Ziegenfuss, Jeanette Y.

4657 Background: While active surveillance (AS) is well recognized as an acceptable treatment strategy for low-risk prostate cancer (PC), the extent to which radiation oncologists and urologists perceive AS as effective and routinely recommend it to patients is unknown. Therefore, we sought to assess the attitudes and treatment recommendations for low-risk PC from a national survey of PC specialists. Methods: A mail survey was sent to a population-based sample of 1,439 physicians in the U.S. from late 2011 and early 2012. Physicians were queried about their attitudes regarding AS and treatment recommendations for patients diagnosed with low-risk PC (PSA<10 ng/dl; T1c; Gleason 6 in one of twelve cores). Pearson Chi-square and multivariate logistic regression were used to test for differences in attitudes and treatment recommendations by physician demographics, compensation structure, primary place of employment, and specialty. Results: Overall, 321 radiation oncologists and 322 urologists completed the survey for a 45% response rate. Most physicians reported that AS is effective for low-risk PC (71%) and stated that they were comfortable routinely recommending AS (67%). Urologists were more likely to agree that AS is effective (77% vs. 67%; p=0.005) and were comfortable recommending AS (74% vs. 61%; p=0.001) compared with radiation oncologists. Most physicians recommended radical prostatectomy (47%) or radiation therapy (32%), but fewer endorsed AS (21%) for low-risk disease. After adjusting for physician covariates, radiation oncologists were more likely to recommend radiation therapy (OR: 10.97; p<0.001), while urologists were more likely to recommend surgery (OR: 4.69; p<0.001) and AS (OR: 2.18; p=0.001) for low-risk PC. Conclusions: Although AS is widely viewed as effective by both radiation oncologists and urologists, most urologists continue to recommend surgery, while most radiation oncologists recommend radiation therapy. Our results may explain in part the relatively low contemporary use of AS in the U.S.

1565 Background: Understanding the prevalence of cancer screening in the US and the factors associated with its accessibility is important for public health promotion. Methods: The 2004 and 2010 Behavioral Risk Factor Surveillance Systems were used to ascertain cancer screening rates among populations indicated for each test by age, gender, and the American Cancer Society recommendation for cancer screenings [fecal occult blood test (FOBT) or endoscopy for colorectal cancer (CRC) screening, digital rectal examination (DRE) or prostate specific antigen (PSA) for prostate cancer screening, clinical breast examination (CBE) or mammogram for breast cancer screening, and Papanicolaou (Pap) test for cervical cancer screening]. Results: Over this period, CRC and breast cancer screening rates significantly increased (15.9%, 13.9%) while prostate and cervical cancer screening rates significantly decreased (1.2%, 5.2%). Race/ethnicity might be an influence in CRC and cervical cancer screening accessibility. Prostate cancer screening accessibility might be influenced by education and income. The older-aged populations (70-79, >79) had high prevalence of CRC, prostate and breast cancer screenings even though there is insufficient evidence for the benefits and harms of screenings in the older-aged group. Conclusions: The disparities in age, race/ethnicity, health insurance, education, employment, and income for the accession to cancer screening of the US population have decreased since 2004. The trajectory of increasing rates of CRC and breast cancer screenings should be maintained. To reverse the trend, the causes of the decreased rate of cervical cancer screening and the high rates of screenings in older-aged populations should, however, be further explored. [Table: see text]

167 Background: Physicians have a variety of resources available about the treatment of localized prostate cancer. Yet, it is largely unknown what resources and evidence radiation oncologists and urologists commonly use to inform patients and possibly alter clinical practice. In this national survey study, we assessed the types of resources prostate cancer specialists’ use and the level of evidence needed to change treatment recommendations in localized prostate cancer. Methods: From a random sample, 1,422 physicians were sent a mail survey assessing what type of information was used to guide prostate cancer treatment. The survey also queried what level of evidence could alter recommendations. Multivariable logistic regression models were used to identify for differences in physician characteristics for each outcome. Results: Survey response rates were similar for radiation oncologists and urologists (44% vs. 46%; p=0.46). Specialty-specific journals represented the most commonly used resource to inform the clinical practice for radiation oncologists (65%) and urologists (70%). Relative to radiation oncologists, urologists were less likely to utilize medical journals (25% vs. 38.7%, OR: 0.50; p=0.01), cancer journals (21.7% vs. 50.8%, OR: 0.50; p<0.001), but more likely to rely on clinical guidelines (46.3% vs. 37.7%,OR: 1.6; p=0.006). Radiation oncologists and urologists both viewed RCT’s as the most likely source of evidence needed to change treatment recommendations (85% vs. 77%). Conclusions: Both specialties most commonly rely on their specialty-specific journals to inform their clinical practice and view RCT’s as the level of evidence needed to change treatment recommendations for localized prostate cancer. Radiation oncologists embraced greater diversity in literature, while urologists were more likely to use clinical guidelines. Utilizing this information may overcome barriers to the dissemination and adoption of new treatment paradigms for localized prostate cancer.

The ability to aggregate clinical data across multiple diverse organizations and to use it for performance measurement, quality improvement, evaluation, and research is rapidly becoming a national necessity, but there are few examples of how to do that. This article uses lessons from a national effort to implement the collaborative care management model for patients with both depression and diabetes or heart disease across 8 partner organizations, 18 medical groups, and more than 170 clinics in 8 states to identify the challenges and provide experience-based recommendations for those tasks. The challenges are divided into those needed for (1) collecting similar data, (2) aggregating those data across care systems, and (3) using the data to both improve and evaluate care. Start with agreement on goals, methods, transparency, and a data system integrated into the electronic medical record while promptly addressing all the legal, regulatory, and human subject requirements.

Abstract Background: Racial disparities in breast cancer (BC) outcomes are well-documented. As guidelines for BC screening change, it is particularly important that women have accurate knowledge of risk factors in order to meaningfully participate in screening decisions. We examined knowledge of risk factors for BC among a nationally representative sample of women for whom mammography screening is routinely recommended. Method: Non-Hispanic black (B), non-Hispanic white (W), Hispanic (H), and women of other/multiple races (O) were surveyed using a probability-based web panel weighted to match the known U.S. population of females aged 40-74 years. A total of 17 items were presented in English or Spanish; response options included: “does not put you at increased risk,” “puts you at a small increased risk,” and “puts you at a large increased risk.” For scoring, the latter two categories were combined to reflect “increased risk.” Items included 9 established risk factors: having mammographically dense breasts, first-degree relative diagnosed with BC, second-degree relative diagnosed with BC, drinking alcohol in excess, history of a breast biopsy, having a first child after age 30, use of hormone therapy for postmenopausal symptoms, BRCA gene mutation, late onset of menopause; 5 protective factors: menarche after age 15, having children, breastfeeding, having a diet rich in fruits and vegetables, exercising or being active; one factor with no clear association: being a smoker (correct response was no increased risk); and 2 distractors (beliefs for which there is no evidence, correct response was no increased risk): using antiperspirant/talc under your arms, experiencing injury/trauma to the breast. The survey cooperation rate was 65% (1,506 responders out of 2,311). Items were scored correct if the respondent's answer matched the actual risk profile (either does/does not put you at increased risk). Percent correct was calculated for each item overall and by race/ethnicity. All reported percentages and analyses are weighted to be nationally representative and compared for differences based on race/ethnicity using logistic regression models. P-values represent differences in percent correct between the racial/ethnic groups. Results: Knowledge of risk factors varied across items (range &gt;90% to 20% correct). Percent correct was high overall for classifying a first-degree relative with BC as a risk factor and differed by race/ethnicity, with 86% B, 98% W, 92% H and 92% O recognizing this risk factor (p&lt;0.001); similar percentages were observed for second-degree relatives (p=0.003). Lower knowledge overall was observed for risk factors including BRCA mutation (25% B, 44% W, 24% H, 38% O, p=0.002), later onset of menopause (41% B, 38% W, 42% H, 37% O, p=0.92), and having the first child after age 30 (39% B, 41% W, 38% H, 33% O, p=0.53). Having mammographically dense breasts is one of the strongest risk factors for BC, however knowledge of this was only moderate and did not differ by race/ethnicity (61% B, 54% W, 56% H, 52% O, p=0.64). Relative to risk factors, knowledge of protective factors was generally higher; only correct classification of fruits/vegetables as a protective factor differed by race/ethnicity (84% B, 93% W, 88% H, 89% O, p=0.03). Most women correctly responded that use of antiperspirant/talc does not increase risk of BC, however 60% of H women incorrectly classified injury/trauma to the breast as a risk factor, relative to 50% B, 41% W, and 40% O (p=0.02). Conclusions: Among U.S. women, there is wide variation in knowledge across several established BC risk factors and only moderate knowledge of breast density as an important risk factor. Differences in knowledge by race/ethnicity for several risk factors highlight the need for targeted education. Citation Format: Carmen Radecki Breitkopf, Deborah J. Rhodes, Sarah M. Jenkins, Jeanette Y. Ziegenfuss, Celine M. Vachon. Racial and ethnic differences in knowledge of risk factors for breast cancer: Findings from a recent national survey. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B42. doi:10.1158/1538-7755.DISP13-B42

Purpose Legislation mandating disclosure of breast density (BD) information has passed in 21 states; however, actual awareness of BD and knowledge of its impact on breast cancer detection and risk are unknown. Methods We conducted a national cross-sectional survey administered in English and Spanish using a probability-based sample of screening-age women, with oversampling of Connecticut, the only state with BD legislation in effect for > 1 year before the survey. Results Of 2,311 women surveyed, 65% responded. Overall, 58% of women had heard of BD, 49% knew that BD affects breast cancer detection, and 53% knew that BD affects cancer risk. After multivariable adjustment, increased BD awareness was associated with white non-Hispanic race/ethnicity (Hispanic v white non-Hispanic: odds ratio [OR], 0.23; P < .001), household income (OR, 1.07 per category increase; P < .001), education (OR, 1.19 per category increase; P < .001), diagnostic evaluation after a mammogram (OR, 2.64; P < .001), and postmenopausal hormone therapy (OR, 1.69; P = .002). Knowledge of the masking effect of BD was associated with higher household income (OR, 1.10; P < .001), education (OR, 1.22; P = .01), prior breast biopsy (OR, 2.16; P < .001), and residing in Connecticut (Connecticut v other states: OR, 3.82; P = .003). Connecticut residents were also more likely to have discussed their BD with a health care provider (67% v 43% for residents of other US states; P = .001). Conclusion Disparities in BD awareness and knowledge exist by race/ethnicity, education, and income. BD legislation seems to be effective in increasing knowledge of BD impact on breast cancer detection. These findings support continued and targeted efforts to improve BD awareness and knowledge among women eligible for screening mammography.

Surveys are an important tool for assessing physician and nursing professionals’ practice patterns and guideline adherence. Obtaining quality survey data consisting of low item and unit nonresponse remains a persistent challenge in these populations. We tested the relative impact of two envelope types (padded vs. priority mail) on unit and item nonresponse in a survey of Minnesota health care workers. Respondents were randomized to receive a survey in one of two envelope types: a padded 8.5′′ × 11′′ envelope or a similarly sized priority mail envelope. After the first mailing, the response rate was 53.9% and did not differ across envelope conditions. Females and RNs were more likely to respond to the priority envelope than the padded envelope, but this finding did not hold in multivariate analysis. There was no difference in item nonresponse across the two envelope conditions. It may be that our two approaches were not enough to permeate the semi-porous membrane of gatekeeping that has been posited as a driver of low physician survey response rates relative to those observed in the general population. Nonetheless, our findings suggest that packaging may matter for some populations and not others.

Background: Recent literature suggests that one in nine children in the United States uses some type of complementary and alternative medicine (CAM). Children with challenging neurological conditions such as headache, migraine, and seizures may seek CAM in their attempts at self-care. Our objective was to describe CAM use in children with these conditions. Methods: We compared use of CAM among children aged 3 to 17 years with and without common neurological conditions (headaches, migraines, seizures) where CAM might plausibly play a role in their self-management using the 2007 National Health Interview Survey (NHIS) data. Results : Children with common neurological conditions reported significantly more CAM use compared to the children without these conditions (24.0% vs 12.6%, P< .0001). Compared to other pediatric CAM users, children with neurological conditions report similarly high use of biological therapies and significantly higher use of mind-body techniques (38.6% vs 20.5%, P<.007). Of the mind-body techniques, deep breathing (32.5%), meditation (15.1%), and progressive relaxation (10.1%) were used most frequently. Conclusions: About one in four children with common neurological conditions use CAM. The nature of CAM use in this population, as well as its risks and benefits in neurological disease, deserve further investigation.

Objective To assess recommendations for prostate‐specific antigen ( PSA ) screening in a national survey of radiation oncologists and urologists following the recent USA P reventive S ervices T ask F orce ( USPSTF ) grade D recommendation. Methods A random sample of 1366 radiation oncologists and urologists were identified from the A merican M edical A ssociation P hysician M asterfile. From N ovember 2011 to A pril 2012, a mail survey was sent to query PSA screening recommendations for men at average risk of prostate cancer for the following age groups: 40–49, 50–59, 60–69, 70–74, 75–79 and ≥80 years. Multivariable logistic regression was used to test for differences in PSA ‐based screening recommendations by physician characteristics. Results Response rates were similar at 52% for radiation oncologists and urologists ( P = 0.92). Overall, 51.5% of respondents recommended PSA ‐based screening for men aged 40–49 years, while nearly all endorsed it for those aged 50–74 years (96.1% for 50–59, 97.3% for 60–69, and 87.7% for 70–74 years). However, screening recommendations decreased to 43.9% and 12.8% for men aged 75–79 and ≥80 years, respectively. On multivariable analysis, urologists were more likely to recommend screening for men aged 40–49 (odds ratio [ OR ] 3.09; P < 0.001) and 50–59 years ( OR 3.81; P = 0.01), but less likely for men aged 75–79 ( OR 0.66; P = 0.01) and ≥80 years ( OR 0.45; P = 0.002) compared with radiation oncologists. Conclusion While radiation oncologists and urologists recommended PSA screening for men aged 50–69 years, there was less agreement about screening for younger (40–49 years old) and older (≥70 years) men at average risk for prostate cancer.