Thematic analysis of the psycho-sexual symptoms in patients with Peyronie's disease present on online forums

Peyronie's disease (PD) is a fibrotic disorder of the tunica albuginea that may result in penile deformity, pain, a palpable plaque, and erectile dysfunction. In order to understand the psycho-sexual impacts of PD on patients and their partners, we selected three online forums containing the largest number of threads on PD. Threads focusing on the psycho-sexual impacts posted from January 1, 2011 to January 1, 2021 were compiled, and thematic analysis was performed on Dedoose. There were 277 unique posters, including 225 patients and 52 partners. Eighty-four categories and five themes were developed including information and social support, physical symptoms, psycho-sexual symptoms, treatment and effect, and impacts on partners and relationship. Emotional distress including depressed mood (n = 75, 33.3%) and feelings of isolation (n = 41, 18.2%) was prevalent. Partners developed sexual dysfunction including sexual dissatisfaction (n = 11, 21.2%) and dyspareunia (n = 4, 7.7%). Relationships experienced disruption (n = 14, 5.1%) or termination (n = 10, 3.6%). Posters received psychological treatment including psychotherapy (n = 20, 8.9%) and antidepressants (n = 17, 7.6%). Of these, 12 reported improvement and 11 stated no improvement. On these forums, psychological burden affecting individuals with PD and their partners is reported. Few seek help from a psychologist or therapist, and psychological distress may persist even after successful PD treatment. Further research is needed to identify strategies for effective psychological management.

Development and pilot of an online, personalized risk assessment tool for a breast cancer precision medicine trial

Breast cancer risk reduction has been validated by large-scale clinical trials, but uptake remains low. A risk communication tool could provide personalized risk-reduction information for high-risk women. A low-literacy-friendly, visual, and personalized tool was designed as part of the Women Informed to Screen Depending On Measures of risk (WISDOM) study. The tool integrates genetic, polygenic, and lifestyle factors, and quantifies the risk-reduction from undertaking medication and lifestyle interventions. The development and design process utilized feedback from clinicians, decision-making scientists, software engineers, and patient advocates. We piloted the tool with 17 study participants, collecting quantitative and qualitative feedback. Overall, participants felt they better understood their personalized breast cancer risk, were motivated to reduce their risk, and considered lifestyle interventions. The tool will be used to evaluate whether risk-based screening leads to more informed decisions and higher uptake of risk-reduction interventions among those most likely to benefit.

QOLP-12. EMBEDDING OUTPATIENT PALLIATIVE CARE INTO NEURO-ONCOLOGY CLINIC – RESULTS FROM A ONE YEAR PILOT

BACKGROUND

Glioblastoma (GBM) patients fall within NCCN and ASCO guidelines for early palliative care (PC). However, data suggests they are less likely than systemic cancers to be referred to PC and often later in their illness. This results in potential missed opportunities, both for improving symptom control and earlier completion of important tasks, like advance care planning. Data on how to best incorporate comprehensive PC into routine neuro-oncology (NO) patient care is needed.

METHODS

We piloted a program embedding a PC physician into UCSF’s NO clinic one half-day per week. NO physicians were encouraged to refer GBM patients within 3 months of diagnosis and other patients with PC needs. PC visits were offered in-person, by telemedicine, or at home. PC physician and NO social worker made joint visits when possible; chaplaincy support was available by telemedicine. Data was collected using Palliative Care Quality Network (PCQN) database and patient satisfaction survey.

RESULTS

To date, 37 patients have been referred resulting in 103 visits (average 2.8 visits/person): 25% in-person; 68% telemedicine; 6% at home. PC physician and NO social worker met jointly with 46% visits. Median age was 58 years, 41% female, 81% non-Hispanic white, 84% GBM, median 9 months from diagnosis, and 73% receiving first line treatment. Interventions addressed across visits: 94% non-pain symptoms, 76% psychosocial needs; 71% pain; and 70% GOC. Results from satisfaction survey demonstrated 79% would recommend seeing PC embedded in NO to others and highest benefits were attention to practical considerations to staying healthy at home, discussing preferences for future medical care, and help with coping.

CONCLUSIONS

Embedding PC into NO clinics is a unique model for addressing symptoms and GOC early, is well received by patients and caregivers, and provides opportunities for collaboration and PC physicians to specialize in caring for needs of NO patients.

Abstract P4-10-03: Tobacco exposure and breast cancer

Background: Smoking is a known risk factor for various types of cancer, and breast cancer patients who smoke are known to have higher breast cancer mortality. However, few studies have found an association between smoking and breast cancer incidence or tumor biology. The Athena Breast Health Network distributes an intake questionnaire at the UCSF and UCSD breast care centers which can be used to investigate links between tobacco exposure and the characteristics of incident breast cancer.

Methods: Intake questionnaires were distributed to all new patients at the UCSF and UCSD breast care centers from December 2012 to May 2018. Patients who completed the questionnaire with a known diagnosis of breast cancer were compared to those without in a case-control study. Breast cancer diagnoses were determined by ICD9 diagnosis codes from the patients' medical records. The association of smoking and breast cancer prevalence and biology was analyzed using generalized linear models and Fisher tests in R.

Results: Of the 7727 patients who completed the Athena intake questionnaire at UCSF and UCSD, 5499 consented to have their data used for research. A first analysis was conducted on 4175 UCSF patients alone: 2186 of the UCSF patients who had completed the questionnaire had a documented breast cancer diagnosis, vs 1989 with no known diagnosis at the time of this analysis. 1096 of the 4175 UCSF patients reported having ever smoked, including 73 who had accrued 30 or more pack years. Complete pathology data was available for 1120 cancer patients. Controlling for age, more patients with invasive breast cancer reported having ever smoked, with an odd's ratio (OR) of 2.32 (p = .0043). By including DCIS, the OR drops slightly to 2.26 (p = .0058). Taking alcohol consumption into account as a confounder lowered the OR to 2.19 (p = .0454). Overall, the risk of breast cancer increases with each additional pack year (OR = 1.08, p = .0211), independent of age. There are no significant differences in tumor biology for any smoking group.

Conclusions: A history of smoking is associated with an increased risk of developing breast cancer and is directly related to cumulative pack years exposure. This association should be further validated in cohort studies.

Citation Format: Dreher N, Layton TM, Parker BA, Shibley WP, Acerbi I, Wallace AM, Blair S, Pierce JP, Glantz S, Guydish J, Hiatt R, van 't Veer L, Esserman L, Athena Breast Health Network Investigators and Advocate Partners. Tobacco exposure and 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 P4-10-03.

Abstract P5-13-17: Comparing characteristics of patients who fill out online surveys before visits with patients who fill out surveys in-clinic with staff assistance at the UCSF breast screening clinic

Background: At the UCSF breast screening clinic, intake surveys are sent to women with upcoming mammogram appointments to obtain their demographic data, comorbidities, and assess breast cancer risk (family history, biopsy history). Many patients complete surveys online before their visit. For those who do not, a staff member is present to assist with survey completion on a tablet in-clinic.

Methods: Data was collected from 10,755 patients from December 2012–May 2018. To assess if different survey modalities capture different demographic groups, we analyzed these submissions, comparing responses completed by patients online before visits and in-clinic with assistance.

Results:On average, 48% of invited patients complete a survey. Of respondents 76% completed surveys before visits and 24% completed surveys in-clinic. Both methods captured electronic data that was summarized and presented to clinicians for clinical decision support. Compared to the in-clinic group, a before group patient was more likely to be white, married, and have at least a college education. The before group included a smaller proportion of patients who were Black/African American, Hispanic/Latina, and 65 years or older. Furthermore, a greater proportion of the before group reported 2 or more comorbidities. The before population reported more often having fair or poor health over the preceding 30 days. While these differences were statistically significant, it is important to put some of these results into perspective: while only 24% of survey responses were collected in-clinic, 59.1% of all Black/African American responses and 33.5% of all Hispanic/Latina responses were represented in this group.

  Before group (N=7869) In-clinic group (N=2886)P valueWhite64.43%55.79%<0.0001Black/African American3.57%10.91%<0.0001Hispanic/Latina7.96%10.91%<0.0001Aged 65 or older29.84%39.54%<0.0001Married66.40%56.10%<0.0001College educated or more79.93%66.87%<0.00012 or more diagnosed comorbidities38.18%30.32%<0.0001Poor or Fair health over last 30 days10.41%5.45%<0.0001

Conclusions/Future Directions: 1) Online surveys are completed more often by traditionally well-represented groups. Offering staff supported electronic surveys in-clinic improves the total yield and diversity of patients who complete surveys. More research is required to see the impact of income levels. 2) We did not anticipate a greater incidence of fair or poor health over the last 30 days or the higher number of patients reporting 2 or more comorbidities in the before group. This could result from the before group having better access to health care, and more familiarity with health surveys, but more detailed study is needed. 3) We will investigate further issues of health care trust, familiarity, and access to adjust our clinic practices. As more studies move surveys entirely online, we need to identify and address factors that prevent patients from completing surveys before appointments. Alternative survey modalities must be made available in accessible ways and integrated into routine clinical practice.

Citation Format: Shibley WP, Dreher N, van 't Veer L, Acerbi I, Fiscalini AS, Keane H, Esserman LJ, Athena Breast Health Network Investigators and Advocate Partners. Comparing characteristics of patients who fill out online surveys before visits with patients who fill out surveys in-clinic with staff assistance at the UCSF breast screening clinic [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 P5-13-17.