Abstract PO-119: Separate and unequal: Examining the role of race and site of care on patient-reported outcomes among patients with metastatic cancer (AFT-39)

Background Racial disparities in patient-reported outcomes (PROs; e.g., symptoms, financial burden) among patients with cancer are well documented. Prior studies have attributed such disparities to patient- and provider-level factors, but less is known about the contribution of practice-level factors. Hospital racial composition of patients has been linked to disparities in care quality and outcomes, but questions remain regarding whether oncology practice racial composition mediates racial disparities. Using 2017-2020 data from the Patient-Reported Outcomes to Enhance Cancer Treatment (PRO-TECT) trial (ClinicalTrials.gov NCT03249090), we examined racial disparities in PROs among patients with metastatic cancer, and whether oncology practice racial composition accounted for observed disparities. Methods Our sample included 1099 patients (n=198 Black; n=901 White) from 51 community oncology practices across the US. Predictors of interest were patient race (Black vs. White) and practice-reported racial composition (Black patient population >20% vs. ≤20%). Patient-reported outcome metrics included pain, appetite loss, fatigue, nausea, dyspnea, insomnia, constipation, diarrhea, and financial burden, measured at baseline and at 1- and 3-month follow-up using the EORTC Quality of Life Core Questionnaire (QLQ-C30). Raw EORTC QLQ-C30 scores were standardized to range from 0 (best) to 100 (worst). We estimated multilevel linear mixed models predicting each PRO as a function of patient race, adjusting for clinical and sociodemographic factors, followed by further adjustment for practice racial composition. Results Twelve out of fifty-one (23.5%) practices reported a Black racial composition of >20%, with 41.6% of Blacks and 14.5% Whites receiving care at these practices.

Across all practices, Blacks reported worse pain (β=5.5, p=0.02), nausea (β=2.5, p=0.04) and financial burden (β=7.6, p<0.01), but less fatigue (β=-4.1, p=0.05) when compared with Whites. Regardless of race, patients receiving care at practices with a Black racial composition of >20% reported more pain (β=5.5, p=0.01), appetite loss (β=8.1, p<0.01), fatigue (β=5.1, p=0.01), nausea (β=2.3, p=0.05), dyspnea (β=4.3, p=0.04), and insomnia (β=4.8, p=0.03) than patients receiving care at practices comprised of ⇐20% Blacks. Practice racial composition did not mediate racial disparities in PROs. Conclusion Racial disparities in PROs were observed among patients treated at US community oncology practices. Practice racial composition was associated with multiple PROs, regardless of patient race, but racial disparities in PROs were not explained by practice racial composition. These findings suggest that identifying and addressing the needs of practices serving a disproportionate share of Black patents may be one effective strategy to mitigate practice-level disparities in cancer outcomes.

Citation Format: Cleo A. Samuel, Olive Mbah, Wendi Elkins, Marjory Charlot, Amylou Dueck, Brenda F. Ginos, Jennifer Jansen, Deborah Schrag, Patty Spears, Angela Stover, Ethan Basch. Separate and unequal: Examining the role of race and site of care on patient-reported outcomes among patients with metastatic cancer (AFT-39) [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-119.

Abstract D071: Impact of racial differences in financial burden on time to treatment

Background Racial disparities in time-to-treatment exist among cancer patients, with patients of color being more likely to experience treatment delays. Such racial differences in treatment initiation are likely on the causal pathway to inequities in treatment outcomes. Emerging research has documented racial differences in financial burden, but little is known about the contribution of financial burden to disparities in treatment delays. In this study, we evaluated whether financial burden partly accounted for racial disparities in time to treatment initiation among a cohort of cancer survivors. Methods We used cross-sectional data of patients enrolled in the University of North Carolina Health Registry/Cancer Survivorship Cohort (HR/CSC) between 2010 and 2016. The sample for this study was limited to cancer patients and survivors who identified as non-Hispanic White or Black, received a diagnosis for breast, genitourinary, gastrointestinal, or head or neck cancer, and completed a questionnaire at least 30 days following their diagnosis (N=2,123). Time to treatment was measured in number of days from diagnosis to start of first course of treatment, ascertained from the medical record. Initial treatment was either surgery, chemotherapy, radiation, or hormonal therapy, depending on the clinical indication. Financial burden was assessed using the Patient Satisfaction Questionairre-18 on the self-reported satisfaction with the financial aspects of care (>3.5 is satisfied; <=3.5 is unsatisfied). To assess racial differences in time to treatment, we conducted both unadjusted and adjusted OLS regression analysis. Results In the first model predicting time to treatment as a function of race and clinical factors only, Black race was associated with a 11.4 day increase in the number of days between diagnosis and treatment (p< 0.001). In a second model adjusting for race, clinical factors and financial burden, the absence of financial burden was associated with a decrease in the number of days between diagnosis and treatment (\beta=-3.2, p= 0.042). Results were similar in the final fully adjusted model accounting for the above covariates in addition to sociodemographic factors, with the absence of financial burden being associated with a minor decrease in the time to treatment initiation (\beta= -3.0, p= 0.044). There was only a minor attenuation in the Black-White disparity in the fully adjusted model, with Black race being associated with an increase of 10.6 days between diagnosis and treatment initiation (p=0.001). Conclusions In Black patients and patients who report experiencing financial burden a greater number of days elapse between diagnosis and treatment initiation. Decreases in the time from diagnosis to first treatment is a modifiable factor in treatment inequities whether both for related to financial burden and race.

Citation Format: Wendi Elkins, Olive Mbah, Jeannette T Benson, Laura Farnan, Neda Padilla, Sam Cykert, Bryce B Reeve, Giselle Corbie-Smith, Cleo A. Samuel. Impact of racial differences in financial burden on time to treatment [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D071.

Abstract B025: Examining the role of perceived respect on racial disparities in cancer-related pain

Background: Black cancer patients consistently report worse pain management than White patients. Effective pain management requires communication, and provider respect is linked to positive provider-patient communication. Racial differences in patient perceptions of respect during clinical encounters are well documented and linked to disparities in care, yet little is known about whether racial differences in perceived respect contribute to disparities in cancer pain. As part of the NCI-funded study, Accountability for Cancer Care through Undoing Racism and Equity, we examined whether perceived respect was associated with racial disparities in pain.

Methods: We obtained prospective survey data from Black and White breast and lung cancer patients in active treatment at two cancer centers from 2013-2017. The primary outcome was a binary measure of moderate-to-severe pain based on patient responses to PROMIS items 90 days post-diagnosis. A binary measure of “high” vs “low” respect was computed based on patient responses to a survey item assessing perceived respect from doctors at the last clinic visit. We estimated logistic regressions assessing associations between race and pain 90 days post-diagnosis and the mediating effect of respect, adjusting for patient demographics, baseline pain, clinical characteristics, and site of care.

Results: Compared with Whites (N = 200), Blacks (N = 119) were more likely to report moderate-to-severe pain (26.9% vs. 49.1%; p < .001), but less likely to report “high” respect during their most recent clinic visit (88.9% vs. 82.3%; p = .073), though the racial gap in respect was marginally significant. In adjusted analyses, Black race remained a statistically significantly predictor of moderate-to-severe pain (adjusted odds ratio [AOR] = 2.62; 95%CI:1.35-5.14). “High” respect was associated with less moderate-to-severe pain (AOR = 0.31; 95%CI:0.13-0.72), but racial disparities in pain were not attributable to racial gaps in perceived respect.

Conclusions: Black-White racial disparities in pain exist among cancer patients. While patient perceptions of respect were linked to pain severity and to some extent, race, perceived respect did not explain racial disparities in pain severity.

Citation Format: Cleo A. Samuel, Jennifer Schaal, Olive Mbah, Eugenia Eng, Linda Robertson, Stephanie Baker, Kristin Z. Black, Crystal Dixon, Katrina Ellis, Fatima Guerrab, Lauren C. Jordan, Alexandra F. Lightfoot, Samuel Cykert. Examining the role of perceived respect on racial disparities in cancer-related pain [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B025.

Community Engagement to Address Cancer Health Disparities: A Process EVALUATION using the Partnership Self-Assessment Tool

BACKGROUND

African Americans suffer disproportionately from cancer health disparities, and population-level prevention is needed.

OBJECTIVES

A community-academic partnership to address cancer health disparities in two predominately African American jurisdictions in Maryland was evaluated.

METHODS

The Partnership Self-Assessment Tool (PSAT) was used in a process evaluation to assess the partnership in eight domains (partnership synergy, leadership, efficiency, management, resources, decision making, participation, and satisfaction).

RESULTS

Mean scores in each domain were high, indicative of a functional and synergistic partnership. However, scores for decision making (Baltimore City's mean score = 9.3; Prince George's County's mean score = 10.8; p = .02) and participation (Baltimore City's mean score = 16.0; Prince George's County's mean score = 18.0; p = .04) were significantly lower in Baltimore City.

CONCLUSIONS

Community-academic partnerships are promising approaches to help address cancer health disparities in African American communities. Factors that influence decision making and participation within partnerships require further research.

Associations between the patient-physician relationship and health-related quality of life among patients with cancer

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Background: Health-related quality of life (HRQOL) is an important cancer care outcome. Patient-physician communication is linked to HRQOL, yet less is known about the role of other aspects of the patient-physician relationship in explaining HRQOL outcomes in cancer patients. Using secondary data from the Accountability for Cancer Care through Undoing Racism and Equity study, we examined associations between multiple patient-physician relationship factors and HRQOL in breast and lung cancer patients. Methods: The analysis included 283 patients receiving care at two cancer centers from 2013-2017. Survey data on socio-demographics, HRQOL, and patient-physician relationship (i.e., doctors’ respectfulness, time spent with doctors, doctors’ involvement of patient in decision-making, satisfaction with quality of care) were collected at baseline and during treatment. The primary outcome was a binary measure of poor-fair (vs. good-excellent) HRQOL 90 days post-diagnosis. We employed multivariate logistic regression to assess associations between patient-physician relationship factors and HRQOL. Results: In adjusted analyses, patients reporting high levels of physician respect had 78% lower odds of reporting poor-fair HRQOL than patients reporting low levels of respect (Adjusted Odds Ratio[AOR] = 0.22; 95%CI = 0.08-0.59). Patients who were optimally involved in their care had lower odds of poor-fair HRQOL than those less involved (AOR = 0.30; 95%CI = 0.12-0.77). Finally, patients who very satisfied with the quality of their care had a 40% lower odds of poor-fair HRQOL than those less satisfied with care (AOR = 0.40; 95% CI = 0.13-0.99). There was no association between amount of time spent with doctor and HRQOL. Conclusions: Multiple aspects of the patient-physician relationship, including doctor’s respectfulness, doctors’ involvement of patient in decision-making, and patient satisfaction with quality of care are associated with HRQOL among breast and lung cancer patients. Given the important role that HRQOL plays in treatment adherence and outcomes, these findings highlight the need for systems of care that optimize the physician-patient relationship in cancer care.

Patient navigation and clinical trial participation: A randomized controlled trial design

Background

To our knowledge, no published studies utilizing a randomized controlled design have examined the efficacy of patient navigation for improving clinical trial enrollment.

Methods

This patient navigation and clinical trial participation study is a randomized controlled trial to assess the effect of a patient navigator on enrollment into therapeutic cancer clinical trials. Participants are randomly assigned to high intensity, patient navigator-delivered patient educational materials (PEM) and needs assessment vs. low intensity patient navigation (patient navigator-delivered patient educational materials [PEM] alone). Discussion: Effective enrollment strategies may include utilization of patient navigators as away to meet individual needs, barriers, and concerns of participants enrolled in clinical trials.

Racial differences in symptom management experiences during breast cancer treatment

PURPOSE

Racial disparities in cancer treatment-related symptom burden are well documented and linked to worse treatment outcomes. Yet, little is known about racial differences in patients' treatment-related symptom management experiences. Such understanding can help identify modifiable drivers of symptom burden inequities. As part of the Cancer Health Accountability for Managing Pain and Symptoms (CHAMPS) study, we examined racial differences in symptom management experiences among Black and White breast cancer survivors (BCS).

METHODS

We conducted six focus groups (n = 3 Black BCS groups; n = 3 White BCS groups) with 22 stages I-IV BCS at two cancer centers. Focus groups were audio-recorded and transcribed verbatim. Based on key community-based participatory research principles, our community/academic/medical partner team facilitated focus groups and conducted qualitative analyses.

RESULTS

All BCS described positive symptom management experiences, including clinician attentiveness to symptom concerns and clinician recommendations for pre-emptively managing symptoms. Black BCS commonly reported having to advocate for themselves to get information about treatment-related symptoms, and indicated dissatisfaction regarding clinicians' failure to disclose potential treatment-related symptoms or provide medications to address symptoms. White BCS often described dissatisfaction regarding inadequate information on symptom origins and clinicians' failure to offer reassurance.

CONCLUSIONS

This study elucidates opportunities for future research aimed at improving equity for cancer treatment-related symptom management. For Black women, warnings about anticipated symptoms and treatment for ongoing symptoms were particular areas of concern. Routine symptom assessment for all women, as well as clinicians' management of symptoms for racially diverse cancer patients, need to be more thoroughly studied and addressed.

Abstract B27: A synergistic regional network's infrastructure to reduce cancer related health disparities

Cancer Health Disparities is defined by the National Cancer Institute (NCI) as “adverse differences in cancer incidence, prevalence, morbidity, mortality, survivorship, and burden of cancer or related health conditions that exist among specific population groups in the United States.” NCI recognizes the substantial progress in cancer treatment, screening, diagnosis, and prevention over the past several decades. However, addressing cancer-related health disparities in certain populations is an area in which progress has not kept pace. Therefore, NCI's Center to Reduce Center Health Disparities (CRCHD) created region-based “hubs” under the Geographic Management of Cancer Health Disparities Program (GMaP) to advance the science of cancer health disparities in the regions, contribute to the next generation of cancer health disparities researchers, and achieve measureable reductions in cancer health disparities in the United States.

GMaP Region 1 North (R1N) hub is based at the University of Kentucky Markey Cancer Center, with Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, University of South Carolina Cancer Prevention and Control Program, and the University of Virginia Cancer Center as lead institutions. The overall goal of GMaP R1N is to enhance the capacity of regional cancer centers, associated academic partners, community partners, and early-stage investigators to contribute to the reduction of cancer health disparities in the region covering Kentucky, West Virginia, Virginia, Delaware, Maryland, New Hampshire, Vermont, Maine, and Washington DC.

GMaP R1N is utilizing an infrastructure of investigators and partners throughout the region that serve on the Advisory Committee, Education and Outreach Subcommittee, Diversity Training Subcommittee, and/or Evaluation Subcommittee to: create opportunities for scientific exchange, cooperation, and collaboration among cancer and cancer-related health disparities researchers throughout the region; attract underrepresented students, trainees/scholars, and investigators to the biomedical cancer research enterprise; enhance access of underrepresented students, trainees, and scholars to career development and mentoring opportunities; and increase cancer information dissemination and sharing of best practices among researchers and trainees/ scholars.

Using this infrastructure, R1N anticipates enhanced collaboration between regional cancer centers and other academic partners, including regional minority serving institutions; increases in the number of competitive collaborative grant applications to NCI from regional cancer and academic centers; increases in the number of successful K- and R- award applications to NCI by underrepresented students, trainees/scholars, and investigators in the region; increased mentoring relationships developed, both within and across regional cancer and academic centers; and increased dissemination of research and career development opportunities across regional institutions.

Citation Format: Neha Jaggi, Julia Faith Houston, James R. Hebert, Mark Dignan, Nathan L. Vanderford, Mark Cromo, Mark Evers, Janice Bowie, Adrian Dobs, Olive Mbah, Ashleigh DeFries Gallagher, Roger Anderson. A synergistic regional network's infrastructure to reduce cancer related health disparities. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B27.

Abstract A81: Utilizing the Geographic Management of Cancer Health Disparities Program (GMaP) Region 1 North partnership survey as a tool to promote mentoring and collaborative grant applications

Introduction:

Region 1 North of the National Cancer Institute's Geographic Management of Cancer Health Disparities Program (GMaP) is based at the University of Kentucky Markey Cancer Center (UK MCC). GMaP was funded for a three-year period as a supplement to the UK MCC Cancer Center Support Grant with an overall goal to reduce cancer health disparities. Efforts to achieve this goal include enhancing the capacity of regional cancer centers, associated academic partners, community partners, and early-stage investigators to increase research on disparities by fostering collaborative research applications and facilitating the career development of the next generation of underrepresented cancer and cancer health disparities investigators.

Methods:

UK MCC GMaP investigators are partnering with researchers at Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, the University of Virginia Cancer Center, the University of South Carolina Cancer Prevention and Control Program, and other regional cancer center and academic partners to implement multi-faceted programming to increase and strengthen collaborative research and training efforts across the Region 1 North coverage area, which includes DC, DE, KY, ME, MD, NH, VA, VT, and WV. GMaP Region 1 North has implemented an online survey of investigators and partners throughout the region to assess their career level, research focus and interests, and readiness to submit grant applications within the next 12 months.

Results:

A total of 161 responses to the survey have been received. The respondents include undergraduate and graduate students, faculty members, research and administrative staff and community members. Over 70% of respondents described themselves as researchers (32% cancer center researchers) and almost 50% as mentors. The most common response categories for types of research conducted include basic science (52%), translational (44%), cancer health disparities (39%) and behavioral/population focused research (36%). Of those currently funded by extramural sources, 26% reported R01 funding and nearly all of the remaining respondents reported funding by a wide variety of other NIH mechanisms. Most (88%) respondents indicated that they are planning R01 and/or R21 applications within the next 12 months.

Conclusion:

The survey has provided Region 1 North investigators with a working foundation for matching mentors with underrepresented early-stage investigators for K- and R-series grant applications. Additionally, the survey results provide a tool to promote collaborative applications across regional institutions through targeted communication and media efforts.

Citation Format: Mark B. Dignan, Nathan L. Vanderford, B Mark Evers, Mark Cromo, Janice Bowie, Adrian Dobs, Ashleigh Gallagher, Olive Mbah, Julia F. Houston, Neha Jaggi, Roger Anderson, James R. Hebert. Utilizing the Geographic Management of Cancer Health Disparities Program (GMaP) Region 1 North partnership survey as a tool to promote mentoring and collaborative grant applications. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A81.

Abstract A86: Challenges and opportunities for increasing the rates of HPV vaccination

Purpose: The purpose of this study is to determine the association between awareness of human papillomavirus (HPV), cervical cancer, and HPV vaccine and intention to vaccinate preteens and teens against HPV.

Background: Genital human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, and results in 14 million new cases each year. Around 50% of new HPV infections occur among persons aged 15-24 years old. Cervical cancer is primarily attributable to HPV, and the yearly cost of cervical cancer screening as well as treatment of HPV-related diseases is around $8 billion. In 2009, around 35,000 HPV-related cancers were reported in the United States. The level of coverage for 3 HPV vaccine doses for females aged 13-15 years was only 30% in 2011. This is far below the 80% target coverage level set by Healthy People 2020. The 2013 National Immunization Survey-Teen found that only 50% of Maryland females aged 13-17 years and only 34.2% of male adolescents reported beginning the HPV vaccine series.

According to the 2013 Maryland Cancer Data, Maryland had the 25th highest cervical cancer mortality rate from 2006-2010. During these years, more black women were diagnosed with cervical cancer than White women, and their rate of cervical cancer incidence has been increasing at a rate of 4.9% more per year than white women. We investigate the relationship between HPV, cervical cancer, and HPV vaccine awareness and intention to vaccinate preteens and teens against HPV.

Methods: Utilizing the principles of community-based participatory research (CBPR), the Johns Hopkins Center to Reduce Cancer Disparities, in collaboration with its Community Advisory Groups in Baltimore City and Prince George's County, developed and implemented a survey to assess the knowledge, awareness and behavioral intentions on cervical cancer, HPV and HPV vaccine. The study was approved by the Johns Hopkins School of Medicine's Institutional Review Board and implemented between March 2015 and July 2015 in Baltimore City and Prince George's County. Four hundred and three individuals recruited through community events completed the assessment. Upon completion of the assessment, participants were given feedback on their responses to address any knowledge gap and educational materials. Binary and multinomial logistic regression were used to determine the association between awareness of HPV, cervical cancer, and HPV vaccine and intention to vaccinate children between the ages of 11 and 18 years against HPV.

Results: The majority of study participants were female (78%), black or African American (87%), have at least one year of college or technical school (55%) and have an annual household income of less $20,000 (38%).

Awareness of the existing of HPV vaccine is significantly associated (OR=2.54, P<0.0007, CI 1.487-4.355) with the intention to vaccinate children against HPV. We also found that individuals who never heard of the HPV vaccine are significantly less likely (OR=0.394, p<0.0007, CI 0.230-0.673) to vaccinate their children against HPV than those who have heard of the vaccine. Furthermore, those who are aware of HPV are significantly more likely to know that HPV can cause cervical cancer (OR=5.25, P<0.0001, CI 3.272-8.454) and to know that HPV is transmitted through sexual contact (OR=3.66, P<0.0001, CI 2.199-6.100) compared to those who never heard of HPV.

Conclusion: Awareness of HPV, cervical cancer, and HPV vaccine are significantly associated the intention to vaccinate children between the ages of 11 and 18 years against HPV. Increasing knowledge of cervical cancer and the importance of HPV vaccination among parents and caretakers of preteens and teens have the potential to increase the rates of HPV vaccination and prevent future cervical cancers. More research is needed to explore other factors that are related to HPV vaccination.

Citation Format: Ahmed Elmi, Saad Tassaduq, Olive Mbah, Ashleigh DeFries, Lee Bone, Anjani Kapadia, Theron Scott, Nichole Tuite, Adrian Dobs. Challenges and opportunities for increasing the rates of HPV vaccination. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A86.

Mobilizing social support networks to improve cancer screening: the COACH randomized controlled trial study design

BACKGROUND

Disadvantaged populations face many barriers to cancer care, including limited support in navigating through the complexities of the healthcare system. Family members play an integral role in caring for patients and provide valuable care coordination; however, the effect of family navigators on adherence to cancer screening has not previously been evaluated. Training and evaluating trusted family members and other support persons may improve cancer outcomes for vulnerable patients.

METHODS

Guided by principles of community based participatory research (CBPR), "Evaluating Coaches of Older Adults for Cancer Care and Healthy Behaviors (COACH)" is a community-based randomized controlled trial to assess the effectiveness of a trained participant-designated coach (support person or care giver) in navigating cancer-screening for older African American adults, 50-74 years old. Participants are randomly assigned as dyads (participant+coach pair) to receiving either printed educational materials only (PEM--control group) or educational materials plus coach training (COACH--intervention group). We defined a coach as family member, friend, or other lay support person designated by the older adult. The coach training is designed as a one-time, 35- to 40-minute training consisting of: 1) a didactic session that covers the role of the coach, basic facts about colorectal, breast and cervical cancers (including risk factors, signs and symptoms and screening modalities), engaging the healthcare provider in cancer screening, insurance coverage for screening, and related healthcare issues, 2) three video skits addressing misconceptions about and planning for cancer screening, and 3) an interactive role-play session with the trainer to reinforce and practice strategies for encouraging the participant to get screened. The primary study outcome is the difference in the proportion of participants completing at least one of the recommended screenings (for breast, cervix or colorectal cancer) between the control and intervention groups.

DISCUSSION

Building on trusted patient contacts to encourage cancer screening, COACH is a highly sustainable intervention in a high-risk population. It has the potential to minimize the effect of mistrust of the medical establishment on screening behaviors by mobilizing participants' existing support networks. If effective, the intervention could have a high impact on health care disparities research across multiple diseases.

TRIAL REGISTRATION

ClinicalTrials.gov ( NCT01613430 ). Registered June 5, 2012.

Targeting and Tailoring Health Communications in Breast Screening Interventions

BACKGROUND

Members of underrepresented minority (URM) groups are at higher risk of disproportionately experiencing greater breast cancer-related morbidity and mortality and thus, require effective interventions that both appropriately target and tailor to their unique characteristics.

OBJECTIVES

We sought to describe the targeting and tailoring practices used in the development and dissemination of three breast cancer screening interventions among URM groups.

METHODS

Three national Community Network Programs (CNPs) funded by the National Cancer Institute have focused on breast cancer screening interventions as their major research intervention. Each targeted different populations and used participatory research methods to design their intervention tailored to the needs of their respective audience. The Alameda County Network Program (ACNP) to Reduce Cancer Disparities partnered with community members to design and conduct 2-hour "Tea Party" education sessions for Afghan women. The Kansas Community Cancer Disparities Network co-developed and deployed with community members a computerized Healthy Living Kansas (HLK) Breast Health program for rural Latina and American Indian women. The Johns Hopkins Center to Reduce Cancer Disparities employed a train-the-trainer COACH approach to educate urban African-American women about breast cancer.

CONCLUSIONS

Each CNP program targeted diverse URM women and, using participatory approaches, tailored a range of interventions to promote breast cancer screening. Although all projects shared the same goal outcome, each program tailored their varying interventions to match the target community needs, demonstrating the importance and value of these strategies in reducing breast cancer disparities.

Abstract B15: Effect of patient navigation on mammography screening among African American female Medicare beneficiaries at risk for low health literacy

Context: African American older adult women are diagnosed with more advanced breast cancer and have lower survival rates than White women. While differences in health literacy may contribute to this disparity, there is limited information on intervention strategies to promote cancer screening among low-literate African American older adults.

Objective: To evaluate the effect of a patient navigator on adherence to mammography screening among African American female Medicare beneficiaries with low literacy scores. Design, Setting, and Participants: We analyzed data from the Cancer Prevention and Treatment Demonstration (CPTD) at Johns Hopkins, an ongoing community-based trial designed to determine whether patient navigation is an effective strategy for improving adherence to cancer screening among African American older adults. Participants are randomized to either a high intensity group (patient navigation = educational materials) or a low intensity group (educational materials only). This analysis included 272 women ages of 65 and older with low literacy scores, who were enrolled into the study between November 2006 and March 2010, and had at least one year of follow up data. Baseline and one year follow up interviews were conducted face to face by trained interviewers through standardized questionnaires. The REALM-R instrument was used to identify participants at risk for low health literacy, based on their score.

Main Outcome Measure: The outcome measure for this analysis was the between-group difference in the proportion of women receiving mammography screening during the follow up period. Multiple logistic regression was performed to control for potential confounders such as age, education, Medicaid coverage, and perceived health status.

Results: Compared to the educational materials only group (n=77), the patient navigation group (n=107) had a similar proportion of women who reported a mammogram at one year follow up (64% vs. 71 %, p-value = 0.32). However, after adjusting for baseline health and demographic characteristics, women in the patient navigation group were more likely to report a mammogram at one year follow up, compared to those in the educational materials group (OR 1.90 95% CI 1.01-3.54). Women who rated themselves as having excellent to good health at baseline were less likely to report a mammogram, than those who reported fair to poor health (OR 0.43 95% CI 0.21-0.87).

Conclusions: Use of a patient navigation-based intervention was positively associated with mammography screening adherence among African American older adult women with low literacy scores. In this study population, perception of health status may influence mammography screening adherence. Our findings underscore the need for tailored intervention strategies to reduce cancer screening disparities among low-literate African American older adults.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B15.