This study assessed spatial accessibility to fixed mammography centres across Oklahoma State, USA using the Two-Step Floating Catchment Area (2SFCA) and the Enhanced Two-Step Floating Catchment Area (E2SFCA) methods to identify areas with limited or no access. For this analysis, we used data from the mammography facilities database of the US Food and Drug Administration verified by direct contact with the facility and the U.S. Census block group population and demographics for women aged 40 years and older. Analyses were stratified by urban areas; large rural areas; and small rural areas. Accessibility scores were calculated using the 2SFCA method with 30-minute drive times and the E2SFCA method with drive times of 10, 20 and 30 minutes weighted by distance decay. Block groups were categorized into quartiles based on accessibility scores. Among 940,994 eligible women, 10% lived in areas with no access. Small rural regions faced the greatest barriers. Spatial disparities were linked to racial and socioeconomic differences: non-Hispanic American Indian/Alaska Native and non-Hispanic White populations were more likely to reside in noaccess zones, while Black and Hispanic populations clustered in high-access urban areas. Spatial analysis reveals significant rural disparities in mammography access. Mobile machines should prioritize underserved rural regions to improve equity.

Background:Obesity is a growing public health crisis in the United States, with over 70% of adults classified as overweight or obese. It has been associated with multiple health conditions, including at least 13 types of cancer. Despite this, awareness of the obesity-cancer link remains low, with only 53% of Americans aware of it as of 2019. Understanding the epidemiology of obesity-related cancers is critical, particularly in high-obesity states like Oklahoma. Objective:To assess the incidence and trends of obesity-related cancers in Oklahoma, focusing on demographic, geographic, and socioeconomic disparities. Methods:Articles were selected through a structured literature search and narratively summarized by key study characteristics and results. We used data from the Oklahoma Central Cancer Registry (OCCR) from 1999 to 2022, identifying cases based on CDC-defined obesity-related cancers. Age-adjusted incidence rates (AAIR) were calculated per 100,000 population, using the 2000 U.S. standard population. Temporal trends were assessed using Joinpoint regression. Spatial analysis was conducted using Global and Local Moran's I statistics. Demographic and socioeconomic data were linked using U.S. Census and Rural-Urban Continuum Codes (RUCC). Results:Between 2018-2022, 44,304 Oklahomans were diagnosed with obesity-related cancers, representing 39% of all cancer cases. Rates were higher in women (AAIR: 243.0) than men (AAIR: 127.0), with notable variation by race, insurance type, rurality, and poverty level. American Indian/Alaska Native populations had the highest incidence. Breast, colorectal, and kidney cancers comprised most cases. Geographic clustering was evident, particularly in southeastern Oklahoma. Conclusion:Obesity-related cancers constitute a significant proportion of the cancer burden in Oklahoma. Disparities by sex, race, socioeconomic status, and geography underscore the need for targeted prevention and education strategies. Public awareness campaigns and health policy interventions addressing obesity may help reduce cancer incidence in high-risk populations.

Background:Despite declining national smoking rates, Oklahoma continues to experience high tobacco use, particularly among groups such as American Indian/Alaska Native (AI/AN) and rural populations. Cigarette smoking is a leading cause of cancer, and tobacco-related cancer incidence remains a significant public health concern in Oklahoma. Methods:Articles were selected through a structured literature search and narratively summarized by key study characteristics and results. We then analyzed tobacco-related cancer incidence data from the Oklahoma Central Cancer Registry (1999-2022), focusing on cancers identified by the CDC as tobacco-related. Rates were age-adjusted to the 2000 US standard population. We assessed trends using Joinpoint regression and stratified findings by age, sex, race/ethnicity, rurality, and insurance status. Results:Between 2018 and 2022, 48,552 tobacco-related cancer cases were reported in Oklahoma, comprising 42% of all cancers. The age-adjusted incidence rate (AAIR) was 278.0 per 100,000. Males (253.5) had higher rates than females (161.3). The highest AAIR was among NH AI/AN individuals (257.5), with 52% of their cancers tobacco-related. Lung, colorectal, and kidney cancers were the most common tobacco-related cancers. Rural areas had higher incidence rates than their urban counterparts. Tobacco-related cancer rates declined over time (APC -0.55%, p < 0.0001), while non-tobacco-related cancer rates slightly increased. A weak positive correlation (r2 = 0.29) was found between county-level smoking prevalence in 2010 and cancer incidence a decade later. Conclusions:Tobacco-related cancers remain prevalent in Oklahoma, especially among males, rural, and AI/AN populations. Although incidence is declining, disparities persist. These findings underscore the ongoing need for targeted tobacco control efforts to address inequities and reduce cancer burden.

Introduction: Residents of counties with higher poverty levels experience elevated smoking rates and disproportionate tobacco-related cancer mortality. This study examined differences in sociodemographic characteristics, tobacco use, and service utilization among Oklahoma Tobacco Helpline (OTH) registrants across county poverty designations. Methods: In this cross-sectional study, data were analyzed from 33847 adults registered with the OTH between 1 July 2023 and 30 June 2024. Counties were classified as persistent poverty (PPC: ≥20% of residents in poverty for ≥30 years), current poverty (CPC: ≥20% of residents in poverty currently for <30 years), or non-poverty (NPC: <20% of residents in poverty). Group differences were examined using the chi-squared test and analysis of variance. Adjusted multinomial logistic regression analyses evaluated associations between poverty status, tobacco use, and service utilization, controlling for age, sex/gender, race, education level, household income, health insurance, and chronic conditions. Results: Registrants residing in PPCs and CPCs differed from those in NPCs in terms of age and race, and they had lower education, income, and greater Medicaid coverage (all P<0.05). In adjusted models, PPC registrants had higher odds of smoking >1 pack/day (heavy smoking) (AOR=1.49; 95% CI: 1.30-1.70; p<0.001) and learning about OTH through personal networks (AOR=1.42; 95% CI: 1.16-1.73; p<0.001) compared with NPCs. Compared with registrants residing in non-poverty counties (NPCs), CPC registrants had higher odds of smoking >1 pack/day (AOR=1.39; 95% CI: 1.16-1.65; p<0.001) and learning about OTH through community/social organizations (AOR=1.77; 95% CI: 1.33-2.35; p<0.001). Service type and nicotine replacement therapy receipt/duration were similar across poverty designations. Conclusions: PPC and CPC registrants showed greater socioeconomic disadvantage and nicotine dependence than NPC registrants but had distinct information pathways. These findings highlight geographically concentrated poverty as a potential contributor to tobacco-related disparities and suggest that interventions addressing social and environmental conditions in PPCs may help enhance cessation engagement and reduce tobacco-related inequities.

To explore feasibility of using a Nurse Cancer Care Coordinator (CCC) to synthesize cancer survivorship care data, assess degree of cancer-related distress, and coordinate care for American Indian (AI) patients seen in a tribal primary care clinic. A CCC from one of Choctaw Nation’s primary care facility collected data on American Indian adults who had completed cancer treatment within the preceding five-years. Measures included demographics, cancer type, treatment and potential adverse effects, schedule of follow-up visits, behavioral risk assessment, global distress and checklist of distress sources, and length of time and frequency of attempts to complete data collection. None of the participants had ever received a survivorship care plan (SCP). A total of 15 oncology providers were contacted to gather SCP and Distress Thermometer (DT) information on the 23 participants. Time to complete the SCP ranged from 30 to 120 min, with an average of 62 min per participant. The baseline DT score was 4.4 out of 10 and the average number of problems reported was 5.0. The top five challenges experienced by participants were fatigue (57

IntroductionAdaptations are common, expected, and often imperative for successful uptake and sustained implementation of clinical or public health programs in real-world practice settings. Understanding which adaptations have been made to evidence-based interventions and subsequent implementation strategies throughout the life cycle of a project can contextualize findings and support future scale-up of the program. Systematic documentation of adaptations is rarely conducted or reported, and little guidance exists on approaches to documenting adaptations.MethodsAccelerating Colorectal Cancer Screening and follow-up through Implementation Science (ACCSIS) is a National Cancer Institute-funded Beau Biden Cancer MoonshotSM Initiative developed to improve colorectal cancer screening, follow-up, and referral for care among underserved groups, including diverse racial and ethnic populations and people living in rural areas. Using an iterative data gathering approach—a survey, data abstraction, and data validation—we compiled information about adaptation documentation and analytic methods and intervention and implementation strategy adaptations from the eight funded ACCSIS research programs. An analytic team representing multiple ACCSIS programs reviewed, coded, and summarized the data using a rapid qualitative analytic approach.ResultsACCSIS programs varied substantially in how they defined and documented adaptations. Nine approaches were used to document adaptations; the most common were periodic reflections and review of meeting minutes and agendas. Nine analytic methods were reported to guide adaptation analysis; the most frequently mentioned were rapid qualitative methods, descriptive statistics, and mixed-methods analysis. A total of 96 adaptations were reported by the eight research programs, most of which occurred during the pre-implementation stage (68%) or were made to the program format (71%). Only 36% of the adaptations were due to the COVID-19 pandemic.ConclusionsOur multi-method, systematic approach allowed us to explore how sites document and analyze adaptations across eight ACCSIS Moonshot programs. Using a systematic approach allowed for comparisons of intervention and strategy adaptations within and across research programs and can inform the science of adaptations, while building a knowledge base of why such adaptations are needed and how they can inform implementation efforts across time. Methods described herein provide a template for similar assessment activities in other large, multi-site research initiatives.

ObjectiveThis study examined the association of e-cigarette use status and history of depression among American Indian (AI) adults who smoke.MethodWe conducted a secondary data analysis using survey data from 375 AI adult smokers collected in 2016 at a tribally operated healthcare facility in northeast Oklahoma. Multivariable logistic regression was used to estimate the association between e-cigarette use and self-reported history of depression while adjusting for potential confounders.ResultsIn the adjusted analyses, compared to never users, current and former e-cigarette users had higher estimated odds of depression history (adj. OR 2.66; 95% CI 1.25-5.72 and adj. OR 2.38; 95% CI 1.36-4.26, respectively). Additional factors independently associated with a history of depression included having strong cravings to smoke (adj. OR 2.28; 95% CI 1.13-4.88) and having a history of chronic disease (adj. OR 2.09; 95% CI 1.20-3.70) after controlling for confounding variables.ConclusionsE-cigarette use among AI adult smokers was independently associated with a history of depression. Whether e-cigarette use among people who smoke results from depression or whether depression results from the combined use of e-cigarettes and cigarettes requires future research using a prospective cohort design.

Introduction:Tobacco use is the leading cause of death in the U.S., and American Indian/Alaska Native people have high rates of tobacco-related diseases. Although the U.S. Food and Drug Administration-approved products and evidence-based methods exist for smoking cessation, people who smoke might use E-cigarettes as cessation aids. Whether E-cigarette use is associated with the use of evidence-based methods is unknown, particularly among American Indian/Alaska Native individuals. Methods:Using survey data collected in 2016 from 289 adult American Indian people who smoke and who reported a previous cessation attempt, the authors conducted multivariate logistic regression analyses to assess the associations between E-cigarette use and evidence-based cessation methods. Analyses were performed in 2023. Results:Individuals who currently or formerly used E-cigarettes were significantly more likely to report using nicotine replacement therapy during their last quit attempt than those who did not use E-cigarettes (current versus never AOR=4.6, 95% CI=1.9, 11.9; past versus never AOR=4.6, 95% CI=2.2, 9.8; p<0.001). Current and former E-cigarette use was significantly associated with prescription use in the unadjusted analysis but lost significance in the adjusted analysis (current versus never AOR=3.1, 95% CI=1.0, 10.5; past versus never AOR=2.7, 95% CI=1.1, 7.9; p>0.05). Individuals with current or former use of E-cigarettes were significantly less likely than individuals who never used E-cigarettes to use the cold turkey method (unassisted cessation) (current versus never AOR=0.3, 95% CI=0.2, 0.6; past versus never AOR=0.3, 95% CI=0.1, 0.7; p<0.01). Conclusions:These results suggest that persons who use E-cigarettes are more likely than individuals who do not use E-cigarettes to previously have tried nicotine replacement therapy but less likely to use the cold turkey method. A larger study is needed to determine whether individuals who use E-cigarettes are also more likely to have tried prescription medication for smoking cessation. Whether E-cigarette use impedes or encourages the use of evidence-based cessation methods is unknown.

Objective:Lung cancer remains the leading cause of cancer death in the United States. Mobile screening units have reduced access barriers. To assess lung cancer screening spatial access, we utilized a two-step floating catchment analysis (2SFCA) and an enhanced two-step floating catchment analysis (E2SFCA) to identify areas for mobile screening deployment. Methods:A spatial analysis was conducted using 2019-2023 census block group population data (ages 50-80) and a validated list of 165 lung cancer screening facilities in Oklahoma collected between December 2024 - May 2025, United States. Block groups were categorized into four spatial access groups. Analyses incorporated rural-urban continuum area codes. The 2SFCA used 30-min drive-time catchments, while the E2SFCA applied gravity-weighted 10-, 20-, and 30-min catchments. Results:Across both methods, 41 % of eligible Oklahomans resided in low or no spatial access areas, covering over 60 % of the state's land. Small rural areas had the highest proportion of residents (up to 67 %) with limited or no spatial access. Urban areas showed better spatial access, but up to 19 % of eligible residents still lacked 30-min access. Conclusions:Large sections of Oklahoma, particularly rural, lack spatial access to lung cancer screening. The 2SFCA and E2SFCA methods effectively identified underserved regions.

INTRODUCTION:Persistent poverty counties (PPCs) are U.S. counties where ≥20% of residents have lived in poverty for ≥30 years. Cancer mortality rates in PPCs are exceptionally high due, in part, to elevated smoking rates. STUDY DESIGN:The study used a parallel 2-group randomized controlled trial design. SETTING/PARTICIPANTS:Participants were Oklahoma Tobacco Helpline (OTH) callers from PPCs who smoked daily (N=165). Data were collected in 2022-2023. INTERVENTION:Participants were randomized to received OTH treatment (coaching calls plus nicotine replacement therapy [NRT]) or OTH treatment + financial incentives (OTH+FI) for completing coaching calls. MAIN OUTCOME MEASURES:Outcome measures included the number of coaching calls completed, call-contingent incentives earned, past 7-day self-reported abstinence rates, and study retention at 8- and 12-weeks post-enrollment. RESULTS:Participants (N=165) were predominantly female (63.6%), 24.2% were racially/ethnically minoritized (18.2% single- or multi-race American Indian), and they smoked an average of 21.01 (SD=11.67) cigarettes per day. Adjusted analyses indicated that participants assigned to OTH+FI were significantly more likely than those assigned to OTH to report past 7-day abstinence at the 8-week (AOR=2.28; 95% CI=1.18, 4.48) and 12-week (AOR=2.00; 95% CI=1.03, 3.96) follow-ups when missing outcomes were considered smoking. Participants assigned to OTH+FI were more likely to complete ≥3 coaching calls (AOR=3.64; 95% CI=1.84, 7.43), and they completed more total calls (aRR=1.53; 95% CI,=1.24, 1.90) than those assigned to OTH. The number of coaching calls completed significantly mediated the relationship between treatment group assignment and abstinence at the 8- and 12-week follow-ups. Overall, study retention was >83% at the 8- and 12-week follow-ups and did not differ between groups. Statistical analyses were conducted in 2024. CONCLUSIONS:Findings support the feasibility and efficacy of offering small FI for completing OTH coaching calls to increase treatment engagement and smoking cessation in PPCs.

Abstract As part of a randomized, controlled trial (RCT) to increase lung cancer screening (LCS) with low-dose CT scan (LDCT) within the Choctaw Nation of Oklahoma’s tribal health system, we conducted a qualitative study to explore the barriers behind patient decisions to forego screening. Thirty eligible participants who had been in the RCT for at least one year were identified as LCS completers (n=7) or non-completers (n=23). A single interviewer completed all interviews using a semi-structured interview guide, designed to explore experiences, barriers/facilitators to LCS, factors influencing screening decisions, and suggested strategies for expanding the LCS program into the community. Interviews were recorded and transcribed verbatim. Data were analyzed using conventional content analysis. Most non-completers reported having no conversations about the availability of LCS with their primary care provider (PCP) or receiving any information about the LCS program. In contrast, the completers all reported PCP-initiated discussions about the LCS program, their risk factors, and an overview of the testing process. Key themes that emerged included fears, e.g., being unsure about what the test involves, afraid of being diagnosed with lung cancer and what might follow, and afraid of dying. Some voiced concerns, e.g., feeling guilty as active smokers and being stigmatized should they be diagnosed with lung cancer. Many participants posited that there was no reason for screening without symptoms. Lack of understanding, especially about cancer care, was identified as a contributing factor. Suggested strategies to increase the reach into the community included using existing infrastructure within Choctaw Nation, such as disseminating information through the tribal newsletter, inserts in prescription refills, and notifications via the patient portal. Community education programs at local community centers, particularly around senior citizen meals, were offered as strategies to change the perception that lung cancer is a death sentence. Hosting an informational booth at the annual tribal Labor Day festival was commonly suggested. In conclusion, multiple reasons were cited for forgoing LDCT screening. In this tribal setting, findings are similar to ones documented in other settings. This suggests that interventions to overcome these challenges may build off known evidence-based interventions, such as the recommendations for cancer prevention documented by the Community Preventive Services Task Force. Addressing fears through multiple educational approaches and adapting strategies from the American Lung Association to address stigma could lead to enhanced interventions. Finally, capitalizing on tribal resources (newsletter) and tribal events to increase LCS awareness may be promising strategies to improve screening in the local tribal setting. Citation Format: Kathleen Dwyer, Zsolt Nagykaldi, Mark Doescher, Dorothy A. Rhoades. Factors influencing patient decision-making to complete Low Dose CT screening for lung cancer [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 B046.

BACKGROUND:Prostate cancer is the most diagnosed cancer in Black/African American men (AA) and the second‑leading cause of cancer-related deaths. A prostate-specific antigen (PSA) blood test is an early detection screening tool for prostate cancer, but uptake of PSA screening remains low among AA men. Greater PSA screening rates among AA men, coupled with earlier treatment, may reduce disparities in prostate cancer outcomes, including mortality. The current pilot study will test the first-of-its-kind mobile health (mHealth) app to improve prostate cancer knowledge and increase PSA screening uptake among AA men using home-based screening methods. METHODS:AA men aged 55 to 69 and are not up to date with PSA screening will be randomly assigned 1:1 to receive a prostate cancer screening app: Prevention Taskforce App (Taskforce App; control condition) or the Prostate Cancer Genius App (Genius App; intervention condition), which was developed specifically for AA men. RESULTS:We will evaluate the preliminary efficacy of the apps via post-intervention group differences on the validated 18-item Prostate Cancer Knowledge Scale (primary outcome). We will also explore post-intervention group differences in perceived engagement, accessibility, and acceptability between the apps. Finally, we will derive preliminary estimates of PSA screening rates between study conditions and identify mechanisms of screening adherence. DISCUSSION:mHealth apps offer promise to improve prostate cancer knowledge and screening rates among AA men. Demonstrating the preliminary efficacy of the Genius App will support future fully-powered mHealth interventions to address health disparities.

e23136 Background: The Native American (NA) population has the poorest cancer survival of all racial groups in the U.S. A long history of research misconduct has caused many tribal communities to hold unfavorable views toward genomic data collection. Routine molecular and genomic testing is standard of care for most metastatic lung and colorectal cancers but the frequency of such testing in NA patients is unknown. Many NA patients have limited financial resources and must rely on coverage for health care from an Indian Health Service, Tribal Health Service, or Urban Indian Health (ITU) program. However, ITU programs do not operate their own cancer treatment services and must refer their patients elsewhere for such care. Methods: A Native American Navigation program (NANP) was established at the Stephenson Cancer Center (SCC) in Oklahoma to promote cancer health equity and provide high-quality cancer care by facilitating access to care for ITU patients from across the state. The NANP interfaces with ITU programs to obtain approvals for care as well as to coordinate clinical and supportive services, such as transportation or food assistance. We conducted a retrospective chart review of patients referred from an ITU program to the SCC NANP in Oklahoma from 1/2014 to 6/2023. Among patients with metastatic colorectal cancer (CRC), we investigated the frequency of testing for KRAS, NRAS, BRAF as well as MSS/MSI. In patients with metastatic non-small cell lung cancer (NSCLC), we identified the frequency of EGFR, ALK, ROS1, and PD-L1 testing. Results: A total of 305 NA patients were referred to SCC for colorectal and lung cancers. Of these, 68 patients had metastatic disease and qualified for molecular and genomic testing per National Comprehensive Cancer Network guidelines. The mean age of our cohort was 63 with a male-to-female ratio of 1.6:1. Most (85.3%) patients eligible for testing had testing for at least one biomarker. In patients with metastatic CRC, 100% received MSS/MSI as well as KRAS testing and the frequency of NRAS and BRAF testing was 69.6% and 84.8% respectively. In patients with metastatic NSCLC, the frequency of EGFR, ALK, and ROS1 testing was 95.8%, 87.5%, and 79.1%, with PD-L1 testing frequency being 83.3%. Conclusions: The overall frequency of molecular and genomic testing in these navigated NA patients (85.3%) was comparable to the range reported in the general population (66-90%). By facilitating access to cancer care, programs such as the NANP may help NA patients receive appropriate testing to guide treatment. Larger studies are needed to further assess the role of navigation programs in reducing cancer disparities by facilitating access to appropriate molecular and genomic testing for NA patients with metastatic cancers.

Objective: Little is known about how the COVID-19 pandemic affected cancer screenings among American Indian people residing in California and Oklahoma, 2 states with the largest American Indian populations. We assessed rates and factors associated with cancer screenings among American Indian adults during the pandemic.Methods: From October 2020 through January 2021, we surveyed 767 American Indian adults residing in California and Oklahoma. We asked participants whether they had planned to obtain screenings for breast cancer, cervical cancer, and colorectal cancer (CRC) from March through December 2020 and whether screening was postponed because of COVID-19. We calculated adjusted odds ratios (AORs) for factors associated with reasons for planned and postponed cancer screening.Results: Among 395 participants eligible for breast cancer screening, 234 (59.2%) planned to obtain the screening, 127 (54.3%) of whom postponed it. Among 517 participants eligible for cervical cancer screening, 357 (69.1%) planned to obtain the screening, 115 (32.2%) of whom postponed it. Among 454 participants eligible for CRC screening, 282 (62.1%) planned to obtain CRC screening, 80 of whom (28.4%) postponed it. In multivariate analyses, women who lived with a child (vs did not) had lower odds of planning to obtain a breast cancer screening (AOR = 0.6; 95% CI, 0.3-1.0). Adherence to social distancing recommendations was associated with planning to have and postponement of cervical cancer screening (AOR = 7.3; 95% CI, 0.9-58.9). Participants who received (vs did not receive) social or financial support had higher odds of planning to have CRC screening (AOR = 2.0; 95% CI, 1.1-3.9).Conclusion: The COVID-19 pandemic impeded completion of cancer screenings among American Indian adults. Interventions are needed to increase the intent to receive evidence-based cancer screenings among eligible American Indian adults.

OBJECTIVES:Compared to Oklahoma, 33 states have higher all-cause cancer incidence rates, but only three states have higher all-cause cancer mortality rates. Given this troubling gap between Oklahoma's cancer incidence and mortality rankings, in-depth examination of cancer incidence, staging, and mortality rates among this state's high-risk populations is warranted. This study provides in-depth information on overall and cause-specific cancer incidence and mortality for the rural and urban Oklahoma populations classified by Rural-Urban Continuum Codes (RUCC).METHODS:Data were publicly available and de-identified, accessed through Oklahoma Statistics on Health Available for Everyone (OK2SHARE). Statistical analysis included calculating age-specific rates, age-adjusted rates, and percentages, as well as assessing temporal patterns using average annual percent change with 95 % confidence intervals determined by Joinpoint regression analysis.FINDINGS:Urban areas had a higher proportion of female breast cancer cases, while large and small rural areas had higher rates of lung and bronchus cancer. Urban residents were more likely to have private insurance and less likely to have Medicare compared to rural residents. Cancer incidence rates increased with age, and men had higher mortality rates than women. Lung and bronchus cancer was the leading cause of cancer death, with lower rates in urban areas compared to rural areas.CONCLUSIONS:Findings demonstrate the need to improve the early detection of cancer among the rural populations of Oklahoma. Additionally, the high mortality rates for most types of cancer experienced by the state's rural population underscores the need to improve cancer detection and treatment in these locations.

Abstract Introduction: Uptake of lung cancer screening (LCS) with low dose computed tomography is poor nationwide. The U.S. Native American (NA) population has a high prevalence of smoking and lung cancer mortality but low rates of LCS completion. Awareness and perceptions of LCS among NA men and women have rarely been studied. Methods: Using a community-engaged research approach in partnership with the Choctaw Nation Health Services Authority in Oklahoma, the “Tribally Engaged Approaches to Lung Screening” study developed and implemented a cluster-randomized controlled trial of a coordinated LCS program. In 2022, NA men and women eligible for LCS from six tribal health clinics completed a baseline survey prior to being referred for LCS. Surveys included demographic characteristics, smoking history, use of cancer preventive services, beliefs regarding personal risk of lung cancer, and perceptions toward LCS. Findings: Among 210 participants (57% women, 43% men), mean age was 63 years; 50% reported annual household income below $25,000, 83% completed high school or equivalent, with 40% having some college education. The median pack years of smoking was 46 years. The proportion of participants who currently smoke was 72%. Current cigarette users were slightly younger than former users (median age 61 vs 64 years, respectively) and similarly had lower maximum estimates of pack-years of use (median, 44 vs 52). Most (93%) had more than one primary care visit within the past 12 months, and 76% completed an annual physical or wellness visit in the past year. Overall, 73% had completed colonoscopy and, among women, 80% had a mammogram. Only 62% had heard about LCS. However, 74% agreed with the statement “It is likely that I will get lung cancer sometime in my lifetime”. More than 90% of participants agreed that LCS would help with each of the following: early detection, chances of dying from lung cancer, reduce personal worry about lung cancer, reduce their family’s worries, improve planning for the future and peace of mind. However, 44% worried that LCS would find “something wrong”, 15% endorsed that they would rather not know if they had any lung problems, and 10% were afraid the scan would damage their lungs. About 20% worried about being a social outcast or being blamed for having smoked. Regarding potential barriers, 32% felt that cost would be a problem, 28% felt they did not have the time, and 17% that transportation would be a problem. Overall,14% reported bad experiences with healthcare or a provider, and 8% did not trust the healthcare system. Regarding LCS, 28% felt they did not know enough about the test, 11% felt they were too old to benefit from LCS, and 8% felt LCS was not worth the effort. Conclusions: Perceptions of the potential benefits from LCS were overall favorable in this sample of NA adults. However, up to 30% perceived significant barriers to LCS uptake. Greater awareness of LCS and mitigation of barriers to LCS would help to reduce the marked disparities in lung cancer mortality among NA patients. Citation Format: Dorothy A. Rhoades, Cara Vaught, Ann Chou, Kathleen Dwyer, Mark P Doescher, Michele Gibson, Zsolt Nagykaldi. Perceptions of lung cancer screening among Native American patients: The Tribally Engaged Approaches to Lung Screening (TEALS) study [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 A148.

Cancer-related financial hardship is an increasingly recognized concern for patients, families, and caregivers. Many Native American (NA) patients are at increased risk for cancer-related financial hardship due to high prevalence of low income, medical comorbidity, and lack of private health insurance. However, financial hardship screening (FHS) implementation for NA patients with cancer has not been reported. The objective of this study is to explore facilitators and barriers to FHS implementation for NA patients. We conducted key informant interviews with NA patients with cancer and with clinical staff at an academic cancer center. Included patients had a confirmed diagnosis of cancer and were referred to the cancer center through the Indian Health Service, Tribal health program, or Urban Indian health program. Interviews included questions regarding current financial hardship, experiences in discussing financial hardship with the cancer care and primary care teams, and acceptability of completing a financial hardship screening tool at the cancer center. Clinical staff included physicians, advanced practice providers, and social workers. Interviews focused on confidence, comfort, and experience in discussing financial hardship with patients. Recorded interviews were transcribed and thematically analyzed using MAXQDA® software. We interviewed seven patients and four clinical staff. Themes from the interviews included: 1) existing resources and support services; 2) challenges, gaps in services, and barriers to care; 3) nuances of NA cancer care; and 4) opportunities for improved care and resources. Patients identified financial challenges to receiving cancer care including transportation, lodging, food insecurity, and utility expenses. Patients were willing to complete a FHS tool, but indicated this tool should be short and not intrusive of the patient’s financial information. Clinical staff described discomfort in discussing financial hardship with patients, primarily due to a lack of training and knowledge about resources to support patients. Having designated staff familiar with I/T/U systems was helpful, but perspectives differed regarding who should administer FHS. We identified facilitators and barriers to implementing FHS for NA patients with cancer at both the patient and clinician levels. Findings suggest clear organizational structures and processes are needed for financial hardship to be addressed effectively.