Oral Abstracts: 1B

Click on the concurrent session title below to view all of the abstracts for that session. Plenary session information is provided in the online schedule’s session description, and poster presentation abstracts are provided elsewhere.

Session 1B: Lung Cancer and Smoking Cessation

Thursday, 22 October 2015, 9:15 AM – 10:45 AM, Salon E


1B-1 – In the state with the greatest lung cancer burden, how can primary care providers impact the lung cancer care continuum?

Celeste Worth1, Ruth Mattingly1, Morel Jones1, Connie Sorrell1, Jamie Studts2
1Kentucky Cancer Program, University of Louisville, Louisville, KY, USA, 2University of Kentucky College of Medicine, Lexington, KY, USA

Abstract: Background/Purpose: Kentucky (KY) leads the nation in lung cancer incidence and mortality. Even though KY currently ranks second highest in the U.S. for adult smoking prevalence (26.5%), other factors may contribute to these dismal statistics. The Provider Education Component of the Kentucky LEADS (Lung cancer Education Awareness Detection Survivorship) Collaborative seeks to improve lung cancer control, care and survivorship through a comprehensive lung cancer continuing education (CE) program for primary care providers (PCPs) in KY. Methods: To best determine educational needs and identify current perspectives and practices, the University of Louisville-based project team conducted semi-structured interviews with 28 PCPs statewide. Family practice and internal medicine physicians (MD/DO), physician assistants, and nurse practitioners were interviewed. The question topics included lung cancer screening, tobacco treatment, patient follow-up, patient care barriers, survivorship support, CE preferences, and EMR usage. Results/Findings: Most providers were either not aware of, or following screening guidelines. While interviewees stated they almost always addressed tobacco use, use of referral resources was minimal. Reported follow-up with patients after diagnosis was variable. Very few PCPs were aware of survivorship resources, with most thinking that survivorship care was the purview of oncologists. There was significant heterogeneity in responses regarding CE preferences. Finally, all PCPs were using EMR systems and most would prefer related EMR prompts. Discussion: With the central role of PCPs in prompting uptake of novel and covered lung cancer screening, and since PCPs have a unique opportunity to influence the entire lung cancer care continuum, they are an ideal audience for pertinent CE. Interview responses indicated a compelling need to increase knowledge of screening guidelines and coverage, tobacco treatment resources, importance of PCP and oncology specialist collaboration, and patient/survivorship resources. For broad reach among PCPs, multi-faceted educational approaches must be developed. Relation to Theme: This abstract relates particularly to disparities since it addresses needs for primary care providers diagnosing and treating patients with lung cancer – a cancer that has the highest mortality rate of all cancers and until recently, little opportunity to impact prognosis through early detection. Providers can help these disparate patients. Learning Objectives: The participant shall be able to 1. Identify four continuing education topics that should be addressed with primary care providers to help them improve lung cancer control, care and survivorship. 2. List at least five findings from in-depth qualitative interviews conducted with primary care providers regarding lung cancer prevention, detection/diagnosis, referrals for care, and survivorship support. References: 1. Abdolmohammadi, A., Sears, W., Rai, S., Pan, J., Alexander, J., & Kloecker, G. (2014). Survey of Primary Care Physicians on Therapeutic Approaches to Lung and Breast Cancers. Southern Medical Journal, 107(7). 2. Golden, S., Soylemez Wiener, R., Sullivan, D., Ganzini, L., & Slatore, C. (2015). Primary Care Providers and a System Problem: A qualitative study of clinicians caring for patients with incidental pulmonary nodule. CHEST. Retrieved from http://journal.publications.chestnet.org/article.aspx?articleid=2210003


1B-2 – Self-care strategies of family caregivers of lung cancer patients following participation in a palliative care educational intervention

Shirley Otis-Green
Collaborative Caring, Toluca Lake, CA, USA

Abstract: Background: As attention has turned to understanding the concerns of family caregivers, there has been growing recognition that they may neglect their own self-care due to the burdens of caring for a family member with cancer. This qualitative study explored family caregivers’ perspectives regarding their experiences in caring for a person with lung cancer, following participation in an educational intervention that encouraged the development of self-care plans using a quality-of-life model. Methods: An interpretive phenomenological analysis was conducted with a purposive sample of 10 family caregivers following participation in a tailored, palliative care educational intervention. Participants were encouraged to develop a personalized self-care plan with attention to their physical, psychological, social and spiritual needs. All participants were over 18 years of age and English-speaking. Results: Participants identified a range of self-care activities. Family caregivers reported that they found participation in the educational sessions to be useful and voiced appreciation for the encouragement to develop self-care strategies, though few were able to regularly engage in their identified self-care plans. Emerging themes clustered around limited energy, lack of resources to actualize their plans, preoccupation with their role as caregivers and a prioritization of the needs of the patient over their own concerns. Discussion: Although the educational intervention was well received, participants remained challenged to regularly engage in self-care activities. Participants reported finding a sense of meaning and purpose in their caregiving role that oft-set their inability to concentrate on their own self-care. Findings from this study provide content useful in the development of more nuanced family support programs. Identifying mechanisms to support family caregivers in developing individualized, realistic and actionable self-care strategies are urgently needed if they are to sustainably provide the level of care needed by seriously ill patients without further compromising their own level of well-being. Relation to Theme: As increasing attention is paid to providing family-focused care, there is urgency to provide tailored support for family caregivers. This study explored the impact of an innovative cancer educational intervention on a diverse group of family caregivers of lung cancer patients at a comprehensive cancer center in Southern California. Learning Objectives: 1. Participants will be able to describe three common concerns from the family caregiver’s perspective of their experience caring for a person with lung cancer. 2. Participants will be able to identify the nuances associated with the family caregiving role and its impact upon self-care activities. 3. Participants will be able to discuss a range of self-care themes identified from the family caregiver interviews. References: 1. Dosser, I. & Kennedy, C. (2012). Family Carers’ Experiences of Support at the End of Life: Carers’ and Health Professionals’ Views. International Journal of Palliative Nursing, 18(10): 491-497. 2. Hudson, P., & Payne, S. (2011). Family Caregivers and Palliative Care: Current Status and Agenda for the Future. Journal of Palliative Medicine, 14(7): 864-869. 3. Williams, A. & Bakitas, M. (2012). Cancer Family Caregivers: A New Direction for Interventions. Journal of Palliative Medicine, 15(7): 775-783. 4. Williams, A. & McCorkle, R. (2011). Cancer Family Caregivers during the Palliative, Hospice, and Bereavement Phases. Palliative and Supportive Care, 9(3).


1B-3 – Tobacco, E-cigarette, and Marijuana use in the US adolescent population: An Update on the Anti-Smoking Health Education Series (ASHES) curriculum.

Pedram Daraei, Charles Moore
Emory University Department of Otolaryngology, Atlanta, GA, USA

Abstract: Background/Purpose: E-cigarette use continues to increase, and its widespread use is gaining greater public attention. Although theoretically promising, unregulated advertisement campaigns continue to tempt teenagers with a device of unknown consequences and effects. Feedback from parents of the participants of the ASHES curriculum demonstrated an overwhelming concern for marijuana use. Marijuana use by vaporization has become increasingly prevalent, mirroring the trend in e-cigarette use. ASHES is a unique curriculum intended to decrease the use of nicotine and marijuana related products with the following specific goals: to discourage children and adolescents from smoking, to educate children on the possible harm related to vaporizing instruments, and to provide information for families about cessation. Description: The ASHES curriculum contains six 30-minute modules that can be implemented with limited materials in any learning environment. Unique to this curriculum is emphasis on electronic cigarettes and marijuana, specifically through vaporizing. The materials are low-cost and easily reproducible, and do not require special training to administer. Evaluation: Pre- and post-test analyses are presented at every iteration of the ASHES curriculum. Students have demonstrated an overwhelmingly positive response when comparing pre- and post-test data. To date, 84% of participants know that cigarettes are addictive, 84% know the addictive compound, 89% know that cigarettes contain tar and ammonia, and 100% feel comfortable telling their friends or family three reasons why they should quit smoking. Alarmingly, only 36% understand that commercials may influence their perceptions of smoking. Usefulness: The ASHES curriculum is easily transferrable amongst communities and healthcare institutions, given that the material is self-contained and can be distributed in any setting. Standardization of the curriculum affords the ability to analyze data to improve the curriculum temporally and sustainability has been achieved by establishing the curriculum as a long-term outreach program with the Medical School and School of Public Health. Relation to Theme: The ASHES curriculum is a health initiative focused on decreasing the use of vaporizing instruments through the use of targeted education, particularly in underserved populations. Our goal is to provide an inexpensive educational series to children and young adults in underserved areas to decrease the use of habits associated with cancer. Learning Objectives: The participant shall be able to identify at least two harms of using vaporizing instruments, also known as vaping. The participant should be able to identify recent trends in e-cigarette and marijuana use through vaporization. The participant should be able to identify at least three aspects of the ASHES curriculum that can be translated and implemented into their own community. References: 1.Dutra LM, Glantz SA. Electronic Cigarettes and Conventional Cigarette Use Among US Adolescents: A Cross-sectional Study. JAMA Pediatr. 2014 Mar 6. doi:10.1001/jamapediatrics.2013.5488. [Epub ahead of print] PubMed PMID: 24604023. 2. Notes from the field: Electronic cigarette use among middle and high school students — United States, 2011–2012. MMWR Morbidity Mortality Weekly Report, 62, 729 Perry BF, Login IS, Kountakis SE. Nonrhinologic headache in a tertiary rhinology practice. Otolaryngol Head Neck Surg. 2004;130:449-52. 3. Goniewicz ML, Zielinska-Danch W. Electronic cigarette use among teenagers and young adults in Poland. Pediatrics. 2012 Oct;130(4):e879-85. doi:10.1542/peds.2011-3448. Epub 2012 Sep 17. PubMed PMID: 22987874. 4. Cho JH, Shin E, Moon SS. Electronic-cigarette.


1B-4 – Breathe easy! Partnering fully compensated nicotine cessation programming and low dose CT screening to reduce lung cancer: Program expansion over last 12 months

Maria Grabowski, Stephanie Clayton
University of Texas Southwestern, Dallas, TX, USA

Abstract: Lung cancer is the leading cause of cancer death in the United States (American Lung Association 2014), Most lung cancer cases are attributed to smoking. Tobacco cessation is enhanced by timely discussion with a trusted health provider. The American Society of Clinical Oncology (ASCO) 2006 Quality Oncology Practice Initiative (QOPI) guidelines include “Smoking cessation counseling recommended to cigarette smokers by second office visit (QOPI, 2006).” However, national compliance is only 34%. The Centers for Medicare & Medicaid Services has established Meaningful Use objectives mandating health care providers record the smoking status for patients 13 years or older, and offer intervention when appropriate (CMS 2010). The National Lung Screening Trial shows low-dose computed tomography (LDCT) lung cancer screening is effective tool for early detection. Health professionals can ensure awareness, education and resource identification to offer comprehensive dialog with interested nicotine users. We have implemented fully compensated programing to reduce lung cancer mortality through nicotine cessation and early detection intervention services including LDCT lung screening. To ensure equal access, all fees are eliminated for both community and existing patient populations. Many program goals have been achieved. Appropriate patient identification and streamline referral occurs though EMR best practice alerts. Programming now spans inpatient and outpatient. Community awareness and referral occur through various outreach events. Education and support is offered in group, individual, and telephone settings. Most prefer telephone counseling. Thus far of the 300 plus served over 50 remain smoke free. Appropriate candidates for LDCT lung cancer screening are referred to fully funded services through private donor support. LDCT lung cancer screening identified two malignancies out of first 50 screened. Oral tobacco users are directed for free oral screening. This comprehensive program is built with thoughtful,resourceful, targeted methods to assist many toward achieving a healthier life style. Relation to Theme: This Abstract reflects innovative programming that ensures fully compensated lung cancer prevention and early detection for everyone including those with financial barriers. This comprehensive streamlined approach encompasses patient and provider education and tools including EMR to identify, educate and refer both patients and the community to campus resources. Learning Objectives: 1. The participant shall be able to identify steps required to implement a streamlined fully compensated comprehensive lung cancer prevention and early detection program through partnering nicotine cessation with early detection low dose CT lung cancer screening. 2. The participant shall be able to identify 2 key strategies for funding to provide fully compensated services in their environments. 3. The participant shall be able to identify 2 key strategies to streamline out patient, inpatient and community to identify and refer individuals for lung cancer prevention and early detection services. References: 1. Rennard, S. I., Rigotti, N. A. , Daughton, D. M. (2014). Overview of smoking cessation management in adults. UptoDate. 2. Szitz, R. (2014). Screening for unhealthy use of alcohol and other drugs. UptoDate. 3. Yip, P. (2014). More seniors struggling with substance and alcohol abuse. Dallas morning news, December 22, 2014. 4. Centers for Disease Control (2013). Cigarette Smoking — United States, 2006-2008 and 2009-2010. Supplements. November 22, 2013 / 62(03);81-84. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/su6203a14.htm?s_cid=su6203a14.htm_w 5. Centers for Disease Control and Prevention (2011) Morbity and Mortality Weekly Report. 2012 Nov 9;61(44):889-94. Current cigarette smoking among adults – United States, 2011. Retrieved from: https://www.google.com/search?q=mmwr+2012+smoking&sourceid=ie7&rls=com.microsoft:en-us:IE-SearchBox&ie=&oe=&safe=active&gws_rd=ssl.


1B-5 – Lessons learned: Creation and development of smoking cessation e-modules for staff, patients and families

Bonnie Bristow, Lisa Di Prospero, Leslie Gibson, Elaine Curle
Sunnybrook Odette Cancer Centre, Toronto, Canada

Abstract: Background: Smoking cessation (SC) programs provide an opportunity to assist tobacco users with quit attempts. Goals for SC include an interprofessional, sustainable program with consistent messaging. Gaps were noted: a) staff wanted more training b) many patients unable to access hospital/ community resources. Online electronic-modules can address these gaps. Electronic (E/e) learning can support staff efforts to integrate brief smoking cessation interventions within practice through accessible learning. Similarly, e-learning can assist individuals who smoke to support their own quit attempts/learn about available resources. Description: Two interactive e-learning modules for smoking cessation were created with one message, a) for staff b) for patients. Development began with creation and consensus of learning objectives. A storyboard was formulated to detail key knowledge/discussion points. Storyboard was transformed into a PowerPoint presentation with engaging narrative and check in activities. Presentations were transferred to Articulate® software. Content was developed with an e-learning specialist and validated by patient education content experts. Evaluation: E-learning module benefits include: accessibility at all times and from all locations, lack of workspace constraints, learn at your own pace/convenience, uniform course content and key messaging as well as increased dissemination to increase sustainability and capacity building. Challenges included: limiting information and narrative to key messaging as per adult learning principles, editing and logistic constraints of branding. Analytics for public internet, as well as staff rosters from in-house learning management system track activities and provide demographics & insight into learner activities. Usefulness: E learning modules can enhance training and education of staff, patients and the community. They can supplement traditional learning and can be accessed anytime and anywhere. Internet was leveraged for public access patient modules to increase patient self efficacy; this provides a safe learning environment for individuals who smoke who might not access this information publically for fear of stigma Relation to Theme: Technology such as electronic learning modules can supplement traditional methods of staff training and provide novel methods for cancer patient education for patients who may not be able to receive this in a traditional manner in a hospital setting due to stigma or other socioeconomic limitations. Learning Objectives: 1. The participant shall be able to identify at least three benefits of implementing electronic learning modules for smoking cessation for staff, patient and in the community. 2. The participant shall be able to identify at least three challenges of implementing electronic learning modules for smoking cessation for staff, patient and in the community. 3. The participant shall be able to identify ways that e-learning can improve access and health outcomes. References: 1.Chou H, Lin I, Woung L, Tsai M. An empirical study on outpatients’ health education needs and the effectiveness of e-learning. Health Promotion Practice 2012 Jan; 13(1):133-9 2.Delf P. Designing effective eLearning for healthcare professionals. Radiography, July 01, 2013 3. Holubar S, Hassinger J, Dozois E, Wolff B, Kehoe M, Cima R, Impact of a multimedia e-learning module on colon cancer literacy: a community-based pilot study. The Journal of Surgical Research 2009 Oct; 156(2):305-11.