Citations

Abstract Introduction: Understanding the behavioral aspects of cancer care in Sub-Saharan Africa (SSA) is crucial for developing effective interventions and improving outcomes, particularly during the peri-treatment phase. Synthesizing knowledge sets the stage for prioritizing cancer-focused research in SSA. Therefore, this scoping review aims to synthesize current knowledge on cancer behavioral research during the peri-treatment phase in SSA, focusing on the behavioral and psychosocial aspects of care. Method: Comprehensive literature searches were conducted across multiple databases and grey literature sources. Studies were selected if they included participants > 18 years old undergoing peri-treatment care, randomized controlled trials, or qualitative/quantitative methodologies focused on behavioral oncology. Only full-text articles published in English were included. Data from the selected studies were systematically extracted and organized. Results: A total of 1,897 cancer patients were included across 18 out of the 24 articles analyzed, with participants aged 8-80 years old. The studies mainly included participants recently diagnosed with cancer or undergoing treatment, covering various cancer types, including prostate, cervical, gastric, liver, and colon cancer, from stage I-III. Only three of the 24 studies referenced theoretical frameworks. Each study identified behavioral factors and outcomes among their sample population. Key findings across the studies underscored significant psychological distress manifested through a spectrum of emotional and psychosocial challenges, including poor social and psychological well-being, depression, anxiety, insomnia, and agoraphobia. Cultural influences, cost considerations, and non-interference of symptoms with day-to-day activities delayed healthcare seeking, especially among women. Despite these challenges, instances of psychological resilience were noted, driven by perceived social support, religiosity, hope, and optimism. The review highlighted the complex interplay between cultural norms, stigma, and health behaviors, with stigma often rooted in cultural beliefs. Spiritual beliefs and practices were central to many participants’ cancer journey, shaping their views on illness, treatment, and recovery. Key factors affecting cancer care include healthcare accessibility, financial limitations, social support networks, healthcare provider attitudes, family involvement in treatment decisions, and emotional support. Conclusion: The findings from this scoping review reveal significant psychological distress and barriers to care among cancer patients in SSA, highlighting the urgent need for comprehensive, culturally sensitive interventions that addresses emotional, social, and cultural dimensions. This approach should integrate accessible mental health services, enhance social support networks, and promote culturally appropriate educational programs to reduce stigma and encourage timely healthcare-seeking. Citation Format: Opeyemi O. Bolajoko, Danetta S. Hooks, Motolani Adedipe, Jessica Saintibert, OluwaSeyi Toye, Clifton Sheri, Folakemi T Odedina. Evidence of behavioral research before and during cancer care in Sub-Saharan Africa: A scoping review [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B172.

Abstract Introduction: In an effort to ensure an all-inclusive initiative that would close the disparity gap among the immigrant communities in Florida, we developed a pilot project under the Inclusive Cancer Care Research Equity (iCCaRE) for Black Men Consortium with generous support from the Mayo Clinic Comprehensive Cancer Center (MCCCC). The objective is to train cancer advocates to engage their communities and develop and implement cancer prevention and screening navigation programs. The central hypothesis for this program is that community-driven cancer advocacy will significantly improve cancer awareness, knowledge, prevention, risk reduction, screening uptake, and early detection among Black immigrants. Methods: We collaborated with immigrant communities’ leaders to brainstorm on the current state of healthcare access and disparities experienced by Black immigrants and to set program and research priorities through listening sessions. Cancer advocates were trained to engage their communities to (1) develop and implement cancer risk reduction and education programs using train-the-trainer approach, (2) mobilize the resources within the community for cancer health promotion, prevention, and screening strategies, (3) partner with key stakeholders to accomplish targeted objectives; (4) raise funds to support advocacy activities; and (5) develop and successfully organize community-centered programs. Results: We are currently working with 10 Black immigrant organizations, including immigrant churches across different ethnicities, including Nigeria, Ghana, Cameroon, Liberia, South Africa, Haiti, Jamaica, and across different cities in the United States. Eighteen community cancer advocates, including breast and prostate cancer survivors, caregivers, and community influencers, were trained to engage the immigrant communities in cancer risk reduction and research in Florida using multiple channels, including in-person community programs and online engagement approaches. We have engaged 720 immigrants in cancer risk reduction education and the need to participate in research during advocate-led in-person community outreaches. We currently have 26 immigrants who have volunteered in the Mayo Clinic Community Research Registry. The program is ongoing, and we anticipate that more than 750 will be engaged, and 100 will volunteer to be registered in the Mayo Clinic Community Research Registry. Conclusion: Advocate-led advocacy in immigrant communities will provide evidence for compelling arguments about the feasibility and availability of the Black immigrant population for robust and sustainable research and program engagements to eliminate disparity and advance cancer health equity. Citation Format: Opeyemi O. Bolajoko, Caleb Ramirez, Shannon Pressey, Noreen A. Stephenson, Vinessa A. Gordon, Binta Onyibe, Kingsley Efe, Austin Okaiwele, Mubo Oloruntobo, Brittany M. Norris, Folakemi T. Odedina. Cancer health equity and research advocacy program among immigrant communities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B002.

Abstract Introduction Prostate cancer (CaP) significantly impacts Black men, who face higher morbidity despite lower overall mortality. The disease and its treatments profoundly affect sexuality, relationships, and quality of life (QoL), necessitating robust support systems. Healthcare, spousal support, community involvement, and interactions with other survivors are crucial for enhancing survivors' self-esteem and daily functioning. Virtual town halls offer a platform to share trusted information and foster community support, overcoming geographic and structural barriers. This town hall event will explore Black CaP survivors' experiences, focusing on sexuality post-diagnosis and related medical and psychological needs. MethodsOn June 13, 2024, The University of Oklahoma and Stephenson Cancer Center will host the 5th town hall event (via Microsoft Teams) to address Black CaP survivors' sexual health concerns. Previous town halls averaged 70 attendees and covered various aspects of the CaP journey. This event will include storytelling and panel discussions, with presentations from two CaP survivors and their spouses on personal experiences and coping strategies. A urologic oncologist will discuss treatment advancements and early detection, while a clinical health psychologist will address psychological and emotional aspects of survivorship. Simultaneous watch parties will be held in Milledgeville, Georgia, and Dallas, Texas. Interactive Q&A sessions will allow participant engagement. Attendees will complete a post-event survey to assess the session's impact and collect clinical and sociodemographic data. Quantitative data will be analyzed using SPSS v28, and audio-recorded sessions will be transcribed and thematically analyzed using Nvivo. Results will be available by the end of June and presented at the conference. Expected Results Participants will gain a deeper understanding of the intersection between CaP and sexuality in Black men's health. Discussions will highlight the psychological impact of a cancer diagnosis, challenges in maintaining sexual health during and after treatment, and the role of mental health support. The town hall aims to emphasize the importance of a strong support system, providing valuable coping skills through shared experiences and expert insights. Topics will include the emotional and psychological impact of sexual health challenges, partner support, and the necessity of open communication with healthcare providers. The event seeks to improve CaP survivors' QoL by emphasizing continuous education and integrating sexual health into overall survivorship care. Conclusion This town hall event aims to bridge gaps in understanding and addressing Black CaP survivors' sexual health concerns. By fostering open dialogue and providing expert insights, we hope to improve these men's QoL and survivorship care, emphasizing mental health support, spousal support, and continuous education. Citation Format: Motolani Ogunsanya, Ernie Kaninjing, Parisa Ghasemi, Skyler Danker, Daniel Morton, Kathleen Dwyer, Mary Ellen Young, Folakemi T. Odedina, Yaw Nyame, Amy Siston, Jordan Neil, Adam C Alexander, Perry Cole, Patrick Beckford, Donald Reese, Thomas Mitchell, Everett Montgomery, Roland Odeleye, Darla E. Kendzor. Beyond the diagnosis: A town hall event to explore black men’s journey with prostate cancer and sexuality [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B028.

Abstract Background: Hispanic American (HA) men with prostate cancer (PC) are more likely to have more aggressive and advanced diseases and greater mortality rates compared to non-Hispanic white (NHW) men. Resistance to the current anticancer therapy is the major hurdle that leads to poor clinical outcomes. Hedgehog, Notch, and Wnt signaling pathways play a crucial role in development, progression, and resistance to the various anticancer therapies. Here, we characterized the enrichment of Hedgehog, Notch, and Wnt signaling pathways and molecular tumors differences between HA and NHW patients. Methods: Our data consist of 88 PC tumors samples (HA=34, NHW=54) obtained from treatment-naive metastatic hormone-sensitive prostate cancer (mHSPC) that were analyzed by next-generation sequencing (592, NextSeq; Whole Exome Sequencing, NovaSeq) and Whole Transcriptome Sequencing (WTS; NovaSeq) (Caris Life Sciences, Phoenix, AZ). Pathway enrichment was determined by Gene Set Enrichment Analysis (GSEA, Broad Institute) by measurable TPM (transcripts per kilobase million). The medical records were reviewed in a deidentified fashion for clinical features. Statistical significance was determined using chi-square and Mann-Whitney U (p<0.05). Results: HA PC had enrichment of Hedgehog signaling (NES: 1.45, FDR=0.04), Notch signaling (NES: 1.41, FDR=0.07), and Wnt/β-catenin signaling (NES: 1.38, FDR=0.11) pathways compared to NHW tumors. HA tumors had higher expression of genes (HES1, Notch1, WNT1, WNT2; FC:1.1-2.5) associated with crosstalk between Hedgehog, Notch, and Wnt/β- catenin signaling pathways (all p<0.05). Moreover, HA tumors had higher expression of stemness (ALDH1A2, ALDH1A1, PROM1; FC: 1.7-3.0), drug efflux (ABCC1, ABCB1; FC: 1.1- 1.5), epithelial to mesenchymal transition (EMT) (TWIST1, MMP2; FC: 1.1-1.5), cell cycle (CCND2; FC: 1.2), inhibition of apoptosis (BIRC2, XIAP; FC: 1.1) and epigenetic (EP300, TET1, TET2; FC: 1.3-1.4) related genes compared to NHW tumors (all p<0.05). HA PC had higher frequency of Hedgehog and Wnt/β-catenin associated SPOP (16% vs 6.6%, p=0.2) and CTNNB1 (12% vs 2.2%, p=0.1) mutation compared to NHW PC. Conclusion: These results demonstrate that tumors from HA patients had enrichment of oncogenic Hedgehog, Notch, and Wnt/β-catenin signaling pathways, higher expression of stemness, drug efflux, EMT, cell cycle, inhibition of apoptosis and epigenetic-related genes, and mutations directly involved in activating the Hedgehog and Wnt/β-catenin signaling pathways. Together, these findings suggest that tumors from HA patients are enriched for gene signatures that promote cancer progression and therapy resistance. Additional research on collaboration and crosstalk between Hedgehog, Notch, and Wnt/β-catenin signaling pathways may help in designing better therapeutic strategies for HA men with mHSPC. Citation Format: Alejandro Recio-Boiles, Sachin Kumar Deshmukh, Ricardo J. Estrada-Mendizabal, Kenneth Barker, Sharon Wu, Joanne Xiu, Milan Radovich, Elisabeth I. Heath, Rana McKay, Juan Chipollini, Cynthia K. Miranti. Defining the role of Hedgehog, Notch, and Wnt signaling pathways in aggressive lethal prostate cancer of Hispanic men [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C100.

Abstract Introduction: In Sub-Saharan Africa (SSA), high cancer incidence is compounded by limited healthcare access and out-of-pocket costs. Additional factors like limited research funding, socioeconomic disparities, and cultural influences further affect cancer survivors' well-being. While some studies identify factors improving psychosocial well-being, there is a gap in understanding SSA-specific contextual and behavioral influences. This study addresses this gap through a scoping review of post-treatment cancer behavioral research, synthesizing current knowledge to inform interventions aimed at enhancing psychosocial support and improving health outcomes for survivors in the region. Methods: Guided by Arksey and O'Malley's 5-step framework, we conducted a scoping review to map cancer-focused behavioral research in Sub-Saharan Africa, aiming to inform policy and identify research gaps. Through comprehensive literature searches and eligibility criteria based on the PICOS framework, we identified relevant studies. Searches were executed from September-October 2023. Our search strategy encompassed multiple databases and supplementary methods to ensure thorough coverage. Screening, extraction, and analysis of the selected articles were conducted independently by at least two reviewers, using Microsoft Excel and Covidence and resolving discrepancies through discussion. Ultimately, seven articles met our inclusion criteria. Data were charted and summarized, covering demographics, study design, barriers, facilitators, cultural factors, support mechanisms, and recommendations. Results: Seven articles from four SSA countries were reviewed, with Nigeria contributing the most studies. The study articles, spanning from 1998 to 2023, used diverse methodologies and theoretical frameworks. The studies covered various cancer types and stages, highlighting significant psychological distress, financial toxicity, and post-traumatic growth among survivors. Cultural influences, including stigma and spiritual beliefs, were prominent. Barriers to care included financial constraints and limited access, while facilitators were social support and positive healthcare relationships. Effective support mechanisms like social and psychological interventions were crucial for enhancing survivors' well-being and promoting long-term follow-up care. Conclusion: This scoping review highlights the significant psychological, financial, and cultural challenges faced by cancer survivors in SSA. Addressing these challenges requires targeted interventions and policies that consider the unique contextual factors of SSA, aiming to enhance psychosocial support and improve overall health outcomes for cancer survivors. Future research should focus on comprehensive and culturally competent approaches to mitigate barriers and leverage facilitators, ultimately fostering a more supportive environment for cancer survivorship in the region. Citation Format: Motolani Ogunsanya, Opeyemi Bolajoko, Jessica Saintibert, Danetta Hooks, Oluwaseyi Toye, Shari Clifton, Folakemi Odedina. Mapping behavioral research in post-treatment cancer care in Sub-Saharan Africa: A scoping review [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C033.

Abstract Intro: Compared to white men, Black men bear the highest burden of prostate cancer, experiencing a higher incidence and mortality rate, and poorer survivorship outcomes. Although prioritized, survivorship and quality of life (QOL) are under-studied in the fight against prostate cancer disparities. To address this issue, clinicians, researchers, and community advocates have formed the Inclusive Cancer Care Research Equity (iCCaRE) Consortium for Black Men. iCCaRE’s goal is to advance the science and practice of survivorship focused on the needs of Black men and their loved ones affected by prostate cancer. Methods: We developed a survivorship care plan (SCP) tailored to the whole person's needs. IRB-approved qualitative methods to preliminarily gain evaluation and guidance on the SCP. The SCP presented content in the following areas: diagnosis and treatment, follow-up care/surveillance, family history, care team, major co-morbidities, symptoms and quality of life, survivorship concerns, and health advisories. Results: 23 Black prostate cancer survivors (PCS) participated and provided feedback on the SCP Mean age was 64 years. PCS diagnosed between 2018-2023 between stages 1-4. The Majority of PCS were provided information for follow-up and side effects. But none had received a comprehensive SCP All agreed that the SCP would contribute to enhancing cancer knowledge, patient activation, and shared decision, and their QOL, if the SCP was obtained. A survivor noted “having inspirational quotes throughout the SCP is important”. An unforeseen consequence to the interviews was the emotional release for the men, justifying the need for the SCP and an expansion of its scope. Domains that the men wanted more contents were social support, sexuality, masculinity, and maintaining a healthy lifestyle. All PCS understood the value of having trusted family and friends to bear the burden of the disease despite some not having a solid support system. PCS emphasized the role of family support stating, “my wife and children helped me stay positive”. Another critical lifestyle component that survivors mentioned was their sexuality and how it directly reflects their masculinity. Although PCS adapted to other forms of intimacy like couples’ activities and stronger communication with their partners, majority of men struggle with adapting to their sexual performance. A quote by a survivor encompasses the mindset expressed by many of the men fear “Like a track star in his prime who can’t run anymore”. Erectile Dysfunction can lead to fear and anxiety among survivors, ultimately affecting QOL. Lastly, PCS wanted more options to stay fit and healthy. Further research and resources are needed to address survivor concerns in this area. Discussion: Overall, PCS have acknowledged that the SCP can assist them in these areas of concern, but more research is required. Life after prostate cancer treatment is an ongoing process; while some survivors cope better than others, it is evident a need for more information and guidance is not being provided to all those affected. Citation Format: James Morrison, Kimlin Ashing, Gaole Song, John McCall, Timethia J. Bonner, Che Ngufor, Getachew A. Dagne, Arnold Merriweather, Ewan Cobran, Cassandra N. Moore, Fornati Bedell, Rotimi Oladapo, Floyd B. Willis, JoAnne S. Oliver, Ernie Kaninjing, Roxana Dronca, Folakemi T. Odedina. iCCaRE qualitative interviews for Black prostate cancer survivors and quality of life [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C042.

Abstract Background: Prostate cancer remains a significant health concern, particularly among Black men who experience higher incidence rates and poorer outcomes compared to other racial and ethnic groups. Despite advances in survivorship care, disparities persist in the survivorship experiences, underlying the urgent need for research focusing on the unique needs of Black men in prostate cancer survivorship. By understanding the advocacy efforts and experiences of Black men who have completed prostate cancer treatment, we can identify strategies to better support this vulnerable population and inform interventions aimed at improving survivorship outcomes. Our study explored the advocacy efforts, experiences, and skills of Black men post-prostate cancer treatment to inform targeted interventions aimed at improving survivorship outcomes. Methods: Qualitative interviews were used to obtain information from 31 Black prostate cancer survivors who have completed treatment to explore their insights on survivorship and advocacy. Grounded Theory approach was utilized to analyze participants’ narratives. We employed open and axial coding techniques to extract themes from audio-recorded interviews that were then transcribed, verified and deidentified. Results: We identified several significant themes among Black men who completed prostate cancer treatment. First, participants actively engaged in "spreading the word," advocating for awareness and early detection within their communities through various channels. Second, they emphasized "the importance of advocacy," advocating for themselves and policy changes to address healthcare disparities. Third, participants were committed to "sharing information," openly discussing experiences and providing support to others navigating prostate cancer. Additionally, they highlighted the significance of "reflecting back," drawing from their life stories to offer valuable insights and guidance. Conclusion: This study sheds light on the advocacy efforts and experiences of Black men who have completed prostate cancer treatment, offering valuable insights into their perspectives and actions within their communities. Through the identification of five significant themes, including spreading awareness, advocacy importance, information sharing, and reflective support, this research underscores the proactive engagement of participants in addressing the challenges of prostate cancer. By amplifying the voices and experiences of these individuals, this study contributes to a deeper understanding of the multifaceted nature of prostate cancer survivorship within marginalized communities, ultimately informing future interventions and policies aimed at improving outcomes and reducing disparities in prostate cancer survivorship care. Citation Format: Fullwood, Mary Ellen Young, Folakemi T. Odedina. Science of Cancer Survivorship Advocacy: Perspectives from Black Prostate Cancer Survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C038.

ObjectiveThe purpose of this study was to evaluate the performance of advanced large language models from OpenAI (GPT‐3.5 and GPT‐4), Google (PaLM2 and MedPaLM), and an open source model from Meta (Llama3:70b) in answering clinical test multiple choice questions in the field of otolaryngology—head and neck surgery.MethodsA dataset of 4566 otolaryngology questions was used; each model was provided a standardized prompt followed by a question. One hundred questions that were answered incorrectly by all models were further interrogated to gain insight into the causes of incorrect answers.ResultsGPT4 was the most accurate, correctly answering 3520 of 4566 questions (77.1%). MedPaLM correctly answered 3223 of 4566 (70.6%) questions, while llama3:70b, GPT3.5, and PaLM2 were correct on 3052 of 4566 (66.8%), 2672 of 4566 (58.5%), and 2583 of 4566 (56.5%) questions. Three hundred and sixty‐nine questions were answered incorrectly by all models. Prompts to provide reasoning improved accuracy in all models: GPT4 changed from incorrect to correct answer 31% of the time, while GPT3.5, Llama3, PaLM2, and MedPaLM corrected their responses 25%, 18%, 19%, and 17% of the time, respectively.ConclusionLarge language models vary in their understanding of otolaryngology‐specific clinical knowledge. OpenAI's GPT4 has a strong understanding of core concepts as well as detailed information in the field of otolaryngology. Its baseline understanding in this field makes it well‐suited to serve in roles related to head and neck surgery education provided that the appropriate precautions are taken and potential limitations are understood.Level of EvidenceNA Laryngoscope, 135:629–634, 2025

Highlights Spino-plastic surgery addresses complex spinal defects using a multidisciplinary approachThe plastic surgeon's role in spinal reconstructive surgery has evolved from reactive to proactive involvement in careVBGs reduce time to spinal fusion without significantly increasing operative time, monitoring, length of stay or transfusions.We discuss the VBGs within the reconstructive ladder, as well as the indications, anatomy and dissection of VBG types.

AbstractThis article aims to assist radiologists in navigating the vascular and biliary anatomy of post-transplant patients, thereby enhancing their diagnostic accuracy and determining the need for potential interventions. We have detailed established methods for anastomosis between the donor and recipient arterial, hepatic venous, portal venous, and biliary systems, while omitting surgical techniques, vascular shunting, and operative procedures, as our primary audience is radiologists. The focus of this review is on inflow and outflow of both blood and bile. Given the numerous possible anastomosis points in hepatic transplantation, familiarizing radiologists with these variations will support their efforts in identifying crucial structures in post-transplant patients.