Janella Hudson

Development of a Question Prompt List as a Communication Intervention to Reduce Racial Disparities in Cancer Treatment

Racial disparities have been found in the use of chemotherapy as cancer treatment. These disparities may be, in part, due to well-documented differences in the quality of communication during clinical interactions with oncologists and Black versus White patients. In this study using a community-based participatory research approach, academic researchers, community members, and oncologists formed a partnership to develop a communication intervention to address racial disparities in cancer care. Partners developed a question prompt list (QPL), a simple tool that can be used to improve communication, and thus treatment, during clinical interactions in which oncologists and Black patients discuss chemotherapy. Partners endorsed the use of a QPL, provided specific suggestions for content and format, conducted and analyzed qualitative interviews with Black patients receiving chemotherapy, and approved the final version. The feasibility and effectiveness of the QPL that resulted from this research process are currently under evaluation in a separate study

Barriers to Cancer Screening Among Orthodox Jewish Women

The increased risk of genetic cancer mutations for Ashkenazi Jews is well known. However, little is known about the cancer-related health behaviors of a subset of Ashkenazi Jews, Orthodox Jews, who are a very religious and insular group. This study partnered with Rabbinical leadership and community members in an Orthodox Jewish community to investigate barriers to cancer screening in this community. Orthodox Jewish women were recruited to participate in focus groups designed to elicit their perspectives on barriers to cancer screening. A total of five focus groups were conducted, consisting of 3–5 members per group, stratified by age and family history of cancer. Focus groups were audio recorded and transcribed. Transcripts were coded using conventional content analysis. The resulting themes identified as barriers to cancer screening were: preservation of hidden miracles, fate, cost, competing priorities, lack of culturally relevant programming, lack of information, and fear. These results provide a unique perspective on barriers to cancer screening in a high risk but understudied population. Findings from this study may serve to inform culturally appropriate cancer education programs to overcome barriers to screening in this and other similar communities.

New promising strategies in oncofertility

ABSTRACT Introduction: Approximately 70,000 adolescent and young adults (AYA) are diagnosed with cancer each year. While advancements in treatment have led to improved prognosis and survival for patients, these same treatments can adversely affect AYA reproductive capacity. Localized treatments such as surgery and radiation therapy may affect fertility by removing or damaging reproductive organs, and systemic therapies such as chemotherapy can be toxic to gonads, (ovaries and testicles), thus affecting fertility and/or endocrine function. This can be traumatic for AYA with cancer as survivors often express desire to have genetic children and report feelings of regret or depression as a result of infertility caused by cancer treatments. Areas covered: Emerging technologies in the field of assisted reproductive technology offer new promise for preserving the reproductive capacity of AYA cancer patients prior to treatment as well as providing alternatives for survivors. The following review revisits contemporary approaches to fertility preservation as well newly developing technologies. Expert commentary: There are several advances in ART that hold promise for patients and survivors. However there are challenges that inhibit uptake including poor communication between providers and patients about risks and fertility preservation options; high costs; and lack of insurance coverage for fertility preservation services.

Fertility counseling for transgender AYAs.

Transgender adolescents and young adults may wish to use cross-sex hormones as a means to achieve identity goals. However, these hormones may impair future reproductive functioning. This case explores the complexities related to clinical decision making concerning fertility and the use of cross-sex hormones in adolescent and young adult transgender populations.

Childbearing across borders: Fertility and parenthood attitudes and decisions among breast cancer survivors in USA and Portugal

OBJECTIVE To compare fertility and childbearing attitudes and decisions of Portuguese and American female reproductive aged breast cancer survivors. METHODS This was a cross-sectional study of 102 young breast cancer survivors (59 from Portugal and 43 from USA). Demographic, clinical and reproductive information were collected. Fertility and parenthood attitudes and decisions were assessed through a self-report questionnaire devised specifically for the study. RESULTS Fertility issues became very important after the diagnosis for most of the women (51%). Few differences existed between USA and Portuguese participants. USA participants were more likely to undergo FP (23% USA vs Portugal 5%, p = 0.01). Portuguese women were more dissatisfied with their physicians explanations about fertility (Portugal: 23% vs USA: 3%; p = 0.01). Overall, women relied on their oncologist for fertility information (70%); only Portuguese women discussed fertility with their family medicine physician (11%). Overall, women showed positive attitudes towards motherhood. Portuguese women were more likely to report their partners placed more value on the family after their illness (Portuguese agree: 55% vs USA agree: 14%; p < 0.001). CONCLUSIONS Fertility and childbearing after breast cancer are important issues regardless of culture, background or countrys heath care system. Overall, few differences across the USA and Portuguese samples were found on fertility and childbearing attitudes and decisions.

Sexual and Gender Minority Issues Across NCCN Guidelines: Results From a National Survey

Background: The lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) population is at higher risk for multiple types of cancers compared with the heterosexual population. Expert NCCN panels lead the nation in establishing clinical practice guidelines addressing cancer prevention, early detection, and treatment of cancer sites and populations. Given the emergence of new data identifying cancer disparities in the LGBTQ population, this study examined the inclusion of medical and/or psychosocial criteria unique to LGBTQ within NCCN Guidelines. Methods: Data were collected for 32 of the 50 NCCN Guidelines. Results: NCCN panel members reported that neither sexual orientation (84%) nor gender identity (94%) were relevant to the focus of their guidelines; 77% responded that their panels currently do not address LGBTQ issues, with no plans to address them in the future. Conclusions: Greater consideration should be given to the needs of LGBTQ patients across the cancer care continuum. Given that research concerning LGBTQ and cancer is in its infancy, additional empirical and evidence-based data are needed to bolster further integration of LGBTQ-specific criteria into clinical care guidelines.

Abstract 595: Heterogeneity of immune checkpoint expression in lung cancer identified through rapid tissue donation

Background: Translational research in advanced lung cancer is hindered by the limited availability of specimens for advanced molecular techniques. Although helpful, the standard practice to biopsy a small amount of tissue from a single site of cancer provides limited information. We launched a thoracic rapid tissue donation (RTD) program to enable lung cancer research with collection of tissue at multiple tumor sites within hours after death. Many patients chose to enroll in the RTD program as an opportunity to contribute to cancer research. RTD tissue will support multiple research projects, such as studying differential expression of immune checkpoint proteins in immune oncology or understanding resistance to targeted agents. Methods: The RTD program for patients with stage IV lung cancer was approved in June 2015 by the Moffitt Cancer Center institutional review board. Tissue specimens from multiple tumor sites from consented donors are collected rapidly (aim

Abstract A80: Cancer communication and prevention behaviors: HPV associated cancer prevention deficits among an MSM population in Tampa Bay

Background: The populations of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are part of a medically underserved community that is gaining visibility in the US. LGBTQ populations are heterogeneous and have specific health needs based on gender identity, sexual behaviors, and other intersecting sociodemographic characteristics. LGBTQ individuals are at increased risk for certain cancers and require cancer education and screening and prevention information explicit to their often unmet and unrecognized needs. Human papillomavirus (HPV), an established human carcinogen, is highly prevalent in both men and women. However, men who have sex with men (MSM) have higher rates of oncogenic HPV infection, putting MSM at higher risk for anal cancer. The goals of this project were to identify i) MSM community perceptions of cancer risk education, screening and prevention, ii) their experiences and behaviors relating to HPV risk and HPV vaccination, and iii) experience with healthcare providers9 knowledge, attitudes, and behaviors regarding HPV and MSM. Methods: A 41-item survey was disseminated to 438 attendees at three community events: Moffitt Cancer Center Men9s Health Forum and Florida PRIDE Parades in Tampa and St. Petersburg. The survey was comprised of 5 domains: demographics, sexual orientation and sexual history, HPV knowledge and screening and prevention, smoking behaviors, and general healthcare experiences including perceptions of physician knowledge, attitudes, and competency. Summary responses are reported for respondents who self-identified as MSM for the HPV knowledge and screening and prevention portion. Results: Of the 438 participants who completed the survey, 79% (N=344) identified as belonging to the LGBTQ population and 42% identified as MSM. Among the MSM population, 84% had some knowledge of or had heard of HPV. Forty-three percent of MSMs were clinically eligible for the HPV vaccine; however, only 24% had discussed the HPV vaccine with their healthcare provider. Among the 43% of MSM who were clinically eligible to receive the vaccine, nearly 1 in 4 (26%) completed the 3-dose series. 11% reported having received only one dose. Intention to get vaccinated in the future was low (9%). Conclusion: These results indicate the HPV cancer risk education and screening and prevention needs for MSM are sub-optimal. Experiences and perceptions of MSM individuals revealed a lack of provider information regarding HPV specific cancer risk factors and preventative measures which may be attributed to healthcare providers9 lack of awareness regarding the health risks and prevalence of risk factors among MSM. A need for additional training regarding the MSM population is indicated. These results highlight the need for curriculum to improve cultural relevance for health care professionals. Citation Format: Lauren E. Wilson, Julian A. Sanchez, Matthew B. Schabath, Janella Hudson, Steven K. Sutton, Peter A. Kanetskey, Vani N. Simmons, Meghan Bowman, Susan T. Vadaparampil, Gwendolyn P. Quinn. Cancer communication and prevention behaviors: HPV associated cancer prevention deficits among an MSM population in Tampa Bay. [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 A80.

Abstract A23: Fertility and Reproductive Health Resources Reported by Nurses Delivering Care for Minority Cancer Patients

Background: African American and Hispanic cancer patients face disparities in cancer care affecting quality of life (QoL) and other health related outcomes. Reproductive health (RH) topics such as risk of infertility due to treatment, contraception, and fertility preservation (FP) are among these QoL issues. The American Society of Clinical Oncology (ASCO) clinical practice guidelines suggest oncology care providers discuss potential fertility loss and refer adolescent and young adult (AYA) patients to reproductive specialists. Yet, recent studies of survivors and retrospective chart reviews show sub optimal rates of discussions and referrals. Less is known about the availability of FP and RH resources for racial/ethnic minority cancer patients. The Educating Nurses about Reproductive Health Issues in Cancer Healthcare (ENRICH) program seeks to improve nurses9 communication skills regarding FP and RH issues with AYA oncology patients. In the current study, we explored availability of FP and RH resources reported by ENRICH participants providing care to African American or Hispanic cancer patients. Methods: Prior to starting the training program, applicants completed information about demographic characteristics, practice setting, and patient population, including an estimate of the proportion of their patients by race/ethnicity (0-25%, 26-50%, 51-75%, and 76-100%). Trainees also provided information about availability (yes/no) of FP and RH institutional resources including: established FP referral guidelines/procedures, reproductive endocrinologist and infertility specialist (REI) on staff, institutional partnership with an REI, RH material for staff, RH patient education material, and “other” RH resources. For the current analysis we used Chi-square tests to compare those who reported a patient population of 26% patients population belonging to these particular racial/ethnic groups across all institutional FP and RH resources. Data on other racial/ethnic groups (White, Asian, Native Hawaiian, and American Indian) were collected, but did not provide sufficient variability with respect to the proportion of patients from those groups to conduct additional analyses. Results: A total of 104 nurses participated in the 2016 ENRICH training program cohort. The majority were Non-Hispanic (82%) and White (90%), and female (99%). On average, nurses reported 14 years of experience, more than half (59%) had at least a bachelor9s degree and worked in academic institutions (66%). Of the participating nurses, 50% reported 26%. Approximately half (59%) served 26% of their patients being Hispanic. Regardless of the proportion of minority patients served, reported availability of FP and RH resources was low to moderate. For example, among only 37% of nurses serving majority Hispanic patients work at institutions with an REI on staff and 27% of those serving majority African American patients had institutional partnerships with REIs. However, among those providing care for Hispanics, those with a greater proportion of Hispanic patients reported higher frequencies of having an established FP referral guidelines/procedures (38% vs 60%) and institutional partnership with an REI (25% vs. 49%) compared to those reporting a smaller proportion (p Conclusion: Available data suggest that among nurses participating in the ENRICH program, availability of FP and RH resources for minority cancer patients are low to moderate. One of the ENRICH goals is to impact individual and workplace level changes to facilitate discussion of FP and RH. Future directions include surveying ENRICH participants9 at 6 months and 1 year after course completion to assess if the program aided in increasing availability of FP and RH resources among those serving minority patients. Citation Format: Susan Vadaparampil, Meghan Bowman-Curci, Cathy Meade, Clement Gwede, Janella Hudson, Gwendolyn Quinn. Fertility and Reproductive Health Resources Reported by Nurses Delivering Care for Minority Cancer Patients. [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 A23.