Aastha Chandak

Patient–Provider Communication About Prostate Cancer Screening and Treatment New Evidence From the Health Information National Trends Survey

The American Urological Association, American Cancer Society, and American College of Physicians recommend that patients and providers make a shared decision with respect to prostate-specific antigen (PSA) testing for prostate cancer (PCa). The goal of this study is to determine the extent of patient–provider communication for PSA testing and treatment of PCa and to examine the patient specific factors associated with this communication. Using recent data from the Health Information National Trends Survey, this study examined the association of patient characteristics with four domains of patient–provider communication regarding PSA test and PCa treatment: (1) expert opinion of PSA test, (2) accuracy of PSA test, (3) side effects of PCa treatment, and (4) treatment need of PCa. The current results suggested low level of communication for PSA testing and treatment of PCa across four domains. Less than 10% of the respondents report having communication about all four domains. Patient characteristics like recent medical check-up, regular healthcare provider, global health status, age group, marital status, race, annual household income, and already having undergone a PSA test are associated with patient–provider communication. There are few discussions about PSA testing and PCa treatment options between healthcare providers and their patients, which limits the shared decision-making process for PCa screening and treatment as recommended by the current best practice guidelines. This study helps identify implications for changes in physician practice to adhere with the PSA screening guidelines.

Estimating the State-Level Supply of Cancer Care Providers: Preparing to Meet Workforce Needs in the Wake of Health Care Reform

PURPOSE This study describes the supply of cancer care providers-physicians, nurse practitioners (NPs), and physician assistants (PAs)-in Nebraska and analyzes changes in the supply over a 5-year period. METHOD We used workforce survey data for the years 2008 to 2012 from the Health Professions Tracking Service to analyze the cancer care workforce supply in the state of Nebraska. The supply of cancer care providers was analyzed over the 5-year period on the basis of age, sex, specialty, and practice location; distribution of work hours for cancer care physicians was analyzed for 2012. RESULTS From 2008 to 2012, there was a 3.3% increase in the number of cancer care physicians. Majority of the cancer care physicians (82.5%), NPs (81.1%), and PAs (80%) reported working in urban counties, whereas approximately half of the states population resides in rural counties (47%). Compared with the national distribution, Nebraska has a lower proportion of medical oncologists, radiation oncologists, and pediatric hematologists/oncologists. The gap between the number of cancer care physicians age ≥ 64 years and the number younger than 40 years is slowly closing in Nebraska, with an increase in those age ≥ 64 years. CONCLUSION Increasing cancer incidence and improved access to cancer care through the Affordable Care Act could increase demand for cancer care workers. Policymakers and legislators should consider a range of policies based on the best available data on the supply of cancer care providers and the demand for cancer care.

Discovering Sexual Health Conversations between Adolescents and Youth Development Professionals.

Youth development professionals (YDPs) working at community-based organizations are in a unique position to interact with the adolescents because they are neither parents/guardians nor teachers. The objectives of this study were to explore qualitatively what sexual health issues adolescents discuss with YDPs and to describe those issues using the framework of the Sexuality Information and Education Council of the United States (SIECUS) comprehensive sexuality education guidelines. YDPs reported conversations with adolescents that included topics related to the SIECUS key concepts of human development, relationships, personal skills, sexual behavior, and sexual health.

Postoperative mortality following multi-modality therapy for pancreatic cancer: Analysis of the SEER-Medicare data

The objective of this study was to examine post‐operative mortality for elderly pancreatic cancer patients treated with multi‐modality therapy.

Risk Factors for In-Hospital Mortality in Heart Failure Patients: Does Rurality, Payer or Admission Source Matter?

PURPOSE Considering the high prevalence of heart failure and the economic burden of the disease, factors that influence in-hospital mortality are of importance in improving outcomes of care for this patient population. The purpose of this study was to examine the determinants of in-hospital mortality for adult heart failure patients. METHODS The study design is a retrospective observational study design using the 2010 Nebraska Hospital Discharge data set including 4,319 hospitalizations for 3,521 heart failure patients admitted to 79 hospitals in Nebraska. Hierarchical logistic regression models including patient- and hospital-specific random intercepts were analyzed. Covariates included in the analysis were patient age in years, gender, comorbidity status, length of stay, primary payer, type and source of admission, transfers, and rurality of county of residence. RESULTS Overall, 3.5% of heart failure patients died during their hospital stay. In logistic regression analysis that adjusted for age, sex, and comorbidities, the odds of dying in hospital for heart failure patients increased with age (OR = 1.03, 95% CI: 1.01-1.04), co-morbidity (OR = 1.15; 95% CI: 1.05-1.25) and length of stay (OR = 1.03, 95% CI: 1.01-1.05). The patients gender, payer source, rurality of county of residence, source, and type of admission were not risk factors for in-hospital death. CONCLUSION Increasing age, comorbidity and length of stay were risk factors for in-hospital death for heart failure. An understanding of the risk factors for in-hospital death is critical to improving outcomes of care for heart failure patients.

Readiness for Teledentistry: Validation of a Tool for Oral Health Professionals

We validated a survey tool to test the readiness of oral health professionals for teledentistry (TD). The survey tool, the University of Calgary Health Telematics Unit’s Practitioner Readiness Assessment Tool (PRAT) gathered information about the participants’ beliefs, attitudes and readiness for TD before and after a teledentistry training program developed for a rural state in the Mid-Western United States. Ninety-three dental students, oral health and other health professionals participated in the TD training program and responded to the survey. Wilcoxon signed rank test was used to assess statistical differences in the change in the readiness rating before and after the training. Principal Components Analysis identified a three factor structure for the PRAT tool: Attitudes/ Attributes of Personnel; Motivation to Change and Institutional Resources. Overall, the evaluation demonstrated a positive change in all trainees’ attitudes following the training sessions, with the majority of trainees acknowledging a positive impact of the training on their readiness for teledentistry.

Abstract A30: Affordability of screening, race and marital status predict early detection of breast cancer: Analysis of cancer registry data

Background: Breast cancer is the most common cancer diagnosis among women in Nebraska. Early diagnosis of breast cancer provides opportunities for better prognosis and treatment options and thereby improves chances of survival. Nebraska is predominantly a rural state, and hence, in addition to problems of affordability of health care due to lack of insurance or under-insurance, the people of rural Nebraska face unique challenges with regards to the availability and accessibility of cancer screening services. The purpose of this study was to examine whether access to cancer screening services, in terms of three dimensions: affordability, availability and accessibility, predict the stage of diagnosis for women diagnosed with breast cancer in Nebraska. Methods: Data on breast cancer cases in Nebraska were obtained from the Nebraska Cancer Registry for the years 2008 to 2012. Proximity to the nearest screening center was calculated as the shortest distance between the population weighted centroid of each census tract in Nebraska and the nearest screening facility, using geocoded facility locations available from the United States Food and Drug Administration website. Spatial accessibility to primary care provider (PCP) was calculated using the two-step floating catchment area method using geocoded PCP locations, using data from the University of Nebraska Medical Center Health Professions Tracking Service annual survey database. Hierarchical logistic regression models adjusted for age, race, ethnicity, marital status, rurality of residence and county poverty level were examined to assess the association of type of insurance: Medicare, Medicaid, Other (including TRICARE, Military, Veterans Affairs Indian/Public Health Service) and Private, supply of screening centers, proximity to screening center and spatial accessibility to primary care physicians with the stage at diagnosis of breast cancer. Breast cancer stage at diagnosis was categorized as early (in-situ or localized stage) or late (regional or distant stage). Geocoding and proximity distance calculations were done using ArcGIS 10.3.2 and statistical analyses were conducted using STATA 14 software. Results: Among 4,975 women aged 40 years or older and diagnosed with breast cancer in Nebraska between 2008 and 2012, 72.3% were diagnosed at an early stage (in-situ or localized). The results from the hierarchical logistic regression found that women who were uninsured were less likely (Odds Ratio [O.R]: 0.42; 95% Confidence Interval [C.I]: 0.25-0.73) to be diagnosed early and those women who had Medicaid coverage were also less likely (O.R: 0.56; 95% C.I: 0.40-0.78) to be diagnosed early, as compared to women having private insurance. Further, married women were 1.3 times more likely (O.R: 1.25; 95% C.I: 1.10-1.44) to be diagnosed early, and white women were 1.4 times more likely (O.R: 1.36; 95% C.I: 1.04-1.77) to be diagnosed early. Conclusion: Affordability of cancer screening services plays an important role in early detection of breast cancer. Hence, the coverage of preventive services through the Affordable Care Act is likely to be a positive policy change leading to higher screening rates and thereby, higher rates of early detection of breast cancer. Further, there exist racial disparities in early diagnosis of breast cancer that may be due to differential access to screening services. Targeted policy efforts will be needed to address these disparities to improve outcomes of breast cancer for all race groups. Citation Format: Aastha Chandak, Preethy Nayar, Ge Kan, Niodita Gupta. Affordability of screening, race and marital status predict early detection of breast cancer: Analysis of cancer registry data. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr A30.

Abstract 3717: One year mortality following pancreatectomy for pancreatic cancer: analysis of the SEER-Medicare data

Proceedings: AACR 106th Annual Meeting 2015; April 18-22, 2015; Philadelphia, PA Introduction: Pancreatic cancer is a disease with high mortality and the incidence of pancreatic cancer in the United States has been steadily increasing over the last few decades. Pancreatectomy remains the mainstay of treatment and can be combined with chemotherapy and radiotherapy. In this study we examined the six month and one year mortality rates of elderly pancreatic cancer patients who underwent pancreatectomy. Methods: We used the Surveillance Epidemiology and End Results (SEER) Medicare linked data from 1991 - 2008 to identify elderly (66 years and older) Medicare beneficiaries with pancreatic cancer who underwent pancreatectomy, using the MEDPAR Medicare claims data. Adjuvant therapy was identified from the Medicare Carrier and Outpatient claims data and was defined as pre-operative or post-operative chemo/radiation administered within 6 months before or after surgery. Patients were divided into two groups: surgery alone (S) and surgery with adjuvant therapy (SA) and the key outcomes analyzed were 6 month and one year mortality following surgery. Hierarchical logistic regression models adjusted for age, gender,cancer stage at diagnosis, race, post-operative complication rate and co-morbidity (Elixhauser co-morbidity conditions) were examined to assess differences in six month and one year mortality for the two treatment groups. Results: We identified 4, 110 patients who underwent pancreatectomy between 1991 - 2008. One year mortality (Odds Ratio = 0.60; p value <0.001; CI: 0.519 - 0.690) and six month mortality ((Odds Ratio = 0.26; p value <0.001; CI: 0.218 - 0.310) following pancreatectomy were significantly lower in the group that underwent pancreatectomy with adjuvant therapy. In addition, patients who had regional or distant disease at the time of diagnosis, had higher odds of dying at 6 months and one year, as compared to those with in-situ or localized disease. Patients who underwent elective surgery had lower odds of dying at 6 months and one year, compared to those who underwent urgent procedures. The odds of dying at 6 months and one year also increased with age. Race and gender were not significantly associated with 6 month or one year mortality. Conclusions: Using a national population health database we examined six month and one year mortality for pancreatic cancer patients who underwent surgery alone and compared to those who had surgery with adjuvant therapy and found that patients in the adjuvant therapy group had better outcomes than those who underwent surgery alone. Citation Format: Preethy Nayar, Chandrakanth Are, Fang Yu, Aastha N. Chandak, Niodita Gupta. One year mortality following pancreatectomy for pancreatic cancer: analysis of the SEER-Medicare data. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3717. doi:10.1158/1538-7445.AM2015-3717