Nolan, Lucia

Abstract Black/African American populations, globally, bear the greatest prostate cancer (CaP) burden compared to other racial/ethnic groups. Addressing CaP disparities in Black men is complex, requiring a patient-centered, community-centric and comprehensive approach. This study integrates iCCaRE Consortium findings and broader literature to address unmet needs in survivorship care. The iCCaRE Consortium implemented five complementary pilot studies using mixed-methods designs, including feasibility trials, qualitative research, and observational analyses across the United States and sub-Saharan Africa. Descriptive statistics, subgroup analyses, and qualitative thematic analyses were performed across these studies. Collectively, projects addressed multilevel determinants including social, behavioral, and biological drivers of disparities. Project 1 implemented a Virtual Reality Assistant (ViRA) across clinical and community settings, with ongoing evaluation in pragmatic trials. Project 2 showed strong patient preference for home-based cancer care. Project 3 enrolled demonstrated trends toward improved health-related quality of life. Project 4 identified key themes influencing survivorship experiences. Project 5 identified biological mechanisms linking stress, immune modulation, and symptom burden. The iCCaRE pilot projects demonstrate the feasibility and early impact of a consortium-based, transdisciplinary approach to addressing CaP disparities in Black men. These findings highlight the importance of integrating patient-centered interventions, community engagement, and biological insights to inform scalable strategies aimed at improving survivorship outcomes and advancing health equity. The iCCaRE Consortium demonstrates that a transatlantic, patient-centered, and multidisciplinary approach integrating social, clinical, and biological factors can generate scalable strategies to improve survivorship outcomes and advance equity in CaP care for Black men.

TPS1679 Background: Cancer care in the United States remains highly centralized, imposing substantial time, caregiver, and financial burdens on patients, particularly those residing in rural and medically underserved regions. While international experience supports the feasibility of home-based cancer therapy delivery, prospective U.S. clinical trial data are limited. The Cancer CARE Beyond Walls (CCBW) program was developed to address these gaps through a decentralized cancer care model integrating virtual oversight, remote monitoring, mobile clinical services, and community-based nursing partners. The study evaluates the feasibility, safety, and patient-centered impact of delivering cancer-directed therapy in patients’ homes or near-home mobile units in the Florida Panhandle, a region characterized by long travel distances to tertiary centers and limited oncology infrastructure. Methods: This is a phase 2, single-arm clinical trial evaluating the delivery of standard-of-care cancer-directed therapy outside of traditional infusion centers. Eligible adult patients (ECOG 0–3) with histologically confirmed malignancies receiving guideline-supported or FDA-approved systemic cancer therapy must demonstrate tolerability of at least one prior in-clinic treatment cycle. Following registration, patients transition to home-based or near-home mobile unit administration for a minimum of 12 weeks, with an option to continue up to 24 weeks. Care delivery is coordinated through a virtual command center providing real-time virtual oversight, remote monitoring, and escalation pathways. Treatment administration is performed by trained local home health nurses, medication shipping, and digital interaction with the electronic health record. A fully equipped mobile unit extends access to rural areas not covered by home health agencies. The primary endpoint is patient preference for treatment location at week 12. Secondary endpoints include safety, avoidable acute care utilization, patient-reported function and global health/quality of life, patient-reported symptoms, and satisfaction with care. Exploratory endpoints assess travel burden, patient perceptions of caregiver experience, and patient perceptions of home versus mobile unit care. Enrollment of 27 patients will provide 80% power to reject a 50% null rate (2-sided exact test, α=0.10), assuming 75% prefer decentralized care or express no preference. This investigator-initiated trial is open to accrual and is supported by a grant from the Florida Cancer Innovation Fund. Clinical trial information: NCT07285044 .