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DISCLOSURES
Disclosure of Relevant Financial Relationships with Commercial Interests
Amedco endorses the standards of the ACCME and ANCC that require everyone in a position to control the content of accredited educational activity to disclose all financial relationships with commercial interests that are related to the content of the educational activity. All accredited activities must be balanced, independent of commercial bias and promote improvements or quality in healthcare. All recommendations involving clinical medicine must be based on evidence accepted within the medical profession.
A conflict of interest is created when individuals in a position to control the content of an accredited educational activity have a relevant financial relationship with a commercial interest which therefore may bias his/her opinion and teaching. This may include receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, stocks or other financial benefits.
Amedco will identify, review and resolve all conflicts of interest that speakers, authors or planners disclose prior to an educational activity being delivered to learners. Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation. Amedco does not endorse any products or services.
The following speakers, authors and planners have provided Amedco with disclosures of relevant financial relationships that exist and may be considered a potential conflict of interest. Presentations of these individuals have been peer-reviewed and were found to be balanced, to be free of commercial bias, and to promote improvements or quality in healthcare:
Oral Abstract Presenter (3B-3), Committee Member: Meredith Giuliani, Princess Margaret Cancer Centre
Potential Conflict: Received funding from Bristol Myers Squibb, AstraZeneca, and Eli Lilly
Oral Abstract Author (3B-3): Daniel Golden, University of Chicago
Potential Conflict: Manager of RadOncQuestions LLC and HemOncReview LLC
Poster Abstract Presenter (P82): Nicole Harnett, Princess Margaret Cancer Centre
Potential Conflict: Received funding from Elekta Inc. and Varian Medical Systems
Poster Abstract Author (P101): Benjamin Smith, MD Anderson Cancer Center
Potential Conflict: Royalty and equity interest in Oncora Medical
All other speakers, authors and planners have disclosed no potential conflicts of interest as of 20 September 2021.
CONFERENCE PROGRAM
PRESENTING AUTHOR LIST
Olufunmilola Abraham (University of Wisconsin-Madison School of Pharmacy) | 3A-3 |
Stefani Acosta (UC San Diego) | P88 |
Kauser Ahmed (UCLA Simms Mann Center) | 3C-1 |
Ailyn Alicea (University of California San Diego) | P56 |
Gilad Amiel (Rambam Health Care Campus) | Workshop 1 |
Joan Anderson (Simms/Mann Center) | 3C-3 |
Paola Anguiano Quiroz (University of California San Diego) | P54 |
Angela Adjetey Appiah (Hackensack MMC) | P18 |
Tanvi Bafna (University of Miami Miller School of Medicine) | P65 |
Jenna Balingit (San Diego State University) | P84 |
Lauren Barnes (Ohio Wesleyan University) | P86 |
Corrine Beaumont (Worldwide Breast Cancer) | 1A-3 |
Tony Beck (NIH/National Institute of General Medical Sciences) | Invited Workshop 5 |
Guy Beresteanu (University of Pittsburgh) | P77 |
Emily Bilenduke (University of Colorado) | P1 |
Maria Bishop (University of Arizona Cancer Center) | Workshop 1 |
Rebecca Block (OCHIN) | 4C-3 |
Quinton Blount (Mercer School of Medicine) | P2 |
Grace Brandhurst (Louisiana State University) | P43 |
William Breitbart (Memorial Sloan Kettering Cancer Center) | Plenary 1 |
Scott Britton (Battle Cancer Program) | P20 |
Mark Buchanan (Simms/Mann UCLA Center for Integrative Oncology) | 3C-4 |
Ilana Buffenstein (John A Burns School of Medicine, University of Hawaii at Manoa) | P47 |
Haley Buller (City of Hope Medical Center) | P21 |
Paola Cancino (UC San Diego) | P61 |
Xian Cao (University of Central Florida) | P22 |
Priscila Chagolla (San Diego State University) | P49 |
Robert Chamberlain (City University of New York School of Medicine) | 1C |
Mary Chamberlin (Dartmouth) | 3A-1 |
Heather Chambliss (St. Jude Children's Research Hospital) | P81 |
Carmen Chan (Sunnybrook Health Sciences) | 2A-1 |
Sarah Christensen (MD Anderson Cancer Center) | P92 |
Shannon M. Christy (Moffitt Cancer Center) | 1A-1 |
Anthony Cirilo (UC San Diego) | P62 |
Elizabeth Cleary (UCLA) | 3C |
Rosa Cobian Aguilar (San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology) | 1A-4 |
Andrea Contreras (University of California San Diego) | P60 |
Katie Cueva (Institute of Social and Economic Research, Univ. of Alaska) | 2B-1 |
Krista Dawdy (Odette Cancer Centre Sunnybrook) | Workshop 1 |
Kate Dean-Haidet (OhioHealth Hospice & Palliative Care) | Workshop 2 |
Elisa Dephilippis (San Diego State University) | P59 |
Mark Dignan (University of Kentucky) | 2C-2 |
Mariam Eljanne (National Cancer Institute) | Invited Workshop 6-2 |
Michael Eselun (Simms/Mann UCLA Center for Integrative Oncology) | 3C-2 |
Andres Espinoza (University of California San Diego) | P66 |
Seun Famojuro (University of Nebraska Medical Center) | P48 |
Kirstin Fearnley (Cancer Support Community) | 2C-4 |
Frank Ferris (OhioHealth) | Workshop 2 |
Michelle Flesaker (Smith College) | P80 |
Miguel Flores (Holistic Wellness Counseling & Consultant Services) | 2B-3 |
Miklos Fogarasi (Frank H. Netter, MD School of Medicine, Quinnipiac University) | 3B-1 |
Gabriella Fonseca (Moffitt Cancer Center) | P63 |
Victoria Forbes (University of Connecticut) | 4A-5 |
Caroline Fuss (George Washington University) | 1C |
Xiomara Gaeta Agreda (UC San Diego) | P36 |
Jessica Geiger (OhioHealth) | Workshop 2 |
Eleni Giannopoulos (Princess Margaret Cancer Centre) | P3, P100 |
Meredith Giuliani (Princess Margaret Cancer Centre) | 3B-3 |
Casey Goldstein (University of Limerick School of Medicine) | P103 |
Jordan Gomezpadilla (University of California San Diego) | P45 |
Geenee Gonzales (San Diego State University) | P97 |
Eduardo Gonzalez (UC San Diego Moores Cancer Center) | P29 |
Amanda Gordon (University of Minnesota) | 1C |
Sydney Gosselin (University of Guelph) | P80 |
Sara Graham (OhioHealth) | Workshop 2 |
Kristi Graves (Georgetown University) | 2A-5 |
Suzanne Gronemeyer (St. Jude Children's Research Hospital) | 3B-4 |
Lila Gutstein (University of South Florida Morsani College of Medicine) | P30 |
Kayoll Gyan (Northeastern University) | P15 |
Nicole Harnett (Princess Margaret Cancer Centre) | P82 |
Joshua Hartman (University of California San Diego) | P39 |
Bret Hassel (University of Maryland School of Medicine) | Invited Workshop 6-4, 4B-3 |
Kathleen Heneghan (American College of Surgeons) | Workshop 1 |
Nayanee Henry-Noel (University of Toronto) | 2A-2 |
Helen Hernandez (UC San Diego) | P53 |
Victoria Herrera (UC San Diego) | P33 |
Kelly Hirko (Michigan State University College of Human Medicine) | 1C |
Sydni Howard (OhioHealth) | Workshop 2 |
Lauren Hudson (Markey Cancer Center) | P4 |
Lauren Huff (UHN Princess Margaret Cancer Centre) | P11 |
Daniel Hughes (University of Texas Health San Antonio) | 4B-2 |
Jaden Huynh (University of California San Diego) | P68 |
Regina Idoate (University of Nebraska Medical Center) | 2B-2 |
Kathy Janes Jinkins (The University of Texas MD Anderson Cancer Center) | P16 |
Hannah Johnston (The University of Texas MD Anderson Cancer Center) | P50 |
Desiree Jones (University of Arizona) | 2B-3 |
Crispin Kahesa (Ocean Road Cancer Institute) | 1C |
Kristina Kaljo (Medical College of Wisconsin) | Workshop 3 |
Mehdi Karkouri (Faculté de Medecine et de Pharmacie de Casablanca) | 1C |
Rishaan Kenkre (UC San Diego) | P32 |
Jamal Khader (King Hussein Cancer Center) | Workshop 1 |
Hussein Khaled (National Cancer Institute of Cairo University) | 1C |
Mohamed Khalis (Mohammed VI University of Health Sciences of Casablanca) | 1C |
Monica Kopec (University Health Network) | P105 |
Megan Korhummel (San Diego State University) | P37 |
Dalia Koujah (UCSD) | P38 |
Abbey Kruper (Medical College of Wisconsin) | Workshop 3 |
Aaron Kruse-Diehr (University of Kentucky) | 1A-5 |
Paige Lake (Moffitt Cancer Center) | 4C-2 |
Karen Lawrie (Princess Margaret Cancer Centre) | 2A-3 |
Nicolette Olivia Le (University of California San Diego) | P8 |
Viena Le (University of California San Diego) | P95 |
Vy Le (UCSD) | P113 |
Emily Leventhal (University of Virginia) | P110 |
Yingyin (Katie) Li (UC San Diego) | P116 |
Alison Lin (National Cancer Institute, Center to Reduce Cancer Health Disparities) | Invited Workshop 5 |
Nicole Liscio (Princess Margaret Cancer Centre, University Health Network) | 1B-5, P17 |
Lydia Lo (United States Postal Service) | P27 |
Amy Loeber (UC San Diego Moores Cancer Center) | P52 |
Shina Luu (UC San Diego) | P115 |
Virginia Ma (Harvard University) | P91 |
Hiela Manely (University of California San Diego) | P69 |
Esmeralda Marquez (San Diego State University) | P117 |
Olayemi Matthew (Florida A & M University) | 1A-2 |
Merrylee McGuffin (Sunnybrook Health Sciences Centre) | 1B-3 |
Geetanjali Meka (Rutgers School of Public Health) | P64 |
Amaya Mendez-Molina (UC San Diego) | P67 |
Fatima Molina (Native American Research and Training Center) | 2B-3 |
Nicholas Monroe (UCSD Moores Cancer Center) | P99 |
Martin Montiel (University of California San Diego) | P108 |
Rafael Moreno (Frank H Netter MD School of Medicine, Quinnipiac University) | 3B-1 |
Khadija Msami (Ocean Road Cancer Institute) | 1C |
Asmaa Namoos (Virginia Commonwealth University) | P73 |
Paula Nelson-Marten (University of Colorado College of Nursing) | 2B-5 |
An Nguyen (Booz Allen Hamilton Consulting Firm) | 1C |
Tin Nguyen (University of California San Diego) | P94 |
Ida Nikjeh (University of California San Diego) | P41 |
Amber O'Brien (UC San Diego) | P96 |
Brenda Ochoa (University of California San Diego) | P34 |
Shawn Ogden (San Diego State University) | P35 |
Sydney Olfus (San Diego State University) | P98 |
Gabriela Ortega-Arvizu (University of California San Diego) | P83 |
Ana Patricia Ortiz (University of Puerto Rico Comprehensive Cancer Center) | 4A-4 |
Ernest Osei-Bonsu (Komfo Anokye Teaching Hospital) | 1C |
Caroline Owen (Peter MacCallum Cancer Centre) | P57 |
Andrea Padilla (UC San Diego Moores Cancer Center) | P70 |
Janet Papadakos (Princess Margaret Cancer Centre) | P79 |
Tina Papadakos (Princess Margaret Cancer Centre) | 4A-3, P7 |
Robyn Pennella (St. Jude Children's Research Hospital) | P5 |
Mitchell Pernia (San Diego State University) | P85 |
John Peteet (Harvard Medical School and Dana-Farber Cancer Institute) | Plenary 4 |
Aliyah Pierre (LSUHSC School of Medicine New Orleans) | P51 |
Naomi Pineda (UC San Diego) | P93 |
Misty Pocwierz-Gaines (University of Nebraska Medical Center) | 4B-1 |
Andrea Pozo Barruel (UHN Princess Margaret Cancer Centre) | P13 |
Kristin Primm (MD Anderson Cancer Center) | 4B-5 |
Gwendolyn Quinn (New York University) | 4C-4 |
Jocelyn Quiroz (University of California San Diego) | P89 |
Sergey Radaev (National Cancer Institute) | Invited Workshop 6-1 |
Janet Rader (Medical College of Wisconsin) | Workshop 3, 1C |
Harika Reddy (Moffitt Cancer Center) | P46 |
Nicole Redvers (University of North Dakota) | P6 |
Allison Reichel (Memorial Sloan Kettering Cancer Center) | P76 |
Carlos Reyes-Ortiz (Florida A & M University) | P24 |
Robert Rivers (NIH/National Institute of Diabetes and Digestive and Kidney Diseases) | Invited Workshop 5 |
Romina Rodriguez (Memorial Sloan Kettering Cancer Center) | 3B-5 |
Aislinn Rookwood (University of Nebraska Medical Center) | P25 |
Patricia Russell | Survivor Panel (no abstract) |
Antonia Sajche Sapon (University of California San Diego) | P55 |
Saima Saleem (The Karachi Institute of Biotechnology and Genetic Engineering) | P26 |
Rajiv Samant (Ottawa Hospital Cancer Centre) | P28 |
Filipe Santos-Silva (i3S - Institute of Research and Innovation in Health) | Workshop 4 |
George Scott (Ponce School of Medicine) | P74 |
Amanda Sheppard (Indigenous Cancer Care Unit at Ontario Health, Cancer Care Ontario) | Plenary 2 |
Vanessa Sheppard (VCU School of Medicine) | 2C-1 |
Julia Shi (Rice University) | P101 |
Z'Kera Sims (Moffitt Cancer Center) | P78 |
Sudha Sivaram (Center for Global Health, National Cancer Institute) | Invited Workshop 6-3, 1C |
Michael Skipworth (University of California San Diego) | P40 |
Nicholas Smith-Stanley (Huron Consulting) | 4A-1 |
Amr Soliman (CUNY Medical School) | Invited Workshop 6 (no abstract), 1C |
Marievelisse Soto-Salgado (UPR Medical Sciences Campus) | 4A-2 |
Shireen Spencer | Survivor Panel (no abstract) |
Petra Sprik (Levine Cancer Institute) | Plenary 5 |
Sydney Stern (University of Maryland, Baltimore) | 4B-4 |
Sarah Storer (Princess Margaret Cancer Centre) | P12 |
Nancy Strand (American College of Surgeons) | 2C-3 |
Bettina Suarez Davila (UC San Diego) | P42 |
Megan Sutter (NYU School of Medicine) | 4C-1 |
Ewa Szumacher (Sunnybrook Health Sciences Center/University of Toronto) | Workshop 1, 1B-2, 2A-2 |
Radoslaw Tarkowski (Wroclaw Medical University) | Plenary 3 |
Diane Thai (University of California San Diego) | P71 |
Tracy Torchetti (Canadian Cancer Society) | P10 |
Joshua Tran (UC San Diego) | P44 |
Mario Trejo (University of Arizona Mel & Enid Zuckerman College of Public Health) | 1C |
Sally Trinh (UC San Diego Moores Cancer Center) | P58 |
Mohamed Ugas (Princess Margaret Cancer Centre) | 3A-4 |
Rowan Ustoy (UC San Diego Moores Cancer Center) | P31 |
Carolyn Vachani (OncoLink) | 1B-4 |
Susan Vadaparampil (Moffitt Cancer Center) | 4C |
Bryan Valcarcel (George Washington University) | 1C |
Samantha Van Staalduinen (ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service) | 2A-4 |
Nathan Vanderford (Markey Cancer Center) | 2B-4 |
Claire Verschraegen (The Ohio State University Comprehensive Cancer Center) | 1B-1 |
Milkie Vu (Northwestern University) | 2C-5, 3A-2 |
Ayesha Warsi (Schulich School of Medicine) | 3B-2 |
David Wiljer (University Health Network) | Workshop 1 |
Anissa Williams (Cancer Support Community) | 3A-5 |
Robert Winn (Virginia Commonwealth University Massey Cancer Center) | Plenary 5 |
Kristen Wong (Sunnybrook Health Sciences Centre) | 1B-2 |
Kristen Wynn (Livestrong Cancer Institutes, Dell Medical School) | 4A-1 |
Xingchen (Stars) Xu (UCSD) | P111 |
Yilin Xu (UC San Diego Moore Cancer Center) | P72 |
Danny Yu (Asian Pacific Islander Cancer Outreach Team) | P112, P114 |
WORKSHOPS AND PLENARY PRESENTATIONS
WORKSHOP 1
Essential Skills in Cancer Education Leadership: Leading and Influencing Changes in Cancer Education - a Comprehensive Interactive Virtual Workshop
Ewa Szumacher1, Maria Bishop2, Gilad Amiel3, Krista Dawdy4, Kathleen Heneghan5, David Wiljer6, Jamal Khadar7
1Sunnybrook Health Sciences Centre, Toronto, ON, Canada , 2 University of Arizona College of Medicine, Southern Arizona Veterans Administration Health Care System, Tucson, AZ, USA 3RAMBAM Healthcare Campus, Haifa, Israel, 4Odette Cancer Centre, Toronto, ON, Canada, 5American College of Surgeons, Chicago, IL, USA, 6University Health Network, Toronto, ON, Canada, 7King Hussein Cancer Centre, Amman, Jordan
Abstract: Sound leadership skills in cancer education are required to ensure that health care educators have the necessary skill sets to shape the future of cancer education globally. This intensive 4 hour workshop will aid in the development of core leadership skills for inter-professional health care educators and trainees. This workshop offers - pre and post-workshop mentoring, whereby the participants will have an opportunity to develop leadership projects or ideas, network and share information virtually Goals Translate the principles of leadership into action Utilize change, networking and consensus building to set, align and achieve goals in an inter-professional setting Engage the participants in leadership in cancer education and inspire initiative for change Objectives At the end of the workshop the participants will be better able to: Describe different leadership styles and how they are used in different situations Define the steps needed to initiate change in practice Address the challenges Maximum: 20 participants. Time: 4 hours This virtual workshop offers an international perspective on leadership in medical and allied health disciplines. It is designed to provide both foundational learning and interactive engagement. Workshop activities include short presentations facilitated by international leaders in cancer education from medical and allied healthcare. In addition, case based breakout sessions will provide participants time to engage with each other, and interactive activities with faculty mentors to develop individual leadership projects or ideas participants plan to introduce and implement in their own institutions. Pre-workshop mentors will engage with participants to encourage and develop projects or topics to present during the workshop to help develop ideas through mentorship from the faculty. Following the workshop, online communication with assigned mentors will be available to allow workshop participants to follow up on their projects and enhance scholarship output in the form of manuscript submission to peer reviewed medical education journals.Objectives: the participants shall be able to: Describe different leadership styles and how they are used in different situations Define the steps needed to initiate change in practice Address the challenges and communication gaps Develop productive/effective mentoring relationships and engage in scholarly projects to develop leadership skills necessary for cancer educators including virtual platforms of communication and program delivery.References: Kumar, R. D. C., & Khiljee, N. (2016). Leadership in healthcare. Anaesthesia and Intensive Care Medicine, 17(1), 63-65. Sfantou, D.F, Laliotis, A., Patelaro, A. E., Sifaki-Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of leadership style towards quality of care measures in healthcare settings: a systematic review. Healthcare Weintraub, P. & McKee, M. (2019). Leadership for Innovation in Healthcare: An Exploration. International Journal of Health Policy and Management, 8(3), 138-144. Moilanen, T., Leino-Kilpi, H., Kuusisto, H., Rautava, P., Seppanen, L., Siekkinen, M., Sulosaari, V., Vahlberg, T., & Stolt, M. (2020). Leadership and administrative support for interprofessional collaboration in
WORKSHOP 2
Improving the Experience of Palliative Education by Incorporating Reflection
Sara Graham1, Frank Ferris2, Sydni Howard1, Jessica Geiger1, Kate Dean-Haidet1
1OhioHealth Riverside Methodist Hospital, Columbus, OH, USA, 2OhioHealth, Columbus, OH, USA
Abstract: The purpose of this workshop is to help health professionals find ways to incorporate reflection not only into traditional classroom teaching, but also into daily bedside clinical teaching. Time constraints are often thought of as reasons to be unable to incorporate reflection, and this will be discussed. End of life topics and goals of care conversations are prime areas to consider incorporating reflective practices. Efficacy of reflection, and evidence-based research supporting reflection are often unknown. Reflection is an important part of what we do to decrease burnout and increase resilience, however is rarely a structured part of learner education. Reflection has also been proven to increase comprehension and explore the emotional impact of medicine1. When art is incorporated into learning, it can also be a tool to help learners reflect on past life and learning experiences2. The strongest evidence for effective reflection at this time involves reflective writing3. We will discuss effective evidence-based techniques that have benefitted our learners to increase interaction and retention, discuss ingraining reflection throughout all aspects of education. We will teach utilizing power point and story-telling, and discuss ways in which we see reflection being most beneficial. We will also formulate questions via poll everywhere for examples of reflective questions that may be utilized in formal education sessions. We will structure our integration on reflection into different categories: Incorporating reflection into didactics; Required 5-minute daily reflection; Reflective questions throughout didactics; Daily prompts to help facilitate topic-specific reflection; Bedside/rounding teaching; Learner preferences; Personal experiences with subject matter; Learner experience with patients with similar needs/symptoms; Utilizing debriefing techniques; Reflection paper; Integrating arts and humanities into reflection project. Objectives: Summarize 4 ways to incorporate reflection into learner experience. Utilize known evidence-based techniques to debrief learner experiences during clinical activities. Develop 2 ideas to incorporate reflection into your daily rounding/education References: 1. Winkel AF, Yingling S, Jones A, Nicholson J. Reflection as a Learning Tool in Graduate Medical Education: A Systematic Review. J Grad Med Educ . 2017 Aug;9(4):430-439. 2. Jones EK, Kittendorf AL, Kumagai AK. Creative Art and Medical Student Development: A Qualitiative Study. Med Educ. 2017 Feb;51(2):174-183. 3. Bandini J, Mitchell C, Epstein-Peterson ZD, Amobi A, Cahill J, Peteet J, et al. Student and Facult Reflections of the Hidden Curriculum. Am J Hosp Palliat Care. 2017 Feb;34(1):57-63.
WORKSHOP 3
Student-centered Pipeline to Advance Cancer Careers: SPARCC-ing Solutions to Address Cancer-Related Disparities utilizing the ‘Shark Tank’ Game Show Framework
Kristina Kaljo, Abbey Kruper, Janet Rader
1Medical College of Wisconsin, Milwaukee, WI, USA
Abstract: This workshop will guide participants through a novel approach to engage learners and future cancer researchers in critical public speaking and problem-solving skills. Funded by the National Cancer Institute, Student-centered Pipeline to Advance Cancer Careers (SPARCC) is for undergraduate students historically marginalized in medicine/biomedical research. ‘SPARCC Tank’ was designed with the Shark Tank gameshow framework for students to innovatively address cancer-related challenges. Attendees will implement this framework to develop their own Shark Tank session. ‘Shark Tank’, a popular reality show, has ‘sharks’ or experts determine whether contestants justified solutions to stated problems. Game show-inspired learning(1) motivates individuals due to inherent competition and collaboration common in problem-based learning(2). Grounded in experiential learning(3) and culturally responsive pedagogy(4), this workshop will engage attendees to address cancer-related health disparities and community needs. Simultaneously, this experience will enhance professional development skills of collaboration and public speaking(5) to sway public policy and attain hypothetical funding. Beginning with a ‘stoke’ or ice breaker, participants brainstorm qualities of memorable public speakers and how the audience was engaged. Think-pair-share will encourage comparison of common public speaking strengths and weaknesses and how to foster those among future researchers, policy makers and cancer providers. The facilitators will provide an overview of game show-based learning, its principles, and benefits. Next, using the experiential learning cycle, participants will be guided through the Shark Tank framework with three scenarios of cancer-related health disparities. Small groups will develop innovative solutions and present those to the ‘Shark Tank’, who will determine which group receives the hypothetical funding. Emphasis will be on use of evocative public speaking skills and proposed solution. The large group will debrief after each presentation to highlight presentation strengths. After completing the session, participants will design their own Shark Tank workshop applicable to their home institutions and unique cancer disparities. Objectives: The participant shall be able to delineate and justify key characteristics and qualities of impactful public speakers. The participant shall be able to apply novel game show-based learning strategies and education principles to engage future learners in developing solutions to address cancer-specific health inequities using communication skills/public speaking skills to aid in obtaining hypothetical grant funding. The participant shall be able to design their own tailored ‘Shark Tank’ workshop focused on cancer-related health inequities to immerse learners in various programs relevant to one’s unique community. References: 1. Crocco, F., Offenholley, K., & Hernandez, C. (2016). A proof-of-concept study of game-based learning in higher education. Simulation & Gaming, 47(4), 403-422. 2. Hwang, L.L. (2018) Educational intervention on undergraduate cancer awareness and self-directed learning. Journal of Cancer Education, 33, 592–601. 3. McNatt, D. B. (2019). Enhancing public speaking confidence, skills, and performance: An experiment of service-learning. The International Journal of Management Education, 17(2), 276-285. 4. Kolb, A. Y., & Kolb, D. A. (2005). Learning styles and learning spaces: Enhancing experiential learning in higher education. Academy of Management Learning & Education, 4(2), 193-212. 5. Ladson-Billings, G. (1995). But that's just good teaching! The case for culturally relevant pedagogy. Theory into Practice, 34(3), 159-165.
WORKSHOP 4
Improving Cancer Education programs through innovative Serious Play®
Filipe Santos-Silva
IPATIMUP, Porto, Portugal
Abstract: The success of Cancer Education programs depends largely on patients, emotional, social, and economic contexts, which profoundly affect their health literacy and communication skills. Patients in unfavorable conditions usually present a defensive posture, fearing judgmental attitudes on the part of health professionals and preventing success in the acquisition of information and knowledge. To overcome these difficulties, we propose an innovative methodology (Serious Play®) based upon a concept of participatory practices and co-creation. Serious Play® is a new concept used to facilitate communication and collective problem solving, that could be successfully used to improve cancer education. The methodology is based on many concepts from psychology and behavioral sciences (Piaget and Papert) and offers patients an educational experience (often therapeutic and cathartic) that facilitates cognitive development, emotional expression, and social bonding. The method provides all patients with a shared “language” regardless of culture, academic degree, or social position. The methodology is a facilitated meeting, communication, and problem-solving technique for groups. In the workshop participants will learn the basic concepts and techniques of the Serious Play® Method and how to apply them to the cancer education context. Participants will actively learn about the core process – Question, Construction, Sharing, Reflection – and application techniques – individual and shared models, making connections, building systems – while improving their facilitation skills. he serious aspect of the method requires focusing on a task or challenge, while the play aspect emphasizes imagination and creativity (building a 3D model). Together these components are able to foster a deeper learning engagement. Through the proposed questions, model construction, and associated metaphors, the facilitator can discuss with patients the knowledge and perspectives on a given topic. Models can take on new meanings and, eventually, represent abstract concepts, serving as the basis for group discussion and knowledge sharing. Objectives: Participants shall be able to: Reproduce the 4 phases of the core process of the Serious Play® method. Create a cancer education initiative with at least 2 application techniques of the Serious Play® method. Formulate at least 2 deep questions that will challenge participants to use their imagination and creativity while building 3D models that represent their perception/knowledge about a cancer topic. Manage the sharing of the 3D models and facilitate the discussion of associated metaphors/concepts among participants. Use the 3D models to review the information and knowledge about addressed cancer topics. References: 1- Sean McCusker: Everybody’s monkey is important: LEGO® Serious Play® as a methodology for enabling equality of voice within diverse groups, in: International Journal of Research & Method in Education, Published online: 29 May 2019. https://www.researchgate.net/publication/333468461_Everybody's_monkey_is_important_LEGOR_Serious_PlayR_as_a_methodology_for_enabling_equality_of_voice_within_diverse_groups. 2- Wouters, E.J.M. en J. van Hoof, Professionals’ views of the sense of home in nursing homes: Findings from LEGO SERIOUS PLAY workshops. Gerontechnology Vol. 16, No. 4. https://journal.gerontechnology.org/currentIssueContent.aspx?aid=2526. 3- Play Produces Serious Results by Wendi Dijks, Ph.D., Jillian H. Gilbert, DSL, and Edgar D. Barron, Ed.D., June 14th, 2019, Azusa University Pacific. https://www.apu.edu/articles/play-produces-serious-results/
INVITED WORKSHOP 5
National Institutes of Health (NIH) Diversity-Focused Research Education and Training Programs
Alison Lin1, Tony Beck2, Robert Rivers3,
1NIH/National Cancer Institute, Bethesda, MD, USA, 2NIH/National Institute of General Medical Sciences, Bethesda, MD, USA, 3NIH/National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
Abstract: An important factor contributing to health disparities is the lack of diversity in the pool of well-prepared trainees and well-trained researchers, and the lack of diversity in the health care workforce. Many population groups that bear a disproportionate burden of cancer are also significantly underrepresented in the U.S. biomedical research and health care workforce. For the progress in cancer research to serve and reach all populations requires a research workforce that reflects its communities. NIH and NCI are committed to supporting scientists and trainees from diverse backgrounds and life experiences. This workshop will allow attendees to become aware of NIH research education and training programs and learn about various funding opportunities. This workshop will highlight different NIH R25s and other programs with a focus on enhancing research workforce diversity and describe common themes as well as distinct goals of each program. The NCI R25 Youth Enjoy Science (YES) program supports early intervention research education efforts that engage underrepresented middle schools, high school and undergraduate students and their teachers. The YES is part of NCI’s Continuing Umbrella of Research Experiences (CURE) program which has supported more than 4,000 students and scientists from diverse populations in cancer research. The National Institute of General Medical Sciences (NIGMS) R25 Science Education Partnership Award (SEPA) program funds projects that develop early pipeline workforce development resources for pre-K to grade 12 (P-12) students, teachers, and parents. SEPA supports the entry point for the NIGMS community-college-to senior-faculty component of the NIGMS workforce diversity portfolio. The National Institute of Diabetes and Digestive and Kidney Diseases R25 Program Short-Term Research Experience Program to Unlock Potential (STEP-UP) funds research experiences for high school and undergraduate students to explore opportunities in research. Objectives: The participant will be provided information on NIH research education and training programs focused on enhancing diversity within the biomedical research workforce. The participant will learn about program requirements, understand better the importance of enhancing diversity in research and education efforts, including early intervention approaches, and obtain tips on formulating successful applications. The participant will also learn about funding opportunities for underrepresented trainees along the academic and research career pipeline. The participant will be provided program contact information and be encouraged to contact program officers for further information. References: AACR Cancer Disparities Progress Report 2020: Achieving the Bold Vision of Health Equity for Racial and Ethnic Minorities and Other Underserved Populations. CancerDisparitiesProgressReport.org [Internet]. Philadelphia: American Association for Cancer Research; ©2020. Available from http://www.CancerDisparitiesProgressReport.org/. NIH Science Education Partnership Award (SEPA) (R25), https://grants.nih.gov/grants/guide/pa-files/PAR-20-153.html. Interactive Digital Media STEM Resources for Pre-College and Informal Science Education Audiences, (SBIR), R43/R44), https://grants.nih.gov/grants/guide/pa-files/par-20-244.html. SEPA website: https://nihsepa.org/. Notice of NIH’s Interest in Diversity: NOT-OD-20-031. Available from https://grants.nih.gov/grants/guide/notice-files/NOT-OD-20-031.html
INVITED WORKSHOP 6-1
NCI’s Support of Cancer Education Through the R25 Funding Mechanism: Renewed Commitment
Sergey Radaev
National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
Abstract: The purpose of this Workshop is to provide information on the recently reissued R25 funding opportunities supported by the NCI Center for Cancer Training (CCT). R25 funding opportunities support various types of cancer educational activities that complement and/or enhance the training of a workforce to meet the nation’s biomedical, behavioral and clinical research needs. NCI has used the R25 funding mechanisms continuously for several decades to support cancer-focused educational activities vital to the NCI mission. During these continued years of support a very broad range of participants from various backgrounds have benefited from educational opportunities provided by the NCI R25 educational programs. This Workshop will describe the current NCI CCT R25 programs and provide guidance to prospective applicants to help them prepare competitive grant applications. An overview of the current NCI CCT R25 portfolio, which in Fiscal Year 2020 included 48 competing and non-competing awards with a total cost of over $10 million will be provided. The three recently renewed R25 funding opportunity announcements will be described in detail, namely, Curriculum or Methods Development (PAR-21-065), Courses for Skills Development (PAR-21-066), and Research Experiences (PAR-21-067). The Workshop will provide useful tips for prospective R25 applicants. Examples of ongoing successful R25 programs that have been competitively renewed will be presented by their Principal Investigators. Objectives: At the end of the Workshop the participants should be able to understand differences between the different types of the current NCI R25 funding opportunity announcements (FOAs) and select the most appropriate FOA for their cancer education projects. The participants should be able to use the information provided in the FOA together with the discussed tips and suggestions to prepare competitive R25 applications. References: Ezelle, H.J., Geiman, T., Schnaper, L.A., Cullen, K.J., Lapidus, R.S., Hassel, B.A. A Translational Approach to Cancer Research, Education and Training. J Cancer Educ. 2020 Jan 6:10. PMID: 31907826; PMCID: PMC7384627. Compaore, S., Ouedraogo, C.M., Koanda, S., Haynatzki, G., Chamberlain, R.M., Soliman, A.S. (2016). Barriers to Cervical Cancer Screening in Burkina Faso: Needs for Patient and Professional Education. Journal of Cancer Education, 31(4):760-766. PMID:26336956; PMCID: PMC4779069.
INVITED WORKSHOP 6-2
NCI Awardee Skills Development Consortium (NASDC): Helping NCI-Funded Junior Faculty Succeed in Academic Cancer Research Careers
Mariam Eljanne
National Cancer Institute/NIH, Bethesda, MD, USA
Abstract: This workshop will help attendees identify the National Cancer Institute (NCI) Awardee Skills Development Consortium (NASDC) goal of helping NCI-funded junior faculty succeed in their academic careers. In addition, it will provide information on the topics of the courses supported through this initiative, the eligibility criteria to take NASDC courses, and the timeline for possible reissuance of the NASDC FOAs, in case they wish to apply for future NASDC funding. NASDC was funded by the NCI Center for Cancer Training in 2020 as a pilot collaborative educational initiative that offers a suite of short courses to NCI-funded junior faculty investigators holding various types of "K", R00, R21, and first R01-equivalent awards. This workshop will describe the program, the courses offered, and some program evaluation data so that the attendees can serve as NASDC ambassadors by promoting the NASDC courses to their NCI-funded junior faculty colleagues. The Workshop will provide an overview of NASDC, introduce the four NASDC courses, and highlight the successes and challenges encountered during the first year of the implementation of the Consortium. The initial offering of the NASDC courses has just completed, and although COVID-19 prevented in-person activities, interest in course participation was very high among eligible NCI grantees. Evaluation data from the first round of courses are being compiled and will be presented. Plans to reissue the NASDC funding opportunity announcements in Spring 2022 are under consideration by NCI.Objectives: The workshop participant shall be able to identify the NASDC goal of helping NCI-funded junior faculty succeed in their academic careers. In addition, the workshop attendees will be able to identify the topics of the courses supported through this initiative and the eligibility criteria to take NASDC courses. Workshop participants shall be able to identify the timeline for possible reissuance of the NASDC FOAs, in case they wish to apply for future NASDC funding. References: Loyal J, Porto A, Camenga D. Creating a Program for Junior Faculty Professional Development: A Tool Kit. 2018 Med Ed Portal 14:10703. Pate A, Smith J, Caldwell D, Horace A, Zagar M. Development, Implementation, and Impact of a Collaborative Junior Faculty Engagement and Professional Growth Program: The Young Faculty Leadership Initiative. 2018. Curr Pharm Teach Learn 10:352-359
INVITED WORKSHOP 6-3
Global Cancer Research Education Collaborations: Lessons and Opportunities
Sudha Sivaram, Yelena Shnayder, Marie Ricciardone, Mark Parascandola
National Cancer Institute, Bethesda, MD, USA
Abstract: The purpose of the presentation is to present NCI’s global research training programs and activities. Cancer incidence is increasing in low- and middle-income countries (LMICs), where over 75% of the global cancer burden will occur by the year 2040(1). Primary drivers of cancer risk in LMICs are environmental and behavioral risk factors, inadequate primary and secondary prevention, co-morbidities, and poor access to treatment and palliation. Addressing these complex determinants of cancer in LMICs requires a well-trained workforce that receives cancer research education and experiences to appropriately respond to cancer inequities(2). The Workshop will provide an overview of the current NCI Center for Global Health portfolio which includes institutional training grants (D43), career development awards targeting US investigators (K01) as well as investigators from LMICs (K43) interested in global cancer research. Objectives: At the end of the Workshop the participants should be familiar with the different types of the current NCI global research training funding opportunities and also have an opportunity to share experiences and comments on development of future research training programs. References: Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424 Global Oncology: Formalizing a Career Path in Building a Better World, Sep 2018.
INVITED WORKSHOP 6-4
The Nathan Schnaper Intern Program connects laboratory research and clinical practice in a translation-focused undergraduate summer internship
Bret Hassel1, Heather Ezelle1, Rena Lapidus1, Kevin Cullen1, Lauren Schnaper2
1University of Maryland Greenebaum Cancer Center, Baltimore, MD, USA, 2Greater Baltimore Medical Center, Baltimore, MD, USA
Abstract: Cancer morbidity and mortality are significant health issues in the US and worldwide. Research has advanced our understanding of cancer etiology and has highlighted the essential relationship between the laboratory and the clinic in cancer detection and treatment. Continued progress requires the exposure of aspiring scientists and clinicians to the field of cancer biology at an early stage of their education. Towards this goal, the Nathan Schnaper Intern Program (NSIP) at the University of Maryland Greenebaum Comprehensive Cancer Center (UMGCCC) provides a ten-week summer internship that emphasizes translation of laboratory discoveries into clinical applications. Interns are recruited from undergraduate institutions nationwide. Twenty interns are selected based on academics, references and a personal statement. Minority participation and inclusion of students from institutions that lack strong undergraduate research is emphasized. Intern support is provided to enhance economic, racial, and geographic diversity. Interns participate in an integrated program of hands-on cancer research, cancer biology and clinical oncology. A laboratory techniques course prepares the interns for mentored research in diverse areas of cancer biology. Results are presented in a campus-wide retreat. Educational modules highlight ongoing translational cancer research at the UMGCCC to provide a broad perspective of the bench-to-bedside-and-back continuum. New program components engage interns in current areas of cancer research and care. Interns are exposed to clinical oncology through shadowing UMGCCC clinicians. Each component of the NSIP is critically evaluated through intern, mentor, consultant and external Advisory Board assessments; current outcomes will be presented. The professional paths of graduates are tracked as an important metric of program success. NSIP data are disseminated through presentations at national meetings. UMGCC resources and NSIP educational components comprise an innovative program to inspire the next generation of cancer researchers to pursue careers in the battle against cancer and fill the need for skilled physician-scientists. Objectives: Identify three components of translational cancer research and describe their interrelationships. Provide examples of lab-to-clinic and clinic-to-lab information flow and describe their importance in translational research. Identify educational activities that illustrate the roles of translational research in clinical oncology. References: “ASCO predicts shortage of oncologists as demand grows” Oncology Practice.com March 12, 2014 (http://www.oncologypractice.com/practice-economics/health-reform/single-article/asco-predictsshortageof-oncologists-as-demand-grows/995da42c6562b9cad9d0afa910fae7f1.html).
Tilghman, S. et al., BIOMEDICAL RESEARCH WORKFORCE WORKING GROUP REPORT National Institutes of Health June 14, 2012 (http://acd.od.nih.gov/biomedical_research_wgreport.pdf)
PLENARY PRESENTATION (Plenary 1)
Meaning Centered Psychotherapy for Cancer Patients: Existential and Spiritual Issues in Treating Despair at the End of Life
William Breitbart
Memorial Sloan Kettering Cancer Center , New York, NY, USA
Abstract: This lecture provides an overview of existential issues in end of life care, with an emphasis of the important role of “meaning”. A novel counseling intervention for patients with advanced cancer, entitled “Meaning Centered Psychotherapy (MCP)” will be described and the basic concepts of Meaning Centered Psychotherapy will be described. Objectives: The attendees will become familiar with the concept of spirituality as a construct composed of faith and/or meaning. The attendees will become familiar with the importance of meaning, as a component of spiritual well-being, and its relationship to depression, hopelessness and desire for death. The attendees will become familiar with a structured, didactic and experiential 8 session intervention for advanced cancer patients aimed at sustaining or enhancing a sense of meaning in the face of terminal illness. References: Breitbart W, Rosenfeld* B, Gibson C, Pessin H, Poppito* S, Nelson* C, Tomarken* A, Kosinski Timm A, Berg A, Jacobsen C, Sorger B, Abbey* J, Olden* M. Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psycho-oncology, 19(1): 21-28, 2010. PMCID: PMC3648880. Breitbart W, Poppito* S, Rosenfeld* B, Vickers AJ, Li, Y, Abbey* J, Olden* M, Pessin H, Lichtenthal* W, Sjoberg D, Cassileth BR. A pilot randomized controlled trial of Individual Meaning-Centered Psychotherapy for patients with advanced cancer. J Clin Oncol, 30(12): 1304-1309, 2012. PMCID: PMC3646315. Breitbart W, Rosenfeld* B, Pessin H, Lichtenthal* W, Applebaum* A, Kulikowski J. Meaning-Centered Group Psychotherapy: An effective intervention for reducing despair in patients with advanced cancer. J Clin Oncol, 33(7): 49-754, 2015. PMCID: PMC4334778. Rosenfeld* B, Saracino* R, Tobias K, Masterson* M, Pessin H, Applebaum* A, Brescia R, Breitbart W. Adapting Meaning-Centered Psychotherapy for the palliative care setting: Results of a pilot study. Palliat Med, 31(2): 140-146, 2017. PMCID: PMC5473503. Rosenfeld* B, Cham H, Pessin H, Breitbart W. Why is Meaning-Centered Group Psychotherapy (MCGP) Effective? Enhanced Sense of Meaning as the Mechanism of Change for Advanced Cancer Patients. Psycho-oncology, 27(2): 654-660, 2018. PMCID: PMC5807154. Breitbart W, Pessin, H, Rosenfeld* B, Applebaum* A, Lichtenthal* W, Li Y, Saracino* RM, Marziliano* A, Masterson* M, Tobias K, Fenn N. Individual meaning-centered psychotherapy for the treatment of psychological and existential distress: A randomized controlled trial in patients with advanced cancer. Cancer, 124(15): 3231-3239, 2018. PMCID: PMC6097940.
PLENARY PRESENTATION (Plenary 2)
“In a good way”: Going beyond Patient Navigation to ensure culturally safe care in the cancer system for First Nations, Inuit, Métis, and urban Indigenous patients in Ontario
Amanda Sheppard
Indigenous Cancer Care Unit at Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
Abstract: Many Indigenous peoples use the medicine wheel as a holistic model to depict how all elements of life are inter-connected. It is only recently that some Western systems are making space for incorporating these Indigenous ways. The Indigenous Navigator role, within Ontario Health, models such a method. Navigating the cancer system can be a significant challenge for First Nations, Inuit, Métis and urban Indigenous (FNIMuI) patients. The Indigenous Navigators provide support and advocacy for FNIMuI patients and families by facilitating and coordinating access to cancer services for palliative and supportive care, addressing cultural and spiritual needs, and networking with FNIMuI and non-Indigenous partners to make the cancer journey a culturally safe experience for FNIMuI patients and families. Objectives: To describe the scope and potential of the Indigenous Navigator role in Ontario. Examples of the extent of the role include facilitating traditional healing, providing health literacy assistance, alleviating anxiety, and getting patients to the right support at the right time. We recommend other cancer agencies and health entitles at large implement this or a similar approach towards improving the physical, mental, spiritual, and emotional wellbeing for the Indigenous peoples they support. References: Chiefs of Ontario, Cancer Care Ontario, & Institute for Clinical Evaluative Sciences. (2017). Cancer in First Nations People in Ontario: Incidence, Mortality, Survival and Prevalence. Retrieved from https://www.cancercareontario.ca/sites/ccocancercare/files/assets/CancerFirstNationsReport.pdf. Greenwood, M., de Leeuw, S., & Lindsay, M.N. (2018). Determinants of Indigenous Peoples' Health, Second Edition; Beyond the Social. Canadian Scholars’ Press.
PLENARY PRESENTATION (Plenary 3)
Non-Technical Skills in Cancer Education
Radoslaw Tarkowski
Wroclaw Medical University, Wroclaw, Poland
Abstract: Non-technical skills (or soft skills such as communication with patients and colleagues, team work, decision making in cancer treatment, situation awareness, problem solving, disclosure of medical errors, leadership, and coping with stress) have an immense impact on outcomes such as the effects of treatment, quality of life, and quality of health care professionals and medical students. Although very important, soft skills are rarely addressed in the medical curriculum. In this presentation, the presenter will review non-technical skills of value in several areas of cancer education. Objectives: List a variety of soft skills important to cancer care settings. Describe the impact and value of soft skills in cancer care settings. References: Buckman RA (2005) Breaking bad news: the S-P-I-K-E-S strategy. Commun Oncol 2(2):138–142Yule S, Flin R, Paterson-Brown S, Maran N (2006) Non-technical skills for surgeons in the operating room: a review of the literature. Surgery 139:140–149
PLENARY PRESENTATION (Plenary 4)
Spirituality in Cancer Care and Education
John Peteet
Harvard Medical School and Dana-Farber Cancer Institute, Boston, MA, USA
Abstract: Spirituality is important to most oncology patients, and is a social determinant of cancer prevention and care. As such, it has a number of implications for the both patients and the clinicians caring for them. Objectives: At the conclusion of the presentation, the participant should be able to: identify the themes in patients’ experience of advanced cancer recognize the impact of religiousness and spiritual care on diagnosis and decision-making at the end of life appreciate opportunities and existing resources for education regarding the role of spirituality in cancer care References: Canada AL, et al. Examining the impact of cancer on survivors' religious faith: A report from the American Cancer Society study of cancer survivors-I. Psycho-oncology 2020; 29:1036-1043. Jeuland J, et al. Chaplains working in palliative care: who they are and what they do. J Palliat Med 2017 May;20(5):502-508.
PLENARY PRESENTATION (Plenary 5)
Falling Short: COVID, Cancer, and Consciousness
Robert Winn
VCU Massey Cancer Center, Richmond, VA, USA
Abstract: By viewing health disparities through the lens of social and racial justice, we are able to understand the structural barriers that perpetuate these inequities. Although biology plays a role in all types of cancer, a person's "ZNA," or the zip code where they live, is just as important to consider and may play an even greater role in health outcomes than the genes they were born with. A person's ZNA contributes to whether they have access to clean water, healthy food, accessible transportation and social support systems. Recognizing these underlying issues is the first step toward addressing structural causes of health disparities. It's imperative to ensure that those who live in underserved areas have the same type of treatment and access to medical breakthroughs as those who live in favorable communities. Objectives: After this lecture, the student should be able to: Understand the difference between DNA and ZNA as well as how the two interact. Identify the historical causes and structures that continue to reinforce health disparities to this day. Explain the difference between trust and trustworthiness and why trust in medicine and science matters. References: AACR Cancer Disparities Progress Report 2020. Philadelphia: American Association for Cancer Research; ISBN: 978-1-7347432-0-3. Available from http://www.CancerDisparitiesProgressReport.org/. Campbell, JD, et al. (2017). Comparison of Prevalence and Types of Mutations in Lung Cancers Among Black and White Populations. JAMA Oncol. 3(6):801-809; doi:10.1001/jamaoncol.2016.6108. Tessum, CW, et al. (2019). Inequity in consumption of goods and services adds to racial-ethnic disparities in air pollution exposure. 116(13): 6001-6006; doi: 10.1073/pnas.1818859116. Tessum, CW, et al. (2021). PM2.5 polluters disproportionately and systemically affect people of color in the United States. Science Advances. 7(18); doi: 10.1126/sciadv.abf4491.
PLENARY PRESENTATION (Plenary 6)
Your Role in Spiritual Care: How we ALL address the spiritual care deficit
Petra Sprik
Levine Cancer Institute, Charlotte, NC, USA
Abstract: Spiritual need exists at all stages of the cancer continuum, but a large portion of cancer patients and caregivers never receive the spiritual care they want or need. Everyone in oncology care plays an important part in addressing this deficit: the key is knowing how to identify spiritual distress, and what interventions are appropriate to provide based on your role and training. Together, we can effectively care for patients’ and caregivers’ spiritual needs. Objectives: At the conclusion of the presentation, the participant should be able to define spirituality, spiritual distress, and spiritual well-being describe the prevalence of spiritual distress among oncology patients and caregivers explain ways interdisciplinary workers not specialized in spiritual care can assess and respond to oncology patients’ and caregivers’ spiritual needs, and give examples of ways spiritual care specialists like chaplains meet spiritual needs for patients and caregivers. References: Selman, LE et al. (2018) Patients’ and caregivers’ needs, experiences, preferences and research priorities in spiritual care: a focus group study across nine countries. Palliat Med, 32(1): 216-230. Nolan TS, Browning K, Vo JB, Meadows R, & Paxton RJ. (2020) CE: Assessing and managing spiritual distress in cancer survivorship. American Journal of Nursing, 120(1): 40-47. Soroka JT et al. (2019) Spiritual care at the end of life: does educational intervention focused on a broad definition of spirituality increase utilization of chaplain spiritual support in hospice? J Palliat Med, 22(8): 939-944.
ORAL ABSTRACT PRESENTATIONS
1A-1: A Multilevel, Dual Language Intervention to Promote Colorectal Cancer Screening in Community Clinics: Findings from a Randomized Controlled Trial
Shannon M. Christy1, Steven K. Sutton1, Rania Abdulla1, Carol Boxtha1, Paola Gonzalez1, Lakeshia Cousin2, Aldenise Ewing1, Samantha Montoya1, Diana Lopez3, Tina Beehler4, Julian Sanchez1, Rodrigo Carvajal1, Cathy Meade1, Clement Gwede1
1Moffitt Cancer Center, Tampa, FL, USA, 2University of Florida, Gainesville, FL, USA, 3Suncoast Community Health Centers, Riverview, FL, USA, 4Premier Community HealthCare Group, Inc., Dade City, FL, USA
Abstract: A multilevel, dual language intervention trial with system-level and patient-level components compared the efficacy of the C-CARES intervention (education+fecal immunochemical test [FIT]) vs. the C-CARES Plus intervention (education+FIT+personalized coaching) to promote initial FIT screening, and examined sociodemographic and psychosocial predictors of FIT screening. Participants were ages 50-75 (n = 326), at average CRC risk, not up-to-date with colorectal cancer (CRC) screening, able to read, speak, and understand English or Spanish, and recruited from two federally qualified health center systems. System-level components (e.g., electronic medical record system and reminders) were leveraged. Following informed consent and baseline interview, participants were randomized to either C-CARES or C-CARES Plus and received intervention materials based upon randomization and in the language in which informed consent was performed. The primary outcome was a completed FIT returned up to 1 year post-intervention. Primary outcome analyses were performed using logistic regression. Fifty-nine percent of participants were female, 47% identified as White, and 53% identified as Hispanic/Latino. The majority of participants reported household incomes less than $25,000 (75%) and being uninsured (62%). A total of 225 participants completed FIT screening (69.0% [95% CI: 64.0-74.0%]). There were no significant differences in FIT uptake by intervention arm (70.8% C-CARES vs. 67.3% C-CARES Plus; p = 0.49). FIT uptake was significantly higher among participants who received Spanish-language materials (77.2%) vs. those who received English-language materials (63.2%; p = 0.007). Among those completing FIT screening, 91.1% returned a FIT within 90 days (range: 0-284 days). Access to FIT screening plus low-literacy, language-concordant education matters to promote CRC screening, especially among Spanish-language preferring patients. Clinic systems should consider patients’ language preferences and have available language and literacy relevant patient education. These strategies promote health equity and save lives from a highly detectable, treatable, and beatable cancer. Objectives: The participants will be able to describe: 1) colorectal cancer screening disparities in the United States; 2) components of a multilevel, dual language colorectal cancer screening intervention; and 3) findings in initial FIT screening following a multilevel, dual language colorectal cancer screening intervention. References: American Cancer Society. (2020). Colorectal Cancer Facts and Figures. American Cancer Society. Retrieved 11/2/2020 from https://www.cancer.org/research/cancer-facts-statistics/colorectal-cancer-facts-figures.html. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58:130-160.
1A-2: Adapting a CHA Intervention for a Colorectal Cancer Screening Education Study for African Americans in the Southern United States
Olayemi Matthew1, Matthew Vargas1, Kristin Wallace2, Rima Tawk1, Askal Ali1, Gebre-Egziabher Kiros1, Tifini Austin1, Deloria Jackson1, Cynthia Harris1, Clement Gwede3, John Luque1
1Florida A&M University, Tallahassee, FL, USA, 2Medical University of South Carolina, Charleston, SC, USA, 3Moffitt Cancer Center, Tampa, FL, USA
Abstract: African Americans experience CRC health disparities due to screening underutilization and issues with quality healthcare access. The objective of this study is to test a community health advisor (CHA) intervention for promoting the easily accessible FIT as a priority screening test in an under-screened population. Formative research using focus groups was used to adapt a CHA intervention to increase stool-based CRC screening in African Americans. Recruitment methods for the subsequent behavioral clinical trial include community health centers sending recruitment messages through texts and emails to eligible participants and posting flyers in waiting rooms. The CHA was recruited from community contacts and trained by the researchers with a structured curriculum on various topics like cancer, CRC, CRC screening, health education, skills for conducting motivational interviewing, and maintaining intervention fidelity. The study employs block randomization, stratified by two community health centers, for randomization of study participants. Focus groups generated qualitative data about CRC education, resources, and text messages to better adapt the intervention. The researchers met with each community health center and developed a plan that enables participants to be recruited and followed longitudinally to determine FIT completion. Interested individuals contact the study coordinator to ascertain eligibility, consent to participate and schedule baseline surveys, after which they are randomized into the treatment or control arm. The CHA contacts intervention arm participants to schedule the CRC educational presentation, which is followed by CHA phone calls and text messages. Follow-up surveys are completed at 3 and 12 months. Focus group participants mostly relied on accurate CRC information from their healthcare providers. Negative attitudes to CRC screening were discussed in terms of lack of insurance, fear, embarrassment, and discomfort. Engaging the community is essential for planning and implementation of behavioral research focused on increasing CRC screening by fostering trust. Objectives: The participant shall be able to: Identify preferences for patient education materials on colorectal cancer screening among African Americans in north Florida. Understand how formative research methods can be used to design a community health advisor (CHA) intervention to increase stool-based CRC screening in African Americans. References: Brittain K, Christy SM, Rawl SM. African American patients' intent to screen for colorectal cancer: Do cultural factors, health literacy, knowledge, age and gender matter? J Health Care Poor Underserved. 2016;27(1):51-67. doi:10.1353/hpu.2016.0022. Coughlin SS, Blumenthal DS, Seay SJ, Smith SA. Toward the Elimination of Colorectal Cancer Disparities Among African Americans. J Racial Ethn Health Disparities. 2016;3(4):555-564. doi:10.1007/s40615-015-0174-z
1A-3: Visual Communication Tools that Overcome Literacy, Fear, and Health Equity Issues
Corrine Beaumont
Know Your Lemons Foundation, Bountiful, UT, USA
Abstract: Patients have difficulty understanding their cancer diagnosis. Unfamiliar medical terms, the emotions of facing a health crisis, and the range of options are often reported as overwhelming. Communicating under these circumstances requires addressing the limits of verbal communication, and understanding how well-designed visuals can play a central role in helping educate patients, improving their ability to participate in decisions about their care, and to support caregivers in navigating treatment. Methodology: The “Dandelion Toolkit” was developed in collaboration with patients, and was piloted in 25 cancer clinics in the USA, Turkey, Australia, and Mexico for Metastatic Breast Cancer patients (MBC). A survey was administered to patients and clinicians who used the toolkit to assess knowledge, use of the tool, and gather qualitative data on patient experience. Results found how the toolkit strengthened interactions, and where HCPs integrated, or did not integrate, the toolkit into their practice. Success was measured in terms of patient satisfaction (95%), and if the visuals were seen as useful to HCPs (71%). 18 out of 19 patients who responded to the survey recommended the toolkit to other patients. Clinician survey revealed opportunities for training on the visual communication technique. The average discussion length of patient conversations: diagnosis (33 minutes), treatment plan (26 minutes), and follow-up discussion (20 minutes). The next plan is to revise the training program for HCPs based on feedback and assessment of use, so that the toolkit can be used to its full potential. Impact: Improve patient knowledge and confidence in order to increase patient engagement and support the caregivers in navigating complicated medical information related to diagnosis and treatment options. Objectives: At the end of this session, practitioners will be able to understand how to implement this communication tool in their own clinic, train staff, and improve patient knowledge and the patient experience at the start of their cancer journey. References: D'Aloisio AA, Nichols HB, Hodgson ME, Deming-Halverson SL, Sandler DP. Validity of self-reported breast cancer characteristics in a nationwide cohort of women with a family history of breast cancer. BMC Cancer. 2017 Oct 23;17(1):692. doi: 10.1186/s12885-017-3686-6. Freedman RA, Kouri EM, West DW, Lii J, Keating NL. Association of Breast Cancer Knowledge With Receipt of Guideline-Recommended Breast Cancer Treatment. J Oncol Pract. 2016 Jun;12(6):e613-25. doi: 10.1200/JOP.2015.008508.
1A-4: Intervention suggestions to improve skin cancer prevention among sexual minority men
Rosa Cobian Aguilar, Kelsey Nogg, Kristen Wells, Nicholas Lucido, Dina Koes, Aleigha Binda, Scott Roesch, Heather Corliss, Aaron Blashill
San Diego State University, San Diego, CA, USA
Abstract: Men are at increased risk of developing skin cancer compared to women, and sexual minority men are at greater risk. This qualitative study explored suggestions of sexual minority men who report intentional tanning or no intentional tanning (indoor or outdoor) in the past, on potential skin cancer prevention intervention approaches. Thirty participants (mean age: 27.93 years, SD age: 3.27) were recruited from Community Marketing and Insights, an LGBTQ+ focused U.S. research panel, using purposeful sampling. Participants who identified as gay or bisexual and reported engaging or not engaging in tanning behaviors were included in the study. Multiple theories were used to develop a semi-structured interview guide and interviews were conducted via videoconferencing. As part of the interview, participants provided suggestions for potential skin cancer prevention interventions. Interviews were audio recorded, transcribed verbatim, and coded by study authors using a codebook. Code schemes were used to summarize the data. Participants suggested several intervention strategies including providing the community with statistics on skin cancer rates among LGBTQ groups or by gender, educating on risks, prevention, and symptoms of skin cancer, and sharing testimonials of individuals who have experienced skin damage. Participants recommended that the intervention information be delivered through interactive media such as videos, posts, or advertisements in public places or online and sun-protective products be distributed at social events or gatherings, by an individual from the LGBTQ community who has experienced a skin cancer diagnosis, or a well-known LGBTQ celebrity or Drag Queen who has a large public following. Skin cancer prevention interventions should be educational, non-judgmental, and delivered by someone who is relatable to sexual minority men. The findings of the present study could be used to inform the development of interventions to reduce skin cancer risk behaviors and enhance skin-protective behaviors among sexual minority men. Objectives: The conference audience will be able to identify at least one intervention approach for a skin cancer prevention program and one preference for interventionists to deliver such a program, as suggested by sexual minority men. References: American Cancer Society. Cancer Facts and Figures 2013. http://www.cancer.org/research/cancerfactsfigures/cancerfactsfigures/cancer-facts-figures-2013. Accessed March 23, 2015. Mansh M, Katz KA, Linos E, Chren M-M, Arron S. Association of Skin Cancer and Indoor Tanning in Sexual Minority Men and Women. JAMA Dermatol. 2015;151(12):1308. doi:10.1001/jamadermatol.2015.3126.
1A-5: Adaptations to colorectal cancer screening interventions in Appalachian Kentucky primary care clinics due to COVID-19
Aaron Kruse-Diehr1, Mark Cromo1, Melinda Rogers1, Angela Carman1, Bin Huang1, David Gross2, Sue Russell2, Vickie Fairchild3, Mark Dignan1
1University of Kentucky, Lexington, KY, USA, 2St. Claire Regional Medical Center, Morehead, KY, USA, 3Northeast Kentucky Area Health Education Center, Morehead, KY, USA
Abstract: Primary care clinics in Appalachian Kentucky have been greatly impacted by COVID-19 due to state mandates, health system regulations, and changes in patient preferences. This presentation describes our ongoing colorectal cancer (CRC) screening interventions in these clinics and the processes by which we selected and implemented adaptations due to COVID-19. Through a series of key informant interviews with primary clinic staff and providers, we identified multilevel barriers to CRC screening and presented clinics with a menu of evidence-based interventions (EBIs) from which to choose that addressed CRC screening barriers at patient, provider, and clinic levels. However, shortly after selecting EBIs, clinics experienced numerous changes to workflow and operations due to COVID-19 that necessitated adaptations to the selected EBIs. Through a series of virtual meetings facilitated by members of the research team, clinic champions selected feasible adaptations that could enable continuation of project activities despite limitations due to COVID-19. Clinic staff cited multiple workflow changes that decreased CRC screening, including parking lot visits for most appointments, patient concerns about paper educational tools, and a state-mandated pause in elective procedures—including colonoscopy. From 1st to 2nd quarter 2020, our project clinics reported half the number of in-person visits but 23 times higher telehealth visits. Clinics selected adaptations to project activities responsive to these changes, including providing online CRC screening information, promoting screening via telehealth visits, and prioritizing stool-based tests for average-risk patients. Across project clinics, FIT and FIT-DNA orders increased substantially by the third quarter of 2020. Despite many Appalachian Kentucky clinic providers preferring colonoscopy as a first-choice CRC screening modality, our clinics showed adaptability by promoting stool-based testing for average risk patients. Rural health systems researchers should communicate with clinic staff to identify and address local COVID-19 barriers so clinics can continue to promote CRC screening. Objectives: The participant shall be able to identify methods by which clinics were able to select timely and responsive adaptations to colorectal cancer screening practices as a result of unplanned barriers (i.e., those related to COVID-19). References: Cancino RS, Su Z, Mesa R, Tomlinson GE, Wang J. The Impact of COVID-19 on Cancer Screening: Challenges and Opportunities. JMIR Cancer. 2020;6(2):e21697. Published 2020 Oct 29. doi:10.2196/21697. Nodora JN, Gupta S, Howard N, et al. The COVID-19 Pandemic: Identifying Adaptive Solutions for Colorectal Cancer Screening in Underserved Communities [published online ahead of print, 2020 Aug 11]. J Natl Cancer Inst. 2020;djaa117. doi:10.1093/jnci/djaa117
1B-1: NASDC: a new educational effort for junior NCI grantees
Claire Verschraegen1, Ushma Neill2, Mia Hashibe3, Elizabeth Olson Hexner4, Andrew Fesnak4, Cauleen Noël4, William Pirl5, Jennifer Temel6, Ann O'Connell1, Rebecca Jackson1, Stephan Grupp7, David Mankoff4, Jedd Wolchok2, Kolawole Okuyemi3, Mariam Eljanne8
1The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA, 3University of Utah, Salt Lake, UT, USA, 4University of Pennsylvania, Philadelphia, PA, USA, 5Dana-Farber Cancer Institute, Boston, MA, USA, 6Massachusetts General Hospital, Boston, MA, USA, 7Children's Hospital of Philadelphia, Philadelphia, PA, USA, 8National Cancer Institute/NIH, Rockville, MD, USA
Abstract: The NCI Awardee Skills Development Consortium (NASDC) is a novel, multi-institutional, collaborative, educational project funded by the National Cancer Institute. NASDC will enhance the training of junior NCI grantees and deliver specialized courses to refine their skills in areas that are critical for establishing and maintaining successful independent academic cancer research careers. The long-term goal is to develop the next generation of research leaders to meet the nation’s biomedical, behavioral and clinical cancer research needs. The NASDC started in 2020. NASDC has a Coordinating Center (U24 mechanisms, (RFA-CA-19-011)) to support logistics and evaluations; and short courses (UE5 mechanism, (RFA-CA-19-010)). NASDC leadership (NCI, U24, and UE5s) meet regularly to develop the new consortium's infrastructure. Courses are innovative, state-of-the-art, and deliver evidence-based scientific and educational content. Participants apply for these courses through the NASDC portal (nasdc.osu.edu). Evaluations are collected for all courses and participants. Infrastructure includes a web portal with a public site and a restricted site for storage of curricula and evaluation data. A steering committee and 5 working groups, each with a specific charter, attend to the portal, the recruitment of participants, curriculum review, evaluations, and publications. As of May 2021, four courses were taught to participants. Of 495 eligible individuals, 134 (27%) applied and 83/134 (62%) were selected to attend a course. First evaluations are yielding very supportive preliminary data that will be reported at the meeting. The success of junior grantees will be compared to national known metrics. NASDC will impact NCI junior grantees in various fields and teach leadership skills and cutting edge technologies needed for the next grant applications. Trainees must be first time recipients of “K” career development mechanisms, R00, R21, and first R01-equivalent awards. An in-depth evaluation survey assess specific outcomes of success. Objectives: The participant shall be able to build at least one new skill in their research area that will benefit their future research projects. References: NCI Paylines Drop as Grant Applications Climb. Cancer Discov, 2019. National Health Service Institute for Innovation and Improvement, Lean Six Sigma:Some Basic Concepts. 2017. Austin, P.C., N. Jembere, and M. Chiu, Propensity score matching and complex surveys. Tufts Clinical and Translational Science Institute, Common Metrics Implementation:Implementation Guide. 2017.
1B-2: Perceptions of Canadian radiation oncologists, radiation physicists, radiation therapists and radiation trainees about the impact of artificial intelligence in radiation oncology – national survey
Kristen Wong, Francois Gallant, Ewa SzumacherSunnybrook Health Sciences Centre, Toronto, ON, Canada
Abstract: Artificial Intelligence (AI), although already being used in practice, is continuously progressing into the Radiation Oncology field, potentially changing how radiation professionals interact with both patients and other professionals in the field. This study investigated radiation oncology professionals' perceptions of AI, and how AI will affect the radiation oncology specialty. Following an in-depth scientific review of existing literature, a 29 Likert-scale questionnaire was developed using Google Survey. The questionnaire was piloted and distributed through national organizations including the Canadian Association for Radiation Oncology (CARO), the Canadian Association of Medical Radiation Therapy (CAMRT) and the Canadian Organization of Medical Physicists (COMP), initially in February, and again March 2020. Radiation oncologists, radiation therapists, medical physicists and radiation trainees voluntarily participated in this study. 159 responses were received from 10 Canadian provinces. Knowledge about AI was moderate, with an average of 5/10, but 91% responded interest in learning more about it. The negative implications of AI were related to fear of losing jobs and shift of practice. 84% percent of the respondents agreed additional training for the use of AI should be mandatory regardless of years of experience. The majority of participants agreed AI would positively impact patient treatment. This work has been published in the Journal of Medical Imaging and Radiation Sciences (JMIRS). Radiation oncology professionals believe AI will be an important part of patient treatment in their future practices. The fear about AI may be mitigated with further education programs about AI, which can gain more confidence in acceptance of AI. Objectives: The participant will be able to identify three current attitudes and perceptions held by radiation oncology professionals towards artificial intelligence. As this was a pilot study, the scope of the study was very broad to get a general understanding of the perceptions of AI from radiation oncology professionals which can be used to conduct future studies in the future which may be more targeted. References: Thompson, R. F., Valdes, G., Fuller, C. D., Carpenter, C. M., Morin, O., Aneja, S., Thomas, C. R. (2018). Artificial intelligence in radiation oncology: A specialty-wide disruptive transformation? Radiotherapy and Oncology,129(3), 421-426. doi:10.1016/j.radonc.2018.05.030, Xiang, Y., Zhao, L., Liu, Z., Wu, X., Chen, J., Long, E., Lin, H. (2020). Implementation of artificial intelligence in medicine: Status analysis and development suggestions. Artificial Intelligence in Medicine, 102, 101780. doi: 10.1016/j.artmed.2019.101780
1B-3: Learning in 360 Degrees: The use of Virtual Reality for Radiation Therapy Patient Education
Merrylee McGuffin1, Brian Liszewski2, Krista Dawdy3, Lisa Di Prospero3, Wing Yan Lai1, Fahad Alam1
1Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 2Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada, 3Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
Abstract: External beam radiation therapy (EBRT) is not well understood by the cancer patient population. This lack of understanding can increase treatment-related anxiety. Virtual Reality (VR) is increasingly being used to manage anxiety in medical settings. This study examined whether a VR video of EBRT could help decrease patient anxiety. The study population included patients having EBRT to the pelvis. Patients with vertigo or prior EBRT were excluded. Participants were randomly assigned to control or intervention arms. All participants completed the National Comprehensive Cancer Network’s Distress Thermometer (DT) as a pre-intervention assessment of anxiety and then received standard patient education. Participants in the intervention arm also watched the VR video. All participants completed a post-intervention DT and a modified Cancer Treatment Survey (CaTS). Descriptive statistics were calculated for all variables of interest. The primary endpoint of pre-post anxiety between groups was assessed using two-tailed paired t-tests. All participants were accrued from a large, metropolitan cancer centre. 56 patients were approached, 40 consented and 3 withdrew. 19 participants were assigned to the control and 18 to the intervention arm. Mean pre-intervention anxiety levels on the DT scale (0-10) were low in both the control (X=2.41,SD=2.33) and intervention arms (X=2.31,SD=2.25). The difference between pre and post-intervention anxiety was not significant in the control arm (X=2.05,SD=2.21,p=0.77) but was significantly different in the intervention arm with post-intervention anxiety being significantly lower (X=1.32,SD=1.38,p=0.02). Responses to Likert scale questions on the CaTS showed similar levels of satisfaction with education received. Participants in the intervention arm reported significantly less anxiety following the VR video. This suggests that VR could be a valuable tool for patients dealing with treatment-related anxiety. We are currently exploring whether viewing the VR video earlier in the care pathway will further decrease anxiety in this patient population. Objectives: The participant shall be able to explain how Virtual Reality can be used to reduce patient anxiety prior to radiation therapy treatment. References: Gao J, Liu S, Zhang S, Wang Y, Liang Z, Feng Q, Hu M and Zhang Q. Pilot Study of a Virtual Reality Educational Intervention for Radiotherapy Patients Prior to Initiating Treatment. Journal of Cancer Education. 2020. https://doi.org/10.1007/s13187-020-01848-5. Ahmad M, Mohammad EB and Anshasi HA. Virtual Reality Technology for Pain and Anxiety Management among Patients with Cancer: A Systematic Review. Pain Management Nursing. 2020. 21(6): 601-607. https://doi.org/10.1016/j.pmn.2020.04.002
1B-4: Incentivizing Workflow Change to Increase Patient Education in Radiation Oncology
Carolyn Vachani1, Karen Arnold-Korzeniowski1, Abigail Neff2, Christina Bach1, Marisa Healy1, Margaret Hampshire1, Alexander Rodriguez1, Courtney Misher1, James Metz1, Christine Hill-Kayser1
1OncoLink, Philadelphia, PA, USA, 2Penn Medicine, Philadelphia, PA, USA
Abstract: Patient education is a primary function of nursing practice in radiation oncology. However, nurses often do not document this activity so there is no record of when, how, or what materials are being provided. To address these issues, we developed an application within our electronic medical record (EMR) to provide patient education and save it to the chart. It also encourages nurses to provide education by making the tool easily accessible and streamlining the process. The goal of this project was to increase nurse-driven patient education using the application. This represented a change in workflow. To support this change, we launched a 4 week “Education Madness” competition across 9 radiation sites at Penn Medicine. The goal set for each location was to provide education via the application to 85% of patients being seen on treatment. We identified champions at each location to provide workflow tips and encouragement for new users. Baseline use was an average 79 documents created per week across all sites. During the competition, this number increased to 294 per week. To keep the momentum going, weekly status reports were sent. An environment of collegial competition appeared to incentivize use. Some teams far exceeded the 85% goal, with a range of 34%-111% for all sites. A few teams did not increase use at all. At the end of the competition, we continued to track use to see if the changes to workflow continued. Overall use continues to be high but is trending down (average 222 documents per week). A competition to create excitement about a workflow change increased use of this EMR-based patient education application; some teams were not responsive to the competition. Going forward, we will continue to provide training and workflow discussions. We continue to track statistics for nursing management to aid in increasing use. Objectives: The participant shall be able to recognize the benefit of incentives to encourage change in workflow. References: Vaartio-Rajalin, H., Huumonen, T., Iire, L., Jekunen, A., Leino-Kilpi, H., Minn, H., & Paloniemi, J. (2015). Patient education process in oncologic context: what, why, and by whom?. Nursing research, 64(5), 381-390. Warren, L. E., Kim, M. B., Martin, N. E., & Shih, H. A. (2016). Analysis of after-hours patient telephone calls in two academic radiation oncology departments: An opportunity for improvement in patient safety and quality of care. Journal of oncology practice, 12(4), e487-e494. See, M. T. A., Chee, S., Rajaram, R., Kowitlawakul, Y., & Liaw, S. Y. (2020). Missed nursing care in patient education: A qualitative study of different leve
1B-5: Refreshing a cancer centre's website to support navigation
Nicole Liscio, Meredith Giuliani, Tina Papadakos
Princess Margaret Cancer Centre, Toronto, ON, Canada
Abstract: To improve the experience of a Toronto Cancer Centre's website, a two-part evaluation is underway. Last year, a health literacy audit was completed, indicating a strong need for plain language editing of the site content. This year, content organization is the focus, with the aim to redesign the homepage and help people find what they need. One challenge of organizing web content at an academic health centre is the need to consider many stakeholder groups. Card sorts and tree tests are well-established tools to support website development with stakeholder engagement. Like other modes of communication for patients and the public, websites need to be usable, straightforward and clear. This project endeavours to redesign the homepage primarily to help patients and families, but also for family physicians making referrals, collaborators, potential students, clinical staff and researchers. Testing has been completed with a mixed group of stakeholders, including 25 patients. Findings will be used to inform content organization and redesign efforts to improve the navigation of the website. The findings will be considered together with web best practices and data from an environmental scan of websites for equally complex audiences from healthcare and other industries. A key resource for the public, the Princess Margaret website must meet its users’ needs. The website can be used to promote trusted information and improve health outcomes. Assessment data will help clarify user demographics, focus improvements, and ensure that users can find what they need when they need it. Objectives: The participant shall be able to: Describe a process for performing an environmental scan and baseline assessment for the purposes of improving digital products (like websites). Discuss the ways in which the principles of user experience and information organization could be employed in their own work to improve the digital experience. References: Shoemaker SJ, et al. Patient Educ Couns 2014;96(3):395-403. Ngyuen MH, et al. Eur J Cancer Care. 2019;28(1):e12882. Faller H, et al. CJ Cancer Surviv. 2016;10(1):62-70. Nelissen S, et al. Health Info Libr J. 2015;32(2):107-19. Fitch M. Canadian Oncology Nursing Journal. 2008;18(1):6-14.
SYMPOSIUM 1C: Mentoring for Professional Cancer Education of Graduate Students in Special Populations
Amr Soliman, Robert Chamberlain
City University of New York School of Medicine, New York, NY, USA
This aim of the 90-minute session is centered around mentoring of public health graduate students in their research in special populations (global and minority populations in the U.S). The session will include global mentors, domestic mentors, and students who participated in the Cancer Epidemiology Education in Special Populations (CEESP) Program. CEESP has been funded by an R25 grant from the National Cancer Institute since 2006 (R25CA112383) to train public health graduate students in cancer research in special populations. The session will include 3-minute comments/presentations by each participating student and mentor about his/her experience as a mentor or mentee and recommendations for optimizing the mentoring experience. The moderators will summarize the presentations, conclude themes and areas for improvement, and outline future directions for improving learning in cancer education and mentoring in this program and others focused on research training and cancer education in special populations.
2A-1: Using professional video interpretation to enhance patient education for radiation therapy patients with limited English proficiency
Carmen Chan, Ruby Bola, Aaron Cumal, Darby Erler, Mikki Campbell
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Abstract: Language barriers in the healthcare setting are linked to less health education, lower interpersonal care and lower patient satisfaction. The purpose of this quality improvement project was to investigate alternate methods to enhance patient education for patients receiving radiation therapy with limited English proficiency (LEP). At the time of the project, professional over-the phone interpreters were used infrequently and LEP patients relied heavily on family members or bilingual staff members to be ad hoc interpreters. A needs assessment was conducted by surveying staff about their perspectives on current LEP education practice coupled with semi-structured interviews. Patients were surveyed to determine their comfort in communicating with their treatment team and preferred interpretation methods. After collating the results of the needs assessment and examining interpretation options, professional video interpretation was implemented in February 2020. Interpreter usage has been tracked and post-implementation evaluation conducted with staff and patients. According to the staff survey (n=69), professional over-the-phone interpreters were used least at 8% compared to other methods. Family members (59%) and bilingual staff (62%) are most commonly used for convenience. Patient surveys (n=12) indicated that the preferred interpretation methods for daily interactions were bilingual staff members (35%), professional face-to-face interpreters (30%), and family members (22%). With the implementation of professional video interpretation, professional interpreter usage increased two-fold after COVID-19 visitor restrictions were enforced. Positive feedback has been received by both patients and staff. Sustainability will be addressed by embedding video interpretation education into new staff orientation. Video interpretation is a convenient tool that allows the healthcare team to use professional interpreters to communicate with patients virtually face-to-face and accurately provide education in their preferred language. Sharing project data with policy makers and communication services will inform wider implementation within the organization and community. Objectives: The participant should be able to: Identify at least four consequences of language barriers in the healthcare setting; Compare usage of professional interpreters before and during COVID-19 pandemic. References: Herzberg, E. M., Barrero-Castillero, A., & Matute, J. D. (2021). The healing power of language: Caring for patients with limited English proficiency and COVID-19. Pediatric Research. https://doi.org/10.1038/s41390-021-01487-6. Perez, G. K., Mutchler, J., Yang, M. S., Tree-Mcgrath, C. F., & Park, E. R. (2016). Promoting quality care in cancer patients with Limited English Proficiency: Perspectives of medical interpreters. Psycho-Oncology, 25(10), 1241–1245. https://doi.org/10.1002/pon.4176.
2A-2: Patient engagement in the continuing professional development programs within the Department of Radiation Oncology at the University of Toronto (UTDRO): a qualitative study
Nayanee Henry-Noel1, Morag Paton1, Rebecca K.S. Wong2, Allia Karim3, Hany Soliman4, Lisa Di Prospero5, Nicole Harnett6, Carlo DeAngelis5, Chaitali Desai4, David Wiljer7, Tamara Harth5, Ewa Szumacher4
1University of Toronto, Toronto, ON, Canada, 2Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada, 3Reserca, Toronto, ON, Canada, 4Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 5Sunnybrook Odette Cancer Centre, Toronto, ON, Canada, 6Princess Margaret Cancer Centre, Toronto, ON, Canada, 7University Health Network, Toronto, ON, Canada
Abstract: Patient engagement (PE) in medical education benefits healthcare providers and patients. Limited research exists on PE in radiation oncology continuing professional development (CPD) programs. This study aims to understand barriers/enablers to PE design, and advance PE design and implementation in University of Toronto Department of Radiation Oncology (UTDRO) CPD programs. A qualitative study was conducted. Seventeen semi-structured interviews with 5 cancer patients and 12 educators were conducted from June 2019 to April 2020. Interview data was used to identify common themes such as: the current state of PE in CPD programming, and key barriers and recommendations on how to engage patients in meaningful and practical ways. Educators and patients were unaware of any patient engagement strategies in the design and implementation of UTDRO CPD programs. Six themes were identified related to PE: the concept of PE, ethical considerations, barriers, key considerations in planning resources and anticipated impact of PE on curriculum planning. Both patients and educators emphasized that creating and sustaining meaningful educator-patient relationships and giving patients an active and effective role in CPD planning would improve curriculum content. The UTDRO should consider building this initiative into its strategic CPD priorities and ensure the appropriate infrastructure is in place. To engage in meaningful collaboration, the university should establish guidelines related to role clarity and expectations for both educators and patients. Objectives: The participant shall be able to identify two barriers to patient engagement. The participant shall be able to identify two recommendations on how patients can be meaningfully engaged in continuing professional development planning. References: Rowland P, Anderson M, Kumagi AK, McMillan S, Sandhu VK, Langlois S. Patient involvement in health professionals’ education: a meta-narrative review. Adv Health Sci Educ. 2019; 24(3):595-617. Domecq JP, Prutsky G, Elraiyah T, Wang Z, Nabhan M, Shippee N, Brito JP, Boehmer K, Hasan R, Firwana B, Erwin P, Eton D, Sloan J, Montori V, Asi N, Abu Dabrh AM, Murad MH. Patient engagement in research: a systematic review. BMC Health Serv Res. 2014;14(89):1-9.
2A-3: Patient Education in Unprecedented Pandemic Times
Karen Lawrie, Eleni Giannopoulos, Naa Kwarley Quartey, Janet Papadakos
Princess Margaret Cancer Centre, Toronto, ON, Canada
Abstract: Patient education is vital in reducing anxiety, increasing satisfaction with treatment, helping with self-management and creating a sense of control for cancer patients.1 Patients access much of their material from health care providers through in-person visits, patient libraries and in-person classes. Due to reductions in in-person visits throughout the pandemic, we sought to understand how patient education programs have responded under varying levels of COVID-19 restrictions to meet the information needs of patients and families. A cross-sectional survey was developed and was distributed to members of the Cancer Patient Education Network (CPEN) and the Health Care Education Association (HCEA) via the respective listservs (n=525). The survey consisted of five sections that included closed and opened questions. Participants were asked questions to describe their patient education programs, how their duties were affected during the pandemic, changes to program activities and the distribution of materials. Sixty-four people completed the survey (n=64) with a 12% response rate. Descriptive statistics were used to summarize survey responses. The most common responses to what percentage of your time is dedicated to patient education was 100% (N=21, 27%) followed by >25% (N=20, 26%). Many respondents indicated changes in daily activities, including COVID-19 related committee work (N=15, 79%) and development of COVID-19 related patient education materials (N=10, 63%). Respondents reported that distribution of hard copy print materials changed with clinical staff distributing these materials (N=9). Most respondents reported changes in the delivery of patient education classes (N=18, 95%) to virtual/online platforms. COVID-19 has ushered in a new era in the delivery of patient education with the rapid deployment of digital cancer patient education2. Results will provide recommendations for adapting to meet the needs of patients during the current pandemic, and inform future directions for the delivery of patient education post-pandemic. Objectives: The participant shall be able to identify ways that patient education programs have adapted and responded to the changing COVID-19 landscape. The participant shall be able to use the summarized information to institute changes, if needed, to provide cancer patients with patient education materials during the current pandemic and beyond. References: 1. Jivraj N, Gallagher LO, Papadakos J, Abdelmutti N, Trang A, Ferguson SE. Empowering patients and caregivers with knowledge: The development of a nurse-led gynecologic oncology chemotherapy education class. Can Oncol Nurs J. 2018;28(1):4-7. Published 2018 Feb 1. doi:10.5737/2368807628147. 2. Giuliani M, Papadakos T, Papadakos J. Propelling a New Era of Patient Education into Practice-Cancer Care Post-COVID-19. Int J Radiat Oncol Biol Phys. 2020;108(2):404-406. doi:10.1016/j.ijrobp.2020.05.036
2A-4: ReGenerate: a cancer survivorship app for adolescents and young adults (AYA)
Samantha Van Staalduinen1, Andrew Murnane1, Greg Bowtell2, Jordan Beth Vincent3, Kate Thompson1
1ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia, 2School of Information Technology, Faculty of Science Engineering & Built Environment, Deakin University, Burwood, VIC, Australia, 3Fika Entertainment, Deakin Research Innovations, Burwood, VIC, Australia
Abstract: AYA survivors are reported to experience a range of poor outcomes including higher rates of obesity and physical morbidity, lower educational achievement, and higher rates of anxiety and depression. Digital health interventions are one approach to supporting young people’s long-term health and wellbeing whilst overcoming traditional barriers to care. This project sought to develop and pilot an app that provides AYA-specific post-treatment education and tools to help support young people’s transition to life after cancer. App development was undertaken as a partnership between AYA specialist clinical, academic and commercial creative entities. A co-design approach with young people was adopted, incorporating brainstorming, design sprint and collaborative content development activities. The result was nine educational modules each comprising interactive text, videos and youth-hosted podcasts, integrated with tools and features to support self-management. Useability, feasibility and acceptability of the app for Australian AYA cancer survivors aged 15-25 is being explored through a mixed methods pilot study (preliminary results to be presented) prior to national rollout. Further research focusing on refinement of the tools and features component of the app is under development and alternative modes of delivery such as progressive web apps or interactive websites are being explored to inform plans for future versions. Whilst there is a growing body of survivorship literature and opportunities for peer connection and support, there remains a dearth of youth-specific information on cancer survivorship. To our knowledge ReGenerate is the only current mobile app specifically targeting the unmet information needs of AYA cancer survivors. Objectives: The participant shall be able to: Identify at least two activities for program co-design with young people; Describe at least two examples of integrating educational design principles with mobile health app design; Evaluate based on initial pilot data the useability, feasibility and acceptability of an app for AYA cancer survivors References: Jones JM, Fitch M, Bongard J, Maganti M, Gupta A, D'Agostino N, Korenblum C. The Needs and Experiences of Post-Treatment Adolescent and Young Adult Cancer Survivors. J Clin Med. 2020 May 13;9(5):1444. doi: 10.3390/jcm9051444. Devine KA, Viola AS, Coups EJ, Wu YP. Digital Health Interventions for Adolescent and Young Adult Cancer Survivors. JCO Clin Cancer Inform. 2018 Dec;2:1-15. doi: 10.1200/CCI.17.00138. Puthenpura V, Marks AM. Clinical Application of Digital Technologies in Adolescent and Young Adult Oncology Supportive Care. J Adolesc Young Adult Oncol. 2021 Apr;10(2):127-130. doi: 10.1089/jayao.2020.0153. Epub 2020 Dec 9.
2A-5: Adaptation of the ÁRBOLES Familiares Training Program for Hereditary Breast and Ovarian Cancer: Lessons Learned Transitioning from Hybrid to All Virtual Format
Kristi Graves1, Jennifer Garcia2, Larisa Caicedo3, Jennifer Ulloa4, Katherine Lopez1, Waleska Santiago-Datil2, Lina Jandorf4, Allison Wheeler1, Laura Moreno2, Susan T. Vadaparampil2
1Georgetown University, Washington, DC, USA, 2Moffitt Cancer Center, Tampa, FL, USA, 3CS Consulting, McLean, VA, USA, 4Icahn School of Medicine at Mount Sinai, New York, NY, USA
Abstract: In the ÁRBOLES Familiares training program, we train bilingual (English/Spanish) community outreach professionals working with Latinx communities to identify and refer individuals at increased risk of hereditary breast and ovarian cancer (HBOC). Our original program consisted of a 2.5 day in-person training flanked by online modules. In response to the COVID-19 pandemic, we transitioned to a completely virtual training program. We share lessons learned and initial outcomes. Adapting ÁRBOLES for virtual delivery included a focus on cultural and linguistic preferences of bilingual (Spanish/English) trainees. We mapped the training content, adapted sessions for online delivery, reviewed materials that could be shared electronically or via mail, and created skill building activities amenable to virtual implementation. We invited trainees from a postponed 2020 hybrid workshop to attend the virtual training or defer to a future in-person training; we also conducted additional national recruitment. Our adapted virtual program consists of 8 sessions (5 synchronous; 3 asynchronous): welcome/overview, genetics 101, family history, genetic counseling and testing, community communication strategies, risk assessment and navigation, an Action Project and wrap-up celebration. Of 32 trainees in the postponed 2020 cohort, 17 opted to participate virtually and we recruited 28 additional individuals (N=45 total cohort). In 4 sessions to date (2 synchronous, 2 asynchronous), lessons learned included: additional time for questions and hands-on activities (e.g., taking a family history), reminders to use mailed materials (e.g., whiteboard for pedigree activity) and virtual ‘office hours’ with training faculty and team members. Trainees’ engagement in virtual training is high: robust participation, numerous questions, and frequent use of the WhatsApp group. Future virtual training will include extended time for synchronous sessions and drop-in office hours. Virtual training of complex topics related to HBOC is possible, with strong trainee participation and retention. Objectives: The participant shall be able to identify challenges and solutions to adaptation of a training program for bilingual health educators, patient navigators and community health workers from a hybrid model (in-person and online) to completely virtual. References: Guan Y, McBride CM, Rogers H, Zhao J, Allen CG, Escoffery C. Initiatives to Scale Up and Expand Reach of Cancer Genomic Services Outside of Specialty Clinical Settings: A Systematic Review. Am J Prev Med. 2021 Feb;60(2):e85-e94. doi: 10.1016/j.amepre.2020.08.029. Epub 2020 Nov 7. PMID: 33168338; PMCID: PMC7855907. Jones T, Trivedi MS, Jiang X, Silverman T, Underhill M, Chung WK, Kukafka R, Crew KD. Racial and Ethnic Differences in BRCA1/2 and Multigene Panel Testing Among Young Breast Cancer Patients. J Cancer Educ. 2021 Jun;36(3):463-469. doi: 10.1007/s13187-019-01646-8. PMID: 31802423; PMCID: PMC7293107.
2B-1: Developing Cancer Education for Rural Alaska Native Youth
Katie Cueva, Jennifer Schmidt
University of Alaska Anchorage, Anchorage, AK, USA
Abstract: Cancer is the leading cause of death for Alaska Native people, who are disproportionately burdened, both by cancer mortality and incidence, as well as associated risk factors. However, these disparities are not intractable. Education and health promotion efforts have the potential to alleviate disparities and reduce cancer risk factors among Alaska Native people. Under the guidance of a community advisory board, a culturally relevant online curriculum has been developed for teachers to use with youth in the region, and includes lessons with videos and activities on tobacco, alcohol, what is cancer, cancer diagnosis and treatments, cancer and the environment, physical activity, healthy eating, sun exposure, HPV, cancer data, and screening exams. The cancer education curriculum has been piloted at the Kotzebue Middle High School. Youth engaged in the project have created their own videos on how the curriculum has been an innovation in their schools. They have interviewed teachers who have piloted the curriculum including in education, health, and PE classes. They have also worked with the community advisory board to understand the cultural significance of the project and its' relationship to traditional Inupiat values. We will share information from the community advisory board, young people, and instructors on how the curriculum has been used, what plans are for next steps, and what impact the project has had. This project has created a culturally relevant way of disseminating cancer education to Alaska Native young people in rural Alaska, potentially empowering the younger generations to make changes for themselves and their families to alleviate cancer disparities impacting their communities. Objectives: The participant shall be able to list culturally relevant cancer education strategies developed for youth in rural Alaska. The participant shall be able to identify ways the developed curriculum has impacted youth References: S. H. Nash and D. G. Redwood, “Potentially Preventable Cancers Among Alaska Native People,” Cancer Health Disparities, vol. 2, Jan. 2018. Melkonian SC, Weir HK, Jim MA, Preikschat B, Haverkamp D, White MC. Incidence and trends of the leading cancers with elevated incidence among American Indian and Alaska Native populations, 2012–2016.external icon American Journal of Epidemiology 2020.
2B-2: A Community-Academic Partnership’s Evaluation of Art Exhibitions to Increase Community Readiness to Address Cancer in an Urban American Indian Northern Plains Community
Regina Idoate1, Tammi Owens2, Aislinn Rookwood1, Mark Gilbert2, Bobbie McWilliams-Leesley1, Mariah Abney1, Hannah Butler Robbins1
1University of Nebraska Medical Center, Omaha, NE, USA, 2University of Nebraska at Omaha, Omaha, NE, USA
Abstract: American Indians in the Indian Health Service Northern Plains region experience higher death rates for multiple cancers compared to American Indians in other regions. One community in this region participated in a community readiness assessment that found a low level of readiness to address cancer and little knowledge about community efforts and resources to address cancer. We evaluate this community's strategic approach of employing the arts to share visuals and stories that present information about cancer to improve readiness. We describe a unique partnership between a cancer research education program, a university library, a public school’s Title VI Indian Education program, and local artists that facilitated co-curation of four public art exhibitions that promoted awareness of community resources and efforts to address cancer in this urban American Indian community. Field notes, observations and surveys associated with these exhibitions were triangulated to evaluate the creation and showing of these exhibitions. Four art exhibitions, Portraits of Care, Buckskin Buddies, Suzanne’s Story and The Body and Mind of Cancer, engaged students, educators and local community in cancer education. For each of the four exhibits, we conducted a focus group with one curator, one presenting artist, one educator and one community member who attended the exhibit to assess how much community knowledge and attitudes towards cancer may have changed as a result of the exhibitions. Community-academic partnerships that employ culturally relevant approaches to share cancer information have potential to improve community readiness to address cancer in diverse communities. Engaging community in the creation and exhibition of art is a promising practice for raising urban American Indian communities' knowledge of cancer and awareness of cancer resources and efforts. Objectives: The participant shall be able to examine relationships among art, cancer, community and American Indian culture and spirituality. The participant shall be able to behold and explore the meaning and purpose in cancer-related artworks created by American Indian community members. The participant shall be able to identify individuals who could contribute to a strong art-based community-academic partnership. The participant shall be able to recognize ways to apply the arts in implementation of stage-specific strategies to increase community readiness to address cancer. References: Drawson, A. S., Toombs, E., & Mushquash, C. J. (2017). Indigenous research methods: A systematic review. International Indigenous Policy Journal, 8(2). Chemi, T., & Du, X. (Eds.). (2018). Arts-based methods in education around the world. River Publishers.
2B-3: Healing the Soul, Healing the Whole: A Traditional American Indian Approach for Cancer Survivors
Fatima Molina1, Teshia Solomon2, Miguel Flores3, Desiree Jones1
1Native American Research and Training Center, Tucson, AZ, USA, 2University of Arizona, Tucson, AZ, USA, 3Holistic Wellness Counseling & Consultant Services, Tucson, AZ, USA
Abstract: The lack of research documenting American Indian traditional healing practices results from a variety of influencing factors, including colonialism and establishing standard ethical protocols for obtaining medical data in cultural environments. Historically, American Indian tribes have implemented cultural healing techniques incorporating traditional medicine derived from natural herbs, plants, and minerals. These indigenous communities relied heavily on the healing properties of naturally derived remedies that could cure or treat symptoms and illnesses. This was an experiential workshop that provided American Indian traditional healing, guidance, and support to cancer survivors. The program provided survivors, who were at different stages of treatment, with American Indian traditional medicine as an alternative or additional healing processes to their Western medical treatment. Services offered through the program included working with clay, mask making, storytelling, talking circles, smudging, and traditional ceremonies. An evaluation was conducted to measure beneficial elements of the program and the impact of the traditional American Indian practices implemented. Qualitative surveys were distributed twice to participants of the program. The outcome of program was to improve overall health outcomes of cancer survivors. Plans to incorporate this model were discussed with Tribal Behavioral Health programs. Findings indicated that participants reported the program was helpful and contributed to positive aspects such as increased restful sleep, appetite, and energy levels in their life. The program also show that participants were more happy and less angry, depressed, anxious, and sad. Objectives: The participant shall be able to: - Increase their knowledge on American Indian traditional practices. - Identify alternative practices to increasing positive well-being among cancer survivors References: Gone, J.P. (2016, Dec). Alternative knowledges and the future of community psychology: provocations from and American Indian health tradition. Am J Community Psychol, 58(3-4), 314-321. doi:10.1002/ajcp.12046. Haozous, E.A., Doorenbos, A., Alvord, L.A., Flum, D.R., Morris, A.M. (2016, Sep). Cancer journey for American Indians and Alaska Natives in the pacific northwest. Oncol Nurs Forum, 43(5), 625-235. doi: 10.1188/16ONF.625-635.
2B-4: Leveraging Culturally-Focused Documentary Photography to Promote Youth’s Understanding of Cancer Disparities in their Appalachian Kentucky Communities
Nathan Vanderford
University of Kentucky, Lexington, KY, USA
Abstract: Kentucky has the highest cancer incidence and mortality rates in the United States with the greatest cancer burden being in the Appalachian region of the state (1, 2). These cancer disparities are driven by unbalanced health equity, social determinants of health, and aspects of Appalachian residents’ cultural practices (2-4). We engaged youth participants of the University of Kentucky’s Appalachian Career Training in Oncology (ACTION) Program in a documentary photography project designed to explore the causes and consequences of cancer in participants’ communities. We used content analysis to identify common themes in the images and their captions. Further, for community outreach/engagement purposes, the photographs/captions have been shared through the social media platform Instagram (https://www.instagram.com/cancer_in_appalachia/). The images capture various aspects of the causes and consequences of cancer in Appalachian Kentucky including the prevalence of tobacco in the region, the presence of harmful chemicals including those related to the coal industry, unhealthy food options and eating habits, and items that remind students of family and friends that have had cancer. The images/captions align with health inequity issues and key social determinants of health that drive the high cancer rates in the region. Through the project, youth are learning more about cancer in their communities and how the disease relates to the environment around them. Moreover, we are engaging the community around cancer risk factors and potentially creating opportunities for individuals to consider changing behaviors that could reduce their cancer risk. Objectives: Identify Kentucky as ranking first in the nation in overall cancer incidence and mortality rates with the greatest burden of the disease being in the Appalachian region of the state. Describe the key social determinants of health driving Kentucky’s cancer disparities. Recognize documentary photography as a useful method for individuals to conceptualize and communicate the causes and consequences of cancer around them. References: Cancer Statistics Center: Kentucky (2021) American Cancer Society. Rodriguez SD, Vanderford NL, Huang B, Vanderpool RC. (2018) A social-ecological review of cancer disparities in Kentucky. South Med J 111:213–219. Yao N, Alcalá HE, Anderson R, Balkrishnan R. (2017) Cancer Disparities in Rural Appalachia: Incidence, Early Detection, and Survivorship. J Rural Health 33(4):375-381. Vanderpool RC, Huang B, Deng Y, Bear TM, Chen Q, Johnson MF, Paskett ED, Robertson LB, Young GS, Iachan R. (2019) Cancer-Related Beliefs and Perceptions in Appalachia: Findings from 3 States. J Rural Health 35(2):176-188.
2B-5: Integrate healing arts into health professional education to encourage use with cancer patients in diverse settings/communities
Paula Nelson-Marten
College of Nursing, University of Colorado, Aurora, CO, USA
Abstract: Healing Arts Programs, i.e., music, art, movement, and poetry/writing experiences, have been offered for patients/family members in major medical centers, often on cancer units and/or palliative care units, since the mid to late 1990’s. The efficacy of these programs has been demonstrated through both practice and research projects. The missing link is that education in healing arts is not routinely offered in graduate health professional cancer education programs. Presentation will include a brief sharing of the common healing arts modalities and how they are used in cancer care settings. Literature related to how cancer patients have responded to these programs will be shared. A brief discussion of how this content might be included in graduate health professional cancer education courses will be shared. Participants will be asked to share their experiences with healing arts in cancer education/practice. Ways to measure outcomes from healing arts modalities used in caring for cancer patients will be shared from the literature. Gaining knowledge related to healing arts and their use in practice is valuable for future cancer health care professionals. He/she will have knowledge to encourage the use of these practices in patient care understanding their relationship to aid physical/spiritual care of cancer patients in diverse settings and communities. Objectives: After attending this session, the participant will be able to: 1) Share two reasons that use of healing arts are important for patients experiencing cancer care. 2) Dialogue as to how healing arts content could be included in one's graduate health professional cancer education courses and/or clinical experiences with these health care students in cancer settings References: Lane, Mary R. Arts in Health Care. (2006). American Holistic Nurse's Association. 10.1177/089010105282465 Http://jhn.sagepub.com. Sabo, B., Singh, M., Snelgrove-Clarke, E., & Maimets, I. (2016). Benefits and challenges in the use of art as an intervention for making sense of the cancer experience: a qualitative systematic review protocol. JBI Database of Systematic Review and Implementation Reports. DOI:10.11124/JBISRIR-2016-2479. Stuckey, H.L. & Nobel, J. (2010). The connection between art, healing, and public health: A review of current literature. Am J Public Health, 100(2):254-263.
2C-1: Symptom Experiences Among Women Who Discontinued Therapy: Opportunities for Patient and Provider Education
Vanessa Sheppard1, Asmaa Namoos1, Arnethea Sutton1, Yangyang Deng1, Alejandra Hurtado-de-Mendoza2, Yvonne Cummings1, Theresa Swift-Scanlan1, Bassam Dahman1
1Virginia Commonwealth University School of Medicine, Richmond, VA, USA, 2Georgetown University, Washington, DC, USA
Abstract: Adherence to adjuvant endocrine therapy (AET) is a critical problem in the treatment of hormone receptor-positive (HR+) breast cancer (BC)(1). Despite its proven benefits of reducing recurrence by 40% and improving mortality by 31%, AET adherence is suboptimal. This study examined the experiences of women who prematurely discontinued AET(2). A mixed-methods study was nested within a larger observational trial (N=594) of women with HR+ BC. Women who discontinued therapy were systematically identified over 1.5 years; quantitative surveys and in-depth interviews were conducted. Paired t-tests were used to compare the mean difference in psychosocial factors and medication-related symptoms between baseline and discontinuation time-points. In-depth open-ended interviews were audio-recorded, transcribed verbatim, and analyzed using the NVivo software program Participant (N=37) ages ranged from 46 to 78 years old (m=60.1); 62.2 % were White and 29.7 % were Black. Quality of life decreases significantly between baseline and discontinuation (19.9 vs. 17.8, p=0.0047). A majority of women reported AET side effects (87.1%) and physician recommendations (25.8%) as their reason for discontinuation. In-depth qualitative data suggested frustration with strategies to address symptoms, being unprepared for the intensity of symptoms, and a desire for better patient-provider communication as reasons for discontinuation. Educational interventions that prioritize patients, physicians, and other medical team members may support better symptom management and ultimately adherence. Opportunities to capture women’s experiences while on treatment and their discontinuation in real-time may help women prevent discontinuation, enhance the quality of life and prevent worsening of medication-related symptoms. Objectives: The participants shall be able to learn about the possible intensity of the symptoms of side effects and they should have the necessary support to be able to discuss and get help to minimize the symptoms. Key objectives are to identify at least three barriers to get the satisfactory depth of details about the possible symptoms and to identify at least three barriers to honest communication with providers about the side effects and how to minimize them. References: Dunnwald LK, Rossing MA, Li CI. Hormone receptor status, tumor characteristics, and prognosis: a prospective cohort of breast cancer patients. Breast Cancer Res. 2007;9(1):R6. doi:10.1186/bcr1639. Sheppard VB, He J, Sutton A, et al. Adherence to Adjuvant Endocrine Therapy in Insured Black and White Breast Cancer Survivors: Exploring Adherence Measures in Patient Data. Journal of managed care & specialty pharmacy. 2019;25(5):578-586. doi:10.18553/jmcp.2019.25.5.578
2C-2: Formative assessment of individual and clinical factors associated with adherence to recommended follow-up care among patients with locally advanced colon cancer (LACC) in Appalachian Kentucky
Mark Dignan, Avinash Bhakta, Aaron Kruse-Diehr, Bin Huang, Nancy Schoenberg
University of Kentucky, Lexington, KY, USA
Abstract: Lack of adjuvant therapy contributes significantly to colorectal cancer (CRC) mortality. Approximately 40% of locally advanced [stage IIb/c and III] colon cancer [LACC] cases in Appalachian Kentucky were non-adherent to guidelines; 99.4% did not receive adjuvant therapy. Barriers to care for rural patients after CRC surgery are relatively unexplored. To increase understanding of factors associated with adherence, patients with LACC and surgical and medical oncology providers were interviewed. Providers (n=10) are recruited by email and telephone, and enrolled for key informant interviews. Patients (n=40) referred by providers are interviewed virtually to collect information on decision-making about obtaining adjuvant therapy after CRC surgery and experiences with receipt of care. Interview data is to be analyzed to identify themes related to recommending and obtaining follow-up care. Data collection is ongoing. Summaries and analyses of provider and patient key informant interviews will be presented, in addition to data on recruitment, interview completion and demographic characteristics. Interpretation of the data and comparison with existing literature will be presented as well as plans for a pilot intervention. The discussion will describe locally-relevant patient and provider perspectives of assets and barriers to receiving adjuvant therapy. We will discuss how these themes have guided the development and implementation plan for an intervention to address the low rate of follow-up for patients with LACC in Appalachian Kentucky. Objectives: The participant shall be able to list factors associated with obtaining adjuvant therapy among patients with colorectal cancer in Appalachian Kentucky. References: Vanderpool RC, Huang B, Deng Y, Bear TM, Chen Q, Johnson MF, Paskett ED, Robertson LB, Young GS, Iachan R. Cancer-Related Beliefs and Perceptions in Appalachia: Findings from 3 States. J Rural Health. 2019 Mar;35(2):176-188. doi: 10.1111/jrh.12359. Epub 2019 Mar 4. PMID: 30830984; PMCID: PMC7219572. Boyne DJ, Cuthbert CA, O'Sullivan DE, Sajobi TT, Hilsden RJ, Friedenreich CM, Cheung WY, Brenner DR. Association Between Adjuvant Chemotherapy Duration and Survival Among Patients With Stage II and III Colon Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019 May 3;2(5):e194154. doi: 10.1001/jamanetworkopen.2019.4154. PMID: 31099875; PMCID: PMC6537824.
2C-3: Your Surgical Breast Cancer Program; A novel program enabling equitable breast cancer education.
Nancy Strand
American College of Surgeons, Chicago, IL, USA
Abstract: Surgery is the main treatment for breast cancer, however, the majority of women electing surgery feel that they are not well enough informed about their breast cancer treatment options.1 Surgical instructions need to be actionable by both patients and caretakers and meet the needs of all health literacy levels to address health disparities in breast cancer treatment and provide interventions that can significantly improve outcomes. Your Breast Cancer Surgery patient education program includes a patient practice guide, videos, exercise guides and logs, discharge and survivorship checklists and an evaluation tool to support the surgical community. Scientifically derived skill development techniques and plain language guide patients through every step of their surgical prep, procedure, and recovery. A discharge and survivorship treatment plan follows the guidelines for routine wellness and tests and follow-up care to monitor for breast cancer recurrence. Associations reviewed the validity of the current standards; reviews by surgeons for best practice; reviews by patients and caretakers to assure clear understanding, and reviews for usability by laypersons. The data include behavioral outcomes (pre-op prep, and home care compliance); affective outcomes (confidence, satisfaction by patients); and clinical outcome data (complication rate, and frequency of use of additional services post-operatively). 84% of laypersons found it clear what a patient should do, and 96% felt the program was helpful, increased their confidence, would recommend to friends and family and would be satisfied if their surgeon referred them to the program. The program will help standardize surgical breast cancer treatment, support gaps in care and screening, improve health outcomes, reduce morbidity, and promote an equitable and cost-effective delivery system for women undergoing breast cancer surgery. The program will be used as a credentialed course for training surgical professionals. Objectives: 1. The participant shall be able to explain the different types of breast cancer and the stages involved in the disease. 2. The participant shall be able to participate in creating an appropriate treatment plan for breast cancer and identifying the best choice for surgical intervention as part of the health care team. 3. The participant will be able to demonstrate the skills necessary for post-operative home management of the surgical site and exercise and self-care guidelines. 4.The participant will be able to identify their need for ancillary treatments such as chemotherapy, radiation therapy and complementary therapies and utilize the guide for ongoing treatment and surveillance. References: 1Mitchell S, MD, Gass J, MD, Hanna M, PhD. How Well-Informed Do Patients Feel about Their Breast Cancer Surgery Options? Findings from a Nationwide Survey of Women after Lumpectomy and/or Mastectomy. J Am Coll Surg, 2018;226:134e146. Published by Elsevier Inc. on behalf of the American College of Surgeons. 2 National Academies of Sciences, Engineering, and Medicine. 2018. Building the Case for Health Literacy: Proceedings of a Workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25068.
2C-4: Understanding the Education Needs of Blacks and African Americans with Multiple Myeloma: Insights from Small Group Discussions with Patients and Caregivers
Claire Saxton, Maria Gonzalo, Owen Renault, Richa Ruwala, Anissa Williams, Kirstin Fearnley
Cancer Support Community, Washington, DC, USA
Abstract: Blacks and African Americans are twice as likely to be diagnosed with multiple myeloma.[1] It has been reported that Blacks and African Americans with multiple myeloma incur barriers to treatment and that one of the reasons for this is the lack of awareness about the disease within the community.[2] Understanding the information needs of this population can support the development of culturally- sensitive programs and the consequent reduction of racial health disparities in multiple myeloma. In 2020, Cancer Support Community facilitated six 2-hour small group discussion sessions with Black and African American multiple myeloma survivors (N=13) and their caregivers (N=6). The purpose was to explore the challenges of living with multiple myeloma and gain insights on knowledge, attitudes, and education needs related to multiple myeloma. Findings will assist in the development of educational materials aimed at enhancing patient awareness about multiple myeloma among African American communities in the U.S. Results were derived via qualitative analysis of group recordings. Findings from this analysis illustrated areas of patient and caregiver education needs. In particular, all patients and caregivers believed there is a lack of awareness and education about multiple myeloma in the African American community. Participants emphasized the need for culturally-appropriate education and support materials that explain multiple myeloma, risk factors, and clearly describe the most common warning signs of the disease. Education and support materials should be developed in different formats, such as videos and brochures, and delivered through religious leadership, community centers, and community leaders. These findings suggest the need to construct culturally-appropriate messaging to raise awareness about multiple myeloma and to carefully design efforts to reach Black and African American communities. These results are currently informing the development of a comprehensive patient educational program about multiple myeloma. Objectives: The participant shall be able to identify: Two ways to increase patient awareness about multiple myeloma among African American communities in the U.S. Two culturally sensitive methods that can be applied to education materials about multiple myeloma. Two barriers to accessing cancer education among Blacks and African Americans. References: [1] https://www.cancer.gov/about-nci/organization/crchd/blog/2017/multiple-myeloma-disparities. [2] https://ascopubs.org/doi/abs/10.1200/JCO.2016.34.15_suppl.8022.
2C-5: A mixed-methods study of U.S. Vietnamese parents' trust in HPV vaccination
Milkie Vu1, Nguyen Tran2
1Emory University, Atlanta, GA, USA, 2Hanoi-Amsterdam High School, Hanoi, Vietnam
Abstract: While trust is critical to HPV vaccine decision-making[1], little research has explored this topic among Asians or immigrants[2]. Using a sample of U.S. Vietnamese parents, this study investigates 1) trust in the HPV vaccine and related medical and regulatory authorities and 2) how pre-migration and migration-related experiences shape such From April 2020 to February 2021, we conducted an explanatory sequential mixed-methods design. In Phase 1, 408 U.S. Vietnamese parents of adolescents aged 9-18 completed a cross-sectional, online survey. In Phase 2, 32 U.S. Vietnamese mothers (selected from survey respondents in Phase 1) participated in semi-structured interviews. We summarized survey data using descriptive statistics and analyzed interview data using a thematic qualitative analysis approach. Almost all surveyed parents indicated “moderate to high/complete trust” in scientists developing adolescent vaccines (94%), federal government agencies (94%), CDC (95%), and FDA (94%). In interviews, U.S. Vietnamese mothers discussed experiences with the Expanded Program on Immunization in Vietnam and U.S. immigration-related requirements for vaccination, all of which shaped their trust in governmental vaccine regulatory systems and vaccine effectiveness. Trust in healthcare providers encouraged HPV vaccine acceptance and uptake. At the same time, some mothers expressed safety concerns regarding the HPV vaccine and believed that the HPV vaccine is different or less extensively tested compared to other vaccines. U.S. Vietnamese parents expressed high level of trust in medical and authorities involved in the development and recommendation of the HPV vaccine. Findings point to the need to strengthen patient-provider trust and relationship to encourage HPV vaccine uptake. Misconceptions or concerns about HPV vaccine safety should be clarified and addressed. Objectives: The participant shall be able to describe U.S. Vietnamese parents' trust in the HPV vaccine and related medical and regulatory authorities. The participant shall be able to describe how pre-migration and migration-related experiences shape such trust. References: [1] Larson, Heidi J., Richard M. Clarke, Caitlin Jarrett, Elisabeth Eckersberger, Zachary Levine, Will S. Schulz, and Pauline Paterson. Measuring trust in vaccination: A systematic review. Human vaccines & immunotherapeutics 14, no. 7 (2018): 1599-1609. [2] Harrington, N., Chen, Y., O'Reilly, A. M., & Fang, C. Y. (2021). The role of trust in HPV vaccine uptake among racial and ethnic minorities in the United States: a narrative review. AIMS Public Health, 8(2), 352-368.
3A-1: Breast Cancer Treatment: Progress for Some, Disparities for Most
Mary Chamberlin1, Ilir Hoxha2, Dafina Ademi Islami3, Glorieuse Uwizeye4, Victoria Forbes5, Erika Moen4, Zoe Chen4
1Geisel School of Medicine at Dartmouth, Lebanon, NH, USA, 2Kolegji Heimerer, Prishtina, Kosovo, 3University Clinical Center of Kosovo, Prishtina, Kosovo, 4Dartmouth College, Hanover, NH, USA, 5University of Connecticut Health Center, Farmington, CT, USA
Abstract: Many women with breast cancer in high-income countries are cured with breast-conserving surgery. Globally, more women are treated with mastectomy despite access to systemic therapies such as tamoxifen or chemotherapy that have been shown to offer equivalent survival when added to lumpectomy. Varying resources and patient factors impact the relative benefits of treatment modalities and contribute to wide disparities in outcomes. A nomogram that applies available resources to outcomes is needed. Resource-stratified guidelines provide an opportunity to modify treatment in low and middle income countries (LMIC’s). Data from early breast cancer trials and geriatric oncology, provide a rationale for a shared decision-making approach whereby a woman may choose lumpectomy rather than mastectomy for improved quality of life. A data collection tool to apply important variables in resources and patient specific factors can lead to development of an international nomogram for breast cancer treatment options. Prediction tools demonstrate that a 65-year-old woman with T2N1 breast cancer has a 68% 10-year survival with surgery and radiation, compared to 87% without cancer. Survival is improved by 11% with systemic therapies. To apply this tool to an LMIC there are several variables known to impact these predictions such as life expectancy, systemic therapy, and nutritional status. The benefit of radiation is reduced due to competing co-morbidities and improvements in systemic therapy suggesting little to no survival advantage to mastectomy over lumpectomy. A data collection tool for creating a nomogram for LMIC’s will be presented. To improve quality of life after breast cancer globally, data on site-specific resources, life expectancy and patient specific factors are needed to develop a nomogram. The participant will be able to identify critical variables that impact breast cancer treatment risks and benefits in variable resource settings. Objectives: Lack of high-quality care skews patterns of care, health care-seeking behaviors, and outcomes of breast cancer treatment. By the time most women in low- or middle-resource settings pursue medical care, breast cancer is often locally advanced or metastatic. Radical or modified radical mastectomy is still “king” in many places, often as the only option when access to radiation is limited, or when the tumors are too large or too locally advanced for breast conservation. The participant will be able to identify at least 2 critical variables that impact breast cancer treatment risks and benefits in variable resource settings. References: 1. Hortobagyi GN. Breast Cancer: 45 Years of Research and Progress. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2020;38(21):2454-62. doi: 10.1200/JCO.20.00199 [published Online First: 2020/04/08]. 2. O'Neil DS, Keating NL, Dusengimana JMV, et al. Quality of Breast Cancer Treatment at a Rural Cancer Center in Rwanda. Journal of global oncology 2018;4(4):1-11. doi: 10.1200/JGO.2016.008672 [published Online First: 2018/09/23]. 3. McCormack V, McKenzie F, Foerster M, et al. Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study. The Lancet Global health 2020;8(9):e1203-e12. doi: 10.1016/S2214-109X(20)30261-8 [published Online First: 2020/08/23]
3A-2: A qualitative study of U.S. Vietnamese mothers' HPV vaccine decision-making for their adolescents
Milkie Vu1, Carla Berg2, Cam Escoffery1, Danny Ta1, Victoria Huynh1, Nguyen Tran3, Robert Bednarczyk1
1Emory University, Atlanta, GA, USA, 2George Washington University, Washington, DC, USA, 3Hanoi-Amsterdam High School, Hanoi, Vietnam
Abstract: U.S. Vietnamese have high cervical cancer incidence; perhaps relatedly, they also have rates of low human papillomavirus (HPV) vaccine uptake. This study qualitatively explores healthcare practice- provider-, and patient-level influences on U.S. Vietnamese mothers' HPV vaccine decision-making for their adolescents. From November 2020 to February 2021, we conducted qualitative interviews among 32 U.S. Vietnamese mothers. Using the P3 model [1], questions explored influences at the practice-level (e.g., clinic-based HPV vaccine materials, ease of making vaccination appointments), provider-level (e.g., content of provider's HPV vaccine recommendation, trust in providers), and patient-level (e.g., perceived benefits and risks). A hybrid approach was used for thematic analysis. Two researchers independently coded 32 transcripts, compared results, and resolved discrepancies. Practice-level barriers included a lack of healthcare utilization and difficulties in tracking appointments for multiple HPV vaccine doses. Mixed perspectives emerged about the utility of clinic-based materials about HPV vaccine, with several mothers voicing a desire for materials in Vietnamese. Provider's recommendation and trust in providers highly encouraged HPV vaccine uptake; however, several Vietnamese mothers also mentioned receiving either no recommendation or low-quality recommendation. Regardless of recommendation quality, several did not immediately accept vaccination upon receiving recommendation. Most common patient-level barriers included perceived child's sexual inactivity and safety concerns. All Vietnamese mothers with unvaccinated children are open to future vaccinations. Interventions should improve reminder systems, deliver high-quality provider recommendation, and educate about vaccine safety and the need for age-based vaccine initiation [2]. Attention to cultural emphasis on preventive care and in-language vaccine promotion materials is needed. These strategies can improve vaccine uptake and reduce HPV-related cancer burden among U.S. Vietnamese. Objectives: The participant shall be able to describe practice-, provider- and patient-level facilitators of and barriers to U.S. Vietnamese mothers' HPV vaccine initiation and completion for their adolescents. References: [1] Bednarczyk, Robert A., et al. Practice-, provider-, and patient-level interventions to improve preventive care: development of the P3 model. Preventive medicine reports 11 (2018): 131-138. [2] Walling, Emily B., et al. “Interventions to improve HPV vaccine uptake: a systematic review. Pediatrics 138.1 (2016).
3A-3: Adolescents’ Perceptions about Cancer and Preferences for Cancer Prevention Education in Schools
Olufunmilola Abraham
University of Wisconsin-Madison, Madison, WI, USA
Abstract: There are limited cancer prevention education programs designed for adolescents in the United States. Few studies have examined adolescents’ knowledge about cancer prevention and preferences for cancer education. This study sought to directly engage a diverse group of adolescents to understand their perceptions and preferences for receiving cancer prevention. The study team developed an online survey consisting of closed-ended questions and Likert scale responses. Survey questions were designed to explore adolescents’ perceptions and knowledge of cancer and cancer prevention, including cancer-related health behaviors. Survey questions related to behavior were adapted from the Youth Risk Behavior Survey, a validated survey instrument. Other survey questions explored adolescents’ information sources and their preferences for receiving cancer prevention education. The survey also collected demographic information. Middle and High school aged students from urban and rural Wisconsin were recruited. Selection criteria included students who could speak, read, and understand English. Data were statistically analyzed using SPSS. Participants (82%) reported that cancer did not include only one disease, and majority (89%) recognized that cancer cells grew at random. Awareness of cancer risk factors was highest for tobacco use (91%), poor diet (80%), and physical activity (80%). Most participants (95%) stated that cancer prevention is important. Only 37.3% understood how to lower their risk of cancer, and 50% reported they made lifestyle choices to lower their chances of getting cancer. Online websites such as google were the most reported resources used for cancer education by adolescents, followed by discussions with parents and doctors. Serious games were the most preferred form of cancer prevention. In order to help reduce cancer risk, it is essential that adolescents understand information regarding cancer origins, risk factors, and health behaviors that can be modified to reduce cancer risks. It is necessary to identify adolescents’ preferences for receiving clear, interactive, engaging, and easy-to-understand information about cancer and cancer prevention. Objectives: The participant shall be able to identify adolescents’ perceptions about cancer and cancer prevention and classify their preferences for receiving cancer prevention education. Asking adolescents questions about their cancer knowledge, awareness of cancer risks, attitudes towards cancer, and favored sources of cancer information, allowed researchers to recognize and categorize their perceptions and preferences for receiving cancer prevention education, and will allow participants to create a tailored cancer education intervention. Attendees can use the information learned from this presentation in their own research to further examine ways to reduce cancer risk among adolescents. References: Merten JW, Parker A, Williams A, King JL, Largo-Wight E, Osmani M. Cancer Risk Factor Knowledge Among Young Adults. J Cancer Educ. 2017;32(4):865-870. doi:10.1007/s13187-016-1093-3. National Cancer Institute. Adolescents and Young Adults with Cancer. Updated September 24th, 2020. https://www.cancer.gov/types/aya Accessed December 11th, 2020. National Cancer Institute. Risk Factors for Cancer, 2019; https://www.cancer.gov/about-cancer/causesprevention/risk. Accessed May 9 2019. Youth Risk Behavior Survey. Wisconsin Department of Public Instruction. https://dpi.wi.gov/news/dpi-connected/2019-youth-risk-behavior-survey. Published February 18, 2019. Accessed April 1, 2021.
3A-4: Investigating Perceptions of COVID-19 Related Information, Sources of Information Used, and Pandemic Related Attitudes & Behaviours
Mohamed Ugas, Diana Samoil, Lisa Avery, Alejandro Berlin, Meredith Giuliani, Tina Papadakos, Naa Kwarley Quartey, Janet Papadakos
Princess Margaret Cancer Centre, Toronto, ON, Canada
Abstract: The COVID-19 pandemic has caused enormous strain on public health. The SARS-CoV-2 virus has a high degree of transmissibility, with cancer patients particularly vulnerable to the disease, in addition to having their treatment plans threatened by public health restrictions designed to contain the spread. This study examined the effects of the pandemic on cancer patient’s treatment and psychology, as well as their knowledge, attitudes and practices concerning COVID-19 via an online survey sent by email to approximately 5,800 patients of an urban, academic cancer centre in Toronto, Canada. Descriptive results were summarized. To examine for potential associations, regression models were tested for the outcomes of patient psychological well-being, knowledge, attitudes and practices, against several predictors. Qualitative feedback was coded and summarized. A total of 1631 surveys were completed and returned. Most patients saw their appointments made virtual and for a substantial minority there was no change. The majority (62.4%) of patients expressed fears about contracting the virus. There were no independent predictors of knowledge regarding COVID-19. Fears were more pronounced among patients who do not speak English and those who use social media more often. Women, those who scored higher on knowledge questions, and those who used cancer centre materials were more likely to take preventative measures against infection. The results of this study provide a snapshot of the state of cancer patient treatment and psychological well-being, as well as their knowledge, attitudes and practices during the first summer of the pandemic. The study’s results can inform our understanding of adaptation to conditions during the outbreak. Objectives: The participant shall be able to identify the extent of treatment changes for cancer patients during the COVID-19 pandemic. They will also be able to describe the characteristics related to the practice of preventative measures for containing the virus among cancer patients. Participants will also be made aware of the role of language proficiency and social media use in patient psychology with respect to the pandemic. References: Catania, C., Spitaleri, G., Del Signore, E., Attili, I., Radice, D., Stati, V., ... & De Marinis, F. (2020). Fears and Perception of the Impact of COVID-19 on Patients with Lung Cancer: A Mono-Institutional Survey. Frontiers in oncology, 10, 2237. Ciążyńska, M., Pabianek, M., Szczepaniak, K., Ułańska, M., Skibińska, M., Owczarek, W., ... & Lesiak, A. (2020). Quality of life of cancer patients during coronavirus disease (COVID-19) pandemic. Psycho-oncology. Chen, Gaili, et al. “Fear of disease progression and psychological stress in cancer patients under the outbreak of COVID-19.” Psycho-oncology (2020)
3A-5: Understanding Barriers to Access to Care among Blacks and African Americans with Multiple Myeloma: Insights from Small Group Discussions with Patients and Caregivers
Claire Saxton, Maria Gonzalo, Owen Renault, Richa Ruwala, Anissa Williams, Kirstin Fearnley
Cancer Support Community, Washington, DC, USA
Abstract: Multiple myeloma is the second most common hematologic malignancy in the US and the most common in African Americans.[1] It has been studied and reported that African American multiple myeloma patients incur significant barriers to accessing care.[2] It is important to understand patients’ perceptions and identify specific barriers to care in order to best address the disproportionate impact of the disease on this population and improve health equity. In 2020, Cancer Support Community (CSC) facilitated six 2-hour small group discussion sessions with Black multiple myeloma survivors (N=13) and their caregivers (N=6). The discussion guides were designed to explore the challenges of living with multiple myeloma and gain insights into the perceptions and barriers to access to care in this population. Results were derived via qualitative analysis of group recordings. Findings will inform the development of support resources aimed at addressing these barriers. Findings from the qualitative analysis suggest that Blacks and African Americans with multiple myeloma face significant barriers to accessing care. Specifically, participants reported that the main barriers to getting an early multiple myeloma diagnosis and accessing care are: Mistrust in the medical community and lack of cultural diversity and competence among physicians. Issues understanding and communicating with their care team. Limited awareness about the disease and understanding of risk factors and common warning signs. Limited access to health care. Financial barriers including transportation and inability to take time off work to attend doctor appointments These findings suggest that distrust towards the healthcare system is still present in Black and African American communities. They also emphasize the importance of improving cultural competency in provider-patient relationships and raising awareness about multiple myeloma to ultimately improve health outcomes for Blacks and African Americans with multiple myeloma. Objectives: Participants shall be able to: Identify barriers in access to health care among Blacks and African Americans with multiple myeloma. Pinpoint key steps in the development of education and support programs that are centered on the specific needs of Black and African American communities with the goal of improving health equity. References: [1] American Cancer Society. Cancer Facts and Figures for African Americans 2019-2021. Atlanta: American Cancer Society, 2019. Available at: www.cancer.org. Accessed April 29, 2021. [2] Marinac, C.R., Ghobrial, I.M., Birmann, B.M. et al. Dissecting racial disparities in multiple myeloma. Blood Cancer J. 10, 19 (2020). https://doi.org/10.1038/s41408-020-0284-7
3B-1: Serial Concept Mapping Facilitates Development of Patient-Centered Thinking in Undergraduate Cancer Education
Rafael Moreno, Miklos Fogarasi
Frank H Netter MD School of Medicine, Quinnipiac University, Hamden, CT, USA
Abstract: Cancer, as a complex health condition, might also be viewed as a paradigm for medical students to appreciate the rich diversity of illness experiences. Learning about survivorship concepts may reveal early on how environmental exposures, social circumstances, and behavioral changes impact health outcomes. Concept mapping (CM) is an active learning strategy promoting reflective thinking (cognitivist learning theory). Applying CMs serially is a novel approach to study how learners’ concepts about complex cancer topics evolve. CM principles were described to 11 Y2 medical students and 2 health sciences undergraduates embarking on a 15-week Survivorship elective. Progressing from hearing about individuals’ survivorship experiences to shared insights by PCPs, social workers, and caregivers, participants submitted serial CMs on Weeks 1-4-8, receiving iterative feedback. Group-mapping utilized case-based stories (Week 5). Individual mapping of a live narrative (Week 11) and of one-on-one survivor interviews (Week 15) were test assignments. Editing CMs and a rubric were assessment tools. Translating narratives into meaningful CMs occurred gradually. Increasingly complex concepts emerged within thoughtfully organized maps. Vertical hierarchies with new sub-concepts developed rapidly. Examples and linking phrases became more meaningful. Recognizing interconnected issues (cross-linking) proved challenging. Comparing weeks 1 and 15, CM complexity grew from 2.6 hierarchy levels to 4/map, cross-links from 1 to 7/map and examples from 9 to 15/map. Maps were used as a feedback tool. Final individual survivor interviews yielded well-integrated CMs. Comparison within student pairs interviewing the same survivor revealed moderately different inter-observer differences, yet all students exhibited deepening insights from baseline. Excessive complexity, however may limit CM's value. CMs successfully integrate physical, socio-cultural, psychological, and spiritual care aspects to cancer education. Structured visuals of complex cases develop holistic views, patient-centered critical thinking, and recognition of social influences on health outcomes. Following emerging concepts allows feedback, promotes teamwork and interprofessional discussions. Nonetheless, student approval may vary and CMs risk becoming superfluous. Objectives: At the conclusion of the talk, the participant shall be able to: Recognize how, through monitoring serial concept maps, facilitators can gain insight into learners’ evolving views in a complex cancer topic. Describe 4 characteristic survivorship care QoL domains and how they uncover the effect of social influences on survivors’ health outcomes. Explain the educational benefits of individual and group maps and describe serial concept mapping as an instructional method for feedback and assessment. References: Brondfield S, Seol A, Hyland K, Teherani A, Hsu G. Integrating Concept Maps into a Medical Student Oncology Curriculum. J Cancer Educ. 2021 Feb;36(1):85-91. doi: 10.1007/s13187-019-01601-7. PMID: 31414369. Peñuela-Epalza M, De la Hoz K: Incorporation and evaluation of serial concept maps for vertical integration and clinical reasoning in case-based learning tutorials: Perspectives of students beginning clinical medicine, Medical Teacher 2019, 41:4, 433-440, DOI: 10.1080/0142159X.2018.1487046. Daley B, Durning S, Torre D, 2016, 'Using Concept Maps to Create Meaningful Learning in Medical Education ', MedEdPublish, 5, [1], 19, https://doi.org/10.15694/mep.2016.000019
3B-2: Leadership, leading, and influencing change in cancer education: development and assessment of a leadership workshop in cancer education for interdisciplinary healthcare staff
Ayesha Warsi1, Krista Dawdy2, Maria Bishop3, Jamal Khadar4, Gilad Amiel5, Kathleen Heneghan6, David Wiljer7, Ewa Szumacher8
1Schulich School of Medicine and Dentistry, Markham, ON, Canada, 2Odette Cancer Centre, Toronto, ON, Canada, 3University of Arizona College of Medicine, Southern Arizona Veterans Administration Health Care System, Tucson, AZ, USA, 4King Hussein Cancer Centre, Aman, Jordan, 5Department of Urology, RAMBAM Healthcare Campus, Haifa, Israel, 6American College of Surgeons, Chicago, IL, USA, 7University Health Network, Toronto, ON, Canada, 8Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Abstract: Effective leaders in healthcare settings create a motivating work environment, initiate changes in practice, and facilitate interdisciplinary collaboration to advance patient-centered care. Health professionals in cancer education need leadership development to meet the continued increase in cancer cases, to keep up with the rapid biomedical and technological advances in global cancer care, and because leadership development in cancer education requires a specific team-based skillset not adequately addressed in existing systems. The identified gap in leadership development in cancer education led to the creation of a unique interactive leadership workshop titled “Essential Skills in Cancer Education: Leadership, Leading, and Influencing Change in Cancer Education”, held at the International Cancer Education Conference in October 2020. The workshop utilized lectures from global leaders in cancer education, mentorship opportunities, interactive case studies, and individual projects to develop core leadership skills in medical and allied health professionals in oncology. Pre- and post-workshop surveys confirmed that participants who attended the workshop felt their knowledge regarding topics in leadership in cancer education increased following completion of the workshop. Answers to the open-ended questions and the feedback provided in workshop surveys showed that participants were able to reflect on their learning and consider ways to apply what they learned in their careers in cancer education and at their institution. Areas where participants reported an increase in knowledge included how to use different leadership styles, how to initiate changes in practice, and how to apply their leadership skills. Feedback from participants on post-workshop evaluations was overwhelmingly positive and demonstrated both an interest and a need for more leadership development opportunities in cancer education. This workshop shows that leadership is a valuable and teachable skill that will benefit both healthcare professionals and patients in the field of cancer education. Objectives: The participant will be able to identify three reasons why cancer education is an area that would benefit from leadership development opportunities. The participant will be able to identify three teaching tools that can be utilized to make a leadership development program effective. References: Kumar, R. D. C., & Khiljee, N. (2016). Leadership in healthcare. Anaesthesia and Intensive Care Medicine, 17(1), 63-65. Sfantou, D.F, Laliotis, A., Patelaro, A. E., Sifaki-Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of leadership style towards quality of care measures in healthcare settings: a systematic review. Healthcare, 5(4). Folkman, A.K., Tveit, B., & Sverdrup, S. (2019). Leadership in interprofessional collaboration in healthcare. Journal of Multidisciplinary Healthcare, 12, 97-107.
3B-3: Impact of the COVID-19 pandemic on postgraduate training in radiation oncology
Meredith Giuliani1, Diana Samoil1, Ankit Agarwal2, Jennifer Croke1, Eleni Giannopoulos1, Daniel Golden3, Ariel E. Hirsch4, Rachel Jimenez5, Nauman Malik6, Janet Papadakos1, Naa Kwarley Quartey1, Che Hsuan David Wu7, Paris-Ann Ingledew8
1Princess Margaret Cancer Centre, Toronto, ON, Canada, 2Department of Radiation Oncology, UNC Health Care, North Carolina, NC, USA, 3University of Chicago, Chicago, IL, USA, 4Department of Radiation Oncology, Boston University School of Medicine, Boston, MA, USA, 5Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA, 6Department of Radiation Oncology, University Health Network, Toronto, ON, Canada, 7Division of Radiation Oncology, University of Calgary, Calgary, AB, Canada, 8University of British Columbia, Vancouver, BC, Canada
Abstract: The COVID-19 pandemic has necessitated unprecedented upheaval in medical care and education. Trainees have faced redeployment, switches to virtual care and a loss of elective and networking activities. This study aims to report the degree to which post-graduate trainees in radiation oncology perceive their education has been impacted by COVID-19. A cross-sectional online survey was administered in June 2020 to trainee members of Canadian Association of Radiation Oncology (CARO). The 82-item survey was adapted from the validated Stanford Acute Stress Reaction and Ways of Coping Questionnaires. The survey addressed the impact on residents’ ability to travel/network for the purpose of their career, the impact of virtual patient contact on their learning, the level of social support from mentors and medical staff, the impact on planned research and academic activities, and unplanned clinical and oncology activities such as redeployment. The survey was developed using best practices including peer-review and cognitive pre-testing. Thirty-four trainees responded. 46%(n=15) indicated the overall impact of COVID-19 on training was negative/very negative. Majority of trainees agreed/strongly agreed with the following statements: “I had difficulty concentrating on tasks” (n=17; 52%), “I had fears about contracting COVID-19” (n=17; 52%), “I had fears of family/loved ones contracting COVID-19” (n= 29; 88%), “I felt socially isolated from friends and family” (n=23; 70%) and “I was concerned that my personal safety was at risk if/when I was redeployed”(n=20; 61%). 67%(n=22) reported severe (>50%) reduction in ambulatory clinical activities, 16(49%) reported a moderate ( < 5 0%) reduction in new patient consultations. Significant changes to radiation oncology training were wrought by the COVID-19 pandemic and roughly half of trainees perceive that these changes had a negative impact on their training. Safety concerns for self and family were significant and strategies to mitigate these concerns should be a priority. Objectives: The participants will be able to describe the degree to which post-graduate trainees in radiation oncology perceive their education has been impacted by COVID-19. References: Bambakidis NC, Tomei KL. Editorial. Impact of COVID-19 on neurosurgery resident training and education. Journal of neurosurgery. Apr 17 2020:1-2. Ahmed H, Allaf M, Elghazaly H. COVID-19 and medical education. The Lancet. Infectious diseases. Mar 23 2020. Landis MS, & Bradley, J.W. The Impact of the 2003 SARS Outbreak on Medical Students at the University of Toronto. University of Toronto Medical Journal. 2005;82(3):158-164.
SYMPOSIUM 3C: A Transdisciplinary, Whole-Person Response to the Spiritual and Cultural Challenges of COVID-19
Our multidisciplinary team developed responsive programming that aimed to address the spiritual, psychosocial, existential, and community needs that COVID-19 heightened for our patients, their caregivers, and the medical community. We will present four specific programs, including a patient group led by our interfaith chaplain, a caregiver group grounded in compassion-focused mindfulness, an educational lecture series presented in Spanish, and a culturally-adapted intervention for families facing advanced disease. Our discussion will highlight how each program attended to patients' spirituality, cultural identities, and drive for interpersonal connection and will expound on how each effort was designed, implemented, and received.
3C-1: A consultation model for enhancing communication in families facing end of life during COVID-19
Kauser Ahmed, Elizabeth Cleary
Simms/Mann UCLA Center for Integrative Oncology, Los Angeles, CA, USA
Abstract: Parents with cancer express anxiety about communicating their diagnosis to their minor children. When the diagnosis is terminal, specific guidance to assist the family is needed, but resources are limited. COVID-19 introduced additional challenges including isolation from family, especially those overseas, and barriers to engaging in culturally meaningful rituals that allow for healthy grieving. The Center’s supportive care to families with distinct cultural practices addresses these gaps in end of life care. Consultations are provided to parents from diagnosis through treatment trajectory using a unique psychoeducation model that facilitates parents’ ability to communicate meaningful change, including imminent death, to their minor children in developmentally and culturally appropriate ways. During COVID 19, this guidance, entirely via telehealth, was critical to offset the loss of familial support. An overview of the consultation model through a case presentation highlights culturally thoughtful supportive care for an Asian American family. The Center provided psychosocial support to 3018 patients with cancer in 2020-2021. Of these, 472 had an advanced cancer diagnosis and were under the age of 55, with minor children. 20% percent of care was to family members of patients, including minors from the age of 4 to 17, and 23 % to ethnic minority patients. Qualitative statements from parents include “These were the single most important conversations for our family through the cancer process”. Beyond COVID-19, as we expand to more diverse regions, we will evaluate our model and incorporate telehealth to give access to more remote communities. The consultation model for facilitating communication between parents and minor children can be readily modified to meet the needs of diverse communities, and can be learned and incorporated into the practices of different health care professionals in the oncology setting including nurses, social workers, chaplains and psychologists. Objectives: Participants will be able to name 2 barriers and 2 facilitators of effective communication for parents at end of life with minor children. Participants will learn 3 strategies for helping families talk about cancer across the cancer trajectory. References: Hanna ,JR, McCaughan, E, Semple ,CJ. Challenges and support needs of parents and children when a parent is at end of life: A systematic review. Palliat Medicine 2019, Vol. 33(8) 1017–1044. Park, EM, Check, DK, Song, MK, et al. Parenting while living with advanced cancer: a qualitative study. Palliat Med 2017; 31(3): 231–238. Sheehan, DK, Mayo, MM, Christ, GH, et al. Two worlds: adolescents’ strategies for managing life with a parent in hospice. Palliat Support Care 2016; 14(3): 177–186. Fearnley, R, Boland, JW. Communication and support from health-care professionals to families, with dependent children, following the diagnosis of parental life-limiting illness: a systematic review. Palliat Med 2017; 31(3): 212–222.
3C-2: Circle of Reflection: A Weekly Virtual Spiritual Support Group
Michael Eselun
Simms/Mann UCLA Center for Integrative Oncology, Los Angeles, CA, USA
Abstract: Those touched by cancer: patients, family, and the bereaved often struggle with spiritual questions to find meaning in their circumstance—a struggle intensified by the isolation imposed by the COVID-19 pandemic. Spiritual support during the pandemic can offer a pathway to meaning making. (Gonçalves et al, 2020.) The Circle of Reflection, facilitated by an interfaith oncology chaplain is an opportunity to reflect and explore these themes, and to build community as well. The Circle meets virtually each week for one hour and draws 14-18 participants. Meetings begin with a reflective reading to spur the discussion. The group spans varying spiritual viewpoints, across generations and cultures, as well as vastly different relationships to cancer. That mix inspires deeper individual reflection as well as an affirmation of self and each other. The Circle creates a sustaining sense of community and safety amidst the uncertainties of cancer and the pandemic. Participants completed an anonymous survey after 12 months of the virtual Circle of Reflection. Participants (N=21) unanimously gave the group the highest ratings on a 1-5 scale for all five items that assessed the group's efficacy in understanding the intersection of spirituality and cancer, as well as the value of this community in coping during the pandemic. Qualitative data includes the feedback, “we know that we are not alone in this struggle,” and that the group is, “a steady source of support and spiritual grounding.” One writes, “It is like pure oxygen when we are feeling...cancer is strangling us.” The background and need for this kind of support is universal within the larger cancer community. With a skilled facilitator, this model could have equal outcomes in any number of cancer settings, with equally diverse communities of participants. Evaluations reflect unanimous recommendation of this group to those touched by cancer. Objectives: The participant shall be able to identify the spiritual needs of those affected by cancer: patients, family, and the bereaved as they often struggle with questions to find meaning in their circumstance—a struggle intensified by the isolation imposed by the COVID-19 pandemic. The participant shall be given the tools to addressing that struggle via a virtual spiritual reflection group. References: Júnior, J. G., de Sales, J. P., Moreira, M. M., de Lima, C. K. T., & Neto, M. L. R. (2020). Spiritual Beliefs, Mental Health and the 2019 Coronavirus (2019-nCoV) Outbreak: What Does Literature Have to Tell Us?. Frontiers in Psychiatry, 11. Young, A. M., Ashbury, F. D., Schapira, L., Scotté, F., Ripamonti, C. I., & Olver, I. N. (2020). Uncertainty upon uncertainty: supportive care for cancer and COVID-19. Supportive care in cancer, 28, 4001-4004. Sannes, T. S., et al (2020). Caring for loved ones with cancer during the COVID-19 pandemic: A double hit risk for social isolation. Psycho-oncology, 10,1002
3C-3: Delivering culturally congruent programming to Spanish-speaking cancer patients in the age of COVID-19
Joan Anderson
Simms/Mann UCLA Center for Integrative Oncology, Los Angeles, CA, USA
Abstract: Spanish-speaking Latinos comprise 28.8% of the California population, and are largely underserved in cancer care (Alcaraz et al, 2020). Barriers include lack of available cancer education and community resources (Yanez et al, 2016). These needs were heightened by COVID-19, which disproportionately impacted the Latino community. These issues were addressed through culturally-responsive, Spanish-language educational programs. A health disparities grant allowed us to target more geographically remote Spanish-speaking communities to extend the scope of our outreach. Through the development of these programs, we are able to provide presentations and discussions on Nutrition in Cancer Care, How to Prepare for an Effective Clinic Visit with your Doctor, and The Emotional Challenges of Cancer, presented by a transdisciplinary team of social work, medical and nutritional professionals in Spanish. By conducting these programs on a virtual platform, we utilize accessible programming and eliminate the need for in-person gathering in light of COVID-19. In October 2020, we reached 105 Spanish-speaking breast cancer patients through these webinars. Of those participants, 65% surveyed reported that the presentations stimulated them to think and motivated them to learn more. Another 55% reported that the presentations motivated them to do something different and increased their confidence/morale. From this, we saw the opportunity to expand these programs, and will conduct two additional webinars in 2021. Through our secured grant funding, we will further our reach into outlying/agricultural regions of Southern California through partner agencies. We will evaluate our impact through participant feedback and post-presentation surveys. Through providing virtual Spanish-language educational services with our partner agencies, we aim to positively impact cancer education disparities among Latino populations. We also aim to learn more about what the needs are within these communities and further ways to promote cancer literacy to Spanish-speaking Latinos. Objectives: The participant shall be able to name strategies for providing accessible virtual education programs to Spanish-speaking populations. The participant shall be able to identify barriers that exist related to making cancer education available to Latino populations, and tools to combat these barriers. References: Yanez, B., McGinty, H. L., Buitrago, D., Ramirez, A. G., & Penedo, F. J. (2016). Cancer outcomes in Hispanics/Latinos in the United States: An integrative review and conceptual model of determinants of health. Journal of Latina/o psychology, 4(2), 114. Alcaraz, K. I., Wiedt, T. L., Daniels, E. C., Yabroff, K. R., Guerra, C. E., & Wender, R. C. (2020). Understanding and addressing social determinants to advance cancer health equity in the United States: a blueprint for practice, research, and policy. CA: a cancer journal for clinicians, 70(1), 31-46. Statistical Atlas (2018). The demographic statistical atlas of the United States: Languages in California. Cedar Lake Ventures. https://statisticalatlas.com/state/California/Languages.
3C-4: Self Compassion Workshop -Engendering Self Care in Caregivers Through Mindfulness Meditation
Mark Buchanan
Simms/Mann UCLA Center for Integrative Oncology, Los Angeles, CA, USA
Abstract: Caregivers of cancer patients are often burdened with fatigue, anticipatory grief, and guilt. The impact of COVID-19 resulted in even greater levels of isolation and limitations on activities that caregivers could utilize for respite (Sannes, Yeh. Gray, 2021). The development of self-compassion through mindfulness meditation is a practice that has evidence to suggest efficacy in reducing the distress of caregivers and in fostering self-care. (Neft, Kristen and Germer, Christopher, 2018) The Self-Compassion Workshop was held virtually for 90 minutes weekly for six weeks. 10 participants attended. Two facilitators, a chaplain and a social work intern began each session with a short didactic followed by a meditation that progressively deepened participants’ experience of compassion. Through group reflection upon these experiences, participants began to recognize the power of the present moment, freedom from self-criticism, the embrace of fear, and the life of compassionate self-care and shared community. Participants completed an anonymous 5-item survey at the conclusion of the workshop. Unanimously, participants (N=5) gave the workshop the highest ratings on a 1-5 scale for all five-items that assessed for workshop efficacy at teaching skills and fostering meaningful connections. Qualitative data from participants included the feedback “being compassionate toward myself helps me be more compassionate to my loved one” and “the meditation skills help me be calmer and better equipped to handle stress every day”. One participant expressed how good it was, “to see the interconnection and compassion that caregivers shared with one another”. Targeting self-compassion through mindfulness meditation has the potential to ameliorate some of the notable stressors of caring for someone with cancer. The virtual group format also provides an opportunity for caregivers who may be isolated and unable to leave their loved one to connect with others and receive social support. Objectives: The participant shall be able to articulate the theoretical rational for a caregiver group grounded in mindful self-compassion and identify specific advantages for caregivers to a virtual group format. Participants will be given insight into the difficulties caregivers experience as they begin their practice of meditation, as well as into the remedy that the group’s reflection process provides individual caregivers and the ways it enables them to grow emotionally and spiritually. References: Sannes, T. S., Yeh, I. M., & Gray, T. F. (2020). Caring for loved ones with cancer during the COVID-19 pandemic: A double hit risk for social isolation and need for action. Psycho-oncology, 10,1002. Germer, C., & Neff, K. (2019). Teaching the mindful self-compassion program: A guide for professionals. Guilford Publications. Batchelor, S. (2020). The Art of Solitude. Yale University Press. Brookfield, S. D., Rudolph, J., & Yeo, E. (2019). The power of critical thinking in learning and teaching. An interview with Professor Stephen D. Brookfield. Journal of Applied Learning and Teaching, 2(2), 76-90.
4A-1: Addressing the Disparity of Women in Oncology and Research Through Early Education Interventional Programs
Nicholas Smith-Stanley, Melissa Huddleston, Ginger Okoro, Laura Pavitt, Kristen Wynn
Livestrong Cancer Institutes; Dell Medical School; The University of Texas at Austin, Austin, TX, USA
Abstract: About a third of practicing oncologists are women; the number of women in academic roles in medical oncology, radiation oncology, and surgical oncology average 35.5%.1 In research, only 19% of tenured senior faculty appointments are held by women.2 Representation continues to decline in leadership positions such as department chairs and medical school deans. Early educational interventional programs like SHE address the disparity of women in oncology by introducing oncology and research to high school students. The Summer Health Experience (SHE) in Oncology is a program offered by the Livestrong Cancer Institutes of the Dell Medical School that introduces high school juniors and seniors who identify as female to a wide range of cancer-related career experiences and opportunities including research, clinical care, survivorship, and community support. The immersion program offers activities, discussions and leadership training, all through the lens of the challenges women face in their careers Students are required to complete a patient action/care plan using information gained during each lecture and activity throughout the program. Using the information in a specific patient case, and from lecture and activities, students create what they feel is the best action plan for the patient, their family and their caregivers. The care plan demonstrates the completion of the learning objectives and outcomes of the course. Students complete knowledge and impact surveys at the start and end of the program. Students and Austin Independent School District administrators also provide feedback through numerous surveys throughout the program. Students gained a better understanding of cancer and research, and the related career opportunities available to them. With consistent mentorship from female leaders, students were empowered to consider oncology and research as a potential career. In 2021 SHE will be expanded to include four cancer centers and one medical school. Objectives: Address the disproportionate number of women in cancer and research. Through SHE, students: Demonstrate a general knowledge of cancer biology; Function as a researcher in a laboratory and field setting using basic tools and equipment; Gain an understanding of how cancer is treated in the clinic, including the approach to patient-centered care; Understand the challenges cancer patients and their families face from the moment of diagnosis; identify community resources to meet their unique set of needs; Practice professionalism in research and clinical setting; Effectively communicate through written and oral presentations; Develop translatable leadership skills References: 1Chowdhary M, Chowdhary A, Royce TJ, et al. Women’s representation in leadership positions in academic medical oncology, radiation oncology, and surgical oncology programs. JAMA Netw Open. 2020;3(3):e200708. 2Martinez ED, Botos J, Dohoney KM, et al. Falling off the academic bandwagon. Women are more likely to quit at the postdoc to principal investigator transition. EMBO Rep. 2007;8(11):977-981. doi:10.1038/sj.embor.7401110
4A-2: Challenges and solutions for the successful execution of the Cancer Prevention and Control (CAPAC) Research Training Program at UPR Cancer Center during the COVID-19 Pandemic
Ana Ortiz1, Marievelisse Soto-Salgado2, Mirza Rivera-Lugo2, Guillermo Tortolero-Luna2, Michael Santiago-Marrero2
1Cancer Prevention and Control (CAPAC) Research Training Program, San Juan, Puerto Rico, USA, 2University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, USA
Abstract: The COVID-19 pandemic presents a unique challenge for the implementation of cancer education programs due to restrictions recommended by the CDC and other organizations. The CAPAC Research Training Program aims to increase student’s interest to pursue a doctoral degree and/or career in cancer research with a focus on Hispanic health. CAPAC will recruit 25 participants annually from all racial/ethnic groups for a research experience of 10 or 15-weeks in Puerto Rico (PR). Participants are matched to a research mentor in the UPR Cancer Center (UPRCCC) or other affiliated institutions according to their research interests. Although the 2020 cycle had to be canceled due to a lockdown in PR, 8 trainees interested were given an opportunity to participate in the 2021 Program. For 2021, we received 70 applications from which 17 (24%) trainees were selected for a final selection of 25 participants for the 2021 Program. Depending on the mentor and their COVID-19 institutional policy, the mentorship experiences will be offered in-person, hybrid, and remote. Given that some mentors (n=7, 28%) cannot receive students in their institutions, workspaces were assigned for these participants within the UPRCCC (primary CAPAC site). Although these mentors will be working remotely with students, they will be virtually meeting with them regularly throughout the program. Given limitations in field-based and laboratory activities in some institutions, most research activities proposed for trainees will include quantitative and qualitative data analysis and manuscript writing, for which access to appropriate analysis programs will be provided. Despite the COVID-19 pandemic, CAPAC successfully recruited 25 students for its 2021 program in PR, representing the first cohort of trainees. Nonetheless, accommodations had to be made with a bigger focus on data analysis and scientific writing activities of previously collected data from cancer research studies in PR. Objectives: The participants shall be able to identify two barriers for the execution of the CAPAC Program in PR during the COVID-19 pandemic. The participants shall be able to identify two solutions for the execution of the CAPAC Program in PR during the COVID-19 pandemic. References: Pasick RJ, Otero-Sabogal R, Nacionales MCB, Banks PJ. Increasing ethnic diversity in cancer control research: description and impact of a model training program. J Cancer Educ. 2003;18(2):73-77. doi:10.1207/S15430154JCE1802_07. Cameron C, Collie CL, Chang S. Introducing students to cancer prevention careers through programmed summer research experiences. J Cancer Educ. 2012;27(2):233-242. doi:10.1007/s13187- 011-0297-9.
4A-3: CPEN membership facilitates cross country partnership to create online health literacy and cancer course
Tina Papadakos1, Devon Poznanski2, Erin Walker1, Eden Klein1, Janet Papadakos1
1Princess Margaret Cancer Centre, Toronto, ON, Canada, 2BC Cancer, Vancouver, BC, Canada
Abstract: Low health literacy is a system-wide problem leaving patients in a position where they cannot easily access, understand, or navigate their health and the healthcare system. Communication is central to improving health literacy. The Princess Margaret Cancer Centre’s (PM) Education program is well-established, with a significant library of resources to support cancer health literacy. Partnering with BC Cancer, PM created an online course introducing staff in the BC Cancer System to health literacy and cancer. Part of the PM Cancer Education program’s success is due to extensive involvement with the Cancer Patient Education Network (CPEN), which brings together healthcare professionals who share experiences and best practices in cancer patient education. Through CPEN membership, BC Cancer and PM Cancer Education formed a cross-country partnership to share health literacy resources. This allowed a one-person patient education team to leverage content developed by a well-established program and apply it locally. The Health Literacy and Cancer course is hosted on the PM Cancer Campus online learning platform, and is available to staff in the BC Cancer system. Total users and user engagement with course activities are tracked. At the end of the course, users are asked to complete a satisfaction survey. Three months after users complete the course, they are contacted to see how they are using the course content in their practice and what further support they need. Analysis of course activity, satisfaction, and use of course content is done on a quarterly basis. By leveraging resources, CPEN members can push the envelope in their patient education programs. For BC Cancer, offering a health literacy course using the PM resources makes the course more accessible to oncologists and staff than an in-person course. Participants can complete the course on their own schedule. Objectives: Participants: Will be able to explain how partnerships can help leverage resources to improve health equity. Consider how they can support and benefit from building partnership through CPEN and other organizations. References: Haidar A, Khoei A, Alex SE, Blick C, Lopez E, Wendt S, Ghanta R, Almohamad M, Cousins S, Noyola J, Tien J, Markham C, Sharma SV. Community-Academic Partnerships to Promote Health Literacy and Address Social Needs Among Low-Income Families During COVID-19. J Nutr Educ Behav. 2021 Jan;53(1):75-78. doi: 10.1016/j.jneb.2020.10.003. Epub 2020 Oct 15. PMID: 33187874; PMCID: PMC7561286. Kieffer Campbell J. Health Literacy in Adult Oncology: An Integrative Review. Oncol Nurs Forum. 2020 Jan 1;47(1):18-32. doi: 10.1188/20.ONF.18-32. PMID: 31845912.
4A-4: The Cancer Prevention and Control (CAPAC) Research Training Program: A mentoring approach to increase trainees’ interest in cancer prevention and control research
Ana Ortiz1, Marievelisse Soto-Salgado2, Guillermo Tortolero-Luna2, Mirza Rivera-Lugo2, Michael Santiago-Marrero2
1Cancer Prevention and Control (CAPAC) Research Training Program, San Juan, Puerto Rico, USA, 2University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, USA
Abstract: The Cancer Prevention and Control (CAPAC) Research Training Program at the University of Puerto Rico Comprehensive Cancer Center (UPRCCC) aims to increase the pool of master’s degree and other health professional students that pursue a doctoral degree and/or career in cancer prevention and control research with a focus on Hispanic health/disparities. CAPAC will recruit 25 participants annually from all racial/ethnic groups for a summer hands-on research experience of 10 or 15-weeks in Puerto Rico (PR). Participants are matched to a mentor according to their research interest on basic, clinical, and population-based research at the UPRCCC and other institutions in PR. Activities include participation in a research project and complementary educational/professional skill-building activities. Participants are requested to complete baseline and exit evaluation surveys and commit to participate in follow-up surveys to track their status and progress towards their career development and the program’s goals. For 2021, we received 70 applications. Of the 25 participants selected, 84% were females, 80% Hispanic/Latino, 56% current master students, and 56% were from PR institutions. While 60% plan to apply to a PhD/DrPH program in the future, 48% are unsure if they will pursue a career in cancer research. Nonetheless, 84% are confident that they will pursue a career in health disparities research, and 100% want to reduce health disparities in their communities. The main reason why they may not pursue a PhD/DrPH degree is they prefer to get a professional degree (MD/PharmD/DMD, 52%), followed by financial constraints (16%). Despite the COVID-19 pandemic, CAPAC successfully recruited students for its 2021 program to participate in cancer research in PR. Follow-up surveys will evaluate the trainees’ summer research experience and the program’s impact on increasing their intention to pursue a doctoral degree and/or a career in cancer prevention and control research. Objectives: The participant shall be able to describe the goals and target population of the CAPAC Training Program. The participant shall be able to identify two barriers for the intent to complete a PhD/DrPH degree in cancer prevention and control research among CAPAC participants. References: Pasick RJ, Otero-Sabogal R, Nacionales MCB, Banks PJ. Increasing ethnic diversity in cancer control research: description and impact of a model training program. J Cancer Educ. 2003;18(2):73-77. doi:10.1207/S15430154JCE1802_07. Cameron C, Collie CL, Chang S. Introducing students to cancer prevention careers through programmed summer research experiences. J Cancer Educ. 2012;27(2):233-242. doi:10.1007/s13187- 011-0297-9.
4A-5: Hematology-Oncology Fellowship Curriculum Goes Global: Developing the next generation of Global Hematologist-Oncologists through Project ECHO
Mary Chamberlin1, Ilir Hoxha2, Dafina Ademi Islami3, Glorieuse Uwizeye4, Victoria Forbes5, Linda Kennedy1, Steven Fiering1, Kathleen Carluzzo4
1Geisel School of Medicine at Dartmouth, Hanover, NH, USA, 2Kolegji Heimerer, Prishtina, Kosovo, 3University Clinical Center of Kosovo, Prishtina, Kosovo, 4Dartmouth College, Hanover, NH, USA, 5University of Connecticut Health Center, Farmington, CT, USA
Abstract: There is growing urgency to address the rising burden of cancer and disparities in access to care in the US and abroad in Hematology-Oncology training programs. In 2015, we began to address this gap in our U.S.-based hematology-oncology fellowship program, by developing a hematology-oncology elective in Rwanda. In 2019, we created a parallel Project ECHOTM course in Global Oncology including disparities of care presented by our global partners. In 2020-21 the format was exclusively virtual. Project ECHOTM is a tele-mentoring platform of didactics, case presentations, and discussion. Didactics covered HIV-related malignancies, sickle cell anemia, cancer with chronic infections, and cancer care with limited resources . Case presentations included small bowel and hepatocellular carcinomas, impact of social media, and breast cancer prevention. Global Health students were trained to facilitate the sessions and a patient advocate participated in the discussant panel. Registration was required to present cases or access recorded sessions Process and outcome measures (Table 1) assessed objectives: To increase confidence in cancer patient management on topics of global importance; To increase registrants; To promote international participation. Confidence surveys were requested pre- and post-course via the Project ECHOTM platform. Year 1 total registered: 19 (26% non-US), number of sessions 4, Confidence increased from 33% to 59%. Year 2 total registered: 59 (37% non-US), number of sessions 10, Confidence non-evaluable (no post-course surveys returned). Project ECHOTM is a feasible model of tele-mentoring for cancer disparities education. Total, and international registrations increased in Year 2. Confidence improved year 1 but was unevaluable year 2. Participants will identify and discuss at least 2 measureable endpoints or barriers to engagement in a telementoring course on cancer disparities. Objectives: The participant shall be able to identify disparities in cancer education regardless of geographic location. Participants will identify and discuss at least 2 measureable endpoints or barriers to engagement in a telementoring course on cancer disparities. References: Domgue JF, Baker E, Manjuh F, Lopez M, Welty T, Schmeler KM. Connecting frontline providers in Africa with distant experts to improve patients' outcomes through Project ECHO: a successful experience in Cameroon. Int J Gynecol Cancer 2019;0:1–2. doi:10.1136/ijgc-2019-000405. Power-Hays A, McGann PT. When Actions Speak Louder than Words--Racism and Sicle Cell Disease. NEJM 383;20. Nov 12, 2020. Piel FB, Steinbery MH, Rees DC. Sickle Cell Disease. NEJM 376:16 April 20, 2017.
4B-1: Impact of a Canvas-based course on the scientific professional identity development of summer undergraduate participants in an online cancer research experience
Misty Pocwierz-Gaines, Alaina Larson, Promise Moore-Saufley, Cassie Liu, Sadie Allen, Catherine Johnson, Gabrielle Brumfield, Sipra Panda, Alesha Baxter, Joyce Solheim
University of Nebraska Medical Center, Omaha, NE, USA
Abstract: Past research has established that students with a stronger professional identity are more likely to persist in college and attend graduate school. Additionally, it has been established that professional identity can be increased through research experiences. Due to the ongoing COVID-19 pandemic, the Eppley Institute (EI) within the University of Nebraska Medical Center (UNMC) hosted a virtual 2021 Summer Undergraduate Research Program (SURP). This program was designed to increase participants’ scientific professional identity. In 2020, our initial conversion of the EI SURP to an online program created challenges in participants identifying as scientists. For summer 2021, we created an asynchronous Canvas-based course that utilizes videos, infographics and discussions to create a more interactive and engaging educational experience. Each participant was paired with a graduate student mentor on whose research project they will consult, and the participants also attended virtual laboratory meetings and seminars while completing the Canvas course. All EI SURP participants complete pre-program and post-program surveys and a post-program interview to determine the influence of the program on development of scientific professional identity. SURP participants from other departments within UNMC that will be having in-person research experiences will also be invited to participate in the Canvas-based course. These students were given the surveys and any student that participated in aspects of the Canvas course will be interviewed. The levels of professional identity of the two groups were assessed to analyze the difference in effect of the Canvas-based course on virtual only students compared to the course plus in-laboratory experiences. This online model has potential to be broadly applicable for increasing the scientific professional identity of students. It could serve as a guide for institutions that desire to supplement traditional laboratory-based undergraduate research experiences, and could benefit students from minoritized populations that may not thrive in a traditional research experience. Objectives: Participants will be able to identify two ways in which scientific professional identity can be increased in undergraduate students through participation in a research-based experience program. Participants will also be able to identify the portions of a Canvas (or other online platform) based course can be used to increase the scientific identity of undergraduate students. Additionally, participants will be able to identify components of an online course that are essential to scientific professional identity. References: Castellanos, M. (2018). Examining Latinas’ STEM Career Decision-Making Process: A Psychosociocultural Approach. Journal of Higher Education, 89(4), 527–552. https://doi.org/10.1080/00221546.2018.1435133. Nadelson, L. S., McGuire, S. P., Davis, K. A., Farid, A., Hardy, K. K., Hsu, Y.-C., Kaiser, U., Nagarajan, R., & Wang, S. (2017). Am I a STEM professional? Documenting STEM student professional identity development. Studies in Higher Education, 42(4), 701–720. https://doi.org/10.1080/03075079.2015.1070819. Talley, K. G., & Martinez Ortiz, A. (2017). Women’s interest development and motivations to persist as college students in STEM: a mixed methods analysis of views and voices from a Hispanic-Serving Institution. International Journal of STEM Education, 4(1), 5. https://doi.org/10.1186/s40594-017-0059-2
4B-2: Éxito! Latino Cancer Research Leadership Training: Fueling the fire to succeed from student to successful researcher
Daniel Hughes1, Stacy Cantu-Pawlik1, Arely Perez2, Rena Pasick3, Amelie Ramirez1
1University of Texas Health Science Center-Institute for Health promotion research, San Antonio, TX, USA, 2Kelsey Research, Houston, TX, USA, 3University of California San Francisco, San Francisco, CA, USA
Abstract: Cancer related health disparities continue. Cancer continues to be the number one cause of death for Latinos in the US. To address this disparity gap requires increasing the pipeline of competent Latino researchers that best represent and understand the cultural factors associated with Latino disparities. Latinos who represent 18% of the current US population, are among the least represented group with doctoral degrees. Éxito! exists to transition students to successful doctoral-trained researchers. Éxito! annually selects top 25 candidates to an intense five-day Summer Institute (SI). The SI promotes collaboration between trainees, presenters, and mentors. Sessions are led by leaders focused on disparities, in a culturally congruent atmosphere that enhances academic self-efficacy, social support, and networking. Up to ten competitive mentorships are awarded annually after the SI. Trainees are matched with mentors focused on Latino health disparities for the opportunity to enhance their research skills. Success is measured by academic self-efficacy, e.g. “accepted into program of choice” ; confidence to overcome barriers, e.g. “applying to a program”; improvement in research skills (internships); and, acceptance into a terminal degree program. In ten years, 225 individuals have completed SI training and 54 internships have been awarded. SI training has been associated with improvement in self-efficacy (p < .001) improvement in confidence toward a doctoral degree (p < .001) and improved research skills (p < .001) during internships. Since 2010, of the 225 Éxito! alumni, 59 have successfully enrolled in doctoral programs; with, 19 graduating to date. As we complete our final year of current funding, we plan to build on our success. We are developing a multi-variate predictive model based on alumni that have succeeded and alumni that have not succeeded. The results will inform enhancements to our program as we seek further funding. Objectives: The participant shall be able to identify how the Éxito! program uses cultural congruence to enhance participant self-efficacy, confidence, and research skills for students desiring to transition into competent researchers focused on Latino cancer-related health disparities. References: American Cancer Society. American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2018-2020. American Cancer Society. 2018. Rubio DM, Hamm ME, Mayowski CA, et al. Developing a Training Program to Diversify the Biomedical Research Workforce. Acad Med. 2019.
4B-3: Robust institutional support and collaboration between summer training programs in cancer and biomedicine drive a pivot to virtual format in response to the covid pandemic
Bret Hassel1, Heather Ezelle1, Gregory Carey2, Kevin Cullen1, Rena Lapidus1, Lauren Schnaper3
1University of Maryland Greenebaum Cancer Center, Baltimore, MD, USA, 2University of Maryland School of Medicine, Baltimore, MD, USA, 3Greater Baltimore Medical Center, Baltimore, MD, USA
Abstract: Summer internships are important for training the next generation of cancer researchers and oncologists. The SARS-CoV-2 outbreak precluded implementation of interactive summer program curricula and led to the cancellation of internships across the US. However, pivoting the Nathan Schnaper Intern Program in Cancer Research (NSIP) to a virtual format created opportunities for trainees to engage in remote research, online learning platforms and multidisciplinary topics as part of a robust institutional COVID response. Nine summer programs consolidated resources to identify mentors with online research projects, adapt training modules to a virtual format and develop novel educational components. Online research provided trainees with a skillset highly relevant in their paths toward professions in which virtual interfaces occupy an increasingly mainstream role. The implementation of virtual programs as part of an institutional response to COVID exposed trainees to the innovation and resilience that are essential components of the biomedical profession. Outcomes evaluation of new components and feedback from participants provided insights into the utility of online platforms to add flexibility and content as a potential mechanism to complement in-person curricula. Comparing outcomes in which identical modules were delivered in-person and online provided information on the impact of COVID restrictions on program implementation and trainee engagement. Pre- and post-session surveys used a Likert scale to assess content learning by participants in different modules. Questionnaires and informal discussion with program leaders provided mechanisms to collect feedback on program format, organization, delivery and trainee-specific components (e.g. research projects and mentoring). Implementation of a virtual NSIP identified approaches to augment content and learning in traditional in person modules that will be retained in future programs. Increased focus on trainee wellness in an online setting revealed best practices that enhance engagement to continue in subsequent curricula. Objectives: The participant shall be able to provide examples of how online modules function in cancer education to foster interns’ perspective of cancer research. The participant shall be able to articulate the benefits and drawbacks of virtual curricula in intern learning and engagement. The participant shall be able to discuss aspects of a virtual curriculum that may augment traditional in-person learning. The participant shall be able to describe the value of intern exposure to institutional responses in public health crises. References: Malayil L, Negahban-Azar M, Goldstein RR, Sharma M, Gleason J, Muise A, Murray R, Sapkota AR. Zooming Our Way through Virtual Undergraduate Research Training: A Successful Redesign of the CONSERVE Summer Internship Program. 2021 J Microbiol Biol Educ. 22(1):22.1.90. doi: 10.1128/jmbe.v22i1.2625. eCollection 2021.PMID: 33953822. Mirza A, Gang L, Chiu T. Utilizing Virtual Exchange to Sustain Global Health Partnerships in Medical Education. 2021 Ann Glob Health. 87(1):24. doi: 10.5334/aogh.3179.PMID: 33747799
4B-4: From Cells to Communities: Bridging the knowledge gap between basic science cancer researchers and cancer survivors
Sydney Stern1, Anagha Krishnan2, Stephanie Zalesak1, Michele Vitolo3, Dbora Schrett4, Laundette Jones3
1University of Maryland Baltimore, Baltimore, MD, USA, 2NCI, Bethesda, MD, USA, 3University of Maryland School of Medicine, Baltimore, MD, USA, 4N/A, Baltimore, MD, USA
Abstract: Traditional training for cancer biologists focuses on understanding biological mechanisms to improve diagnosis and treatment. The lack of instruction on non-biological factors that contribute to cancer limits one’s ability to engage in team-based approaches for effective cancer control. We aimed to create a workshop that exposes trainees to patient perspectives beginning at early stages of their research career. The goal is to develop well-rounded researchers who fully understand the scientific and social dimensions of cancer. “From Cells to Communities” is a 6-week pilot workshop that brought together scientist trainees, patient advocates, and cancer survivors to engage in a mutually beneficial knowledge exchange to develop a common language and a broader perspective of cancer. Pre- and post-surveys were used to assess the impact of participation on trainees' and survivors' understanding of cancer at the scientific and social levels, and level of comfort conveying understandable scientific knowledge to lay audiences. 75 participants attended the virtual workshop with 23 participants attending at least three sessions. 48.9% of participants were trainees, 17.0% were patients, and 19.1% were scientists. Trainees and scientists had a wide range of research interests, including cancer biology and immunology. Survivors represented diverse cancer diagnoses. Following the program, trainees demonstrated marked increase in comfortability presenting to lay audiences and understanding of the many obstacles cancer patients face. Both trainees and survivors were eager to explore the potential benefits of establishing a bidirectional communication partnership that exemplifies transformative learning in a profoundly different way. The current pilot suggests that the creation of education programs that bridge the knowledge between the science of researchers and the lived experiences of survivors should be explored. Our pilot workshop is a foundation to generate community-engaged researchers, while strengthening outreach to diverse individuals and communities in our catchment area. Objectives: The participant shall be able to create and deliver presentations that successfully convey understandable, yet comprehensive scientific knowledge to lay audiences. The participant shall be able to speak in general public informal settings about the scientific and social dimensions of cancer with ease. References: Riter, Robert N., and Robert S. Weiss. Connecting students with patients and survivors to enhance cancer research training.” Cancer research 79.16 (2019): 4011-4014. Salamone, Jeannine M., et al. Promoting scientist-advocate collaborations in cancer research: why and how. Cancer research 78.20 (2018): 5723-5728.
4B-5: Fostering the development of the next generation of Cancer prevention scientists – Insights from an Early Career mentor
Kristin Primm, Shine Chang
The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Abstract: While the area of cancer prevention and control increasingly requires a transdisciplinary approach, there are few training opportunities for students interested in pursuing a career in cancer prevention research, and even fewer opportunities for early career professionals gain valuable mentoring experiences. The Cancer Prevention Education Student Research program aims to grow the field of cancer prevention research through mentored research opportunities designed for undergraduate, graduate, and health professional students interested in career cancer prevention research. To broaden the field, the NCI-funded Cancer Prevention Education Student Research program at MD Anderson recruits and exposes summer undergraduate, graduate and health professional students to cancer prevention through mentored research opportunities. As part of this program, early career professionals, including post-doctoral fellows, gain valuable experience as part mentoring teams. From the perspective of an early career mentor, this abstract describes the learning processes, needs, resources, and mentoring strategies developed and used over the 10-week program. The mentoring team included one post-doctoral trainee and one senior faculty, who co-mentored two undergraduate students. Students were assigned research project looking at colorectal cancer disparities using SEER registry data. Mentors created a series of step-by-step video tutorials detailing how to use SEER*stat software to obtain data and statistics for their respective projects. The recorded trainings enabled students to learn at their own pace, allowing them to pause, rewind, relisten, or review content as needed. Mentors learned how to create effective instructional videos that can be used to train future students. Co-mentors met weekly to plan learning activities, share advice, and review- Mentored summer research experiences that provide valuable research and professional development opportunities for students interested in careers in cancer prevention can also provide excellent opportunities for early career investigators (including graduate and postdoctoral fellows) to gain valuable mentoring experience. Objectives: The participant shall be able to describe the overall purpose of the Cancer Prevention Education Student Research program at MD Anderson. The participant shall be able to the learning processes, needs, and mentoring strategies developed as part of a mentored research experience. References: 1. Chang, S., & Collie, C. L. (2009). The future of cancer prevention: will our workforce be ready?. Cancer Epidemiology and Prevention Biomarkers, 18(9), 2348-2351. 2. Chang, S., Hursting, S. D., Perkins, S. N., Dores, G. M., & Weed, D. L. (2005). Adapting postdoctoral training to interdisciplinary science in the 21st century: the Cancer Prevention Fellowship Program at the National Cancer Institute. Academic Medicine, 80(3), 261-265.
SYMPOSIUM 4C: Sexual and Gender Minority (LGBTQ) Adolescent and Young Adult (AYA) Patients with Cancer: Reproductive Health Care
This symposium will discuss the reproductive health needs of sexual and gender minority (LGBTQ) adolescent and young adult (AYA) with cancer and showcase the development of a training module to improve allied health professionals communication skills regarding fertility, contraception, and sexual health.
4C-1: “I worry I won’t say the right thing” Oncology Allied Health Professionals Experiences with LGBT AYA Patients with Cancer and Reproductive Health
Megan Sutter1, Amani Sampson2, Julia Gagliardi1, Susan T. Vadaparampil3, Gwendolyn Quinn2
1NYU Grossman School of Medicine, New York, NY, USA; 2New York University, New York, NY, USA; 3Moffitt Cancer Center, Tampa, FL, USA
Abstract: Lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents and young adults (AYAs) with cancer have multiple intersecting barriers to supportive services. Understanding these barriers from the perspectives of clinicians who care for LGBTQ AYAs may provide an important foundation for developing institutional interventions. Using qualitative data from an online survey with four qualitative items distributed to 601 allied health professionals who received training regarding reproductive health needs of AYAs with cancer. Using content analysis and the constant comparison method, two investigators independently analyzed qualitative survey responses. Together, they refined themes, resolving disagreements through consensus. Steps were repeated iteratively until all responses were reviewed and thematic saturation was noted. Inter-rater reliability was 90%. Of 346 survey participants, 190 (55%) answered any of the open-ended questions. Four themes were identified: 1) challenges with identity disclosure and confidentiality; 2) patient and clinician assumptions about fertility in LGBTQ AYA; 3) lack of training impacting confidence in providing affirming care; and 4) the need to reduce barriers by creating inclusive and welcoming environments in physical space, educational materials and with institutional policies. To resolve barriers to supportive reproductive care for LGBTQ AYA patients with cancer and survivors, systemic and institutional change is required. There is a strong desire for education among clinicians and efforts are underway to develop a unique module for ECHO to address training needs. Objectives: 1. The participant should be able to describe the ways the culture and structure of institutions and societies may create the conditions for barriers to care for LGBTQ AYA people with cancer. 2. The participant should be able to describe the ways that institutional barriers can create conflicts in providing affirming and confidential care. 3. The participant should be able to explain why decreasing barriers to care for LGBTQ AYA people with cancer may require institutional and systemic change. References: Griggs, J., Maingi, S., Blinder, V., Denduluri, N., Khorana, A. A., Norton, L., ... & Rowland, J. H. (2017). American Society of Clinical Oncology position statement: strategies for reducing cancer health disparities among sexual and gender minority populations. Obstetrical & Gynecological Survey, 72(10), 598-599. Peditto, K. (2018). Reporting qualitative research: Standards, challenges, and implications for health design. HERD: Health Environments Research & Design Journal, 11(2), 16-19.
4C-2: Examining clinician knowledge and confidence in reproductive health needs among sexual and gender minority (SGM) Adolescent and Young Adult (AYA) patients with cancer
Paige Lake1, Amani Sampson2, Megan Sutter3, Ash Alpert4, Susan T. Vadaparampil1, Gwendolyn Quinn2
1Moffitt Cancer Center, Tampa, FL, USA; 2New York University, New York, NY, USA; 3NYU Grossman School of Medicine, New York, NY, USA; 4University of Rochester Medical Center, Rochester, NY, USA
Abstract: Adolescent and Young Adult (AYA) cancer patients have unique reproductive health needs (RHN). AYA-SGM patients have greater unmet sexual health needs (SHN) than cisgender and heterosexual peers. Clinicians treating these patients need training. We assessed knowledge and confidence of ENRICH/ECHO trainees to identify the impact in addressing RHN of AYA-SGMs. Clinicians (n=307) who participated in the ENRICH/ECHO program and regularly treat AYA patients completed a 7-item survey assessing knowledge and confidence discussing reproductive health with SGM AYAs. Knowledge items focused on screening, risk factors, and communication behaviors for SGM AYAs. Items were scored as correct/incorrect and groups were created based on correct answers (6-7 correct: high knowledge, 4-5 correct: moderate, 0-3 correct: low). Descriptive statistics were used to summarize confidence items. Chi square tests examined differences in confidence discussing RH and confidence in knowledge of RHN and health needs by knowledge group. Confidence discussing and confidence in knowledge of RH and health needs was lower regarding transgender and non-binary patients vs other sexual minority groups (SMGs). The majority of providers were confident discussing RH with patients, but less confident in their knowledge of RHN among SGM. Nearly half of providers (45%) demonstrated low knowledge, while 38% and 17% demonstrated moderate and high knowledge, respectively. The high knowledge group demonstrated greater confidence in knowledge of health needs in all SGMs and in RHN of gay and lesbian and bisexual and queer patients (p’s<.05). The majority of our learners demonstrated low or moderate knowledge on factors that can influence AYA SGM patient care, suggesting this is a key area for improvement. Further, improving provider knowledge may subsequently improve confidence in health needs and RH needs of SGM patients, resulting in patient-centered care. Objectives: 1. The participant shall be able to identify unique needs of AYA-SGMs. 2. The participant shall be able to identify areas for improvement in AYA-SGM patient care. References: 1. Gibson AW, Radix AE, Maingi S, Patel S. Cancer care in lesbian, gay, bisexual, transgender and queer populations. Future Oncol. 2017 Jun;13(15):1333-1344. doi: 10.2217/fon-2017-0482. Epub 2017 Jun 7. PMID: 28589734. 2. Boehmer U, Gereige J, Winter M, Ozonoff A. Cancer survivors' access to care and quality of life: Do sexual minorities fare worse than heterosexuals? Cancer. 2019 Sep 1;125(17):3079-3085. doi: 10.1002/cncr.32151. Epub 2019 May 20. PMID: 31106409; PMCID: PMC8011296.1.
4C-3: Developing LOVE-ECHO: LGBTQIA Sexual Health Education for Allied Health Professionals
Rebecca Block1, Gwendolyn Quinn2
1OCHIN, Portland, OR, USA; 2New York University, New York, NY, USA
Abstract: A prior survey identified low knowledge and communication skill needs among oncology clinicians for delivering inclusive and affirming care for LGBTQIA AYA cancer patients and survivors. The LOvE (LGBT Oncofertility Education) module for ECHO (Enriching Communication skills for Health professionals in Oncofertility was developed to address this need. ECHO alumni were surveyed to identify knowledge, attitudes and practice behaviors regarding sexual health for LQBTQIA adolescents and young adults (AYAs). Among the 365 respondents, low knowledge but positive attitudes emerged. The desire to receive more training was notable, especially in providing affirming and inclusive care to transgender patients. Additionally, expert input in AYA cancer and LGBTQIA advocacy and current literature on inclusive and affirming care informed the development of LOvE module based in Critical Race Theory and an intersectional perspective. Twelve LGBTQIA youth and AYA cancer survivors provided feedback on the module to increase relevance and accuracy. The LOvE module was built to educate, engage and motivate. An interactive glossary teaches shared language followed by a lecture on skills for creating a welcoming environment, discussion topics and other practical tips. The 3 case studies allow learners to “choose their own adventure” for how they would respond based on presented information. The action plan invites learners to identify activities they will initiate now and later. The pre and post -test function measures knowledge and practice behaviors. The module was tested with a cohort of 123 new ECHO learners; results are provided in another abstract for this session. The LOvE ECHO module was developed on learner needs and community based participatory approaches to curriculum design. Further improvements will be informed by learner feedback and the ECHO team comprised of AYA cancer, LGBTQIA and reproductive health experts. The dissemination of this work serves to increase visibility to LGBTQAI heath disparities. Objectives: The participant shall be able to describe the need for training in caring for LGBTQIA cancer patients and survivors. The participant shall be able to identify interactive approaches to training providers to deliver inclusive and affirming care. References: Clarke, M., et al., Overlooked minorities: the intersection of cancer in lesbian, gay, bisexual, transgender, and/or intersex adolescents and young adults. Journal of adolescent and young adult oncology, 2019. 8(5): p. 525-528. Lisy, K., et al., Experiences and unmet needs of lesbian, gay, and bisexual people with cancer care: A systematic review and meta-synthesis. Psycho-oncology, 2018. 27(6): p. 1480-1489. Kamen, C.S., et al., “Treat us with dignity”: a qualitative study of the experiences and recommendations of lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients with cancer. Supportive Care in Cancer, 2019. 27(7): p. 2525-2532.
4C-4: Pilot Study on reproductive health communication training for Allied Health Professionals working with LGBTQ Adolescent and Young Adult (AYA) with cancer
Gwendolyn Quinn1, Susan T. Vadaparampil2, Jillian Pecoriello1, Amani Sampson1, Megan Sutter3
1New York University, New York, NY, USA; 2Moffitt Cancer Center, Tampa, FL, USA; 3NYU Grossman School of Medicine, New York, NY, USA
Abstract: Gaps in clinician training may result in reproductive health disparities among LGBT AYAs. The R25 Enriching Communication Skills for Health Professionals in Oncofertility (ECHO) curriculum recently expanded to include LGBT Oncofertility Education (LOvE). The objective of this study was to evaluate the impact of the module on knowledge and satisfaction. Participants completed a 10-item multiple-choice pre and posttest assessing knowledge of providing affirming reproductive health care to LGBTQ AYAs with cancer (range: 0 = no correct responses to 10 = all correct). A post-module survey also evaluated module relevance, quality, and appropriateness to professional practice. Response options ranged from strongly agree to strongly disagree. Six open-ended items invited respondents to describe experiences and suggestions for improving training in LGBTQ AYA cancer care. Paired t-tests were used to analyze changes in correct answers between pre- and posttests (p < 0 .05). Content analysis was applied to qualitative responses Among 47 learners completing the pre and posttest, 8.1% correctly answered all questions at pretest, compared to 59.5% at posttest. Average pretest score was 83%; average posttest score was 95% (M=-1.2, t (37)=4.55, p < .0001). Questions with the lowest number of correct answers were: 1.Why LGBTQ AYAs are at high risk for health challenges (13.5%) and 2. The relevance of educational materials about fertility to LGBTQ patients (22%). This improved to 64.9% and 98.2% correct in posttest, respectively. Eighty-nine percent strongly agreed LOvE ECHO was relevant to their work. Open-ended responses focused on the need to strengthen provider-patient relationship and The LOvE ECHO module results demonstrated significant improvement in knowledge of inclusive and affirming care for LGBTQ AYAs with cancer. Improving clinician knowledge may improve confidence in providing care for LGBTQ AYA patients with cancer, resulting in improved whole person care, social support and improved health equity Objectives: 1. Participants will identify LGBTQ adolescent and young adult (AYA) with cancer and survivors, unique reproductive health needs during the cancer care experience. 2. Participants will generate ideas to apply this education in their workplace setting. References: DeMulder, J., Kraus-Perrotta, C. and Zaidi, H., 2020. Sexual and gender minority adolescents must be prioritised during the global COVID-19 public health response. Sexual and Reproductive Health Matters, 28(1), p.1804717. Alexander, R., Parker, K. and Schwetz, T., 2016. Sexual and gender minority health research at the National Institutes of Health. LGBT health, 3(1), pp.7-10.
POSTER PRESENTATIONS
P1: Role of education to support multilevel intervention for hereditary cancer screening
Emily Bilenduke1, Andrea Dwyer1, Kristin Kilbourn1, Betsy Risendal2
1University of Colorado, Aurora, CO, USA, 2Colorado School of Public Health, Aurora, CO, USA
Abstract: Hereditary cancers account for 5% of breast and colorectal, 10-15% of ovarian cancer cases. Current rates of genetic counseling indicate unaddressed determinants for specific populations that disproportionately impact the rate at which people are accessing genetic services. The current study utilized a community engagement framework of multilevel stakeholders across Colorado to identify specific determinants of accessing genetic cancer screening. Key community stakeholders were recruited to represent a statewide, grass-roots organization of patient navigators, physicians, and community health workers whose members represented healthcare systems and community-based organizations reaching the medically under resourced. The stakeholders participated in multiple ranking surveys of determinants. Determinants were identified through recent literature and a survey of stakeholder community needs. Through the ranking stages, determinants ranked with the highest priority were considered in future rounds. The final determinants were confirmed during a stakeholder meeting discussion. The determinants were utilized in implementation mapping to identify potential evidence-based approaches to increase access to genetic counseling. Thirteen organizations ranked 32 determinants identified from a literature review. Two rounds of ranking identified four determinants: patients lack access, patients experience barriers, providers lack a systemic way to identify eligible patients, and lack of system level supports to address barriers to care. During the confirmation, stakeholders emphasized the importance of education to inform ways to address barriers and to identify eligible patients. Through implementation mapping, education objectives should use evidence-based approaches on multiple levels. Education should focus on self-efficacy, perceived susceptibility, and social detereminants of health for patients and complexity and perceived advantage of genetic counseling for providers and system. The findings of the current study will be used in implementation mapping to identify an evidence-based approach to address the determinants to increase hereditary cancer screening. Current education practices will be evaluated to address identifying patients and reducing barriers to care through a multilevel approach. Objectives: The participant shall be able to explain the impact of barriers to genetic cancer screening on multiple levels. The participant shall be able to identify education objectives that address community identified determinants to improve genetic cancer screening. The participants shall be able to name the different levels education will impact genetic cancer screening. References: Baumann, A. A., & Cabassa, L. J. (2020). Reframing implementation science to address inequities in healthcare delivery. BMC health services research, 20(1), 190-190. doi:10.1186/s12913-020-4975-3 Emmons, K. M., & Colditz, G. A. (2017). Realizing the Potential of Cancer Prevention — The Role of Implementation Science. The New England journal of medicine, 376(10), 986-990. National Cancer Institute. Genetic Testing for Hereditary Cancer Syndromes. 2019. Accessed at www.cancer.gov/about-cancer/causes-prevention/genetics/genetic-testingfact-shee doi:10.1056/nejmsb1609101 on October 26, 2020
P2: A Retrospective Cohort Study on the Social and Clinical Manifestations of SARS-CoV-2 Pandemic on Oncologic Patients
Quinton Blount, David Marvin, Kaitlyn Brooks, Charles Moore
Emory University School of Medicine, Atlanta, GA, USA
Abstract: SARS-CoV-2 virus causes increased risk of severe clinical events in cancer patients: ICU admissions, invasive ventilation, and death.2 Lung, breast, gastrointestinal, hematologic, and metastatic malignancies are disproportionately afflicted.1,2,4 Complications are higher than in non-cancer populations.2,5 Public safety measures can inadvertently contribute to delayed diagnosis, missed treatments, and reluctance to pursue medical treatment.3 The purpose of this study is to characterize social and clinical consequences of the COVID-19 virus for cancer patients during the pandemic. We conducted a retrospective review of adult patients admitted to Grady Memorial Hospital, a large, urban, high-volume, safety-net medical center, between January 1 - December 31, 2020. Social determinants of health data include homelessness, poverty, food security, transportation, and education were obtained using ICD-10 ‘Z-codes’. Objective data, symptoms, labs, imaging, procedures, hospital length of stay, and mortality, were extracted. Results pending. We plan to have data to present prior to the ICEC 2021. We can add/edit this section once we recieve our final dataset. Social and clinical factors revolving around the COVID-19 pandemic have rendered effective care to cancer patients increasingly difficult. Further research and organization of quality cancer care, during a pandemic, is warranted. Objectives: The participant shall be able to identify high risk malignancies associated with higher susceptibility to COVID-19 infection. The participant shall be able to identify the common severe complications to COVID-19 in cancer patients. The participant shall be able to identify social barriers to timely, adequate cancer screening and treatment as perpetuated by the COVID-19. The participant shall be able to identify the socioeconomic impacts of the COVID-19 lockdown. References: Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-337. doi:10.1016/S1470-2045(20)30096-6 Liu C, Zhao Y, Okwan-Duodu D, Basho R, Cui X. COVID-19 in cancer patients: risk, clinical features, and management. Cancer Biol Med. 2020 Aug 15;17(3):519-527. doi: 10.20892/j.issn.2095-3941.2020.0289. PMID: 32944387; PMCID: PMC7476081. Moraliyage H, De Silva D, Ranasinghe W, Adikari A, Alahakoon D, Prasad R, Lawrentschuk N, Bolton D. Cancer in Lockdown: Impact of the COVID-19 Pandemic on Patients with Cancer. Oncologist. 2021 Feb;26(2):e342-e344. doi: 10.1002/onco.13604. Epub 2020 Nov 26. PMID: 33210442; PMCID: PMC7753606.
P3: The experiences of cancer caregivers who are newcomers with limited language proficiency: a scoping review
Mijia Murong1, Lorraine Pirrie2, Eleni Giannopoulos3, Meredith Giuliani3, Janet Papadakos3
1Faculty of Medicine, University of Toronto, Toronto, ON, Canada, 2Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada, 3Princess Margaret Cancer Centre, Toronto, ON, Canada
Abstract: Limited language proficiency (LLP) and newcomer status, compounded by the effects of a cancer diagnosis may negatively affect caregivers’ physical and psychological wellbeing. This scoping review sought to explore themes related to the experiences of unpaid cancer caregivers who are immigrants, and understand the language-related barriers faced by this population. A scoping review was conducted from April to May 2020 using the Arksey and O’Malley Scoping Review Framework. This technique was used to map the existing literature on linguistically diverse cancer caregivers who are newcomers, using the following databases: Medline, ALL, Cochrane SR, Embase, Emcare, Psycinfo, Scopus and GIM. Search terms included “neoplasms”, “caregiver, “immigrants”, “linguistic” and “barrier”. The review considered only original peer-reviewed research and publications written in English. This scoping review employed the Joanna Briggs Institute methodology; two independent reviewers conducted title, abstract and full-text review of publications using Covidence software for systematic review management. The search yielded 11,165 abstracts. Following the removal of duplicates, 6,179 articles remained for analysis and underwent title and abstract screening, leaving 215 articles for full-text review. 159 articles were excluded. To date, 56 articles meeting inclusion criteria have been identified. In the majority of studies, the caregiver was a partner/spouse (44%) or parent/guardian (44%) and caregivers were primarily Spanish-speakers (40%) from Central/South America (54%). Themes uncovered include: lack of access to information, lack of support in retrieving appropriate information, challenges interacting with interpreters and translational services, as well as the role of interpretation in communicating with the patient and healthcare provider. Findings will offer insight about the impact of limited language proficiency and newcomer status on cancer caregivers. Understanding the barriers faced by LLP cancer caregivers will provide an understanding of how to best support this population and offer guidance into specific tailoring of interventions and resources. Objectives: The participant will be able to identify barriers related to the experiences of unpaid newcomer cancer caregivers with limited language proficiency (LLP). The participant will be able to explain why tailored interventions and curated programs are needed to address newcomer LLP cancer caregivers’ needs. The participant will be able to describe similarities and differences of newcomer LLP caregivers across various health systems. References: Munn, Z., Peters, M.D.J., Aromataris, E. (2018). Systematic review or scoping review. Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol, 18(1), 143. Wang, T., Molassiotis, A., Chung, B. P. M., & Tan, J. Y. (2018). Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC palliative care, 17(1), 96. Kent, E., Rowland, J.H., Northouse, L., Litzelman, K., Chou W.S., Shelburne, N, et al. (2016). Caring for caregivers and patients: Research and clinical priorities for informal caregiving. Cancer. 122(13):1987-95.
P4: Developing Evidence-Based Cancer Education Curriculum to Enhance Cancer Literacy in Appalachian Kentucky Middle and High School Students
Lauren Hudson, Nathan Vanderford
University of Kentucky, Lexington, KY, USA
Abstract: Driven by health inequities, Kentucky faces the highest cancer rates in the country with the greatest concentration of the disease being in the Appalachian region of the state (1-3). Enhanced cancer literacy, a person's ability to make appropriate healthcare decisions, could reduce Kentucky’s cancer burden. We created a brief cancer education intervention by administering a 10-question pretest to Kentucky middle and high school students in 6 counties, 5 of which are located in the Appalachian region. Access to these students was obtained by contacting school administrators and teachers, who then allowed visitation during regular science and health class periods. The pretest was then followed by a cancer education presentation given by Markey Cancer Center employees. Then, we administered a posttest with identical questions to the pretest. Students also recieved a 3-month follow-up survey. All questionnaries used were designed specifically for this study. The results show that the intervention improves cancer knowledge in students. Moreover, it demonstrates that these students are likely to share this information with others. To further improve cancer literacy, we developed a 3-part culturally tailored and academic standard responsive cancer curriculum to be incorporated into science and/or health classrooms. The first lesson teaches about the basics of cancer. The second discusses risk factors, and the third covers treatment. These lessons include a PowerPoint presentation, in-class activities, and a teacher's guide. Such curriculum could aid in lowering Kentucky cancer rates especially in the Appalachian region of the state. Improving cancer literacy, which can be achieved through proper education, can increase cancer prevention behaviors. By making cancer curricula more widely available, students and even community members’ cancer literacy could increase, and Kentucky's cancer disparities could be reduced. Objectives: Identify the cancer disparity in Appalachia Kentucky and identify specific factors that increase cancer incidence and mortality rates. Define cancer literacy and explain its potential implications on the cancer rates in Appalachia Kentucky. Examine potential methods and explore developed curriculum that strives to increase cancer literacy rates in Appalachia Kentucky. References: American Cancer Society. Cancer Facts & Figures 2020. 2020 Yao, N., et al., Cancer Disparities in Rural Appalachia: Incidence, Early Detection, and Survivorship. J Rural Health, 2017. 33(4): p. 375-381. Rodriguez, S.D., et al., A Social-Ecological Review of Cancer Disparities in Kentucky. South Med J, 2018. 111(4): p. 213-219. CDC. About Social Determinants of Health. 2020 19 Aug. 2020.
P5: Impact of STEM Programing in the Virtual Space
Robyn Pennella1, Katherine Ayers1, Katie Wade-Jaimes2
1St. Jude Children's Research Hospital, Memphis, TN, USA, 2University of Nevada Las Vegas, Las Vegas, NV, USA
Abstract: Equity in science and engineering education is still an unmet goal. Afterschool STEM programs are important for broadening participation in STEM careers, helping make STEM subjects more inclusive and creating sustained interest ad participation in STEM disciplines. To provide equitable access to afterschool STEM programming in underserved communities, St. Jude Children’s Research Hospital partnered with Shelby County Schools, a large, urban school district in Memphis, TN, to develop the St. Jude STEM Club. The St. Jude STEM Club is a ten-week afterschool club that aims to increase 5th-grade students’ science identities and critical thinking skills. During the club, students study a patient with osteosarcoma who requires a prosthetic and engage in an engineering design challenge to build a prosthetic hand. Due to COVID-related school closures, the Fall 2020 clubs shifted to a virtual platform. This study compared the impacts of the virtual and in-person versions of the club. On the final day of both the virtual and in-person versions of the program, students completed a retrospective, self-change survey to assess the club’s impact on STEM identity, STEM engagement, critical thinking, perseverance, adult relationships, and peer relationships. To contextualize these results, students also provided written responses to the following prompt: “Was your prosthetic successful? Why or why not?” Responses were qualitatively coded and themed. Preliminary comparison of the virtual and in-person versions of the club showed that STEM engagement, STEM identity, critical thinking and adult relationships remained relatively unchanged. Peer relationships, however, showed slight decrease in the virtual format. Hosting virtual STEM clubs appears to increase students’ STEM identity, STEM engagement, critical thinking and foster relationships with adults in a way that is similar to the in-person version of the clubs; but may be deficient in fostering peer relations, perhaps due to the independent nature of the virtual space. Objectives: The participant will be able to identify three successes and one drawback of hosting a virtual afterschool cancer education STEM club. References: Menekse, M., and Chi, M.T.H. (2019). The role of collaborative interactions versus individual construction on students’ learning of engineering concepts. European Journal of Engineering Education, 44(5), 702-725 Prins, R., Avraamidou, L., and Goedhart, M. (2017) Tell me a story: The use of narrative as a learning tool for natural selection. Educational Media International, 54(1), 20-33.
P6: Colorectal Cancer Prevention Education Strategies: Indigenous Voices from North Dakota
Nicole Redvers, Mia Wilkinson, Courtney Fischer
University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, USA
Abstract: American Indians (AI) present with higher rates of advanced-stage disease for screening detectable cancers and have a lower level of basic cancer screening knowledge, than non-AI patients. We sought to identify and elevate perspectives on colorectal cancer screening from a strengths-based approach within AI communities. A community engagement process was carried out in addition to a regional environmental scan to ensure proper grounding in the topic area. We carried out semi-structured interviews across four tribal reservation communities in North Dakota, USA. We utilized purposive sampling to ensure maximum variation in age, gender, and community until data saturation was achieved. Thematic analysis was carried out to identify consistent themes rooted within the AI experience. An Indigenous methodological orientation was also engaged throughout the research process that facilitated a culturally appropriate interview process. Ethical approval was gained for this project from all the relevant IRBs. We carried out twelve semi-structured interviews with AIs between the ages of 40-75 years of age located on one of the four reservations in North Dakota. Four main themes were identified as barriers for the engagement with colorectal cancer prevention including: colorectal cancer screening barriers (transportation, rurality), focused on other health problems (diabetes), lack of colorectal cancer tailored health promotion, and socio-cultural factors effecting colorectal cancer prevention (mistrust). Three main themes were identified as facilitators for the engagement with colorectal cancer prevention including: reasons for getting a colorectal cancer screen (role model), role of culture (storytelling), and getting out into the community. There is need for more community-informed, strengths-based approaches to colorectal cancer education strategies in AI communities. Due to shared structural barriers including colonization across AI communities, our findings may have relevance in other regions. More in-depth research on AI socio-cultural factors that affect uptake of colorectal cancer education are needed. Objectives: -The participant will be able to describe and understand the difference between strengths-based vs deficit-based approaches to colorectal cancer education screening approaches in American Indian communities. The participant will be able to list the considerations for incorporating American Indian culture into colorectal cancer education and screening implementation processes. References: Harris R, Van Dyke ER, Ton TG, Nass CA, Buchwald D. Assessing Needs for Cancer Education and Support in American Indian and Alaska Native Communities in the Northwestern United States. Health Promot Pract. 2016 Nov;17(6):891-898. Cueva K, Revels L, Cueva M, Lanier AP, Dignan M, Viswanath K, Fung TT, Geller AC. Culturally-Relevant Online Cancer Education Modules Empower Alaska's Community Health Aides/Practitioners to Disseminate Cancer Information and Reduce Cancer Risk. J Cancer Educ. 2018 Oct;33(5):1102-1109. Burhansstipanov L, Harjo L, Kaur JS. How can an Education Workshop Serve as an Intervention for American Indian Screening Participation. J Cancer Educ. 2019 Apr;34(2):216-222.
P7: Effectiveness of incorporating an inclusive language workshop into an online simulation-based difficult conversations training program for oncology healthcare trainees
Sarah Storer1, Tina Papadakos2, Mohammad Salhia3, Dalia Al-Mouaswas4
1Princess Margaret Hospital, Toronto, ON, Canada, 2Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 3Michener Institute at UHN, Toronto, ON, Canada, 4University Health Network, Toronto, ON, Canada
Abstract: Effective communication between healthcare providers (HCPs) and patients is important for HCP well-being, patient engagement, and health outcomes. Yet, HCPs do not receive adequate communication skills training and report feeling unprepared for difficult conversations with patients. Difficult Conversations in Health Literate Care was developed to meet this need. Four years later, a workshop on inclusive language has been integrated given a sharpened, social focus on inclusion, exploring how words manifest our biases, and impact care. Designed to focus HCPs on the needs of each standardized patient presented to them in 5 live simulations, course facilitators had noticed a gap in the curriculum around language and how poor choice of language can detract from care. The course was redesigned to include an interactive unit on the power of inclusive language. Run as pilot sessions involving ~75 multi-professional learners, comparative evaluation data will be presented. Evaluation of this program is currently underway. Impact will be measured by assessing participant's motivational beliefs around incorporating inclusive language and other techniques in difficult conversations with patients before and after the program, through a qualitative review of peer and facilitator feedback and satisfaction data. This program has the potential to increase HCP's competency in conducting difficult conversations with patient and families and in utilizing inclusive language to foster inclusion and build a culture of belonging within the health care organization. Objectives: The participant shall be able to: Describe the differences expressed by participants taking the regular offering of the Difficult Conversations in Health Literate Care program with when it included a focus on inclusive language. Discuss the role of language and its link to conscious and unconscious bias and the relationship of language to person-centered care. Understand how language can enhance (or hinder) their practice as hcp and educators References: Papadakos, C.(., Stringer, T., Papadakos, J. et al. Effectiveness of a Multiprofessional, Online and Simulation-Based Difficult Conversations Training Program on Self-Perceived Competence of Oncology Healthcare Provider Trainees. J Canc Educ (2020). https://doi.org/10.1007/s13187-020-01729-x Diversity Council Australia https://www.dca.org.au/inclusive-language-0 Sue, D. W. (2010). Microaggressions in everyday life: race, gender, and sexual orientation. Wiley. Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: implications for clinical practice. American psychologist, 62(4), 271. Tannenbaum, M. (2013, October 14).
P8: Engaging Community College Students in Reducing Cancer Disparities
Nicolette Olivia Le1, France Nguyen-Grozavu1, Szu-ying Chen1, Sandy Bohan2, Vanessa Malcarne2, Georgia Robins Sadler1
1UC San Diego Moores Cancer Center, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA
Abstract: The UC San Diego Moores Cancer Center hypothesized that it could help diversify the health and science workforce, determined by NIH to reduce the nation’s cancer burden, by training students to address health disparities. The first critical step to joining the workforce, completing college, can be hindered by financial barriers. Education program eligibility included U.S. citizenship or permanent residency, plus being from a low-income household, first-generation college student, and/or members of underrepresented racial and/or ethnic communities in health and science. Surveys completed by 378 freshman and transfer students included questions about their perceived barriers to completing college. Responses were analyzed across gender, ethnicity, race, birth place, and admission status. The sample, gathered from 2001 to 2020, included 152 (40%) incoming freshmen and 226 (60%) community college transfers; 77% were from racially and/or ethnically underrepresented communities, 88% were first-generation college students, and 99% were from low-income families. When asked to list the biggest problems that would make it difficult for students to continue college, 84% (n = 317) of the entire sample identified financial barriers, with 90% of the 317 listing finances first. Although 61% (n = 229) of all students reported their families would help them figure out how to meet the costs, incoming freshmen were statistically significantly more likely than community college students to report anticipated financial help from their families and statistically significantly less likely to report that the financial costs of college are beyond what their parents are willing/able to help them figure. Financial concerns were widespread, but statistically more prevalent among community college transfers. Due to their diverse backgrounds they may be an underutilized resource for addressing cancer disparities. Research needed to better support these students’ transfer to 4-year universities, matriculation to graduate school, and entry into the health and science workforce. Objectives: The participant shall be able to identify the unique contributions graduates of community colleges can make to efforts to reduce cancer disparities. The participant shall be able to identify the major barriers that community college transfer students encounter when transferring to a four-year college. References: Wibrowski CR, Matthews WK, Kitsantas A (2017) The Role of a Skills Learning Support Program on First-Generation College Students’ Self-Regulation, Motivation, and Academic Achievement: A Longitudinal Study. J Coll Stud Retent Res Theory Pract 19:317–332. https://doi.org/10.1177/1521025116629152 Carpi A, Ronan DM, Falconer HM, Lents NH (2017) Cultivating minority scientists: Undergraduate research increases self-efficacy and career ambitions for underrepresented students in STEM. J Res Sci Teach 54:169–194. https://doi.org/10.1002/tea.2134
P9: Reducing barriers to information and support for people living with advanced cancer
Tracy Torchetti, Clodagh McCarthy
Canadian Cancer Society, Toronto, ON, Canada
Abstract: In late 2019, the Canadian Cancer Society (CCS) undertook research to understand the information and support needs of people living with advanced cancer and use a co-design approach to update its publication Advanced Cancer. Research on the perceptions, experiences and psychosocial needs of this population indicates that health systems are difficult to navigate, self-advocacy, and even personal needs assessment, is challenging and social and mental health supports are vital. CCS’s advanced cancer project (phase 2) aims to reduce barriers for people with advanced cancer to access CCS cancer information and supports. Key deliverables are: recommendations for how CCS can augment its services (building on existing research); confirmation of which support programs to augment and implement (co-developed with clients).To inform these deliverables, public-facing CCS staff and volunteers are undertaking training to recognize and respond to the needs and concerns of clients with advanced cancer. The project will be evaluated using the following indicators, among others: number of staff and volunteers trained in values and beliefs surrounding advanced cancer diagnosis; system navigation, advocacy and care planning; communication and relationships; advance care planning and palliative care; death, dying and bereavement; number of community services for people living with advanced cancer vetted and added to CCS’s public database; increase in inquiries to CCS from clients living with advanced cancer and their caregivers Leveraging primary research, expert input and lived experience of people with advanced cancer and caregivers will help enhance the quality of life of people living with cancer. The ultimate aim is to identify programs that can be augmented to help people better access supports within and beyond CCS. Objectives: By the end of this presentation, participants will be able to: describe at least two societal values and perceptions that can limit access to social supports during the advanced cancer experience; identify two key responses from the Canadian Cancer Society to address barriers. References: Advanced Cancer Publication Generative Research Findings. Groundswell Projects, 2020. Unmet care needs in people living with advanced cancer: a systematic review. Moghaddam N, Coxon H, Nabarro S, Hardy B, and Cox K. Supportive Care in Cancer, ISSN 0941-4355, 8/2016, Volume 24, Issue 8, pp. 3609 – 3622.
P10: Preliminary evaluation results: Improving It’s My Life!, an interactive online tool, to increase cancer prevention awareness
Tracy Torchetti, Apiramy Jeyapalan
Canadian Cancer Society, Toronto, ON, Canada
Abstract: In 2014, the Canadian Cancer Society created It’s My Life!, an interactive, evidence-informed tool to educate Canadians about cancer prevention and empower them to make lifestyle changes. Awareness of cancer risk varies in groups such as low income or education (1). In 2020, the tool was redesigned after user testing with a diverse group of users including rural and urban, LGBTQ2+ community and varied education. Feedback received was used to improve usability, inclusivity, and enhance content. A voluntary, pop up, short survey is included at the end of the tool. The survey includes a few statements to determine the participants’ awareness and reaction to the tool which includes the relevancy and understandability of the information, knowledge about how to reduce cancer risk, and participant’s intention to make lifestyle changes to reduce cancer risk. A Likert scale from strongly agree to strongly disagree is used. Survey data collected pre and post redesign were analyzed separately, then compared. Overall, the positive responses increased or stayed the same for both the English (EN) and French (FR) tools after the redesign. Cancer risk reduction knowledge increased from about 92% to about 94% (EN), and about 90% to about 92% (FR). The intention to change behaviour to reduce cancer risk increased from about 93% to about 94% (EN) and stayed at 97% (FR). Qualitative feedback was collected. Follow up survey three months after use has been sent. Combined, these findings will inform actions to enhance the cancer prevention tool. About 94% of Canadians have home Internet access (2). With many Canadians going online for health information, a similar tool can be developed to educate and improve behaviours for various diseases. A similar tool can also be developed by other countries and in different languages. Objectives: The participants will be able to recognize the importance of user testing with diverse users to improve an online educational tool’s relevancy and understandability. The participants will be able to identify the methods used in the evaluation plan and be able to apply this in their work. References: Union for International Cancer Control (2020). International Public Opinion Survey on Cancer 2020. Statistics Canada. (2019). Canadian Internet use survey.
P11: Using Video Animations to Optimize First Appointments With Genetic Counsellors
Lauren Huff, Jeanna McCuaig, Emily Thain, Brittany Gillies, Janet Papadakos
Princess Margaret Cancer Centre, Toronto, ON, Canada
Abstract: Familial Cancer Clinics counsel an increasingly high volume of patients regarding hereditary cancer risk. The first appointment typically takes an hour, most of which is spent educating the patient on the foundational principles of hereditary cancer and genetic testing. In order to liberate time for genetic counsellors to focus on more personal consultation and potentially see a higher volume of patients, we developed a video series to educate patients prior to their first appointment. A salient belief assessment asking 15 patients to write down their thoughts about genetic testing and cancer was distributed to ensure their most pertinent informational needs were addressed. Subject matter experts further developed the content. The 3-video series covers hereditary cancer, genetic testing, and possible results. Videos used plain language and a high degree of understandability and actionability evidenced by the achievement of at least 80% on the Patient Education Materials Assessment Tool (PEMAT). A 12-item survey was developed to evaluate perceptions of the videos’ value in reducing first-appointment times and facilitating patient understanding. The survey included questions regarding the quality of information in the videos, feasibility of implementing the videos as a standard of practice, and predicted time savings during genetic counselling appointments. A digital survey link was sent to the Canadian Cancer Genetics and Genomics (C2G2) Community of Practice in May 2021. The C2G2 is a national community comprised of 350 individuals interested cancer genetics, including genetic counsellors, geneticists, oncologists, and patient representatives. Results are expected June 2021. By providing baseline information prior to genetic counselling, these videos are expected to improve the quality of genetic counselling appointments and allow patients to make more informed healthcare decisions. Genetic counsellors may also be able to help more patients as the demand for their services continue to grow. Objectives: The participant shall be able to identify how to reduce patient appointment times through education. The participant shall be able to consider how to implement a virtual pre-appointment education program in their institutions. The participant shall be able to list steps taken to create effective patient education animations. References: Stoll, K., Kubendran, S., & Cohen, S. A. (2018). The past, present and future of service delivery in genetic counseling: Keeping up in the era of precision medicine. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 178(1), 24-37. doi:10.1002/ajmg.c.31602. Dahodwala, M., Geransar, R., Babion, J., De Grood, J., & Sargious, P. (2018). The impact of the use of video-based educational interventions on patient outcomes in hospital settings: A scoping review. Patient Education and Counseling, 101(12), 2116-2124. doi:10.1016/j.pec.2018.06.018.
P12: Cancer 360 – A Holistic Curriculum
Sarah Storer1, Tylar Stringer2, Nicole Woods3, Maria Mylopoulos3, Meredith Giuliani2, Tina Papadakos2
1Princess Margaret Hospital, Toronto, ON, Canada, 2Princess Margaret Cancer Centre, Toronto, ON, Canada, 3University of Toronto, University Health Network, Toronto, ON, Canada
Abstract: Cancer is a major public health concern globally and the incidence is rapidly rising. Focused on capacity-building on a local and global scale, education priorities include growing the cancer workforce, nurturing a culture of critical inquiry and embedding interprofessional care and patient engagement into all aspects of cancer care. Cancer 360 is a new open access online course intended to inspire and inform. The course includes topics not typically covered in clinical training. The Cancer 360 course includes 12 multimedia units including Indigenous cancer care, cancer prevention and survivorship, interprofessional care, health literacy, knowledge translation, smoking cessation and research methods. Course content was constructed to foster productive struggle, knowledge integration and reflection. Two streams of Cancer 360 are offered, one for high school students in partnership with a local school board and a second open version for cancer professionals around the world. Data are being analyzed from both streams to assess whether students exposed to the course would consider a future career in cancer and how current practitioners feel the course has impacted their practice. To date, over 900 people from 120 countries accessed the Cancer 360 course, with satisfaction data showing that 95% of survey respondents would recommend the course to a friend or colleague. Next steps include a new course ‘Cancer 360 Advanced’ which will target experienced professionals and include topics such as: Caring for Older Adults with Cancer, Innovations in Cancer Treatment, and Homelessness and Cancer, among others. The Cancer 360 course promotes a holistic understanding of cancer and cancer survivorship from diverse professional perspectives and human experiences. The course aims to challenge participants to take a team-based approach to care, to look beyond the clinic and adapt their expertise to providing cancer care for the whole person. Objectives: Discuss the integration of concepts from the learning sciences into online education. Review evaluation data including learning assessments, usage and completion rates and satisfaction References: Steenhof, Naomi; Woods, Nicole N; Van Gerven, Pascal W. M ; Productive Failure as an Instructional Approach to Promote Future Learning, Advances in health sciences education: theory and practice, 10/2019, Volume 24, Issue 4. Manzone, J. C., Mylopoulos, M., Ringsted, C., & Brydges, R. (2021). How supervision and educational supports impact medical students’ preparation for future learning of endotracheal intubation skills: A non-inferiority experimental trial. BMC Medical Education, 21, 1-9. doi:http://dx.doi.org/10.1186/s12909-021-02514-0.
P13: Alone but not lonely: Fostering Social support for caregivers through an asynchronous program that does not have interaction between users
Andrea Pozo Barruel, Karen Lawrie, Lauren Huff, Meredith Giuliani, Tina Papadakos, Naa Kwarley Quartey, Michelle Snow, Mohamed Ugas, Janet Papadakos
Princess Margaret Cancer Centre, Toronto, ON, Canada
Abstract: Informal caregivers take new responsibilities that alter their everyday life, reducing the time for activities that involve self-care or socialization. When caregivers need more interaction and social support, they have less time to receive it. Asynchronous education programs provide caregivers with flexibility to learn during the time and place that works best for their personal routine. However, a disadvantage of these courses is the lack of interaction between users. The Caregiver Support and Skills Program is an asynchronous program that does not involve socialization between users. However, it promotes social support by presenting content that fosters socialization between caregivers and their friends and family. The program: Actively includes the voice of caregivers as part of the curriculum through videos, animations and quotes. Teaches strategies to socialize with others in situations that are common among cancer caregivers. Informs caregivers about relevant community support services that deliver in-person support. The program is stored in a Learning Management System (LMS). The LMS can track the number of clicks made to each resource. We will measure how many clicks caregivers make to the resources that promote socialization. Additionally, a caregiver and patient committee will validate the usefulness of the content in the program. This validation will evaluate the impact of the caregiver videos, animations, community services listed and relevant eLearning modules. Cancer education initiatives can promote social support even if they do not offer interaction between users. Listening to others’ experiences, connecting with specialized institutions and learning how to interact with friends and family during difficult times can encourage caregivers to look for social support. Objectives: The participant will be able to identify and utilize strategies to promote social interaction through asynchronous courses. The participant will be able to justify the value of encouraging social interaction in asynchronous courses. References: Balfe M, Keohane K, O'Brien K, Sharp L. Social networks, social support and social negativity: A qualitative study of head and neck cancer caregivers' experiences. Eur J Cancer Care (Engl). 2017 Nov; 26(6). Benson JJ, Oliver DP, Washington KT, Rolbiecki AJ, Lombardo CB, Garza JE, Demiris G. Online social support groups for informal caregivers of hospice patients with cancer. Eur J Oncol Nurs. 2020 Feb; 44:101698. C. Blanchard MSW, T. Albrecht PhD, J. Ruckdeschel MD, FACP, C. Grant PhD & R. Malcolm Hemmick MA (1995) The Role of Social Support in Adaptation to Cancer and to Survival, Journal of Psychosocial Oncology, 13:1-2, 75-95
P15: Embodied Conversational Agents: Potential Acceptance for HPV Vaccine Promotion among Black Men
Kayoll Gyan1, Stephanie Devane-Johnson2, Timothy Bickmore1, Jill Hamilton3
1Northeastern University, Boston, MA, USA, 2Vanderbilt University School of Nursing, Nashville, TN, USA, 3Emory University, Atlanta, GA, USA
Abstract: Interventions utilizing communication technologies may increase HPV-vaccination. Embodied conversational agents (ECA) are a technological approach that offers advantages for HPV vaccine promotion by marrying the strengths of in-person interventions (personal interactions) with the strengths of mobile health interventions (privacy, sensitivity, accessibility) to address low HPV-vaccination rates in Black men. Six online focus groups with N=31 Black men were conducted between August and December 2020 to examine acceptance of an ECA system to promote HPV knowledge and HPV vaccination among Black men ages 18-26-years-old. An integrated framework- the Information-Motivation-Behavioral skills model and PEN-3 cultural model guided this study. Community-engaged approaches, and social media facilitated recruitment. Participants were asked about 1) barriers and motivators to HPV vaccination, 2) acceptance of an ECA to promote HPV vaccination, and, 3) strategies to culturally tailor the ECA system for Black men. Data were analyzed using conventional qualitative content analysis and constant comparison techniques. A culturally tailored ECA intervention was acceptable to Black men and identified strategies for culturally tailoring the intervention content: 1) Race/ethnicity: preference for a Black male or female agent to role model healthy behavior and increase trust and relatability; 2) Agent persona: favored the agent to have the persona of a younger medical professional (doctor or nurse); 3) Setting: Using a hospital or clinic background to convey the seriousness of HPV; 4) Language: Deliver HPV information in simple, clear way with limited medical jargon; 5) Credibility- provide links to government sites and display professional credentials on the ECA. A culturally tailored, ECA system is an innovative, accessible and highly scalable approach to augment clinical care by provide trusted, interactive, and accurate HPV information to Black men to reduce HPV vaccination barriers and promote HPV vaccination uptake. Objectives: The participant shall be able to: 1. Describe the state of the science for HPV infection among young Black men ages 18-26 years old. 2. Identify at least two barriers and facilitators to HPV vaccination promotion among Black men ages 18-26 years old. 3. Evaluate the potential acceptance and usefulness of embodied conversational agents for HPV vaccine promotion among Black men. References: Francis DB, Cates JR, Wagner KPG, Zola T, Fitter JE, Coyne-Beasley T. Communication technologies to improve HPV vaccination initiation and completion: A systematic review. Patient Education and Counseling. 2017;100(7):1280-1286. Bickmore T, Trinh H, Olafsson S, et al. Patient and Consumer Safety Risks When Using Conversational Assistants for Medical Information: An Observational Study of Siri, Alexa, and Google Assistant. J Med Internet Res. 2018;20(9). Dutta MJ, Collins W, Sastry S, et al. A Culture-Centered Community-Grounded Approach to Disseminating Health Information among African Americans. Health Communication. 2019;34(10):1075-1084.
P16: Adapting Service Delivery and Ensuring Access in a Resource Library During COVID-19
Kathy Janes Jinkins, Sarah Christensen
The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Abstract: Services at our institution changed dramatically in March 2020 with the advent of widespread COVID-19. Face-to-face services shuttered, including the patient education resource library. The equitable delivery of services to patients and resultant patient experience issues became challenges to overcome. Having no knowledge when to expect an ending to the restrictions, services were planned for immediate and long-term utilization to meet patient health and disease information needs and new virtual services and programs were implemented. Changing from a highly interactive face-to-face service presented challenges. As staff began working remotely, the interaction ceased and staff were longing for interactions with their patrons. Patients had information needs that were not realized or being met with restricted access to the facility. By implementing new virtual services, patient needs were met and staff had patron interaction, albeit virtually. Patient access and staff satisfaction were outcomes specifically realized with the implementation of new services. New virtual services and programs were analyzed for best return on meeting patient needs, ease and immediacy of implementation, ability of users and access of users to utilize technology, and long-term efficacy. All services had to meet these criteria for consideration. New services implemented included live chat and live text to chat with library staff, direct messaging to library from portal on patients' electronic health record with access via web or mobile app, use of social media for outreach, staff assignment to clinical areas for information referrals, email question and reference service, and enlisting institutional communications assistance with messaging. Patients, families and caregivers had heightened information needs while navigating the pandemic. These needs were met with new services and offered access via phone, email, virtual sessions and messaging. All virtual services implemented in pandemic circumstances will continue once onsite interactions are allowed and are an enhancement to service delivery. Objectives: The participant shall be able to evaluate new resource library services relative to meeting patient needs, ease and immediacy of implementation, ability of users to utilize and long-term efficacy. The participant shall be able to assess and evaluate resource library service ideas and challenges to equitable access for potential implementation in their institution. References: Johnson F. Health information professionals: delivering core services and value in extraordinary times. Health Info Libr J. 2020 Sep; 37(3):245-247. “REALM Project-RE-opening Achives, Libraries, and Museums”. OCLC, 29 Apr. 2021, www.oclc.org/realm/home.html
P17: Recognizing excellence in cancer education: An awards program review
Nicole Liscio, Meredith Giuliani, Tina Papadakos
Princess Margaret Cancer Centre, Toronto, ON, Canada
Abstract: Staff engagement can improve outcomes for health care organizations [1]. Since 2015, the Princess Margaret Cancer Centre’s Cancer Education Awards have recognized excellence in the field of cancer education. Healthcare workers in the Cancer Program who go above and beyond in their practice are nominated by their peers, and award winners from a variety of clinical roles are celebrated at an annual awards ceremony. Each year, improvements are made to the awards process based on learnings from the previous cycle. For the 2020 awards cycle, the nomination, selection, and celebration of award winners were shifted to a virtual environment out of necessity due to the pandemic, whereas in previous years, some aspects of the awards had been conducted in person. In a year where healthcare workers have been stretched and tested with clinical priorities, the response to the 2020 awards was overwhelmingly positive, with a record number of nomination submissions and ceremony attendees compared to previous years. The nomination and selection processes were modified to improve and streamline the experience of the nominators and selection committee. An evaluation of past awards cycles and winners will summarize lessons learned and opportunities to improve recognition of staff. Evaluating past Cancer Education Awards cycles will help determine which practices to continue during the pandemic and beyond. Learnings will highlight where improvements may be made in streamlining the nomination process and increasing diversity of clinical staff groups that may not have been represented in past cycles. Objectives: The participant shall be able to: Discuss the gaps and opportunities for different approaches to staff recognition in a healthcare workplace. Describe ways to optimize the application and selection process and create a morale-boosting virtual space to recognize staff excellence. References: George V, et al. Proactive Strategy to Improve Staff Engagement. Nurse Lead 2020;18(6):532-535. DOI: 10.1016/j.mnl.2020.08.008. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516666/. Kelly LA, et al. Effect of Meaningful Recognition on Critical Care Nurses’ Compassion Fatigue. Am J Crit Care 2017;26(6):438-444. DOI: 10.4037/ajcc2017471. Available at: https://aacnjournals.org/ajcconline/article/26/6/438/4142/Effect-of-Meaningful-Recognition-on-Critical-Care.
P18: Implement Breast, Cervical Cancer, HPV Clinical Prevention & Pop Health for Women of African Descent
Angela Adjetey Appiah
Pace University, Tappan, NY, USA
Abstract: The majority of preventable cancers are treatable when detected by screening and appropriate tests (American Cancer Society, 2018a; American Cancer Society, I., 2019; Rodriguez et al., 2020). Ethnic groups, especially those of African ancestry/descents in the United States (US) of America, are diagnosed and treated with late-stage breast and cervical cancer and lack health promotion for HPV-preventable cancers. The quality improvement project enhance awareness, education, screening, health promotion, prevention, and knowledge, using an Evidence-Based. Community Health Needs Assessment (CHNA) was conducted in 2019 acknowledges the gap in clinical prevention and population health management with Breast, cervical cancer, and Human papillomavirus (HPV), among women of African descent that needs to be addressed to improve the community’s health due to the prevalence and mortality. The Model for Improvement: Plan-Do-Study-Act (PDSA) Cycle; Pre-post-follow-up approach and the Health Promotion Model (HPM) are used to guide the project. Conduct a pre and post-intervention survey to assess participants awareness and knowledge, perform an education and sustaining the program. Survey/questionnaire using the African Women Awareness of CANcer (AWACAN) tool for measuring awareness of breast and cervical cancer. Use the resources and toolkit to perform education and awareness on breast, cervical cancer, and HPV prevention for the community identified from the need’s assessment. Follow-up phone calls, referral to resources/access, education, and reminders increase participation in the following screening & prevention activities and decrease the disparities indicated in the community health needs assessment (CHNA). a. Mammography and Breast Self-examination b. HPV test Breast, cervical cancer, and HPV as health care and population health problem are significant concerns to the community. Early detection impacts the mortality rate and helps with decreasing the death rate for those diagnosed. Regular screening tests, education, and early detection approaches that are culturally congruent can decrease deaths. Objectives: Identify at least two intervention approaches to creating a culturally congruent cancer education, awareness, screening, and prevention among women of African descent. Identify two toolkits to utilize for community/population health approach with breast, cervical cancer, and HPV prevention and education. Identify two barriers to the dissemination of cancer education during a pandemic References: American Cancer Society. (2018). Cancer statistics center. https://cancerstatisticscenter.cancer.org/#!/. American Cancer Society, I. (2019). American Cancer Society Prevention and Early Detection Guidelines. https://www.cancer.org/health-care-professionals/american-cancer-society-prevention-early-detection-guidelines.html. Rodriguez, E. M., Jandorf, L., Devonish, J. A., Saad-Harfouche, F. G., Clark, N., Johnson, D., Stewart, A., Widman, C. A., & Erwin, D. O. (2020). Translating new science into the community to promote opportunities for breast and cervical cancer prevention among African American women. Health Expectations, 23(2), 337-347. 10.1111/hex.12985
P20: Structured functional fitness as a program for those post cancer treatment to aid recovery
Scott Britton
Battle Cancer, Totnes, Devon, United Kingdom
Abstract: Our goal is to provide free structured functional fitness classes following an evidence based program over 12 weeks to those post primary cancer treatment. There is significant need for those post-cancer treatment to re enter the process of physical exercise to reduce chronic fatigue along with other associated effects both physical and mental. Through coach led and online training sessions the Battle Cancer program offers a incremental program of functional training and movement assessments. Using over 65 academic resources, the Program offers alternative movements for those post-cancer treatment. The Program is designed around time domain-based exercise, and each movement is selected to echo the functions of everyday movement. The Program utilises group training and self-assessment to encourage community interaction. The Program also uses social interaction exercises to address the mental impact of cancer diagnosis. The Program is delivered inside CrossFit gyms twice a week for 12 weeks. The Program is centred on physical strength and fitness, and the WHO Quality of Life questionnaire. Participants are assessed on several physical measures including resting heart rate, mobility and strength-based exercises. Participants also complete a self-assessment of the WHO Quality of Life questionnaire three times over the 12 weeks. Impact on both physical ability and quality of life is measured by the change in these scores. The Program is creating a growing data set that identifies trends in cancer survivors' age, gender, cancer type, treatment, and symptoms post-treatment along with the impact of structured exercise on these conditions and side effects. This data, combined with participants' and coaches' feedback allows the program to continuously improve and develop. Data will inform safe movement and exercise programs for those affected by cancer across the world. By funding Programs in gyms across the U.S and by offering it to fitness professionals for free, we will drastically improve the accessibility to fitness among cancer survivors in all social groups regardless of their financial situation. Objectives: The participant shall be able to access a structured exercise program to aid in recovery post-cancer treatment. Fitness professionals shall also be able to access the latest advice on how to best support those post-cancer treatment back into physical exercise. The data collected will help to show the impact of a structed fitness program on those post-treatment to improve mobility, fatigue, strength and cardiovasular capacity. With a wide subject range, we will also be able to offer this data to the wider academic and medical community. References: Mustian KM, Alfano CM, Heckler C, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol. 2017;3(7):961–968. [PMC free article] [PubMed] [Google Scholar]. Williams TE, Chalder T, Sharpe M, White PD. Heterogeneity in chronic fatigue syndrome – empirically defined subgroups from the PACE trial. Psychol Med. 2017:1–12. [PubMed] [Google Scholar]
P21: Spiritual and Cultural Training in an Interprofessional Communication Cancer Education Program
Haley Buller1, Betty Ferrell1, Judith Paice2, Myra Glajchen3, Trace Haythorn4
1City of Hope Comprehensive Cancer Center, Duarte, CA, USA, 2Northwestern University Feinberg School of Medicine, Chicago, IL, USA, 3MJHS Institute for Innovation in Palliative Care, New York, NY, USA, 4Association for Clinical Pastoral Education, Atlanta, GA, USA
Abstract: Clinical practice guidelines emphasize the importance of oncology clinicians improving their communication skills to provide quality spiritual and cultural care. However, few clinicians receive formal communication skills training with an emphasis in spiritual and cultural aspects of care. The purpose of this abstract is to describe the Interprofessional Communication Curriculum (ICC), a train-the-trainer course for interprofessional oncology dyads to help prepare them to provide communication skills training at their home institutions. Organized by the 8 domains of the National Consensus Project (NCP) Guidelines, ICC includes skill-building exercises (e.g. role plays and case studies), interactive small group discussions, and vignette demonstrations, to improve participants’ abilities to provide effective spiritual and cultural care for cancer patients and their families. Using a goal-directed method of teaching, teams develop 3 goals for integrating communication training into their clinical settings. Evaluation included a pre-course survey and an immediate post-course evaluation. The first ICC course was held January 2021 (virtually) with 27 teams (52 participants) consisting of nurses, social workers, and chaplains. The pre-course survey revealed participants’ least effective areas of communication were related to spirituality and culture and when asked how frequently they provided spiritual care, an average of 2.7 on a scale of 1 to 5 (1=never) was reported. Post-course evaluations, on a scale of 1 to 5 (1=lowest), revealed that the course met participant’s expectations (4.8) and that the spiritual (4.9) and cultural (4.8) modules and small group discussion sessions provided the most value to their practices. With funding from an R25 NCI training grant, four additional ICC courses will be held in the next four years nationwide. A 6-and-12-month post-course follow-up will occur to capture participant training activity and goal progression. Objectives: The participant shall be able to identify at least two ways to integrate communication skills training at their institutions to improve spiritual and cultural aspects of care. References: Balboni, T.A., & Balboni, M.J. (2018). The Spiritual Event of Serious Illness. Journal of Pain and Symptom Management, 56(5), 816-22. Burgunder-Zdravkovski, L., Guzman, Y., Creech, C. et al. (2020) Improving Palliative Care Conversations Through Targeted Education and Mentorship. Journal of Hospice & Palliative Nursing, 22(4):319-326.
P22: Macro-Level Factors Impacting Colorectal Cancer Screening Behavior Among Church-Going First-Generation Chinese Americans: A Convergent Mixed-Method Study
Xian Cao, Su-I Hou
University of Central Florida, Orlando, FL, USA
Abstract: Chinses Immigrants (CIs) have a low CRC screening rate. It might be affected by macro-level social determinants of health, such as immigration experience, social networks, and widespread adoption of mobile media. This study examined macro-level social determinants affecting CIs’ CRC screening. This study used a convergent mixed method to examine (1) whether sociodemographic factors (e.g., gender, age, doctor recommendation), acculturation, religious social capital (e.g., trust among church members), and mobile media-based cancer information seeking can predict CIs’ endoscopy screening; (2) How these factors affect CI’s screening. The validated survey and interviews that have the same questions were used to collect data. 90 surveys and 32 individual interviews were collected from church-going Chinese Immigrants in local Chinese American churches. Logistic regression was used to model the three macro-level predictors of screening behavior. A thematic qualitative analysis was used to analyze interview data. The majority aged between 50-64, highly educated, married, employed, had a high income, had private insurance and received doctor recommendations. 54.4% did an endoscopy, while 25.6% did annual stool tests. Moreover, participants are highly acculturated (Mean=26, high acculturated: scored ≥15), high religious social capital, and high mobile media-based cancer information-seeking scores. Logistic regression showed that doctor recommendation and income were significantly positively associated with endoscopy screening (p<.05). The qualitative study confirmed that doctor recommendation is the determinative motivator for endoscopy screening. Religious social capital and mobile media can facilitate endoscopy screening by reducing screening anxiety and knowing screening benefits and Multiple interventions are needed to enhance endoscopy screening among CIs. Doctors should provide culturally and language-tailored screening recommendations. Chinese American churches should take advantage of religious social capital to share endoscopy screening information and provide mental and tangible supports. Mobile media should be used to enhance CI’s screening knowledge. Objectives: Previous studies mainly focused on relationships between CRC screening behaviors and cognitive/affective factors, but few have looked at systematic level factors. In my research, participants will be able to view the relationships between CRC screening behaviors from a systematic/macro level. They will be able to identify at least one determinator (doctor recommendation) and two facilitators (religious social capital and mobile media) of CRC screening among Chinese Immigrants. Moreover, the mixed research method provides a comprehensive picture of factors affecting Chinese immigrants’ CRC screening and how. This research will also provide a knowledge foundation for future cancer education research and practice. References: American Cancer Society (ACS). (2017). Colorectal Cancer Facts & Figures 2017-2019.Atlanta: American Cancer Society. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2017-2019.pdf. Ding, F.-Y. (2019). Developing a Regional Understanding of Church Growth of Chinese Churches in the US and a Plan for Disciple-making-based Church Growth at a Local Chinese Church. Trinity International University. https://search.proquest.com/docview/2313733226?pq-origsite=gscholar&fromopenview=true Li, C. C., Matthews, A. K., & Dong, X. (2018). The Influence of Health Literacy and Acculturation on Cancer Screening Behaviors Among Older Chinese Americans. Gerontol Geriatr Med, 4, 2333721418778193. Zhang, Y., Wen, N., & Chao, N. (2019). Effects of mobile information-seeking on the intention to obtain CRCcancer screening among Chinese women: testing
P24: Religiosity and cancer screening use in a national sample of older adults
Carlos Reyes-Ortiz, Torhonda Lee, John Luque
Florida A&M University, Tallahassee, FL, USA
Abstract: Studies suggest that religiosity and/or religious participation may influence cancer screening behaviors. Further research is needed to understand the role of religiosity and participation in religious groups in shaping health beliefs and behaviors. The study objective is to assess the relationship between religiosity and participation in religious groups with cancer screening. Data from the SABE (Salud, Bienestar y Envejecimiento) Colombia Study, a cross-sectional face to face survey conducted in 2015 [released at the end of 2016] involving 10,660 women and 8,344 men aged ≥60 years living in both urban and rural areas of Colombia. The outcomes are mammogram and Pap test use in women and prostate examination use in men within the last two years. Religiosity was assessed by self-rated religiosity (high religiosity versus low) and participation in religious groups (as volunteer or member). Logistic regression analyses were used adjusting for potential confounders such as sociodemographic characteristics, comorbidity, and functional status. Fifty-four percent of women received a Pap test, and 39% had a mammogram. Forty-seven percent of men had a prostate examination. Eighty-five percent of participants had high religiosity, and 35% participated in religious groups. Multivariate logistic regression analyses showed that participation in religious groups was associated with higher odds of having a mammogram (OR=1.10; p=0.0235) or a Pap test (OR=1.12; p=0.0069) in women and a prostate examination (OR=1.13; p=0.0158) in men. Also, high religiosity was associated with higher odds of having a mammogram in women (OR=1.21; p=0.0074). Participation in religious groups is associated with increased cancer screening use among older men and women, with potential application in religious organizations worldwide. Contacting religious leaders to provide information in health prevention campaigns or regular events and celebrations could enhance opportunities for cancer screening education and prevention. Objectives: The participant shall be able to identify types of religious beliefs or participation as potential associated factors for cancer screening use in older adults. The participant shall be able to discuss the role of religious groups for promoting cancer screening use among older men and women. References: Kretzler, B., König, H. H., & Hajek, A. (2020). Religious Attendance and Cancer Screening Behavior. Frontiers in oncology, 10, 583925. https://doi.org/10.3389/fonc.2020.583925. Pratt, R., Mohamed, S., Dirie, W., Ahmed, N., Lee, S., VanKeulen, M., & Carlson, S. (2020). Testing a Religiously Tailored Intervention with Somali American Muslim Women and Somali American Imams to Increase Participation in Breast and Cervical Cancer Screening. Journal of immigrant and minority health, 22(1), 87–95. https://doi.org/10.1007/s10903-019-00881-x
P25: Addressing cancer in Indigenous communities through arts-based research methods: a scoping review
Mariah Abney, Hannah Butler Robbins, Aislinn Rookwood, Regina Idoate
University of Nebraska Medical Center, Omaha, NE, USA
Abstract: Cancer disproportionately affects Indigenous peoples, and efforts to address cancer are much more successful when culturally relevant. Many Indigenous peoples communicate in visual ways. This research team conducted a scoping review to identify studies that have utilized arts-based research methods with Indigenous peoples to address cancer across the cancer control. Literature searches were conducted in MEDLINE, CINAHL, Embase, and Scopus databases using search terms related to arts-based research methods and Indigenous peoples. All countries of origin, date ranges, and grey literature were included in this review. Literature selection was based on pre-determined inclusion and exclusion criteria and three reviews by an analysis team in more than two iterative cycles. The initial selection was based on a review of manuscript titles, keywords, and abstracts. Literature selection was finalized after a review of the full article text and a consensus meeting to resolve any disagreements. Of the 128 publications found, 31 met the review's inclusion criteria. Art as research (55%) was the most common arts-based research method followed by art in research (35%). The most common art forms employed in arts-based research were visual (32%), such as photovoice, traditional arts, and crafting, and sound (29%), such as storytelling. Most publications (58%) did not specify a single cancer type; cervical (13%) and breast (13%) were the most identified cancer types in publications that did specify. Half of the publications selected were not specific to one stage in the cancer control continuum (52%). This review identifies the need to further investigate the ways in which arts-based methods can be used to make cancer efforts culturally appropriate. Furthermore, these publications demonstrate how arts-based research methods can be utilized to develop effective cancer education and research with Indigenous peoples across the cancer control continuum. Objectives: The participant shall be able to identify arts-based research methods and practices that have been previously implemented with Indigenous populations to address cancer across the cancer control continuum. References: 1.Wang, Qingchun, et al. "Arts-based methods in socially engaged research practice: A classification framework." Art/Research International 2.2 (2017): 5-39. 2.NCI. “Cancer Control Continuum.” Cancer Control Continuum | Division of Cancer Control and Population Sciences (DCCPS), 2020. cancercontrol.cancer.gov/about-dccps/about-cc/cancer-control-continuum. 3.Flicker, Sarah, et al. “Because we have really unique art”: Decolonizing Research with Indigenous Youth Using the Arts." International Journal of Indigenous Health 10.1 (2014): 16-34. 4.Hammond, Chad, et al. "Arts-based research methods with indigenous peoples: An international scoping review." AlterNative: An International Journal of Indigenous Peoples 14.3 (2018): 260-276. 5.Cajete, Gregory. Native science: Natural laws of interdependence. Clear Light Pub, 2000. 6.Denzin,
P26: Analyses of Genetic Variation(s) of Long Non- Coding RNA (lncRNA) Gene in Oral Squamous Cell Carcinoma (OSCC)
Saima Saleem
The Karachi Institute of Biotechnology and Genetic Engineering (KIBGE), University of Karachi, Karachi, Sindh, Pakistan
Abstract: The human genome contains more non coding gene than protein coding genes. Long non-coding RNAs (lncRNAs) are transcripts of over 200 nucleotide lacking protein coding activity. These lncRNAs regulate various biological process, epigenetic, and transcriptional or post transcriptional changes. Their aberrant expression are involved in cancer development and progression. The aim of the study was to educate and evaluate the knowledge and skills of the doctors treating patients of oral squamous cell carcinoma (OSCC) and spread awareness in OSCC patients and educate them about the disease and genetic findings causing disease. Also to educate them about the chewing habit DNA defects issues which is the major cause of OSCC. Blood and tissue samples of patients and blood samples of controls were included in the study. The samples were compared with age and sex-matched controls. Oral squamous cell carcinoma is prevalent in a wide range of age groups. The patients included in this study were range from age 20 to 80 years. In the study, most of the patients belong to the age group between 40 to 60 years. The frequency of female and male is 6 and 19 respectively. The OSCC is prevalent in patients with chewing habits of tobacco and its related products. These compounds are rich in reactive oxygen species (ROS) and carcinogens that can cause DNA damage. The genotypic frequency, homozygous mutant (CC) is more prevalent in blood and tissue of the patient. Pearson chi square test value (χ2 = 69.5, p with oral squamous cell carcinoma (OSCC) and involved in increasing risk. Identification of these genetic variation might help in improving the early diagnosis, prognosis and management of OSCC. Objectives: To find the genetic association of long non-coding RNA gene with oral and head and neck squamous cell carcinoma. The objective of this study is to find genetic variation in HOTTIP gene and to check its association with OSCC. Samples were collected from patients and controls after taking written informed consent. Blood and tissue samples of patients and blood samples of controls were included in the study. The samples were compared with age and sex-matched controls. DNA was extracted by the standard phenol-chloroform method. Tetra primers amplified refractory mutation system (t-ARMS) PCR was performed to identify targeted genetic variations. References: Long non-coding RNAs as emerging regulators of differentiation, development, and disease, Bijan K Dey 1, Adam C Mueller, Anindya Dutta. DOI: 10.4161/21541272.2014.944014
P27: Factors associated with surgery among South Asian American and non-Hispanic White women with breast cancer
Lydia Lo1, Jaya Satagopan2
1Rutgers University, New Brunswick, NJ, USA, 2Rutgers University School of Public Health, Piscataway, NJ, USA
Abstract: South Asian American (SAA) women are diagnosed with more aggressive breast cancer than non-Hispanic White (NHW) women. Partial, subcutaneous, total, or radical mastectomy, are common surgeries. Understanding the factors governing these surgeries can shed light to educate women with breast cancer from this culturally distinct population to make health decisions. We extracted data on age at diagnosis, grade, stage, estrogen and progesterone receptors, and surgery from 4591 SAA and 429,030 NHW breast cancer cases in the Surveillance, Epidemiology and End Results (SEER) program. We used logistic regression with surgery as the binary outcome (subcutaneous, total, or radical mastectomy (STRM) versus partial mastectomy, no, unknown or other (PNUM)) and included main effects of all the variables and their interactions with race/ethnicity (SAA and NHW). Type I error of 5% was used to assess statistical significance of the effects. All analyses were done using the R programming language version 4.0.5. SAA were significantly more likely than NHW cases to receive STRM relative to PNUM surgery among women diagnosed at or after age 50 years and having localized stage disease (OR = 1.27, 95% CI = 1.06 – 1.52). Further, SAA were significantly less likely than NHW cases to receive STRM relative to PNUM surgery among those diagnosed before age 50 years and having regional or distant stage disease (OR = 0.75, 95% CI = 0.59 – 0.95 for age at diagnosis < 40 years; OR = 0.77, 95% CI = 0.62 – 0.95 for age at diagnosis 40-49 years). Disease characteristics play a key role on the type of surgery received by breast cancer patients. The findings of unadjusted analysis that SAA women are more likely than NHW women to receive STRM is driven largely by more aggressive disease occurring in SAA women at the time of diagnosis. Objectives: The audience will be able to identify specific factors associated with surgery decisions in breast cancer patients. The audience will be able to interpret odds ratios and identify that treatment decisions are based on tumor characteristics in both South Asian and non-Hispanic White breast cancer patients. References: Bellavance, E. C., & Kesmodel, S. B. (2016). Decision-Making in the Surgical Treatment of Breast Cancer: Factors Influencing Women's Choices for Mastectomy and Breast Conserving Surgery. Frontiers in oncology, 6, 74. https://doi.org/10.3389/fonc.2016.00074. Zhang C, Zhang C, Wang Q, Li Z, Lin J, Wang H. Differences in Stage of Cancer at Diagnosis, Treatment, and Survival by Race and Ethnicity Among Leading Cancer Types. JAMA Netw Open. 2020;3(4):e202950. doi:10.1001/jamanetworkopen.2020.2950
P28: Satisfaction among cancer patients undergoing radiation: What is needed to improve care?
Rajiv Samant, Elisabeth Cisa-Paré, Katelyn Balchin, Julie Renaud, Linda Bunch, Joanne Meng, Angela McNeil
The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
Abstract: Cancer organizations and healthcare providers (HCPs) want to provide the best care possible and strive to maximize the patient experience. Published reports suggest a variety of factors that are considered important. We decided to survey patients undergoing radiotherapy to determine what they considered desirable traits and identify areas for improvement. An ethics approved 35-item patient satisfaction survey evaluating cancer patient experience was developed at our centre by an interdisciplinary team of HCPs working in the radiation medicine program. It was an anonymous, voluntary, paper-based survey for self-completion. It evaluated a variety of domains with respect to the quality-of-care patients received (not just radiation-related) and was administered to patients undergoing radiotherapy at our academic hospital-based cancer centre. The survey was completed by 199 patients. Overall patient satisfaction was high. Most (>90%) stated they received adequate explanations about treatment, and had their questions answered. The majority (93%) felt included in the decision-making process. However, areas for improvement were identified. These included the following: receiving more information about clinical trials and other treatment options; being given contact information about community resources and psychosocial services; and being offered future appointments to discuss their diagnosis and treatment. Also, HCPs tended to focus mainly on the physical needs of patients and to a lesser degree on their emotional needs, but spiritual and cultural needs were not routinely addressed ( < 1 0%). Cancer patients undergoing radiation reported high rates of satisfaction with the care that they received. However, there remain areas for improvement including providing more information, having enough time available to address concerns, and addressing spiritual and cultural needs. Objectives: The participants will be able to understand and appreciate the various aspects of care that cancer patients undergoing radiotherapy value and this should highlight areas for improvement. Our study stresses the importance of maximizing all aspects of cancer care, emphasizing a holistic approach. References: Factors predicting patient satisfaction in women with advanced breast cancer: a prospective study. Wendy W. T. Lam, Ava Kwong, Dacita Suen, Janice Tsang, Inda Soong, Tze Kok Yau, Winnie Yeo, Joyce Suen, Wing Ming Ho, Ka Yan Wong, Wing Kin Sze, Alice W. Y. Ng, Richard Fielding. BMC Cancer. 2018; 18: 162. Published online 2018 Feb 7. doi: 10.1186/s12885-018-4085-3. Minority ethnicity patient satisfaction and experience: results of the National Cancer Patient Experience Survey in England. Richard J Pinder, Jamie Ferguson, Henrik Møller. BMJ Open. 2016; 6(6): e011938. Published online 2016 Jun 28. doi: 10.1136/bmjopen-2016-011938
P29: Gastric and lymphatic-hematopoietic tissue cancer mortality across provinces in Ecuador, 2010 – 2020
Eduardo Gonzalez1, Briana Chronister1, Georgia Robins Sadler2, Jose R. Suarez-Lopez1
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Although gastric cancer has decreased globally, it is the leading cause of cancer deaths in Ecuador. In addition, lymphatic-hematopoietic tissue cancers were also among the top 15 general causes of death in 2019 in Ecuador. The present report describes cancer mortality in Ecuador across provinces between 2010 - 2020. Using the statistical registry of general deaths by the National Institute of Statistics and Censuses of Ecuador (Instituto Nacional de Estadistica y Censos, INEC), we characterized mortality rates and proportional mortality for gastric and lymphatic-hematopoietic tissue cancers across provinces over time. Ecuadorian mortality rates for lymphatic-hematopoietic tissue cancers increased between 2010 and 2019 by 25%, while gastric cancer decreased by 20%. In 2017, males (≥75 years of age) had highest cancer deaths of gastric (n=415) and lymphatic-hematopoietic related tissues (n=170) combined. In 2020, 1.5% (n=1753) of deaths were due to gastric cancer and 1.0% (n=1180) were due to lymphatic-hematopoietic tissue cancers. In 2020, provinces with the highest mortality rates (per 100,000) from gastric cancer were Bolívar (17.15), Chimborazo (16.79), Cañar (16.70), and Cotopaxi (14.73), while mortality rates from lymphatic-hematopoietic tissue cancers were Imbabura (11.34), Loja (9.98), Azuay (8.96), and Cañar (8.88). We observed cancer disparities between provinces. Further research in Ecuador is needed to identify the determinants of geographical patterns associated with specific cancers. Socio-economic conditions and access to medical care may play a role in cancer mortality based on provinces. Objectives: The participant shall be able to discuss cancer deaths in Ecuador for gastric and lymphatic-hematopoietic tissue cancers. The participant shall be able to identify at least three leading Ecuadorian provinces with the highest cancer mortality rates for gastric and lymphatic-hematopoietic tissue cancers. The participant shall be able to discuss at least two possible strategies for reducing those disparities. References: Corral Cordero, F., Cueva Ayala, P., Yépez Maldonado, J., & Tarupi Montenegro, W. (2018). Trends in cancer incidence and mortality over three decades in Quito—Ecuador. Colombia Médica, 49(1), 35–41. https://doi.org/10.25100/cm.v49i1.3785. Garrido, D. I., & Garrido, S. M. (2018). Cancer risk associated with living at high altitude in Ecuadorian population from 2005 to 2014. Medicine and Pharmacy Reports, 91(2), 188–196. https://doi.org/10.15386/cjmed-932. Montero-Oleas, N., Núñez-González, S., & Simancas-Racines, D. (2017). The remarkable geographical pattern of gastric cancer mortality in Ecuador. Cancer Epidemiology, 51, 92–97. https://doi.org/10.1016/j.canep.2017.10.014
P30: Colorectal Cancer and Hepatitis C Virus Screening Knowledge, Health Beliefs, Intentions and Uptake among Diverse Baby Boomers
Lila Gutstein1, Wenyi Fan2, Richard Reich2, Emalyn Deak2, Rania Abdulla2, Anna Giuliano2, Cathy Meade2, Susan T. Vadaparampil2, Aldenise Ewing2, Richard Roetzheim2, Elizabeth Lawrence3, Tracy Johns3, Diana Lopez4, Aaron Collier2, Clement Gwede2, Shannon M. Christy2
1University of South Florida Morsani College of Medicine, Tampa, FL, USA, 2Moffitt Cancer Center, Tampa, FL, USA, 3Turley Family Health Center, Clearwater, FL, USA, 4Suncoast Community Health Centers, Riverview, FL, USA
Abstract: Despite evidence-based recommendations for screening among age-eligible individuals, rates of colorectal cancer (CRC) and Hepatitis C Virus (HCV) screening are below national goals. This study examined CRC and HCV screening knowledge, beliefs, recommendation receipt, intentions, and uptake among individuals of multiple races born between 1945-1965 and recruited from community clinics. Participants (N = 50) were recruited at partnering community health centers. Eligibility criteria included being born between 1945-1965, at average risk for CRC, asymptomatic for CRC, no personal history of CRC or liver cancer, and not being enrolled in another CRC or HCV screening study. Using separate scales for items relevant to CRC and HCV, knowledge, Preventive Health Model health beliefs (e.g., perceived susceptibility, response efficacy, salience and coherence, social influence, self-efficacy, cancer worry), screening behaviors and intentions, sociodemographic characteristics, and healthcare experiences were assessed. Data were summarized using descriptive statistics (e.g., frequencies, means, range, confidence intervals) and analyzed using SAS 9.4. Most participants (70.0%) reported having ever completed a CRC screening test, whereas 30.6% intended to complete CRC screening in the subsequent 6 months. Forty percent reported prior HCV screening, with 16% intending to complete HCV screening in the subsequent 6 months. Thirty percent of participants reported history of both CRC and HCV screening. Completion of both screenings was significantly associated with higher educational attainment (p = .014), having health insurance (p = .022), being born in the United States (p = .043), higher CRC salience and coherence scores (p = .040), and higher HCV salience and coherence scores (p = .004). Findings demonstrate low knowledge and uptake of both CRC and HCV screening. Results inform a multi-behavioral cancer education intervention which highlights the relevance of CRC and HCV screening for individuals born between 1945-1965 in order to promote CRC and HCV screening behaviors among this at-risk age cohort. Objectives: The participant will be able to 1) describe CRC and HCV health disparities, 2) describe knowledge, health beliefs, screening uptake, and intentions among Baby Boomers receiving care at two community health centers, 3) identify the relationships between sociodemographic factors and completion of CRC and HCV screenings among Baby Boomers, and 4) recognize the need for an intervention promoting CRC and HCV screening among this at-risk age cohort. References: American Cancer Society. Colorectal Cancer Facts & Figures 2020-2022. Atlanta: American Cancer Society; 2020. Patel EU, Mehta SH, Boon D, Quinn TC, Thomas DL, Tobian AAR. Limited coverage of hepatitis C virus testing in the United States, 2013-2017. Clinical Infectious Diseases. 2019; 68(8): 1402-1405.
P31: Examining change of diet as a possible contributing factor of higher cancer rates in Puerto Ricans residing in the United States vs in Puerto Rico
Rowan Ustoy, Georgia Robins Sadler
UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Puerto Ricans in Puerto Rico (PR) have lower cancer rates than their counterparts who have migrated to the United States (US). Many possible contributing factors have yet to be thoroughly examined. This literature review will more closely examine the difference in diet and its possible role in the disparity. A literature review was conducted using PubMed, CINAHL, and Google Scholar databases with keywords: Puerto Rican, Hispanic Americans, Latino, Migrant, Cancer Rates, United States, Puerto Rico, Island, Mainland, Acculturation, Diet Change, Nutrition, Western Diet, Traditional Puerto Rican Diet, Anticancer, Protective, Legumes, Tuber roots, Plantains, Fish. The inclusion criteria included publications that were in full-text English and peer-reviewed. Articles were viewed from 1980-2021 to establish that the cancer disparity still warrants further investigation as it has not improved. Additional articles were found from the reference list of previously identified articles. Various lifestyle changes may be associated with increased US cancer rates, such as activity level, socioeconomic status, and diet. The diet of Puerto Ricans in the US relies more heavily on processed foods, such as white bread, meats, and cheese, as they are more affordable and accessible than traditional Puerto Rican foods. In PR, although the diet is heavily influenced by the Western diet, aspects of the traditional PR diet still contribute to total nutrient intakes, such as legumes, plantains, fish, yautia, and other tuber vegetables. These foods are studied for their anticancer properties particularly in breast and colon cancer. Nutrition is an important part of our culture and health. The cancer disparity between the two populations presents a unique opportunity to examine the role of diet in cancer, and protective factors certain foods may have. Once better understood, specific ethnic outreach programs could be designed to address this disparity. Objectives: The participant shall be able to identify two differences in the diet of Puerto Ricans in the United States vs in Puerto Rico. References: Lopez-Cepero, Andrea, et al. “Comparison of Dietary Quality among Puerto Ricans Living in Massachusetts and Puerto Rico.” Journal of Immigrant and Minority Health, Springer US, 17 Aug. 2016, link.springer.com/article/10.1007/s10903-016-0480-5. Truesdell, Emily, et al. “Foods Contributing to Macronutrient Intake of Women Living in Puerto Rico Reflect Both Traditional Puerto Rican and WESTERN-TYPE DIETS.” Nutrients, MDPI, 6 Sept. 2018, www.ncbi.nlm.nih.gov/pubmed/30200564.
P32: Racial, ethnic and socioeconomic disparities to access cancer targeted therapies using real-world evidence analysis
Rishaan Kenkre1, Olivier Harismendy2, Vanessa Malcarne3, Georgia Robins Sadler2, Alyssa Choi3
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA, 3San Diego State University, San Diego, CA, USA
Abstract: Targeted therapy utilizes drugs matched to dysregulated biological processes in cancer cells. This study had two tasks: 1) Literature review about the influence of socioeconomic status (SES) and race/ethnicity on access to cancer treatments; 2) Analysis of the influence of these factors on targeted therapy using a medical registry. A search of the scientific literature on the influence of SES and race/ethnicity on access to cancer treatments was conducted. PubMed, JSTOR, EBSCO, and Google Scholar were the databases utilized to inspect articles published within the last few years. The search terms used to refine the focus of the articles I examined were: cost, cancer, treatment, expensive, race, ethnicity, underserved, communities, and underprivileged. Of the 38 articles reviewed, 14 articles were deemed as applicable for the literature review. A local medical registry of 5304 patients (ARMOR) containing drug-mutation matching information was used to validate and expand the observations. A majority of the studies reviewed suggest SES is a significant factor in cancer patients receiving expensive cancer treatments, with people of low SES being 17% less likely to receive precision therapy treatment. In addition, African Americans are at the highest risk of not receiving access to effective but expensive cancer treatments. Low SES patients, as inferred from non-private medical insurance, were less likely to receive targeted therapy (TT) as observed in 210 EGFR-lung cancer patients in the ARMOR registry. In contrast, race and ethnicity were not significantly associated with the TT prescription. The studies reviewed demonstrate that financial and racial disparities in cancer treatment are prevalent across the majority of cancer types. Comprehensive research regarding the implementation of specific programs to educate and assist communities that experience disparities in access to expensive cancer treatments are needed. Objectives: The participant will be able to identify at least one racial/ethnic community that experiences barriers to access to expensive and effective cancer treatment. The participant will be able to identify 2 factors that present additional barriers to access to expensive and effective cancer treatment. The participant will be able to recognize whether or not insurance is related to access to expensive targeted therapy treatment based on analysis of the medical registry. References: Norris, Ruth P., Rosie Dew, Linda Sharp, Alastair Greystoke, Stephen Rice, Kristina Johnell, and Adam Todd. “Are There Socio-Economic Inequalities in Utilization of Predictive Biomarker Tests and Biological and Precision Therapies for Cancer? A Systematic Review and Meta-Analysis.” BMC Medicine 18, no. 1 (December 2020): 282. https://doi.org/10.1186/s12916-020-01753-0. Zavala, Valentina A., et al. “Cancer Health Disparities in Racial/Ethnic Minorities in the United States.” British Journal of Cancer, vol. 124, no. 2, Jan. 2021, pp. 315–32. www.nature.com, doi:10.1038/s41416-020-01038-6.
P33: How limitations in dermatology education may contribute to skin cancer disparities among people of Hispanic and African descent
Victoria Herrera1, Vanessa Malcarne2, Georgia Robins Sadler3
1University of California San Diego, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Incidence of melanoma in African Americans (AA) and Hispanics is low, but these groups are diagnosed at later stages, have lower survival rates, and experience worse outcomes than Caucasians. This study investigated how limited representation of skin color in dermatology education and research contributes to skin cancer disparities. A narrative literature review was conducted with PubMed, MedlinePlus, and CINAHL databases using such keywords as: Hispanic, African American, Black, skin cancer, disparities, education, medical school, and melanoma. Additional articles were identified using the references of key articles. Eligible articles were focused on skin cancer disparities in AA and/or Hispanic American populations. Full-text articles written in English, published between 2010 and 2021, and focused on the United States population were eligible for inclusion. In addition, three classic dermatology textbooks were examined for content about skin cancer prevention, detection, and patient education with darker skinned patients. Six of the 24 articles identified discussed melanoma disparities within dermatology. AAs’ and Hispanics’ experience increased mortality rates, late-stage diagnosis, higher Breslow depth, limited access to care, and decreased screening and survival rates compared to Caucasians. Acral lentiginous melanoma (ALM), the most common skin cancer within Hispanic and AA populations, is often underdiagnosed because it presents differently than melanomas on white skin. Physician mistrust and limited training in recognizing melanomas on darker skinned patients may contribute to poorer outcomes. There was a dearth of studies comparing dermatologists’ versus primary physicians’ accurate detection or excision of melanomas on darker skinned patients. Physicians’ training should enable them to recognize dermatological abnormalities on darker skinned patients. Since ALMs tend to occur on extremities, physicians need to adjust their examinations accordingly. Darker skinned patients need to be examined with the same frequency as lighter skinned patients and offered tailored skin cancer educational programs. Objectives: The participant shall be able to name two issues in dermatological education and how that might affect Hispanic and African American skin cancer patients. The participant shall be able to explain why tailored skin cancer programs are essential for darker skinned people. References: Adelekun, A., Onyekaba, G., & Lipoff, J. B. 2021. Skin color in dermatology textbooks: An updated evaluation and analysis. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2020.04.084. Lester, J. C., Taylor, S. C., & Chren, M. M. 2019. Under-representation of skin of colour in dermatology images: not just an educational issue. The British Journal of dermatology. https://doi.org/10.1111/bjd.17608.
P34: The Potential Epigenetic Mechanisms of Environmental Health Disparities in Pediatric Acute Lymphoblastic Leukemia in Hispanics Exposed to Pesticides
Brenda Ochoa1, Georgia Robins Sadler2, Vanessa Malcarne3, Michael Alcazar1
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA, 3San Diego State University, San Diego, CA, USA
Abstract: Hispanic children are more likely to be exposed to pesticides than children from other demographics. As Hispanic children in the United States possess the highest rates of acute lymphoblastic leukemia (ALL) diagnoses and poor treatment outcomes, this study elucidates the potential link between pesticide exposure and ALL in an epigenetic perspective. A narrative literature review combining environmental health and epigenetics was conducted. PubMed and Proquest were utilized to identify articles with principal search terms: pediatric acute lymphoblastic leukemia, children of farm workers, Hispanic farm workers, Hispanic children + ALL, epigenetics + pesticide exposure, and pesticide exposure + ALL. The references of key articles were analyzed to gain additional scientific information and background. Lastly, Google Scholar was used to further obtain peer-reviewed articles in various journals. The rate of Hispanic children diagnosed with acute lymphoblastic leukemia steadily increases despite extensive research on its mechanisms and treatment innovations. Poor outcomes such as mortality and drug resistance are common in Hispanic children. Urine samples of children of farmworkers reflect higher rates of pesticide exposure while the majority of farmworkers are Hispanic. Although in-depth studies of Hispanic children of farm workers & ALL have not been conducted, epigenetic research has shown that DNA methylation is a possible mediator to pesticide-exposure related pathogenesis, including ALL. Furthermore, DNA methylation serves as an epigenetic biomarker for drug resistance in pediatric ALL. ALL disparities in Hispanic children are, at least in part, a byproduct of environmental injustice. Reducing the effects of residential, ambient, and occupational pesticide exposure coupled with epigenetic research and pharmaco-epigenetic treatments can significantly diminish the burdens of pathogenesis/tumorigenesis and poor treatment outcomes. Objectives: The participant shall be able to identify environmental health conditions that potentially lead to acute lymphoblastic leukemia while acknowledging the disparities seen in Hispanic children along with the burdens that render these cancer disparities in a scientific and social perspective. References: Metayer et. al. 2017. A Task-based Assessment of Parental Occupational Exposure to Pesticides and Childhood Acute Lymphoblastic Leukemia. Environmental Research. doi:10.1016/j.envres.2017.03.001. Timms et. al. 2016. DNA methylation as a potential mediator of environmental risks in the development of childhood acute lymphoblastic leukemia. Epigenomics. doi: 10.2217/epi-2015-0011
P35: The gut microbiome effects polycystic ovary syndrome: Relationship to uterine cancer deaths in African American women
Shawn Ogden1, Vanessa Malcarne1, Georgia Robins Sadler2, France Nguyen-Grozavu2, Scott Kelley1
1San Diego State University, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: There is an association between bacteria level imbalances in the gut microbiome and increased risk of polycystic ovary syndrome (PCOS) in women. African American (AA) women and white women have the highest rates of PCOS and uterine cancer, yet AA women have the highest mortality rate for both. Twenty-eight articles were used to examine how the gut microbiome increases the risk for PCOS and uterine cancer. This literature review also addressed the racial disparity faced by AA women in having a higher mortality rate than their white counterparts. Articles, published since 2016, were found in PubMed, CINAHL, and Google Scholar using the search terms: AA women, cancer, gut microbiome, endometrium, uterine, and PCOS. Reference lists of these articles were searched for additional key articles. The American Cancer Society and National Cancer Institute were used to provide cancer statistics for uterine cancer. Dysbiosis, a gut microbiome imbalance, is increased in PCOS individuals; additionally, studies support a link between the gut microbiome and various types of cancer. PCOS patients shed their uterus lining less often, thus increasing their risk for uterine cancer. AA women have high incidence rates of PCOS and uterine cancer, as well as biological differences in their gut microbiome, including genetic variance. Research shows that the human microbiome plays a role in cancer treatment effectiveness which may explain why AA women have a higher mortality rate of PCOS and uterine cancer, compared to their white counterparts. There is a biological difference in AA women’s gut microbiome compared to their white counterparts, which may be associated with increased mortality rates for both PCOS and uterine cancer. The connection between the gut microbiome and cancer has been established, but more PCOS and uterine cancer research is needed. Objectives: The participant shall be able to identify the connection between the gut microbiome and polycystic ovary syndrome and how it relates to uterine cancer. The participant shall also be able to identify the disparity that African American Women face compared to their white counterparts, in both polycystic ovary syndrome and uterine cancer. References: Rizk MG, Thackray VG (2021) Intersection of Polycystic Ovary Syndrome and the Gut Microbiome. Journal of the Endocrine Society 5: https://doi.org/10.1210/jendso/bvaa177. Alizadehmohajer N, Shojaeifar S, Nedaeinia R, et al (2020) Association between the microbiota and women’s cancers – Cause or consequences? Biomedicine & Pharmacotherapy 127:110203. https://doi.org/10.1016/j.biopha.2020.110203
P36: Factors contributing to poor cervical cancer outcomes in Latinas in the United States
Xiomara Gaeta Agreda1, Elizabeth Diaz1, Priscila Chagolla2, Georgia Robins Sadler3, Vanessa Malcarne2
1University of California San Diego, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Hispanic/Latina women experience the highest cervical cancer incidence and mortality rates of any racial/ethnic group in the United States. This is despite many preventative measures available, as well as cancer screening. This literature review focuses on identifying factors that contribute to this health disparity. A search for published studies related to cervical cancer in Hispanic/Latina women, cancer screening, Human Papillomavirus (HPV) vaccine, and HPV testing was conducted. This literature review collected articles published since 2011 through the following databases: PubMed/Medline, Google Scholar, ProQuest, EBSCO and CINAHL. Major search keywords included: cervical cancer, hispanic/latina women, cancer screening, HPV vaccine, HPV vaccine attitudes, HPV testing, machismo, religion, spirituality, fatalism, health disparities, and marianismo. Additional published studies were collected through the reference list of key articles. The biggest contributing factors for this health disparity are both the community's cultural beliefs and their socioeconomic status. Cultural beliefs include religion, machismo, and fatalism. Hispanic/Latina women who were more religious or fatalistic were less likely to get screened; also men who were high in machismo were less supportive of women seeking care. Additionally, socioeconomic status plays a major role given that low-income individuals lacked awareness of both risk factors and preventative measures. Culture and socioeconomic status are contributing factors to the ongoing disparities in cervical cancer incidence affecting Hispanic/Latina women in the United States. Despite the advancements made in cancer screening and prevention, the lack of preventative measures by the Hispanic/Latina women suggests that further research and education are necessary. Objectives: The participant will be able to identify two reasons cervical cancer screening rates are lower in Hispanic/Latina women. References: Chen, Nancy Nien-Tsu, et al. “Understanding Cervical Cancer Screening among Latinas through the Lens of Structure, Culture, Psychology and Communication.” Journal of Health Communication, vol. 23, no. 7, 2018, pp. 661–69. PubMed Central, doi:10.1080/10810730.2018.1500661. Fernandez-Pineda, Madeline, et al. “Salient Factors among Hispanic Parents in South Florida Rural Communities for Vaccinating Their Children against Human Papillomavirus.” Journal of Pediatric Nursing, vol. 54, Sept. 2020, pp. 24–33. ScienceDirect, doi:10.1016/j.pedn.2020.05.016.
P37: Barriers to genetic testing in men with an increased risk for BRCA mutations or diagnosed with prostate cancer
Megan Korhummel1, Alyssa Choi1, Chelsea Rapoport1, Georgia Robins Sadler2, Vanessa Malcarne1
1San Diego State University, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: BRCA mutations are associated with a higher overall risk of prostate cancer (PCa) and a higher risk of an aggressive phenotype. Genetic testing (GT) for BRCA is important for cancer screening and treatment. This study identified barriers that may explain why men with PCa are less likely to receive GT. This narrative literature review explored barriers to GT that men face by examining articles found using PubMed/Medline, CINAHL, PsycINFO, and ERIC. Among the keywords used were prostate cancer, BRCA, men, genetic testing, cancer, and education. Reference lists of key articles were also reviewed to find additional relevant articles. The search focused on two groups: men at risk of BRCA mutations and men diagnosed with PCa. Articles were excluded if germline variants other than BRCA1 and BRCA2 mutations were primarily discussed in genetic testing or the focus of cancer was other than prostate. Out of 230 screened articles, 20 examined barriers to GT in men at risk for BRCA mutations, or those already diagnosed with PCa. These barriers included cost, accessibility, knowledge, and recognition of the benefits of GT for BRCA in men. These barriers impacted both men and their healthcare teams. Studies identified the growing need to inform men at risk of or diagnosed with PCa, and their healthcare teams, about BRCA considerations in screening and treatment decisions; however, little progress has been made to fill the educational and accessibility gaps regarding the incorporation of GT in PCa risk assessment and care. Results showed a lack of awareness, accessibility, and use of GT in men at risk for BRCA. Awareness of GT benefits and expanded resources for men at risk or diagnosed with PCa could decrease barriers, as previously achieved for women at risk for BRCA and associated cancers. Objectives: The participant shall be able to identify three barriers to genetic testing that men at risk for BRCA mutations or men diagnosed with prostate cancer face. References: Loeb, S., Byrne, N., Walter, D., Makarov, D. V., Wise, D. R., Becker, D., & Giri, V. N. (2020). Knowledge and practice regarding prostate cancer germline testing among urologists: Gaps to address for optimal implementation ✰,✰✰. Cancer Treatment and Research Communications, 25, 100212. https://doi.org/10.1016/j.ctarc.2020.100212. Nicolosi, P., Ledet, E., Yang, S., Michalski, S., Freschi, B., O’Leary, E., Esplin, E. D., Nussbaum, R. L., & Sartor, O. (2019). Prevalence of Germline Variants in Prostate Cancer and Implications for Current Genetic Testing Guidelines. JAMA Oncology, 5(4), 523–528. https://doi.org/10.1001/jamaoncol.2018.6760
P38: Exploring the barriers to breast cancer screening for Arab-American women: a review of the literature
Dalia Koujah1, Vanessa Malcarne2, Georgia Robins Sadler1
1UC San Diego Moores Cancer Center, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA
Abstract: Arab American women (AAW) are more likely to be diagnosed with advanced-stage breast cancer and have significantly lower breast cancer screening rates than non-Hispanic white women. This literature review examines the barriers to breast cancer screening for AAW, in order to identify culturally concordant interventions that reduce these barriers. A review of the scientific literature related to breast cancer screening behaviors and perceptions of AAW was conducted. The following databases were searched for articles published since 2011: PubMed/Medline, PsychInfo, CINAHL. Major search terms included Arab American, breast cancer, and screening. Reference lists of the articles were reviewed to identify additional published studies. The search was expanded to include studies comparing AAW to other ethnic minorities, as well as studies on Muslim Americans with Arab-Americans as a subgroup. Studies were excluded if conducted outside of the US. 19 articles out of 23 screened examined perceived barriers to screening and community-based interventions for AAW. Most studies were cross-sectional in design, while some included focus group interviews and interventional studies. Groups studied included AAW of all religious backgrounds and nationalities. The most significant barriers to breast cancer screening for AAW included insurance coverage, cost, language proficiency, lack of provider recommendation, and perceived discrimination by healthcare providers. Studies were inconsistent regarding the impact of religious fatalism and modesty concerns on screening behaviors. Acculturation, measured by the length of US residency and English language proficiency, was associated with increased screening practices. Due to the distinct cultural values and health behaviors of AAW, physicians and researchers must disaggregate data on AAW from non-Hispanic white women. Future interventions to address screening barriers must utilize social networks and religious frameworks, in addition to training physicians in the delivery of culturally competent care for AAW. Objectives: The participant shall be able to identify at least one cultural barrier to breast cancer screening for Arab-American women. The participant shall be able to identify at least one proposed intervention for increasing cancer screening rates for Arab-American women. References: Alatrash, Manal (2021) Determinants of Breast Cancer Screening in Three Arab American Women Subgroups. Journal of Transcultural Nursing. https://doi.org/10.1177/10436596211008215. Jaffee K, Cohen M, Azaiza F (2021) Cultural Barriers to Breast Cancer Screening and Medical Mistrust Among Arab American Women. Journal of Immigrant and Minority Health. https://doi.org/10.1007/s10903-020-01019-0
P39: Factors associated with an increased risk of Multiple Myeloma in the African American community
Joshua Hartman1, Leslie Crews1, Georgia Robins Sadler2
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Multiple Myeloma (MM) is the second most common blood cancer in the US and the first most common for African Americans (AAs). The incidence and death rates of MM for AAs are double that of the nearest demographic. The factors which account for these disparities are an ongoing topic of investigation. A narrative literature review was conducted using PubMed, Google Scholar, Embase, CINAHL, Psycinfo, and Web-of-Science in order to isolate factors contributing to an increased risk of MM among AAs. Articles concerning MM disparities published in English with full text between 2016 and 2021 were identified and their references were reviewed for maximum and updated accuracy. The following six factors were identified: obesity, immunological challenges, family history, genetic variations, access to healthcare, and disparities in treatment. Once sorted, each factor and its corresponding effects were synthesized into a comprehensive summary detailing the causes for the disparities in MM risk. The literature search revealed that obesity played a significant role in the development of MM. However, many studies suggest that immunological challenges, family history of MM, genetic mutations and variations, decreased access to healthcare, and racial differences in treatment and therapy have also shown correlation to increased MM risk. It is theorized that AAs exhibit higher incidence of MM because larger proportions of the AA community suffer from and are affected by a combination of these factors. While family history and genetic variations are difficult to control, factors such as obesity, immunological challenges, access to healthcare, and treatment differences can be addressed with focused interventions. Future strategies should aim to address social injustice issues linked to MM. Objectives: The participant shall be able to list at least 3 factors which cause higher risk of Multiple Myeloma in African Americans. References: Marinac, Catherine R., Irene M. Gohbrial, Brenda M. Birmann, Jenny Soiffer, Timothy R. Rebbeck. 2020. Dissecting Racial Disparities in Multiple Myeloma. Blood Cancer Journal. https://doi.org/10.1038/s41408-020-0284-7. Ailawadhi, Sikander, Kirtipal Bhatia, Sonikpreet Aulakh, Zahara Meghji, Asher Chanan-Khan. 2017. Equal Treatment and Outcomes for Everyone with Multiple Myeloma: Are We There Yet?. Current Hematologic Malignancy Reports. https://doi.org/10.1007/s11899-017-0393-y. Smith, Cheryl Jacobs, Stefan Ambs, Ola Landgren. 2018. Biological determinants of health disparities in multiple myeloma. Blood Cancer Journal. https://doi.org/10.1038/s41408-018-0118-z.
P40: Freedom from Smoking: Tailored cessation programs’ effect on smoking abstinence before and after release
Michael Skipworth1, France Nguyen-Grozavu2, Vanessa Malcarne3, Georgia Robins Sadler2
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA, 3San Diego State University, San Diego, CA, USA
Abstract: The United States is a record-holder for high incarceration rates. Prisons’ smoke-free policies mandate prisoners’ immediate tobacco abstinence, thereby linking freedom from prison with freedom to smoke again. A search for evidence-based interventions that effectively reduce the high post-release smoking relapse rate prompted this review of the scientific literature. A scientific review of the literature was conducted relating to smoking cessation and substance abuse programs designed for persons during and after incarceration. Databases including PubMed, PsycINFO, CINAHL, and EBSCOhost, were searched using the following search terms: incarcerat*, smoking cessation, behavioral therapy, tobacco, prison*, and correctional facilities. Reference lists of articles were reviewed to identify additional articles related to article content and search terms. Eligible papers were written in English and published in peer review journals from 2010 to 2021. Articles were excluded if they were not accessible in full text. Although many incarcerated members report an intent to quit, incarcerated members expressed the lack of resources regarding both smoking risks and prolonged smoking cessation from incarceration into release. Few incarceration centers have endorsed smoking cessation programs despite these programs providing a key compulsory resource focused on persistent smoking abstinence during incarceration and after release. Studies indicate that programs involving intensive group-based cessation with pharmacotherapy, in-prison delivery of motivational interviewing, or cognitive behavioral therapy are effective treatments to address tobacco dependence. Furthermore, increased social support from family, peers, or environment following release alongside the smoking cessation treatment facilitated greater smoking abstinence. With incarcerated members expressing a desire to abstain from smoking, a greater emphasis on incarceration tailored cessation programs will potentially reduce smoking and increase preventative measures within incarceration facilities. Further research is needed concerning programs and policies that may encourage smoking abstinence and provide effective resources toward support following release. Objectives: The participants will be able to understand potential factors contributing to harmful smoking behaviors within the incarcerated community and identify potential methods to retain smoking abstinence before and after incarceration. References: Puljević, C., & Segan, C. J. (2019). Systematic Review of Factors Influencing Smoking Following Release From Smoke-Free Prisons. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 21(8), 1011–1020. https://doi.org/10.1093/ntr/nty088. Valera, P., Acuna, N., & Vento, I. (2020). The Preliminary Efficacy and Feasibility of Group-Based Smoking Cessation Treatment Program for Incarcerated Smokers. American Journal of Men’s Health, 14(4), 1557988320943357. https://doi.org/10.1177/1557988320943357.
P41: The lack of diversity in genomic research and utilization of stem cell treatments due to a deficiency of stem cell donors.
Ida Nikjeh1, Andres Espinoza1, Vanessa Malcarne2, Georgia Robins Sadler3
1University of California San Diego, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Disparities in access to stem cell medicine are found in underrepresented minority (URM) communities and low socioeconomic communities. Reduced participation in stem cell donations among URM communities contributes to a lack of diversity that limits generalizing genomic research findings and reduced availability among minority groups to utilize stem cell treatment. This narrative literature review explores the factors contributing to the lack of participation in stem cell donation, stem cell treatment, and genomic research. The articles using PubMed, JSTOR, and CINAHL databases using these keywords: Asian/Asian American, Latinx/Latin American, African American/Black, stem cell medicine/treatment, inequalities, socioeconomic, cord blood banking, and genomic research/data. These articles were mainly composed of a mix of cross-sectional and longitudinal designs. The reference lists from key articles were reviewed. Forty articles highlighted the racial and socioeconomic disparities in cancer research and stem cell treatment. Along with Native Americans and Hispanic Americans, African Americans are significantly underrepresented in clinical studies. Studies suggested that the lack of diversity and cultural competency of recruiters may contribute to low donor participation rates among minority groups. Furthermore, studies have shown that African Americans and Hispanic Americans were less likely to utilize stem cell transplants as a cancer treatment due to financial barriers, lower health literacy, and medical mistrust. Low socioeconomic communities are at a disadvantage for affording cord blood banking. Solutions to address these disparities include, but are not limited to, providing more representation/mutual identity in registry recruiters and promoting educational programs. Changing health insurance accessibility to make treatment options affordable may aid in reducing these disparities. Bridging these disparities will improve clinical care, survival rates, and genetic research. Objectives: The participant shall be able to list two inequalities that minorities face in stem cell medicine. The participant shall be able to identify three reasons why these disparities exist. References: Williams R. "It's harder for the likes of us": racially minoritised stem cell donation as ethico-racial imperative. Biosocieties. 2021 Jul 13:1-22. doi: 10.1057/s41292-021-00241-9. Epub ahead of print. PMID: 34276806; PMCID: PMC8275909. Fiala MA, Wildes TM. Racial disparities in treatment use for multiple myeloma. Cancer. 2017;123(9):1590-1596. doi:10.1002/cncr.30526
P42: Factors that explain higher rates of breast cancer in Hispanic women in the United States than Hispanic women in Mexico
Bettina Suarez Davila1, Elizabeth Diaz1, Chelsea Rapoport2, Vanessa Malcarne2, Georgia Robins Sadler3
1University of California San Diego, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Hispanic women born in the United States are more likely than Hispanic women born in Mexico to develop breast cancer. The purpose of this study is to explore the multiple factors that contribute to the higher rates of breast cancer in Hispanic women in the United States. This literature review was conducted using articles from PubMed, the American Association for Cancer Research, and data from the U.S. Department of Health and Human Services. Contributing articles examined the different factors that contribute to Hispanic women in the United States having higher rates of breast cancer than Hispanic women in Mexico. Keywords included: Hispanic women, breast cancer, Mexico, acculturation, lifestyle, health care, language barrier, education, Native Americans, Hispanic Americans, and Hispanic. Studies showed that Hispanic women born and raised in the United States have different lifestyles from Hispanic women living in Mexico. Overall, Hispanic women in the United States have a lower level of physical activity, belong to a lower socioeconomic status, and are younger during their first pregnancy. These disparities are considered risk factors for decreased breast cancer survival. Further, the United States has an overall higher rate of alcohol consumption, which increases the risk of developing breast cancer. People become more acculturated as Hispanics in the United States proliferate. Their lifestyle and age of reproduction now resemble the American lifestyle. Differences in survival rates of breast cancer are related to women’s place of origin. More education on breast cancer awareness is needed to ameliorate disparities for Hispanic women. Objectives: The participant shall be able to identify four different factors that may increase the risk of developing breast cancer in the Hispanic female community in the United States. References: Elizabeth Diaz and Chelsea Rapoport, 2021. Cancer disparities: Power, E. J., Chin, M. L., & Haq, M. M. (2018). Breast Cancer Incidence and Risk Reduction in the Hispanic Population. Cureus, 10(2), e2235. https://doi.org/10.7759/cureus.2235
P43: Health Disparities in High-Risk Lung Cancer Families and Their Association with Smoking, Environmental Exposures, and Other Etiological Factors
Grace Brandhurst1, Angelle Bencaz1, Sarah North1, Ellen Jaeger1, Diptasri Mandal1, Joan Bailey-Wilson2
1Louisiana State University Health Sciences Center, New Orleans, LA, USA, 2NIH/NHGRI, Baltimore, MD, USA
Abstract: African Americans are disproportionately affected with lung cancer in comparison to all other racial and ethnic groups in the US. This study aims to characterize genetic, clinical, and environmental risk factors among individuals of European American and African American ancestry from high-risk families that could hold important clinical value to address lung cancer health disparities. Study participants were recruited from a network of 30 hospitals from Louisiana along with multiple states across the country. Study participants with at least two confirmed cases of primary lung cancer within the family were eligible. Medical and pathology reports were obtained from hospitals along with demographic and environmental data from the families. A total of 192 study participants (157 European American and 35 African American) from the years 1992 through 2021 were used in this study. Data abstracted from the pathology, clinical reports, and study questionnaire were entered into spreadsheets and analyzed. Histology of LC diagnosis and clinical reports on mutation analysis were documented. The preliminary analyses of results have found that the average age of onset for AAs is significantly lower than in EA (P value < 0.0001). Additionally, while smoking is commonly referred to as a major contributor to LC disparities, AAs were found to have significantly lower pack years of cigarette use than EAs (P value < 0.05). The average age the AA participants ‘begin to smoke’ was also found to be significantly lower than EAs (P value < 0.05). The majority of the study participants with LC were diagnosed with adenocarcinoma irrespective of the number of pack-years for cigarette use. Additional analysis is ongoing. Clinical and pathological characterization in association with risk factors from high-risk families with European American and African American ancestry will provide us with a better understanding behind the disproportionate distribution of incidence and survival for lung cancer in the African American population. Objectives: The participant shall be able to recognize the social, cultural, environmental, behavioral and biological factors contributing to lung cancer disparities. References: Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2018, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2018/, based on November 2020 SEER data submission, posted to the SEER web site, April 2021. Ryan BM. Lung cancer health disparities. Carcinogenesis. 2018;39(6):741-751.
P44: Cumulative exposure: Could the effect of harmful microbiome exposures negatively impact African-American women with breast cancer?
Joshua Tran1, Jack Gilbert2, Georgia Robins Sadler3, Vanessa Malcarne4, Elizabeth Diaz1, Michael Skipworth1
1University of California San Diego, San Diego, CA, USA, 2Department of Pediatrics and Scripps Institution of Oceanography, La Jolla, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA, 4San Diego State University, San Diego, CA, USA
Abstract: Recent literature indicates that gut microbiome alterations may trigger an increase in breast cancer risk. African-American (AA) women have the second-highest breast cancer morbidity rate and the highest mortality rate. This literature review explores harmful microbiome influences and their impact on increasing AA breast cancer rates. This search of scientific literature explored the effects of microbial dysbiosis associated with the increased risk of breast cancer as well as higher mortality rates among African American women. This narrative literature review identified articles from PubMed, CINAHL, and Google Scholar databases using keywords such as African American/Black, women, microbiome, gut, breast cancer, microbial dysbiosis, and mortality. Reference lists of articles were reviewed to identify additional articles relating to keywords and content. Articles were excluded if unavailable in full text. Eligible papers were published in peer-reviewed journals from 2016 to 2021 and written in English. Studies showed that socioeconomic factors, host genetics, and environmental influences can affect microbial diversity in breast tissue. After review, growing evidence strongly suggests an association between microbial dysbiosis and breast cancer in women. Microbial diversity in breast tumor tissue of non-Hispanic Black (NHB) women was found to be significantly lower compared to non-Hispanic White (NHW) women. Although the relationship between microbiota diversity and microfauna composition within breast tissue differs among racial groups, especially between NHB women diagnosed with breast cancer and healthy NHB women, it is unclear what factors contribute directly to these microbiota compositional differences. Unhealthy diets, polluted communities, and stress-inducing factors negatively affect the microbiome and increase the significant health disparity that exists among AA women with breast cancer. Research demonstrated a variation in microbiome composition of breast cancer patients of differing racial/ethnic backgrounds, warranting further research to understand these differences. Objectives: Participants should be able to identify at least two factors that negatively impact the microbiome of African-American women with breast cancer. Participants should also be able to grasp how the cumulative exposures of the built environment affect the microbiome of different racial/ethnic demographics disproportionately. References: Plaza-Díaz, J., Álvarez-Mercado, A. I., Ruiz-Marín, C. M., Reina-Pérez, I., Pérez-Alonso, A. J., Sánchez-Andujar, M. B., Torné, P., Gallart-Aragón, T., Sánchez-Barrón, M. T., Lartategui, S. R., García, F., Chueca, N., Moreno-Delgado, A., Torres-Martínez, K., Sáez-Lara, M. J., Robles-Sánchez, C., Fernández, M. F., & Fontana, L. (2019, May 24). Association of breast and gut microbiota dysbiosis and the risk of breast cancer: A case-control clinical study. BMC Cancer. Thyagarajan, S., Zhang, Y., Thapa, S., Allen, M. S., Phillips, N., Chaudhary, P., Kashyap, M. V., & Vishwanatha, J. K. (2020, August 24). Comparative analysis of racial differences in breast tumor microbiome. Nature News.
P45: Glioblastoma, a double edge disparity for white men
Jordan Gomezpadilla1, Michael Alcazar2, Vanessa Malcarne3, Georgia Robins Sadler2
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA, 3San Diego State University, San Diego, CA, USA
Abstract: Non-Hispanic white (NHW) men have the highest incidence rate of glioblastomas. Although this population tends to have better and easier access to medical care, their survival rate is the lowest compared to other ethnic groups. The purpose of this study was to identify factors related to this disparity. A literature review was conducted using PubMed, Academic Research Complete, CINAHL, ERIC, and Google Scholar to find articles related to ethnic/racial differences of patients diagnosed with glioblastomas since 2016. The keywords searched were white/male, genetic variations, brain tumor survival, disparities/brain cancer, and ethnic/cultural survival rates. Reference lists within articles were used to acquire additional key articles. Thirteen articles addressed ethnic/racial differences between glioblastoma patients. The majority of the studies used retrospective analysis from SEER, WHO, and CBTRUS databases. The incidence rate in NHW was 25-50% more than other groups. Age, type of diagnosis, and type of care were found to be important prognostic factors. NHW are diagnosed later in age, are more likely to receive a primary glioblastoma diagnosis, which is harder to detect and are more likely to receive gross total resection. Non-NHW have genetic mutations at younger ages and associated better treatment response. Younger age at diagnosis is the largest contributing factor correlated with survival in NHW. However, Asian/Pacific Islander and Hispanic patients diagnosed at younger ages may have a net survival loss and lower quality of life. Research to address the disparities of older and younger patients is needed. Objectives: The participant will be able to identify three reasons the survival rate is lower in non-hispanic white males. References: Bohn, A., Braley, A., Rodriguez de la Vega, P., Zevallos, J. C., & Barengo, N. C. (2018). The association between race and survival in glioblastoma patients in the US: A retrospective cohort study. PLoS ONE, 13(6), 1–10. https://doi.org/10.1371/journal.pone.0198581. Ostrom, Q. T., Krebs, H. L., Patil, N., Cioffi, G., & Barnholtz-Sloan, J. S. (2021). Racial/ethnic disparities in treatment pattern and time to treatment for adults with glioblastoma in the US. Journal of Neuro-Oncology, 152(3). https://doi.org/10.1007/s11060-021-03736-4
P46: Self-Reported Health Literacy and Numeracy Among a Diverse National Sample of United States Adults Aged 18-45
Harika Reddy1, Lakeshia Cousin2, Naomi Brownstein1, Junmin Whiting1, Katharine Head3, Susan T. Vadaparampil1, Clement Gwede1, Cathy Meade1, Shannon M. Christy1
1Moffitt Cancer Center, Tampa, FL, USA, 2University of Florida, Gainesville, FL, USA, 3Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
Abstract: Adequate health literacy and numeracy skills are key in improving preventive health behaviors such as HPV vaccination uptake in racially diverse populations. The current study assessed self-reported health literacy and numeracy and examined associations with sociodemographic characteristics among a diverse sample of adults aged 18-45 living in the United States. Racially and ethnically diverse participants (n=3,757) completed an anonymous online survey assessing health literacy and numeracy skills, sociodemographic variables, health beliefs, and engagement in HPV vaccination behaviors. Literacy was measured with 3 self-reported items, assessing difficulty obtaining medical information, understanding health information from healthcare providers, and understanding written health information. Numeracy was measured with 4 self-reported items, assessing difficulty understanding medical statistics, dependence on numerical information to make health decisions, preference of receiving information using words or numbers, and an objective numeracy question. Descriptive statistics, multivariable logistic regression for binary outcomes, and proportional odds models for ordinal outcomes were utilized. Approximately 69% of participants reported white race, and 18.5% reported Hispanic ethnicity. Approximately 38% of participants reported it was very easy to obtain and understand written health information. More than half (51.9%) preferred receiving information using numbers over words. Being Asian (OR: 1.545 [1.211-1.969]) or other/mixed race (OR: 1.308 [1.034-1.654]), Hispanic (OR: 1.225 [1.023-1.466]), married/partnered (OR: 1.232 [1.024-1.481]), unemployed (OR: 1.319 [1.051]), disabled/retired/other (OR: 1.212 [1.017-1.444]), a homemaker or student (OR:1.3 [1.057-1.599]), in a non-monogomous dating relationship for more than one week (OR: 1.646 [1.041-2.600]), and non-heterosexual sexual orientation (OR: 1.212 [1.017-1.444]) were associated with higher difficulty seeking health information. Our results indicate that there are differences in health literacy and numeracy skills based on sociodemographic characteristics. This demonstrates the need for interventions targeted toward improving skills in populations subgroups that have difficulty understanding health information, as well as communicating health information utilizing methods that are easily understood by all. Objectives: The participant will be able to identify sociodemographic characteristics which were related to self-reported health literacy and numeracy skills in a large sample of United States adults ages 18-45. References: McDonald, M., Shenkman L. J. (2018). Health literacy and health outcomes of adults in the United States: Implications for providers. The Internet Journal of Allied Health Sciences and practice, 16(4), Article 2. Wittink, H., Oosterhaven, J. (2018). Patient education and health literacy. Musculoskeletal Science and Practice, 38, 120-127. https://doi.org/10.1016/j.msksp.2018.06.004
P47: Systematic Review of Recruitment Bias in U.S. Phase 2 and 3 Randomized Clinical Trials of Cancer & Chemotherapy in Adults: 2008-2019
Ilana Buffenstein1, Emily Jane Taylor2, Bree Kāneakua2, Masako Matsunaga1, So Yung Choi1, Enrique Carrazana2, Kore Kai Liow2, Jason Viereck2, Arash Ghaffari-Rafi3
1John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA, 2Hawaii Pacific Neuroscience, Honolulu, HI, USA, 3Dept of Neurological Surgery, University of California Davis, Davis, CA, USA
Abstract: To promote health equity within the field of oncology, clinical trials should strive for unbiased representation. A systematic review of randomized clinical trials recruiting U.S. adults for treatment of neoplasms, and initiated between 2008 and 2019, was performed using four databases: Medline, Embase, Central, and the U.S. Clinical Trial registry. The Cochrane Handbook of Systematic Reviews of Interventions and PRISMA guidelines were used to identify trials. Meta-analyses were performed to obtain summary proportions and 95% confidence intervals (CI) of ethnicity and race groups. Summary proportions were compared with the corresponding Census proportions based on the 2010 U.S. Census. The systematic review identified 406 trials (total participants, n=56,878) related to the treatment of neoplasms. 39% reported ethnicity (157 trials) and 64%% reported race of the participants (260 trials). Proportions of Hispanics (4.62%, 95% CI 3.60-5.75), Asians (1.37%, 95% CI 1.07-1.71), and Blacks (8.20%, 95% CI 6.91-9.58) were lower than Census proportions (14.2%; 5.01%; 12.3%; ps < 0 .0001). Proportions of American Indians (0.99%, 95% CI 0.85-1.15) and multiracial participants (1.05%, 95% CI 0.89-1.24) were not significantly from Census proportions (1.10%; 1.56%). Proportions of NHPI (0.82%, 95% CI 0.70-0.96) and Whites (88.4%, 95% CI 86.9-89.9) were higher than Census proportions (0.20%, 79.8%; ps < 0 .0001). These results highlight disparities in cancer clinical trial recruitment. More than half of the trials did not report ethnicity. The results suggest that Hispanics, Asians, and blacks are underrepresented, while NHPI and whites are overrepresented. Overall, oncology trials may not reflect the demographics of the populations sought to be served. Objectives: The participant shall be able to identify specific disparities between ethnicity and race proportions in clinical trials of neoplastic disorders, and the representation of these same groups in the U.S. population. Reasons for disparities in trial participation are myriad, including historical issues of racial injustice in medical research, anxiety and cynicism towards clinical trials, as well as practical limitations in communication, transportation, and financial capacity of trial participants. Understanding these disparities is important to the field of cancer education, and may help to inform discussions between healthcare providers and minority patients who seek to participate in clinical trials. References: 1. Loree JM, Anand S, Dasari A, et al. Disparity of race reporting and representation in clinical trials leading to cancer drug approvals from 2008 to 2018. JAMA Oncol. 2019;5(10):e191870. 2. National Institutes of Health, US Department of Health and Human Services. Inclusion across the lifespan. Updated July 10, 2019. 3. US Department of Health & Human Services. National Institutes of Health. NIH policy and guidelines on the inclusion of women and minorities as subjects in clinical research. Updated December 6, 2017. 4. Knepper TC, McLeod HL. When will clinical trials finally reflect diversity? Nature. 2018;557(7704):157-159.
P48: Health behaviors of cervical cancer screening among refugee women in Omaha, Nebraska
Seun Famojuro1, Na-omi Hassane Dan Karami2, Moses New-Aaron1, Drissa Toure1, Jessica Maxwell1, Lynette Smith1, Dejun Su1
1University of Nebraska Medical Center, Omaha, NE, USA, 2Iowa State University, Ames, IA, USA
Abstract: Refugee women have been poorly screened for cervical cancer (CC) despite being ranked among the top cancers in women; however, this population's reasons are not well known. The purpose is to assess the health behaviors using the health belief model and explore the indicators of CC screening uptake among refugee Secondary data was collected from a convenience sample of refugee women at Bridge to Care health fair and refugee women meetings between 2017 – 2019. although no documentation was inquired to ascertain their refugees' status. The survey was administered to 121 refugee women assessing their baseline knowledge, healthcare access, behaviors, attitudes, and perceptions towards CC. Descriptive statistics, chi-square independence test, and binary logistic regressions were used to estimate the association between socio-demographic determinants and health belief model (e.g., perceived susceptibility, perceived benefits, and cues to actions), barriers, and uptake of CC screening, and facilitators predicting CC screening. 1) Most participants were from Asia, particularly Burma. 2) There was an association between parity and perceived susceptibility to having CC. Likewise, an association exists between health insurance and perceived benefits of screening; 3) 17% of refugee women were unaware they should go for screening, 26% did not know where to go for screening, and 40% mentioned other reasons for not going for cervical cancer screening. 4)The facilitators of cervical cancer screening uptake among refugee women are good health insurance coverage and high parity. Higher parity increased refugee women's perception of developing CC later in life and promote screening behavior due to greater exposure to health education from frequent antenatal visits. Health insurance with comprehensive coverage is likely to have pap smear screenings included. Future qualitative research is needed to understand CC screening barriers. Objectives: Identify the facilitators of uptake of cervical cancer screening among the minority population. Identify the barriers to increasing cervical cancer screening among refugee women of different cultures. Identify areas where policymakers can make national recommendations for promoting CC screening in underserved populations. References: 1) American cancer society (2020). Key statistics for cervical cancer. Retrieved from https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html. 2) Adunlin, G., Cyrus, J.W., Asare, M., et al . (2019). Barriers and Facilitators to Breast and Cervical Cancer Screening Among Immigrants in the United States. J Immigrant Minority Health. https://doi.org/10.1007/s10903-018-0794-6]
P49: Disparities in Pre-Treatment Fertility Preservation
Priscila Chagolla1, Chelsea Rapoport1, France Nguyen-Grozavu2, Georgia Robins Sadler2, Vanessa Malcarne1
1San Diego State University, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Certain cancer treatments have been linked to an increased risk of infertility, raising reproductive concerns, especially among young adults. Few patients are provided with information about the impact of cancer treatment on fertility. This literature review identified barriers to fertility preservation in cancer patients. A literature review was conducted to highlight disparities in family preservation among cancer patients. Relevant articles were identified using the following databases: CINAHL, Pub-Med, Google Scholar, and PsycINFO. Keywords included fertility, reproductive, fertility preservation, cancer treatment, reproductive health, cancer patients, and young adults. Barriers to fertility preservation include lack of awareness of infertility risk, lack of educational resources, and low physician referral. The risk of infertility with certain treatments is often not communicated effectively by providers, posing multiple issues for fertility preservation. The literature identified age, gender, type of cancer, financial challenges, and lack of insurance coverage as influencing sociodemographic factors for being informed about family preservation. Female patients were more likely to receive information compared to males. Females 35 years or older were less likely to receive information. Language and cultural differences between physicians and patients also served as barriers. Highlighting barriers to fertility preservation is important for increasing awareness on this topic. Patients should be provided with information and the opportunity to make their decisions about fertility preservation before initiating cancer treatment. Further research is needed to target minority groups and provide culturally appropriate information to patients. Objectives: The participant shall be able to identify existing disparities within family preservation among patients with cancer. References: Kappy, M., Lieman, H. J., Pollack, S., & Buyuk, E. (2021). Fertility preservation for cancer patients: treatment gaps and considerations in patients’ choices. Archives of Gynecology & Obstetrics, 303(6), 1617–1623. Mobley, E. M., Ryan, G. L., Sparks, A. E., Monga, V., & Terry, W. W. (2020). Factors Impacting Fertility Preservation in Adolescents and Young Adults with Cancer: A Retrospective Study. Journal of Adolescent & Young Adult Oncology, 9(2), 208–221.
P50: Evaluation of Sexual and Gender Minority Cancer Care Collaboration Seminar for Future Healthcare Professionals
Hannah Johnston, Camille Charles
The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Abstract: Practicing and future healthcare professionals are responsible for addressing the disproportionate cancer experience of sexual and gender minority (SGM) patients. The Cancer Prevention Research Training Program at MD Anderson encouraged summer students to explore careers in oncology through a student-organized seminar, Cancer Care Collaborators: LGBTQIA+ Initiatives, which included a panel of cancer professionals. The intention was to promote SGM cancer research and use attendee feedback to offer advice to others organizing similar events. One college and one medical student, with support from the summer program director, recruited five SGM panelists from different institutions and professions. The students then designed a QR code pre-registration flyer which they emailed to over 100 MD Anderson summer students and to SGM volunteer/support groups. The hour-long Zoom seminar was co-facilitated by the students including introductions, a presentation, and audience questions. They administered a pre-survey and post-survey to participants to evaluate the seminar’s effectiveness. Of 34 attendees, there were 10 undergraduates, 5 medical students, and 5 MD/PhD/DO. 22 attendees had no experience with SGM research. Most reported having enough time for questions (n=26) and being satisfied with the seminar’s organization (n=29). Many (n=20) were very/extremely interested in seminars about research collaboration and suggested genomics and cancer prevention, legality and medicine, combined MD/PhD funding, research opportunities/initiatives, prospective researchers advice, survivorship, and pandemic-altered cancer care as future seminar topics. Other suggestions included decreasing survey reminders, changing marketing approaches, adding break-out sessions, more direct audience interaction with panelists, a summary, and more discussion about panelists’ publications. Online seminars expose young professionals to the importance of SGM status in cancer care, the detrimental effects of health disparities, and new career path exploration. Improving cancer education seminars will better prepare the organizing students for leadership and the attendees to serve diverse individuals, settings, and communities. Objectives: The participant shall be better able to educate trainees on specialized topics, especially when the format is online seminar style. References: Dominic C, Bhalla G. A framework for student-led education conferences. Clin Teach. 2021 Apr;18(2):104-108. doi: 10.1111/tct.13260. Epub 2020 Oct 5. PMID: 33015968. Grosz AM, Gutierrez D, Lui AA, Chang JJ, Cole-Kelly K, Ng H. A Student-Led Introduction to Lesbian, Gay, Bisexual, and Transgender Health for First-Year Medical Students. Fam Med. 2017 Jan;49(1):52-56. PMID: 28166581.
P51: Assessing Baseline Cancer Demographics Versus Cancer Trial Participation Demographics Over One Year in Louisiana
Aliyah Pierre
Louisiana State University Health Sciences Center, New Orleans, LA, USA
Abstract: To determine which barriers exist for cancer clinical trial particpation in Louisiana to define areas for improvement, we report cancer demographics of all new cancer diagnoses in Louisiana in 2019 and compare those to the baseline demographics of cancer patients that enrolled on a cancer treatment trial. A retrospective study evaluating baseline cancer demographics over 2019 was performed. Our baseline population included all new cancer diagnoses in patients 18 years and older registered with the Louisiana Tumor Registry (LTR) between January-December 2019. Baseline demographics were compared between all patients enrolled in a cancer treatment clinical trial in 2019 through the Gulf South Clinical Trials Network (GSCTN) versus those who were not. Summary statistics were performed with regards to basic cancer and patient demographics. Although patients of the highest socioeconomic group made up, n=5,444, (21.9%) of total cancers, a larger proportion, n=35, (32.4%), p=0.01 ultimately enrolled in a trial. Similarly, of those living in an urban area, n=22,258, (84.5%), a larger proportion, n=103, (92.8%), enrolled in a trial when compared to those that were not, p=0.02. There was a significant positive correlation (p=0.01) between clinical trial enrollment and residency in geographic areas with higher rate of high-school graduation. Lastly, our data demonstrated that a smaller proportion, n=7, (6.3%), of clinical trial participants died compared to those who did not participate, n=5176, (19.6%), p < 0 .01. Lack of geographic access proves to be a barrier for recruitment in clinical cancer trials. Patients of higher SES that live in urban areas make up a larger proportion of clinical trial participants and have better survival rates than those who do not participate. Objectives: The participant shall be able to describe cancer demographics in Louisiana and understand the differences to those that participate in clinical trials. References: 1) Clark LT, Watkins L, Piña IL, et al. Increasing diversity in clinical trials: Overcoming critical barriers. Current problems in cardiology. 2019;44(5):148-172. http://dx.doi.org/10.1016/j.cpcardiol.2018.11.002. doi: 10.1016/j.cpcardiol.2018.11.002. 2) Doamekpor LA, Zuckerman DM. Lack of diversity in cancer drug clinical trials may exacerbate racial disparities in mortality rates. Cancer Epidemiology. 2014;38(5):645-646. https://www.sciencedirect.com/science/article/pii/S1877782114001106. Accessed Jun 10, 2021. doi: 10.1016/j.canep.2014.06.007.
P52: Exploring the Impacts of Cis-normative Structures on Transgender Men with Breast Cancer
Amy Loeber1, Andrea Padilla2, Veronica Cardenas2, Vanessa Malcarne2, Georgia Robins Sadler3
1University of California San Diego, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Cis-normative structures assume all patients identify with their assigned gender identity at birth, which ostracizes transgender patients. Studies examine factors like discrimination that seclude transgender patients, without a focus on cis-normativity. This narrative review examines cis-normative structures in medical facilities and their impact on transgender men with breast cancer. Peer-reviewed research articles accessible in full text and published from 2016 to July 2021 were eligible for inclusion in this review. PubMed, PsycINFO, and ProQuest databases were searched using the following terms: trans/transgender, trans/transgender men, breast/breast cancer, dysphoria, transphobia, mammograms, and discrimination. The reference lists of identified articles were reviewed to identify additional relevant articles. Twenty-three articles were reviewed that discussed disparities within the transgender community. Only four of them examined cis-normative structures and their impact on transgender men with breast cancer. Most studies were qualitative and included Latinx, Native Americans, Asian, and Caucasian individuals. In terms of gender, the studies focused on transgender women and men. Transgender individuals were less likely than cisgender individuals to feel welcomed at medical institutions and more likely to be excluded when pursuing breast cancer-related resources. Few studies specifically studied transgender men with breast cancer and their struggles with cis-normative models/terminology for their cancer experience. Proficiency in gender competence is crucial to create inclusive environments in medical facilities. Clinicians should respect pronouns, transition processes and medications used by transgender individuals. Further research should be conducted on the impact of cis-normative structures on transgender men with breast cancer to ensure a welcoming cancer experience. Objectives: The participant will be able to define and identify cis-normativity within medical environments and have solutions to combat them. References: Fehl, A., Ferrari, S., Wecht, Z., & Rosenzweig, M. (2019). Breast cancer in the transgender population. Journal of the Advanced Practitioner in Oncology, 10(4), 387–394. https://doi.org/10.6004/jadpro.2019.10.4.6. Taylor, E. T., & Bryson, M. K. (2016). Cancer’s margins: Trans* and gender nonconforming people’s access to knowledge, experiences of cancer health, and decision-making. LGBT Health, 3(1), 79–89. https://doi.org/10.1089/lgbt.2015.0096
P53: Identifying the Protective Factors for Pediatric Brain Cancer Within Minority Versus White Non-Hispanic Infants and Children.
Helen Hernandez1, Georgia Robins Sadler2, Vanessa Malcarne3
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA, 3San Diego State University, San Diego, CA, USA
Abstract: White non-Hispanic infants and children have higher rates of malignant brain tumors (MBT) then infants and children of other racial/ethnic groups in the United States. This narrative literature review explored what is known about possible risk and protective factors related to childhood MBT in diverse ethnic/racial groups. A narrative literature review was conducted on pediatric malignant brain tumors and cancer disparities regarding racial/ethnic and socio-economic factors. Strategies to tailor cancer prevention efforts toward various racial/ethnic groups were identified using the PubMed, NCBI, CINAHL, and Google Scholar databases. The following keywords were used to identify potential key articles: Epidemiology, Infant, Neoplasm, Prognosis, Risk Factors, and Diagnostic Imaging. Articles were eligible if published from 2005 to present and written in English. Reference lists of articles were reviewed to identify additional articles. Eight articles identified protective factors for pediatric MBT across racial/ethnic groups (good nutrition, average birthweight, breast-feeding, early testing, use of informational resources) as well as risk factors (poor nutrition, low/high birthweight, formula exposure, late testing, and nonuse of informational resources). Ethnic groups included White, Black, and Asian non-Hispanics, and Hispanics with samples of children with MBT ages 0 – 4. Studies demonstrated that White non-Hispanics have a higher risk of MBT, while racial/ethnic minority populations are at lower risk. This may be due to disparities in access to care, socio-economic barriers, and host genetic factors requiring further investigation. With White non-Hispanics having the highest MBT diagnosis in infants and children, racial/ethnic differences in pediatric MBT may relate to key differences such as genetics. Changing the way parents receive pediatric cancer information and access services may help address disparities in risk factors and diagnosis rates. Objectives: The participant shall be able to identify risk and protective factors for infant and child malignant brain tumors across ethnic/racial groups. References: Jaimes C, Poussaint TY. Primary Neoplasms of the Pediatric Brain. Radiologic Clinics of North America. 2019;57(6):1163-1175. doi:10.1016/j.rcl.2019.06.004. Siegel DA, Li J, Ding H, Singh SD, King JB, Pollack LA. Racial and ethnic differences in survival of pediatric patients with brain and central nervous system cancer in the United States. Pediatr Blood Cancer. 2019;66(2):e27501. doi:10.1002/pbc.27501
P54: Factors explaining why hispanic women diagnosed with breast cancer in the United States have a higher risk of mortality
Paola Anguiano Quiroz1, Farhoud Faraji2, Sydney Ramirez3, Georgia Robins Sadler2
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA, 3La Jolla Institute for Immuology, La Jolla, CA, USA
Abstract: Breast cancer is the most common non-cutaneous malignancy among women. Compared to other groups, Hispanic women have among the lowest breast cancer incidence rates. Yet they have higher rates of breast cancer mortality. These effects are related to delays in diagnosis and are partially attributable to lower rates of screening. The purpose of this study was to conduct a review of the literature to address factors influencing why Hispanic women have lower rates of breast cancer screening. Articles were identified using PubMed, Google Scholar, and EBSCOhost databases. Keywords searches include “Hispanic,” “women,” “clinical breast examination”, “breast cancer disparities,” “low mammography screening,” “mortality and incidence rates,” and “language/educational barriers.” Reference lists of identified articles were cross-referenced for additional relevant studies. Reoccurring factors contributing to low screening rates were summarized following a discussion of recommendations for future research and health interventions specifically designed to address the needs of Hispanic women. Health literacy and U.S. acculturation rates were found to be significant predictors of cancer screening outcomes. Lack of English fluency was associated with inadequate health literacy and low acculturation rates in Hispanic women, particularly among the foreign-born women. Reports of health care avoidance due to fear of deportation suggest that available data likely underestimate screening rates in undocumented Hispanic women. These unaddressed disparities diminish participation in preventative services and contribute to unfamiliarity with the healthcare system. Importantly, reduced screening rates are associated with more advanced disease stage at diagnosis and increased risk of breast cancer mortality in Hispanic women. Hispanic women lack resources such as adequate medical facilities, language interpreter services, and readily available medical information in a preferred language. Further research of breast cancer disparities and implementation of educational and other interventions to promote access to and utilization of preventive services are necessary to address disproportionate mortality rates. Objectives: The participants shall be able to identify at least 2 to 3 barriers in cancer screening among Hispanic women. References: Yanez, Betina, et al. “Cancer Outcomes in Hispanics/Latinos in the United States: An INTEGRATIVE Review and Conceptual Model of Determinants of Health.” Journal of Latina/o Psychology, U.S. National Library of Medicine, 5 May 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4943845/. Miller, Kimberly D., et al. “Cancer Statistics FOR Hispanics/Latinos, 2018.” American Cancer Society Journals, American Cancer Society, 4 Oct. 2018, acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21494.
P55: Exploring the Hepatocellular Carcinoma Disparity Within the Latinx Community
Antonia Sajche Sapon
University of California San Diego, San Diego, CA, USA
Abstract: The Hispanic community has the highest rates of liver cancer morbidity and mortality, and these rates have been increasing. This literature review examines how these rates compare to other groups and explore ethnic-related barriers that have been reported to contribute to these higher rates of disease and death. This literature review identified articles using PubMed, PsycINFO, CINAHL, and Google Scholar using the following keywords: liver disease cancer, Hispanic, Latinx, men/women, socioeconomic status, immigration status, liver cancer, hepatitis, hepatocellular carcinoma, screening, insurance, and education. The reference section of key articles was reviewed to identify additional relevant studies. Articles were eligible for inclusion if they were available in full-text, in English or Spanish, peer-reviewed, and published between 2010 and 2021. Thirty-six articles (out of 72 screened) examined liver cancer’s impact on the Latinx community. Several studies suggested that diet and metabolic risk factors may play a significant role in increasing the risk of liver cancer. Hispanics experience high comorbidity from such diseases as non-alcoholic fatty liver disease, hepatitis, and diabetes compared to non-Hispanics, possibly contributing to increased rates of liver cancer morbidity and mortality rates. The few studies that evaluated whether insurance status was related to late-stage disease detection found no significant effect on diagnosis, treatment, or survival rates within the Latinx population. These differences are not attributed to insurance status and may have a racial/ethnic component related to diet and other health risk factors. Further research is needed to address this disparity. Overall, the Latinx community was at a higher risk of liver cancer compared to other ethnicities. Objectives: The participant shall be able to identify 3 reasons liver cancer mortality rates are higher in the Latinx community. The participants will be able to name two barriers to liver cancer risk factors and explore ethnic-related barriers reported etiology to this disease. References: Pomenti S, Gandle C, Abu Sbeih H, Phipps M, Livanos A, Guo A, Yeh J, Burney H, Liu H, Dakhoul L, Kettler C, Gawrieh S, deLemos A, Scanga A, Chalasani N, Miller E, Wattacheril J. Hepatocellular Carcinoma in Hispanic Patients: Trends and Outcomes in a Large United States Cohort. Hepatol Commun. 2020 Aug 12;4(11):1708-1716. doi: 10.1002/hep4.1575. PMID: 33163839; PMCID: PMC7603535. Shebl FM, Capo-Ramos DE, Graubard BI, McGlynn KA, Altekruse SF. Socioeconomic status and hepatocellular carcinoma in the United States. Cancer Epidemiol Biomarkers Prev. 2012 Aug;21(8):1330-5. doi: 10.1158/1055-9965.EPI-12-0124. Epub 2012 Jun 5. PMID: 22669949; PMCID: PMC3647693.
P56: Why are Hispanic smokers less likely to be advised to quit compared to white smokers? Cultural and institutional factors.
Ailyn Alicea1, Michael Skipworth1, Elizabeth Diaz1, Vanessa Malcarne2, Georgia Robins Sadler3
1University of California San Diego, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Although Hispanics are less likely to smoke than non-Hispanic whites, they are less likely to receive advice to quit smoking. Further, Hispanic smokers receive fewer invitations to join cessation programs. Few studies have tested cessation programs in Hispanic communities. This review examined cultural and institutional factors related to this disparity. This narrative literature review identified clinical studies and research articles that have gathered data on Hispanic smokers using PubMed, Google Scholar, and CINAHL databases. Keywords included Hispanics, smokers, cessation, quitting smoking, and healthcare intervention among Hispanics. Additional information was identified through the research articles and clinical studies’ reference lists. Articles were excluded if not written in English or published between 2003 and 2021. Hispanic smokers that received less frequent advice to quit were more inclined to visit their physician compared to white smokers. Hispanic smokers were more likely to quit due to personal motivation and familial support rather than through cessation programs or support services. They expressed more positive attitudes towards quitting. Lower socioeconomic status in Hispanic communities plays a role since their decreased access to quality care lowers the availability of practitioner-run smoking cessation programs. Hispanics received more medical care, but past research indicated that immigration/insurance status and socioeconomic/cultural factors presented barriers to establishing rapport between physicians and Hispanic smokers. Culturally appropriate care may help build rapport between physicians and Hispanic communities to address potential disparities. Further research, increased access to healthcare, and educational resources regarding cessation services may help address these disparities, increase awareness, and may decrease lung cancer rates within this community. Objectives: The partcipant will be able to identify the factors behind Hispanic disparaties regarding cessation programs. References: Piñeiro, B., Díaz, D. R., Monsalve, L. M., Martínez, Ú., Meade, C. D., Meltzer, L. R., Brandon, K. O., Unrod, M., Brandon, T. H., & Simmons, V. N. (2018). Systematic Transcreation of Self-Help Smoking Cessation Materials for Hispanic/Latino Smokers: Improving Cultural Relevance and Acceptability. Journal of health communication, 23(4), 350–359. https://doi.org/10.1080/10810730.2018.1448487. Babb S, Malarcher A, Asman K, Johns M, Caraballo R, VanFrank B, et al. Disparities in Cessation Behaviors Between Hispanic and Non-Hispanic White Adult Cigarette Smokers in the United States, 2000–2015. Prev Chronic Dis 2020;17:190279.
P57: A case for education: developing a tailored education program for cancer support staff to enhance staff professional development and wellbeing
Caroline Owen, Michelle McCarthy, Jill Francis, Meinir Krishnasamy
Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
Abstract: Clinical administration and support staff are a critical team in patient-centred care. Few studies address education and training initiatives for these staff in the oncology setting, or implementation of strategies to improve their support. A recent learning needs survey confirmed this gap, leading to development of the Clinical Administration and Support Education (CASE) program - a two-part project to work with staff to develop a targeted education program to meet their education and learning needs. A working group comprised of relevant administration leads promoted the program to staff to assist with engaging their interest in the first co-design stage of the project. A convenience sampling approach identified staff volunteers across different roles to participate in semi-structured interview or focus group discussions to explore education gaps impacting on their preparedness for their work. At the completion of the discussions, participants were invited to contribute to a follow-up co-design consultation workshop. Qualitative data from the Phase 1 interviews/focus groups (audio recordings) were transcribed and analysed using a content analysis approach (NVivo (2020) Qualitative Data Analysis software). This allowed identification of education themes, while also considering differences in experiences between participants. These insights informed the framework for discussion of key themes in the co-design consultation workshop, building a profile of the education content and resources required to address the learning needs emerging from the interviews. This project represents development of an approach for implementation of education initiatives, with potential application across different staff groups, to support evidence-based learning and patient-centred care. Synthesis of the interview data supported development of the co-design workshop discussion framework, to assist in identifying meaningful endpoints for reviewing the impact of the implementation of the education on the target staff cohort, such as levels of satisfaction or stress, perceived changes in confidence in work skills and knowledge. Objectives: Participants will be able to describe how to use a co-design approach to review learning needs and develop a targeted staff education program to support patient-centred care in the oncology setting. References: Mack H et.al. A small cog in a large wheel: an exploratory study into the experiences of porters, ward clerks and domestics working in an English Cancer Centre. Eur J Oncol Nurs. 2003 Sep;7(3):153-61; discussion 162-3. Cashavelly BJ et.al. The forgotten team member: meeting the needs of oncology support staff. Oncologist. 2008 May;13(5):530-8.. Berry, LL, et. al. Improving Nonclinical and Clinical-Support Services: Lessons From Oncology. Mayo Clinic proceedings. Innovations, quality & outcomes,2018, 2(3), 207–217. Slater PJ. Hospital administration team development and support in a children's cancer service. Aust Health Rev. 2011 Nov;35(4):436-43.
P58: The key determinants of a cancer survivorship needs model
Sally Trinh1, France Nguyen-Grozavu1, Vanessa Malcarne2, Georgia Robins Sadler1
1UC San Diego Moores Cancer Center, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA
Abstract: Cancer survivors lack support financially, physically, and psychologically after their treatment has been completed. Models have been proposed to address survivorship needs, yet a standardized model does not exist. This narrative literature review compares and contrasts existing models and identifies the burdens cancer survivors frequently face. This exploration of peer-reviewed, evidence-based literature used the search terms financial, economic, psychological, physical, financial toxicity, burden, cancer survivor, survivorship, cancer, outcome, health, and quality of life. The databases used were PubMed and CINAHL. The inclusion criteria consisted of publications from 2011 to 2021, in full-text English, and from the United States. Identified models were compared. Broad umbrella categories were created for easy comparison. For example, depression and anxiety were considered psychological burdens; fatigue and pain were considered physical burdens. The reference list of relevant articles was used to search for other articles. This evidence-based literature review produced five models. In ranking order, financial toxicity and psychological burden were cited the most, followed by physical burden, quality of life, and family inclusion, then overall health status. Most of the literature concerned adult cancer survivors and their ability to work. Economic stability was a heavy emphasis. Three models used financial toxicity as a causal factor for other burdens. How the model would be implemented was not stated. However, there was supporting literature that proposed that cancer survivorship models could be used by advanced practice provider settings or lay health workers in cancer centers. Cancer survivorship needs is a complex topic that must be further investigated. While three categories have been identified, survivorship needs vary from person to person and in the type of cancer. A standardized model is only one step towards providing better care for cancer survivors. Objectives: The participant will be able to identify at least 2 common categories that were found when comparing the models. References: Jones SM, Henrikson NB, Panattoni L, Syrjala KL, Shankaran V. A theoretical model of financial burden after cancer diagnosis. Future Oncol. 2020 Dec;16(36):3095-3105. doi: 10.2217/fon-2020-0547. Epub 2020 Sep 25. PMID: 32976048; PMCID: PMC7787147. Ramsey I, Corsini N, Hutchinson AD, Marker J, Eckert M. A core set of patient-reported outcomes for population-based cancer survivorship research: a consensus study. J Cancer Surviv. 2021 Apr;15(2):201-212. doi: 10.1007/s11764-020-00924-5. Epub 2020 Aug 31. PMID: 32865766; PMCID: PMC7966135.
P59: The intersection of breast cancer and cardiovascular disease in African American women: A review of the literature
Elisa Dephilippis1, Shawn Ogden1, Georgia Robins Sadler2, Vanessa Malcarne1, Micheal Gates1, Helina Hoyt1, Beverly Carlson1
1San Diego State University, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: African American women have the highest mortality rates of breast cancer compared to all other racial/ethnic groups. This literature review discusses the disparities faced by African American breast cancer patients/survivors in the context of cardiovascular sequelae and challenges in receiving culturally-specific survivorship care plans and post-treatment education. A thematic literature review was used to search databases and organizational websites for quantitative and qualitative studies and literature reviews related to breast cancer and cardiovascular disease in African American women. Inclusion criteria included English language articles since 2016 with search terms African American, Black, women, breast cancer, survivorship, care plan, cardiovascular, risk, disparities, and cardio-oncology. Databases searched were: PubMed, CINAHL, Google Scholar, and PsycINFO. Organizational websites searched were: The American Cancer Society, National Cancer Institute, Centers for Disease Control and Prevention, and the American Society of Clinical Oncology. A thematic literature review yielded 19 articles and a Cancer Survivorship Care Plan template meeting inclusion criteria. Several themes emerged. First, there has been an increase in cardio-oncology research. Cardiotoxicity from certain breast cancer treatments is an increasing concern. Second, cardiovascular disease is the leading cause of death within the African American community, suggesting an intersectionality of increased cardiovascular risk in African American women post breast cancer treatment. Third, optimizing screening and treatment for increased cardiovascular risk for these patients through a Cancer Survivorship Plan template incorporates the newer evidence suggesting added benefit beyond routine plans of care. Opportunities to inform African American, breast cancer patients/survivors about their cardiovascular risk are being missed in survivorship care plans. Patient-provider communication about cardiovascular risk is needed, particularly among at-risk subgroups. Tailored information about cardiovascular risk and follow-up should be included in survivorship care plans for all Breast Cancer survivors. Objectives: The participant shall be able to identify 2 cardiovascular risks associated with breast cancer treatment. The participant shall be able to identify at least 2 cardiovascular risks in African American women. The participant shall be able to identify cardiovascular screening recommendations post breast cancer treatment. References: Prasad, P., Branch, M., Asemota, D. et al. Cardio-Oncology Preventive Care: Racial and Ethnic Disparities. Curr Cardiovasc Risk Rep 14, 18 (2020). https://doi.org/10.1007/s12170-020-00650-8. Husain,Marium,Timiya S. Nolan,Kevin Foy,Raquel Reinbolt,Cassandra Grenade,Maryam Lustberg. 2019. An overview of the unique challenges facing African-American breast cancer survivors. Journal of the Multinational Association of Supportive Care in Cancer. https://doi.org/10.1007/s00520-018-4545-y. Mehta S. Laxmi, Karol E. Watson, Ana Barac, Theresa M. Beckie, Vera Bittner, Salvador Cruz-Flores, Susan Dent, Lavanya Kondapalli, Bonnie Ky, Tochukwu Okwuosa, Ileana L. Piña,Annabelle Santos Volgman. 2019. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association. Circulation. https://doi.org/10.1161/CIR.0000000000000556
P60: Survival rate disparities between osteosarcoma and Ewing’s sarcoma in pediatric patients
Andrea Contreras1, Eduardo Gonzalez1, Elizabeth Diaz1, Vanessa Malcarne2, Georgia Robins Sadler3
1University of California San Diego, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Osteosarcoma and Ewing’s Sarcoma (ES) are both malignant bone tumors that affect pediatric populations. Despite their diagnostic similarities, the five-year survival rates for osteosarcoma and ES are different. We hypothesize that certain factors such as age, gender, race/ethnicity, genetics and research funding contribute to disparities between osteosarcoma and ES. A narrative literature review was conducted in order to identify articles with information pertaining to the survival rate disparities of osteosarcoma and ES. Articles dated from 2010 to 2021 were found in PubMed, CINAHL, and EBSCO databases by using the following keywords: osteosarcoma, Ewing’s sarcoma, pediatrics, survival rate, Hispanic Americans, and genetics/genetic testing. Other sources, such as the American Cancer Society website, and key articles' reference lists were also searched for relevant information. Eligible articles were full-text accessible and written in English or Spanish. Twelve articles identified factors contributing to the 5-year survival rate of these sarcomas. Between 2010 and 2016, the five-year survival rates of childhood osteosarcoma (ages 0-14) and adolescent osteosarcoma (ages 15-19) were 68% and 67%, respectively. The five-year survival rates for childhood ES and adolescent ES were 75% and 58%, respectively. These findings suggest that children have a higher survival rate post-ES diagnosis whereas adolescents have a higher survival rate post-osteosarcoma diagnosis. Hispanics and African Americans had higher diagnostic and mortality rates in osteosarcoma whereas whites had higher rates in ES. Findings did not suggest research funding-related disparities. The literature review did not suggest any explanations for differences in morbidity and mortality rates nor were these differences recorded to be correlated with other factors, other than age. As with other less commonly occurring cancers, additional research funding is needed to help reduce the suffering caused by these sarcomas. Objectives: The participant shall be able to idenity at least two possible contributing factors that need additional research to determine if a survival rate disparity between osteosarcoma and Ewing's Sarcoma is present. References: Tacyildiz, Nurdan, Hatice Mine Cakmak, Emel Unal, et al. Late effects of osteosarcoma and its treatment in pediatric patients: A single-center experience. JBUON. (26)3:1102. Hesla, Asle, Andri Papakonstantinou, and Panagiotis Tsagkozis. Current status of management and outcomes for patients with Ewing Sarcoma. Cancers. https://doi.org/10.3390/cancers13061202
P61: A literature review on psycho-oncology care for breast and cervical cancer patients in Mexico
Paola Cancino1, Chelsea Rapoport2, Georgia Robins Sadler3, France Nguyen-Grozavu3, Vanessa Malcarne2
1University of California San Diego, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Breast and cervical cancer incidence and prevalence rates are the highest among all cancers for women in Mexico. A breast and cervical cancer diagnosis can contribute to high psychological distress and a need for more social support. Psychological, behavioral, and emotional care, like psycho-oncology, can help combat this. This literature review searched for practicing methods in Mexico in relation to psycho-oncology care for breast and cervical cancer patients. Articles were found using databases such as SciELO, Google Scholar, PubMed, and by reviewing the reference list of key articles. Literature published between 2000-2021 in English and Spanish were reviewed and available in full text. Key articles in English or Spanish were identified by using Google Scholar, PubMed, and SciELO databases, as well as the reference lists of key articles. The keywords used included Latin*, Latin-America, Mexico, psycho-oncology care, health-anxiety, mental health, breast, and cervical cancer, and CBT. In Mexico universal healthcare is offered through Seguro Popular; however, mental health care is rarely offered as part of oncological care. The literature identified several psychosocial issues for individuals with chronic diseases (i.e. cancer). The most common are anxiety, depression, acceptance towards their diagnosis, and prognosis. Women with either breast or cervical cancer were determined to have unmet needs in terms of psycho-oncology, supportive care, and patient-centered cancer care. These women are at high risk for developing probable depression, anxiety, and several other psychological disorders. Mexico’s healthcare also lacks survivorship care programs for cancer patients. An in-depth literature search demonstrated a need for further research on psycho-oncology care for breast and cervical cancer patients in Mexico. Programs that include psycho-oncology, supportive care, and patient-centered cancer care are necessary to meet the psychosocial needs. These programs should be included in treatment decisions and survivorship care. Objectives: The participant shall be able to identify what psycho-oncology practices are available for breast and cervical patients in Mexico. They should also be able to associate psychosocial therapies used for oncology patient. The participant will be able to identify one barrier to providing psycho-oncology as part of a patient’s treatment plan. In addition to the specific needs that are necessary to improve the patient’s quality of life. References: Hubbeling, H. G., Rosenberg, S. M., González-Robledo, M. C., Cohn, J. G., Villarreal-Garza, C., Partridge, A. H., & Knaul, F. M. (2018). Psychosocial needs of young breast cancer survivors in Mexico City, Mexico. PLOS ONE, 13(5). https://doi.org/10.1371/journal.pone.0197931. Doubova, S. V., & Pérez-Cuevas, R. (2020). Association of supportive care needs and quality Of patient-centered cancer care with depression in women with breast and cervical cancer in Mexico. Psycho-Oncology, 30(4), 591–601. https://doi.org/10.1002/pon.5608
P62: Childhood Cancer Survivors: A Literature Review of Allostatic Load and Adverse Health Outcomes
Anthony Cirilo1, Gavrila Ang1, Meredith Pung1, Suzi Hong1, Vanessa Malcarne2, Georgia Robins Sadler3
1University of California San Diego, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Allostatic load (AL) is defined as the physiological dysregulation of the body’s systems resulting from chronic exposure to psychosocial stressors or possible traumatic events. Childhood cancer patients are known to undergo physical and psychological forms of chronic stress, with possible correlation to further adverse physical and mental health outcomes. This review presents the findings of AL as a key predictor of adverse health outcomes in childhood cancer survivors (CCS). A total of 50 articles were found by searching key databases, including PubMed/Medline, PsycINFO, CINAHL, and Embase, to acquire peer-reviewed original articles published between 2012 and 2021. 22 articles that concerned pediatric or childhood cancer survivors, chronic stress, and health outcomes were included in this review. Keywords include: allostatic load, allostasis, chronic stress, cancer survivor, pediatric cancer survivor, and health outcomes. AL indices varied between studies, though AL is greater in cancer survivors than in healthy controls. CCS describe cancer as a traumatic experience, possibly affecting social, emotional, language, and learning development milestones. Post-traumatic stress symptoms (PTSS) and disorders (PTSD) are found among CCS with PTSS and PTSD prevalence ranging from 12% to 44% and 3.0% to 29%, respectively. Cardiovascular diseases are a leading cause of death in CCS, with obesity, type-1, and type-2 diabetes also prevalent physical outcomes. AL is linked with cancer-specific mortality and can be a predictor of all-cause mortality in CCS. The literature presented prevalent, adverse psychiatric outcomes associated with AL, primarily PTS symptoms, and varied findings regarding physical outcomes among CCS. Future intervention studies to reduce AL composite scores to improve the long-term health outcomes of CCS, and cancer survivors in general, are warranted. Objectives: The participant should be able to name at least three adverse health outcomes that are of greater risk to cancer survivors based on allostatic load measures. References: Mathew, A., Doorenbos, A. Z., Li, H., Jang, M. K., Park, C. G., & Bronas, U. G. (2020). Allostatic load in Cancer: A systematic review and mini meta-analysis. Biological Research For Nursing, 23(3), 341–361. https://doi.org/10.1177/1099800420969898. Kosir, U., Wiedemann, M., Wild, J., & Bowes, L. (2019). Psychiatric disorders in adolescent cancer survivors: A systematic review of prevalence and predictors. Cancer Reports, 2(3). https://doi.org/10.1002/cnr2.1168
P63: Barriers and Facilitators to Vaccination Uptake Among Cancer Survivors: A Scoping Review
Gabriella Fonseca1, Kavita Renduchintala2, Mary Katherine Haver2, Clement Gwede2, Smitha Pabbathi2, Shannon M. Christy2
1University of South Florida, Tampa, FL, USA, 2Moffitt Cancer Center, Tampa, FL, USA
Abstract: Cancer survivors may be immunocompromised post-treatment, leaving them susceptible to illness. Yet, vaccination uptake tends to be low among cancer survivors. The current scoping review aimed to: 1) describe vaccination rates among cancer survivors, and 2) identify barriers and facilitators affecting vaccination uptake among cancer survivors. A scoping literature search was conducted using Ovid MEDLINE, Embase and CINAHL Complete databases and according to PRISMA guidelines. Eligibility criteria included discussing vaccination uptake among cancer survivors who had completed treatment, examining factors affecting vaccination adherence (e.g., barriers and facilitators), being published in English, and being published between 1990-2021. Articles were imported into Covidence, and screened by two independent reviewers with a third reviewer serving as arbiter as needed. The search returned 4,215 total articles, and 271 duplicates were removed. During abstract/title screening, 212 articles were identified. Following full-text screening, 64 articles were found to meet inclusion criteria. The ages of participants reported in the full-text articles ranged from 9-85+. Types of vaccination behaviors examined included: Influenza (n=31), Human Papillomavirus (n=24), Pneumococcal (n=12), SARS-coV-2 (n=1), Shingles (n=1), Hepatitis A and/or B (n=2), and multiple vaccines (n=3). Vaccine uptake ranged from 2%-82%. Factors affecting vaccination uptake included, but were not limited to, sociodemographic variables (e.g., age, gender), access variables (e.g., insurance status), health beliefs, vaccine attitudes, and provider recommendation. Vaccine uptake ranged broadly based upon type of vaccine and numerous factors. Multiple barriers and facilitators to vaccination uptake were identified. Findings of this scoping review inform potential targets for multi-level interventions to improve vaccination rates among cancer survivors. Future interventions may inform healthcare practice and policy. Objectives: The participant will be able to: 1) identify why vaccine adherence rates tend to be low among cancer survivors, 2) identify at least 3 facilitators and barriers to vaccine uptake, and 3) describe disparities in vaccine uptake. References: 1) American Cancer Society. Why People with Cancer Are More Likely to Get Infections [Internet]. [updated 2020, Mar 13; cited 2021, Jun 17]. Available from: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/infections/why-people-with-cancer-are-at-risk.html. 2) Ariza-Heredia EJ, Chemaly RF. Practical review of immunizations in adult patients with cancer. Hum Vaccin Immunother. 2015;11(11):2606-14. doi: 10.1080/21645515.2015.1062189. Epub 2015 Jun 25. PMID: 26110220; PMCID: PMC4685676. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685676/
P64: Determinants of Colorectal cancer follow up – Results from a graduate capstone project
Geetanjali Meka, Jaya Satagopan
Rutgers University School of Public Health, Piscataway, NJ, USA
Abstract: Colorectal cancer incidence is increasing among several minority groups in the US. In this ongoing work, we study the characteristics of colorectal cancer and survival and examine the determinants of effective follow-up after colorectal cancer diagnosis among various race/ethnicities. Data from Surveillance, Epidemiology and End Results (SEER) 18 Registries between 2000 and 2016 were used to study disease characteristics for colorectal cancer in multiple race/ethnicities. We calculated median survival and median follow-up times across race/ethnicities. We developed an approach to classify patients that were lost to follow-up according to stage and conducted a logistic regression analysis to identify the determinants of poor follow-up. We conducted bivariable analyses to compare mean age at diagnosis and frequencies of stage and grade categories between cases that are lost and not lost to follow-up. In our ongoing analysis, there were 136400 alive cases with complete data. Cases were considered lost to follow-up if the follow-up duration was < 5, < 3, < 2 years for localized, regional, and distant stages respectively. Cases lost to follow up were likely to be older (62 vs 60 years), of Asian race/ethnicity (5% vs 2% to 3% for White and Black race/ethnicity), and have a distant stage (6% vs 2% to 3% regional, localized). In logistic regression, younger age, female sex, single marital status, Black and Asian race/ethnicity, and distant stage were significantly associated with increased loss to follow-up. Follow-up time is important in correctly identifying the survival probability and progression of disease among cases. Our results show that Black and Asian Americans are more likely to be lost to follow-up. Further research is needed to understand the reasons and develop strategies to increase follow-up rates in these populations. Objectives: The participant shall be able to identify the determinants of loss to follow up among colorectal cancer cases. References: Gill, A., Gosain, R., Bhandari, S., Gosain, R., Gill, G., Abraham, J., & Miller, K. (2018). “Lost to follow-up” among adult cancer survivors. American journal of clinical oncology, 41(10), 1024-1027. Gomez, S. L., Von Behren, J., McKinley, M., Clarke, C. A., Shariff-Marco, S., Cheng, I., ... & Glaser, S. L. (2017). Breast cancer in Asian Americans in California, 1988–2013: increasing incidence trends and recent data on breast cancer subtypes. Breast cancer research and treatment, 164(1), 139-147.
P65: Effects of Cancer Treatment on Educational Outcomes in the South Florida Pediatric Cancer Population
Tanvi Bafna, Jessica Fine, Sarah Griffith, Daniel Montes de Oca, Justine M. Ransdell, Derek M. Isrow
University of Miami Miller School of Medicine, Miami, FL, USA
Abstract: As pediatric cancer survival rates have improved to nearly 90%, it is imperative that the long-term effects of treatments and their impact on quality of survivorship be explored. This study examines the effects of pediatric cancer treatment on educational outcomes and learning ability in the diverse population of South Florida. 468 pediatric oncology patients who were diagnosed at age 3 times via email, telephone, and text message between August 2020 - July 2021. Variables including demographics, diagnosis, treatment, educational history, school re-entry, and educational attainment were collected via survey and medical record review. Descriptive statistical analysis was performed. 49 patients (10.47%) responded to the survey. Respondents (26 male, 21 female) self-identified as White Non-Hispanic (24.49%), Black Non-Hispanic (16.33%), Hispanic (55.10%), or Other (4.08%). The mean age at diagnosis was 8.87. Patients who received whole brain radiation (46.97%) reported a longer period of absence from school (25% >1 year) than those who received extracranial radiation (8.7% >1 year). 34.69% of respondents noted some cognitive deficit after cancer treatment and 26.53% reported that their treatment continues to affect their learning ability today. Only 6.1% of respondents indicated that their school was equipped to handle the educational needs of cancer survivors. This study reveals that the South Florida pediatric cancer population experiences significant gaps in education during treatment and long-term deficits in learning abilities. Further research is necessary to analyze the deficits experienced by these patients in order to improve quality of survivorship among pediatric oncology patients in the future. Objectives: The participant will be able to identify at least two effects of pediatric cancer treatment on education and learning ability. The participant will be able to establish at least one potential area in both the hospital and school setting that could be improved to lessen the educational burden on pediatric cancer patients. References: Dixon SB, Li N, Yasui Y, et al. Racial and ethnic disparities in neurocognitive, emotional, and quality-of-life outcomes in survivors of childhood cancer: A report from the childhood cancer survivor study. Cancer. 2019;125(20):3666-3677. doi:10.1002/cncr.32370. Zheng DJ, Krull KR, Chen Y, et al. Long-term psychological and educational outcomes for survivors of neuroblastoma: A report from the Childhood Cancer Survivor Study. Cancer. 2018;124(15):3220-3230. doi:10.1002/cncr.31379. Saatci D, Thomas A, Botting B, Sutcliffe AG. Educational attainment in childhood cancer survivors: A meta-analysis. Archives of Disease in Childhood. 2019;105(4):339-346. doi:10.1136/archdischild-2019-317594
P66: Utilizing epigenetic biomarkers to improve cancer outcomes: a review of the literature
Andres Espinoza1, Georgia Robins Sadler1, France Nguyen-Grozavu1, Vanessa Malcarne2
1UC San Diego Moores Cancer Center, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA
Abstract: Lung cancer is the leading cause of cancer-associated deaths worldwide. Studies suggest that the use of epigenetic biomarkers could serve as an early-detection diagnostic tool to predict lung cancer development and prognosis. This narrative literature review aims to explore the effectiveness of utilizing epigenetic biomarkers for improving lung cancer outcomes. This literature review used the databases PubMed, PsycINFO, CINAHL, and Google Scholar to search for evidence of reliable epigenetic biomarkers to predict lung cancer onset and prognosis. Eligible articles were published between 2010 and 2021 and are available as full-texts. The reference lists of the identified articles were also reviewed for additional eligible articles. The following key search terms were included in the review: biomarkers, cancer outcomes, DNA methylation, epigenetics, histone modifications, lung cancer, miRNA. The literature revealed that epigenetic modifications are associated with the early stages of tumorigenesis. Studies indicate that promoter regions of tumor suppressors were commonly hypermethylated among lung cancer patients. Aberrant DNA methylation was detected in promoter regions of genes such as SHOX2, APC, RASSF1, CDH13 and CDKN2A, HIST1H4F, p16, NR3C1, MGMT, ZAR1, among others. Studies suggest that abnormal methylation patterns were also associated with lung cancer recurrence. Evidence shows aberrant epigenetic changes could be utilized as biomarkers to predict lung cancer onset. Epigenetic biomarkers have the potential to reduce lung cancer mortality rates and improve outcomes. Future studies should aim to identify and validate further novel epigenetic biomarkers to use in lung cancer screening. This research also confirmed the critical need for more racial and ethnic diversity in epigenetic biomarker studies. Objectives: The participant shall be able to identify the advantages of utilizing epigenetic biomarkers as an early detection tool for lung cancer. The participant shall also be able to identify at least 3 epigenetic biomarkers that are associated with lung cancer development. The participant shall also be able to identify at least one challenge that research has in epigenetic studies. References: Daugaard, I., Dominguez, D., Kjeldsen, T. E., Kristensen, L. S., Hager, H., Wojdacz, T. K., & Hansen, L. L. (2016). Identification and validation of candidate epigenetic biomarkers in lung adenocarcinoma. Scientific Reports, 6(1), 35807. https://doi.org/10.1038/srep35807. Duruisseaux, M., & Esteller, M. (2018). Lung cancer epigenetics: From knowledge to applications. Seminars in Cancer Biology, 51, 116–128. https://doi.org/10.1016/j.semcancer.2017.09.005. Lerner, L., Winn, R., & Hulbert, A. (2018). Lung cancer early detection and health disparities: The intersection of epigenetics and ethnicity. Journal of Thoracic Disease, 10(4), 2498–2507. https://doi.org/10.21037/jtd.2018.04.07
P67: Cultural barriers to cancer care for indigenous women from Oaxaca, Mexico
Amaya Mendez-Molina1, Farhoud Faraji2, Sydney Ramirez3, Georgia Robins Sadler2
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA, 3La Jolla Institute for Immunology, La Jolla, CA, USA
Abstract: Indigenous people from Oaxaca are burdened by high cancer mortality rates. For women in this community, cancer of the reproductive system is a leading cause of cancer-related mortality. This analysis examines cultural and ethnic barriers to screening, diagnosis, and treatment that may influence cancer-related outcomes for indigenous women from Oaxaca. A search of the scientific literature on the effect of cultural identity and beliefs corresponding with cancer screenings, diagnosis, and treatment was conducted. The following databases were searched for articles published: CINAHL, PubMed/Medline, ResearchGate, Elsevier, and JSTOR. Major search terms in English and Spanish included: indigenous, Oaxaca, Hispanic/Latino/Latina, cancer, spirituality/religiosity, language, access, and cultural barriers. An initial search yielded 30 articles. Articles were selected based on relevance after review of the title and abstract, which resulted in 7 articles of use. Indigenous women from Oaxaca face inadequate multicultural competencies displayed by health care providers. Literature identified the most regarded cultural barrier being the taboo surrounding sexuality. For example, medical screening and examinations such as pap smears for cervical cancer and mammography for breast cancer are embarrassing because the body is considered reserved for the patient and their partner. Other highly regarded cultural barriers include myths and beliefs about cancer, and traditional views about health. The differences in cultural practices and perspectives prevent indigenous Oaxacan women from seeking adequate preventative care, ultimately leading to delayed diagnosis and increased cancer-related mortality. Health care providers may be insensitive to cultural differences resulting in decreased cancer screenings and treatment by the indigenous community. Implementing cultural competency programs for providers may improve cancer-related outcomes. Understanding barriers to care in the indigenous community and developing effective interventions to improve cancer-related outcomes is critical. Objectives: The participant shall be able to identify at least two culturally-associated barriers to cancer care for women in the indigenous Oaxacan community. References: Salazar, L., Benavides, M., & Valencia, S. (2018). Papel de la interculturalidad en el control del cáncer en pueblos indígenas. Revista Investigaciones Andina, 20(36), 123–143. https://doi.org/10.33132/01248146.973. Saldaña-Téllez, M., & Lena, M. M. y L. (2017). Barreras percibidas por el personal de salud para la toma de la citología cervical en mujeres zapotecas de Juchitán, Oaxaca. Psicooncología, 14(2–3), 343–364. https://doi.org/10.5209/PSIC.57090
P68: Does serious mental illness predict higher cancer fatality rates?
Jaden Huynh1, Elizabeth Diaz1, Vanessa Malcarne2, Georgia Robins Sadler3
1University of California San Diego, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Persons with serious mental illness (SMI) have a higher fatality rate than the general population. Persons with SMI with a comorbid cancer diagnosis may have an even higher fatality rate. This narrative review explored research examining this disparity and potential contributing factors (e.g., social stigma related to SMI). This literature review used the PubMed, ScienceDirect, and Google Scholar databases. Search terms included: serious mental illness (SMI), social stigma, higher fatality rates, cancer, and disparities. SMI was defined as: schizophrenia, psychotic disorder, bipolar disorder, and severe major depressive disorder. References cited at the end of closely aligned articles were also explored in the search for relevant articles. Articles published between 2011 and 2020 were included if they focused on adults, were available in full text, and were in English. Of the 80 articles screened, seven studies identified higher fatality rates in cancer patients with SMI compared to those without. Factors associated with this disparity included medical contraindications, restrictive research treatment eligibility, institutionalized stigma, lack of SMI integration in health care services, and low socioeconomic status. Although studies recognized other factors contributing to poorer outcomes (e.g., missing or advanced stage at diagnosis and lower screening quality/rates), few studies proposed solutions. A single pilot study proposed The Bridge Model as a proactive approach to providing person-centered care for persons with SMI and cancer. Results clearly showed a higher fatality rate in persons with SMI and cancer, versus cancer alone. Although one intervention based on the Bridge Model has been proposed, the intervention has only been pilot tested in a single group trial and must be further studied. Future research is needed. Objectives: The audience will be able to determine whether or not serious mental illness predicts higher cancer fatality rates, and will learn about current research endeavors to curb this disparity. The audience will be able to iterate at least 3 factors contributing to persons with serious mental illness (SMI) and a comorbid cancer diagnosis having higher fatality rates. References: Mahar, A. L., Kurdyak, P., Hanna, T. P., Coburn, N. G., & Groome, P. A. (2020). Cancer staging in individuals with a severe psychiatric illness: a cross-sectional study using population-based cancer registry data. BMC cancer, 20(1), 476. https://doi.org/10.1186/s12885-020-06943-w. Irwin, K. E., Moy, B., Fields, L. E., Callaway, C. A., Park, E. R., & Wirth, L. (2019). Expanding Access to Cancer Clinical Trials for Patients With Mental Illness. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 37(18), 1524–1528. https://doi.org/10.1200/JCO.18.01881
P69: A literature review of barriers to breast cancer screening among immigrant Muslim women in the United States
Hiela Manely1, Chelsea Rapoport2, Alyssa Choi2, Vanessa Malcarne2, Georgia Robins Sadler3
1University of California San Diego, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Immigrant Muslim women get diagnosed for breast cancer at later stages compared to U.S. born Muslim citizens, limiting treatment options. Research has also documented that immigrant Muslim women have low breast cancer screening rates. This literature review will identify barriers and possible solutions to increase screening behaviors. A narrative literature review was conducted using PubMed, EBSCO, CINAHL, and PyscINFO databases using keywords Muslim, Islamic, women, breast cancer, screening, mammography, and immigrant, and refugees. The reference lists of key articles were reviewed to identify additional published articles. Groups studied included Afghan, Somali, Iranian, South- Asian, and Middle- Eastern women. The inclusion criteria consisted of publications from 2010 to 2020, studies administered in the United States, and participants in research studies who self-identified as Muslim women Religious beliefs, cultural practices, and language barriers contribute to low screening rates among this population. The Islamic religion may increase patient tendency toward privacy and modesty with male physicians, which may decrease the likelihood of screening. Additionally, dependency on male counterparts for transportation and interpretation needs can reduce screening participation. There is also a lack of knowledge from the patients’ home countries regarding mammographic practices, contributing to the belief that preventive care is unnecessary. Further, understanding different terminology for screening and treatment is difficult when health education is not accessible or not in patients’ native language. This review revealed that socio-cultural barriers, religious beliefs, and a lack of breast cancer-related education can contribute to lower screening rates for Muslim immigrant women in the US. An increase in translation resources and an environment that encourages open cross-cultural discussions may improve patient-physician communication and reduce this disparity. Objectives: The participants will be able to name two barriers that immigrant Muslim women face regarding breast cancer screening access. The participants will be able to name one potential action to reduce disparities in this population. References: Kamimura, A., Pye, M., Sin, K., Nourian, M. M., Assasnik, N., Stoddard, M., & Frost, C. J. (2018). Health and Well-being of Women Migrating from Predominantly Muslim Countries to the United States. Journal of Health Care for the Poor and Underserved, 29(1), 337–348. https://doi.org/10.1353/hpu.2018.0023. Siddiq, H., Alemi, Q., Mentes, J., Pavlish, C., & Lee, E. (2020). Preventive Cancer Screening Among Resettled Refugee Women from Muslim-Majority Countries: A Systematic Review. Journal of Immigrant and Minority Health, 22(5), 1067–1093. https://doi.org/10.1007/s10903-019-00967-6
P70: End of life and dying conversations: The power of religion and spirituality for U.S. Latinx advanced cancer patients and their loved ones
Andrea Padilla1, Adriana Nuncio Zuniga1, Caroline Cardenas2, Jesse Nodora3, Georgia Robins Sadler3, Veronica Cardenas1
1University of California San Diego, San Diego, CA, USA, 2Meridian University, Kalaheo, HI, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: The Latinx population makes up 18% of the United States, where 61% view religion and spirituality as an important part of their lives. This study explores the influence of religion on Latinx cancer patients and their caregivers' views/beliefs of a good death and healthcare professionals’ acceptability of such conversations. Latinx advanced cancer patients and their caregivers were recruited in an academic oncology clinic at UC San Diego Moores Cancer Center. Patients and caregivers had to meet the following criteria: 1) Patient identifies as Latino/a, 2) Patient must have a known incurable cancer diagnosis where their prognosis was determined to be less than 2 years, 3) Spanish is the preferred language of patient and caregiver. Patients and their caregivers completed a semi-structured interview and quantitative interview questionnaire. Their interviews were professionally transcribed then coded in Dedoose to identify key themes and relevant quotes. Ten Latinx advanced cancer patients and ten caregivers enrolled in the study and successfully completed the interviews. The interviews revealed how religious and spiritual affiliation play an important role in their dying process. The questionnaire demonstrated that the majority of patients and caregivers claimed their spirituality/religion was “very helpful” during their own/loved one’s illness. The semi-structured interviews unveiled two themes: 1) Patients and caregivers trusted that the fate of their health was in God’s hands, 2) Religion and spirituality guided their relationship with God in seeking/asking for God’s help/strength and expressing gratitude, resulting in improved physical health. To foster engagement of comfortable conversations regarding death/dying with U.S. Latinx advanced cancer patients, the adoption of religious and cultural humility is vital. Healthcare professionals can expand their awareness for such conversations by learning U.S. Latinx patient’s religious/spiritual beliefs, which serves to reduce psychological and spiritual suffering. Objectives: The participant shall be able to identify two ways in which religion and spirituality play a central role in the dying process for Latinx cancer patients and their caregivers and the gravity that they have in alleviating human suffering. References: VanderWeele, T. J. (2017). Religion and health: A synthesis. In M. J. Balboni & J. R. Peteet (Eds.), Spirituality and religion within the culture of medicine: From evidence to practice (pp. 357–401). Oxford University Press. Kent, B.V., Davidson, J.C., Zhang, Y., Pargament, K.I., VanderWeele, T.J., Koenig, H.G., ... Shields, A.E. (2021), Religion and Spirituality among American Indian, South Asian, Black, Hispanic/Latina, and White Women in the Study on Stress, Spirituality, and Health. Journal for the Scientific Study of Religion, 60: 198-215.
P71: Exploring end-of-life care disparities in Asian American cancer patients
Diane Thai1, Paola Cancino1, Nicholas Wu2, Vanessa Malcarne3, Georgia Robins Sadler2, Veronica Cardenas1
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA, 3San Diego State University, San Diego, CA, USA
Abstract: End-of-life (EOL) care can enhance quality of life and is essential for patients with advanced cancer. This narrative review of the scientific literature explored Asian Americans’(AA) use of EOL compared to other groups to identify patterns and levels of utilization as well as influential factors. This literature review examines EOL care for Asian American cancer patients through databases such as PubMed, PsycINFO, Google Scholar, and CINAHL. The keywords utilized in the search were: Asian American, immigrants, Vietnamese, Chinese, Hmong, Japanese, Korean, Indian, palliative, terminal, patient-physician relations, end-of-life, and cancer. Articles written in English and published between 2003 to the present were eligible for inclusion. The literature identified 38 articles in relation to end-of-life for Asian Americans. Of the 38 articles identified, 4 articles were found directly relevant to this review. The references cited in key articles were also evaluated for eligibility. AA patients diagnosed with cancer are more likely than other racial groups to receive aggressive care and die in an ICU and have the lowest rates of hospice care utilization. Compared to Non-Hispanic White patients, AA patients are given fewer consultations on EOL care planning. They experience poorer physician-patient relations and are less aware of palliative care. In addition, cultural differences between different Asian ethnic groups, different levels of acculturation, and EOL care costs are influential factors in these choices. There has been little research on interventions to improve the delivery of EOL care for AA patients diagnosed with cancer. Patient education is needed to raise awareness of EOL care among AA and provider education can help improve communication between physician and patient. Integrating EOL discussions during doctor visits can increase use of hospice services. Further research is needed in relation to cultural and ethnic differences for AA EOL care. Objectives: The participant will be able to identify four factors contributing to lower hospice-use rates among Asian Americans. The participant will be able to name at least 2 suggestions for improvement in the delivery of end-of-life care planning to Asian Americans. References: Islama, Jessica Y., April Deveaux, Rebecca A. Previs, and Tomi Akinyemiju. 2021. Racial Disparities in Palliative Care Utilization among Metastatic Gynecological Cancer Patients Living at Last Follow-Up. Data Brief 10.1016/j.dib.2020.106705. Jang, Yuri, Nan Soon Park, David A. Chiriboga, Kavita Radhakrishnan, and Miyong T. Kim. 2017. The Knowing-Doing Gap in Advance Directives in Asian Americans: the Role of Education and Acculturation. AM J HOSP PALLIAT MED 10.1177/1049909116668518. Periyakoil, Vyjeyanthi S., Eric Neri, and Helena Kraemer. 2016. Patient-Reported Barriers to High-Quality, End-of-Life Care. Journal of Palliative Medicine 10.1089/jpm.2015.0403
P72: A literature review of cultural disparities in palliative care among African American women with breast cancer
Yilin Xu
UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: African American women (AAW) continue to have the highest mortality rate and are less likely to access palliative care despite the national focus to create better breast cancer-related outcomes. This literature review was conducted to interpret scientific evidence related to identifying correlations between cultural disparities and palliative care access for AAW. This literature search focused on palliative care and cultural disparities in AAW diagnosed with breast cancer. PubMed, ScienceDirect, and Google Scholar databases were used to search for related terms such as Black women, African American women, health disparities, cultural disparities, Breast Cancer, and palliative care access. All full-text articles meeting search criteria in English published between 2003 and 2021 were examined. Fifteen articles (out of forty-seven screened) were identified that examined breast cancer outcomes and access to palliative care in AAW. Most studies were observational or conducted a narrative literature review. Overall, AAW are less likely to receive palliative care due to mistrust of the health care system, inadequate health insurance, and lack of access to healthcare providers. Lack of access to quality healthcare and miscommunication between providers and patients contributed to low enrollment rates for palliative care among AAW patients. Access to quality palliative care can provide physical and emotional comfort for AWW patients during their final stage of life. Educational programs are essential for AAW to improve the relationship and trust with their medical providers and increase their use of palliative care services. Objectives: The participant shall be able to identify the factors contributing to the low enrollment rate of palliative care in African American breast cancer patients. References: 1. Mogal HD, Howard-McNatt M, Dodson R, Fino NF, Clark CJ. Quality of life of older African American breast cancer survivors: a population-based study. Support Care Cancer. 2017 May;25(5):1431-1438. doi: 10.1007/s00520-016-3539-x. Epub 2016 Dec 16. PMID: 27987093; PMCID: PMC7064808. 2. Lee KT, George M, Lowry S, Ashing KT. A Review and Considerations on Palliative Care Improvements for African Americans With Cancer. Am J Hosp Palliat Care. 2021 Jun;38(6):671-677. doi: 10.1177/1049909120930205. Epub 2020 Jun 3. PMID: 32489113.
P73: Correlates of Awareness of the Human Papilloma Virus among Egyptian Muslim Women
Asmaa Namoos1, Tamas Gal1, NourEldin Abosamak2, Dustin Bastaich1, Maryam Abdelkarim2, Rana Ramadan2, Mostafa Abdou2, Dina Ramadan2, Vanessa Sheppard1
1Virginia Commonwealth University, Richmond, VA, USA, 2Alexandria School of Medicine, Alexandria, Egypt
Abstract: Most cervical cancers are caused by the Human Papilloma Virus (HPV), and there are available effective vaccines to prevent HPV. Shaltout et al. found that the prevalence of HPV infection is 10.4% in Egypt and only 9% of the participants reported some knowledge about HPV. Our study hypothesizes that education This cross-sectional quantitative study was conducted in Alexandria Egypt in 2021. A questionnaire composed of validated items was administered and captured religiosity, healthcare provider mistrust, and knowledge about HPV prevention. Eligible participants were recruited from clinics at Alexandria University Hospitals and had to be >18 years and able to give informed consent. A multivariable logistic regression model with stepwise selection was employed to examine the associations between covariates and HPV awareness. The 99 participants were aged between 18 and 55 years (median age: 32); most were married, had education below high school, and had a monthly income between $100 to $300. Awareness about HPV was generally low (10.1%). Women who reported low HPV awareness tended to be unmarried(87.5%), educated beyond high school(70.0%), and a have higher income. In the stepwise logistic regression model, education level and religiosity score remained in the model and were significantly associated with HPV awareness. The odds of having heard of HPV were higher for respondents with higher education (OR=6.84; CI=1.42, 33.03) and lower for those with higher religiosity (OR=0.74, CI=0.57, 0.96). The areas of education and faith may be important factors to consider when increasing awareness of HPV. Programs focusing on lower education and highly religious populations would help raise awareness in groups of patients that appear to be less knowledgeable about the disease. Objectives: The participants shall be able to learn about the HPV infection and preventions method even they are related to the conservative community which has no sex out of the marriage frame. Also the benefit of the HPV vaccine. The key objectives are to identify at least three barriers to get in-depth details about HPV hesitancy among the Muslim community (Religion, Education, and Income) References: Shaltout MF, Sallam HN, AbouSeeda M, Moiety F, Hemeda H, Ibrahim A, et al. Prevalence and type distribution of human papillomavirus among women older than 18 years in Egypt: a multicenter, observational study. Int J Infect Dis. 2014;29:226-31
P74: Exploring ways to Evaluate the Impact of a Community Cancer Educational Event in Puerto Rico
George Scott, Roxanna Maldonado, Luis Centeno-Matos, Cynthia Cortes, Arline Vela-Vidal, Eida Castro-Figueroa, Melissa Marzán-Rodríguez, Julio Jimenez
Ponce Health Sciences University, Ponce, Puerto Rico, USA
Abstract: Currently, cancer is the second leading cause of death in Puerto Rico. Thus, community engagement in educational activities is essential to reduce risk factors. However, little is known about the effectiveness of these activities. This study explores the increase of cancer-related awareness and behavioral changes following an outreach event. To assess the educational event’s impact, the study team conducted a telephone survey. Based on the literature review, the investigators designed a culturally adapted questionnaire by a Community Advisory Panel. From November 2017 to February 2018, 190 individuals were randomly selected from the Hablemos de Cáncer participants’ registry list. At the awareness level, 72% of the participants agreed that lifestyles could improve or worsen life quality. At the behavioral changes, 77% reported improved lifestyle, modifying aspects such as nutrition and physical activities in their lives. The results suggest that the educational event promote favorable changes in awareness and behavior related to cancer prevention. This study recommends that continued efforts in this area improve strategies that measure educational events' outcomes. Objectives: Objective: Identify ways to evaluate the impact of a cancer outreach educational event. References: Cancer Screening Guidelines: Detecting Cancer Early. American Cancer Society. (2020). https://www.cancer.org/healthy/find-cancer-early/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html. Jiménez, J., Ramos, A., Ramos-Rivera, F. E., Gwede, C., Quinn, G. P., Vadaparampil, S., Brandon, T., Simmons, V., & Castro, E. (2016). Community Engagement for Identifying Cancer Education Needs in Puerto Rico. Journal of Cancer Education, 33(1), 12–20. https://doi.org/10.1007/s13187-016-1111-5
P76: Common practices and challenges in healthcare organizations’ patient education material review schedules and workflows
Allison Reichel1, Devon Poznanski2, Carolyn Vachani3, Laura Paloubis1, Dhruti Ramchandani4, Amanda Stamplis5
1Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2BC Cancer, Vancouver, BC, Canada, 3OncoLink, Philadelphia, PA, USA, 4City of Hope National Medical Center, Duarte, CA, USA, 5MD Anderson Cancer Center, Houston, TX, USA
Abstract: There is little existing evidence or consensus regarding best practices for patient education (PE) material review and revision. Reviewing and revising materials more often than necessary can lead to unneeded resource expenditure, while reviewing and revising them too infrequently can result in patients receiving outdated or inaccurate information. The goal of this project was to learn about healthcare organizations’ schedule and workflow for reviewing internally developed PE materials. We developed a 7-question survey including questions about review cycles for internally developed PE materials, reason(s) for choosing that cycle, review workflow, if that workflow is working well, and department capacity. Questions were chosen by consensus following conversation about variability among CPEN’s Health Literacy Special Interest Group members’ review cycles and workflows. The survey was sent via email to the CPEN and Institute for Healthcare Advancement (IHA) listservs and received 47 responses. The most common review cycle was 3 years (n=22). Some respondents noted their review cycle was determined by clinical educators or on a case-by-case basis. Reasons for choosing a review cycle varied, with “Other” being the most common (n=17) and “Evidence” the least common (n=6). Review workflows varied widely. Two main challenges respondents identified were getting timely feedback from subject matter experts and managing the volume of PE materials awaiting review. Notably, respondents who chose their review cycle based on evidence (n=6) or best practice (n=14) reported varying review cycle lengths. This may be the topic of a future survey. Identifying a best practice for reviewing and revising internally developed PE resources will help organizations maintain the quality of their PE resources while avoiding unnecessary resource expenditure. Best practices for PE material review may also give patient education departments evidence to support the need for additional resources. Objectives: The participant shall be able to identify at least 2 common challenges in patient education material review practices. The participant shall be able to identify at least 1 key area to assess opportunity for improvement in their organization’s patient education material review practices. The participant shall be able to identify networking opportunities with other cancer patient education professionals whose programs are similar to their own. References: Liang L., Brach C.(2017). Health Literacy Universal Precautions Are Still a Distant Dream: Analysis of U.S. Data on Health Literate Practices. HLRP: Health Literacy Research and Practice. 1(4) e216-e230. doi: 10.3928/24748307-20170929-0 Date accessed: 01 apr. 2021. Brach, Cindy, Debra Keller, Lyla M. Hernandez, Cynthia Baur, Ruth Parker, Bernard Dreyer, Paul Schyve, Andrew J. Lemerise, and Dean Schillinger (2012). Ten Attributes of Health Literate Health Care Organizations. Institute of Medicine of the National Academes. https://nam.edu/wp-content/uploads/2015/06/BPH_Ten_HLit_Attributes.pdf.
P77: Predictors of AML Patient Response to 7+3 Induction Chemotherapy
Guy Beresteanu
University of Pittsburgh, Pittsburgh, PA, USA
Abstract: Acute Myeloid Leukemia (AML) is aggressive cancer of blood and bone marrow. Response to chemotherapy measured by the 2017 European LeukemiaNet (ELN) response criteria and measurable residual disease (MRD) are powerful prognostic. 211 patients underwent induction chemotherapy, demographic, clinical, genetic predictors were used to predict responses and overall survival (OS). We considered two variable selection approaches, the LASSO and step-wise regression, to build a prediction model for the binary outcomes. The average area under the curve (AUC) estimated based on 5-fold cross-validation (CV) was compared to select the best prediction method. Then, the best variable selection approach was fitted to the whole dataset to obtain the most important predictors. We then compared the average AUCs of the models without genetic predictors. Lastly, Cox proportional hazard model with the LASSO selection was used to determine important predictors explained OS from the start of therapy and bone marrow transplant (BMT). The logistic LASSO regression had a larger average AUC compared to the stepwise regression for both binary outcomes (ELN response 77.6% vs 76.2% and MRD response 79.7% vs 75.2%). Additionally, the models with genetic predictors had a larger average AUC compared to the ones without (ELN 77.6% vs 71.4% and MRD response 79.7% vs 73.9%). Using survival analysis, we found that the median OS was 32 months. If the patients had disease present in their bone marrow after the first round of chemotherapy, then the median OS dropped to 20 months. Our data show that genetic mutations present in patients can significantly help predict treatment success. We observed that removing disease from bone marrow after the first round of chemotherapy predicts OS. Furthermore, patients who received a bone marrow transplant had a much better prognosis than those who did not. Objectives: The participant shall be able to identify which genetic mutations are best at predicting patient response to chemotherapy and OS. They will also be able to differentiate between LASSO and step-wise regression. Participants will recognize the value of using cross-validation to compare different models. Lastly, audience members will be able to see the medical applications of this project, how knowing a patient’s genetic mutations can help explain outcomes and identifying which mutations a patient has can help predict treatment success. They will also learn why patients who receive bone marrow transplants had a better prognosis and better survival. References: Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Acute Myeloid Leukemia—Genetic Alterations and Their Clinical Prognosis.
P78: Southeast Partnership for Improving Research and Training in Cancer Health Disparities (SPIRIT-CHD): A Multisite Cancer Research Education Program for Underrepresented Undergraduate & Medical Students
Z'Kera Sims1, Vivekka Suppiah1, Lakeshia Cousin2, Clement Gwede1, Ursula Pradeda-Martinez1, Cathy Meade1, Gwendolyn Quinn3, Vani Simmons1, Fern Tsien4, Jovanny Zabaleta4, Arnold Zea4
1Moffitt Cancer Center, Tampa, FL, USA, 2University of Florida, Gainesville, FL, USA, 3New York University, New York, NY, USA, 4Louisiana State University Health Sciences Center, New Orleans, LA, USA
Abstract: The Southeast Partnership for Improving Research and Training in Cancer Health Disparities (SPIRIT-CHD) is a 4-year cross-institutional partnership between Moffitt Cancer Center (MCC) and Louisiana State University Health Sciences Center (LSUHSC). SPIRIT-CHD aims to train undergraduate and medical students from underrepresented backgrounds through an immersive Cancer Research Education Program (CREP). This poster will provide an overview of the 4-year CREP program, describe training strategies, and present program evaluation findings. The CREP includes an 8-week summer internship program at LSUHSC and MCC. CREP students are paired with a mentor to work on a cancer or cancer health disparities-related research project, participate in a joint web-based didactic curriculum, and have community outreach and engagement experiences in underserved communities. To date, four cohorts (n=42 students) have completed the CREP, 21 at MCC and LSUHSC, respectively. Preliminary results for CREP cohorts 1 and 2 demonstrate that at program end, students expressed an increased intention to pursue cancer health disparities research in the future. Additionally, improvements were seen with confidence in relaying scientific information to lay audiences and performing basic and behavioral research (P<.05). CREP cohorts 1 – 4 completed Pre and Post Internship evaluations using nationally validated scales (e.g., Science Teaching Efficacy Belief Instrument) and other assessments (e.g., Knowledge Assessment). Post-internship follow-up tracking is an additional measure of impact. Cohort 4 completed the CREP August 2021; evaluations are undergoing analysis and will be presented. Preliminary results upon program completion demonstrate that participants significantly improved in knowledge gains, cancer health disparity awareness, and confidence to communicate to scientific and lay communities. In addition, alumni tracking demonstrates an increase in the diversity of the biomedical research workforce prepared to address cancer health disparities and work with diverse communities. Objectives: The reviewer shall be able to: Describe innovative strategies for training underrepresented undergraduate and medical students in cancer and cancer health disparities research. Identify evaluation measures that assess the utility and efficacy of research-intensive summer training programs for underrepresented students. References: Quinn, G. P. et al. (2018) Diversity Beyond Race and Ethnicity: Enhancing Inclusion With an Expanded Definition of Diversity. American journal of bioethics. [Online] 18 (4), 47–48. Blanchard, S. A. et al. (2019) Building the Network of Minority Health Research Investigators: A Novel Program to Enhance Leadership and Success of Underrepresented Minorities in Biomedical Research. Ethnicity & disease. [Online] 29 (Suppl 1), 119–122.
P79: Benchmarking Patient Education: A Pilot Project
Janet Papadakos1, Laura Carr2, Sarah Christensen3, Louise Rambo4, Zaira Escamilla Gonzalez1, Liliana Mulato5, Maritza Nassif6, Tina Papadakos1, Devon Poznanski7, Naa Kwarley Quartey1, Amanda Stamplis3, Clare Sullivan6, Diane Cole8
1Princess Margaret Cancer Centre, Toronto, ON, Canada, 2Seattle Cancer Care Alliance, Seattle, WA, USA, 3MD Anderson Cancer Center, Houston, TX, USA, 4National Cancer Institute, Bethesda, MD, USA, 5Huntsman Cancer Institute, Salt Lake City, UT, USA, 6Dana-Farber Cancer Institute, Boston, MA, USA, 7BC Cancer, Vancouver, BC, Canada, 8Custom Management Group, Charlottesville, VA, USA
Abstract: The Cancer Patient Education Network (CPEN) is dedicated to promoting and providing models of excellence in patient, family, and community education across the continuum of care. The CPEN Board of Directors piloted a biennial survey to benchmark the state of cancer patient education (PE) with the intent to identify opportunities to support members in developing and improving their cancer patient education programs. We adapted a benchmarking survey from Ontario Health. The resultant survey included 24 items and was estimated to take 15-20 minutes to complete. The survey consisted of seven domains: 1) the organization, 2) mission and strategic plan, 3) structure, 4) professional development, 5) funding/budget, 6) patient education resources, 7) research/evaluation. The survey was sent to CPEN members (n=120) via the CPEN listserv in March 2021 and remained open for 1 month. 53 members completed the survey with a response rate of 44% and completion rate of 45%. Respondents worked at non-profit organizations (47%, n=25) located in the US and Canada. 43% (n=23) of organizations have a PE mission statement and 38% (n=20) have a strategic plan. 38% (n=20) have a formal Program and 38% (n=20) think that staff have the competencies to perform their roles according to best practices. 32% (n=17) have a dedicated budget and 32% (n=17) evaluate PE activities. Respondents shared that CPEN can best support them by sharing best practices, providing training, and offering opportunities to network. Many organizations have cancer PE programs to some extent, but the budget and organization of the programs varies greatly. The completion rate of the survey suggests that further refinement is needed. Objectives: To understand what benchmarking is and how it can be used in cancer patient education. To understand the differences in patient education programs across the US and Canada. To establish baseline data for comparison biennially. References: Cancer Patient Education Network. (2019). About the Cancer Patient Education Network (CPEN). About CPEN. https://www.cancerpatienteducation.org/CPEN/About_CPEN/About/CPEN/About_CPEN/About_CPEN.aspx.
P80: Associations Between Insulin Resistance-related Traits and Breast Cancer Risk by Molecular Subtype: a Mendelian Randomization Study
Michelle Flesaker1, Xiang Shu2
1Smith College, Northampton, MA, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA
Abstract: Insulin resistance (IR) has been shown to be associated with overall breast cancer (BC) risk, but the relationship between IR and molecular subtypes of BC is unknown. We conducted a Mendelian Randomization study to investigate the relationship between IR and risk of BC subtypes. IR-related traits included fasting glucose (FG), fasting insulin (FI), 2-hour glucose tolerance (2hGlu), and hemoglobin A1c (HbA1c). 209 single nucleotide polymorphisms (SNPs) associated with FG (75 SNPs), FI (39 SNPs), 2hGlu (14 SNPs), and HbA1c (81 SNPs) were obtained from a large-scale genome-wide association study1. Association estimates of those SNPs with BC subtypes were obtained from Breast Cancer Association Consortium2. MR approaches including inverse variance weighted, median estimator, MR Egger, and MR PRESSO were used. Sensitivity analyses were undertaken to address pleiotropy by removing SNPs associated with other IR-related traits or body mass index (BMI). In main analyses, there were no significant associations found between IR-related traits and subtypes of breast cancer in the population of European women, after adjusting for multiple comparisons. With removal of SNPs with pleiotropic effects, 104 variants remained for the sensitivity analyses, including for FG (35 SNPs), FI (14 SNPs), 2hGlu (2 SNPs), and HbA1c (53 SNPs). In these sensitivity analyses, FG and FI were significantly, inversely associated with Luminal A-like breast cancer (FDR-adjusted p < 0.05). No other relationships between IR-related traits and subtypes were observed in these analyses. Results indicate that IR is not associated with risk of BC subtypes in European women, contradicting findings from previous Mendelian randomization studies3; however, sensitivity analyses identified significant inverse relationships between Luminal A-like BC and FG and FI. Our findings warrant further replication using independent sets of data. Objectives: The participant shall be able to identify the benefits underlying Mendelian randomization, and why this method was used in this study. Additionally, the participant shall be able to identify that there is a gap in our understanding of the relationship between insulin resistance related traits and molecular subtypes of breast cancer. References: Chen J, Spracklen CN, Marenne G, et al. The trans-ancestral genomic architecture of glycemic traits. Nature Genetics. 2021;53(6):840-860. doi:10.1038/s41588-021-00852-9. Zhang H, Ahearn TU, Lecarpentier J, et al. Genome-wide association study identifies 32 novel breast cancer susceptibility loci from overall and subtype-specific analyses. Nat Genet. 2020;52(6):572-581. doi:10.1038/s41588-020-0609-2. Shu X, Wu L, Khankari NK, et al. Associations of obesity and circulating insulin and glucose with breast cancer risk: a Mendelian randomization analysis. International Journal of Epidemiology. 2019;48(3):795-806. doi:10.1093/ije/dyy201.
P81: COVID-19 Communications: Experiences from St. Jude Children’s Research Hospital
Heather Chambliss, Elizabeth Bartholomew, Daniel Bastardo Blanco, Adrienne Sloan, Owen McGuire, Emily VanGilder, Samantha Ransone, Diane Roberts
St. Jude Children's Research Hospital, Memphis, TN, USA
Abstract: With the emergence of the COVID-19 pandemic, St. Jude Children’s Research Hospital moved quickly to protect the health and safety of its patients, families, and employees. Nearly every area of the institution was transformed, requiring specific, accurate, and timely communication. It was important to provide clear, easy-to-understand messages to our patients and family caregivers to promote understanding of the virus, encourage adherence to infection prevention behaviors, and share changes in hospital policies and procedures. Content covered a range of topics such as COVID-19 and Children with Cancer, How to Talk to Your Child About Coronavirus and COVID-19, Social Distancing, and Fever and COVID-19. Information was made available through the hospital website, patient app, and Together website (together.stjude.org). Additionally, a COVID-19 coloring book and an activity book were developed to provide age-appropriate information regarding the virus, how to protect yourself and others, and what changes to expect at the hospital. St. Jude-specific COVID-19 information for patient families is available by direct link on the hospital website or through the patient app, allowing time-sensitive updates. Additional COVID-19 information on a range of topics is available on the Together website. Since the pandemic began, COVID-19 content accounts for about 60% of traffic to Together. The COVID-19 coloring book has been translated into 16 languages and available in both digital and print format. Resources continue to be developed with a current focus on vaccine education, including community outreach activities and a planned coloring book. The pandemic required the dissemination of rapidly changing, complex information. Using varied communication formats and channels allowed us to provide timely, tailored messages to serve our patient families as well as global audiences. These processes and learnings will be carried forward during the next phase of pandemic communication and beyond. Objectives: After attending this session, the participant shall be able to: Identify two content strategy ideas to use in patient education in their own institution. List three challenges in developing COVID-19 education for pediatric settings. Discuss three considerations in adapting communication for internal and external audiences. References: Kristen M C Malecki, Julie A Keating, Nasia Safdar Crisis Communication and Public Perception of COVID-19 Risk in the Era of Social Media. Clin Infect Dis. 2021 Feb 15; 72(4): 697–702. doi: 10.1093/cid/ciaa758 PMCID: PMC7337650. Darlington AE, Morgan JE, Wagland R, et al. COVID-19 and children with cancer: Parents' experiences, anxieties and support needs. Pediatr Blood Cancer. 2021;68(2):e28790. doi:10.1002/pbc.28790. Wen-Ying Sylvia Chou, Caitlin E. Burgdorf, Anna Gaysynsky, Christine M. Hunter. COVID-19 Vaccination Communication: Applying Behavioral and Social Science to Address Vaccine Hesitancy and Foster Vaccine Confidence. Available for download: https://obssr.od.nih.gov/sites/obssr/files/inline-files/OBSSR_VaccineWhitePaper_FINAL_508.pdf
P82: Accelerating Precision Radiotherapy Practice Change – working together while apart
Nicole Harnett1, Murali Rajaraman2, Clare Summers2, Carol-Anne Davis2, Robin Urquart2, Rebecca K.S. Wong3
1Princess Margaret Cancer Centre, Toronto, ON, Canada, 2Nova Scotia Health Authority, Halifax, NS, Canada, 3Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
Abstract: Atlantic Canada (AC) has six radiation therapy (RT) centres equipped with modern technologies capable of precision RT technique which remains under-utilized. A grant-funded, region-wide collaborative program – Advancing Radiation Oncology Practice in Atlantic Canada (AROPAC) - was designed to accelerate implementation of precision RT techniques through inter-professional learning. Funding was used to support meeting organization and coordination, multidisciplinary participation, and communication platforms. The objective is to present early impact of the initiative in the region. A multidisciplinary team from AC and Toronto conducted needs assessments of AC RT centres (2019, 2020) that guided program development. A virtual program was delivered in four phases over 4 months. Phase I and II consisted of two half-day meetings. Phase IIIa was a half-day “working meeting” for centre project leaders. Phase IIIb included half-day mentor-facilitated break out group discussions. Phase IV was a one-day meeting of both centre- and technique specific break out groups. At the conclusion of Phase IV, a summative evaluation was conducted using anonymous live polling. Of 22 respondents, 100% agreed there is value in AROPAC; that there will be positive carryover of what was learned; and that there is value in continuing the program. 96% agreed that involvement will enable implementation; and 83% felt more prepared for development and implementation. When identifying ongoing barriers, 26% said “none”, while 30% indicated human resource issues as their key barrier. 91% rated their experience with AROPAC as good or excellent. All centres that completed a “progress meter” indicated positive progress across phases. Data show that a regional, collaborative approach to build capacity for stereo-tactic, hypofractionated RT techniques can be effective despite variations in centre size and mandates. Key enabling factors are access to expert mentors, facilitation of collaboration and sharing of resources. Future evaluation will track progress of individual centres. Objectives: The participant will be able to: - identify the components of a high quality virtual learning program; - describe methods of measuring impact of educational activities; - list the characteristics that enhance regional quality improvement initiatives. References: Diane O’Doherty, Marie Dromey, Justan Lougheed, Ailish Hannigan, Jason Last & Deirdre McGrath. Barriers and solutions to online learning in medical education – an integrative review. BMC Medical Education. Volume 18, Article number: 130 (2018). Elisabeth Clark, Jan Draper, Jill Roger. Illuminating the process: Enhancing the impact of continuing professional education on practice. Nurse Education Today. Volume 35, Issue 2, February 2015, Pages 388-394
P83: Association between Leaf-blowers and lung cancer risk in Hispanic men landscape workers
Gabriela Ortega-Arvizu1, Vanessa Malcarne2, Georgia Robins Sadler3
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA, 3San Diego State University, San Diego, CA, USA
Abstract: Lung cancer is common among Hispanic men. Leaf-blowers for landscape maintenance are a potential contributing factor, as they emit millions of harmful toxic pollutants into the air, such as hydrocarbons and particulate matter (PM). This narrative review explored the dangers of leaf-blowers and their implications for addressing cancer disparities. This narrative literature review identified articles that explored the correlation between gas leaf-blowers and the risk of developing lung cancer. CINAHL, PubMed, EBSCO, and Google Scholar were among the databases searched for relevant full-text accessible articles. Citations of key articles were reviewed to identify other eligible articles. Reputable websites of organizations were also searched for relevant information. Among the keywords used were: leaf-blowers, Hispanic men, air pollution, lung cancer, landscape, urban, agricultural workers, gardener, and PM. Ten (out of thirty screened) articles considered leaf-blowers as a risk factor for lung cancer. Leaf-blowers emit quantities of hydrocarbons from unburned fuel, which react to form ozone. Benzene is an aromatic hydrocarbon, known as a carcinogen, that is emitted from gas powered leaf-blowers. Leaf-blower PM exposure (median, tons per day) from curbs/gutters, shoulders, and paved roadways were 61.2, 60.1, and 2.90, respectively. A systematic review and meta-analysis article linked outdoor PM exposure to lung cancer. Articles validated the carcinogenic exposure from leaf-blowers, which may contribute to higher rates of lung cancer among Hispanic men. Reducing exposure to PM may be achievable by transitioning to electric leaf-blowers. However, higher costs are a barrier to encouraging the use of electric leaf-blowers, and future policies should consider affordability. Objectives: The participant will be able to discuss at least two barriers that relate to HIspanic landscape and lung cancer. The participant will discuss at least one policy solution reducing Hispanic lung cancer disparities. References: Costa-Gómez, I., Bañón, D., Moreno-Grau, S., Revuelta, R., Elvira-Rendueles, B., & Moreno, J. (2020). Using a low-cost monitor to assess the impact of leaf blowers on particle pollution during street cleaning. Air Quality, Atmosphere & Health, 13(1), 15-23. GLEE, D. Leaf blowers in DC─ a fact sheet.(2016)
P84: Asian Glow: Aldehyde Dehydrogenase-2 Enzyme Polymorphism in the Asian Population and Its Link to Liver Cancer
Jenna Balingit1, Christal Sohl1, Alyssa Choi1, Georgia Robins Sadler2, Vanessa Malcarne1
1San Diego State University, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: About 30-40% of the Asian population carry an enzyme mutation of Aldehyde Dehydrogenase-2 (ALDH2) where the body has a hard time properly breaking down alcohol when ingested. This study explores how the enzyme mutation contributes to liver cancer (hepatocellular carcinoma [HCC]) in the Asian population. A search of scientific literature related to ALDH2 in the Asian population and its correlation to liver cancer was conducted. The following databases were searched for articles published since 2016: Pubmed/Medline, ProQuest, cBioPortal, and Protein Data Bank. Major search terms included: Asian, East Asian, ALDH2, enzyme, liver cancer, hepatocellular carcinoma, alcohol metabolism, polymorphism, genetics, screening, alcohol. References cited in key publications were reviewed to identify additional articles. Out of 58 articles screened, nine articles were identified that examined ALDH2 and HCC risk among the Asian population through cross-sectional surveys, animal studies, and assay analysis. Studies addressed the relationship of the ALDH2 mutated genotype to HCC. Research suggested that Asians who carry the ALDH2 mutation and have the Hepatitis B virus (HBV) infection are at even greater risk of HCC compared to those who do not have HBV. HBV is a liver infection that can be prevented with a vaccine, but studies show that many Asians are not aware of treatment options and how HBV relates to ALDH2. ALDH2 polymorphism in the Asian population appears to be related to liver cancer rates, but the role of the enzyme is only partially understood among the population. Bringing awareness about HBV screening and physiological effects of alcohol consumption among Asians may help to address cancer disparities in this ethnic group. Objectives: The participant will be able to identify the role of the enzyme deficiency in the Asian community. The participant will be able to identify the importance of HBV screening and educational barriers the Asian community may encounter. References: Huang, P.-H., Hu, C.-C., Chien, C.-H., Chen, L.-W., Chien, R.-N., Lin, Y.-S., Chao, M., Lin, C.-L., & Yeh, C.-T. (2019). The Defective Allele of Aldehyde Dehydrogenase 2 Gene is Associated with Favorable Postoperative Prognosis in Hepatocellular Carcinoma. Journal of Cancer, 10(23), 5735–5743. https://doi.org/10.7150/jca.33221. Wang, Q., Chang, B., Li, X., & Zou, Z. (2021). Role of ALDH2 in Hepatic Disorders: Gene Polymorphism and Disease Pathogenesis. Journal of Clinical and Translational Hepatology, 000(000), 1–9. https://doi.org/10.14218/jcth.2020.00104
P85: A comparison of the oral microbiome of children exposed to thirdhand-smoke and adult smokers as a risk factor for oral cancer
Mitchell Pernia1, Shawn Ogden1, Elizabeth Diaz2, Vanessa Malcarne1, Georgia Robins Sadler3
1San Diego State University, San Diego, CA, USA, 2University of California San Diego, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Thirdhand-smoke (THS) is as dangerous as secondhand-smoke (SHS) and some children are heavily exposed to it without control over their environment. This study compares how children’s oral microbiome is altered (such as the amount of bacteria present) when exposed to THS, versus the oral microbiome of a smoking adult. Various scientific literature related to THS was identified in this review. Fifteen articles since 2016 were found using the databases PubMed and GoogleScholar using keywords such as oral microbiome, thirdhand-smoke, oral cancer, children, and adult. Relevant articles were also identified from the Thirdhand Smoke Research Center database. Citations from key articles were reviewed. This literature review will compare the risk of oral cancer in non-smoking children exposed to THS and adult smoker. This comparison focuses on certain bacteria found in the oral microbiome of these two age groups. Thirdhand smoke (THS) is the pollution that is left behind in any cigarette smoking environment. Children in THS environments have an increased risk of altering their oral microbiome because they have a high hand-to-mouth behavior. Research shows that bacteria that indicate healthy oral microbiome such as Capnocytophaga, Peptostreptococcus and Leptotrichia are depleted in smokers’ oral microbiome. A similar bacteria, Veillonella, was found to be depleted in children living in THS-polluted homes. There are similar patterns found in the oral microbiome of children exposed to THS and adult smokers. A THS environment affects the oral microbiome of children and increases their risk for oral cancer. Further research should be conducted to investigate the specific bacteria that is altered by THS because the health of children is highly dependent on their environment. Objectives: The participant shall be able to identify the bacteria that are found in an unhealthy oral microbiome of smoking adults and compare them to a healthy oral microbiome of a child to assess the negative effects of thirdhand smoke exposure. The participant should also be able to relate altered oral microbiome from thirdhand smoke exposure to the development of oral cancer. References: Indranil Chattopadhyay, Mukesh Verma, and Madhusmita Panda. 2019. Role of Oral microbiome signatures in diagnosis and prognosis of oral cancer. Technology in Cancer Research and Treatment. doi: 10.1177/1533033819867354. Scott T. Kelley, William Liu, Penelope J. E. Quintana, Eunha Hoh, Nathan G. Dodder, E. Melinda Mahabee-Gittens, Samuel Padilla, Shawn Ogden, Sia Frenzel, Laura Sisk-Hackworth, and Georg E. Matt. 2021. Altered microbiomes in thirdhand smoke-exposed children and their home environments. Pediatric Research. https://doi.org/10.1038/s41390-021-01400-1
P86: Association Between Fish Oil Supplements and Per- and Polyfluoroalkyl Substances (PFAS)
Lauren Barnes1, Kelli O'Connell2, Elizabeth Kantor2
1Ohio Wesleyan University, Delaware, OH, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA
Abstract: Per- and polyfluoroalkyl substances (PFAS) are widespread pollutants and classified as potentially carcinogenic to humans. Although fish consumption has been associated with increased PFAS levels, little is known about the association between fish oil and PFAS. Here, we examine associations between fish oil supplement use and serum PFAS levels. This analysis includes 4,672 U.S. adults, ages 25 and older, surveyed from 2007-2014 as part of the National Health and Nutrition Examinations Survey (NHANES). Fish oil supplement use over the prior 30 days was assessed during an in-home interview, and defined as follows: no use, low use (< 1 serving/day), and high use (1+ serving/day). Outcomes include four serum PFAS compounds: PFOS, PFOA, PFNA, and PFDE. To determine the association between fish oil use and log-transformed PFAS levels, survey-weighted linear regression was used to evaluate the multivariate-adjusted ratios between supplement-users’ and non-users’ geometric mean PFAS concentrations. Compared to no use of fish oil supplements, high use was inversely associated with PFOS levels (ratio = 0.88; 95% CI = 0.77, 0.997), with no association observed for PFOA, PFNA, and PFDE. Associations pertaining to PFOA varied by survey cycle (p-interaction = 0.048), but fish oil use was not significantly associated with PFOA levels in any survey cycle. Results did not vary significantly by age or sex. However, fish oil supplement use was significantly associated with lower PFOS levels in female participants (p-trend=0.03), but not male participants. Fish oil supplements were inversely associated with PFOS levels- an association driven by female participants. Fish oil use was not associated with the other PFAS examined. Future work is needed to determine if this pattern of association reflects a true association, residual confounding, or chance. Objectives: The participant shall be able to describe the inverse association between PFOS levels and self-reported fish oil supplement use. References: Brantsæter AL, Whitworth KW, Ydersbond TA, Haug LS, Haugen M, Knutsen HK, Thomsen C, Meltzer HM, Becher G, Sabaredzovic A, Hoppin JA, Eggesbø M, Longnecker MP. Determinants of plasma concentrations of perfluoroalkyl substances in pregnant Norwegian women. Environ Int. 2013 Apr;54:74-84. doi: 10.1016/j.envint.2012.12.014. Epub 2013 Feb 15. PMID: 23419425; PMCID: PMC3605228. Christensen KY, Raymond M, Blackowicz M, Liu Y, Thompson BA, Anderson HA, Turyk M. Perfluoroalkyl substances and fish consumption. Environ Res. 2017 Apr;154:145-151. doi: 10.1016/j.envres.2016.12.032. Epub 2017 Jan 7. PMID: 28073048.
P88: Border vs. Non-Border Cities: Differences in Blood Cancer Diagnoses within the Hispanic Community
Stefani Acosta1, Elizabeth Diaz2, Anthony Cirilo2, Vanessa Malcarne3, Georgia Robins Sadler1
1UC San Diego Moores Cancer Center, San Diego, CA, USA, 2University of California San Diego, San Diego, CA, USA, 3San Diego State University, San Diego, CA, USA
Abstract: The U.S. Hispanic community is the ethnic group with the highest rates of blood cancer diagnosis, especially acute lymphoblastic and myeloid leukemia. Hispanics living along the border that are considered low socioeconomic status are more inclined to undergo these disparities. This narrative literature review identified articles using PubMed/Medline and Google Scholar databases applying the keywords Hispanic(s), blood cancers, diagnosis, and border cities. Reference list of key articles concerning blood cancers and the Hispanic community. The literature concerns the disparities that Hispanics face concerning cancer. This presentation will discuss the findings from the literature review and provide suggestions for future research. Research has shown that Hispanic communities closer to the border have higher rates of diagnosis than communities farther away. Hispanic individuals also typically fall within low socioeconomic status, a key factor impacting adequate care, resources, and information available in their communities. 72% of the Hispanic population lacks medical coverage, leading to a barrier in accessing preventative healthcare. This may be further exacerbated by lack of adequate healthcare facilities and resources within their communities that can help mitigate these blood cancer diagnoses. Other related factors included lack of education, environmental factors, and genetic mutations. Multiple factors develop the disparity in the Hispanic population in border cities. Proper cancer treatment facilities in border cities should be funded to help with the diagnosis rates. Further studies concerning blood cancers need to be done in order the better the diagnosis and survival rates within the Hispanic community. Objectives: The participant shall be able to list at least two factors leading to the disparity between the Hispanic community faces living in border towns versus non-border. References: Bencomo-Alvarez, A. E., Gonzalez, M. A., Rubio, A. J., Olivas, I. M., Lara, J. J., Padilla, O., Orazi, A., Corral, J., Philipovskiy, A., Gaur, S., Mulla, Z. D., Dwivedi, A. K., & Eiring, A. M. (2020, December 3). Ethnic and border differences on blood cancer presentation and outcomes: A TEXAS population-based study. American Cancer Society Journals. https://acsjournals.onlinelibrary.wiley.com/doi/pdfdirect/10.1002/cncr.33347. Bencomo-Alvarez, A. E., Rubio, A. J., Gonzalez, M. A., & Eiring, A. M. (2021, April 8). Blood cancer health disparities in the United STATES Hispanic population. Cold Spring Harbor molecular case studies. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040735/.
P89: The Road to Recovery: Mastectomy Tattoos Following Breast Cancer Treatment
Jocelyn Quiroz1, Georgia Robins Sadler2, Vanessa Malcarne3, Chelsea Rapoport3, Alyssa Choi3
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA, 3San Diego State University, San Diego, CA, USA
Abstract: The abrupt physical changes accompanying breast cancer treatment, along with societal and cultural expectations of femininity, can create a sense of powerlessness among patients and negatively impact their quality of life. Mastectomy tattoos may serve as a form of emotional healing for women who feel disconnected from their post-mastectomized bodies. This narrative literature review identified articles using PubMed, Google Scholar, EBSCOhost, and PsycINFO databases using keywords: mastectomy, tattoos, body image, healing. Twenty-nine articles concerning mastectomy tattoos were included in this review. Articles that were in English and published between 2010-2021 were included. Additionally, articles were excluded if the full text was not available. Reference lists of key articles were reviewed for additional relevant articles. The literature reported that women who had a mastectomy often felt less feminine and beautiful and struggled with heteronormative body ideals within society. While women acquired tattoos for a variety of reasons, common motivations for getting a tattoo were self-expression, healing, and transformation. Studies explored the positive effects of tattooing through identity development, empowerment, and increased confidence, and suggested that women viewed themselves more positively after acquiring a tattoo. Quantitative studies on mastectomy tattoos were lacking, but there was a growing body of qualitative studies regarding the motivating factors and potential benefits of tattoos following breast cancer treatment. Post-mastectomy tattoos may improve women’s self-view and quality of life by promoting agency, empowerment, and emotional healing. However, more quantitative studies are necessary to examine the potential benefits and other complexities involved in tattooing to sufficiently educate survivors weighing mastectomy tattoos as a potential option. Objectives: The participant shall be able to identify at least 3 popular motives for acquiring mastectomy tattoos and describe the benefits of these tattoos based on qualitative evidence provided in the literature. References: Mastectomy tattoos: An emerging alternative for reclaiming self, Victoria Reid-de Jong PhD candidate, Anne Bruce PhD, 18 July 2020 https://doi.org/10.1111/nuf.12486. Emotional healing with unconventional breast tattoos: The role of temporary tattoos in the recovery process after breast carcinoma and mastectomy, Lindsay P. Osborn BA, Philip R.Cohen MD, https://doi.org/10.1016/j.clindermatol.2017.11.002.
P90: “I Think There Should Be Photos”: Female Indoor Tanners’ Perceptions of Health Warning Labels for Tanning Beds
Sydney Gosselin1, Jennifer McWhirter1, Seema Mutti-Packer2, Scott McEwen1, Andrew Papadopoulos1, Cheryl Rosen3, Jennifer Beecker4
1University of Guelph, Guelph, ON, Canada, 2Alberta Health Services, Edmonton, AB, Canada, 3Toronto Western Hospital, Toronto, ON, Canada, 4University of Ottawa, Ottawa, ON, Canada
Abstract: This study explores female indoor tanners’ perceptions of the current Canadian health warning label (HWL) for tanning equipment, along with pictorial, evidence-based alternatives. Images are important and ubiquitous in cancer communication, but this HWL is text-only. Additionally, it has not been evaluated in the literature, representing a critical research gap. We created 10 test HWLs depicting 4 categories of UV effects: skin damage, eye damage, premature aging, and death. The text in these test HWLs was informed by plain language guidelines and communication theory. In focus groups, women aged 18-34 who had tanned indoors in the past year discussed the test HWLs and the current federal HWL. Key discussion questions included participants’ recognition of the federal HWL; perceived effectiveness; likes and dislikes about the images and text; comprehensibility; and suggested modifications. We recorded and transcribed the group discussions and conducted a thematic analysis to summarize participants’ perceptions of the HWLs. Many participants found the federal HWL informative. However, most either did not recognize it, or mentioned they would not read it due to the small text, wordiness, and lack of an image. Graphic images depicting the face or eyes were seen as effective. Common criticisms of the images were lack of believability, relatability, and comprehensibility. Although concise text encouraged reading, many participants wanted more information in the test HWLs. Premature aging was often identified as a concern, but the aging-related images were not perceived as effective. Although the death-related HWL text was seen as effective, most participants dismissed the images. Our findings suggest that stronger HWLs are needed to inform tanners and discourage IT. Graphic images may increase HWL effectiveness, especially by attracting attention. Future research could develop text that increases the believability, relatability, and comprehensibility of images. With these modifications, HWLs could become informative and engaging cancer prevention messages. Objectives: The participant shall be able to: Describe at least three qualities of effective images for indoor tanning prevention. Identify at least two effective text features for indoor tanning prevention. Compare text-only and pictorial health warning labels in their ability to communicate the risks of indoor tanning. Identify at least two challenges in the use of HWLs as a cancer communication tool for indoor tanning. References: Health Canada. (2017). Guidelines for tanning salon owners, operators, and users. Noar, S. M., Hall, M. G., Francis, D. B., Ribisl, K. M., Pepper, J. K., & Brewer, N. T. (2016). Pictorial cigarette pack warnings: a meta-analysis of experimental studies. Tobacco Control, 25(3), 341-354. Sontag, J. M., & Noar, S. M. (2017). Assessing the potential effectiveness of pictorial messages to deter young women from indoor tanning: An experimental study. Journal of Health Communication, 22(4), 294–303. World Health Organization (2017). Artificial tanning devices: Public health interventions to manage sunbeds.
P91: Characterization of treatment-associated genomic changes in rectal cancer patients treated with neoadjuvant therapy
Virginia Ma1, Francisco Sanchez-Vega2
1Harvard College, Boston, MA, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA
Abstract: Patients with locally advanced rectal cancer (LARC) are treated with neoadjuvant therapy (NAT), a combination of radiation and chemotherapy, followed by surgical resection. The degree of response to NAT varies widely across patients, and there is currently no effective way to predict response prior to treatment initiation. To investigate biological mechanisms of response and resistance to NAT, we analyzed DNA sequencing data from 67 LARC patients. For 47 patients with an incomplete response who underwent surgical resection, we compared somatic mutations in matched tumors sequenced before and after NAT. Whole-exome sequencing (WES) for tumor and matched normals was performed at Memorial Sloan Kettering and WES data was processed in-house using internal computational pipelines. The OncoKB precision oncology knowledgebase was used to identify variants of functional relevance (putative driver mutations), and the FACETS tool was used to infer the cancer cell fraction associated with individual mutations. Excluding hypermutated samples, median tumor mutational burden (TMB) was higher in post-treatment samples (2.89 Mut/Mb vs. 3.64 Mut/Mb; p=0.001, Wilcoxon rank-sum), and 72% of patients experienced a TMB increase. Patients with a decrease in TMB had at least 70% pathological response, whereas half of patients with increased TMB had less than 50% response. Most novel mutations were variants of unknown significance, and few driver mutations were gained in post-treatment samples. Driver mutations most frequently lost throughout treatment affected APC, TP53 and KRAS genes. Novel driver mutations gained included SOX9, ATRX and SMAD4 genes. These findings provide novel insights into the cell-intrinsic mechanisms of response and resistance to NAT in LARC. Understanding these mechanisms is important in order to design future therapies that overcome treatment resistance and maximize the likelihood of complete response, therefore improving survival rates and quality of life. Objectives: The participant shall be able to identify specific genes and mutations of interest for further study of mechanisms underlying response and resistance to neoadjuvant therapies in locally advanced rectal cancer. References: Kamran SC, Lennerz JK, Margolis CA, Liu D, Reardon B, Wankowicz SA, Van Seventer EE, Tracy A, Wo JY, Carter SL, Willers H, Corcoran RB, Hong TS, Van Allen EM. Integrative Molecular Characterization of Resistance to Neoadjuvant Chemoradiation in Rectal Cancer. Clin Cancer Res. 2019 Sep 15;25(18):5561-5571. doi: 10.1158/1078-0432.CCR-19-0908. Epub 2019 Jun 28. Zehir, A., Benayed, R., Shah, R. et al. Mutational landscape of metastatic cancer revealed from prospective clinical sequencing of 10,000 patients. Nat Med 23, 703–713 (2017). https://doi.org/10.1038/nm.4333 Sanchez-Vega F, Mina M, Armenia J, Chatila WK, Luna A, La KC, Dimitriadoy S, Liu DL, Kantheti HS, Saghafinia S, Chakravarty
P92: Concise Guide for Action: Patient Education Practice Guidelines for Health Care Professionals
Sarah Christensen1, Carolyn Cutilli2
1MD Anderson Cancer Center, Houston, TX, USA, 2Penn Medicine, Ambler, PA, USA
Abstract: The Patient Education Practice Guidelines for Health Care Professionals was developed to provide a concise, evidence-based resource for frontline health care professionals. A group of 27 multidisciplinary volunteers committed to the project. A grant was secured to provide funding for a librarian-mediated literature search resulting in over 10,000 articles and resources for review. The final Guidelines are an open source tool based on the most relevant evidence-based practices for patient education. The Guidelines are based on four patient education components: assessment, planning, implementation and evaluation (APIE). Each component is essential for delivering effective patient education. Individualizing education is accomplished through assessment of the patient. Planning focuses on the patient’s priorities in addition to needs identified by the healthcare professionals. Implementation uses key learning strategies and can be adapted based on the patient’s response. In the evaluation component, the patient’s change in knowledge or behavior is verified. The Guidelines were creating by a multidisciplinary team providing input at every step of the process. The first draft on the concept was reviewed by 100 participants at a national conference. Their qualitative feedback was reviewed and implemented if it supported the original goal of being concise and evidenced-based. The final Guidelines draft was review by 42 healthcare providers whose feedback was incorporated as applicable. Their overall review was in strong agreement that the final Guidelines were concise, effective, and implementable. The Guidelines web page had 9,000 hits in the first 6 months of implementation. The Guidelines apply to any health care setting where consumers learn about disease information, test preparation, results, treatments, accessing care, appointments or resources. The Guidelines utilize a broad definition of consumer to include patients, family, friends, neighbors, guardians, significant other/partner or anyone else designated to address care needs. Objectives: 1. The participant shall be able to navigate the Guidelines for optimal use. 2. The participant shall be able to apply guidelines to enhance current educational processes References: R.W. Batterham, M. Hawkins, P.A. Collins, R. Buchbinder, R.H. Osborne. Health literacy: applying current concepts to improve health services and reduce health inequalities, Public Health, Volume 132, 2016, Pages 3-12, ISSN 0033-3506, https://doi.org/10.1016/j.puhe.2016.01.001. L. Killian, M. Coletti. Role of Universal Health Literacy Precautions in Minimizing “Medspeak” and Promoting Shared Decision Making, AMA J Ethics. 2017;19(3):296-303. doi: 10.1001/journalofethics.2017.19.3.pfor1-1703.
P93: Indoor Air Pollution as a Cancer Risk Factor Among Lower Socioeconomic Populations
Naomi Pineda1, Alyssa Choi2, Jennifer Walston1, Vanessa Malcarne2, Georgia Robins Sadler3
1University of California San Diego, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Pollution indoors may be more harmful than outdoors because of degradation and the smaller size of suspended particles, which increases the risk of lung and skin cancer. Lower socioeconomic status (SES) individuals may be at risk because of increased household pollution. This literature review examined the link between indoor pollution and low SES. Eight highly related articles were found by utilizing the databases PubMed and EBSCOhost using the keywords indoor air pollution, household pollution, low socioeconomic status, low income, and cancer. The reference sections of key articles were reviewed to identify additional studies. Included articles were in English, peer-reviewed and published between the years 2000 to 2021. Overall, studies found that lower SES populations were disproportionately affected by indoor air quality. Lower SES households often have multifamily units which could increase the number of people who smoke and the amount of chloroform exposure from tap water. Particulate matter smaller than 2.5 micrometers (PM2.5), which has been proven to be harmful for the lungs, was found to be caused by smoking and cooking. Low SES populations that smoke may also use air fresheners to cover the smell, which produces volatile organic compounds (VOC). All these factors pose a risk factor for lung cancer to people living in these buildings. Crowded living spaces and smoking were the two main risk factors for low SES communities. Because the majority of individuals’ time is spent indoors, it is important to assess these inequalities. Programs to address smoking, better ventilation systems, and cleaning these buildings are some ways to address this disparity. Objectives: The participant shall be able to identify two main risk factors for cancer in low SES communities related to indoor pollution. The participant shall be able to understand two main reasons why indoor pollution is more harmful than outdoor pollution. References: Ferguson, L., Taylor, J., Davies, M., Shrubsole, C., Symonds, P., & Dimitroulopoulou, S. (2020). Exposure to indoor air pollution across socio-economic groups in high-income countries: A scoping review of the literature and a modelling methodology. Environment International, 143, 105748. https://doi.org/10.1016/j.envint.2020.105748. Ni, Y., Shi, G., & Qu, J. (2020). Indoor PM2.5, tobacco smoking and chronic lung diseases: A narrative review. Environmental Research, 181, 108910. https://doi.org/10.1016/j.envres.2019.108910. Chu, M. T., Gillooly, S. E., Levy, J. I., Vallarino, J., Reyna, L. N., Cedeño Laurent, J. G., Coull, B. A., & Adamkiewicz, G. (2021). Real-time indoor PM2.5 monitoring in an urban cohort: Implications for exposure disparities and source control. Environmental Research, 193, 110561. https://doi.org/10.1016/j.envres.2020.110561
P94: Factors explaining higher cancer rates among Vietnamese immigrants in the United States
Tin Nguyen1, Michael Alcazar1, Vanessa Malcarne2, Georgia Robins Sadler3
1University of California San Diego, San Diego, CA, USA, 2San Diego State University, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: United States’ Vietnamese immigrants experience higher cancer incidence rates than Vietnamese living in Vietnam. While cancer is the third leading cause of death in Vietnam, it’s the number one cause of death in the US Vietnamese population. This study examines what factors contribute to higher cancer rates among Vietnamese immigrants. This narrative literature review identified articles using PubMed, CINAHL, Embase, and Ethnic Newswatch databases, using such keywords as: Vietnamese, Vietnamese American, immigrant, cancer, rates, morbidity, mortality, and cancer incidence. References found in key articles were reviewed and included when appropriate. Articles published between 2000 and 2021 and written in English or Vietnamese were eligible for inclusion in this review. Six of the forty articles identified during the literature search were eligible for inclusion in this review. Vietnamese Americans carry a higher risk of liver and stomach cancers due to such infections as Hepatitis B and Helicobacter Pylori, infections that are endemic in Vietnam. They also develop a higher risk of colorectal and breast cancers, believed to be attributed to the process of westernization. This includes a higher red meat consumption and a sedentary lifestyle. The language barrier combined with lower health literacy levels also contributes to lower cancer screening rates among Vietnamese immigrants, lower awareness of early warning signs of cancer, and lower use of medical interventions, such as the Hepatitis B vaccination. Adapting to a new lifestyle following immigration appears to correlate with increased cancer risk in Vietnamese immigrants. This suggests that cancer disparities among Vietnamese in the US may be addressed by working directly with the immigrant population to increase cancer awareness, education, and testing. Objectives: The participant will be able to identify three reasons for the higher cancer rates in Vietnamese Immigrants in the United States compared to the Vietnamese population in Vietnam. The participant will be able to name two barriers that the Vietnamese Immigrants face to access cancer screening in the United States. References: Thuy Phuong Nguyen, Hung N. Luu, Mai Vu Tuyet Nguyen, Mo Thi Tran, Thuy Thi Van Tuong, Chi Thi Du Tram, Paolo Boffetta. 2019. Attributable Causes of Cancer in Vietnam. http://ascopubs.org/doi/full/10.1200/JGO.19.00239. Richard K. Lee, Ravi A. Madan, Jayoung Kim, Edwin M. Posadas, Evan Y. Yu. 2021. Disparities in Cancer Care and the Asian American Population. https://doi.org/10.1002/onco.13748
P95: Factors Contributing to an Increase of Cervical Cancer and a Decrease of Screening Rates Among Victims of Sexual Abuse
Viena Le1, Georgia Robins Sadler2, Vanessa Malcarne3, Elizabeth Diaz1, France Nguyen-Grozavu2
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA, 3San Diego State University, San Diego, CA, USA
Abstract: Studies have shown that women who have been victims of sexual abuse are at a higher risk of developing cervical cancer, and yet, they are also less likely to participate in screening for cervical cancer. This study aims to identify the factors that contribute to these statistics. This narrative literature review identifies English language articles between 2011 and 2021, using the following databases: PubMed, CINAHL, and PsycINFO, as well as additional articles derived from reference lists. The following key search words were used: cervical cancer, sexual abuse, childhood sexual abuse, cervical dysplasia, sexual assault, and gynecological care. Eighteen articles were identified that confirmed that women who are victims of sexual abuse are at higher risk for cervical cancer. These women are more likely to become sexually active at a younger age, have STIs, engage in smoking and unsafe sex, and have a history of abuse, all factors that can lead to an increased risk of cervical cancer. In some cases the risk is amplified when factors are combined. Additionally, these women are often less likely to have screenings due to psychological factors (e.g., retraumatization), and rarely receive the adequate support needed to overcome these psychological barriers. Sexual abuse questions should be included in patient intake forms. Care providers need training in how to respond effectively to the needs of victims of sexual abuse. It is essential to include the perspectives of the victims in the development of those questions and the training programs for providers. Objectives: Participants should be able to identify one risk factor among victims of sexual abuse that correlates with cervical cancer. Participants should be able to identify one barrier for victims of sexual abuse that correlates with their low screening rates. References: Alcalá, H. E., Mitchell, E., & Keim-Malpass, J. (2017). Adverse childhood experiences and cervical cancer screening. Journal of Women's Health, 26(1), 58–63. https://doi.org/10.1089/jwh.2016.5823. Hindin, P., Btoush, R., & Carmody, D. P. (2019). History of childhood abuse and risk for cervical cancer among women in low-income areas. Journal of Women's Health, 28(1), 23–29. https://doi.org/10.1089/jwh.2018.6926
P96: Disparities in quality of life among pediatric brain cancer survivors
Amber O'Brien1, Vanessa Malcarne2, Georgia Robins Sadler3
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA, 3San Diego State University, San Diego, CA, USA
Abstract: Pediatric brain cancer results in long-term cognitive and behavioral functioning deficits for survivors. This literature review identifies disparities in quality of life (QOL) among pediatric brain cancer survivors. Identifying these disparities is key to reducing barriers to resources that improve the quality of life for pediatric brain cancer survivors. A narrative literature review was conducted of PubMed/Medline, EBSCOhost, PsycINFO, CINAHL, ProQuest, and Google Scholar. Key terms for the search included: Pediatric/Child/Children/Adolescent, Brain Cancer/Tumor, QOL, Socioeconomic (SES)/Low-Income/Poverty, Ethnicity/Race/Minority, Religion/Religiosity/Religious beliefs, and Parental Influence/Expectations/Decision-making. Criteria consisted of a focus on pediatric brain cancer/tumors, and quality of life outcomes in relation to SES/ethnicity/religion/parental influence. Articles written in English or Spanish were eligible for inclusion. Articles were excluded if they did not meet the main criteria of containing at least a focus upon pediatric brain cancer/tumors, QOL outcomes/rehabilitation, and at least one of the SES/ethnicity/religions/parental influence requirements. SES (including insurance coverage) was a significant predictor of QOL outcomes among pediatric brain cancer survivors. Other factors identified for their influence upon QOL were ethnicity, parental education, and type of treatment received. In studies controlling for SES, ethnicity was not a significant predictor of QOL outcomes. Lower levels of parental education predicted poorer QOL. Children that received chemotherapy/radiation therapy reported lower QOL. There is a lack of literature surrounding how specific religious doctrines may affect parental expectations of their disabled children following brain cancer/tumor. Some studies support younger age at diagnosis and being female predictive of poorer QOL. Educating low SES parents about the benefits of cognitive/behavioral intervention options and educating health care providers on billing/coding methods to improve insurance approval rates may alleviate some barriers to access for pediatric brain cancer survivors. Further research should include investigating how culture and differing religious ideologies influence QOL outcomes. Objectives: The participant shall be able to identify at least two barriers to health equity among pediatric brain cancer survivors. The participant shall be able to identify at least two risks associated with long-term quality of life outcomes in underserved populations. The participant shall be able to distinguish at least two factors that would benefit from further research. The participant shall be able to discern at least two recommendations to increasing health equity among pediatric brain cancer survivors. References: Barrera, Maru, Eshetu G. Atenafu, Fiona Schulte, Ute Bartels, Lillian Sung, Laura Janzen, Joanna Chung, et al. “Determinants of Quality of Life Outcomes for Survivors of Pediatric Brain Tumors: Barrera et al.” Pediatric Blood & Cancer 64, no. 9 (September 2017): e26481. https://doi.org/10.1002/pbc.26481. Raghubar, Kimberly P., Jessica Orobio, M. Douglas Ris, Andrew M. Heitzer, Alexandra Roth, Austin L. Brown, M. Fatih Okcu, et al. “Adaptive Functioning in Pediatric Brain Tumor Survivors: An Examination of Ethnicity and Socioeconomic Status.” Pediatric Blood & Cancer 66, no. 9 (September 2019). https://doi.org/10.1002/pbc.27800.
P97: Links between obesity and breast cancer in Asian American women
Geenee Gonzales1, Jennifer Walston2, Alyssa Choi1, Georgia Robins Sadler3, Vanessa Malcarne1
1San Diego State University, San Diego, CA, USA, 2University of California San Diego, San Diego, CA, USA, 3UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Most research examining the effects of obesity on breast cancer (BC) has been focused on non-Hispanic white women in the United States and Europe. However, links between obesity and BC may vary across racial/ethnic groups. This literature review investigated possible disparities in obesity and BC affecting Asian American women. A narrative literature review was conducted to investigate the possible relationship between obesity and BC in Asian American women. Research articles published in the past decade (2011 to 2021) were identified using the databases PubMed, CINAHL, PsycInfo, ERIC, and Google Scholar. Keywords used for the search were breast cancer, obesity, Asian American, race/ethnicity, cancer risk, and cancer survival. Reference lists of key articles were examined for additional sources. Findings on the effects of obesity on BC in Asian American women were mixed. Of the 21 articles reviewed, ten were found to directly examine this disparity. Most were cross-sectional in design, except for the Multiethnic Cohort (MEC) study (White et al., 2012). Some studies, including MEC, found that obesity in Asian American women was associated with increased BC risk compared to other racial/ethnic groups. This disparity may be explained by higher visceral than subcutaneous adipose tissue, higher levels of estrogen and androgen, and higher body fat composition among Asian American women. However, other studies found no disparity. The links between obesity and BC among Asian American women remain poorly understood. Disaggregation of data into Asian ethnic subgroups and larger sample sizes may be a more accurate approach to conducting studies investigating this disparity, similar to the MEC. Objectives: The participant will be able to describe how obesity may be related to worse outcomes in breast cancer in Asian American women. References: Elisa V. Bandera, Catherine M. Alfano, Bo Qin, Dong-Woo Kang, Ciarán P. Friel, and Christina M. Dieli-Conwright. 2021. Harnessing Nutrition and Physical Activity for Breast Cancer Prevention and Control to Reduce Racial/Ethnic Cancer Health Disparities. American Society of Clinical Oncology. Kimberly M. Arnold, Nicole J. Flynn, and Jennifer Sims-Mourtada. 2016. Obesity and Breast Cancer: Do Age, Race and Subtype Matter?. BAOJ Cancer Research & Therapy.
P98: Distress and Suicidality in Women with Gynecologic Cancers
Sydney Olfus1, Chelsea Rapoport1, Georgia Robins Sadler2, Vanessa Malcarne1, Alyssa Choi1
1San Diego State University, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Gynecologic cancer patients are at a higher risk of distress and suicidality compared to the general public and women with other malignancies, reasons for which are poorly understood. This literature review will identify quality of life factors impacting distress and suicidality in gynecologic cancer patients. A search was conducted to identify literature on factors that may negatively impact psychological distress and suicidality of gynecologic cancer patients. Searches included all cancer stages and treatment phases. Articles were identified using PubMed, PsycInfo, CINAHL, Google Scholar, and GenderWatch databases. Major search terms included: gynecologic cancer, suicidality/suicidal ideation, depression, distress, anxiety, sexual dysfunction, fertility, and body image. Other sources were identified using reference lists from core articles. In this literature search, 34 possible articles were identified and 24 were selected for review. The review identified unique quality of life (QoL) concerns contributing to psychological distress and suicidality in women with gynecologic cancers. Studies indicated that women with gynecologic malignancies experienced higher suicidality risk due to sexual dysfunction, fertility concerns, and low social support. These QoL issues correlated with greater psychological distress and demoralization, increasing the risk of major depressive disorder and subsequent suicidal ideation. Ovarian cancer patients were identified to have the highest suicide risk of the gynecologic cancer population due to concern regarding high mortality rates and invasive treatment procedures. Unfortunately, clinicians may feel uncomfortable discussing these issues with patients. Sexual dysfunction, fertility concerns, and a lack of social support are related to increased distress and suicidality in patients. Health care professionals should assess these concerns and identify patients at greater risk of distress and suicidality. Better patient-provider communication is needed to support at-risk gynecologic cancer patients. Objectives: The participant shall be able to identify 3 unique quality of life issues correlating with psychological distress and suicidality in gynecologic cancer patients. References: Bae, H., & Park, H. (2016). Sexual function, depression, and quality of life in patients with cervical cancer. Supportive Care in Cancer, 24(3), 1277–1283. https://doi.org/10.1007/s00520-015-2918-z. Violette, C. J., Mandelbaum, R. S., Nusbaum, D. J., Duval, C. J., Matsuzaki, S., Machida, H., Roman, L. D., & Matsuo, K. (2019). Temporal trends and characteristics of suicide among women with gynecologic malignancy in the United States. Gynecologic Oncology Reports, 30, 100510. https://doi.org/10.1016/j.gore.2019.100510
P99: Disparities pertaining to Wilms Tumor patients in different cultures and socioeconomic backgrounds.
Nicholas Monroe1, Vanessa Malcarne1, Georgia Robins Sadler2
1San Diego State University, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Wilms Tumor (WT) is a highly curable cancer when detected and treated early. It occurs predominantly in children between the ages of 3 and 4. This narrative review of the literature explores differences in morbidity and mortality rates for WT patients based on socioeconomic status (SES) and race. A review of the scientific literature was undertaken using such databases as: PubMed, CINAHL, and PsycINFO. Search terms included: disparities, ethnicities, Wilms Tumor, multicultural, and SES. English language articles published between 2014 and 2020 were eligible for inclusion. Once morbidity and mortality rates were identified, additional search terms were added to explore correlations and causes of differences. These included such key terms as: race, religion, medical mistrust, health literacy, and cancer worry. Of the thirty articles found, fifteen were closely aligned with the goals of this narrative review. The majority of the studies performed were longitudinal in design. The researched groups were African Americans, Sub Saharan Africans, Caucasian Americans, and Hispanic Americans. Ultimately, studies indicated that Sub Saharan Africans and those residing in other developing countries experienced the worst outcomes. While this is likely to be due to the resource-constrained circumstances common in developing countries, the research conducted of those in developing, low-income countries remains limited. In contrast, numerous studies have identified disparities in patient outcomes pertaining to WT patients in the United States, Europe, and other first world countries. Overall, statistics showed that WT is most commonly found in African American children and those of lower SES. This narrative review underscores the disparities along the lines of SES and race for patients with WT. With the access to sufficient resources, a decrease in the disparity of morbidity and mortality rates may be possible for those most affected by WT. Objectives: The participant will be able to recognize at least two factors contributing to Wilms Tumor morbidity and mortality rates and why they are increased in the Black population. References: Cunningham ME, Klug TD, Nuchtern JG, Chintagumpala MM, Venkatramani R, Lubega J, Naik-Mathuria BJ. Global Disparities in Wilms Tumor. J Surg Res. 2020 Mar;247:34-51. doi: 10.1016/j.jss.2019.10.044. Epub 2019 Dec 3. PMID: 31810638. Apple AN, Neuzil KE, Phelps HM, Li B, Lovvorn Iii HN. Race disparities in genetic alterations within Wilms tumor specimens. J Pediatr Surg. 2021 Jun;56(6):1135-1141. doi: 10.1016/j.jpedsurg.2021.02.030. Epub 2021 Feb 26. PMID: 33745745.
P100: Evaluation of radiation therapy patient education in fourteen cancer centres
Sarah McBain1, Eleni Giannopoulos2, Jenney Wang3, Victoria Zwicker3, Colleen Fox1, Janet Papadakos2
1Cancer Care Ontario, Toronto, ON, Canada, 2Princess Margaret Cancer Centre, Toronto, ON, Canada, 3Ontario Health, Toronto, ON, Canada
Abstract: Many patients will receive radiation therapy as part of their cancer treatment. Patient education (PE) materials are provided to help patients understand what to expect from treatment and support self-management of symptoms. In order to mitigate decreasing levels of health literacy, there is a need to evaluate patient education materials. An evaluation of radiation therapy PE materials was undertaken at fourteen cancer centres in Ontario, Canada. PE leaders independently conducted a quality and comprehensiveness assessment on radiation therapy PE materials at their respective centres. The quality assessment was an evaluation of readability using two validated measures: Flesch Reading Ease and Simple Measure of Gobbledygook (SMOG) Readability Formula. The Patient Education Materials Assessment Tool for Print and Audiovisual Materials (PEMAT-P and PEMAT-A/V) was used to evaluate understandability and actionability of materials. The comprehensiveness assessment was an evaluation of the format of PE materials and the scope of symptoms covered. PE leaders submitted a total of 555 PE materials. Seventy materials were purposively selected for the assessment. Under half of the materials (n=34, 49%) scored at or above the 80% target for understandability (x̄ = 74%, 33-100%) and just over half of the materials (n=36, 51%) scored at or above the 80% target for actionability (x̄ = 71%, 33-100%). Most materials had a reading grade level above the recommended Grade 6 (x̄ = 9, range = 4-12). Of the 555 materials, the vast majority were pamphlets (89%). Only two centres (N=2/14, 14%) had PE materials covering all listed side effects/symptoms pertaining to radiation therapy treatment. Findings indicate that radiation therapy PE materials do not meet health literacy best practices. This evaluation highlights a need to improve the quality, availability and access to PE materials used in cancer centres. Objectives: The participant will be able to assess the quality of cancer patient education materials for radiation therapy using various validated instruments. The participant will be able to evaluate the comprehensiveness of radiation therapy materials by analyzing the format and content coverage. The participant will be able to identify content gaps in current patient education collections at various cancer centres. References: Bonin, K., et al., Evaluation of an Online Education Resource on Radiation Therapy Created for Patients with Postprostatectomy Prostate Cancer and Their Caregivers. J Med Imaging Radiat Sci, 2018. 49(4): p. 365-370. Prabhu, A.V., et al., Radiation Oncology and Online Patient Education Materials: Deviating From NIH and AMA Recommendations. Int J Radiat Oncol Biol Phys, 2016. 96(3): p. 521-8
P101: Socioeconomic barriers to breast cancer clinical trial retention
Julia Shi1, Kelsey Kaiser2, Ying-Shiuan Chen2, Benjamin Smith2, Grace Smith2
1Rice University, Houston, TX, USA, 2MD Anderson Cancer Center, Houston, TX, USA
Abstract: It is known that socioeconomic factors impact clinical trial participation. We aim to determine the impact of these factors on retention; retention means participants receive planned therapy and outcome assessments. We hypothesized that participants facing more severe socioeconomic deprivation would be less likely to be retained in a breast cancer trial. A retrospective analysis was conducted of 287 women age≥40 years with early stage breast cancer treated on a trial of breast conserving surgery and radiation. Exclusion criteria were: treated outside Texas (n=14) or did not have a linkable home address (n=16) for a sample of n=257. Patients were defined as “retained” on the trial if they attended the trial follow-up and received 3-year outcome assessment. Patients’ neighborhood-based socioeconomic deprivation was measured using the Area Deprivation Index (ADI) linked to their address; higher ADI indicated greater deprivation. Patients’ reasons for not being retained and social work support needs were abstracted. Median age was 61; 74% of patients were White Non-Hispanic; 22% were not retained. Reasons for not being retained were: lost contact (25.76%), insurance/provider loss/change (16.67%), transportation barrier (16.67%), active decision not to continue enrollment (13.64%), finances (10.60%), health (6.06%), other logistical (1.51%), and unknown (9.09%). Median ADI score for patients retained vs. not retained was 36.5 (IQR, 22-57) vs. 46 (IQR, 29-60) (P=0.03). Among those who requested social work support, resource needs for patients retained vs. not retained was significantly different (P=0.03). Retained patients needed psychological distress support while those not retained needed more practical help. To optimize generalizability and minimize bias in clinical trials, diverse participants need to be retained. Structural socioeconomic barriers were associated with decreased retention. Participants with baseline risks of socioeconomic deprivation may benefit from interventions which educate both patients and providers, and identify barriers to participation and retention. Objectives: The participant will be able to identify at least one potential socioeconomic barrier to clinical trial retention amongst breast cancer patients. The participant will be able to explain how socioeconomic barriers correlate with retention. References: Alcaraz, K.I., Wiedt, T.L., Daniels, E.C., Yabroff, K.R., Guerra, C.E. and Wender, R.C. (2020), Understanding and addressing social determinants to advance cancer health equity in the United States: A blueprint for practice, research, and policy. CA A Cancer J Clin, 70: 31-46. https://doi.org/10.3322/caac.21586. Joseph M Unger, PhD, MS, Dawn L Hershman, MD, MS, Raymond U Osarogiagbon, MD, Anirudh Gothwal, Seerat Anand, MBBS, Arvind Dasari, MD, Michael Overman, MD, Jonathan M Loree, MD, Kanwal Raghav, MD, Representativeness of Black Patients in Cancer Clinical Trials Sponsored by the National Cancer Institute Compared With Pharmaceutical Companies, JNCI Cancer Spectrum, Volume 4, Issue 4, August 2020, pkaa034, https://doi.org/10.1093/jncics/pkaa034
P103: Numeracy Education for Health Care Providers: A Scoping Review
Casey Goldstein1, Rebecca MacKinnon2, Rouhi Fazelzad3, Bhajan Gill4, Meredith Giuliani3, Tina Papadakos3, Qinge Wei4, Nicole Woods5, Janet Papadakos3
1University of Limerick School of Medicine, Limerick, County Limerick, Ireland, 2University of Guelph, Guelph, ON, Canada, 3Princess Margaret Cancer Centre, Toronto, ON, Canada, 4Western University, London, ON, Canada, 5University of Toronto, University Health Network, Toronto, ON, Canada
Abstract: Numeracy is fundamental in the role of a healthcare provider (HCP) and forms the basis of practicing evidence-based medicine. Despite attaining a high level of education, many HCPs struggle with numeracy. Numeracy is often integrated into healthcare training curricula, but the teaching approach, competencies covered, learner satisfaction, and effectiveness varies. A scoping review was conducted to explore and summarize what is known about numeracy education for HCPs. A comprehensive literature search was conducted from January 2010 - April 2021 in 10 databases. Where available, both controlled vocabulary terms and text words were used. The search was restricted to human studies, adults (age over 18 years), and the English language. Of the 31,607 articles identified in the literature search, 68 met the eligibility criteria. Articles were included in the review if they were related to numeracy education for HCPs or HCPs in-training, and provided details regarding methods, evaluation and results. Following removal of duplicates, 26,144 studies remained for analysis and underwent title and abstract screening, leaving 438 studies for full-text review. 370 studies were excluded and 68 underwent extraction and synthesis. Preliminary analysis shows that while numeracy teaching increases HCPs’ self-efficacy and skills from baseline, contextual or interactive interventions show greater improvements and increased learner satisfaction than didactic teaching alone. Given the growing need for HCPs to interpret and apply numerical information to guide clinical decision making and best practices, a greater emphasis should be placed on incorporating numeracy and EBM in training curricula. Objectives: The participant will be able to identify at least one opportunity for improvement in the delivery of numeracy education for HCPs. The participant will be able to identify at least two successful educational interventions or teaching methods in numeracy education for HCPs. References: Apter, A. J., Paasche-Orlow, M. K., Remillard, J. T., Bennett, I. M., Ben-Joseph, E. P., Batista, R. M., . . . Rudd, R. E. (2008). Numeracy and Communication with Patients: They Are Counting on Us. Journal of General Internal Medicine, 23(12), 2117-2124. doi:10.1007/s11606-008-0803-x. Rao, G. (2008). Physician numeracy: Essential skills for practicing evidence-based medicine. Family Medicine, 40(5), 354-358. Golbeck, A. L., Ahlers-Schmidt, C. R., Paschal, A. M., & Dismuke, S. E. (2005). A Definition and Operational Framework for Health Numeracy. American Journal of Preventive Medicine, 29(4), 375-376. doi:10.1016/j.amepre.2005.06.012
P105: Improving Access to Patient Education: An Audit of Extant Educational Materials
Monica Kopec, Naa Kwarley Quartey, Michelle Snow, Andrew Stechkevich, Janet Papadakos
Princess Margaret Cancer Centre, Toronto, ON, Canada
Abstract: The exchange of health information between provider and patient, along with patient participation in their care (self management), can lead to improved health outcomes [1,2]. A step towards achieving better outcomes is the systematic provision of education materials to patients and caregivers throughout the cancer trajectory. The project team conducted an audit of patient education materials available at the cancer centre to identify gaps and determine areas for future development. The Patient Education Audit was conducted in 13 outpatient clinics. Clinic specific educational materials were identified and each item was reviewed and categorized by cancer type and under the following topics: About Cancer/Disease, Medical Tests & Imaging, Treatments, Symptom Management, Rehabilitation/Survivorship, General Wellbeing, Medical Device Care, Practical and Other. Totals for each topic were summed and analysis was conducted to determine opportunities for education development. Four hundred forty-three resources were included in the audit. Results varied based on clinic and cancer type. Majority of the materials were found in the following clinics: hematology (75), genitourinary (74) and gastrointestinal (55). The most common topics of information were treatment (277), about cancer/disease (134) and symptom management (120). When broken down by individual cancer type, it was clear that while the collection of patient education materials is well established for some (i.e. 22 prostate specific resources), there is a significant dearth in materials for others (i.e. 0 penile specific resources). The results of this audit will be presented to outpatient clinic leads to identify areas of need and to identify opportunities for future education material development. Identifying gaps in site-specific information for patients and families is important for increasing equity and access to information. Objectives: The participant shall be able to conduct a site-specific audit of patient education materials in order to establish priorities for material development toward improving equity, specific to their organization. References: [1] Chen, Min, Sheng Guo, and Xuan Tan. (2019). Does Health Information Exchange Improve Patient Outcomes? Empirical Evidence from Florida Hospitals. Health affairs 38.2: 197,204,204A-204I. https://doi.org/10.1377/hlthaff.2018.05447. [2] Bovenkamp, H., & Dwarswaard, J. (2017). The complexity of shaping self-management in daily practice. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, 20(5), 952–960. https://doi.org/10.1111/hex.12536
P108: Moving with the times, alternative cancer approach for children.
Martin Montiel
University of California San Diego, San Diego, CA, USA
Abstract: Cancer treatment can be an invasive and traumatizing experience that takes its toll in children. Supportive care methods have been explored into the form of video games and how it’s unique approach to entertainment may be the perfect tool to aid children who struggle with this disease. An overview of various scientific studies that accumulated into a literature review was used to observe children with cancer and the use of video games in their treatment program. Articles from APA PsycINFO, Pubmed, The Journal of Medical Internet Research and The Journal of Education and Health Promotion and more were used with the keywords Video Games, Cancer, Pain, Alternative Treatments, Children, Adolescents, Comfort, Disparities, Digital, Management, Challenges, and Medium. Citations from these articles were reviewed. A link between alternative cancer treatment options involving video games will be gathered in this literature review. Children were instructed to play video games during active cancer treatment in which pain would accompany treatment prompting use of Morphine use during treatment. Children who were allowed to play video games during this treatment period required a lower dosage use of morphine indicated that children experienced less pain during these treatments when playing video games. Along with educational software such as Re-Mission that allowed children to have a visual interpretation of what’s going on inside their body which improved their willingness to keep up treatment options. In this literature review we found that Video games use during treatment options showed significant results in children experiencing less pain which further encouraged continuous treatment options as the rewards of playing a video game incentivized the child to continue prompt treatment options. Objectives: The participant shall be able to identify alternative digital mediums that help children cope with cancer treatment and be educated in cancer treatment. References: Puig1, M. A., Alonso-Prieto2, M., Miró3, J., Torres-Luna2, R., Sabando4, D. P. L. de, Reinoso-Barbero2, F., Foundation, 1J., & Alonso-Prieto, C. A. M. (2020, March 3). The Association between pain Relief using video games and an increase in vagal tone in children with CANCER: Analytic observational study with A QUASI-EXPERIMENTAL PRE/POSTTEST METHODOLOGY. Journal of Medical Internet Research. https://www.jmir.org/2020/3/e16013/. Ghazisaeidi, M., Safdari, R., Goodini, A., Mirzaiee, M., & Farzi, J. (2017, May 5). Digital games as an effective approach for CANCER management: Opportunities and challenges. Journal of education and health promotion. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441205/.
P110: Benchmarking Allele-Specific Copy Number Methods on Single Cell Whole Genome Sequencing Data
Emily Leventhal
Penn State, State College, PA, USA
Abstract: Recurrence after resection of colorectal liver metastases (CRLMs) occurs in up to 75% of patients. Surgery is the only potentially curative option but is associated with high morbidity. This project aims to determine if radiomics features can be useful in predicting recurrence within one year of a CRLM resection. The cohort consisted of 199 colorectal cancer patients with prior liver metastasis who underwent resection for CRLM. 256 texture features were generated from preoperative computed tomography (CT) scans. Highly correlated variables were removed based on Pearson correlation (rho > .85). Lasso, elastic net and ridge regression models were fitted on training and test sets to predict if a recurrence or death occurred within the first 12 months since resection. We used area under the curve (AUC) as a measure of accuracy for the models. 64 of 256 variables were included after correlation filtering. Of those 11 were chosen in the final Lasso model, indicating that many of the radiomics features may be noisy predictors. The Lasso training set had an AUC of 0.715 and the test set had an AUC of 0.50 indicating low predictive value of radiomics features alone. The results for Elastic net and ridge regression models are very similar. Models appear to be overfitting in the testing set. Radiomics features alone were not predictive of early CRLM recurrence in this data set but a larger data set is needed to confirm findings. Future work may include time to event modeling to predict recurrence time and incorporate radiomics variables into clinical datasets to enhance the prediction of recurrence. Objectives: The participant shall be able to identify if radiomics features can be used to predict the recurrence of liver metastasis in colorectal patients. References: Simpson, A. L., Doussot, A., Creasy, J. M., Adams, L. B., Allen, P. J., DeMatteo, R. P., Gönen, M., Kemeny, N. E., Kingham, T. P., Shia, J., Jarnagin, W. R., Do, R., & D'Angelica, M. I. (2017). Computed Tomography Image Texture: A Noninvasive Prognostic Marker of Hepatic Recurrence After Hepatectomy for Metastatic Colorectal Cancer. Annals of surgical oncology, 24(9), 2482–2490. https://doi.org/10.1245/s10434-017-5896-1
P111: Measuring Instagram's Delivery of Clinical Trials Information
Xingchen (Stars) Xu1, Georgia Robins Sadler2, Danny Yu2, Vy Le1, Shina Luu1, Yingyin (Katie) Li1, Amberine Kabir1
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: The COVID-19 pandemic prevented in-person cancer education sessions with the Asian Pacific Islander (API) communities. Social media platforms offered an alternative dissemination strategy to disseminate clinical trials information. Instagram was tested as a dissemination strategy. This presentation describes the analytics generated to evaluate the success of an Instagram campaign. Post posters that relate to the public health information on Instagram. There are a total of six topics, published weekly for two months. The data of posters were collected, including followers, likes, comments, saves, reach, etc. were recorded over two months. Then, the data was obtained for sorting and analysis to explain whether Instagram is an appropriate platform to disseminate public health information. To be more specific, whether Instagram can be used as an important component to eliminate disparities between public health information and underrepresented populations. Starting from 127 followers at the beginning of the project, 11 unfollows and 34 follows were recorded, giving a net increase of 23 followers. During the two months, 89 total likes on posts, 1 comment, 1 save, and 328 people reached were recorded. Our results suggest that Instagram could be a potential social media platform to disseminate public health information. Although Instagram posts were not able to actively engage our audience to comment or save, data indicate that Instagram was successful in reaching out to the younger audience. While Instagram may not be the optimal platform for disseminating public health information to underrepresented groups, it is a suitable platform. However, Instagram should be considered a place to disseminate public health information due to the large number of users and the choice of paid promotion to promote posters. Objectives: Based on our study, the participants shall be able to understand the significance of clinical trials information and the reasons why people should disseminate clinical trials information to their family members and friends around in order to disparity the clinical trials gap between everyone. Moreover, participants should realize that social media platforms are also a proper way to disseminate clinical trials information to the community and better to help people understand the necessity of clinical trials. References: Asthana, Rahul, et al. “The Role of Color Theory in Digital Marketing.” Socialnomics, 27 Oct. 2018 socialnomics.net. “Instagram Revenue and Usage Statistics (2021).” Business of Apps, 8 Mar. 2021
P112: Using Instagram to Spread Cancer Control Information
Danny Yu1, Xingchen (Stars) Xu2, Vy Le2, Yingyin (Katie) Li2, Shina Luu2, Georgia Robins Sadler1, Amberine Kabir2
1UC San Diego Moores Cancer Center, San Diego, CA, USA, 2University of California San Diego, San Diego, CA, USA
Abstract: Instagram, a free photo and video sharing social media platform, was pilot-tested as a strategy for disseminating clinical trials information to older Asian Americans. Two-thirds of the roughly one billion active Instagram monthly users are under the age of 34 and represent trusted sources of information for their elders. Six Instagram posts culturally aligned with the Asian young adult community were developed and posted weekly. Each new post included backgrounds and colors culturally aligned with Asian Americans. Instagram’s story highlight option helped promote each clinical trial post. Promotion of clinical trials posts was done directly by sharing with friends of the team members, posting on UC San Diego Facebook groups, and emailing the UC San Diego student list. Promotion was done indirectly, by “following” formal and informal Asian student opinion leaders who then “followed” back to regularly see our messages. Instagram’s analytics were explored to assess outcome measures. This pilot study evaluated the feasibility of using four outcome measures to assess success in delivering clinical trials information to older Asians through younger Asians. 1. Did we create culturally aligned content that attracts the Asian community? 2. Is our clinical trials content easily understood and a call to action? 3. Is usage data accessible? 4. Did we reach our once removed audience? Through review and feedback from our peers and Instagram analytics, questions 1 through 3 would be viable outcome measures. The fourth measurable could not be determined because the Instagram analytics do not track posts shared with others Creating information attracting younger Asians and encouraging them to share their information with older family members used three viable outcome measures. Our project illustrates success in creating aligned and informative content. The next step is to create a viable measure for our fourth outcome, measuring transmission of information to elders. Objectives: Specific: The participant shall be able to identify how to utilize social media platforms to disseminate important health information to underrepresented communities. Measurable: The participant shall be able to collect and analyze data through Instagram analytics. Attainable: The participant shall be able to construct their own social media platform to disseminate health information to the public. Relevant: The participant shall be able to utilize social media platforms to engage the younger generation during these times of the COVID pandemic. Time-Limited: The participant shall be able to create and replicate our pilot study project within a timeline of three months References: Pizzuti, A. G., Patel, K. H., McCreary, E. K., Heil, E., Bland, C. M., Chinaeke, E., Love, B. L., & Bookstaver, P. B. (2020, February 6). Healthcare practitioners' views of social media as an educational resource. PloS one. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004337/. Chan, W. S., & Leung, A. Y. (2018, March 28). Use of social network sites for communication among Health Professionals: Systematic review. Journal of medical Internet research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895921/.
P113: Using Facebook as an Informative Platform for Analytics and Educating Public about Clinical Trial
Vy Le1, Danny Yu2, Xingchen (Stars) Xu1, Shina Luu1, Yingyin (Katie) Li1, Georgia Robins Sadler2, Amberine Kabir1
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: With the COVID-19 pandemic happening worldwide, it is essential to recognize available resources around the community. This research aims to investigate the efficiency of Facebook to convey information about clinical trials to the public. We will employ a Multi-modal Methodology combining qualitative and quantitative data to evaluate the effectiveness of our public health demonstration project. Postings a team introduction and five posts about clinical trials topics, including: Intro about types of clinical trials. Difference between IRB-approved clinical trials vs. marketing surveys, scams, and gimmicks. Benefits & Risks of clinical trials participation. Importance of diverse samples. Where to find clinical trials? Tracking page activities, page views/likes, and post reach/engagement every day, weekly and monthly, then collecting data from Facebook’s Insights. By gender, men landed on the Facebook page more often than women. By age range, 18-24 year-olds landed on the Facebook page most, 25-34 second, 35-44, and 45-54 third. Landings by age and gender only differed for those 55 and older. For 55-64, 4% of the whole sample were women compared to 2% men. The opposite occurred in the 55-64-year-old group, while for 65+, there is 0% of women compared to 0.7% of men landing on these posts. Facebook can be a great social media platform to provide helpful information and a fast communication tool to the public. At the same time, it has powerful analytics to promote the evaluation of the platform’s effectiveness over time. Objectives: The participant shall be able to identify the parallel knowledge that exists between the clinical trials for COVID-19 and cancer-related diseases. Our goal is to translate that pandemic-specific knowledge into greater awareness for clinical trials specific to cancer. One way for us to reach out to a large population of diverse individuals is to use an online social media platform: Facebook, as a medium to bridge the health literacy gap. In addition to having a potential for health promotion, social media allows for an interactive experience that enables and empowers people in their health-related decisions. References: Pullen, M. F., Pastick, K. A., Williams, D. A., Nascene, A. A., Bangdiwala, A. S., Okafor, E. C., Hullsiek, K. H., Skipper, C. P., Lofgren, S. M., Engen, N., Abassi, M., McDonald, E. G., Lee, T. C., Rajasingham, R., & Boulware, D. R. (2021). Lessons Learned From Conducting Internet-Based Randomized Clinical Trials During a Global Pandemic. Open Forum Infectious Diseases, 8(2), 1–9. https://doi.org/10.1093/ofid/ofaa602. VANDORMAEL, A. et al. An entertainment-education approach to prevent COVID-19 spread: study protocol for a multi-site randomized controlled trial. Trials, [s. l.], v. 21, n. 1, p. 1–8, 2020. DOI 10.1186/s13063-020-04942-7. Disponível em: https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=147623667&site=ehost-live. Acesso em: 9 ago. 2021.
P114: Using TikTok as a Public Health Dissemination Platform: The Analytics
Danny Yu1, Yingyin (Katie) Li2, Shina Luu2, Xingchen (Stars) Xu2, Vy Le2, Georgia Robins Sadler1, Amberine Kabir2
1UC San Diego Moores Cancer Center, San Diego, CA, USA, 2University of California San Diego, San Diego, CA, USA
Abstract: Improving accessibility to public health information in underrepresented communities is important to reducing cancer disparities. The COVID-19 pandemic disrupted time-tested in-person outreach strategies. To adapt, the TikTok social media platform was used to disseminate relevant clinical trials information to the Asian Pacific Islander (API) community. This project describes the analytics. To create appealing 15-second TikTok videos, 36 UC San Diego college students were recruited to provide feedback. Students were recruited through emails, Facebook student groups, Discords, and friends. Fifteen videos were then created, aligned with the API college students’ preferences. Throughout two month evaluation period, attention to the TikTok videos was generated using the same student recruitment strategies. “Like” views, “profile” views, visits to our clinical trials website, and other data were collected. Progression to the clinical trials website from TikTok was facilitated through QR codes and having the clinical trials website on the TikTok profile page. During two months, over 3,000 views, 119 profile views, 3 followers, and 14 visits to our linked clinical trials website were recorded. Other data collected from the TikTok videos is the average watch time which we found to be 4.9 seconds. Data indicates that our short TikTok videos were successful in reaching out to a large young audience. However, using TikTok was not very successful in reaching older Asians. The breakdown of data collected from the surveys done by the 36 UC San Diego college students recruited to provide feedback would be explored further in the presentation. Tiktok is not the best social media platform to disseminate information to older Asians. However, the platform’s popularity among younger Asians suggests it may be a viable platform for disseminating information on topics more relevant to that demographic, e.g., HPV, AIDS, sunscreen use, tobacco cessation, Hepatitis B vaccinations. Objectives: Specific: The participant shall be able to identify how to use TikTok as a social media platform to disseminate important public health messages like cancer knowledge to underrepresented communities. Measurable: The participant shall be able to interpret and evaluate data collected from TikTok insights and other analytical software. Attainable: The participant shall be able to develop their own way of using TikTok to disseminate public health information. Relevant: The participant shall be able to incorporate social media platforms in their dissemination strategies of cancer education during the COVID-19 pandemic. Time-Limited: The participant shall be able to reproduce results found in our project within a timeline of three months. References: Comp, G., Dyer, S., & Gottlieb, M. (2020, October 21). Is TikTok the next social MEDIA frontier for medicine? Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1002/aet2.10532. Dannell D. Boatman, S. E. (2021, May 10). Human papillomavirus Vaccine messaging ON Tiktok: Social media content analysis - DANNELL d. BOATMAN, Susan Eason, Mary Ellen CONN, Stephenie K. Kennedy-Rea, 2021. SAGE Journals. https://journals.sagepub.com/doi/10.1177/15248399211013002?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%2B%2B0pubmed.
P115: Exploring TikTok’s potential as a tool for cancer control “edutainment”
Shina Luu1, Danny Yu2, Yingyin (Katie) Li1, Vy Le1, Xingchen (Stars) Xu1, Amberine Kabir1, Georgia Robins Sadler2
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: COVID-19 forced cancer educators to explore alternative methods for disseminating cancer control information. TikTok, a social media platform developed in China (2016), offered cancer educators a new platform for disseminating information. This narrative review of the literature searched for evidence-based examples of TikTok’s cancer education applications to guide new programs. To understand the role TikTok plays in cancer and health education, the databases PubMed and CINAHL were searched for scientific articles. Searches used such keywords as, TikTok, cancer, clinical trials, education, and underrepresented to find relevant articles. The reference lists of relevant articles were also searched for additional citations. All articles were reviewed to gain an understanding of TikTok’s applications in scientific-educational literature. A comparison search was also conducted, using only the term TikTok and only Facebook to gain a comparison of the uses of the new social media platform with the more established Facebook platform. The search for “TikTok” on PubMed returned 61 results, with only four results remaining when the filter “cancer” was applied. In comparison, the keyword “Facebook” yielded 4,983 results. The Facebook citations dated back to 2009, whereas the TikTok citations dated back to 2019. An English-only text filter shows that all TikTok-related publications were included, while 79 Facebook-related publications were excluded. This finding demonstrates the limited research on TikTok in the scientific community. Content analysis of the TikTok articles revealed the most common topics on TikTok were videos on dermatology and the COVID-19 pandemic, and only four on cancer control. Video-sharing platforms like TikTok excel at providing an open-access reach to health knowledge for the public. The most common theme regarding TikTok’s potential for “edutainment” explains that despite its grand ability to promote medical knowledge among the youth, there is a strong necessity to address the dangers of widespread misinformation. Objectives: Specific: The participant shall be able to identify the role TikTok plays as a social media platform to spread public health messages related to cancer clinical trials to underrepresented communities. Measurable: The participant shall be able to recognize the extent to which current literature in the scientific-educational community has on social media platforms. Attainable: The participant shall be able to conduct similar reviews to develop an understanding of common themes in literature, including barriers such as the spread of misinformation. Relevant: The participant shall be able to engage the younger generation in cancer education dissemination through social media during the COVID-19 pandemic. References: De La Garza, Henriette, et al. “Impact of Social Media on Skin Cancer Prevention.” International Journal of Environmental Research and Public Health, MDPI, 9 May 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8125878/. Xu, Alex J., et al. “TikTok and Prostate Cancer: Misinformation and Quality of Information Using Validated Questionnaires.” BJU International, John Wiley & Sons, Ltd, 21 June 2021, bjui-journals.onlinelibrary.wiley.com/doi/10.1111/bju.15403.
P116: Social Media Use for Cancer Education During the COVID-19 Pandemic
Yingyin (Katie) Li1, Shina Luu1, Danny Yu2, Xingchen (Stars) Xu1, Amberine Kabir1, Vy Le1, Georgia Robins Sadler2
1University of California San Diego, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: The COVID-19 pandemic posed challenges to cancer educators. Facebook, one of the most popular social-media platforms worldwide, was pilot-tested as an alternative venue to disseminate cancer control information. A literature review is conducted to search for examples of Facebook’s relevance to public health education to guide new outreach programs. The database PubMed is screened for literature containing keywords such as Facebook, social-media, public health, cancer, clinical trials, and underrepresentation. Articles were reviewed to gain an understanding of Facebook’s presence as a social media platform educational module. The literature was evaluated for its relevance to cancer education outreach geared toward the Asian and Pacific Islander (API) community, who are the desired target audience of the outreach program currently being pilot-tested. Other related articles used include literature in the reference list. The search for “Facebook” and “Public Health” yielded 2,731 results mainly of articles relating to COVID-19 rather than cancer, but still offer applicable examples on quantifying Facebook engagement. When “cancer” was additionally applied to the filter, only 221 results were returned. The addition of “underrepresented” produced 15 results while “Asian and Pacific Islander” yielded one result. This demonstrates the limited research on using Facebook to spread cancer awareness to underrepresented communities. Common topics of the 15 results found from searching “Facebook,” “Public Health,” and “Underrepresented” surrounded recruitment and emphasized the importance of cultural specificity in recruitment messages. As the most popular social media platform, Facebook offers a large and viable platform for the communication of public health information. Considering the limited literature content on developing cancer-related outreach programs targeting specifically the API community, our pilot program has important implications for future educational programs disseminating cancer education information. Objectives: The participants shall be able to identify at least 2 advantages of using Facebook as a dissemination platform for cancer education information over other social media platforms. References: Sesagiri Raamkumar, A., Tan, S. G., & Wee, H. L. (2020). Measuring the Outreach Efforts of Public Health Authorities and the Public Response on Facebook During the COVID-19 Pandemic in Early 2020: Cross-Country Comparison. Journal of Medical Internet Research, 22(5). https://doi.org/10.2196/19334. Tolma, E. L., Stoner, J. A., Thomas, C., Engelman, K., Li, J., Dichkov, A., & Neely, N. (2018). Conducting a Formative Evaluation of an Intervention Promoting Mammography Screening in an American Indian Community: The Native Women’s Health Project. American Journal of Health Education, 50(1), 52–65. https://doi.org/10.1080/19325037.2018.1552216
P117: Wearable technology in cancer prevention and care
Esmeralda Marquez1, Hakan Toreyin1, Georgia Robins Sadler2, Vanessa Malcarne1
1San Diego State University, San Diego, CA, USA, 2UC San Diego Moores Cancer Center, San Diego, CA, USA
Abstract: Wearables are electronic devices designed to be worn throughout the day for the purpose of monitoring one’s vital signs, body movement, and environment. Wearables use for continuous monitoring is well reported. This narrative literature review examines whether wearables are an appropriate medical intervention for prevention and care in oncology. The exploration of the scientific literature used variations of such terms as wearables, monitoring, cancer, care, prevention, clinical trials, survivors, and biosensors. The databases used were PubMed, Google Scholar, and CINAHL. The inclusion criteria consisted of peer-reviewed, full text, English, or Spanish articles published between 2017 to the present. Reference articles citations were also examined to identify additional articles related to the content. New terms identified in the review were added to the searches. Out of the 80 articles identified, 60 articles were found to be directly relevant to this review. Integrating wearable technology to improve cancer care and reduce incidence rates of cancers has been proven feasible by providing clinicians with relevant, reliable, and continuous data to better understand patients’ health behaviors and tolerance to treatment. For cancer prevention, wearables like PACT 2.0 and SHADE have been studied to help limit certain lifestyle behaviors like smoking and over-exposure to ultraviolet radiation, respectively. Data that monitored one’s physical activity level, like step count, was most helpful for cancer monitoring and early intervention. Studies reveal great promise for wearables capacity for assisting clinicians and scientists, patient care, but more research is needed. Incorporating wearables into clinical care and research can give clinicians and scientists critical, real-time information to guide and assess patients’ and research participants’ well-being and assess adherence to recommended regimens. Including wearables can assist in bridging communication gaps, leading to better communication, treatment, and awareness to promote healthier lifestyles. Objectives: The participant will be able to identify at least one wearable device used in prevention or treatment. References: Low, Carissa A. “Harnessing consumer smartphone and wearable sensors for clinical cancer research.” NPJ digital medicine vol. 3 140. 27 Oct. 2020, doi:10.1038/s41746-020-00351-x. Sempionatto, Juliane R et al. “Wearable and Mobile Sensors for Personalized Nutrition.” ACS sensors vol. 6,5 (2021): 1745-1760. doi:10.1021/acssensors.1c00553
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2021 International Cancer Education Conference Program and Abstracts. J Canc Educ 36 (Suppl 2), 111–189 (2021). https://doi.org/10.1007/s13187-022-02141-3
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DOI: https://doi.org/10.1007/s13187-022-02141-3