Abstract D067: The REACT study: A feasibility study to develop and test the integration of a California Cancer Registry Early Case Ascertainment process via electronic pathology reporting with an online clinical trial matching tool

Background: Representation of diverse patient populations in prostate cancer clinical trials is essential to ensure that trial results are applicable to all affected men. However, underrepresentation among racial/ethnic minorities remains a critical problem in cancer research. Population-based cancer registries provide a potential platform to overcome problems with inclusion of diverse patient populations in clinical research if they are used as a source for recruitment. Methods: Leveraging the statewide implementation of electronic pathology (e-path) for cancer case identification, we performed a pilot feasibility study, REACT (Registry Early case Ascertainment process via e-path with an online Clinical Trial matching tool), within the Greater Bay Area Cancer Registry to (1) develop and test a process using e-path to rapidly identify new cases of advanced prostate cancer for potential enrollment into existing prostate cancer clinical trials; and (2) test the utility of an online clinical trial matching tool used in combination with e-path to improve matching of underrepresented patients into advanced prostate cancer clinical trials. All study materials were translated into Spanish, and a Spanish-speaking bilingual recruiter is one of two recruiters. This study will accrue 50 patients. Results: Thus far, a total of 224 cases were identified from 19 reporting facilities through e-path and 213 (92%) were sent invitation letters. We have initiated recruitment contact calls with N=101; of these, 11 were excluded due to physician-indicated contraindication, and 17 (17%) declined participation. To date, 12 patients have enrolled in the study, 10 of whom completed baseline surveys, and 4 subsequently completed follow-up surveys after using the online matching tool. The majority (N=7) of participants were NH White; of higher income, >$150,000 (N=6); and of higher education, >bachelor’s/associate degree (N=8). Nine participants indicated use of the internet to learn about prostate cancer and 4 found internet prostate-cancer related information very useful. Nine participants reported receipt of prostate cancer treatment in the past 3 months, 8 received hormonal therapy, 4 received radiation, and 2 received surgery. To assess research knowledge and attitudes, 7 indicated awareness of cancer clinical trials, 6 indicated interest in participating in clinical research, 7 held a positive and 3 held a neutral attitude towards cancer clinical trials, however 5 indicated that they would not participate in a randomized study. To assess utility of the matching tool, 2 indicated it increased their interest in participating in clinical trials. Discussion: As the study progresses, we will focus effort on recruitment of underserved patients. However, thus far, preliminary results indicate that e-path used in combination with an online clinical trial matching tool may serve as an important recruitment vehicle for prostate cancer clinical trials.

Citation Format: Hala T Borno, Christine Duffy, Sylvia Zhang, Todd Golden, Zinnia Loya, Debby Oh, Anobel Odisho, Scarlett Lin Gomez. The REACT study: A feasibility study to develop and test the integration of a California Cancer Registry Early Case Ascertainment process via electronic pathology reporting with an online clinical trial matching tool [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 D067.

Designing for impact: identifying stakeholder-driven interventions to support recovery after major cancer surgery

PURPOSE

Complex bladder and colorectal cancer surgeries are associated with significant patient morbidity, yet few resources exist to prepare patients for the high levels of distress and complications they may experience. After ethnographic research to identify design challenges, we held a user-centered design (UCD) workshop to begin to develop patient- and caregiver-centered interventions to support preparation for and recovery after complex cancer surgery.

METHODS

Concepts that emerged from brainstorming sessions were visually represented on storyboards and rated. Highly scored concepts were further developed in break-out prototyping sessions and then presented to the entire group for review in person and during subsequent webinars. We collected workshop products (worksheets, prototypes, and recordings) for analysis to identify opportunities for intervention. The workshop, held in late 2014, was attended by three colorectal/oncologic surgeons, three urologic surgeons, five ostomy nurses, one quality improvement leader, three patients, one caregiver, and three experienced UCD facilitators.

RESULTS

Three opportunity areas were identified: (1) enhanced patient education including tele-health and multi-media tools (available at hospitals/clinics or online in any setting), (2) personalized discharge assessment and care planning, and (3) integrated symptom monitoring and educational interventions. Stakeholders reached consensus that enhanced patient education was the most important direction for subsequent intervention development.

CONCLUSIONS

We engaged diverse stakeholders in a participatory, UCD process and concluded that research and practice improvement should prioritize the development of educational interventions in the pre-operative period to set the groundwork for improving appropriate self-care during recovery from major colorectal and bladder cancer surgeries.

Using an abdominal phantom to teach urology residentes ultrasound-guided percutaneous needle placement

INTRODUCTION

To assess the effect of a hands-on ultrasound training session to teach urologic trainees ultrasound-guided percutaneous needle placement.

MATERIALS AND METHODS

University of California, San Francisco (UCSF) urology residentes completed a time trial, placing a needle into a phantom model target under ultrasound guidance. Participants were randomized into three educational exposure groups: Group 1's time trial occurred prior to any teaching intervention, group 2's after experiencing a hands-on training module, and group 3's after exposure to both the training module and one-on-one attending feedback. Needle placement speed and accuracy as well as trainees' perceived confidence in utilizing ultrasound were measured.

RESULTS

The study cohort consisted of 15 resident trainees. Seven were randomized to group 1, three to group 2, and five to group 3. All residents reported minimal prior ultrasound experience. Their confidence in using ultrasound improved significantly after completing the training module with the most significant improvement seen among junior residents. Time to needle placement was fastest after receiving attending feedback (46.6sec in group 3 vs. 82.7sec in groups 1 and 2, p<0.01). Accuracy also improved with attending feedback, though the number of repositioning attempts did not differ significantly between groups.

CONCLUSIONS

A hands-on training module and use of an abdominal phantom trainer increased resident confidence and skill in their use of ultrasound to guide percutaneous needle positioning. Attending feedback is critical for improving accuracy in needle guidance toward a target. Ultrasound-guided needle positioning is a teachable skill and can be applicable to multiple urologic procedures.

Disparities in prostate cancer treatment associated with population density of the county of residence

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Background: We sought to assess disparities in primary treatment of prostate cancer by examining the effect of population density of the county of residence on treatment for clinically localized prostate cancer and quantify variation in primary treatment attributable to county and SEER site. Methods: Participants included 138,226 men with clinically localized prostate cancer who underwent surgery, radiation, or conservative therapy in the Surveillance, Epidemiology, and End Result (SEER) database diagnosed in 2005 through 2008. Mixed effects hierarchical logit models were used to examine the effect of population density of the county of residence on treatment while accounting for the random effects of counties nested within SEER sites. In order to quantify the effect of county and SEER site on individual treatment, the percent of total variance in treatment attributable to county of residence and SEER site was estimated with residual intraclass correlation coefficients. Results: Men in metropolitan counties had 23% higher odds of being treated compared with men in rural counties, controlling for number of urologists per county as well as patient clinical and sociodemographic characteristics. Age, race/ethnicity, PSA at diagnosis, and tumor characteristics were also significant predictors of treatment in the multivariable model. The percent of variation in treatment attributable to the county of residence was consistently higher than that attributable to SEER site. 3% (95% CI: 1.2%-6.2%) of the total variation in treatment was attributable to SEER site, while 6% (95% CI: 4.3%-9.0%) of variation was attributable to county of residence, controlling for clinical and sociodemographic characteristics. This variation at the county and SEER site increased to 4% and 10%, respectively, when specific type of treatment (surgery or radiation) was assessed. Conclusions: Variation in treatment for localized prostate cancer exists for men living in different population dense counties of the country. These findings highlight the need for comparative effectiveness research and health policy initiatives to advance prostate cancer research and reduce disparities in current clinical practice.

Misclassification of bronchioloalveolar carcinoma with cytologic diagnosis of lung cancer

INTRODUCTION

Cytology is commonly used to diagnose non-small cell lung cancer (NSCLC) but is an inaccurate means of diagnosis of bronchioloalveolar carcinoma (BAC). The aims of this study were to calculate the sensitivity and specificity of cytologic diagnosis of BAC and to estimate the misclassification of BAC as other subtypes of NSCLC.

METHODS

Preoperative fine-needle aspiration cytology diagnoses were compared to histology diagnoses in 222 patients, including 51 patients with pure or mixed BAC, who underwent lung resection for NSCLC at our institution since 1999.

RESULTS

The sensitivity and specificity of a cytologic diagnosis of BAC were 12% and 99%, respectively. Based on cytologic diagnosis, 63% of BAC was misclassified as adenocarcinoma, and 18% was misclassified as undifferentiated NSCLC. In this cohort, 35% of adenocarcinomas and 12% of undifferentiated NSCLC diagnosed by cytology had BAC histology.

CONCLUSIONS

Diagnosis of NSCLC by cytology alone results in significant misclassification of BAC, most commonly as adenocarcinoma or undifferentiated NSCLC. Because patients with BAC respond differently to certain treatments such as endothelial growth factor receptor inhibitors and surgical resection of multifocal lung cancer, misclassification of BAC may have important therapeutic implications.