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Barriers and Facilitators Impacting Lung Cancer Screening Uptake Among Black Veterans: A Qualitative Study

Neelima Navuluri, Tiera Lanford, Abigail Shapiro, Govind Krishnan, Angela B. Johnson, Isaretta L. Riley, Leah L. Zullig, Christopher E. Cox, and Scott Shofer

Background: Racial disparities in lung cancer screening (LCS) are well established. Black Veterans are among those at the highest risk for developing lung cancer but are less likely to complete LCS. We sought to identify barriers and facilitators to LCS uptake among Black Veterans. Patients and Methods: A qualitative study using semistructured interviews was conducted with 32 Black Veterans to assess for barriers, facilitators, and contextual factors for LCS and strategies to improve screening. Veterans were purposively sampled by age, sex, and LCS participation status (ie, patients who received a low-dose CT [LDCT], patients who contacted the screening program but did not receive an LDCT, and patients who did not connect with the screening program nor receive an LDCT). Interview guides were developed using the Theoretical Domains Framework and Health Belief Model. Data were analyzed using rapid qualitative analysis. Results: Barriers of LCS uptake among Black Veterans include self-reported low LCS knowledge and poor memory, attention, and decision processes associated with the centralized LCS process. Facilitators of LCS uptake among Black Veterans include social/professional role; identity and social influences; perceived susceptibility, threat, and consequences due to smoking status and military or occupational exposures; emotion, behavioral regulation, and intentions; and high trust in providers. Environmental context and resources (eg, transportation) and race and racism serve as contextual factors that did not emerge as having a major impact on LCS uptake. Strategies to improve LCS uptake included increased social messaging surrounding LCS, various forms of information dissemination, LCS reminders, balanced and repeated shared decision-making discussions, and streamlined referrals. Conclusions: We identified addressable barriers and facilitators for LCS uptake among Black Veterans that can help focus efforts to improve disparities in screening. Future studies should explore provider perspectives and test interventions to improve equity in LCS.

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Cost-Effectiveness of Unselected Multigene Germline and Somatic Genetic Testing for Epithelial Ovarian Cancer

Ranjit Manchanda, Li Sun, Monika Sobocan, Isabel V. Rodriguez, Xia Wei, Ashwin Kalra, Samuel Oxley, Michail Sideris, Caitlin T. Fierheller, Robert D. Morgan, Dhivya Chandrasekaran, Kelly Rust, Pavlina Spiliopoulou, Rowan E. Miller, Shanthini M. Crusz, Michelle Lockley, Naveena Singh, Asma Faruqi, Laura Casey, Elly Brockbank, Saurabh Phadnis, Tina Mills-Baldock, Fatima El-Khouly, Lucy A. Jenkins, Andrew Wallace, Munaza Ahmed, Ajith Kumar, Elizabeth M. Swisher, Charlie Gourley, Barbara M. Norquist, D. Gareth Evans, and Rosa Legood

Background : Parallel panel germline and somatic genetic testing of all patients with ovarian cancer (OC) can identify more pathogenic variants (PVs) that would benefit from PARP inhibitor (PARPi) therapy, and allow for precision prevention in unaffected relatives with PVs. In this study, we estimate the cost-effectiveness and population impact of parallel panel germline and somatic BRCA testing of all patients with OC incorporating PARPi therapy in the United Kingdom and the United States compared with clinical criteria/family history (FH)–based germline BRCA testing. We also evaluate the cost-effectiveness of multigene panel germline testing alone. Methods: Microsimulation cost-effectiveness modeling using data from 2,391 (UK: n=1,483; US: n=908) unselected, population-based patients with OC was used to compare lifetime costs and effects of panel germline and somatic BRCA testing of all OC cases (with PARPi therapy) (strategy A) versus clinical criteria/FH-based germline BRCA testing (strategy B). Unaffected relatives with germline BRCA1/BRCA2/RAD51C/RAD51D/BRIP1 PVs identified through cascade testing underwent appropriate OC and breast cancer (BC) risk-reduction interventions. We also compared the cost-effectiveness of multigene panel germline testing alone (without PARPi therapy) versus strategy B. Unaffected relatives with PVs could undergo risk-reducing interventions. Lifetime horizon with payer/societal perspectives, along with probabilistic/one-way sensitivity analyses, are presented. Incremental cost-effectiveness ratio (ICER) and incremental cost per quality-adjusted life year (QALY) gained were compared with £30,000/QALY (UK) and $100,000/QALY (US) thresholds. OC incidence, BC incidence, and prevented deaths were estimated. Results: Compared with clinical criteria/FH-based BRCA testing, BRCA1/BRCA2/RAD51C/RAD51D/BRIP1 germline testing and BRCA1/BRCA2 somatic testing of all patients with OC incorporating PARPi therapy had a UK ICER of £51,175/QALY (payer perspective) and £50,202/QALY (societal perspective) and a US ICER of $175,232/QALY (payer perspective) and $174,667/QALY (societal perspective), above UK/NICE and US cost-effectiveness thresholds in the base case. However, strategy A becomes cost-effective if PARPi costs decrease by 45% to 46% or if overall survival with PARPi reaches a hazard ratio of 0.28. Unselected panel germline testing alone (without PARPi therapy) is cost-effective, with payer-perspective ICERs of £11,291/QALY or $68,808/QALY and societal-perspective ICERs of £6,923/QALY or $65,786/QALY. One year’s testing could prevent 209 UK BC/OC cases and 192 deaths, and 560 US BC/OC cases and 460 deaths. Conclusions: Unselected panel germline and somatic BRCA testing can become cost-effective, with a 45% to 46% reduction in PARPi costs. Regarding germline testing, unselected panel germline testing is highly cost-effective and should replace BRCA testing alone.

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Racial Differences in Germline Genetic Testing Completion Among Males With Pancreatic, Breast, or Metastatic Prostate Cancers

Jeffrey W. Shevach, Danielle Candelieri-Surette, Julie A. Lynch, Rebecca A. Hubbard, Patrick R. Alba, Karen Glanz, Ravi B. Parikh, and Kara N. Maxwell

Background: Germline genetic testing is a vital component of guideline-recommended cancer care for males with pancreatic, breast, or metastatic prostate cancers. We sought to determine whether there were racial disparities in germline genetic testing completion in this population. Patients and Methods: This retrospective cohort study included non-Hispanic White and Black males with incident pancreatic, breast, or metastatic prostate cancers between January 1, 2019, and September 30, 2021. Two nationwide cohorts were examined: (1) commercially insured individuals in an administrative claims database, and (2) Veterans receiving care in the Veterans Health Administration. One-year germline genetic testing rates were estimated by using Kaplan-Meier methods. Cox proportional hazards regression was used to test the association between race and genetic testing completion. Causal mediation analyses were performed to investigate whether socioeconomic variables contributed to associations between race and germline testing. Results: Our cohort consisted of 7,894 males (5,142 commercially insured; 2,752 Veterans). One-year testing rates were 18.0% (95% CI, 16.8%–19.2%) in commercially insured individuals and 14.2% (95% CI, 11.5%–15.0%) in Veterans. Black race was associated with a lower hazard of testing among commercially insured individuals (adjusted hazard ratio [aHR], 0.73; 95% CI, 0.58–0.91; P=.005) but not among Veterans (aHR, 0.99; 95% CI, 0.75–1.32; P=.960). In commercially insured individuals, income (aHR, 0.90; 95% CI, 0.86–0.96) and net worth (aHR, 0.92; 95% CI, 0.86–0.98) mediated racial disparities, whereas education (aHR, 0.98; 95% CI, 0.94–1.01) did not. Conclusions: Overall rates of guideline-recommended genetic testing are low in males with pancreatic, breast, or metastatic prostate cancers. Racial disparities in genetic testing among males exist in a commercially insured population, mediated by net worth and household income; these disparities are not seen in the equal-access Veterans Health Administration. Alleviating financial and access barriers may mitigate racial disparities in genetic testing.

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Volume 22 (2024): Issue 2.5 (Apr 2024): Abstracts from the NCCN 2024 Annual Conference

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BIO24-030: Unifying Multimodal Data, Time Series Analytics, and Contextual Medical Memory: Introducing MINDS as an Oncology-Centric Cloud-Based Platform

Aakash Tripathi, Asim Waqas, and Ghulam Rasool

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BIO24-031: Hierarchical Multimodal Learning on Pan-Squamous Cell Carcinomas for Improved Survival Outcomes

Asim Waqas, Aakash Tripathi, Ashwin Mukund, Paul Stewart, Mia Naeini, and Ghulam Rasool

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BIO24-032: Early Diagnosis of Cancer Cachexia Using Body Composition Index as the Radiographic Biomarker

Sabeen Ahmed, Nathan Parker, and Ghulam Rasool

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BPI24-008: Pumping Iron in the Preoperative Period: Is It Beneficial in Reducing Blood Transfusions?

Carla Patel, Danielle Fournier, Susan Knippel, Cheryl Fraser, TaCharra Laury, Hue Cao, Mini George, and Arlene Correa

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BPI24-009: Improving Adherence to Safe Handling of Oral Hazardous Drugs and Contaminated Wastes Guidelines

Eliane Vieira, Grace Allen, and Sadeeka Al-Majid

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BPI24-010: Temporary Toilet Lids Minimize Contamination of Bathroom Surfaces With Hazardous Drugs

Eliane Vieira, Grace Allen, and Sadeeka Al-Majid