Background: Black cancer patients face significant disparities in medical care throughout the cancer care continuum. While multilevel factors contribute to these disparities including access to care, socioeconomic status and cultural factors, overt and perceived discrimination in the health care setting may likely exacerbate disparities for black cancer patients. However, little is known about how experiences of racial discrimination unfold for Black cancer patients when navigating care and the consequences of such treatment. Purpose: To explore how experiences of racial discrimination in the health care setting manifests for Black cancer patients and to understand how these experiences might contribute to disparities. Methods: We conducted semi-structured in-depth interviews with 18 Black cancer survivors, lasting between 45 – 60 minutes from 2019-20. All interviews were audio-recorded, professionally transcribed, and uploaded into Dedoose software for analysis. Two independent coders met regularly and analyzed the interview transcripts using a deductive constant comparison approach to establish and modify codes based on facets of the biopsychosocial model of stress. Results: Participants included breast, colorectal, and prostate cancer survivors aged 29 to 88 years old. Most patients expressed experiencing some form of racial discrimination, perceived more than overt when receiving medical care. Participants experienced instances of perceived discrimination from their interactions with healthcare staff, medical assistants, front desk staff, health insurance administrators, or other staff within the facility. Instances of perceived discrimination resulted in patients expressing that they did not trust their provider or was a stressor contributing to their mental well-being. Patients who experienced perceived discrimination noted “walking out” of their visit and not having their health issues addressed, demonstrating a broader link between the two factors. Patients internalized experiences of perceived discrimination, resulting in behavior changes in subsequent visits to mitigate the effects. Overt discrimination in the health care setting was rooted in stereotypes and manifested through verbal microaggressions such recollections of physicians using phrases such as “you people”. Patients still sought care when they experienced discrimination out of necessity and believing it was an inevitable part of the Black experience. Patients who had positive experiences navigating care expressed a personal relationship and emotional connection characterized by mutual respect and compassion between them and their provider. Conclusion: Themes identified in this study support possible mechanisms for discrimination in the health care setting contributing to racial health disparities in cancer care such that discrimination serves as a stressor for Black cancer patients and impacts health-seeking behaviors. Future recommendations for healthcare staff should focus on ensuring patient-centered communication and care to support this vulnerable population. Citation Format: Elleyse Garrett, Albert Farias, Carol Ochoa, Cindy Ma, Stephanie Navarro, Paul Yoon. “You people”- A qualitative analysis of black cancer patients navigating a healthcare system of discrimination [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-007.

BackgroundThe purpose of this study was to understand the experiences of Black patients with cancer in health care by comparing drivers of high and low ratings.MethodsSemistructured in‐depth interviews were conducted with 18 Black patients with cancer recruited from cancer survivorship support groups and Facebook between May 2019 and March 2020. Interviews were coded across all transcripts by using a thematic analysis approach before comparing low‐ and high‐rating groups.ResultsThere were three major themes that influenced whether patients rated their care as low or high, which included the patient–provider relationship, health care staff interactions, and cancer care coordination. For example, the high‐rating group described good communication with the health care team as physicians listening to their needs, being responsive to their concerns, and providing recommendations on how to address side effects. In contrast, the low‐rating group described poor communication with their health care team as their needs being dismissed and being excluded from decision‐making processes. Additionally, there were two distinct themes that influenced patients’ low ratings: insurance and financial toxicity issues and experiences of health care discrimination.ConclusionsIn an effort to promote equitable cancer care experiences for Black patients, it is important that health systems work to prioritize patient interactions with health care providers and staff, comprehensive care management for patients with cancer, and reductions in the financial burden of caring for cancer.

45 Background: Patient-reported outcomes (PROs) are recognized as strong predictors of cancer prognosis, outcomes, and care. However, racial/ethnic minorities with colorectal cancer (CRC) tend to report poorer general health status (GHS) and mental health status (MHS) compared to non-Hispanic whites. The objectives of this study were to determine: (1) if there are racial/ethnic differences in GHS and MHS within 36 months of CRC diagnosis and (2) if poorer GHS and MHS in recently diagnosed CRC patients are associated with mortality. Methods: We used the population-based Surveillance, Epidemiology, and End Results (SEER)-Consumer Assessment of Healthcare Providers and Systems (CAHPS) dataset to analyze Medicare beneficiaries aged ≥65 years who were diagnosed with CRC between 1998 and 2011, received surgical resection for their tumor, and completed a CAHPS survey within 6-36 months post-diagnosis. CAHPS surveys captured patient-reported GHS and MHS on a five-point Likert scale ranging from “poor” to “excellent.” We used stepwise multivariable logistic regression to examine associations between patient race/ethnicity and fair or poor health status, adjusting for clinical and sociodemographic factors. Additionally, a multivariable Cox proportional hazards regression was used to determine the risks of mortality associated with fair or poor GHS and MHS. Results: Of 1,867 patients with CRC, 79.5% were non-Hispanic white (NHW), 6.4% were non-Hispanic black (NHB), 7.5% were Hispanic, and 6.6% were non-Hispanic Asian (NHA). In Model 1 of our stepwise logistic regression, NHB patients had higher unadjusted odds for fair or poor GHS (OR 1.56, 95% CI 1.06-2.28) compared to NHW patients while Hispanic patients had higher unadjusted odds for both fair or poor GHS (1.48, 1.04-2.11) and MHS (1.92, 1.23-3.01). In Model 2, this relationship persisted after adjusting for clinical factors, with NHB patients being more likely to report fair or poor GHS (1.62, 1.10-2.40) and Hispanic patients being more likely to report fair or poor GHS (1.49, 1.04-2.13) and MHS (1.92, 1.22-3.00). In Model 3, after adjusting for both clinical and sociodemographic factors, the association between race/ethnicity and fair or poor GHS ( p = 0.53) and MHS ( p = 0.23) no longer remained. Reporting fair or poor GHS and MHS was associated with a greater risk of mortality among all CRC patients (HR 1.52, 95% CI 1.31-1.76 and 1.62, 1.34-1.99, respectively). Conclusions: Our study illustrates that racial/ethnic differences in PROs are largely driven by sociodemographic factors as opposed to clinical factors. As fair or poor GHS and MHS shortly after diagnosis reflect a higher risk of mortality in CRC patients, efforts to understand unmet biopsychosocial concerns may help further elucidate racial differences in CRC survival that may be otherwise overlooked in standard clinical practice.