Expressions of masculinity and associations with suicidal ideation among young males

BACKGROUND

Adolescent boys and young men are at particular risk of suicide. Suicidal ideation is an important risk factor for suicide, but is poorly understood among adolescent males. Some masculine behaviors have been associated with deleterious effects on health, yet there has been little quantitative examination of associations between masculinity and suicide or suicidal ideation, particularly among boys/young men. This study aimed to examine associations between conformity to masculine norms and suicidal ideation in a sample of adolescents.

METHODS

A prospective cohort design, this study drew on a sample of 829 Australian boys/young men from the Australian Longitudinal Study on Male Health. Boys were 15-18 years at baseline, and 17-20 years at follow-up. Masculine norms (Wave 1), were measured using the Conformity to Masculine Norms Inventory (CMNI-22). Suicidal ideation (Wave 2) was a single-item from the Youth Risk Behavior Survey. Logistic regression analysis was conducted, adjusting for available confounders including parental education, Indigenous Australian identity and area disadvantage.

RESULTS

In adjusted models, greater conformity to violent norms (OR = 1.23, 95% Confidence Interval [CI]: 1.03-1.47) and self-reliance norms (OR = 1.40, 95% CI: 1.15-1.70) was associated with higher odds of reporting suicidal ideation. Greater conformity to norms regarding heterosexuality was associated with reduced odds of reporting suicidal ideation (OR = 0.80, 95% CI: 0.68-0.91).

CONCLUSIONS

These results suggest that conforming to some masculine norms may be deleterious to the mental health of young males, placing them at greater risk of suicidal ideation. The results highlight the importance of presenting young males with alternative and multiple ways of being a male. Facilitating a relaxation of norms regarding self-reliance, and encouraging help-seeking, is vital. Furthermore, dismantling norms that rigidly enforce masculine norms, particularly in relation to heteronormativity, is likely to benefit the broad population of males, not only those who do not conform to heterosexual and other masculine norms.

Revisiones Sistemáticas Exploratorias como metodología para la síntesis del conocimiento científico

Introducción: En la actualidad los sistemas de salud alrededor del mundo apuestan por una toma decisiones clínicas basadas en la evidencia científica. Para ello, es necesario que los profesionales de la salud consulten los resultados de las investigaciones científicas. Sin embargo, dada la gran cantidad de literatura, los investigadores han desarrollado metodologías de revisión para compilar los estudios científicos dentro de un área específica. Aun cuando existen más de 10 tipos de metodologías para la revisión de la literatura, la Revisión Sistemática Exploratoria (RSE) ha recibido poca atención en la literatura sobre métodos de investigación científica de habla hispana. Objetivo: Detallar la metodología de la RSE, sus propósitos y las fases para su desarrollo. Desarrollo: Este trabajo detalla las generalidades de la RSE basándose en la metodología propuesta por Arksey & O’Malley. Así mismo, se describen las áreas o ámbitos donde este tipo de revisión se puede emplear, las fases para desarrollar la revisión y ejemplos de las RSE. Conclusiones: Las RSE tienen la fortaleza de hacer saber a los profesionales de la salud sobre un tema en específico que permita incidir en las políticas públicas. Al igual que las Revisiones Sistemáticas, las RSE utilizan una metodología clara y replicable, aportando datos confiables y científicos para los profesionales de la salud.

Protocol of a two arm randomised, multi-centre, 12-month controlled trial: evaluating the impact of a Cognitive Behavioural Therapy (CBT)-based intervention Supporting UPtake and Adherence to antiretrovirals (SUPA) in adults with HIV

Background

Delay to start antiretroviral therapy (ART) and nonadherence compromise the health and wellbeing of people living with HIV (PLWH), raise the cost of care and increase risk of transmission to sexual partners. To date, interventions to improve adherence to ART have had limited success, perhaps because they have failed to systematically elicit and address both perceptual and practical barriers to adherence. The primary aim of this study is to determine the efficacy of the Supporting UPtake and Adherence (SUPA) intervention.

Methods

This study comprises 2 phases. Phase 1 is an observational cohort study, in which PLWH who are ART naïve and recommended to take ART by their clinician complete a questionnaire assessing their beliefs about ART over 12 months. Phase 2 is a randomised controlled trial (RCT) nested within the observational cohort study to investigate the effectiveness of the SUPA intervention on adherence to ART. PLWH at risk of nonadherence (based on their beliefs about ART) will be recruited and randomised 1:1 to the intervention (SUPA intervention + usual care) and control (usual care) arms. The SUPA intervention involves 4 tailored treatment support sessions delivered by a Research Nurse utilising a collaborative Cognitive Behavioural Therapy (CBT) and Motivational Interviewing (MI) approach. Sessions are tailored to individual needs and preferences based on the individual patient’s perceptions and practical barriers to ART. An animation series and intervention manual have been developed to communicate a rationale for the personal necessity for ART and illustrate concerns and potential solutions. The primary outcome is adherence to ART measured using Medication Event Monitoring System (MEMS). Three hundred seventy-two patients will be sufficient to detect a 15% difference in adherence with 80% power and an alpha of 0.05. Costs will be compared between intervention and control groups. Costs will be combined with the primary outcome in cost-effectiveness analyses. Quality adjusted life-years (QALYs) will also be estimated over the follow-up period and used in the analyses.

Discussion

The findings will enable patients, healthcare providers and policy makers to make informed decisions about the value of the SUPA intervention.

Trial registration

The trial was retrospectively registered 21/02/2014, ISRCTN35514212.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6893-z) contains supplementary material, which is available to authorized users.

Subject-Specific Studies of CSF Bulk Flow Patterns in the Spinal Canal: Implications for the Dispersion of Solute Particles in Intrathecal Drug Delivery

BACKGROUND AND PURPOSE

Recent flow dynamics studies have shown that the eccentricity of the spinal cord affects the magnitude and characteristics of the slow bulk motion of CSF in the spinal subarachnoid space, which is an important variable in solute transport along the spinal canal. The goal of this study was to investigate how anatomic differences among subjects affect this bulk flow.

MATERIALS AND METHODS

T2-weighted spinal images were obtained in 4 subjects and repeated in 1 subject after repositioning. CSF velocity was calculated from phase-contrast MR images for 7 equally spaced levels along the length of the spine. This information was input into a 2-time-scale asymptotic analysis of the Navier-Stokes and concentration equations to calculate the short- and long-term CSF flow in the spinal subarachnoid space. Bulk flow streamlines were shown for each subject and position and inspected for differences in patterns.

RESULTS

The 4 subjects had variable degrees of lordosis and kyphosis. Repositioning in 1 subject changed the degree of cervical lordosis and thoracic kyphosis. The streamlines of bulk flow show the existence of distinct regions where the fluid particles flow in circular patterns. The location and interconnectivity of these recirculating regions varied among individuals and different positions.

CONCLUSIONS

Lordosis, kyphosis, and spinal cord eccentricity in the healthy human spine result in subject-specific patterns of bulk flow recirculating regions. The extent of the interconnectivity of the streamlines among these recirculating regions is fundamental in determining the long-term transport of solute particles along the spinal canal.

Engaging Australian men in masculinity and suicide - A concept test of social media materials and a website

ISSUE ADDRESSED

Men dominate the suicide statistics and are less likely than women to seek help for emotional problems, and this has been linked to aspects of stoic masculinity. Promoting help-seeking and challenging stoic thinking may help to address this problem, but it is unclear what works in engaging men in these topics.

METHODS

We developed a multimedia intervention called Man Up - including a documentary and digital campaign. We tested promotional materials and the website by interviewing 17 men from different ages and backgrounds about their perceptions, and asked them whether the materials generated interest in the topics of the documentary.

RESULTS

Participants preferred visual materials that were relatable to them and included active and direct language. This helped them to understand and identify with the messages being imparted. Participants had mixed views on talking about masculinity and the use of the term "man up," with some expressing interest and others being deterred by it. Sharing content about mental health and suicide was seen by some as a risk to personal reputation and their relationships with others.

CONCLUSIONS

Our findings informed the design of targeted materials for the national Man Up campaign and website which were then used in a multilevel national health promotion intervention in Australia. SO WHAT?: Our study provided valuable insights beyond Man Up for those seeking to design and deliver health promotion interventions targeting Australian men and engage in sensitive and stigmatised male health issues. Using active and empowering language was especially important when addressing men which contrasts with many promotional materials currently available.

Working towards least restrictive environments in acute mental health wards in the context of locked door policy and practice

There has been a shift towards provision of mental health care in community-based settings in Australia. However, hospitals continue to care for people in acute mental health wards. An increasing proportion of the people in wards are admitted involuntarily, subject to restrictions of movement to minimize risk of harm to self and others. In response to concerns about the safety of people absconding from care, Queensland Health introduced a policy requiring all acute mental health wards in the State to be locked. In response, the Queensland Mental Health Commission funded a project to understand the impact of this policy and develop evidence-based recommendations regarding provision of least restrictive, recovery-oriented practices in acute wards. Facilitated forums were conducted with 35 purposively selected participants who identified as consumers, carers, or staff of acute mental health hospital wards, to test the acceptability, feasibility, and face validity of a set of evidence-informed recommendations for providing least restrictive, recovery-oriented practices. Participant responses were recorded, and data were analysed through an inductive, thematic approach. A recovery-oriented approach was supported by all stakeholders. Reducing boredom and increasing availability of peer support workers were considered key to achieving this. Focusing less on risk aversion was reported as central to enabling true Recovery Orientation. This project enabled recognition of the perspectives of consumers, carers, and staff in the consideration of evidence-informed recommendations that could be implemented to provide least restrictive care in the context of locked doors.

Evaluating the effectiveness of a website about masculinity and suicide to prompt help-seeking

ISSUE ADDRESSED

A website was designed to form the core of a multimedia strategy surrounding the Man Up documentary - a three-part documentary that aimed to address the problem of male suicide in Australia. Together these formed a media-based, public health intervention that explored the link between masculinity and suicide and promoted help-seeking. This is of great importance given the demonstrated link between masculine norms, men's reduced help-seeking and suicidal thinking. This study assesses the website's effectiveness in facilitating help-seeking and fostering conversations about suicide, mental health and help-seeking. Help-seeking indicators included website clicks to helping organisations, downloads of health information from the website and request for help received via emails.

METHODS

Google Analytics data, emails to the Man Up team received through the website and open-ended responses to an online survey were analysed.

RESULTS

The website reached 43 140 users. Indictors of help-seeking activity on the website included 307 outbound clicks to helping organisations and 802 downloads of health information. Qualitative analysis of emails received and responses to the survey demonstrated that Man Up's messages resonated with viewers and provided further evidence of help-seeking.

CONCLUSION

The findings demonstrate that the website provided an important opportunity for people to engage with Man Up and seek help. SO WHAT?: Media-based public health interventions offer enormous potential to provide suicide prevention interventions and promote help-seeking. The website evaluation findings provide insight into the ways in which websites can be used as part of a multimedia strategy to address the problem of male suicide.

Abstract P1-13-02: Real world outcomes of adjuvant FECD, ddACT and ACT for the treatment of early stage breast cancer - A multicenter retrospective analysis

Background: Adjuvant chemotherapy combining anthracyclines and taxanes for early stage breast cancer (ESBC) have demonstrated disease-free survival (DFS) and overall survival (OS) benefits. Among the 3rd generation regimens, 2 options have been favoured: FEC-Docetaxel (FECD) and AC-Paclitaxel (ACT). ACT may be delivered with dose-dense (ddACT) or weekly taxane scheduling (ddACWT), compared to traditional every 3-weekly (q3ACT) scheduling. Despite literature supporting both FECD and (dd)ACT regimens in the management of ESBC, no direct prospective trial has evaluated their comparative effectiveness.

Methods: A retrospective review of the BC Cancer Breast Cancer Outcomes Unit (BCOU) and the Alberta Health Services (AHS) databases was performed to identify patients with HER2 negative, stage 1-3 ESBC, who received adjuvant chemotherapy between 2007-2014. The primary endpoint was OS and the secondary endpoint was RFS, defined as freedom from local (invasive), regional or distant recurrence or breast cancer death. Outcome comparisons were made between FECD, ddACT/ddACWT and q3ACT using the Kaplan Meier method. Treatment arms were compared using a log-rank test for univariate analysis. A multivariate analysis was also conducted for OS comprising age, stage, grade, receptor status and type of chemotherapy received (FECD vs combined ACT group).

Results: A total of 4047 patients met inclusion criteria, including 2685 FECD, 1259 ddACT and 103 ACT. Median age was 53 (24-77) in the FECD group vs 52 (26-68) in the ddACT/ddACWT group and 58 (43-78) in the q3ACT group. The majority had stage 2 disease, 51.3%, 53.5% and 50.5% in the FECD, ddACT/ddACWT and q3ACT groups, respectively. Most were HR+, 84.5% in the FECD group vs 66.9% in both the ddACT/ddACWT and q3ACT groups. In the FECD group, 42.8% had a grade 2 tumour and 48.2% a grade 3 tumour vs 35.4% and 56.4% in the ddACT/ddACWT group and 35.0% and 58.3% in the q3ACT group. Lymphovascular invasion (LVI) was present in 40.7% of patients who received FECD vs 39.7% for ddACT/ddACWT and 26.2% for ACT. 5-year OS, for the FECD group was 90.3% (95%CI 89.1,91.4) vs 87.0% (95%CI 84.3,89.2) for the ddACT/ddACWT and 84.9% (95%CI 75.5,90.8) for the q3ACT groups, p=0.0907. 5-year RFS was 85.5% (95%CI 84.0-86.8) with FECD vs 84.4% (95% 81.9,86.6) for ddACT/ddACWT and 87.7% (95%CI 79.2,92.8) with q3ACT,p=0.4200. In multivariate analysis: age, stage and grade were significantly associated with OS whereas type of chemotherapy received (FECD vs ACT) was not (p=0.165). Finally, OS rates were compared across provinces and no significant differences were identified, 87.0% vs 88.0% (p=0.6294). Subgroup analyses by receptor type, comparing HR+ and TNBC are ongoing.

Conclusions: The use of FECD as compared to ACT based chemotherapy did not reveal significant differences in OS or RFS in this population-based study. Further, chemotherapy regimen was not associated with differences in overall survival, as compared to other well recognized prognostic factors. While the results were obtained from a retrospective analysis, conclusive prospective data is lacking. These results may therefore reassure physicians and patients alike on a comparable efficacy of these regimens in a real-life setting.

Citation Format: LeVasseur N, Veitch Z, Diocee RM, Gondara L, Cheung W, Khan O, Cossetti R, Gelmon KA, King K, Lupichuk S, Chia SK, Tang P, Simmons C. Real world outcomes of adjuvant FECD, ddACT and ACT for the treatment of early stage breast cancer - A multicenter retrospective analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-13-02.

Abstract P6-17-29: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Veitch ZW, Bedard P, Tang PA, Conway JL, Ribnikar D, Albaba H, King K, Lupichuk S, Cescon D. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-29.

Abstract P4-16-12: Does initial cardiac imaging impact clinical outcomes in patients with breast cancer?

Background: Echocardiography (echo) and multigated acquisition (MUGA) scans are the most commonly used modalities to assess cardiac function during breast cancer (BC) treatment. However, a case series of 176 patients with cancer suggests enhanced cardiac care with echo surveillance. We hypothesized that patients with early BC imaged by echo have improved cardiac outcomes compared to those imaged by MUGA.

Methods: Consecutive patients with stage I to III breast cancer undergoing pre-treatment echo or MUGA were retrospectively screened from January 2010 to December 2014. Patients participating in clinical trials with mandated imaging and/or cardiac reviews were excluded. Demographics, medical history and clinical events were collected via chart review and electronic health records. All patients had a minimum 1 year of follow-up. The primary outcome was a composite of death, cardiac hospitalization or cardiac emergency room visit.

Results: 598 patients were identified as having a baseline echo and 636 had had baseline MUGA. Mean follow-up was 4.5±1.4 years. Patients undergoing MUGA were younger, had more advanced stage of disease and received more anthracycline and trastuzumab (table1). Patients imaged by MUGA had lower cardiac function at baseline compared to echo, LVEF 64% vs. LVEF 65% respectively, P <0.001. Cancer therapy related cardiac dysfunction was similar between groups, 10% vs. 11%, p=0.81. Patients in the echo group were more likely to be seen by cardiology, 7% vs. 3%, p<0.0001, and to be initiated on beta blocker, 4% vs. 1%, p=0.006, or angiotensin converting enzyme inhibitor, 3% vs. 1%, p=0.002.However, there was no difference between groups for the primary outcome, 10% event rate in each group, even after adjustment for age, BC stage, chemotherapy and cardiac medications, hazard ratio 1.04 (CI 0.72-1.49), p=0.842.

Conclusion: For patients with early stage BC, the choice of cardiac imaging modality at baseline does not impact adverse cardiac events. However, patients undergoing echo were more likely to be evaluated and managed by cardiology.

Table 1.Baseline Characteristics Echo (N=598)MUGA (N=636)Age mean54±1053±10*BMI mean29±629±7Cardiovascular HistoryDiabetes66(11%)56(9%)Hypertension154(26%)155(24%)Dyslipidemia83(14%)75(12%)CAD9(2%)6(1%)CHF7(1%)4(1%)Beta Blocker22(4%)28(4%)ACE-Inhibitor51(9%)64(10%)Angiotensin Receptor Blocker69(12%)44(7%)*Cancer HistoryStage*Stage I65(11%)56(9%)Stage II377(63%)361(57%)Stage III155(26%)219(34%)Receptor StatusTriple negative64(11%)76(12%)HER2 negative, hormone positive342(58%)387(61%)HER2 positive192(32%)173(27%)Cancer TherapyChemotherapy (any)528(88%)594(93%)*Anthracycline310(52%)394(62%)*Trastuzumab170(28%)148(23%)*Anthracycline & trastuzumab6(1%)19(3%)*Hormone therapy459(77%)487(77%)Radiation (any)487(81%)527(83%)Radiation left side237(49%)259(49%)Surgery597(100%)633(100%)* p<0.05 for comparison between echo and MUGA groups

Citation Format: Parent S, Xu L, Becher H, Mackey J, King K, Pituskin E, Paterson I. Does initial cardiac imaging impact clinical outcomes in patients with breast cancer? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-16-12.

Impacts of a Documentary about Masculinity and Men's Health

As part of a larger study, we developed a three-part documentary called Man Up that explored the relationship between masculinity, mental health, and suicide. In this study, we examine in detail the qualitative feedback provided by those who viewed Man Up, in order to gain a more in-depth understanding of its impact on them. A total of 169 participants provided qualitative feedback via an online survey 4 weeks after viewing Man Up. We examined their opinions about the show and whether they reported any changes in their attitudes and/or behaviors as a result of watching it. All the men who provided feedback on Man Up were overwhelmingly positive about it. The majority reported significant and profound impacts of viewing the documentary. They reported being more aware of others, more willing to help others, and more open about their emotions and problems, as well as demonstrating associated behavioral changes related to helping others and being more emotionally expressive. The data presented here demonstrate the potential for men's health outcomes to be positively impacted by novel, media-based public health interventions.

Enhanced primary mental healthcare for Indigenous Australians: service implementation strategies and perspectives of providers

Background

Improving access to culturally appropriate mental healthcare has been recognised as a key strategy to address the often greater burden of mental health issues experienced by Indigenous populations. We present data from the evaluation of a national attempt at improving access to culturally appropriate mental healthcare for Indigenous Australians through a mainstream primary mental healthcare program, the Access to Allied Psychological Services program, whilst specifically focusing on the implementation strategies and perspectives of service providers.

Methods

We conducted semi-structured interviews with 31 service providers (primary care agency staff, referrers, and mental health professionals) that were analysed thematically and descriptively.

Results

Agency-level implementation strategies to enhance service access and cultural appropriateness included: the conduct of local service needs assessments; Indigenous stakeholder consultation and partnership development; establishment of clinical governance frameworks; workforce recruitment, clinical/cultural training and supervision; stakeholder and referrer education; and service co-location at Indigenous health organisations. Dedicated provider-level strategies to ensure the cultural appropriateness of services were primarily aimed at the context and process of delivery (involving, flexible referral pathways, suitable locations, adaptation of client engagement and service feedback processes) and, to a lesser extent, the nature and content of interventions (provision of culturally adapted therapy).

Conclusions

This study offers insights into key factors underpinning the successful national service implementation approach. Study findings highlight that concerted national attempts to enhance mainstream primary mental healthcare for Indigenous people are critically dependent on effective local agency- and provider-level strategies to optimise the integration, adaptation and broader utility of these services within local Indigenous community and healthcare service contexts. Despite the explicit provider focus, this study was limited by a lack of Indigenous stakeholder perspectives. Key study findings are of direct relevance to inform the future implementation and delivery of culturally appropriate primary mental healthcare programs for Indigenous populations in Australia and internationally.

Electronic supplementary material

The online version of this article (10.1186/s41256-018-0071-1) contains supplementary material, which is available to authorized users.

Using a television documentary to prevent suicide in men and boys

OBJECTIVES

We investigated whether a documentary about masculinity and suicidality ( Man Up) could raise males' awareness of societal pressures to conform to masculine norms and influence their likelihood of connecting with their male friends and seeking help.

METHODS

We conducted a repeat cross-sectional survey, posting versions of the survey online before and after Man Up was screened.

RESULTS

1287 male respondents completed the survey; 476 completed the pre-screening survey, 811 the post-screening survey (192 had not viewed Man Up, 619 had). Those who had viewed Man Up were more likely to desire closer relationships with their male friends than those who had not, and had greater awareness of societal pressures on males, but were no more likely to seek help. Almost all respondents who saw Man Up indicated they would recommend it to others, and most said it changed the way they thought about the term 'man up'. They indicated they would be likely to undertake a number of adaptive actions following the show, and provided overwhelmingly positive feedback.

CONCLUSIONS

Man Up appeared to effectively address factors that place males at heightened risk of suicide.

An Evaluation of the Implementation of the Australian ATAPS Suicide Prevention Services Initiative

The Access to Allied Psychological Services (ATAPS) Suicide Prevention Services initiative is an Australian Government-funded primary mental healthcare initiative providing free intensive psychological intervention for consumers at moderate risk of self-harm or suicide. Findings from a multi-method evaluation aimed at identifying whether the initiative is being implemented as stipulated within the operational guidelines, barriers and facilitators to implementation, and preliminary outcomes suggest that the Suicide Prevention Services are largely being implemented as stipulated in the Guidelines, but with some exceptions. In particular, service delivery barriers unique to rural and remote areas place limitations on implementation. Uptake of the ATAPS Suicide Prevention Services is high (10,428 consumers were referred to the Suicide Prevention Services between October 2008 and April 2013, and 86% of those attended at least one session), as is acceptance from organizations involved in its implementation.

Influencing the Conversation About Masculinity and Suicide: Evaluation of the Man Up Multimedia Campaign Using Twitter Data

BACKGROUND

It has been suggested that some dominant aspects of traditional masculinity are contributing to the high suicide rates among Australian men. We developed a three-episode documentary called Man Up, which explores the complex relationship between masculinity and suicide and encourages men to question socially imposed rules about what it means to be a man and asks them to open up, express difficult emotions, and seek help if and when needed. We ran a three-phase social media campaign alongside the documentary using 5 channels (Twitter, Facebook, Instagram, YouTube, and Tumblr).

OBJECTIVE

This study aimed to examine the extent to which the Man Up Twitter campaign influenced the social media conversation about masculinity and suicide.

METHODS

We used Twitter insights data to assess the reach of and engagement with the campaign (using metrics on followers, likes, retweets, and impressions) and to determine the highest and lowest performing tweets in the campaign (using an aggregated performance measure of reactions). We used original content tweets to determine whether the campaign increased the volume of relevant Twitter conversations (aggregating the number of tweets for selected campaign hashtags over time), and we used a subset of these data to gain insight into the main content themes with respect to audience engagement.

RESULTS

The campaign generated a strong following that was engaged with the content of the campaign; over its whole duration, the campaign earned approximately 5000 likes and 2500 retweets and gained around 1,022,000 impressions. The highest performing tweets posted by the host included video footage and occurred during the most active period of the campaign (around the screening of the documentary). The volume of conversations in relation to commonly used hashtags (#MANUP, #ABCMANUP, #LISTENUP, and #SPEAKUP) grew in direct relation to the campaign activities, achieving strongest growth during the 3 weeks when the documentary was aired. Strongest engagement was found with content related to help-seeking, masculinity, and expressing emotions. A number of followers tweeted personal stories that revealed overwhelmingly positive perceptions of the content of the documentary and strongly endorsed its messages.

CONCLUSIONS

The Man Up Twitter campaign triggered conversations about masculinity and suicide that otherwise may not have happened. For some, this may have been game-changing in terms of shifting attitudes toward expressing emotions and reaching out to others for help. The campaign was particularly effective in disseminating information and promoting conversations in real time, an advantage that it had over more traditional health promotion campaigns. This sort of approach could well be adapted to other areas of mental (and physical) health promotion campaigns to increase their reach and effectiveness.

Abstract P3-12-11: Disparities in adjuvant hormone adherence in breast cancer patients within a universal healthcare model

Background: Patient adherence to adjuvant hormonal therapy for breast cancer (BC) is correlated with improved survival. Recent publications have demonstrated ethnic disparities in adjuvant hormone adherence (AHA) for privatized healthcare models.

Objective: To identify disparities in AHA for BC patients within a universal healthcare system in Alberta, Canada.

Methods: Patients diagnosed from 2007-2014 with stage I-III, ER+/HER2- BC receiving adjuvant FECD or DC chemotherapy and at least one month of adjuvant hormonal therapy in Alberta, Canada were retrospectively assessed. Hormone monotherapy (tamoxifen, AI), switch strategies (tam to AI), and treatment duration were collected. Compliance was assessed with central pharmacy data. Patient ethnicity was identified using patient first/last and parental last name via Onolytics® ethnographic software. Ethnicity was further verified using a centrally collected place of birth. Age, AJCC stage, psychiatric diagnoses (mood, bipolar), and comorbidity were collected. Log rank and Chi squared were used to assess difference between adjuvant hormonal therapy for variables at 1, 2, and 5 years. Log rank p-values at 2 years are reported.

Results: A total of 2,399 ER+ patients were included for analysis. AHA was non-significant for ethnicity (p=0.797), comorbidity (p=0.623), psychiatric disorders (p=0.145), or elderly cohorts (p= 0.814). AHA by stage was significant with stage III > II > I (p=0.004) having the highest compliance rates. AHA was highest for planned hormonal switch strategies (p=0.004) compared to monotherapy.

Hormone Adherence RatesCharacteristicsNo. of Patients% AdherenceEthnicity  Caucasian211891.6Asian15293.4Middle Eastern/African9593.7Hispanic2491.7Age  <65207791.8>6534192.1Comorbidity  096191.21-3134392.2>311493Psychiatric Dx  Yes31189.7No210792.1Stage  I45388.3II151292.1III45394.5Hormone Strategy  Monotherapy173190.9Switch68794.2

Conclusion: AHA is not dependent on ethnicity, age, comorbidity, or psychiatric diagnosis in a universal healthcare model. Conversely, higher rates of AHA are seen with planned switch strategy compared to monotherapy, contradictory to the BIG I-98 trial. Patients with higher stage, and thus higher risk of BC recurrence have increased adherence compared to their low risk counterparts. Reinforcement of AHA for low/moderate risk BC patients, in addition to tamoxifen to AI switch strategies may improve overall adherence.

Citation Format: Veitch ZW, Khan OF, Tilley D, Kostaras X, King K, Lupichuk S, Tang P. Disparities in adjuvant hormone adherence in breast cancer patients within a universal healthcare model [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-12-11.

Abstract P5-20-12: Adjuvant DCH vs TCH for low-risk (node negative); and FECDH vs TCH for high-risk (node positive) HER2+ breast cancer – A retrospective provincial analysis

Background: Chemotherapy plus trastuzumab for early HER2+ breast cancer (BC) is associated with improved survival. Optimal regimens for low-risk (node negative) and high-risk (node positive) HER2+ breast cancers are unknown and choice of regimen varies in real-world clinical practice.

Objective: (1) For low-risk breast cancer, to compare DCH (4 cycles) and TCH (6 cycles) in terms of disease free (DFS) and overall survival (OS). (2) For high-risk breast cancer, to compare FECDH (6 cycles) and TCH (6 cycles) in terms of DFS and OS.

Methods: All women diagnosed from 2007-2014 with stage I-III, hormone receptor (HR) +/-, HER2+ BC receiving adjuvant chemotherapy plus trastuzumab (n=986) in Alberta, Canada were included. Patients with low-risk (node negative) disease were stratified into DCH (n=104) or TCH (n=360) cohorts for DFS/OS comparison (Kaplan-Meier). Patients with high-risk (node positive) disease were stratified into FECDH (n=145) or TCH (n=314) cohorts. Subgroup analysis of the high-risk cohorts by HR+/HER2+ and HR-/HER2+ for FECDH vs TCH were performed. Chi-square was used to evaluate for difference between cohort variables.

Low- Risk Cohort DCH TCH  n (104)%n (360)%Age (mean)55.3 53.0 Hormone Status    ER+ or PR+8682.727676.7ER and PR-1817.38423.3Grade    121.951.423230.88523.637067.327075.0Surgery    lumpectomy525010830.5mastectomy525024669.5

High-Risk Cohort FECDH TCH  n (145)%n (314)%Age (mean)50.2 53.6 Hormone Status    ER+ or PR+11579.323875.8ER and PR-3020.77624.2Grade    10051.6229206119.631168014678.8Surgery    lumpectomy3927.19831.2mastectomy10572.921668.8Node Status    N18357.219461.8N24128.37323.2N32114.54715

Results: Median follow-up was 58.1 months in the low-risk cohort and 63.1 months in the high-risk cohort. In the low-risk group, patients receiving TCH had more mastectomy (69.5%) than lumpectomy (30.5%; p<0.001) compared to those receiving DCH (50%; 50%). No significant difference was seen in DFS (p=0.153) or OS (p=0.409) for patients in the DCH (92.3%; 95.2%) vs TCH (95.2%; 96.9%) cohorts. In the high-risk group, no significant difference was seen in DFS (p=0.226) or OS (p=0.164) for FECDH (92.4; 95.2%) or TCH (88.5%; 91.4%) respectively. In subgroup analysis of high-risk HR+/HER2+ BC, patients receiving FECDH demonstrated superior OS (98.3%; p=0.014) and a trend towards superior DFS (94.8%; p=0.069) relative to TCH patients (OS = 91.6%; DFS= 88.7%). Conversely, analysis of high-risk HR-/HER2+ BC, patients demonstrated higher DFS and OS for TCH (88.2%; 90.8%) relative to FECDH (83.3%; 83.3%); although this was non-significant (p=0.516; p=0.298) and likely underpowered. Nodal status was balanced between all groups (p=0.602).

Conclusion: In low-risk HER2+ BC, 4 cycles of DCH chemotherapy has high survival with similar outcomes to 6 cycles of TCH. In high-risk HER2+ BC, FECDH has comparable outcomes to TCH consistent with BCIRG-006. This study suggests that women with HR+/HER2+ breast cancer have improved OS with anthracycline containing regimens, such as FECDH. Although non-significant, patients with HR-/HER2+ BC may have some improvement in DFS and OS with TCH, a carboplatin containing regimen.

Citation Format: Veitch ZW, Khan OF, Tilley D, Kostaras X, Tang PA, King K, Lupichuk S. Adjuvant DCH vs TCH for low-risk (node negative); and FECDH vs TCH for high-risk (node positive) HER2+ breast cancer – A retrospective provincial analysis [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-20-12.