Abstract PO-106: Colon cancer death and associations with clinical and non-clinical support among non-Hispanic Black and White urban colon cancer patients
Authors: Carnahan Leslie R. , Molina Yamilé , Watson Karriem S. , Altfeld Susan , Ferrans Carol E. , Rauscher Garth E. 
Published: January 2022

Abstract
Background: Non-Hispanic Black (NHB) patients are more likely to present with a later stage colon cancer and to die from the disease compared to their non-Hispanic White (NHW) counterparts. Despite a plethora of research regarding their effects on intermediate outcomes (e.g., patient satisfaction, behavioral outcomes), little is known about the role of clinical (i.e., patient-provider communication [PPC]) and non-clinical social support in survival. Objective: To describe clinical (PPC) and non-clinical social support among NHB and NHW urban colon cancer patients, and examine their associations with risk of colon cancer death. Method: Colon Cancer Patterns of Care in Chicago was a cross-sectional, multi-site study that examined disparities in colon cancer screening, diagnostic stage, and treatment. Patients were eligible if they were diagnosed with a first primary colon cancer, self-identified as NHB or NHW, and were between 30 and 79 years of age. Participants completed a 90-minute interview and consented to medical record abstraction. For these analyses we examined: 1) clinical support (PPC), treated as a categorical variable (low, moderate, or high), 2) non-clinical social support (no, yes), and 3) colon cancer death, ascertained via a National Death Index Plus search. We used multivariable Cox proportional hazard models to estimate hazard ratios (HRs) for associations of race, sex, PPC, and social support with colon cancer death. Adjusted models included the following covariates: age, marital status, education, income, insurance, comorbidities, body mass index, having a regular provider, healthcare utilization, and healthcare access. Results: The final sample of 407 colon cancer patients had (by design) a roughly equal distribution by race and gender. Overall, 26% of patients died due to colon cancer, and risk of death was highest for NHB males (33%) and lowest for NHW males (20%). NHB patients were more likely than NHW patients to report low PPC and no non-clinical social support. Low PPC was associated with a two-fold increased hazard of colon cancer death (HR=2.0, 95% CI: 1.06, 3.84), whereas non-clinical social support was not associated with risk of colon cancer death. The hazard of colon cancer death was two-fold (HR=2.05, 95% CI: 1.07, 3.71) greater for NHB males compared to NHW females. Conclusion: These findings suggest that clinical support – specifically PPC - can potentially decrease the risk of colon cancer death, especially among NHB male patients. Future research should determine optimal strategies for PPC improvement, including provider training in shared decision-making practices and high-quality informational support. Reducing survival disparities may thus require not only advances in diagnostics and treatment, but also in clinical support factors.
Citation Format: Leslie R. Carnahan, Yamilé Molina, Karriem S. Watson, Susan Altfeld, Carol E. Ferrans, Garth E. Rauscher. Colon cancer death and associations with clinical and non-clinical support among non-Hispanic Black and White urban colon cancer patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-106.