Hew, Trevanne Matthews

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.

e13611 Background: Decentralized cancer care models may reduce treatment burden for patients with advanced prostate cancer (CaP), particularly those facing mobility, transportation, of scheduling challenges. However, prospective patient-reported experience and quality-of-life data comparing home- versus clinic-based oncology care remain limited. Mayo Clinic Cancer CARE Beyond Walls (CCBW) is a patient-centered program designed to deliver selected standard-of-care cancer therapies in the home with virtual clinical oversight. This observational study evaluated patient-reported experience, feasibility, safety, and quality of life among men with advanced or metastatic CaP receiving care at home. Methods: Men with advanced/metastatic CaP receiving active standard-of-care therapy including hormone-based treatments, oral anticancer therapies, anti-bone resorptive agents, or intravenous chemotherapy who were participating in a CCBW randomized trial were enrolled into a companion observational study. After confirmation of treatment tolerance in clinic, patients received home-based care for 24 weeks (Arm A) or in-clinic care for 8 weeks followed by home-based care for 16 weeks (Arm B). Patient-reported outcomes were collected at baseline and Weeks 8, 16, and 24, using CAHPS-based measures and CCBW-specific surveys assessing overall cancer care experience, patient preference for site of care, comfort with home infusions, functional/symptom assessment and quality of life. Descriptive analyses were performed. Results: Eighteen participants were analyzed (Arm A n = 10; Arm B n = 8). Participants were medically stable, and predominantly insured by Medicare. Survey completion was 100% at baseline and 83% at all follow-up time points. At Weeks 16 and 24 when all respondents had received home-based care, 100% and 92% reported being “quite a bit” or “very much” comfortable receiving treatment at home. Communication with at-home and remote nursing teams was rated highly, and most respondents reported transition, scheduling, and equipment use easy or very easy. At Weeks 16 and 24, 45% and 40% of respondents reported improved quality of life from receiving home-based care, with no reports of worsening. No emergency department visits, hospitalizations, or urgent care visits occurred in either arm. Conclusions: In this prospective, observational study, home-based oncology care delivered through CCBW was feasible, safe, and associated with high patient satisfaction among men with advanced CaP receiving diverse systemic therapies. These findings support further evaluation and expansion of decentralized care integrating home-based treatment with virtual clinical oversight.

5543 Background: Glucagon-like peptide-1 (GLP-1) receptor agonists are widely used for the treatment of type 2 diabetes and obesity. Emerging evidence suggests that these agents may have potential anti-tumor activity as GLP-1 signaling may influence pathways involved in cell proliferation and inflammation. Endometrial cancer is the most common gynecologic malignancy, and obesity represents a well-established, modifiable risk factor that may adversely affect oncologic outcomes through chronic inflammation and metabolic dysregulation. Our study aims to evaluate the impact of GLP-1 receptor agonists on outcomes among patients with endometrial cancer and comorbid obesity. Methods: A retrospective cohort study was conducted using the TriNetX Global Collaborative Network, covering January 2000 to December 2025, encompassing data from 168 global healthcare organizations. Patients aged 18 and above with endometrial cancer and comorbid obesity were identified and then stratified into two groups based on treatment with GLP1 agonists or not. The two groups were then propensity-matched based on age, ethnicity, medical comorbidities, and stage of cancer. Outcomes were assessed for five years from treatment initiation and included overall mortality, myocardial infarction (MI), ischemic stroke; development of peritoneal, lymph node, and visceral metastases; sepsis, pancreatitis, and ED visits. Time-to-event analyses were performed using Kaplan-Meier methods and Cox proportional hazards models. Results: After propensity matching, 6352 patients were included in each cohort with balanced baseline characteristics. Our analysis found that patients with endometrial cancer and comorbid obesity who received GLP-1 agonists had a significantly lower risk of overall mortality (Hazard Ratio [HR]: 0.45, 95% CI: 0.39-0.51, p-value <0.001), development of peritoneal metastases (Risk Difference [RD]: -2.16%, 95% CI: -2.74% to -1.58%, p-value <0.001), nodal metastases (RD: -0.41%, 95% CI: -0.72% to -0.09%, p-value =0.01), visceral metastases (RD: -3.76%, 95% CI: -4.60% to -2.93%, p-value =0.01), and sepsis with and without shock (RD: -1.42%, 95% CI: -2.14% to -0.70%, p-value <0.001) compared to patients who did not receive GLP-1 agonists. There was no statistically significant difference in the rates of MI, ischemic stroke, ED visits, and pancreatitis between the two cohorts. Conclusions: In this large real-world analysis, patients with endometrial cancer and comorbid obesity who received GLP-1 agonists had lower rates of overall mortality; peritoneal, lymph node, and visceral metastases, and sepsis with or without shock. Additional longitudinal cohort studies are imperative to explore the associations between these agents and inform clinical practice guidelines in this patient population.

Abstract Introduction: This ongoing study investigates the impact of vitamin D deficiency on the immune response to prostate cancer (CaP) in Black patients and its potential contribution to CaP disparities. The study also evaluates differences in immune function, including p53 and CaP associated antibody levels, in Black men with localized versus metastatic CaP. Methodology: Eligible patients with a history of localized or metastatic CaP are enrolled following informed consent (in person or remote). At baseline, blood is collected for calcium and vitamin D3 levels, and for immune testing. Patients who participate in the screening portion of the trial and are found to have vitamin D3 levels &lt;30 ng/mL are prescribed oral vitamin D3 (2000 IU daily) and asked to record adherence in a medication diary. Follow-up includes a 4-week check-in and end-of-treatment labs at 8 weeks for calcium, vitamin D3 levels, and immune re-testing. Virtual consults occur after baseline and at 8 weeks. Quality of life is measured at baseline and EOT follow-up using the CDC HRQOL–4. The study began accruing patients in December 2021. In an attempt to accelerate patient accrual, the protocol was amended to become one of Mayo Clinic’s first fully decentralized clinical trials. Newly integrated components included at-home and community-based blood collection (outside of Mayo Clinic southern sites) and continued virtual engagement. These changes were designed to reduce barriers linked to social determinants of health (SDOH) and expand participation among medically underserved populations. This is a report on the impact of clinical trial DCT. Results: From December 2021 to September 2023 (pre-DCT), 24 patients were enrolled from 66 patients who participated in the screening portion for the trial (mean accrual: 1.09/month; SD: 1.15). Following the DCT amendment, enrollment rose to 102 patients from 213 screened (mean: 4.86/month; SD: 3.12) through June 2025. Of 126 enrolled patients, 119 (94.4%) returned medication diaries, with only 6 non-returns occurring post-DCT. QOL measures were completed by approximately 75% of participants. Importantly, 90 of 126 participants (71%) were enrolled from outside Jacksonville, FL or Scottsdale/Phoenix, AZ, indicating successful national expansion. A total of 111 patients failed the screening due to baseline vitamin D levels &gt;30 ng/ml. The total number of protocol deviations increased post-DCT (60 from 10/23–6/25 vs. 14 from 12/21–9/23), there was no change in the number of protocol deviations per enrolled patients. Minor documentation and study timeline deviations were the most common in both periods. Conclusions: The successful implementation of a fully decentralized model was associated with a marked increase in the accrual of underserved patients and allows the completion of critical clinical trials that address important cancer care disparities without impacting protocol integrity. Clinical trial DCT can potentially reduce SDOH-related barriers and improve representation of underserved populations in research. Citation Format: Sandra Casanova Leyva, Kim M. Barbel Johnson, Tufia Haddad, Lydia Mercado, Trevanne Matthews Hew, Cassandra Moore, Gerardo Colon-Otero, Devina Joshi, Roselyn Heduvor. Feasibility of an interventional clinical trial addressing prostate cancer disparities in Black men by decentralization (DCT): A potential solution to disparities in clinical trial participation [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C064.