Abstract PO4-09-12: Academic-community partnership bridges disparities in African American patient representation in accelerated partial breast irradiation clinical trials
Authors: Kakadiaris Ev , Lue Brian , Kwon Young Suk , Alluri Prasanna , Kim D Nathan , Sprangler Ann , Arbab Mona , Timmerman Robert , Rahimi Asal 
Published: May 2024

Abstract
Purpose/Objectives: Clinical outcomes in African American (AA) patients diagnosed with breast cancer continue to lag behind other racial groups. Thus, AA women are 41% more likely to die from breast cancer than White women despite lower incidence of breast cancer in AA women. Some of these disparities are related to barriers in access to standard-of-care treatments such as radiation therapy (RT). The prolonged nature of radiation treatments confers disproportionate higher burden (due to lost wages, transportation costs etc.) on economically disadvantaged groups such as AA women. Accelerated partial breast irradiation (ABPI), which dramatically reduces treatment time in appropriately selected patients, has the potential to mitigate financial toxicity, and improve access and treatment compliance for AA. However, underrepresentation of AA patients in APBI trials may pose a barrier to wide adoption of APBI treatments in this patient population. At our institution, we have established a unique partnership between our University Hospital and a county hospital that serves as a safety-net hospital for many economically disadvantaged groups and treats a large proportion of AA patients. The goal of this study is to determine if our unique academic-community partnership improves disparities in representation of AA patients in APBI trials. Methods: We performed a PUBMED search to identify 197 clinical trials involving ABPI. After excluding international trials and multiple reports from the same trials, we identified 80 unique studies that were based in the United States. A total of 20 studies investigating APBI provided demographics data, comprising 1735 total patients. AA enrollment rate in these trials was compared to APBI trials completed at our institution in partnership with our county hospital partner. Results: Out of 1785 patients enrolled in APBI trials in the United States where demographic information was available, 1488 patients were White (85.7%), 124 were Black (7.1%), 67 were Hispanic (3.9%), and 46 were Asian (2.7%), and 10 patients were classified as multiple or unknown (0.6%). We compared these results to two APBI trials conducted at our institution investigating 5-fraction and single fraction APBI regimens. Out of a total of 104 patients treated, 17 patients (16.3%) were Black. This difference in proportion of AA patient enrollment between our institution (16.3%) versus those reported in APBI trials across the United States (7.1%) was statistically significant (p &lt; 0.05). Conclusion: Reporting and representation of AA patients in APBI trials remains low, which may lead to lower adoption of APBI treatments in AA patients. This may lead to underutilization of APBI, a convenient treatment with lower financial toxicity, among AA patients. Our study shows that effective academic-community partnerships can bridge such disparities in AA patient representation in APBI trials. Expansion of such academic-community partnerships across the country may bridge systemic disparities in AA patient representation in oncology clinical trials. Future studies are needed to determine if improved access to novel and convenient treatments such APBI will bridge existing disparities in clinical outcomes in patients diagnosed with breast cancer.
Citation Format: Ev Kakadiaris, Brian Lue, Young Suk Kwon, Prasanna Alluri, D Nathan Kim, Ann Sprangler, Mona Arbab, Robert Timmerman, Asal Rahimi. Academic-community partnership bridges disparities in African American patient representation in accelerated partial breast irradiation clinical trials [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-09-12.