Understanding metabolic and immune regulation inherent to patient populations is key to improving the radiation response for our patients. To date, radiation therapy regimens are prescribed based on tumor type and stage. Patient populations who are noted to have a poor response to radiation such as those of African American descent, those who have obesity or metabolic syndrome, or senior adult oncology patients, should be considered for concurrent therapies with radiation that will improve response. Here, we explore these populations of breast cancer patients, who frequently display radiation resistance and increased mortality rates, and identify the molecular underpinnings that are, in part, responsible for the radiation response and that result in an immune-suppressive tumor microenvironment. The resulting immune phenotype is discussed to understand how antitumor immunity could be improved. Correcting nutrient deficiencies observed in these populations should be considered as a means to improve the therapeutic index of radiation therapy.

Background: Health disparities in lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (LGBTQ+) individuals are well documented, and there is a dearth of primary care providers (PCPs) with the knowledge, skills, and attitudes to sensitively care for this diverse population. Purpose:The purpose of this research study was to ask LGBTQ+ patients what qualities they prefer in their PCP. The findings will be used to better prepare nurse practitioners (NPs) to care for this diverse community and inform the training of future NPs to provide patient-centered care to LGBTQ+ individuals. Methodology:In this qualitative descriptive study, four focus groups were conducted remotely between December 2020 and January 2021 with self-identified LGBTQ+ patients of an LGBTQ+ health center in the northeast. Thematic analysis of the data elicited codes, categories, and themes. Strategies were implemented to promote trustworthiness of the results.Results: Twenty-eight participants shared the qualities they value in their PCP. Analysis revealed four themes: "Ditch the white coats"; "Meet me where I am"; "The relationship is key"; and "Be knowledgeable about and comfortable with LGBTQ+ people and their health care needs." Conclusions:The focus groups elucidated important information on caring for the LGTBQ+ communities and insights into what NPs must do to provide patient-centered care to this diverse population.Implications: These findings can improve practice through a better understanding of LGBTQ+ patients' perspectives. Additionally, this study demonstrates the feasibility of directly asking our patients what they want in their health care provider.

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Background: Although the U.S. cancer death rate has declined significantly over three decades, health disparities continue to exist. Factors such as the environment in which our patients work, live, and play, also known as social determinants of health (SDoH), may play a role. Adverse SDoH are associated with increased cancer risk factors and negative health outcomes. Determining how SDoH may be linked to cancer beliefs could inform future interventions to decrease health disparities. Methods: Data from a population-level survey of an NCI-designated cancer center’s catchment area was used to calculate adverse SDoH scores ranging from 0 to 9 for 859 survey respondents. Spearman's correlation coefficients quantified the relationship between the SDoH score and six cancer belief items. Results: The majority of participants were less than 41 years old (60.4%), female (68.1%), and white (67%). The median SDoH score was 2, indicating the number of adverse SDoHs. Those with higher SDoH scores were more likely to agree that they would not like to know their cancer risk (p<0.001), that cancer is a death sentence (p<0.001) and there isn’t much you can do to lower your cancer risk (p<0.001). Conclusion: Adverse SDoHs may play a role in cancer beliefs and may influence patients’ willingness to engage in risk prevention behaviors or in their clinical care if diagnosed with cancer. Educational efforts to alter cancer beliefs can target those with increased adverse SDOH. Screening for and intervening on SDoH may increase cancer screening rates and clinical trial participation.