PurposeTo evaluate the association of subjective social status (SSS) with metabolic syndrome (MetS) severity and its potential contribution to racial health disparities in women with breast cancer. Methods Multi-center cross-sectional study (10 US hospitals) in women (n=1206) with primary diagnosis of invasive breast cancer received during Mar/2013- Feb/2020. Participants, self-identified as non-Hispanic white or black, underwent physical and laboratory examinations and survey questions assessing socioeconomic parameters, medical history and behavioral risks. SSS was measured with the 10-rung McArthur scale. MetS severity was measured with a validated Z-Score. Generalized linear mixed modeling was used to analyze the associations. Missing data were handled using multiple imputation. ResultsAverage age was 58 years. On average, the SSS of black women, given equivalent level of income and education, was lower than the SSS of white women: 6.6 (6.1 to 7.0) vs 7.7 (7.54 to 7.79) among college graduates and 6.8 (6.4 to 7.2) vs 7.6 (7.5 to 7.8) among women in the high-income category (> $75,000). In multivariable analysis, after controlling for age, income, education, diet and physical activity, increasing SSS was associated with a decrease in MetS-Z, - 0.10 (-0.16 to -0.04) per every 2 rung increase in the McArthur scale. Conclusion Black women with breast cancer rank their SSS lower than white women with breast cancer do at each level of income and education. As SSS is strongly associated with MetS severity these results identify potentially modifiable factors that contribute to racial disparities.

PurposeTo evaluate the association of subjective social status (SSS) with metabolic syndrome (MetS) severity and its potential contribution to racial health disparities in women with breast cancer. Methods Multi-center cross-sectional study (10 US hospitals) in women (n=1206) with primary diagnosis of invasive breast cancer received during Mar/2013-Feb/2020. Participants, self-identi ed as non-Hispanic white or black, underwent physical and laboratory examinations and survey questions assessing socioeconomic parameters, medical history and behavioral risks. SSS was measured with the 10-rung McArthur scale. MetS severity was measured with a validated Z-Score. Generalized linear mixed modeling was used to analyze the associations. Missing data were handled using multiple imputation.ResultsAverage age was 58 years. On average, the SSS of black women, given equivalent level of income and education, was lower than the SSS of white women: 6.6 (6.1 to 7.0) vs 7.7 (7.54 to 7.79) among college graduates and 6.8 (6.4 to 7.2) vs 7.6 (7.5 to 7.8) among women in the high-income category (> $75,000). In multivariable analysis, after controlling for age, income, education, diet and physical activity, increasing SSS was associated with a decrease in MetS-Z, -0.10 (-0.16 to -0.04) per every 2 rung increase in the McArthur scale.Conclusion Black women with breast cancer rank their SSS lower than white women with breast cancer do at each level of income and education. As SSS is strongly associated with MetS severity these results identify potentially modi able factors that contribute to racial disparities.

The survival for breast cancer (BC) is improving, but remains lower in Black women than White women. A number of factors potentially drive the racial differences in BC outcomes. The aim of our study was to determine if insulin resistance, defined as homeostatic model assessment for insulin resistance (HOMA-IR) mediated part of the relationship between race and BC prognosis, defined as improved Nottingham prognostic index (iNPI). We performed a cross-sectional study, recruiting self-identified Black and White women with newly diagnosed primary invasive BC from ten US hospitals between March 2013 and February 2020. Surveys, anthropometrics, labs and tumor pathology data were gathered, and we compared the results between Black and White women. We calculated HOMA-IR as well as iNPI scores, and examined the associations between HOMA-IR and iNPI. After exclusions, the final cohort was 1206; 911 (76%) White, and 295 (24%) Black women. Metabolic syndrome, and insulin resistance were more common in Black than White women (P<0.001 for all comparisons). Black women had less lobular BC, three times more triple-negative BC, and BCs with higher stage and iNPI scores than White women. Fewer Black women had BC genetic testing performed. HOMA-IR mediated part of the association between race and iNPI, particularly in BCs that carried a good prognosis and were HR-positive. Higher HOMA-IR scores were associated with progesterone receptor (PR)-negative BC in White women, but not Black women. Overall, our results suggest that HOMA-IR contributes to the racial disparities in BC outcomes, particularly for women with HR-positive BC.

560 Background: Metabolic syndrome (MS) is associated with worse breast cancer prognosis. Black women have higher rates of advanced breast cancer, as well as MS, diabetes and obesity. As socioeconomic status is associated with MS, we asked whether the subjective perception of social status (SSS), might influence this association in black and white women with a new breast cancer (BC) diagnosis. Methods: We surveyed, obtained serum and conducted anthropometric measures of 1206 women with a new BC diagnosis. Triglycerides, systolic blood pressure (SBP), waist circumference (cm), HDL and glucose were used to calculate a severity index of MS (MS-Zscore: mean=0; sd=1). Women reported their SSS on the 10 rung McArthur US social status ladder, their household income, education attained, diet quality (5 point scale), and exercise measured with metabolic equivalents (METS). Data were analyzed with multivariable generalized linear models. Missing data were imputed with multiple imputation. Results: Average age was 58 yrs of 295 black and 911 white women. BC stage > II was in 11.6% of black and 2.4% of white women. On average black women had higher BMI (31.5 vs 26.6; p<0.001), waist circumference (103 vs 93; p<0.001) glucose (96 vs 92; p<0.001) and SBP (132 vs 126; p<0.001); lower triglycerides (92 vs 104; p<0.001) and HDL (59 vs 68; p<0.001). Black women were more likely than white women to live in poverty (23.7% vs 4.6%; p<.001); report poor diet (32.4% vs 10.4%; p<.001) and less exercise (29.7% v 23.6% in the 25th %ile), and less likely to graduate college (30.3% vs 70.4%). MSZ-score was positively associated with age (.02 per year; p<.001) and black race (0.35; <.001) and negatively with better diet (-.20 per point in 4 point scale); p<.001), exercise (-.11 per quartile increase in METS; p<.001) and SSS (-.04 per ladder rung; p=.004). SSS was lower in black women within the same levels of income and education). Conclusions: Race, age, diet, exercise and subjective social status all impact metabolic syndrome, a risk factor for breast cancer. Of concern, among breast cancer patients, black women are more likely to rate their SSS below white women, within each education or income level. Subjective social status among women with a new breast cancer diagnosis is associated with MS and may be important to address as a risk factor among breast cancer patients.[Table: see text]

e18159 Background: Care coordination affects the quality of cancer treatment. Multiple Myeloma (MM) patients frequently are cared for by local and referral center physicians. We sought to determine whether getting treated at different sites might impact on the quality of MM care. Methods: We used NCCN 2014 and CMS guidelines to define categories of treatment quality and transplant eligibility. We defined high quality MM care as: Induction for all patients with ECOG < 4; harvest & transplant for patients completing induction without progression, with albumin > 2.8, bilirubin < 3 and age ≤77 years; maintenance for transplant ineligible patients completing induction with no progression & for transplant eligible patients completing transplant with no progression; and supportive care of receiving bone targeting agents, anticoagulation and infection prophylaxis for all patients receiving MM therapy. Patients who received care with both local and referral center physicians were considered to have received care at 2 sites. We abstracted 709 charts of patients with ICD-9 diagnosis of MM from 2010-2014 for demographics, site of care and treatments received. We compared groups with chi square and multivariate logistic regression models with age, insurance, race, comorbidity and sites of care to predict care quality. Results: Of the 709, 388 had active MM. On average, patients were 62 ±11 years. Overall, 70% received care at > 1 site. Referred patients had no differences by age, comorbidity index, insurance or race. Having > 1 care site was associated with higher rates of induction and harvest. Conclusions: Historically, hand-offs in care have been associated with poorer quality. However, in a referral center, hand-offs do not negatively affect induction and harvest care quality. Patients referred to a MM center are more likely to get high quality treatments for which they are referred, but referral does not ensure receiving the full gamut of needed MM treatments.[Table: see text]