Gunaratne, Madugodaralalage D. S. K.

This cross-sectional study of laboratory test records from US hospitals compares the total types of complete blood count results recorded in academic and community settings.

152 Background: The American Society of Clinical Oncology (ASCO) started the Diversity in Oncology initiative in 2017. Minority representation in the US oncology physician workforce was the subject of a recent series of ASCO State of the Oncology Workforce in America snapshots (1). However, Asian minority representation was not mentioned in any of these reports. Our objective was to determine the proportion of Asian workforce in various oncology specialties inclusive of physician and non-physician practitioners as well as physician trainees. Methods: We searched the web for publicly available data on Asian representation among US oncology adult (A) and pediatric (P) practitioners and trainees. Major data sources included the 2020 US Census, Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, and professional societies. Practitioners included hematologists/oncologists (H/O), gynecologic oncologists (GYNO), radiation oncologists (RADO), surgical oncologists (SURGO), hematopathologists (HP), oncology nurse practitioners (ONP), oncology physician assistants (OPA), and oncology nurses (ON). Trainees included fellows (F) and residents (R). For reference, we obtained similar data on US population, medical students (MS), adult internal medicine residents (AIMR), gynecology residents (GYNR), pediatric residents (PR), pathology residents (PATHR), surgery residents (SURGR), nurses (RN), nurse practitioners (NP), and physician assistants (PA). For a snapshot of the oncology workforce, data from 2020-2022 were used. Whenever available, we obtained serial data for trainees over the years. Results: A snapshot of the proportions of Asians based on their professions is shown (Table). While Asians comprise only 6.2% of the US population, between 14.7% to 32.1% of physician practitioners in various oncology subspecialties are Asian. Moreover, between 17.9% to 35.3% of oncology physician trainees and 26.7% of medical students are Asian and these proportions have remained stable from 2005 to 2022. Data are unavailable for HP, SURGO, and non-physician practitioners except for OPA (7.0%) and RN (7.2%). Conclusions: Asians comprise a large segment of the US oncology workforce. While only 1 in 20 people in the US are Asians, between 1 in 3 and 1 in 5 oncology physician practitioners and trainees are Asians. Data are limited for non-physician practitioners. Asian minority representation should be highlighted and considered as an example of success in diversity. 1. JCO Oncol Pract 2020-2022. Snapshot of Asian representation among oncology trainees and practitioners in the US. Trainees 2022 A-H/O-F 35.3% AIMR 35.9% 2022 P-H/O-F 20.0% PR 22.0% 2022 RADO-R 26.4% MS 26.7% 2022 GYNO-F 17.9% GYNR 14.9% 2022 HP-F 20.0% PATHR 26.6% 2022 SURGO-F 21.2% SURGR 19.2% Practitioners 2021 A-H/O 32.1% OPA 7.0% 2021 P-H/O 20.4% RN 7.2% 2021 RADO 25.9% HP/SURGO/ONP/ON NA 2020 GYNO 14.7% US Census 6.2%

191 Background: ANC is used to determine the dosing of chemotherapy and eligibility in clinical trials. Duffy-null phenotype is associated with a lower ANC and present in 2/3 of the Black population. Therefore, ANC reference intervals from hospitals serving a larger percentage (%) of Black population are expected to be lower. Ideally, reference intervals should represent the normal values of the population served. The objective of this study is to determine if the ANC reference intervals of hospitals in the US are representative of the population served based on racial diversity. Methods: We obtained hospital ANC reference intervals from the Mayo Clinic EPIC electronic medical records Care Everywhere health information exchange. Reference intervals from 2020-2023 were included. For each hospital, we determined the city where it is located. For each city, the % of Black population was obtained from the 2020 US Census. We studied the correlation (Pearson) between reference ANC values and % of Black population. To determine the expected ANC reference intervals, we obtained ANC data from the 2021-2022 National Health and Nutrition Examination Survey (NHANES) and performed a reference interval simulation study. Individuals with cancer and cirrhosis were excluded. Random samples of 120 individuals were selected, consisting of n samples from Black individuals and 120-n samples from non-Black individuals. This was performed for n from 0 to 120, and repeated 1000 times per n. Results: We collected data from 107 hospitals across 40 states and 81 cities. Fifty-three (49.5%) hospitals were academic. The % of Black populations in the cities served by the hospitals was a mean of 23.4% (range, 0.7%-82.8%). There was no correlation between ANC upper (r = -0.17, p=0.07) and lower (r = 0.01, p=0.88) limits based on the % Black population. This finding was similar in both academic and non-academic hospitals. Assessment of the ANC distribution in the US population based on race by using the NHANES database showed a clear association with race at the 2.5th (p<0.001) and 97.5th (p=0.009) percentiles with an overall estimated mid-95% reference range of 2.0-8.3 for non-Black individuals and 1.3-7.7 for Black individuals. Conclusions: Hospitals serving a higher % of Black population have similar upper and lower ANC reference intervals compared to those serving a lower % of Black population. This contrasts with the findings from NHANES data which showed significant variations in the normal ANC values between Black and non-Black individuals. Therefore, current hospital ANC reference intervals may not represent the diversity of the population served. Potential clinical implications include misdiagnosis of neutropenia, delay or underdosing of chemotherapy, and inappropriate exclusion in clinical trials, especially in areas with a high % of Black population.

101 Background: In the US, minority patients are underrepresented in cancer clinical trials. This is due to multiple factors, including socioeconomic barriers, limited medical insurance coverage and restrictive clinical trial eligibility, e.g., ANC cutoff. For the latter, conservative ANC cutoff disadvantages Black patients. Two-in-three Black individuals have a Duffy-null phenotype, that is associated with lower ANC with 5% prevalence of ANC <1,500 cells/µl. To improve Black patient accrual to cancer clinical trials, lowering the ANC cutoff was proposed as a potential solution over a decade ago. Its implementation is not known. This study evaluates the ANC cutoff values as part of the eligibility criteria for cancer clinical trials. Methods: We accessed the Clinicaltrials.gov website on 5/25/2023 and obtained the ANC cutoff of cancer clinical trials conducted in the US. We included adult therapeutic trials in the phases of recruiting, not yet recruiting, enrolling by invitation, and active-not yet recruiting. Trials with drug interventions were selected. Those focusing on surgical, behavioral, nutritional and radiotherapeutic interventions were excluded. All ANC cutoff values were converted to “cells/µl” for analysis. Results: A total of 911 trials were evaluated, and 470 met the eligibility criteria. Of the 470 trials, 366 (78%) involved solid malignancies, and 104 (22%) involved hematologic malignancies. Hematologic trials have significantly lower ANC cutoffs compared to solid tumor trials with median ANC cutoff of 1,000 (range, 250-2000) vs. 1,500 (range 250-3,000); p=<0.001. In all, 323 trials (68.7%) required patients to have ANC >1,500, and 116 trials (24.6%), primarily hematologic, required patients to have ANC >1,000. For myeloma and prostate cancer, two cancers with higher incidence among Blacks, 12.9% and 86.4% of the trials require ANC >1,500, respectively. All genitourinary, breast, head & neck, sarcoma, lung, skin, and neuroendocrine tumor trials excluded patients with ANC <1,000. Conclusions: Most hematologic malignancy trials have a more liberal ANC cutoff allowing patients with ANC <1,500 to participate. However, solid tumor trials remain more conservative, with 4 in 5 trials requiring an ANC cutoff of >1,500. A strict ANC cutoff remains a barrier to minority accrual.[Table: see text]