Introduction: Significant cancer disparities exist between racial/ethnic minorities and Non-Hispanic whites. More specifically, African American/Black (AA/B) patients have the highest incidence of complex malignancies, such as lung and gastrointestinal cancer subtypes, and have higher rates of morbidity and mortality. 1 While access to healthcare and lower socioeconomic status are often attributed to causing these differences in outcomes, evidence indicates that AA/B patients face more complex circumstances surrounding their care. At initial diagnosis of pancreatic, colorectal, and esophageal cancer, AA/B patients are more likely to present with later stage disease, and later they are found to have less favorable responses to treatment and lower receipt of guideline concordant care. 2-5 AA/B are also less likely to undergo curative surgery for early-stage lung cancer. 1 While AA/B patients issues with insurance coverage and barriers to care are present, interpersonal interactions between physicians and their patients have been found to strongly influence patient outcomes. 6 This study aims to further elucidate the breakdown in the physician-patient relationship that leads to lower rates of guideline concordant care, surgical resections, and survival among AA/B patients. Methods: Adults undergoing treatment at UC Health for primary lung and gastrointestinal cancers were identified using Epic and were approached at their initial appointments in the thoracic surgery and surgical oncology clinics. After informed consent was obtained, patients participated in a RedCap survey and semi-structured interview. Data was de-identified and further analyzed. After completion, patients were followed in Epic to determine outcomes of treatment. Results: A total of 24 patients participated in the study (Female: 8, Male: 16, Age: 62.33) 37.5% identified as African American/Black and 62.5% identified as Non-Hispanic White. Patients either had a confirmed or suspected diagnosis of malignant lung (N=19) or gastrointestinal tumor (N=5). 66.7% of the AA/B participants had Medicaid coverage, compared to 13.3% of NHW participants. AA/B participants were more likely to report lower satisfaction with the length of their appointments and understanding of their treatment plan as well as their physician’s ability to answer questions, display of empathy, communication, and cultural competence. AA/B participants also exhibited more apprehension towards treatment and lower health literacy in semi-structured interviews. Follow-up data analysis found that AA/B participants were more likely to refuse surgery (OR=2.8) and not receive guideline concordant care (OR=5) AA/B patients also waited 2x longer for the start of cancer treatment. Conclusion: Social determinants of health and genetics are powerful influencers of cancer outcomes. However, interventions implemented to detect cancer at earlier stages and strengthen trust and communication between physicians and patients can lead to higher compliance and improved responses to treatments.