Erica Sercy

Knowledge of, attitudes toward, and use of low-dose computed tomography for lung cancer screening among family physicians

The results of the National Lung Screening Trial showed a 20% reduction in lung cancer mortality and a 6.7% reduction in all‐cause mortality when high‐risk patients were screened with low‐dose computed tomography (LDCT) versus chest x‐ray (CXR). The US Preventive Services Task Force has issued a grade B recommendation for LDCT screening, and the Centers for Medicare and Medicaid Services and private insurers now cover the screening cost under certain conditions. The purpose of this study was to assess the knowledge of, attitudes toward, and use of LDCT screening for lung cancer among family physicians.

Implementation of Lung Cancer Screening in the United States: Changing Trends Based on a Survey of Society of Thoracic Radiology Members.

Purpose: The aim of this study was to determine whether practices and protocols regarding low-dose CT (LDCT) screening for lung cancer have changed among Society of Thoracic Radiology (STR) members after the recent release of recommendations in favor of LDCT screening by organizations such as the US Preventive Services Task Force (USPSTF). Materials and Methods: We administered an online survey to members of the STR in 2013, before the release of the USPSTF recommendations, to determine the availability and attributes of screening programs at their institutions. Here we report results of a follow-up survey conducted using the same protocols but distributed in November 2014, after the release of the guidelines. We filtered returned surveys such that each institution was represented only once in the data. Results: Of the 75 unique institutions represented in the 2014 survey, 62 (83%) had an active screening program, compared with 66% of institutions in the original 2013 survey. In addition, approximately half of the institutions reported >50 patients screened in the 12 months before administration of the 2014 survey compared with 28% in 2013. In 2014, most institutions without an active screening program were considering implementing one. Conclusions: Our follow-up survey showed several trends in the utilization of LDCT screening for lung cancer between 2013 and 2014: in 2014, an increased number of sites had active screening programs, increased numbers of patients were screened, and there was greater integration of smoking cessation counseling as part of the screening programs at individual institutions.

Planning and Implementation of Low-Dose Computed Tomography Lung Cancer Screening Programs in the United States

BACKGROUND One of the largest, most expensive randomized, controlled trials, the National Lung Screening Trial, found that annual low-dose computed tomography (LDCT) scans led to a 20% reduction in lung cancer deaths. OBJECTIVES This study describes the characteristics and program implementation barriers experienced by LDCT screening programs in the United States. METHODS Using a mixed-methods approach, Lung Cancer Alliance Screening Centers of Excellence were surveyed and interviewed in 2013. Representatives from 65 centers completed an electronic questionnaire, followed by in-depth interviews with 13 physicians and nurse navigators regarding their institutions screening programs. FINDINGS Participants cited low patient demand and few physician referrals as barriers, but few centers reported needing additional staff or equipment. Those interviewed discussed the importance of a multidisciplinary team and overcoming barriers related to insurance reimbursement, costs, and physician knowledge to improve program implementation.

Developing and testing a brief clinic-based lung cancer screening decision aid for primary care settings

Cancer screening‐related decisions require patients to evaluate complex medical information in short time frames, often with primary care providers (PCPs) they do not know. PCPs play an essential role in facilitating comprehensive shared decision making (SDM).

Sistas Inspiring Sistas Through Activity and Support (SISTAS): Study Design and Demographics of Participants

Introduction Recruiting racial, ethnic, and other underserved minorities into conventional clinic-based and other trials is known to be challenging. The Sistas Inspiring Sistas Through Activity and Support (SISTAS) Program was a one-year randomized controlled trial (RCT) to promote physical activity and healthy eating among AA women in SC to reduce inflammatory biomarkers, which are linked to increased breast cancer (BrCa) risk and mortality. This study describes the development, recruitment, and implementation of the SISTAS clinical trial and provides baseline characteristics of the study participants. Methods SISTAS was developed using community-based participatory research (CBPR) approaches. At baseline, study participants completed assessments and underwent clinical measurements and blood draws to measure C-reactive protein (CRP) and interleukin-6 (IL-6). Participants randomized to the intervention received 12 weekly classes followed by nine monthly booster sessions. Post-intervention measurements were assessed at 12-week and 12-month follow-ups. Results We recruited a total of 337 women who tended to: be middle-aged (mean age 48.2 years); have some college education; be employed full-time; have Medicare as their primary insurance; be non-smokers; and perceive their personal health as good. On average, the women were pre-hypertensive at baseline (mean systolic blood pressure = 133.9 mm Hg; mean diastolic blood pressure = 84.0 mm Hg) and morbidly obese (mean BMI >40.0 kg/m2); the mean fat mass and fat-free mass among participants were 106.4 lb and 121.0 lb, respectively. Conclusion The SISTAS RCT addresses some of the gaps in the literature with respect to CBPR interventions targeting AA women, such as implementing diet and physical activity in CBPR-based studies to decrease BrCa risk.

Estimating county-level tobacco use and exposure in South Carolina: a spatial model-based small area estimation approach

PURPOSE Local health statistics are increasingly requested for policy-making and programmatic purposes; however, population-based surveys are often inadequate to support direct estimation for small areas. Model-based estimation techniques can be used to create local estimates for public health outcomes. Using the 2014-2015 South Carolina (SC) Adult Tobacco Survey, we examined tobacco-related outcomes at the county level using a spatial multilevel, poststratification approach. METHODS To create county-level tobacco estimates, we used a two-level model with a spatially intrinsic conditional autoregressive random intercept. Stratum-specific (race, age, and sex) estimates for each county were then created and averaged based on population data obtained from the U.S. Census. RESULTS The estimated prevalence of current smoking in SC counties among adults ranged from 7.4% to 35.1%, and the percentage reporting ever trying an e-cigarette ranged from 4.2% to 30.2%. Model validation showed considerable agreement between direct and indirect estimates (Pearson and Spearman correlations all >0.75) that varied by the sample size of the outcome, as hypothesized. CONCLUSIONS Data from the SC Adult Tobacco Survey were used to develop county-level estimates of multiple tobacco-related outcomes using a spatial multilevel, poststratification approach. The results showed heterogeneity in smoking behaviors across the state along with marked spatial correlation.

Abstract 4216: Racial disparities in receipt of adjuvant hormonal therapy among patients diagnosed with breast cancer in South Carolina

Background: Women with hormone receptor-positive (HR+) breast cancers (BC) have experienced significant reductions in mortality as a result of the use of adjuvant hormonal therapy (AHT). However, mortality rates remain higher among Blacks compared to Whites. This disparity has widened despite overall improved BC survival rates over time. The widening gap in Black-White mortality for BC may be related to differences in tumor biology, treatments received and access to care. The objective of this study was to assess racial disparities in the receipt of AHT among patients diagnosed with BC in South Carolina (SC). Methods: We derived data on all female BC cases in 2002 to 2009 from the Central Cancer Registry linked with administrative medical and pharmacy claims data for the Public Employee Benefits Plan (private insurance) and Medicaid. HR+ BC included three potential classifications for estrogen (ER+ or ER-) and progesterone receptors (PR+ or PR-): ER+/PR+, ER+/PR-, ER-/PR+. The main outcome variable was receipt of AHT (receipt vs non-receipt). The main exposure variable was patient race (White vs Black). Chi-square tests and logistic regression analyses were conducted to compare patients who received AHT to those who did not to identify important predictors of AHT receipt. Two-way interactions were assessed between seven covariates hypothesized to modify the effect of race (age at diagnosis, marital status, county of residence, year of diagnosis, receipt of surgery (early vs late), tumor stage and tumor grade). Results: Of the 1611 total breast cancer cases reported in the study period, 834 were HR+ (641 white, 76.86%; 193 black, 23.14%). The crude odds of non-receipt of AHT were 1.59 (95% CI: 1.14-2.21), and the adjusted odds was 1.23 (95% CI: 0.85-1.78) among Black compared to White patients. The adjusted odds of non-receipt of AHT were 2.02 (95% CI: 1.36-2.99) and 5.15 (95% CI: 3.41-7.77) among tumor grade II and III/IV compared to grade I respectively. Stratified analysis showed that among patients who were married, the odds of non-receipt of AHT were 2.19 (95% CI: 1.28-3.74) among Blacks compared to Whites; among those that received late surgery, the odds of non-receipt of AHT were 3.00 (95% CI: 1.34-6.71) among Blacks compared to Whites; and among tumor stages II and III/IV, the odds of non-receipt of AHT were 1.81 and 2.42 (95% CI: 1.14-2.87 and 1.29-4.55), respectively among Blacks compared to Whites. Conclusions: To improve overall use of AHT, efforts need to be directed at Black BC patients that received late surgery (>30 days after diagnosis). Citation Format: Oluwole A. Babatunde, Swann Adams, Tisha Felder, Jan Eberth, Robert Moran, Erica Sercy, James Hebert. Racial disparities in receipt of adjuvant hormonal therapy among patients diagnosed with breast cancer in South Carolina [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4216. doi:10.1158/1538-7445.AM2017-4216

Abstract C20: Racial Disparities in Breast Cancer Diagnosis-to-treatment Waiting Times in South Carolina

Background: Although incidence of breast cancer is higher among white females, mortality rates remain higher among black women. This disparity has widened despite improved breast cancer survival rates over time. The widening gap in black-white mortality for breast cancer may be related to differences in tumor biology, treatments received and access to care. The objective of this study was to assess racial disparities in breast cancer diagnosis-to-treatment waiting times in South Carolina (SC). Methods: Data for this analysis includes all female breast cancer cases in SC from 2002-2009 derived from linked files from the SC Central Cancer Registry and Office of Revenue and Fiscal Affairs (who maintains the administrative medical claims data for the South Carolina Public Employee Benefits plan and Medicaid). The main outcome variable was diagnosis-to-treatment time (overall and by cancer treatment type) which was defined as the interval between the date of diagnosis and the date of any first course of treatment or the date of receipt of breast cancer-related surgery, radiation, chemotherapy, and hormonal therapy. The main exposure variable was patient race (white vs black). Students9 t test with a significance level of 0.05 was used to assess the difference in diagnosis-to-treatment time by patient race. Results: A total of 1611 breast cancer patients including 1205 white and 406 black females were reported in the study period. There was a consistent increase in the mean number of diagnosis to receipt of first course of treatment among blacks compared to whites overall (22.7 vs 18.4); from diagnosis to surgery (27.2 vs 23.1); from diagnosis to radiation therapy (142.2 vs 122.8 radiation); from diagnosis to chemotherapy (65.5 vs 62.3); from diagnosis to hormonal therapy (148.7 vs 85.3). There was also a consistent increase in the median number of days (18 vs 15; 18 vs 15; 140 vs 91; 56 vs 52; and 136 vs 115) from diagnosis to receipt of first course of treatment overall, and by type (surgery, radiation, chemotherapy and hormonal therapy respectively) among blacks compared to whites. This difference was statistically significant for time to any first course of treatment overall (p: Conclusions: Black females experience consistently longer waiting times from diagnosis to treatment (overall and by all subtypes of treatments) than their white counterparts. Further exploration is needed to know the reasons why black females have persistent increase in diagnosis to treatment wait times and particular attention should be placed on reduction of the diagnosis to treatment wait times in an attempt to reduce already existing racial disparities in breast cancer outcomes among Blacks and Whites. Citation Format: Oluwole Adeyemi Babatunde, Swann Arp Adams, Jan Eberth, Erica Sercy, James Hebert. Racial Disparities in Breast Cancer Diagnosis-to-treatment Waiting Times in South Carolina. [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 C20.