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Individuals in the United States from Asian and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) backgrounds face a distinct set of cancer-related disparities. In this study, in conjunction with the American Association for Cancer Research Asian/AANHPI Task Force, we highlight the unique disparities faced by AANHPI patients and professionals, and we offer actionable recommendations on how to strengthen AANHPI leadership in cancer research., (©2025 American Association for Cancer Research.)

To clarify the role of socioeconomic status (SES) in cardiovascular and cancer mortality disparities observed between Black, Hispanic, and Asian compared to White adults, we conducted a meta-analysis of the longitudinal research in the USA. A PubMed, Ovid Medline, Web of Science, and EBSCO search was performed from January 1995 to May 2023. Two authors independently screened the studies and conducted risk assessments, with conflicts resolved via consensus. Studies were required to analyze mortality data using Cox proportional hazard regression. Random-effects models were used to pool hazard ratios (HR) and reporting followed PRISMA guidelines. Twenty-two studies with cardiovascular mortality (White and Black (n = 22), Hispanic (n = 7), and Asian (n = 3) adults) and twenty-three with cancer mortality endpoints (White and Black (n = 23), Hispanic (n = 11), and Asian (n = 10) adults) were included. The meta-analytic sample for cardiovascular mortality endpoints was 6,199,049 adults (White = 4,891,735; Black = 935,002; Hispanic = 295,623; Asian = 76,689), while for cancer-specific mortality endpoints was 7,745,180 adults (White = 5,988,392; Black= 1,070,447; Hispanic= 484,848; Asian = 201,493). Median follow-up was 10 and 11 years in cohorts with cardiovascular and cancer mortality endpoints, respectively. Adjustments for SES attenuated the higher risk for cardiovascular (HR, 1.46; 95% CI, 1.30-1.64) and cancer mortality (HR, 1.35; 95% CI, 1.32-1.38) of Black compared to White adults by 25% (HR, 1.21; 95% CI, 1.15-1.28) and 19% (HR, 1.16; 95% CI, 1.13-1.18), respectively. However, the Hispanic cardiovascular (HR, 0.79; 95% CI, 0.73-0.85) and Asian cancer mortality (HR, 0.81; 95% CI, 0.76-0.86) advantage were independent of SES. These findings emphasize the need to develop strategies focused on SES to reduce cardiovascular and cancer mortality in Black adults., Competing Interests: Declarations. Ethics Approval: Not applicable. Consent to Participate: Not applicable. Consent for Publication: Not applicable. Competing Interests: The authors declare no competing interests., (© 2023. W. Montague Cobb-NMA Health Institute.)

For many anatomic cancer sites, it is unclear to what extent differences in health insurance coverage contribute to racial and ethnic disparities in the diagnosis of stage III and IV disease. Using the National Cancer Database (1 893 026 patients aged 18-64 years, diagnosed between 2013 and 2019), we investigated a potential mediating role of health insurance (privately insured vs uninsured) in explaining racial and ethnic disparities in stage at diagnosis of 10 cancers-breast (female), prostate, colorectum, lung, cervix, uterus, stomach, urinary bladder, head and neck, and skin melanoma- detectable early through screening, physical examination, or clinical symptoms. The analyses provided evidence of mediation of disparities among non-Hispanic Black vs White individuals in 8 cancers (range of proportions mediated: 4.5%-29.1%), in Hispanic vs non-Hispanic White individuals in 6 cancers (13.2%-68.8%), and in non-Hispanic Asian or Pacific Islander vs White individuals in 3 cancers (5.8%-11.3%). To summarize, health insurance accounts for a statistically significant proportion of the racial and ethnic disparities in diagnosis of stage III and IV disease across a range of cancer types., (Published by Oxford University Press 2024.)

Background: Migrants face barriers accessing healthcare, risking delays in cancer diagnosis. Diagnostic delays result in later stage diagnosis which is associated with poorer cancer survival. This review aims to compare the differences in cancer stage at diagnosis between migrants and non-migrants., Methods: We conducted a systematic review and meta-analysis of three databases from 2000 to 2023 for studies conducted in OECD countries that compared stage at diagnosis between migrants and non-migrants. Meta-analysis compared odds ratios (OR) for early (stage I and II) stage at diagnosis. The Risk of Bias in Non-randomised Studies of Exposure tool was used to assess study quality., Results: 41 of the 11,549 studies identified were included; 34 studies had suitable data for meta-analysis. Overall, migrants were significantly less likely to be diagnosed with early stage cancer compared with non-migrants (OR 0.84; 95% CI 0.78-0.91). This difference was maintained across cancer types, although only statistically significant for breast (OR 0.78; 95% CI 0.70-0.87) and prostate cancer (OR 0.92; 95% CI 0.85-0.99)., Discussion: Published studies indicate that migrants are less likely to be diagnosed with early stage cancer. Variation by cancer type, study location and region of origin highlights the need for further research to understand these differences., Competing Interests: Competing interests: Harvey-Sullivan, Ali, Dhesi, and Painter are NIHR-funded academic clinical fellows. Otherwise, the authors declare no conflict of interest. Ethics approval and consent to participate: Ethical approval was not requested because this study retrieved and synthesised data from already published studies., (© 2024. The Author(s).)

Improving understanding of behaviors that increase or reduce cancer risk for different Hispanic groups is a public health priority; such knowledge is sparse in new gateway immigration locations such as Indiana. The aims of this study were to: 1) describe cancer beliefs and cancer preventive/risk reduction behaviors (physical activity, tobacco, and alcohol use) among Hispanic adults; 2) examine differences in cancer beliefs and preventive behaviors by country/territory of birth, socioeconomic status, and area of residence (urban vs. rural); and 3) determine predictors of engagement in cancer prevention and risk reduction behaviors in this population. A cross-sectional online survey targeted adult Indiana residents who identified as Latino, Hispanic, or Spanish recruited using Facebook-targeted advertising. Complete survey data from 1520 respondents were analyzed using descriptive, unadjusted, and adjusted models. The majority of respondents believed they were unlikely to get cancer but held many other fatalistic beliefs about cancer. Only 35.6% of respondents had received the HPV vaccine, 37.6% reported they were currently smoking cigarettes, and 64% reported occasional or frequent drinking of alcohol. Respondents spent an average of 3.55 days per week engaged in moderate exercise. Differences were observed by country/territory of birth, income, and education but not by rural residence status. Predictors of cancer risk/risk reduction behaviors were identified. The Hispanic population in Indiana is diverse and effective interventions for cancer prevention should be culturally targeted based on country/territory of birth and individually tailored based on cancer-related beliefs., Competing Interests: Declarations. Ethics Approval: The study was approved by a Midwestern university institutional review board and informed consent was obtained from all participants. This information is included in the manuscript. Competing Interests: The authors have no relevant financial or non-financial interests to disclose., (© 2023. The Author(s).)

To address leading health organizations' calls for public health professionals to adopt family health history (FHH) into their practice, we developed the first community health worker Texas state-certification program focusing on FHH-based cancer prevention for Chinese Americans, for whom cancer is the leading cause of death. The 160-hour program trained 46 Chinese American CHWs to provide FHH-based cancer prevention services for 1129 Chinese Americans. Our program contributes to the establishment of a public health workforce with FHH-based competence and reduces cancer disparities. ( Am J Public Health . 2025;115(2):138-141. https://doi.org/10.2105/AJPH.2024.307895).

Background: COVID-19 infection severity differs by race and ethnicity, but its long-term effect on cancer-related outcomes is unknown. Therefore, information on COVID-19 history is critical to ascertain among new cancer patients in order to advance research on its impact on cancer outcomes and potentially related health disparities., Methods: A cross-sectional study was conducted among 16,025 new patients seeking care at Moffitt Cancer Center (MCC) between 2021 and 2022. Patient self-reported histories of COVID-19 infection and other pre-existing health conditions were obtained from electronic questionnaires administered to all new MCC patients. Associations between demographics and COVID-19 infection and hospitalization were examined., Results: A total of 1,971 patients (12.3%) reported ever having COVID-19. Self-reported COVID-19 history was significantly more prevalent in Hispanic vs. non-Hispanic patients (OR = 1.24, 1.05-1.45) and less prevalent in Asian versus White patients (OR = 0.49, 95% 0.33-0.70). Among patients who ever had COVID-19, 10.6% reported a COVID-19-related hospitalization. Males had higher odds of a COVID-19 related hospitalization than females (OR = 1.50, 95% CI = 1.09-2.05), as did Black/African American patients (OR = 2.11, 95% CI = 1.18-3.60) and patients of races other than Black/African American and Asian (OR = 2.61, 95% CI = 1.43-4.54) compared to White patients. Hispanic patients also experienced higher odds of hospitalization (OR = 2.06, 95% CI-1.29- 3.23) compared with non-Hispanic patients of all races in a sensitivity analysis that combined race/ethnicity. Pre-existing lung and breathing problems were associated with higher odds of being hospitalized with COVID-19 (OR = 2.38, 95% CI = 1.61-3.48), but these and other health conditions did not explain the observed associations between race and COVID-19 hospitalization., Conclusions: Higher rates of COVID-19 hospitalization were observed among patients identifying as Black/African American or Hispanic independent of pre-existing health conditions. Future studies evaluating long-term effects of COVID-19 should carefully examine potential racial/ethnic disparities in cancer outcomes., Competing Interests: Declarations. Financial interests: Unrelated to the presented work, Dana E. Rollison serves on the Board of Directors for NanoString Technologies, Inc. All other authors declare no financial interests. Ethics Approval: The Moffitt Scientific Review Committee reviewed the study protocol (MCC#22268) and determined that the study met the definition of non-human subjects research and did not require IRB approval., (© 2023. The Author(s).)

Background: Black/African Americans experience disproportionate cancer burden and mortality rates. Racial and ethnic variation in cancer burden reflects systemic and health-care inequities, cancer risk factors, and heredity and genomic diversity. Multiple systemic, sociocultural, economic, and individual factors also contribute to disproportionately low Black/African American participation in cancer clinical trials., Methods: The Participatory Action for Access to Clinical Trials project used a community-based participatory research approach inclusive of Black/African American community-based organizations, Henry Ford Health, and the University of Michigan Urban Research Center. The project aims were to understand Black/African Americans' behavioral intentions to participate in cancer clinical trials and to obtain recommendations for improving participation. Audio-recorded focus group data were transcribed and coded, and searches were conducted to identify themes and subthemes. Representative text was extracted from the transcripts., Results: Six community focus group discussions (70 participants) and 6 Henry Ford Health patient/survivor focus group discussions (29 participants) were completed. General themes related to trial participation were identified, including (1) systemic issues related to racism, health disparities, and trust in government, health systems, and clinical research; (2) firsthand experiences with health care and health systems; (3) perceived and experienced advantages and disadvantages of clinical trial participation; and (4) recruitment procedures and personal decision-making processes. Specific recommendations on how to address barriers were obtained., Conclusions: Community-based participatory research is effective in bringing communities equitably to the table. To build trust, health systems must provide opportunities for patients and communities to jointly identify factors affecting cancer clinical trial participation, implement recommendations, and address health disparities., (© The Author(s) 2024. Published by Oxford University Press.)

Purpose of Review: This study aims to examine the current state of psychosocial oncology (PSO) research concerning Black Canadian communities, focusing on their experiences, psychological states, and non-biological aspects of their cancer journey., Recent Findings: Although there has been increased attention to PSO in the past two decades, there remains a lack of studies specifically addressing the experiences of Black Canadians affected by cancer. This is especially concerning considering the disparities identified by PSO researchers among Black individuals in the United States and the acknowledged health inequities affecting Black individuals in Canada. This scoping review identified a total of five studies that highlighted the significance of religion and spirituality in coping with cancer among Black individuals. While faith emerged as a crucial source of strength, there was notable hesitation to discuss religious beliefs in mainstream support settings. Additional barriers, including stigma surrounding cancer, transportation issues, and limited access to care, further complicated their healthcare experiences. This review reveals critical gaps in research regarding the PSO experiences of Black Canadians affected by cancer and underscores the urgent need for additional studies and the development of tailored support programs to address their unique psychosocial needs and barriers to care., Competing Interests: Declaration. Conflicts of Interest: The authors declare no conflicts of interest., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Cultural influences on parental perceptions of their children's cancer effect familial coping and adjustment. We investigated parental perceptions of their child's illness severity and treatment among Jewish Israeli and Arab (Palestinian Israelis and Palestinians from the West Bank /Gaza) parents of pediatric oncology patients to better understand possible cultural differences and similarities., Methods: During this mixed-methods cross sectional study, the Brief Illness Perception Questionnaire was completed by 205 parents of children receiving treatment in four medical centers throughout Israel., Results: Jewish parents perceived the hospital treatment to be more effective. Arab parents perceived that cancer has a greater negative emotional influence on them as compared to Jewish parents. Further, Jewish parents felt that their child's illness had greater impact on their lives compared to Arab parents. Finally, Arab parents felt they had greater control of the illness and better understanding of the illness. When asked what they believed had 'caused' their children's cancer, both groups expressed, spiritual-religious, child's immunity status and environmental causes, yet Arab parents mentioned unhealthy food, superstitions and Supernatural (the evil eye) causes more frequently., Conclusions: Understanding how culture influences parental illness perceptions can assist pediatric oncology nurses and social workers to offer more effective treatment management., Implications for Nursing Practice: These results highlight the need to extend cultural competence to incorporate illness perception among different ethnic and religious groups being treated in a pediatric oncology department., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background/purpose: Studies have demonstrated existing racial and ethnic disparities in multiple aspects of pediatric oncology. The purpose of this study was to examine how racial and ethnic disparities in mortality among pediatric oncology patients have changed over time. We examined mortality by race and ethnicity over time within the Surveillance, Epidemiology, and End Results (SEER) registry., Methods: Patients <20 years-old from 1975 to 2016 (n = 49,861) were selected for the analysis. Demographic characteristics, cancer diagnosis, and mortality data were extracted. Patients were divided by race and ethnicity: 1) non-Latino White, 2) Black, 3) Latino, and 4) Other Race. The interaction between race/ethnicity and decade was evaluated to better understand how disparities in mortality have changed over time., Results: Unadjusted mortality among all cancers improved significantly, with 5-year mortality decreasing from the 1970s to the 2010s (log-rank: p < 0.001) for all race/ethnicity groups. However, improvements in mortality were not equal, with 5-year overall survival (OS) improving from 62.7 % in the 1970s to 87.5 % (Δ = 24.8 %) in the 2010s for White patients but only improving from 59.9 % to 80.8 % (Δ = 20.9 %) for Black patients (p < 0.01). The interaction between Race/Ethnicity and decade demonstrated that the Hazard Ratio (HR) for mortality worsened for Black [HR (95 % Confidence Interval): 1.10 (1.05-1.15) and Latino [1.11 (1.07-1.17)] patients compared to White, non-Latino patients., Conclusion: There has been a dramatic improvement in survival across pediatric oncology patients since 1975. However, the improvement has not been shared equally across racial/ethnic categories, with overall survival worsening over time for racial/ethnic minorities compared to White patients., Level of Evidence: III., Competing Interests: Conflict of interset The authors have no competing interests to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Preferences of patients with advanced cancer are well studied in Western countries but less so in Asian communities where end-of-life discussions can be seen as taboo. This may lead to patients receiving care that is incongruent with their wishes as their disease progress. It is important for healthcare providers to have a better understanding of patients' experiences and preferences especially in a multicultural country like Malaysia with its diverse beliefs and values to facilitate better planning for future medical care., Objectives: To explore the experiences and preferences of Malaysian patients with advanced cancer., Design: Qualitative study of semi-structured interviews with thematic analysis., Setting/subjects: Purposive sampling of 19 patients with Stage 4 cancer recruited from inpatient and outpatient settings in National Cancer Institute Malaysia., Results: Three major themes emerged in the exploration of patients' experiences and care preferences in facing advanced cancer namely: 1) Dealing with poor prognosis 2) Spirituality as a source of strength and 3) Enablers of advance care planning., Conclusion: This study highlighted the preference for healthcare providers to be culturally sensitive during end-of-life care discussion and the need for improved spiritual care for Malaysian patients with advanced cancer. Further studies exploring the role of spiritual and cultural factors in advance care planning among Malaysians would be helpful in guiding these efforts., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Ethnic diversity in cancer clinical trials is essential to ensure that therapeutic advances are equitable and broadly applicable in multicultural societies. Yet, missing consensus on the documentation of ethnic origin, partially based on the complexity of the terminology and fear of discrimination, leads to suboptimal patient management of minority populations. Additionally, eligibility criteria, such as stringent laboratory cut-offs, often fail to account for variations across ethnic groups, potentially excluding patients without evidence-based justification., Patients and Methods: This analysis addresses this issue by investigating ethnic diversity in clinical trials that led to European Medicines Agency (EMA) and Food and Drug Administration (FDA) approvals between 2020 and 2022. Trials were identified from FDA and EMA databases, and available protocols and full-text publications were reviewed for documentation of ethnic background and eligibility criteria for organ function (bone marrow, liver, and renal). Descriptive statistics were applied to summarize the findings., Results: Of the 56 trials analyzed, only two-thirds of primary result publications included information on ethnic origin. Caucasian and Asian groups were documented in most of those trials and also had the highest percentages of participants across trials, while other ethnic subgroups were less frequently documented and only made up a small proportion of trial participants. Eligibility criteria often set strict organ function cut-offs that did not consider variations among ethnic groups, potentially excluding minorities. The Cockcroft-Gault formula was frequently used to assess kidney function, despite its known limitations for multiethnic cohorts., Conclusions: Ethnic homogenous participants and eligibility criteria that favor majority groups limit the applicability of findings in diverse populations, leading to inadequate patient management. While United States guidelines encourage inclusivity, similar recommendations are lacking in Europe. Thus European regulatory authorities, research organizations, and patient advocates should establish guidelines to improve ethnic diversity in cancer clinical trials, aligning research practices with the increasingly multicultural composition of European societies., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: Cancer remains the leading cause of death among Hispanics in the US. While social determinants of health, such as educational attainment, have been linked to negative health outcomes, their biological mechanisms remain poorly understood. We evaluated the association between educational attainment and allostatic load (AL), a measure of chronic physiologic stress, with risk of cancer mortality in Hispanic women from the National Health and Nutrition Examination Survey (NHANES)., Methods: We performed a retrospective analysis among 5637 Hispanic women in NHANES from 1988 to 2010 with follow-up data through 2019. Educational attainment was categorized into a two-level variable: less than high school education vs high school graduate and above. AL score was calculated as the sum of nine abnormal biomarkers and health measures. Participants were considered to have high AL if their score was three or more. Weighted Cox proportional hazards models were fitted to estimate adjusted hazard ratios of cancer death between educational attainment and AL (adjusted for age, family poverty to income ratio, country of birth, marital status, preferred language, health insurance, current smoker status, congestive heart failure and history of heart attack)., Results: Hispanic women who did not attain high school education and living with high AL had more than a 3-fold increased risk of cancer death when compared to Hispanic women with at least high school education with low AL (unadjusted HR: 3.18, CI: 1.64-6.17). Hispanic women who did not complete high school and had high AL had a nearly two-fold increased risk of cancer mortality (unadjusted HR: 1.96, CI: 1.10-3.49) compared to their low AL counterparts. These effects attenuated after adjustments for age., Conclusion: Hispanic women with higher AL face elevated cancer mortality risk, with a greater effect observed among women with lower educational levels. Future research among a larger Hispanic sample should explore additional factors such as length of US residence, citizenship status, and country of birth, to better understand their influence on educational attainment, AL, and cancer mortality., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Inequalities in cancer, palliative, and end-of-life care services remain a significant challenge, particularly for ethnic minorities who face systemic barriers such as limited awareness, cultural stigmas, and language differences. These disparities hinder equitable access to essential services and contribute to poorer health outcomes for affected communities. Addressing these challenges requires targeted, culturally sensitive initiatives that promote both awareness and uptake of care. Community readiness is a critical factor in the success of such interventions, as it reflects the willingness and capacity of a community to engage with and support change., Methods: A mixed-methods approach was used, combining individual interviews and two focus groups with key informants (N = 14). This study, conducted in the ethnically and geographically diverse region of Bedfordshire, Luton, and Milton Keynes in southeast England, aimed to assess community readiness to embrace initiatives designed to reduce health inequalities in cancer, palliative, and end-of-life care. The key informants, including faith leaders and professional stakeholders, rated community readiness on five anchored scales: Knowledge of efforts, Leadership, Knowledge of the issue, Community Climate, and Resources. The focus groups facilitated a discussion of the ratings, providing deeper insights into community dynamics and barriers., Results: Overall, the community was identified as being at the pre-planning stage of readiness to address disparities in cancer, palliative, and end-of-life care for ethnic minorities. Quantitatively, faith and religious leaders assessed readiness at the vague awareness stage (mean: 3.88), while professional stakeholders rated it at the pre-planning stage (mean: 4.87). Qualitative findings highlighted limited community knowledge, passive leadership with potential for 'community champions' to foster openness, a positive climate influenced by younger generations, widespread misconceptions, language barriers, and resource constraints affecting service accessibility., Conclusions: The Community Readiness Model provides an insight into the community's position regarding disparities in access to cancer, palliative and end-of-life services. In order to ensure that continuing efforts are successful in addressing existing inequalities rather than exacerbating them, this study emphasises how critical it is to evaluate the readiness of the community in order to avoid widening inequalities in access and use of services., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and all procedures were approved by The Ethics Committee of the Institute for Health Research, University of Bedfordshire (reference number IHREC1009). All participants were given an information sheet had the opportunity to ask questions about the study, and all participants gave informed consent. Consent for publication: Consent for participation and publication was obtained from all participants through a university-approved consent form, which explicitly stated that anonymised data would be used for research and publication purposes. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Aim: To develop processes for the development of decentralised clinical trial methodology for Aotearoa New Zealand, focussing on equity of access to cancer clinical trials for Māori, Pacific people, vulnerable communities and those in rural settings., Methods: A national steering committee supported by Te Aho o Te Kahu - Cancer Control Agency was formed to: guide the adaptation and implementation of overseas decentralised clinical trial models to suit the needs of Aotearoa New Zealand with an equity focus; provide high-level oversight and expertise for direction and development of policies, procedures and infrastructure compliant with ICH GCP R2; and implement a national strategy., Results: Twelve standard operating procedures were developed, as well as a supervision plan and a glossary. These were made freely available on the New Zealand Association of Clinical Research website., Conclusion: Decentralised clinical trials offer a novel method of trial conduct that is patient- and whānau-centred. The model allows patients to remain in their local area with whānau and support networks, and their local treating team, increasing clinical trial accessibility and quality of care. This methodology has the potential to support improvement in research capabilities nationally and be utilised beyond oncology. It would benefit from significant investment in national clinical trial infrastructure., Competing Interests: Nicola J Lawrence received support from Te Aho o Te Kahu for a project manager for this work and is is co-lead of the New Zealand DCT committee. Marina Dzhelali is a New Zealand Association of Clinical Research board member. Ngapei Ngatai received support from CTNZ for this manuscript. Alvin Tan is director at SalutisCare. Michelle Wilson received support from Te Aho o te Kahu for a project manager for this work and is co-lead of the New Zealand DCT committee., (© PMA.)

Background: The Hispanic population is the second largest racial/ethnic group in the United States, consisting of multiple distinct ethnicities. Ethnicity-specific variations in cancer mortality may be attributed to countries of birth, so we aimed to understand differences in cancer mortality among disaggregated Hispanics by nativity (native- or foreign-born vs. US-born) over 15 years., Methods: A total of 228,197 Hispanic decedents (Mexican, Puerto Rican, Cuban, and Central or South American) with cancer-related deaths from US death certificates (2003-2017) were analyzed. Seven cancers that contribute significantly to Hispanic male (lung and bronchus, colon and rectum, liver, prostate, and pancreas cancers) and female (lung and bronchus, liver, pancreas, colon and rectum, female breast, and ovary cancers) mortality were selected for analysis. 5-year age-adjusted mortality rates [(95% confidence interval); per 100,000] and standardized mortality ratios (95% confidence interval) using foreign-born as the reference group were calculated. Joinpoint regression analysis was used to model cancer-related mortality trends., Results: Puerto Rico-born Puerto Ricans, Cuba-born Cubans, and US-born Mexicans had some of the highest cancer death rates among all the Hispanic groups. In general, foreign-born Hispanics had higher cancer mortality rates than US-born Hispanics, except Mexicans. Overall, US-born and non-US-born (i.e., native- or foreign-born) Hispanic groups experienced decreasing rates of cancer deaths over the years., Conclusions: We noted vast heterogeneity in mortality rates by nativity across Hispanic groups, a fast-growing diverse US population., Impact: Understanding disaggregated patterns and trends in cancer burden can motivate deeper discussion around community health resources, which may improve the health of Hispanics across the United States., (©2024 American Association for Cancer Research.)

Objective: Health disparities in lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+), or sexual and gender minority (SGM) people are known. SGM people have higher cancer risk, but lower rates of screenings, resulting in a higher likelihood of late-stage disease. This study evaluates medical students' clinical cultural awareness in cancer care of SGM patients to identify gaps in education., Methods: This was a cross-sectional survey distributed to medical students at a academic center. There were 38 questions on demographics, attitudes, and knowledge of SGM topics. Descriptive statistics were used for demographic information and stratified analyses assessed responses by demographic subgroups., Results: There were 238 responses from 1145 students (response rate = 20.7 %). Of the responders, 91.2 % and 79 % were comfortable treating lesbian, gay, bisexual (LGB) and transgender patients respectively. Only 28.6 % and 21.8 % were confident treating LGB and transgender patients respectively after taking the survey. 91.2 % of students were interested receiving education regarding SGM health needs., Conclusion: While most medical students are comfortable treating LGBTQ+ patients, most are not confident in their knowledge. This difference is most profound in knowledge of transgender patients., Practice Implications: Schools must provide more education in SGM topics to improve student knowledge to produce competent providers., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier B.V.)

Introduction: CancerSupportSource (CSS), a distress screening and referral program, identifies unmet needs of people with cancer and links them to resources and support. We developed and validated a Spanish-language version (CSS-Spanish) to better serve Hispanic and Latino communities and promote health equity. Methods: The 25-item CSS-Spanish was created leveraging rigorous translation methods and cognitive interviews to ensure cultural relevance and topical breadth. A total of 210 Spanish-speaking Hispanic and Latino individuals completed CSS-Spanish and comparison measures. Psychometric analyses examined dimensionality and statistical validation, and determined scoring thresholds for depression and anxiety risk subscales. Results: CSS-Spanish represented key concerns across five factors and exhibited strong internal consistency and test-retest reliability, convergent validity, and known-groups validity. Risk subscales demonstrated adequate sensitivity. Conclusion: CSS-Spanish is a reliable, valid multidimensional distress screener that rapidly assesses needs of Hispanic and Latino individuals. Embedded depression and anxiety risk flags can support staff in identifying those with high-acuity needs., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Institutional research support was granted to the Cancer Support Community and not individual study authors: Dr. Fortune: Institutional research funding from: AbbVie, Amgen Oncology, AstraZeneca, Astellas Pharma, Bristol Myers Squibb, Genentech, Gilead Sciences, Lilly Oncology, Merck & Co, Inc, Servier, Sumitomo Dainippon Pharma Co, Takeda Oncology. Dr. Zaleta: Institutional research funding (received by Cancer Support Community): Astellas Pharma, Boston Scientific Foundation, Gilead Sciences, Novartis, Seagen. Consulting or Advising (funds received by Cancer Support Community): BeiGene, Bristol Myers Squibb.

Background: Since immigrants and their descendants represent a growing proportion of the US population, there is a strong demographic imperative for scientists to better understand the cancer risk factors at multiple levels that exist for these populations. Understanding the upstream causes of cancer, including neighborhood context, may help prevention efforts. Residence in ethnic enclaves may be one such contextual cause; however, the evidence is mixed, and past research has not utilized prospective designs examining cancer incidence or mortality., Methods: We examined the association between residency in ethnic enclaves and cancer events among Hispanic (n = 753) and Chinese (n = 451) participants without a history of cancer in the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective cohort study that enrolled participants ages 45-84 in six US cities. Cancer events included deaths and hospitalization for any cancer diagnosis from 2000-2012. Residency in an ethnic enclave was operationalized as their geocoded baseline census tract having a concentration of residents of the same ethnicity greater than the 75th percentile (compared to non-ethnic enclave otherwise). Potential confounders were blocked into three categories: sociodemographic, acculturation, and biomedical/health behavior variables. To examine the association between ethnic enclaves and cancer, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards models., Results: Among Hispanic participants, residing in ethnic enclaves (vs. not) was associated with a 39% reduction in cancer risk (HR 0.61, 95%CI: 0.31, 1.21) after adjusting for sociodemographic variables. Among Chinese participants, residing in ethnic enclaves was associated with a 2.8-fold increase in cancer risk (HR 2.86, 95%CI; 1.38, 5.94) after adjusting for sociodemographic variables., Conclusions: Our results suggest that the association between ethnic enclaves and cancer events differs by ethnic group, suggesting that different social and contextual factors may operate in different communities., Competing Interests: Declarations Ethics Approval, Consent to Participate, and Consent to Publish The study was approved by the Institutional Review Boards at each participating MESA site, and all participants gave written informed consent for participation and publication. Competing Interests The authors declared no competing interests., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Despite higher income and education, there are profound health disparities among Asian Americans. These disparities are highlighted in particular by screening behaviors for cancer. Between 1998 and 2008, cancer rates increased threefold among Indian Americans, raising concern that cancer screening in this group may be especially low. To better understand cancer screening behavior, we collected data from a total of 157 self-identifying Indian Americans residing in the greater Philadelphia area. Nearly all participants reported having health insurance (98.7%), and most had received a physical exam within a year (87.3%). Only17.4% of the participants were referred for mammography, while 30% of participants over age 30 were referred for ovarian cancer screening. Just 4 participants were recommended for pancreatic cancer screening. The findings contribute new information to the understanding of health needs of Indian Americans residing in the greater Philadelphia region and reveal a need for greater focus on preventive care., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: In the United States, cancer mortality rates continue to decline, yet geographic and racial disparities persist and are particularly evident in the Delta region, characterized by high economic distress and disease burden. We examined cancer mortality patterns by demographic groups across geographic region (Delta vs non-Delta) and investigated the influence of macro-level social determinants of health (SDoH) in cancer death., Study Design and Methods: This observational study included cancer death records of individuals aged ≥20 years from 2018 to 2021 in the United States. County-level characteristics were ascertained through the linkage of multiple national administrative and community surveys. We estimated age-standardized mortality rates (ASR) and rate ratios. We calculated the adjusted relative risks by county-level SDoH (geographic region, rurality, household income, income inequality, health insurance, and education) and other factors using age-adjusted multivariate quasi-Poisson regression., Results: In 2018-2021, approximately 2.4 million cancer deaths occurred in the United States. We observed important declines in the Black-White disparities, from 16.6% in 2018 (ASR = 289.9 vs 248.6 per 100,000) to 12.1% in 2021 (281.1 vs 250.8) in the Delta region and from 15.9% (254.9 vs 219.9) to 10.7% (240.6 vs 217.3) in the non-Delta region, though Black men in the Delta region remained the highest rate (ASR 2021  = 346.9 per 100,000). County-level analyses provided strong evidence of geographic inequality and the role of SDoH, particularly education and income inequality., Conclusions: Unfavorable SDoH are associated with increased cancer death risk. Region-specific health policies and interventions in the Delta region are essential to advance cancer health equity., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Importance: Cancer is the leading cause of death among Asian American individuals and the second leading cause of death among Native Hawaiian and Pacific Islander people., Objective: To evaluate longitudinal cancer mortality trends from 1999 to 2020 among Asian American and Pacific Islander populations in the US by demographic characteristics., Design, Setting, and Participants: This cross-sectional study used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database to obtain age-adjusted cancer death rates among Asian American and Pacific Islander individuals of all ages between January 1, 1999, and December 31, 2020. Data were analyzed from January 12 to March 19, 2024., Exposures: Age, sex, cancer type, and US census regions., Main Outcomes and Measures: Trends and average annual percent changes (AAPCs) in age-adjusted cancer-specific mortality (CSM) rates for non-Hispanic Asian American and Pacific Islander populations were estimated by cancer type, age, sex, and region using Joinpoint regression., Results: Between 1999 and 2020, 305 386 Asian American and Pacific Islander individuals (median [IQR] age, 69.5 [58.5-79.2] years; 51.1% male) died of cancer in the US. Overall, the CSM rate decreased by 1.5% annually. Men experienced a greater CSM rate decrease (AAPC, -1.8%; 95% CI, -2.2% to -1.3%) compared with women (AAPC, -1.1%; 95% CI: -1.2% to -1.0%). For women, death rates decreased for most cancer types but increased for uterine (AAPC, 2.5%; 95% CI, 2.0%-3.0%) and brain and central nervous system (AAPC, 1.4%; 95% CI: 0.7%-2.1%) cancers. Colorectal cancer mortality rates increased among men aged 45 to 54 years (AAPC, 1.3%; 95% CI, 0.5%-2.1%). Liver and intrahepatic bile duct cancer mortality increased for both men and women in all US census regions, uterine cancer mortality increased in all regions for women, and pancreatic cancer mortality increased in the Midwest for both men and women., Conclusions and Relevance: Although these findings show an overall decrease in CSM among Asian American and Pacific Islander populations, specific cancer types exhibited increased mortality rates, with further disparities by sex and age. Targeted, culturally adapted clinical and public health interventions are needed to narrow disparities in cancer mortality.

Background: Asian New York City residents have the lowest cancer screening uptake across race and ethnicity. Few studies have examined screening differences across Asian ethnic subgroups in New York City., Methods: Cross-sectional survey data were analyzed using multivariable logistic and multinomial regression analyses. Differences among Chinese, Korean, and South Asian adults in breast, cervical, and colorectal cancer screening uptake; breast and colorectal cancer screening knowledge; and cancer fatalism were examined. Associations between breast and colorectal cancer screening knowledge and their uptake were also assessed along with associations between cancer fatalism and breast, cervical, and colorectal cancer screening uptake., Results: Korean women reported 0.52 times [95% confidence interval (CI), 0.31-0.89] lower odds of Pap test uptake compared with Chinese women; South Asian adults had 0.43 times (95% CI, 0.24-0.79) lower odds of colorectal cancer screening uptake compared with Chinese adults. Korean adults reported 1.80 times (95% CI, 1.26-2.58) higher odds of knowing the correct age to begin having mammograms compared with Chinese adults; South Asian adults had 0.67 times (95% CI, 0.47-0.96) lower odds of knowing the correct age to begin colorectal cancer screening compared with Chinese adults. Korean adults had 0.37 times (95% CI, 0.27-0.53) lower odds of reporting cancer fatalism compared with Chinese adults., Conclusions: Low cancer screening uptake among Asian American adults, low screening knowledge, and high cancer fatalism were found. Cancer screening uptake, knowledge, and fatalism varied by ethnic subgroup., Impact: Findings indicate the need for ethnicity-specific cultural and linguistic tailoring for future cancer screening interventions., (©2024 American Association for Cancer Research.)

Background: Racial and ethnic minoritized groups report disproportionately lower trust in the health-care system. Lower health-care system trust is potentially related to increased exposure to racial discrimination in medical settings, but this association is not fully understood. We examined the association between racial discrimination in medical care and trust in the health-care system among people with and without a personal cancer history., Methods: We examined racial discrimination and trust in a nationally representative American adult sample from the Health Information National Trends Survey 6. Racial discrimination was defined as any unfair treatment in health care on the basis of race or ethnicity. Trust in the health-care system (eg, hospitals and pharmacies) was grouped into low, moderate, and high trust. Multinomial logistic regression models were used to compare low and moderate trust relative to high trust in the health-care system and estimate odds ratios (ORs) and 95% confidence intervals (CIs)., Results: A total of 5813 respondents (15% with a personal cancer history) were included; 92% (n = 5355) reported no prior racial discrimination experience during medical treatment. Prior experiences of racial discrimination were positively associated with low (OR = 6.12, 95% CI = 4.22 to 8.86) and moderate (OR = 2.70, 95% CI = 1.96 to 3.72) trust in the health-care system relative to high trust. Similar associations were observed when stratifying by personal cancer history., Conclusion: Respondents who reported racial discrimination during medical encounters had lower trust in the health-care system, especially respondents with a personal cancer history. Our findings highlight the need to address racial discrimination experiences during medical care to build patient trust and promote health-care access., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: Peer support networks have been suggested to have significant utility in the care of patients with cancer, especially among racial minorities. This article proposes an approach to integrate peer support networks into the care of racial minorities with cancer., Methods: Methods to integrate peer support groups across racial minorities with cancer include utilizing language and religion in strategic recruitment of peer supporters, recruiting minority peer supporters in online oncology peer support groups, and emphasizing relationship & trust building for participant retention., Results: Language concordance among peer support groups may enhance patient understandability, emotional expression, and create a sense of community and safety. Religious integration may also promote support group accessibility, particularly among Blacks, who tend to depend on their religious communities for cancer care guidance to a greater extent. In addition to providing knowledge, online opportunities may also decrease cancer-related stress, depression, and trauma. Trust between individuals and their sociocultural environment and healthcare system, as well as between the community and the healthcare system, is necessary, particularly for racial minorities who may harbor a historical mistrust of the healthcare system., Conclusions: To close the racial cancer care gap, a multi-pronged approach is crucial. This includes establishing tailored peer support networks within minority communities that account for language, religion, and cultural factors to build trust and meet psycho-social needs. However, peer support is just one tool. Other critical tools such as holding healthcare institutions accountable for providing equitable care to racial minorities is equally vital in reducing disparities and improving survival outcomes., Competing Interests: Declarations Conflict of interest Oyepeju Abioye, Lauren Kiel, and Rebekah Kaufman declare no financial or non-financial interests. Narjust Florez reports a consultant/advisor role to Merck, DSI, Pfizer, AstraZeneca, BMS, Regeneron Janssen, Novartis, and NeoGenomics. Narjust Florez reports a consultant/advisor role to Merck, DSI, Pfizer, AstraZeneca, BMS, Regeneron Janssen, Novartis, and NeoGenomics., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Traffic-related air pollutants have been associated with a variety of adverse human health impacts, including cancers. In the United States, numerous studies have documented racial inequities in neighborhood exposures to traffic-related air pollution. Emerging evidence suggests that structural racism may influence neighborhood exposures to air pollutants. However, existing research has largely focused on residential racial segregation, one indicator of structural racism. This study developed a multidimensional measure of structural racism to examine the relationship between structural racism and estimated cancer risk from air pollutants in Georgia., Methods: Carcinogenic air toxics data were obtained from the US Environmental Protection Agency's 2019 Air Toxics Screening Assessment and sociodemographic data from the American Community Survey. Guided by stakeholder input, county-level data on residential segregation, education, employment, incarceration, economic status, political participation, and homeownership were used to create a multidimensional county-level structural racism index. Relative risks (RRs) were estimated for associations between structural racism and elevated (top 10% in Georgia) estimated cancer risk from air toxics., Results: Multilevel analyses revealed a significant association between multidimensional structural racism and exposure to carcinogenic traffic-related air pollutants. Neighborhoods in the highest quartile of structural racism exhibited an elevated cancer risk from traffic-related air pollutants (RR, 7.84; 95% CI, 5.11-12.05) compared to neighborhoods with lower levels of structural racism., Conclusions: Multidimensional structural racism was associated with estimated cancer risk from traffic-related air pollution in Georgia. Findings can inform future studies and policy interventions that address racial inequalities in exposure to traffic-related air pollution., (© 2024 American Cancer Society.)

Background: Cancer rates in rural areas vary by insurance status, socioeconomic status, region, race, and ethnicity., Methods: California Cancer Registry data (2015-2019) were used to investigate the stage of diagnosis by levels of rurality for the five most common cancers. The percentage of residents in rural blocks within census tract aggregation zones was categorized into deciles up to 50%. Multivariable logistic regression was used to estimate associations with rurality, with separate models by cancer site, sex, race, and ethnicity (non-Hispanic White and Hispanic). Covariates included individual-level and zone-level factors., Results: The percentage of late-stage cancer diagnosis was 28% for female breast, 27% for male prostate, 77% for male lung, 71% for female lung, 60% for male colorectal, 59% for female colorectal, 7.8% for male melanoma, and 5.9% for female melanoma. Increasing rurality was significantly associated with increased odds of late-stage cancer diagnosis for female breast cancer (Ptrend < 0.001), male lung cancer (Ptrend < 0.001), female lung cancer (Ptrend < 0.001), and male melanoma (Ptrend = 0.01), after adjusting for individual-level and zone-level factors. The strength of associations varied by sex and ethnicity. For males with lung cancer, odds of late-stage diagnosis in areas with >50% rural population was 1.24 (95% confidence interval, 1.06-1.45) for non-Hispanic White patients and 2.14 (95% confidence interval, 0.86-5.31) for Hispanic patients, compared with areas with 0% rural residents., Conclusions: Increasing rurality was associated with increased odds for late-stage diagnosis for breast cancer, lung cancer, and melanoma, with the strength of associations varying across sex and ethnicity., Impact: Our findings will inform cancer outreach to these rural subpopulations., (©2024 American Association for Cancer Research.)

This report provides a summary of the identified evidence gaps and a general discussion of the next steps to advance cancer epidemiology research in Hispanic/Latino (H/L) populations based partly on the workshop, "Cancer Epidemiology in Hispanic Populations," convened by the NCI in September 2021. The cancer burden among H/L populations varies greatly by nativity and country of origin, yet this variation is not often captured due to systemic challenges in how racial/ethnic data have been collected and often reported in aggregate for this heterogeneous population. Developing culturally relevant assessment tools, increasing the representation of H/L participants, and adopting appropriate methodologic approaches are critical to enhancing cancer research. There is a variety of current funding mechanisms that may be used to address these evidence gaps and priorities, including investigator-initiated mechanisms. Cancer epidemiologic research in H/L populations should leverage existing resources where possible. New and ongoing studies should collect information on nativity status, country of origin, and related measures, use culturally specific assessment tools, engage in collaborative science, and maintain strong community engagement to build studies that will meaningfully address the cancer burden experienced by the growing H/L population., (©2024 American Association for Cancer Research.)

Purpose: Significant disparities exist in cancer detection, treatment, and outcomes for racial/ethnic minoritized groups in the US. The objective of this study was to explore racial/ethnic disparities in healthcare utilization, cancer care experiences, and beliefs about cancer in patients diagnosed with cancer among diverse racial/ethnic groups in the US., Methods: Data from the Health Information National Trends Survey -Surveillance, Epidemiology, and End Results (HINTS-SEER 2021) were analyzed for 1,108 cancer survivors. Bivariate analysis of the study variables with race/ethnicity were conducted with weighted analysis from STATA version 17. Sampling weights using svy was conducted., Results: Racial/ethnic differences in healthcare utilization remained significant when controlling for the confounding factors. Asians and Hispanics were less likely to have a regular healthcare provider compared to non-Hispanic whites (NHW) (aOR = 3.31, p = .003; aOR = 2.17, p = .014; respectively). Asians were less likely than NHW to have had healthcare provider visits in the past 12 months (aOR = 4.89, p = .011). There were no statistically significant differences between racial/ethnic groups in the cancer care experiences. Racial/ethnic differences in fatalistic beliefs about cancer were not significant in the final multivariate model; however, being older (β = -.41, p = .033), and having a higher education level (β = -1.23, p < .001), were associated with lower level of fatalistic beliefs about cancer., Conclusion: The findings suggest tailored approaches to improve healthcare utilization rates among racial/ethnic minoritized groups and highlight the need for increased research and clinical practice efforts to address racial/ethnic disparities in the cancer care continuum., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Despite Medicare coverage, financial hardship is a prevalent issue among those diagnosed with cancer at age 65 years and older, particularly among those belonging to a racial or ethnic minority group. Sociodemographic, clinical, and area-level factors may mediate this relationship; however, no studies have assessed the extent to which these factors contribute to the racial/ethnic disparities in financial hardship., Methods: Surveys assessing financial hardship were completed by 721 White (84%) or Black (16%) patients (aged 65 years and older) who were diagnosed with breast (34%), prostate (27%), lung (17%), or colorectal (14%) cancer or lymphoma (9%) at the University of Alabama at Birmingham between 2000 and 2019. Financial hardship included material, psychological, and behavioral domains. Nonlinear Blinder-Oaxaca effect decomposition methods were used to evaluate the extent to which individual and area-level factors contribute to racial disparities in financial hardship., Results: Black patients reported lower income (65% vs. 34% earning <$50,000) and greater scores on the Area Deprivation Index (median, 93.0 vs. 55.0). Black patients reported significantly higher rates of overall (39% vs. 18%), material (29% vs. 11%), and psychological (27% vs. 11%) hardship compared with White patients. Overall, the observed characteristics explained 51% of racial differences in financial hardship among cancer survivors, primarily because of differences in income (23%) and area deprivation (11%)., Conclusions: The current results identify primary contributors to racial disparities in financial hardship among older cancer survivors, which can be used to develop targeted interventions and allocate resources to those at greatest risk for financial hardship., (© 2024 American Cancer Society.)

Background: In primary care, health professionals use blood tests to investigate nonspecific presentations to inform referral decisions. Reference ranges for the commonly used blood tests in western countries were developed in predominately White populations, and so may perform differently when applied to non-White populations. Knowledge of ethnic variation in blood test results in healthy/general populations could help address ethnic inequalities in cancer referral for diagnosis and outcomes., Objective: This systematic review explored evidence of ethnic differences in the distribution of selected blood test results among healthy/general populations to inform future research aimed at addressing inequalities in cancer diagnosis., Methods: We searched PubMed and EMBASE to identify studies reporting measures of haemoglobin, MCV, calcium, albumin, platelet count, and CRP in nondiseased adults from at least 2 different ethnic groups. Two reviewers independently screened studies, completed data extraction and quality assessment using an adapted Newcastle-Ottawa scale. Participants were stratified into White, Black, Asian, Mixed, and Other groups. Data were synthesised narratively and meta-analyses were conducted where possible., Results: A total of 47 papers were included. Black men and women have lower average values of haemoglobin, MCV, and albumin, and higher average values of CRP relative to their White counterparts. Additionally, Black men have lower average haemoglobin than Asian men, whereas Asian women have lower average CRP values when compared with White women., Conclusions: There is evidence of ethnic differences in average values of haemoglobin, MCV, CRP, and albumin in healthy/general populations. Further research is needed to explore the reasons for these differences. Systematic review registration: CRD42021274580., (© The Author(s) 2024. Published by Oxford University Press.)

Objective: Prior authorization is used to ensure providers treat patients with medically accepted treatments. Our objective was to evaluate prior authorization decisions in cancer care by race/ethnicity for commercially insured patients., Study Design: Retrospective study of 18,041 patients diagnosed with cancer between January 1, 2017, and April 1, 2020., Methods: Using commercial longitudinal data from a large national insurer, we described the racial and ethnic composition in terms of prior authorization process outcomes for individuals diagnosed with cancer. We then used linear regression models to evaluate whether disparities by race or ethnicity emerged in prior authorization process outcomes., Results: The self-identified composition of the sample was 85% White, 3% Asian, 10% Black, and 1% Hispanic; 64% were female, and the mean age was 53 years. The average prior authorization denial rate was 10%, and the denial rate specifically due to no medical necessity was 5%. Hispanic patients had the highest prior authorization denial rate (12%), and Black patients had the lowest prior authorization denial rate (8%). Regressions results did not identify racial or ethnic disparities in prior authorization outcomes for Black and Hispanic patients compared with White patients. We observed that Asian patients had lower rates of prior authorization denials compared with White patients., Conclusions: We observed no differences in the prior authorization process for Black and Hispanic patients with cancer and higher rates of prior authorization approvals for Asian patients compared with White patients.

Clonal hematopoiesis of indeterminate potential (CHIP) has emerged as a significant precursor to hematological malignancies and is associated with several age-related diseases. We leveraged public data to explore differences in the mutational landscape of CHIP between males (Ms) and females (Fs) and across diverse racial populations. DNA (cytosine-5) methyltransferase 3 alpha (DNMT3A) mutations were substantially more prevalent in Fs than in Ms (38.94% vs. 31.37%, p-value: < 0.001, q-value: < 0.001). Additional sex combs-like 1 (ASXL1) mutations were more frequent in Ms than Fs (5.82% vs. 2.69%, p-value < 0.001, q-value < 0.001). In the racial cohorts with sufficient sample sizes, STAT5B and CSF1R mutations were most frequent in Asian populations (1.40% and 0.84%), followed by Black populations (0.98% and 0.24%) and White populations (0.29% and 0.09%) (p-value: < 0.001 , q-value: 0.023 for both genes). Several other CHIP mutations were enriched in Black: RARA, SMAD2, CDKN1B, CENPA, CTLA4, EIF1AX, ELF3, MSI1, MYC, SOX17, and AURKA. On the other hand, H3C1, H3C4, and MYCL were enriched in the Asian cohort. Our analysis highlights sex and racial differences in CHIP mutations among patients with cancer. As CHIP continues to gain recognition as a critical precursor to malignancies and other diseases, understanding how these differences contribute to CHIP's underlying mechanisms and clinical implications is critical., Competing Interests: Conflict of Interest Disclosure The authors do not have any conflicts of interest to declare in relation to this work., (Copyright © 2024 International Society for Experimental Hematology. Published by Elsevier Inc. All rights reserved.)

Knowledge related to how oncology treatment trial design influences enrollment of racial and ethnic minorities is limited. Rigorous identification of clinical trial design parameters that associate favorably with minority accrual provides educational opportunities for individuals interested in designing more representative treatment trials. We identified oncology trials with a minimum of 10 patients at an NCI-Designated Comprehensive Cancer Center from 2010 to 2021. We defined a study endpoint of racial and ethnic minority accrual greater than zero. Multivariable logistic regression was used to determine whether co-variables predicted our study endpoint. P-values of less than 0.05 were considered significant. A total of 352 cancer trials met eligibility criteria. These studies enrolled a total of 7981 patients with a total of 926 racial and ethnic minorities leading to a median enrollment of 10%. Trials open in community sites (yes versus no) were more likely to have a minority patient (OR, 2.21; 95% CI, 1.02-4.96) as well as pilot/phase I studies compared to phase II/III (OR, 3.19; 95% CI, 1.34-8.26). Trials incorporating immunotherapy (yes versus no) were less likely to have a minority patient (OR, 0.47; 95% CI, 0.23-0.94). Trials open in community sites as well as early phase treatment studies were more likely to accrue minority patients. However, studies including immunotherapy were less likely to accrue racial and ethnic minorities. Knowledge gained from our analysis may help individuals design oncology treatment trials that are representative of more diverse populations., (© 2024. The Author(s) under exclusive licence to American Association for Cancer Education.)

We characterized trends in early onset (aged 20-49) cancer incidence by race/ethnicity and sex using the 2011-2020 Surveillance, Epidemiology, and End Results (SEER) Program dataset. We estimated age-standardized cancer incidence rates, incidence rate ratios (IRR), and annual percentage changes (APC) with 95 % confidence intervals (CI). During the time period examined, cancer incidence increased for female breast (APC: 0.64; 95 % CI: 0.10, 1.20), female colorectal (APC: 2.16; 95 % CI: 1.22, 3.10), and male colorectal (APC: 2.49; 95 % CI: 1.81, 3.19) cancer. Among racial/ethnic groups examined, Hispanic individuals had the largest increases in female all sites (APC: 1.31; 95 % CI: 0.38, 2.25), female breast (APC: 1.04; 95 % CI: 0.29, 1.81), and female (APC: 4.67; 95 % Cl: 3.07, 6.30) and male (APC: 3.53; 95 % CI: 2.58, 4.49) colorectal cancer incidence. Further research is needed to clarify the causal mechanisms driving these patterns., Competing Interests: Declaration of Competing Interest The authors have no disclosures., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Individuals living with cancer and survivors of cancer who self-identify as Hispanic experience higher pain burden and greater barriers to pain management compared with their non-Hispanic counterparts. The Society for Integrative Oncology-ASCO guideline recommends acupuncture and massage for cancer pain management. However, Hispanic individuals' expectations about these modalities remain under-studied and highlight a potential barrier to treatment utilization in this population. We conducted a subgroup analysis of baseline data from two randomized clinical trials to evaluate ethnic differences in treatment expectations about integrative pain treatment modalities among Hispanic and non-Hispanic cancer patients and survivors of cancer. The Mao Expectancy of Treatment Effects (METE) instrument was used to measure treatment expectancy for electro-acupuncture, auricular acupuncture, and massage therapy. Results of this study demonstrated that Hispanic participants reported greater expectation of benefit from electroacupuncture, auricular acupuncture, and massage (all P < 0.01). After controlling for age, gender, race, and education, Hispanic ethnicity remained significantly associated with greater expectation of benefit from integrative therapies for pain (coef.=1.47, 95% CI, 0.67-2.27). Non-white race (coef.=1.04, 95% CI, 0.42-1.65), no college education (coef.=1.16, 95% CI, 0.59-1.74), and female gender (coef.=0.94, 95% CI, 0.38-1.50) were also associated with a greater expectation of benefit from integrative therapies. Pain management should be informed by a shared decision-making approach that aligns treatment expectancy with treatment selections to optimize outcomes. Compared with non-Hispanic participants, Hispanic individuals reported higher expectation of benefit from acupuncture and massage, highlighting the potential role for integrative therapies in addressing ethnic pain disparities. Trial Registration NCT02979574 NCT04095234., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: Adolescents and young adults (AYAs, 18-39 years) with cancer identifying as racially/ethnically minoritized or 2SLGBTQIA+ (Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex, asexual and "+" referring to other queer identities) have been underrepresented in cancer research. This study explores the aspects of identity that hold significance for these minoritized AYAs and how these facets impact their healthcare experiences., Methods: Eligible participants comprised English-speaking AYAs who self-identified as racially/ethnically minoritized and/or 2SLGBTQIA+, were diagnosed with cancer between the ages of 15-39, currently aged > 18, and had received or were receiving cancer care within Canadian healthcare system. Additionally, four patient partners meeting the same criteria were recruited as research collaborators. Semi-structured one-on-one virtual interviews guided by an interview script were conducted, and qualitative analysis employed a framework approach., Results: We recruited 23 participants from 4 Canadian provinces (mean age: 28, Range: 20-44); 17 identified as racially/ethnically minoritized, one as sexual/gender minoritized, and five as racially/ethnically and sexually/gender minoritized. Participants emphasized that their culture/ethnicity, religion/spirituality, sexuality, gender, family, career, and being an immigrant are important aspects of their identity, with only one participant recognizing their identity as a "person with cancer". A cancer diagnosis altered the aspects of identity deemed most significant by participants. Both visible and invisible aspects of identity shaped participants' experiences and influenced their level of trust in the healthcare system., Conclusion: Racially, ethnically, gender, or sexually minoritized AYAs with cancer place considerable importance on aspects of their identity that are shaped by their respective communities. Recognizing and respecting these identities are paramount for healthcare professionals to deliver safe and inclusive care., (© 2024 The Author(s). Psycho‐Oncology published by John Wiley & Sons Ltd.)

Background: Black/African American adults are underrepresented in oncology clinical trials in the United States, despite efforts at narrowing this disparity., Objective: This study aims to explore differences in how Black/African American oncology patients perceive clinical trials to improve support for the clinical trial participation decision-making process., Methods: As part of a larger randomized controlled trial, a total of 244 adult oncology patients receiving active treatment or follow-up care completed a cross-sectional baseline survey on sociodemographic characteristics, clinical trial knowledge, health literacy, perceptions of cancer clinical trials, patient activation, patient advocacy, health care self-efficacy, decisional conflict, and clinical trial intentions. Self-reported race was dichotomized into Black/African American and non-Black/African American. As appropriate, 2-tailed t tests and chi-square tests of independence were used to examine differences between groups., Results: Black/African American participants had lower clinical trial knowledge (P=.006), lower health literacy (P<.001), and more medical mistrust (all P values <.05) than non-Black/African American participants. While intentions to participate in a clinical trial, if offered, did not vary between Black/African American and non-Black/African American participants, Black/African American participants indicated lower awareness of clinical trials, fewer benefits of clinical trials, and more uncertainty around clinical trial decision-making (all P values <.05). There were no differences for other variables., Conclusions: Despite no significant differences in intent to participate in a clinical trial if offered and high overall trust in individual health care providers among both groups, beliefs persist about barriers to and benefits of clinical trial participation among Black/African American patients. Findings highlight specific ways that education and resources about clinical trials could be tailored to better suit the informational and decision-making needs and preferences of Black/African American oncology patients., (©Ariel Hoadley, Linda Fleisher, Cassidy Kenny, Patrick JA Kelly, Xinrui Ma, Jingwei Wu, Carmen Guerra, Amy E Leader, Mohammed Alhajji, Paul D’Avanzo, Zoe Landau, Sarah Bauerle Bass. Originally published in JMIR Cancer (https://cancer.jmir.org), 30.09.2024.)

Racial and ethnic disparities persist in cancer survival rates across the United States, despite overall improvements. This comprehensive analysis examines trends in 5-year relative survival rates from 2002-2006 to 2015-2019 for major cancer types, elucidating differences among racial/ethnic groups to guide equitable healthcare strategies. Data from the SEER Program spanning 2000-2020 were analyzed, focusing on breast, colorectal, prostate, lung, pancreatic cancers, non-Hodgkin lymphoma, acute leukemia, and multiple myeloma. Age-standardized relative survival rates were calculated to assess racial (White, Black, American Indian/Alaska Native, Asian/Pacific Islander) and ethnic (Hispanic, Non-Hispanic) disparities, utilizing period analysis for recent estimates and excluding cases identified solely through autopsy or death certificates. While significant survival improvements were observed for most cancers, notable disparities persisted. Non-Hispanic Blacks exhibited the largest gain in breast cancer survival, with an increase of 5.2% points (from 77.6 to 82.8%); however, the survival rate remained lower than that of Non-Hispanic Whites (92.1%). Colorectal cancer survival declined overall (64.7-64.1%), marked by a 6.2% point drop for Non-Hispanic American Indian/Alaska Natives (66.3-60.1%). Prostate cancer survival declined across all races, with Non-Hispanic American Indian/Alaska Natives showing a decrease of 7.7% points (from 96.9 to 89.2%). Lung cancer, acute leukemia, and multiple myeloma showed notable increases across groups. Substantial racial/ethnic disparities in cancer survival underscore the notable need for tailored strategies ensuring equitable access to advanced treatments, particularly addressing significant trends in colorectal and pancreatic cancers among specific minority groups. Careful interpretation of statistical significance is warranted given the large dataset., (© 2024. The Author(s).)

Purpose: It is unknown whether Medicaid expansion under the Affordable Care Act (ACA) or state-level policies mandating Medicaid coverage of the routine costs of clinical trial participation have ameliorated longstanding racial and ethnic disparities in cancer clinical trial enrollment., Methods: We conducted a retrospective, cross-sectional difference-in-differences analysis examining the effect of Medicaid expansion on rates of enrollment for Black or Hispanic nonelderly adults in nonobservational, US cancer clinical trials using data from Medidata's Rave platform for 2012-2019. We examined heterogeneity in this effect on the basis of whether states had pre-existing mandates requiring Medicaid coverage of the routine costs of clinical trial participation., Results: The study included 47,870 participants across 1,353 clinical trials and 344 clinical trial sites. In expansion states, the proportion of participants who were Black or Hispanic increased from 16.7% before expansion to 17.2% after Medicaid expansion (0.5 percentage point [PP] change [95% CI, -1.1 to 2.0]). In nonexpansion states, this proportion increased from 19.8% before 2014 (when the first states expanded eligibility under the ACA) to 20.4% after 2014 (0.6 PP change [95% CI, -2.3 to 3.5]). These trends yielded a nonsignificant difference-in-differences estimate of 0.9 PP (95% CI, -2.6 to 4.4). Medicaid expansion was associated with a 5.3 PP (95% CI, 1.9 to 8.7) increase in the enrollment of Black or Hispanic participants in states with mandates requiring Medicaid coverage of the routine costs of trial participation, but not in states without mandates (-0.3 PP [95% CI, -4.5 to 3.9])., Conclusion: Medicaid expansion was not associated with a significant increase in the proportion of Black or Hispanic oncology trial participants overall, but was associated with an increase specifically in states that mandated Medicaid coverage of the routine costs of trial participation.

In the United States, Black individuals have higher rates of cancer mortality than any other racial group. Here, we examine chromosome copy number changes in cancers from more than 1800 self-reported Black patients. We find that tumors from self-reported Black patients are significantly more likely to exhibit whole-genome duplications (WGDs), a genomic event that enhances metastasis and aggressive disease, compared to tumors from self-reported white patients. This increase in WGD frequency is observed across multiple cancer types, including breast, endometrial, and lung cancer, and is associated with shorter patient survival. We further demonstrate that combustion byproducts are capable of inducing WGDs in cell culture, and cancers from self-reported Black patients exhibit mutational signatures consistent with exposure to these carcinogens. In total, these findings identify a type of genomic alteration that is associated with environmental exposures and that may influence racial disparities in cancer outcomes., (© 2024. The Author(s).)

Background: Although racially and ethnically minoritized populations are less likely to participate in cancer trials, it is unknown whether social determinants of health (SDOH) explain these inequities. Here we identify SDOH factors that contribute to racial and ethnic inequities in clinical trial participation among patients with 22 common cancers., Methods: This retrospective cohort study used electronic health record data (2011-2023) linked to neighborhood (US Census tract) data from multiple sources. Patients were followed from diagnosis to clinical study drug receipt (proxy for trial participation), death, or last recorded activity. Associations were assessed using Cox proportional hazards models adjusted for clinical factors (year of diagnosis, age, sex, performance status, disease stage, cancer type). To elucidate which area-level SDOH underlie racial and ethnic inequities, mediation analysis was performed using nonlinear multiple additive regression tree models., Results: This study included 250 105 patients (64.7% non-Latinx White, 8.9% non-Latinx Black, 5.2% Latinx). Black and Latinx patients were more likely to live in economically or socially marginalized areas (eg, disproportionately minoritized [measure of segregation], limited English proficiency, low vehicle ownership) than White patients. Black (3.7%; hazard ratio = 0.55, 95% confidence interval [CI] = 0.52 to 0.60) and Latinx patients (4.4%; hazard ratio = 0.63, 95% CI = 0.58 to 0.69) were less likely to participate in trials than White patients (6.3%). Fewer patients in economically or socially marginalized neighborhoods participated in trials. Mediators explained 62.2% (95% CI = 49.5% to 74.8%) of participation inequities between Black and White patients; area-level SDOH-including segregation (29.9%, 95% CI = 21.2% to 38.6%) and vehicle ownership (11.6%, 95% CI = 7.0% to 16.1%)-were the most important mediators. Similarly, Latinx-White participation inequities were mediated (65.1%, 95% CI = 49.8% to 80.3%) by area-level SDOH, such as segregation (39.8%, 95% CI = 28.3% to 51.3%), limited English proficiency (11.6%, 95% CI = 2.8% to 20.4%), and vehicle ownership (9.6%, 95% CI = 5.8% to 13.5%)., Conclusions: To improve racial and ethnic diversity in cancer trials, efforts to address barriers related to adverse neighborhood SDOH factors are necessary., (© The Author(s) 2024. Published by Oxford University Press.)

Introduction: Fertility after cancer is a top concern for adolescents and young adults with cancer (AYAs) (15-39 years old at diagnosis). The authors characterized live births after cancer by race and ethnicity ("race/ethnicity") in a population-based sample of female AYAs., Methods: This study used Texas Cancer Registry data linked to birth certificates (1995-2016) to estimate cumulative incidence of live birth, based on first live birth after cancer, and compared differences by race/ethnicity. Proportional subdistribution hazards models were used to estimate associations between race/ethnicity and live birth, adjusted for diagnosis age, cancer type, stage, year, and prior live birth, overall and for each cancer type., Results: Among 65,804 AYAs, 10-year cumulative incidence of live birth was lower among non-Hispanic Black AYAs than other racial/ethnic groups: 10.2% (95% confidence interval [CI], 9.4-10.9) compared to 15.9% (95% CI, 14.1-17.9) among Asian or Pacific Islander, 14.7% (95% CI, 14.2-15.3) among Hispanic, and 15.2% (95% CI, 14.8-15.6) among non-Hispanic White AYAs (p < .01). In the adjusted overall model, Black AYAs were less likely to have a live birth after cancer than all other groups. In adjusted models for each cancer type, live birth was significantly less likely for Black AYAs with gynecologic cancers or lymphomas (compared to White AYAs) or thyroid cancers (compared to Hispanic AYAs)., Conclusion: Black AYAs are less likely than AYAs of other races/ethnicities to have a live birth after cancer, in contrast to patterns of live birth in the general population. Research and action to promote childbearing equity after cancer are imperative., (© 2024 American Cancer Society.)

Background: Survivors of adolescent and young adult (AYA) cancer experience significant psychological distress and encounter barriers to accessing mental health care. Few studies have investigated racial/ethnic disparities in psychological health outcomes among AYA survivors, and none have compared outcomes within a racially minoritized population., Methods: National Health Interview Survey data (2010-2018) were analyzed that identified non-Hispanic Black (hereafter, Black) survivors of AYA cancer and age- and sex-matched Black noncancer controls. Sociodemographic factors, chronic health conditions, modifiable behaviors (smoking and alcohol use), and psychological outcomes were assessed with χ 2 tests. Logistic regression models, adjusted for survey weights, were used to evaluate the odds of psychological distress by cancer status after adjusting for covariates. Interactions between variables and cancer status were investigated., Results: The study included 334 Black survivors of AYA cancer and 3340 Black controls. Compared to controls, survivors were more likely to report moderate/severe distress (odds ratio [OR], 1.64; p < .001), use mental health care (OR, 1.53; p = .027), report an inability to afford mental health care (OR, 3.82; p < .001), and use medication for anxiety and/or depression (OR, 2.16; p = .001). Forty-one percent of survivors reported moderate/severe distress, and only 15% used mental health care. Among survivors, ages 18-39 years (vs. 40-64 years) and current smoking (vs. never smoking) were associated with the presence of moderate/severe distress. Among survivors with distress, high poverty status was associated with reduced utilization of mental health care., Conclusions: A cancer diagnosis for a Black AYA is associated with greater psychological distress within an already vulnerable population., (© 2024 American Cancer Society.)

Introduction: Rates of common cancers are continuously increasing among Indigenous peoples and are above the incidence rates of non-Indigenous Canadians. When considering the intersecting social determinants of health such as culture, geography, funding, and access to basic health services, these all contribute to the unique cancer burden faced by Indigenous people. Indigenous patients sometimes feel alienated by the word "cancer", intimidated in the oncology setting and often avoid or delay seeking care, bypass screening and preventative care, and cease prescribed treatment before it is finished. Providing culturally competent, safe care to improve Indigenous health outcomes have been suggested and prioritized in health care systems across Canada., Methods: Using an Indigenous methodology, sharing circles were held in Northern Alberta, Canada. Five Indigenous survivors of cancer and two Indigenous caregivers shared their experiences with oncology treatment in the radiation therapy centre. Results were transcribed verbatim and thematic analysis was conducted., Results: This resulted in four main themes (1) historical and cultural understandings (2) reduce systemic harm by having dedicated Indigenous staff, cultural competency, and Indigenous specific supports (3) meaningful time commitment and relationship building (4) importance of kinship and Indigenous-centred, family-and-patient-centred care. These themes fed into the development of nine recommendations for policy and decision makers to improve cultural safety in the Alberta radiation therapy centres., Conclusion: Support for Indigenous patients and caregivers is essential to improve care in the radiation therapy centres. The findings from this work will support recommendations for health decision and policy makers within radiation therapy centres, which may be transferable to other centres within oncology and health., (Copyright © 2024. Published by Elsevier Inc.)

Background: The COVID-19 pandemic had a significant impact on cancer screening and treatment, particularly in 2020. However, no single study has comprehensively analyzed its effects on cancer incidence and disparities among groups such as race/ethnicity, socioeconomic status (SES), persistent poverty (PP), and rurality., Methods: Utilizing the recent data from the United States National Cancer Institute's Surveillance, Epidemiology, and End Results Program, we calculated delay- and age-adjusted incidence rates for 13 cancer sites in 2020 and 2015-2019. Percent changes (PCs) of rates in 2020 compared to 2015-2019 were measured and compared across race/ethnic, census tract-level SES, PP, and rurality groups., Results: Overall, incidence rates decreased from 2015-2019 to 2020, with varying PCs by cancer sites and population groups. Notably, NH Blacks showed significantly larger PCs than NH Whites in female lung, prostate, and colon cancers (e.g., prostate cancer: NH Blacks -7.3, 95% CI: [-9.0, -5.5]; NH Whites: -3.1, 95% CI: [-3.9, -2.2]). Significantly larger PCs were observed for the lowest versus highest SES groups (prostate cancer), PP versus non-PP groups (prostate and female breast cancer), and all urban versus rural areas (prostate, female breast, female and male lung, colon, cervix, melanoma, liver, bladder, and kidney cancer)., Conclusions: The COVID-19 pandemic coincided with reduction in incidence rates in the U.S. in 2020 and was associated with worsening disparities among groups, including race/ethnicity, SES, rurality, and PP groups, across most cancer sites. Further investigation is needed to understand the specific effects of COVID-19 on different population groups of interest., (© 2024 Information Management Services, Inc. Cancer Medicine published by John Wiley & Sons Ltd. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)