life or excessive memory usage limiting their ability to execute resource-intensive functionality and inhibit proper medical monitoring. This paper presents a methodology for measurement-based performance assessment of cloud backend and mobile networks that support mHealth services. The methodology targets the assessment of a prototype mHealth app developed for breast cancer patients undergoing Endocrine Hormone Therapy (EHT). It models third-party cloud backend services to examine the performance in a representative testing scenario for end-users accessing the app. Experimental results are reported and compared for native Android and iOS implementations. The analysis further reflects the impact of the network and device battery conditions on response times and end-user quality of experience. The contribution of this work is twofold: (a) First, it presents a performance methodology and analysis of a fully functional medication adherence management mHealth app implemented on major duopoly of mobile platforms (android and iOS) and (b) Second, based on the performance analysis, conclusions are drawn that serve as the recommendation pathway for the development of similar medical reference mobile apps.

Background: The successful use of hormone therapy (HT) has contributed to improved 5-year cause-specific breast cancer survival rates, and evidence shows that long-term use produces a larger reduction in recurrence and mortality, with nearly 50% reduction in breast cancer mortality during the second decade after diagnosis. Despite the proven benefits, hormone therapy adherence is suboptimal (less than 80% of daily doses taken), and about 33% of women who are prescribed HT do not take their medication as prescribed and are at increased risk of disease recurrence and increased mortality. Smartphone ownership has increased substantially over the past decade, providing an extraordinary opportunity for innovation in the delivery of tailored interventions to improve patients' adherence to hormonal therapy. Purpose: We present preliminary results of a pilot study that involves a theory-based, culturally tailored, interactive mobile app + patient navigation to improve adherence to HT among breast cancer patients attending the breast clinic at the Mays Cancer Center (MCC). Methods: This is a 2-group parallel, randomized control trial that is currently recruiting 120 breast cancer patients and randomly assigning them to the intervention (60) or the control (60) group. The intervention group receives two components: 1) the HT Helper phone app; and 2) assistance from a patient navigator who will provide educational, psychosocial support and reinforcement, address common barriers, and facilitate the interaction with the medical team as needed. The control group receives the usual care and information provided by the MCC's breast clinic to patients undergoing HT. The app and navigation support are based in Social Cognitive Theory and principles of motivational interviewing. Results: Due to the COVID-19 pandemic, we were forced to suspend the start of the intervention until May 2021. We have recruited 27 patients and will present a general description of participants and preliminary results of the 3-month follow-up. This theory-based intervention will empower patients' self-monitoring and management. It will facilitate patient education, identification/reporting of side effects, delivery of self-care advice, and simplify communication between the patient and the oncology team. Conclusions: The anticipated outcome is a scalable, evidence-based, and easily disseminated intervention with potentially broad use to patients using HT and other oral anticancer agents. The ultimate goal of this innovative multi-communication intervention is to improve overall survival and life expectancy, enhance quality of life, reduce recurrence, and decrease healthcare costs. Citation Format: Patricia Chalela, Edgar Muñoz, Vivian Cortez, Armida Flores, Pramod Sukumaran, Cliff Despres, Devasena Inupakutika, David Akopian, Amelie G. Ramirez. Improving adherence to hormone therapy among breast cancer patients through a mobile app and patient navigation: Preliminary results [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-082.

Adjuvant endocrine hormonal therapy (EHT) is highly effective and appropriate for nearly all breast cancer patients with hormone receptor-positive tumors, which represent 75% of all breast cancer diagnoses. Long-term use of EHT reduces recurrence rates and nearly halves the risk of death during the second decade after diagnosis. Despite the proven benefits, about 33% of women receiving EHT do not take their medication as prescribed. This causes an increase in the risk for recurrence and death.To promote adherence to EHT among breast cancer patients, this study will develop and pilot-test an intervention consisting of 1) a bilingual, culturally tailored, personalized, interactive smartphone application (app); and 2) support from a patient navigator. The control group will receive usual care. This 2-group randomized control trial will recruit 120 breast cancer patients receiving EHT at the Mays Cancer Center at UT Health San Antonio. The two-year study will have 3-time assessments (baseline, 3 and 6 months).This theory-based intervention will empower patients' self-monitoring and management. It will facilitate patient education, identification/reporting of side effects, delivery of self-care advice, and simplify communication between the patient and the oncology team. The ultimate goal of this innovative multi-communication intervention is to improve overall survival and life expectancy, enhance quality of life, reduce recurrence, and decrease healthcare cost. The anticipated outcome is a scalable, evidence-based, and easily disseminated intervention with potentially broad use to patients using EHT and other oral anticancer agents. Keywords: Breast cancer, Endocrine hormone therapy, Adherence, Smartphone app, Patient navigation

PURPOSE: The goal of this education and culinary-based dietary intervention was to increase adherence to a Mediterranean-style, anti-inflammatory dietary pattern in breast cancer survivors (BCS) by promoting consumption of anti-inflammatory foods, herbs, and spices. METHODS: Overweight and obese, early-stage, BCS were randomized to the Intervention (n=76) or Control (n=77). The six-month intervention included monthly nutrition and cooking workshops, Motivational Interviewing telephone calls and individualized newsletters. Control participants received monthly informational brochures and no navigational services. Dietary intakes were collected via questionnaire and 3-day food records at baseline and 6 months. RESULTS: One hundred twenty-five BCS (n=60 I; n=65 C) completed post-testing (81.7%) and were included in analyses. Adherence to Mediterranean diet guidelines significantly increased in the intervention group, but not in the control group (+22.5% vs. +2.7%, P

In South Texas, smoking rates among young Latino adults aged 18–29 are high (23.2%–25.7%). This is a serious public health problem, yet few are reached by services to help them quit smoking. Cellular phones have an extraordinary potential for assisting smoking cessation by providing access to peer modeling and social reinforcement for behavior change. Quitxt is a bilingual text-messaging and mobile media service designed at UT Health San Antonio to help young adults quit smoking. Text messages include links to web content and YouTube videos with peer modeling of reasons and skills to quit smoking. Quitxt was promoted in South Texas via social media advertising and other recruitment channels. An assessment of the program included 798 participants with a mean age of 29 years; 57% were males and 36% identified themselves as Hispanic or Latino. The mean number of cigarettes consumed per day was 11.5. Abstinence was assessed at 2, 4, and 7 months; at the 7-month follow up, 21% reported abstinence. This is consistent with high success rates found in studies of telephone counseling for young adults and confirms that text messaging services specifically designed for young adults are a feasible and cost-effective way to promote smoking cessation. Young adult smokers in South Texas can be reached via mobile media service. This highly scalable service makes mobile, personalized, smoking-cessation advice/support an affordable approach to reach disadvantaged population groups, affect public health, reduce health service costs, and reduce smoking-related health disparities.

Many issues surrounding cancer disparities among US Latinos—testing, clinical product rules, drug approvals, and funding for research—touch the arena of public policy. During a panel discussion at the conference, Advancing the Science of Cancer in Latinos, experts offered different perspectives on emerging health policy. Congressman Joaquin Castro, Representative from the 20th Congressional District in Bexar County, Texas, made a call to researchers to advocate for their own work with policy makers in Congress and expressed the need to increase funding for cancer research. Dr. Esteban Lopez from Blue Cross and Blue Shield of Texas spoke about understanding drivers and barriers for Latinos in cancer care. To find strategies for culturally relevant care, Blue Cross is using both published and online research to gain knowledge about what health challenges Latinos face. Dr. Robert Croyle, from the National Cancer Institute, pointed out that health disparities research has moved from documenting what is wrong to raising aspirations and goals to what is possible. Still, Latinos are underrepresented in cancer clinical trials, and one barrier to Latino accrual is the use of comorbidities as exclusion criteria. Also, NCI validates its cancer statistics by linking cancer registry data to census data; so, to support cancer research, we must support a good census. Dr. Elena Rios, President and CEO of the National Hispanic Medical Association, gave a comprehensive presentation on cancer and Latino advocacy. Some of the issues that need advocacy from the Congressional legislation in the 115th Congress include health insurance reform, research funding, CDC cancer prevention programs, Health Workforce Programs (HRSA and Department of Education), and minority health. Dr. Rios also described trends in health policy, health care, and care management and provided background for important federal strategic plans.

The conference Advancing the Science of Cancer in Latinos brought together researchers, scientists, physicians, health care professionals, patient advocates, and students from across the nation and beyond, engaging them in open dialogue. The intent was to move beyond documented health disparities in Latinos to set a new agenda for future initiatives that specifically address cancer health disparities and improve outcomes in Latino communities. Toward that end, conference participants made recommendations for future research that will advance the science of cancer in Latinos and eventually lead to lives saved.

Hispanics are greatly underrepresented in the large cancer and genomic databases, and by placing all Latinos into one category, these datasets do not capture the variation in cancer determinants and outcomes that exist among Latino subgroups. Part of the solution is to include more Latinos in research, which requires improving upon the historically low Latino recruitment into cancer clinical trials. Cancer clinical trials must reflect the subpopulation that is being studied in order to capture differences among ethnic groups and to make inferences that are generalizable. There are many challenges involved in enrolling patients into clinical trials and additional barriers that must be overcome to recruit a representative number of Latinos. Recruitment programs from both the Massey Cancer Center at Virginia Commonwealth University and the Mays Cancer Center at UT Health San Antonio are excellent models of program designs that enhance Hispanic accrual and address underrepresentation in clinical trials. Recommended steps to improve accrual into clinical trials are to educate physicians to better promote enrollment; build awareness among Hispanics about the role of clinical trials in improving cancer care; enhance care navigation for treatment planning including matching the right patient with the right study; develop language- and culture-appropriate educational materials; and share lessons learned among centers and investigators.