Oral Abstracts: 2B

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 2B: Cancer Education in Women’s Health

Thursday, 22 October 2015, 2:00 PM – 3:30 PM, Salon E


2B-1 – Breast Cancer Patients’ Preferences for Adjuvant Radiotherapy Post-Lumpectomy: Whole Breast Irradiation Versus Partial Breast Irradiation – Single Institutional Study

Ewa Szumacher1, Merrylee McGuffin1, Roseana Presutti2, Jean-Philipe Pignol3, 4Tamara Harth, 2Aruz Mesci, 5Deb Feldman-Stewart, 4Edward Chow, 4Lisa Di Prospero, 4Danny Vesprini, 4Eileen Rakovitch, 4Justin Lee, 4Mary Doherty, 4Hanny Soliman, 4Ida Ackerman, 6Xingshan Cao, 6Alex Kiss
1Sunnybrook Health Sciences Centre , Toronto, Canada, 2University of Toronto, Toronto, Canada, 3Erasmus MC: University Medical Center, Rotterdam, The Netherlands, 4Sunnybrook Odette Cancer Centre, Toronto, Canada, 5Cancer Research Institute, Queen’s University, Kingston, Canada, 6Institute of Clinical Evaluative Sciences, Toronto, Canada

Abstract: Background: This study was conducted to determine whether patients with early stage breast cancer would prefer PBI or WBI and to identify important factors when making their treatment decisions. Methods: New patients with early breast cancer who were referred for adjuvant radiotherapy at the large academic cancer center were invited to participate. Women >40 years of age with a new histological diagnosis of ductal carcinoma in-situ or invasive breast carcinoma treated with breast conserving surgery showing clear margins for non-invasive and invasive disease and negative axillary nodes were eligible. Descriptive statistics were calculated for all variables of interest. Survey question responses were compared between those preferring WBI or PBI using chi-square analyses or Fisher’s exact tests. Results: Ninety /126 patients who were approached about this study completed the survey, 27(30%) preferred PBI and 55(62%) preferred WBI. Four patients (4%) required more information to choose between WBIvsPBI, and 3 patients (3%) had no preferences. From patients who choose WBI,32(58%)patients preferred hypofractionated RTvs 14 (25%)conventional RTregimen,Factors rated as important by patients in making their decision included convenience [PBI=18/26(69%), WBI=36/54(67%)], financial factors [PBI=14/26(53%), WBI=21/55(38%)], radiation dose to the breast [PBI=20/26(80%), WBI=46/55(83%)], invasiveness [PBI=18/26(69%), WBI=43/53(81%),, recurrence rate [PBI=26/26(100%), WBI=55/55(100%)], survival [PBI=26/26(100%),WBI=54/55(98%)], side effects PBI 21/26 (81%) WBI 47/55(85%) effectiveness [PBI=25/26(96%),WBI=54/54(100%)], standard method of treatment [PBI=16/26(61%), WBI=52/54(96%), p=0.001] and radiation dose to surrounding organs [PBI=23/26(88%), WBI=52/54(95%)]. Conclusions: Our study shows that patients with early breast cancer prefer WBI as an adjuvant treatment post lumpectomy. Patients preferring WBRT were more likely to consider standard treatment as more important than those preferring PBI.There was a marginally significant association between marital status and preference of radiotherapy(p=0.0773) and employment (p=0.0667). A detailed analysis of all decisional preferences between WBI and PBI will be presented at the meeting. Relation to Theme: Ours study is specifically looking at the breast cancer patients and their involvement in the decision making process for two radiotherapy regimens. Patients with cancer can be perceived as a minority group. In addition, women patients very often face challenges when discussing their treatment options with their oncologists. Learning Objectives: 1. To understand use of DA in patients with breast cancer 2. To familiarize the participants with the factors that influenced patients’ choice between two different treatment regimens (WBI vs. PBI) References: 1. Wong JJ, D’Alimonte L, Angus J, Paszat L, Soren B, Szumacher E. What do older patients with early stage breast cancer want to know while undergoing adjuvant radiotherapy? J Canc Educ. 2011;26:254-261. 2. Hoopes DJ, Kaziska D, Chapin P, Weed D, Smith BD, Hale ER, et al. Patient preferences and physician practice patterns regarding breast radiotherapy. Int J Radiat Oncol Biol Phys. 2012;82(2):674-81.


2B-2 – Improving shared decision making in breast cancer using an interactive online learning platform

Karen Overstreet1, Lois Colburn2, Deborah, Susalka3, Denise H. Britigan4
1Imedex, Raleigh, NC, USA, 2University of Nebraska Medical Center, Omaha, NE, USA, 3Imedex, LLC, Alpharetta, GA, USA, 4Maurer Center for Public Health, Omaha, NE, USA

Abstract: Background: The overexpression of human epidermal growth factor receptor-2 (HER2) in breast cancer (BC) is associated with poor prognosis and unfavorable outcomes. The optimal treatment settings for HER2-targeting agents have yet to be established. Treatment decisions require close cooperation between patients and their care team.1-3 Women actively involved in choosing their treatment have higher overall quality of life than those with passive involvement.4 A major consideration for effective patient-centered care is patients’ varying levels of health literacy. Description: We created Improving Understanding: Communication Strategies to Support the Patient’s Role in Shared Decision Making, a multi-faceted E-learning activity for clinicians who care for patients with HER2+ BC. A multi-disciplinary team including nurse navigators evaluated the importance of assessing patients’ health literacy prior to education and recommended proactive communication strategies to support each patient. The activity was developed using a highly interactive learning platform, which effectively leverages 4 natural learning actions: note-taking, reminder-setting, related search, and social learning.5,6 The education includes predisposing, enabling, and reinforcing components; instructional strategies include learner notes, reminders, embedded search, and in-lesson polling.= Evaluation: Lesson completion rates for education delivered on this platform average 2- to 3-fold higher than historical standards for online CME, and participation is associated with strongly significant knowledge change (p Usefulness: Real-time engagement reports allow planners and faculty to segment learner cohorts to identify those who need additional support and those that are ready to take action in practice. Additionally, the ability to triangulate learner pre- and post-test data with learner actions will provide educators with an in-depth understanding of what is most appealing to learners and their needs for further education. Relation to Theme: Breast cancer is prevalent in diverse populations across the US. Most patients prefer that physicians share treatment decisions with them, but 9 out of 10 have difficulty understanding relevant information. This session will evaluate the effectiveness of online education promoting shared decision making among breast cancer treaters and patients. Learning Objectives: The participant shall be able to 1. Identify tools that clinician-learners can use to improve communication with patients with cancer. 2. Assess the effectiveness of an innovative e-learning platform to promote shared decision making among cancer patients and their care teams. References: 1. Untch M, et al. Neoadjuvant therapy for BC. Breast. 2014. 2. Del Barco S, et al. Systemic treatment of early BC. Clin Transl Oncol. 2013;15:1011-7. 3. Institute of Medicine. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. 2013. Available at: http://www.iom.edu/Reports/2013/Delivering-High-Quality-Cancer-Care-Charting-a-New-Course-for-a-System-in-Crisis.aspx. 4. Hack TF, et al. Participating in medical decision making: Longitudinal follow-up of women with BC. Psychooncology. 2006;15(1):9-19. doi:10.1002/pon.907. 5. McGowan BS, et al. A data-driven model for nursing education. J Cont Ed Nurs. 2014: 45: 1-2. Pelletier S. New CME architecture aims to enable better learning. Medicalmeetings.com.


2B-3 – HPV vaccine awareness and knowledge among predominantly African-American low income women living with HIV

Lisa Wigfall1, Shalanda Bynum2, Heather Brandt1, James Hebert1
2University of South Carolina, Columbia, SC, USA, 2Uniformed Services University of the Health Sciences, Bethesda, MD, USA

Abstract: Background/Purpose: Cervical cancer risk is increased among some women living with HIV (WLH). HPV vaccination is approved for use in females 9-26 years old, and has been shown to be safe and immunogenic among WLH. We examined HPV vaccine awareness and HPV knowledge among WLH. Methods: An interviewer-administered online survey was conducted between March 2011 and April 2012. A total of 145 urban and rural dwelling medically-underserved WLH were recruited from Ryan White-funded clinics and AIDS service organizations located in the southeastern United States. HPV vaccine-related questions asked: Have you ever heard of the HPV shot or cervical cancer vaccine? (yes/no) (awareness=outcome), and HPV can cause cervical cancer (true, false/don’t know) (knowledge=exposure). Stata/IC 13 was used to perform chi-square tests and multivariate logistic regression analyses. Results/Findings: WLH (n=127) were mostly non-Hispanic Black (90%) and reported an annual household income <$10,000 (64%). Minor children resided in the homes of 38% of the WLH in our study. Only 66% had heard of HPV, and even fewer (38%) had heard of the HPV vaccine. Half (50%) knew that HPV caused cervical cancer. There was a 10-fold increase in HPV vaccine awareness among WLH who knew HPV caused cervical cancer (OR=10.17;95%CI:3.82-27.06). Income (OR=2.21;95%CI:0.84-5.77) and health literacy (OR=3.20;95%CI:1.04-9.87) were potential confounders of the relationship between HPV vaccine awareness and knowledge. A Hosmer-Lemeshow goodness-of-fit test was performed on full model (p=0.42). Discussion: The quadrivalent HPV vaccine was approved for use in females 9-26 years old in 2006. Almost 10 years later, HPV vaccine awareness remains low among WLH despite their increased cervical cancer risk. These findings underscore the importance of increased cancer prevention efforts aimed at raising HPV vaccine awareness and increasing HPV knowledge to reducing cervical cancer disparities among WLH. Our findings also have implications for increasing health literacy among WLH. Relation to Theme: This abstract describes cervical cancer prevention education needs of WLH who are largely African American and disproportionately burdened with cervical disease and cancer. Health literacy is also described as a potential confounder of the relationship between HPV vaccine awareness and knowledge about HPV among WLH. Objectives: After attending this presentation, participants will be able to: 1. Describe the link between HIV infection and cervical cancer. 2. Describe the cervical cancer prevention education needs of WLH. References: 1. Toft et al. Vaccination against oncogenic human papillomavirus infection in HIV-infected populations: review of current status and future perspectives. 2014. Sex Health. 11(6):511-23. doi: 10.1071/SH14015. 2. Dames et al. High-Risk Cervical Human Papillomavirus Infections among Human Immunodeficiency Virus-Positive Women in the Bahamas. 2014. PloS one,9(1):e85429. doi: 10.1371/journal.pone.0085429 3. Sichanh et al. Knowledge, awareness and attitudes about cervical cancer among women attending or not an HIV treatment center in Lao PDR.BMC cancer,14(1):161. doi: 10.1186/1471-2407-14-161. 4. Massad et al. Knowledge of cervical cancer prevention and human papillomavirus among women with HIV. 2010. Gynecol Oncol. 117(1):70-6. doi: 10.1016/j.ygyno.2009.12.030.


2B-4 – A Qualitative Assessment of the Effects of Stigma on the Outcomes of Women with Cervical Cancer in Accra, Ghana

Michelle Williams
University of Alabama at Birmingham, Birmingham, AL, United States

Abstract: Background/Purpose: Cervical cancer is the leading cause of cancer death among women in Ghana, West Africa. Data indicates that the age standardized cervical cancer mortality rate in Ghana is nearly three times the global cervical cancer mortality rate. Despite the availablity of cervial cancer screening, the rate of preventive screenings remains extremely low among Ghanian women. Sociocultural barriers that prevent Ghanaian women from seeking preventive cervical cancer screening include the stigmatization of cervical cancer, and the minimization of perceived susceptibility to cervical cancer due to stigmatizing beliefs. The purpose of this exploratory study is to characterize the impact of stigma on the attitudes, beliefs and actions of women with cervical cancer. Methods: Semi-structured interviews were conducted with 42 nurses at an urban hospital (n = 21) and a rural hospital (n=21) in Ghana. Focused coding of the qualitative data was preformed to identify the nature of cervical cancer stigma, the impact of stigma on cervical cancer screening behaviors, and solutions to increasing screening uptake. Member checking was done to establish the validity of the results. Results: Accurate knowledge of cervical cancer risk factors was low overall. Stigmatizing beliefs about cervical cancer included the fear of cervical cancer, cervical cancer cannot be cured, cervical cancer causes pain and death, and cervical cancer is caused by a curse. Furthermore, the belief that knowing one’s cancer status increased the chance of death was a significant factor that leads women to seek screening only when symptoms are severe. The majority of the participants agreed that nurses could be trained to educate women about cervical cancer and promote screening within their communities. Discussion: The results of this study will be used to develop a culturally relevant cervical cancer stigma reduction intervention aimed at reducing the impact of cervical cancer stigma on screening behaviors. Relation to Theme: Global health disparities in cervical cancer disproportionately effect women in low and middle income countries. The lack of cancer education in Ghana can lead to stigmatizing beliefs. This innovative study will Identify factors that lead to the development of stigmatizing attitudes, beliefs and actions that results in lower cervical cancer screening rates among Ghanaian women. Learning Objectives: 1. The participant shall be able to define cancer stigma. 2. The participant shall be able to identify negative perceptions that lead to stigmatizting beliefs about cervical cancer. 3. The participant shall be able to describe how stigma effect cervical cancer screening behaviors. References: 1. World Health Organization. Summary report on HPV and cervical cancer statistics in Ghana: 2013. (2014). 2. Agyei-Mensah, S. & de-Graft Aikins, A. Epidemiological Transition and the Double Burden of Disease in Accra, Ghana. J. Urban Heal. Bull. New York Acad. Med. 87, 879–897 (2010). 3. Edelen MO, Chandra A, Stucky B, Schear R, Neal C, Rechis R. Developing a Global Cancer Stigma Index. SAGE Open 2014;4(3):2158244014547875.


2B-5 – Awareness of HPV and cervical cancer prevention among Greek healthcare workers

Evi Farazi1, Panayiota Hadji2, Zoey Roupa1
1University of Nicosia, Nicosia, Cyprus, 2University of Thessaly, Larissa, Greece

Abstract: The incidence rate of cervical cancer varies geographically with less developed regions showing the highest rates. Several strains (predominantly HPV 16 and HPV 18) of the Human Papilloma Virus (HPV) cause almost all cervical cancers. All risk factors for cervical cancer are actually preventable with the adoption of the appropriate lifestyle changes (i.e. cautious sexual behaviour, no smoking, no use of oral contraceptives, regular pap test etc). In addition, vaccines protecting against infection by the majority of HPV high risk strains have been developed. Even though cervical cancer is preventable not all women are aware how it can be prevented. Thus, it is essential for every nation to assess the level of knowledge of its population regarding cervical cancer and HPV prevention. Of primary importance is the assessment of healthcare workers’ knowledge, since they have a great influence on patients and can serve as a source of information. To this end, we assessed the level of awareness and attitudes of Greek female healthcare workers regarding cervical cancer and HPV prevention through the delivery of a validated questionnaire in three hospitals in Greece. Our results show that there exist gaps in the knowledge of women on this topic, especially regarding the latest information on cervical cancer prevention. In fact, only 20% of surveyed women knew about the existence of HPV testing. In addition, about 30% of these women were not willing to vaccinate themselves, and similar percentages were not willing to vaccinate their daughters or sons. Thus, we propose more information needs to be transmitted to the Greek population regarding HPV testing and vaccination. Even though cervical cancer incidence is not extremely high in Greece, this number can easily change if no prevention measures are taken, especially in light of the economic crisis and the increasing rates of migration. Relation to Theme: The study on HPV and cervical cancer prevention awareness was conducted in Greece and can be compared to similar studies in other countries. This would help identify disparities in the knowledge of various populations and point to socioeconomic factors that may be responsible for such cancer education disparities. Learning Objectives: The participant shall be able to appreciate the problems that exist in the field of cancer education regarding cancer prevention. In this particular case the prevention of HPV and cervical cancer are being addressed in a Greek subpopulation of healthcare workers. In addition, this study can be compared to similar studies in other countries of similar as well as different socioeconomic background, thus raising some hypotheses on the factors that may be contributing to cancer education disparities. References: 1. Pan et al., Acceptability and Correlates of Primary and Secondary Prevention of Cervical Cancer among Medical Students in Southwest China: Implications for Cancer Education, PLoS ONE, 2014. 2. McCarey et al. Awareness of HPV and cervical cancer prevention among Cameroonian healthcare workers. BMC Women‘s Health 2011. 3. Pandey et al. Awareness and Attitude towards Human Papillomavirus Vaccine among Medical Students in a Premier Medical School in India. PLoS ONE, 2012. 4. Blödt et al. Human Papillomavirus awareness, knowledge and vaccine acceptance: a survey among 18-25 year old male and female vocational school students in Berlin, Germany. Eur J Public Health. 2012.