Ngufor, Che

Abstract The objective of our study is to evaluate the feasibility, acceptance, and impact of patient-centered home care (PCHC) on patient reported outcomes (PROs) and health-related quality of life (HQoL) of black men with advanced prostate cancer (CaP). Meeting patients where they are and offering treatment in or closer to their homes reduce psychological distress and increase treatment compliance, especially for disadvantaged patients in rural areas, those on low incomes, with poor access to transport, elderly and people with disabilities. In 2023, Mayo Clinic has developed the Cancer Care Beyond Walls (CCBW) program, a cancer care delivery model that integrates virtual with in facility treatment and provides a package of care to support administration of cancer-directed therapy (chemotherapy, immunotherapy, hormonal therapy) and/or supportive care in the patients’ homes. Our study will assess if patients and families are comfortable with cancer therapy at home, what factors influences their decision, and use this data to inform our understanding of the proportion of the black men with advanced CaP who would be willing to receive and would benefit from this level of care at home. Patients with advanced CaP from our practice requiring active anti-cancer therapy are administered a brief questionnaire regarding preference for location of therapy at the infusion center or in the home, with perceived difficulties and advantages of each approach. A focus group session with prostate cancer survivor advocates is also conducted to capture patients’ thoughts, feelings, attitudes, and questions towards cancer treatments being administered at home versus a hospital setting. In addition, we are conducting an observational study of 20 patients with advanced prostate cancer receiving supportive care/symptom management and/or anti-cancer therapy in the home as part of the Mayo Clinic CCBW Program to assess the safety of cancer directed therapy when administered at home by a home health provider with remote patient monitoring and command center support, and establish the impact of home cancer treatment administration on patient-reported function and global health/quality of life, patient-reported symptoms, clinical outcomes, and cost of care. Successful completion of the project will deliver data on patient understanding and acceptability of cancer care at home, strategies for overcoming barriers to care for underserved communities, and the foundation from which we discover, translate and apply new knowledge in administering personalized care to vulnerable populations. Citation Format: Roxana S. Dronca, Folakemi Odedina, Che Ngufor, Kimlin Ashing, Ernest Kaninjing, Solomon Rotimi. Feasibility of patient-centered home care (PCHC) to reduce disparities in high-risk black men with advanced prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 819.

Abstract Background: The point of prostate cancer (CaP) diagnosis (PPCD) instantly leads to a life changing experience for Black men, with diverse emotional reactions that includes fear, denial, overwhelmingness, cancer fatalism etc. Black men diagnosed with CaP expressed several needs at the PPCD, including time to reflect on the diagnosis, being comfortable, emotional support, psycho-oncology support and social determinants of health (SDOH) navigation. Given that Black men are diverse in terms of their needs at the PPCD, precision intervention is needed to support them. Aim: The aim was to develop, implement, and establish the acceptance and usability of a Virtual Reality Assistant (ViRA) that will provide precision intervention tailored to the needs of Black men at the PPCD. This study is one of the five iCCaRE for Black Men projects focused on survivorship care. Methodology: The development of the ViRA was guided by CaP survivors through qualitative study. Reflective, analytic, and interpretive memos were used to generate action plans for the development of the ViRA. Based on a comprehensive PPCD ViRA intervention guide created by the team, the ViRA prototype was developed with mobile immersive technologies that integrated SDOH navigation, standard CaP psycho-oncology support and emotional support. The goal was to have the intervention personalized to everyone based on participant-provided information. Alpha testing of the ViRA is ongoing and will be completed on November 20, 2023. Participants are three prostate cancer survivors and three clinicians. The assessments will confirm the accuracy of the ViRA predictions and the functionality of the ViRA. Results: We developed the ViRA SDOH screening and navigation tool to identify participants’ needs and appropriately connect them with relevant support services and resources in their communities. The emotional support intervention was based on four CaP survivors as virtual reality avatars, providing empathetic rapport through self-disclosure and sharing of survivorship stories in different settings (home, clinic, barbershop etc). The psycho-oncology support intervention was developed with the guidance of a psycho-oncologist, with her avatar providing psychoeducation about the PPCD experience, reify and concretize the PPCD experience, and foster hope using the basic tenets of Problem-Solving Therapy. The results of the alpha testing and the modified ViRA will be presented during the conference. Conclusion: Meeting the needs of Black men at the PPCD requires a personalized and decentralized approach, which would allow Black men to access support anywhere. The presentation will unveil the iCCaRE ViRA, a smart and connected personalized AR-enabled intervention that will deliver SDOH navigation, CaP psycho-oncology support and emotional support tailored to the needs of Black men. Citation Format: Folakemi T. Odedina, Che Ngufor, Arnold Merriweather, Deidre Pereira, Roxana Dronca, Ernest Kaninjing, Kimlin Ashing, Solomon Rotimi, Vinessa Gordon, iCCaRE for Black Men Consortium. Connecting Black men to point of prostate cancer diagnosis (PPCD) support using precision intervention based on Virtual Reality Assistant (ViRA) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2230.

Abstract Background: Health Zone 1 in Jacksonville, Fl contains a large population of underserved residents with limited resources. The high level of poverty, lower educational attainment, increased chronic illness diagnoses, and higher rates of mortality can be attributed to poorer overall health from diseases such as cancer and diabetes when compared to other health zones. Mayo Clinic Comprehensive Cancer Center Community Outreach and Engagement (MCCC COE) partnered with American Legion Post 197 (ALP 197), a veteran led organization, to specifically address the health disparities face by residents of this community. The post is located within Health Zone 1 and has a history of philanthropic contributions, making it a trusted community partner vital to the success of community health initiatives. In November 2022, ALP began instituting twice monthly Lunch & Learn (LL) programs, offering meals/snacks in conjunction with health education. Aims: The aims of LL programs are to increase resident access to: (1) health information, (2) health resources, and (3) clinical trials. Methodology: Using the community based participatory research framework and funded by the Department of Defense, MCCC COE first increased infrastructure of ALP197 by upgrading internet and public connectivity, installation of touch kiosks, mounting digital boards, and health literature (flyers and pamphlets). The LL are where healthcare experts facilitate discussion with participants on various topics, specifically requested by residents. Topics have included SDoH, understanding prescribed medication, the importance of clinical trials, mental health and stress management, stroke prevention, and proton therapy. LL are advertised on radio stations and shared through emails to past participants and other organizations. During LL programs, participants are instructed about and directed to the kiosks, where they may obtain more information on illnesses, access resources, and sign up for clinical trials. Results: To date, LL have been attended by over 50 residents. The efforts at the ALP 197 has led to increased knowledge, access to resources via the kiosks, and an increase in signup for clinical trials. The outcomes of this effort have also resulted in additional partnerships. One such partnership is with LitTV, a black owned and operated TV network that disseminates information locally in Duval County, nationally and internationally. Reach of the activities at the post includes television interviews, and articles, viewed by thousands and disseminated widely discussing our collaboration. Conclusion: The impact of our partnership with ALP 197 to reduce disease burden among in Health Zone 1 is already far reaching. LL continue to increase in monthly participation with new topic requested by residents regularly. Future monitoring of participant knowledge and attitude changes from LL are planned to be studied through pre/post surveys. We have received additional funding from the DOD to expand this initiative to health organizations and to other American Legion Posts in the Duval area. Citation Format: Vinessa Gordon, Shaina Flynn, Jennifer Crook, Arnold Merriweather, Vermelle Smith, Fullwood Marvin, Che Ngufor, Cassandra Small, Folakemi Odedina. Addressing health disparities through lunch and learns in underserved communities [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A046.

Observational medical data present unique opportunities for analysis of medical outcomes and treatment decision making. However, because these datasets do not contain the strict pairing of randomized control trials, matching techniques are to draw comparisons among patients. A key limitation to such techniques is verification that the variables used to model treatment decision making are also relevant in identifying the risk of major adverse events. This article explores a deep mixture of experts approach to jointly learn how to match patients and model the risk of major adverse events in patients. Although trained with information regarding treatment and outcomes, after training, the proposed model is decomposable into a network that clusters patients into phenotypes from information available before treatment. This model is validated on a dataset of patients with acute myocardial infarction complicated by cardiogenic shock. The mixture of experts approach can predict the outcome of mortality with an area under the receiver operating characteristic curve of 0.85 ± 0.01 while jointly discovering five potential phenotypes of interest. The technique and interpretation allow for identifying clinically relevant phenotypes that may be used both for outcomes modeling as well as potentially evaluating individualized treatment effects.

Abstract Black men are disproportionately affected by prostate cancer (CaP), with limited progress in closing the CaP care and survivorship gaps experienced by Black men compared to other racial/ethnic groups. Unfortunately, there is an uptick in CaP incidence rate in the United States (US) since 2014. As reported by the American Cancer Society, the rising CaP incidence rate indicates a shift towards higher grade and stage during diagnosis. The prostate cancer (CaP) disparities experienced by Black men in the US is a microcosm of the global burden of CaP seen in men of African ancestry. For example, the top ten countries leading CaP mortality in the world are all Black nations in Africa and the Caribbean. The complexity of CaP disparities and the need for a unique approach to better understand and address a complex chronic disease, such as CaP, underscores the need for consortium research that is multilevel, collaborative, translational, and global. Through the Department of Defense funding, we formed an inclusive Cancer Care Research Equity (iCCaRE) for Black Men Consortium to advance health equity and reduce disparities in CaP. Comprising CaP survivors, advocates, scientists, and clinicians, the iCCaRE for Black Men Consortium addresses structural, social and biological determinants of CaP among ethnically diverse Black men globally, including US Black men, West African immigrant men in the US and indigenous West African men. The overall goal of the iCCaRE consortium is to optimize CaP diagnosis experiences, treatment and survivorship based on the Science of Survivorship (SOS). Our central hypothesis is that improving social-determinants of health (SDOH) factors, CaP care and survivorship (CaPCaS)-related factors and mediating biological factors will lead to an improvement in patient-reported outcomes (PROs). This presentation will highlight the structural inequities, societal injustices and biological determinants found to be associated with CaP care and survivorship among Black men. Additionally, we will present the use of Community Living Lab (CoLLab) Health System approach to address inequity in minoritized and marginalized communities. Citation Format: Folakemi Odedina, Roxana Dronca, Kimlin Ashing, Ernest Kaninjing, Solomon Rotimi, Che Ngufor, Arnold Merriweather, iCCaRE Consortium. Science of prostate cancer care and survivorship in black men: Structural, social and biological determinants [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr IA007.

Abstract The day I received news of my prostate cancer diagnosis time paused for a minute. My heart was heavy, and my mind racing and my soul appeared to leave my body as the physician kept talking. I’m looking at this doctor and having internal conversations with myself about dying. My attention switched from listening to reflecting to Fred Sanford holding his heart and saying “Elizabeth, I am coming to join you”, but my wife was right next to me holding my hand. The embrace of our interlocked fingers without saying a word to one another assured both of us this too shall pass. My knowing I had support encouraged me to begin educating myself about the science of survivorship. The presence of prostate cancer resources was absent in my community. I began reading information online to grasp a better understanding of this disease. The information gained encouraged me to request a second opinion from another oncologist. I was amaze by the difference in opinion about treatment options. I felt the urge to identify and specifically speak with other Black men going through this process. Everywhere I looked for support groups felt like removing my hands from pocket and watching lent flee from my fingers. What did I do? I registered my own prostate cancer support group with the state of Florida. The group grew from a few to 20 Black men across major metropolitan cities in Florida. These group meetings extended to men leading groups in their communities. I joined the Prostate Health Education Network as the Regional Ambassador to promote prostate awareness and clinical trials. My advocacy presence in the state of Florida led to Dr. Odedina and I crossing paths to champion elimination of prostate cancer health disparities for Black men. I am a Citizen Scientist in the lab of Dr. Odedina working on the inclusive cancer care and research equity for Black men consortium. I have co-authored publications, co-presented at conferences, served on research projects, and contributed to grant funding totaling over $25 million as a citizen scientist. Currently working on a Department of Defense funded grant focusing on the point of prostate cancer diagnosis. The project has completed several events to dispel myths about participation in clinical research while discussions about early detection is vital to improve survivorship. The reward from this work is knowing I am helping create spaces for Black men never to travel this journey alone. I believe men appreciate having a patient supporter but require fellowship with men who have traveled the road to gain navigational insights on how to maneuver across this terrain. Citation Format: AJ Merriweather, Dottington Fullwood, Che Ngufor, Jennifer Crook, Emelina Asto-Flores, Parisa Fathi, Roxana Dronca, Shannon Pressey, Folakemi Odedina. Early detection saves lives: I survived, and you can too— Any day above ground is a good day [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 727.

Abstract Background: Black men continue to be disproportionately affected by prostate cancer incidence and mortality as compared to their White counterparts, despite worldwide declining prostate cancer diagnosis rates. This complex phenomenon remains poorly understood, especially at the point of a prostate cancer diagnosis. Newly diagnosed Black men report initial feelings ranging from being “shocked,” to “receiving a death sentence,” and both an ineptness of asking questions and a reliance on physicians for treatment options due to lack of knowledge. The psychological distress from prostate cancer uncertainties affects health management and treatment decisions, though it is unclear to what extent the role of social determinants of health factor in making informed healthcare decisions. Aim: In this scoping review, we examined the influence of the social determinants of health at point of prostate cancer diagnosis among Black men seeking to make an informed decision about their treatment plans. Methods: We followed the methodological framework: the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Five electronic databases, Emabase, Pubmed, PsycInfo, Scopus, and Web of Science were searched for quantitative and qualitative primary studies from the period 2005 until March 2022. Two authors independently screened titles and abstracts, and full texts, against predefined criteria: empirical research, post 2000, in English-language peer-reviewed journals; participants included Black prostate cancer survivors and research explored social determinants of health at point of prostate cancer diagnosis. Studies were quality assessed for data charting. Results: The search yielded 283 studies, with 45 included studies for synthesis. Traditional social determinants of health were frequent. However, identification of themes such as social support, masculinity and stigma, fear of abandonment by medical staff, and cost of diagnostic procedures were prominent determinants. Notably, sub-themes emerged that included coping factors such as emotional distress, perceptions of normalcy, and poor prostate cancer knowledge. Conclusion: Understanding the social determinants of health impact on Black men, especially at point of prostate cancer diagnosis will allow survivors, physicians, and researchers to work at solving these health disparities. Citation Format: Dottington Fullwood, AJ Merriweather, Che Ngufor, Deidre Pereira, KC Balaji, Roxana Dronca, Gerardo Colon-Otero, Jennifer Crook, Parisa Fathi, Emelina Asto-Flores, Shannon Pressey, Folakemi Odedina. iCCaRe: Social determinants of health navigation, psycho-oncology, and emotional support for Black prostate cancer survivors: Review of current practices. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4371.

Abstract Background: To date, the disparate burden of prostate cancer (CaP) in Black men (BM) is still poorly understood. More disconcerting is the limited access to effective, culturally tailored behavioral interventions to support BM diagnosed with CaP, especially at the point of prostate cancer diagnosis (PPCD). From the PPCD, the transition to CaP survivorship can be mentally and physically trying, especially for those lacking emotional and financial support. It is important to provide psycho-oncology support, address social determinants of health (SDOH) and make emotional support available to ethnically diverse BM at the PPCD. We are addressing the CaP disparities experienced by BM at the PPCD through the Inclusive Cancer Care Research Equity (iCCaRE) for Black Men Consortium. Aim: As part of the iCCaRE for Black men Consortium, the specific aim of our project is to develop a PPCD-based Augmented Reality (AR) intervention program, the iCCaRE PPCD Virtual Robot Assistant (ViRA). The ViRA is based on the established efficacy of six CaP care and survivorship (CaPCaS) video interventions, and will support BM at the PPCD. Methodology: The efficacy of six CaPCaS videos were established through formative research that included 17 BM in Florida. Based on pre- and post-test design, data were collected from participants using a structured survey tailored to each CaPCaS intervention: Prevention, Detection, Diagnosis, Treatment, Survivorship and Advocacy form. Following the efficacy study, the iCCaRE PPCD ViRA was proposed as one of five iCCaRE Science of Survivorship (S.O.S) projects to improve the quality of life of BM. Results: Most of the participants for the efficacy study reported that they were: US-born BM; married; college educated; earn less than $60,000; retired; have health insurance; have annual health examination; have a regular doctor; and were screened within the last year. The CaPCaS videos were found to be efficacious in improving attitude towards CaP screening, beliefs about CaP screening, perceived behavioral control and CaP knowledge. Participants also rated the quality of the videos high and expressed high satisfaction with the videos. We are currently in the development phase of the PPCD iCCaRE ViRA, which is based on behavioral science and health communications model. The ViRA will provide SDOH navigation services, psycho-oncology support and emotional support. The acceptance and usability of the iCCaRE ViRA will be established at urology clinics in Florida as part of the iCCaRE Consortium HEROICA Phase I study. We will test the central hypothesis that improving SDOH factors and CaPCaS-related factors will lead to an improvement in patient reported outcomes. Conclusion: We established the efficacy of the CaPCaS interventions in supporting BM across the CaP care continuum. The iCCaRE ViRA under development will target intervention at the PPCD and deliver a smart and connected personalized AR-enabled intervention system that will positively impact CaP diagnosis experience of BM. Citation Format: Folakemi Odedina, Che Ngufor, Arnold Merriweather, Deidre Pereira, Jennifer Crook, Fathi Parisa, Roxana Dronca, Ernest Kaninjing, Solomon Rotimi, Kimlin Ashing, Manisha Salinas, Sha’Reff Rashad, John McCall, Ebenezer Erefah, Ayinde Yahaya, Wes Sholes. A point of prostate cancer diagnosis (PPCD) Virtual Robot Assistant (ViRA) intervention for newly diagnosed Black men: An iCCaRE consortium for prostate cancer in Black men project [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B028.