Disparities in metastatic renal cell carcinoma (mRCC) outcomes persist in the era of oral anticancer agents (OAAs) and immunotherapies (IOs). We examined variation in the utilization of mRCC systemic therapies among US Medicare beneficiaries from 2015-2019. Logistic regression models evaluated the association between therapy receipt and demographic covariates including patient race, ethnicity and sex. In total, 15,407 patients met study criteria. After multivariable adjustment, non-Hispanic Black race and ethnicity was associated with reduced IO (adjusted relative risk ratio (aRRR) = 0.76 [0.61-0.95]; P = 0.015) and OAA receipt (aRRR = 0.76 [0.64-0.90]; P = 0.002) compared to non-Hispanic White race and ethnicity. Female sex was associated with reduced IO (aRRR = 0.73 [0.66-0.81]; P < 0.001) and OAA receipt (aRRR = 0.74 [0.68-0.81]; P < 0.001) compared to male sex. Thus, disparities by race, ethnicity, and sex were observed in mRCC systemic therapy utilization for Medicare beneficiaries from 2015-2019.

BackgroundCancer incidence among individuals with incarceration exposure has been rarely studied due to the absence of linked datasets. This study examined cancer incidence during incarceration and postincarceration compared to the general population using a statewide linked cohort.MethodsWe constructed a retrospective cohort from a linkage of state tumor registry and correctional system data for Connecticut residents from 2005 to 2016, and identified cancers diagnosed during and within 12 months postincarceration. We estimated incidence rates (including for screen‐detectable cancers) and calculated the standardized incidence ratios (SIR) for the incarcerated and recently released populations, relative to the general population. We also examined cancer incidence by race and ethnicity within each group.ResultsCancer incidence was lower in incarcerated individuals (SIR = 0.64, 95% CI 0.56–0.72), but higher in recently released individuals (SIR = 1.34, 95% CI 1.23–1.47) compared with the general population, and across all race and ethnic strata. Similarly, nonscreen‐detectable cancer incidence was lower in incarcerated and higher in recently released populations compared to the general population. However, non‐Hispanic Black individuals had elevated incidence of screen‐detectable cancers compared with non‐Hispanic White individuals across all three populations (incarcerated, SIR = 1.66, 95% CI 1.03–2.53; recently released, SIR = 1.83, 95% CI 1.32–2.47; and general population, SIR = 1.18, 95% CI 1.16–1.21).ConclusionCompared with the general population, incarcerated persons have a lower cancer incidence, whereas recently released persons have a higher cancer incidence. Irrespective of incarceration status, non‐Hispanic Black individuals have a higher incidence of screen‐detectable cancers compared with non‐Hispanic White individuals. Supplemental studies examining cancer screening and diagnoses during incarceration are needed to discern the reasons for observed disparities in incidence.

610 Background: Immune checkpoint inhibitors (IOs) and oral anti-cancer agents (OAAs) have demonstrated survival improvements in randomized trials of patients with metastatic renal cell carcinoma (mRCC). IOs were approved as second-line mRCC therapy in 2015 (nivolumab), followed by first-line approval in 2018 (ipilimumab/nivolumab). Real-world changes in overall treatment rates and IO usage have not been examined in patients over 65, who are often underrepresented in trials. Disparities in mRCC outcomes have persisted in the era of these novel therapies, raising the question of whether receipt of IOs and OAAs varies by race and ethnicity. Methods: We conducted a retrospective cohort study of Medicare beneficiaries over age 65 diagnosed with mRCC from 2015 through 2019 who were enrolled in fee-for-service Medicare Parts A, B, and D from 1 year prior to diagnosis through 1 year after presumed diagnosis or until death. We identified our cohort using diagnosis codes for primary or secondary kidney malignancy. We queried claims from 2014-2020, identifying receipt of IO, OAA, or other systemic therapies in the 2 months before through 1 year after diagnosis. Patients that received both IOs and OAAs were categorized as IO if both therapies were started within 60 days; otherwise, patients were categorized by the first therapy received. We assessed trends in treatment from 2015-2019, stratifying by race and ethnicity to compare non-Hispanic White (NHW) patients with Hispanic, Black, Asian, Pacific Islander, American Indian, Native Alaskan, or Other patients (grouped as non-NHW due to limited sample sizes). Results: We identified 15,407 patients who were diagnosed with mRCC between 2015-2019 and met study criteria. Non-Hispanic White patients comprised 84% of our sample. Receipt of IOs increased from 4% of patients in 2015 to 37% in 2019 ( P < .001). Among NHW patients, IO treatment receipt increased from 4% in 2015 to 38% in 2019 ( P < .001); for non-NHW patients, IO receipt grew from 3% in 2015 to 31% in 2019 ( P < .001). OAA usage decreased over time, from 31% of all patients in 2015 to 11% in 2019 ( P < .001). The percent of NHW patients treated with any systemic therapy increased from 51% in 2015 to 60% in 2019 ( P < .001), while there was no significant change for non-NHW patients (51% in 2015 to 54% in 2019; P = 0.27). Conclusions: Among Medicare beneficiaries, receipt of IO therapy for mRCC increased from 2015-2019. Receipt of any systemic therapy significantly increased over time for NHW patients, but not for non-NHW patients. [Table: see text]

ImportanceImprovements in cancer outcomes have led to a need to better understand long-term oncologic and nononcologic outcomes and quantify cancer-specific vs noncancer-specific mortality risks among long-term survivors.ObjectiveTo assess absolute and relative cancer-specific vs noncancer-specific mortality rates among long-term survivors of cancer, as well as associated risk factors.Design, Setting, and ParticipantsThis cohort study included 627 702 patients in the Surveillance, Epidemiology, and End Results cancer registry with breast, prostate, or colorectal cancer who received a diagnosis between January 1, 2003, and December 31, 2014, who received definitive treatment for localized disease and who were alive 5 years after their initial diagnosis (ie, long-term survivors of cancer). Statistical analysis was conducted from November 2022 to January 2023.Main Outcomes and MeasuresSurvival time ratios (TRs) were calculated using accelerated failure time models, and the primary outcome of interest examined was death from index cancer vs alternative (nonindex cancer) mortality across breast, prostate, colon, and rectal cancer cohorts. Secondary outcomes included subgroup mortality in cancer-specific risk groups, categorized based on prognostic factors, and proportion of deaths due to cancer-specific vs noncancer-specific causes. Independent variables included age, sex, race and ethnicity, income, residence, stage, grade, estrogen receptor status, progesterone receptor status, prostate-specific antigen level, and Gleason score. Follow-up ended in 2019.ResultsThe study included 627 702 patients (mean [SD] age, 61.1 [12.3] years; 434 848 women [69.3%]): 364 230 with breast cancer, 118 839 with prostate cancer, and 144 633 with colorectal cancer who survived 5 years or more from an initial diagnosis of early-stage cancer. Factors associated with shorter median cancer-specific survival included stage III disease for breast cancer (TR, 0.54; 95% CI, 0.53-0.55) and colorectal cancer (colon: TR, 0.60; 95% CI, 0.58-0.62; rectal: TR, 0.71; 95% CI, 0.69-0.74), as well as a Gleason score of 8 or higher for prostate cancer (TR, 0.61; 95% CI, 0.58-0.63). For all cancer cohorts, patients at low risk had at least a 3-fold higher noncancer-specific mortality compared with cancer-specific mortality at 10 years of diagnosis. Patients at high risk had a higher cumulative incidence of cancer-specific mortality than noncancer-specific mortality in all cancer cohorts except prostate.Conclusions and RelevanceThis study is the first to date to examine competing oncologic and nononcologic risks focusing on long-term adult survivors of cancer. Knowledge of the relative risks facing long-term survivors may help provide pragmatic guidance to patients and clinicians regarding the importance of ongoing primary and oncologic-focused care.

e18647 Background: Interest is growing in identifying and addressing health related social needs for patients with cancer. One proposed approach is the creation of coordinated social care networks (CSCNs) to facilitate access to community-based resources and communication between community-based organizations (CBOs) serving patients with cancer. However, little is known about the perspectives of CBO leaders’ perspectives of addressing address health-related social needs or participating in CSCNs to serve patients with cancer. Methods: We conducted qualitative interviews of CBO leaders in New Haven, CT to assess perceived barriers to and facilitators for joining a CSCN. We also assessed leaders' awareness of how their services align with cancer care guidelines to address social and material needs of patients with cancer. CBOs were identified through a resource inventory of all New Haven-based CBOs. We employed qualitative content analysis and applied the Consolidated Framework for Implementation Research (CFIR) to classify emergent themes. Results: Respondents (N = 15) representing food pantries (n = 3), transportation agencies (n = 2), financial assistance organizations (n = 2), cancer-specific advocacy groups (n = 2), homeless shelters (n = 1), and general service organizations (n = 5) participated. We identified four themes: COVID-19 impact, referral challenges to other CBOs, challenges addressing client needs, and barriers and facilitators to joining a CSCN. The strongest theme was challenges addressing client needs which aligns with the CFIR domains of inner setting and individual characteristics. For instance, CBO leaders identified significant challenges with providing resources for patients with cancer due to lack of knowledge of client’s diagnosis. The theme of referral challenges to other CBOs, which aligns with the intervention CFIR domain, was exemplified by sentiments of limited funding and resources, lack of availability of information, and desire for client privacy. The impact of the COVID-19 pandemic was a theme relevant to both the individual and inner setting CFIR domains, particularly given its lasting effect on both the general community and patients with cancer utilizing CBOs at a higher rate, contributing to longer waitlists. Lastly, barriers to and facilitators of joining a CSCN largely align with the process CFIR domain. Respondents noted that lack of funding and resistance to adapting new technologies were barriers to implementing a CSCN in the New Haven area. Conclusions: While CSCNs may be a helpful mechanism to increase coordination between CBOs to help patients with cancer, critical barriers such as capacity, funding, and technology resistance may hinder implementation.