1B-1: Beginning Smoking Cessation at Your First Doctor Visit: An Integration of the American Cancer Society FreshStart® Program into Clinics at a Major Urban Medical Facility

Pedram Daraei¹, Odetta Muhammad², Oswaldo Henriquez¹, Charles Moore^1
1Emory University Department of Otolaryngology, Atlanta, GA, USA; ²Grady Health Systems, Atlanta, GA, USA

Abstract: Background/Purpose: Tobacco abuse has decreased in the general population over the past half century due to aggressive media campaigns, increased awareness, education, and federal policy. However, tobacco products continue to cause morbidity and mortality, particularly in areas of low socioeconomic status. The FreshStart® program is an evidence-based series of lectures and activities targeting tobacco use to encourage smoking cessation and maintenance of a smoke-free life. Description: The FreshStart® program was adapted by the Grady Health Systems Department of Otolaryngology and incorporated into clinics. This is an urban, public hospital which provides indigent care to primarily African-American and Hispanic patients. Participants are screened for tobacco use at three stages: triage, check-in, and again by the physician during the visit. If the patient smokes, a notification is created in the EMR. At each stage, the patient is asked if they would like to enroll in the FreshStart® program. If the invitation is declined, this process begins again at their next visit. Evaluation: Throughout the program, activities are used to engage the participant and encourage critical thinking. Each activity allows dialogue between participants and the facilitator so that patient-specific details can be discussed. After each lesson, participants complete questionnaires that gauge understanding, subjective effectiveness, and satisfaction. Sustainability and modification measures are presented to ensure appropriate changes to the curriculum based on current data and patient comments. To date, 328 individuals have registered for the Smoking Cessation Program. The inclusion of the three-step invitation/intervention has resulted in an approximately 50% increase in the acceptance rate of joining the program. Of those completing program, 59.2% of participants have been tobacco free for longer than 1 year. Usefulness: The FreshStart® curriculum is standardized and easily transferrable among communities and healthcare institutions. Modifications are made and supplements added to address specific issues in a target population. Learning Objectives: The participant shall be able to describe a smoking cessation program that is effective in the workplace and can be easily integrated into day-to-day activities in the hospital setting, with the intention of decreasing patient related morbidity and mortality. The participant shall be able to identify the four steps in the FreshStart® Program and the methods used to initiate and maintain smoking cessation. The participant shall be able to identify the inequality seen in areas of low socioeconomic status and understand the steps that can be taken in the urban hospital setting to establish equity. References: Centers for Disease control and Prevention (CDC) (2012) Current cigarette smoking among adults—United States, 2011. MMWR Morb Mortal Wkly Rep 61:889–894. Workplace Solutions, Building a healthy workforce. Retrieved April 10, 2016, from http://www.acsworkplacesolutions. com/freshstart.asp. J Canc Educ 

1B-2: Societal and Demographic Factors Influencing Differential Primary Treatment of Ductal Carcinoma In Situ

Jack Sariego¹, Ryan Gruner^2
1Aria Health System, Jenkintown, PA, USA; ²Drexel University Department of Surgery, Philadelphia, PA, USA

Abstract: Background: There exists considerable discussion surrounding documented discrepancies in the treatment of breast cancer offered to different demographic groups. The current analysis was undertaken to determine whether or not those discrepancies in care extended to ductal carcinoma in situ (DCIS) as well. Methods: A retrospective review was performed of all DCIS patients registered in the American College of Surgeons National Cancer Database Benchmark Reports (NCDBR) between 2003 and 2013. Data were stratified according to initial treatment rendered and compared with regard to the following characteristics: race, insurance status, household income, education level, age, and treatment facility size. Results: The study cohort consisted of 583,874 patients. Caucasians comprised 45.7 % and non-Caucasians 54.3 %. A significantly larger percentage of Caucasians were treated with breast-conserving modalities when compared to non-Caucasians: 43.1 vs 13.7 %. Similarly, patients with private insurance were more likely to be treated with breast conservation (43.6 %) than were patients with no insurance (41 %) or government insurance (42.5 %). Unexpectedly, breast conservation was more commonly performed in patients with lower household incomes, lower education, and more advanced age. Though these differences were statistically significant, the absolute differences were small and disappeared when corrected for race. Finally, patients treated at Community Cancer Centers were more likely to undergo breast conservation than those in Comprehensive Community Cancer Centers and Academic Centers: 46.1, 44.5, and 40.2 %, respectively. This difference persisted even when data were corrected for race. Discussion: There are a number of societal and demographic factors that influence the treatment rendered to DCIS patients. The most significant of these are race and the type of facility at which that treatment is rendered. Though there may be multiple reasons for this dichotomy, it behooves society to educate all population groups as well as all caregivers specifically to assure that such differences do not continue to be demographically driven and to jeopardize access to care for select demographic groups. Learning Objectives: The participant shall be able to identify two major factors that significantly impact the differential provision of care to patients with DCIS. The participant shall further be able to identify at least four other demographic and socioeconomic factors that influence the treatment offered and rendered to DCIS patients, thus enabling the recognition of those societal cohorts for which access to care is either limited or significantly negatively altered by their societal status. References: Williams, D.R., Mohammed, S.A., & Shields, A.E. (2016) Understanding and effectively addressing breast cancer in African American women: Unpacking the social context. Cancer doi: 10.1002 (Epub ahead of print). 

1B-3: Awareness and Attitudes of Nigerian Men living in Abuja on Prostate Cancer and Screening

Evi Farazi¹, Rahama John², Olabode Oluwole^3
1University of Nebraska Medical Center, Omaha, NE, USA; ²University of Nicosia, Nicosia, Cyprus; ³University of Abuja, Abuja, Nigeria

Abstract: Prostate cancer (PCa) is the most common cancer in men in Nigeria. A community-based screening study in Lagos, Nigeria has shown the majority of men are diagnosed with advanced and highgrade disease. This makes prostate cancer a priority for Nigerians with the first step to attacking it being early diagnosis at a stage when it can be treated. Previous studies in rural areas of Nigeria such as Ikenne have shown low level of awareness on prostate cancer. This research aims to address the level of awareness of Nigerian men living in Abuja (an urban region) on the risk factors, screening methods, and treatment regimens for PCa and identify their attitudes towards PCa. The objective was to measure the level of awareness of these men by delivering previously validated questionnaires using a random selection scheme to 600 men in Abuja. Data was analyzed using descriptive and analytical statistics in SPSS. The results showed that the level of awareness of prostate cancer in men in Abuja is medium but higher than that of similar studies carried out in rural areas of Nigeria. More specifically, 75% of the respondents were not familiar with prostate cancer symptoms, 74.3% did not know where the prostate gland is located, and only 20.5% were well familiar with the factors that cause PCa. Interestingly, 53.5% of the respondents had the wrong perception that they cannot have PCa if they are unaware of it. Education and monthly income were positively associated with awareness level, whereas there was no strong association between age or family history and awareness. The results of the study can be used to make recommendations on designing effective prostate cancer awareness education programs with the ultimate goal to reduce the burden of prostate cancer in Nigeria by early detection. Learning Objectives: The participant shall be able to identify factors associated with prostate cancer awareness in the urban area of Abuja, Nigeria, identify factors that are not associated with prostate cancer awareness in the population under study, compare the results of the study which involved an urban area to those of a rural area in Nigeria, compare the results of the study in Nigeria to those in other countries, and point out ways in which prostate cancer awareness can be improved globally. References: 1. Miller, D., 2014. Pre-Screening Age African-American Males: What Do They Know About Prostate Cancer Screening, Knowledge, and Risk Perceptions? Social Work in Health Care, 53(3), pp. 268-268. 2. Nakandi, H., Kirabo, M., Semugabo, C., Kittengo, A., Kitayimbwa, P., Kalungi, S. and Maena, J., 2013. Knowledge, Attitudes and practices of Ugandan men regarding prostrate cancer. African Journal of Urology, 19, pp. 165-170. 3. Oranusi C, Mbieri U, Oranusi I, Nwofor A. 2012. Prostate cancer awareness and screening among male public servants in Anambra State, Nigeria. African Journal of Urology, 18 (2), pp. 72-74.

1B-4: Patterns of Care among Canadian Radiation Oncologists and Urologists Related to Postoperative Radiotherapy for Patients with Prostate Cancer

Ewa Szumacher¹, Mohammed Aldehaim², Bonnie Bristow³, Katija Bonin³, Chee Ka Candice Lam², Xingshan Cao^4
1Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ²University of Toronto, Toronto, ON, Canada; ³Odette Cancer Centre, Toronto, ON, Canada; ⁴Institute of Clinical Evaluative Sciences, Toronto, ON, Canada

Abstract: Background/Purpose: The American Society for Radiation Oncology (ASTRO) and American Urological Association (AUA) developed post-prostatectomy radiotherapy (RT) guidelines to aid patient counselling regarding adjuvant (ART) and salvage radiotherapy (SRT). The objective of this study was to examine awareness and compliance of these guidelines among Canadian radiation oncologists (RO) and urologists (U). Methods: An online 28-item survey was developed, pretested, and distributed by the Canadian Association of Radiation Oncology (CARO) and Canadian Urology Association (CUA) to RO and U that treat prostate cancer. Similarities and differences between RO and U were examined using Wilcoxon rank sum test and chi-square test. Only p values for significant findings were reported. Results/Findings: Fifty-two of 87 RO and 76/570 U responded to the survey. Ninety percent RO and 40% U practiced in academic centers. Eighty-two percent RO and 49% U had read the guidelines. Discussion: Considerably less U had read the guidelines compared to RO. There was concurrence about the level of awareness for some parts of the guidelines; however, other areas had low compliance. Conforming to guidelines is important in providing patients with an appropriate level of education to ensure the highest quality of patient care. Learning Objectives: (1) The participant shall be able to identify three ASTRO guidelines. (2) The participant shall be able to identify three differences or commonalities in response from radiation oncologists and urologists with regards to the guidelines. (3) The participant shall be able to identify these results and can facilitate better communication and collaboration. References: Thompson, I., Valicenti, R., Albertsen, P., Davis, B., Goldenberg, L., Hahn, C., Klein, E., Michalski, J., Roach, M., Sartor, O., Wolf, S., & Farday, M. (2013). Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline. The Journal of Urology, 190. 441-449. Showalter, T., Ohri, N., Teti, K., Foley, K., Keith, S., Trabulsi, E., Lallas, C., Dicker, A., Hoffman-Censits, J., Pizzi, L., & Gomella, L. (2014). Physician beliefs and practices for adjuvant and salvage radiation therapy after prostatectomy. Int J Radiat Oncol Biol Phys. PMC 2014 Jan 2.

1B-5: Uptake of Cervical Cancer Screening and Associated Factors Among 15–49-Year-Old Women in Dessie Town, Northeast Ethiopia

Israel Mitiku Hatau
Wollo University, Dessie, Amhara, Ethiopia

Abstract: Background: Cervical cancer screening is acknowledged as the most effective approach to reduce incidence and mortality rates from the disease. Nevertheless, there are limited data on the rate of uptake of cervical cancer screening and factors that are related to uptake of screening services in Ethiopia. The purpose of this study was to determine the level of uptake of screening and determine associated factors among women of age 15–49 years in Northeast Ethiopia. Methods: A community-based cross-sectional survey was conducted among 620 women residing in Dessie town, Northeast Ethiopia. The respondents were selected using a multistage sampling technique. Data were collected using interviewer-administered questionnaires. Binary and multiple logistic regressions were employed to determine factors associated with the uptake of cervical cancer screening service. Results: Overall, 57.7% of the women had ever heard of cervical cancer, and 51.9% had sufficient knowledge about the disease. However, only 11% underwent at least one cervical screening in their lifetime. After adjusting for covariates, knowledge of cervical cancer (adjusted odds ratio (AOR) 11.1; 95 % CI 5.0– 24.8) and age (being 25–34 years (AOR 5.0; 95 % CI 1.5–16.7) and being within the age group of 34–49 years (AOR 6.0; 95 % CI 1.74–20.8)) were significantly associated with screening service uptake. Discussion: In this study, uptake of cervical cancer screening service was found to be low. Increasing women’s knowledge about cervical cancer, particularly targeting the younger ones, is crucial to enhance uptake of screening. Learning Objectives: The participants shall be able to identify sociodemographic factors actors influencing screening uptake among women in developing countries. References: Chumworathayi B (2012) Interventions targeted at women to encourage the uptake of cervical screening: RHL commentary. The WHO Reproductive Health Library. World Health Organization, Geneva. AliRisasiet, Paul Mulumba, Kristien Verdonck, Davy Vanden Broeck, and Marleen Praet. 2014. Knowledge, attitude and practice about cancer of the uterine cervix among women living in Kinshasa, the Democratic Republic of Congo. BMC Women’s Health 14:30. Getahun F, Mazengia F, Abuhay M, and Birhanu Z. 2013. Comprehensive knowledge about cervical cancer is low among women in Northwest Ethiopia BMC Cancer 13:2 Available: http://www.biomedcentral.com/1471-2407/1413/1472.