Cancer advocacy in residency education: From principles to competencies

INTRODUCTION

The global cancer burden is increasing. Current global evidence indicates there will be a 47% rise of cancer cases for the period 2020-2040. The cancer rate differential also is evident within countries and regions. Efforts have been used to reduce the health disparities; however, the inequity prevails. One potential way to help reduce the disparity is through advocacy by physicians.

METHODS

Two recent systematic review articles on advocacy among physicians note that physicians are unlikely to be taught advocacy in medical education, and also note there are no advocacy competencies or skill sets that are either taught or valued in medical education. We explore literature and develop a model to understand the components of advocacy in medical education, specifically in resident training. We follow the model's main components by examining principles of advocacy, relevant domains of advocacy, and competencies and values for advocacy education.

RESULTS

Four ethical principles of advocacy education are identified: beneficence, non-maleficence, autonomy, and justice. These principles must be applied in meaningful, culturally sensitive, respectful, and promotion of the well-being ways. Three domains are identified: the practice domain (provider-patient interaction), the community domain (provider-community collaboration), and the health policy domain (the larger social environment). Advocacy occurs differently within each domain. Finally, competencies in the form of knowledge, skills, and values are described. We present a table noting where each competency occurs (by domain) as well as the value of each knowledge and skill.

POLICY SUMMARY

The significance of including advocacy instruction in medical education requires a change in the current medical education field. Besides valuing the concept of including advocacy, principles, domains, and competencies of inclusion are critical. In summary, we encourage the inclusion of advocacy education in resident medical programs so physicians become competent medical providers at diverse levels of society.

Measuring the visual angle of polarization-related entoptic phenomena using structured light

The ability to perceive polarization-related entoptic phenomena arises from the dichroism of macular pigments held in Henle's fiber layer of the retina and can be inhibited by retinal diseases, such as age-related macular degeneration, which alters the structure of the macula. Structured light tools enable the direct probing of macular pigment density and retinal structure through the perception of polarization-dependent entoptic patterns. Here, we directly measure the visual angle of an entoptic pattern created through the illumination of the retina with a structured state of light and a perception task that is insensitive to corneal birefringence. The central region of the structured light stimuli was obstructed, with the size of the obstruction varying according to a psychophysical staircase. Two stimuli, one producing 11 azimuthal fringes and the other three azimuthal fringes, were presented to 24 healthy participants. The pattern with 11 azimuthal fringes produced an average visual angle threshold of 10° ± 1° and a 95% confidence interval (C.I.) of [6°, 14°]. For the pattern with three azimuthal fringes, a threshold extent of 3.6° ± 0.3° C.I. = [1.3°, 5.8°] was measured, a value similar to the published extent of Haidinger's brush (4°). The increase in apparent size and clarity of entoptic phenomena produced by the presented structured light stimuli offers the potential to detect the early signs of macular disease over perception tasks using uniform polarization stimuli.

Culturally adapting an evidence-based intervention to promote a healthy diet and lifestyle for Yup'ik Alaska native communities

Underserved populations are at increased risk for obesity and related cardiovascular disease, type 2 diabetes, and other chronic diseases. Lack of access to healthy foods, sedentary behaviour, and other social environmental factors contribute to disease risk. Yup'ik Alaska Native communities are experiencing lifestyle changes that are likely to affect their cardiometabolic risks. Barrera & Castro's Cultural Adaptation Framework was used to adapt an evidence-based intervention (EBI) originally designed for Latino communities for use in Yup'ik communities. Focus groups and key informant interviews were held in two Yup'ik communities. Major themes included causes of obesity, barriers and facilitators to healthy foods and physical activity, and intervention ideas. The adaptation process was guided by a Community Planning Group of Yup'ik women and included information gathering, preliminary adaptation design, preliminary adaptation tests, and adaptation refinement. Two of the adapted educational modules were pilot tested. Involving community members as co-researchers in cultural adaptation is vital for an EBI to be effective in another population. Small group gatherings led by local lay health workers are culturally appropriate and may be an effective health promotion model in Yup'ik communities. Social environmental factors affecting healthy food availability and physical activity need further exploration.

Alteration of oral microbiome composition in children living with pesticide-exposed farm workers

Our prior work shows that azinphos-methyl pesticide exposure is associated with altered oral microbiomes in exposed farmworkers. Here we extend this analysis to show the same association pattern is also evident in their children. Oral buccal swab samples were analyzed at two time points, the apple thinning season in spring-summer 2005 for 78 children and 101 adults and the non-spray season in winter 2006 for 62 children and 82 adults. The pesticide exposure for the children were defined by the farmworker occupation of the cohabitating household adult and the blood azinphos-methyl detection of the cohabitating adult. Oral buccal swab 16S rRNA sequencing determined taxonomic microbiota proportional composition from concurrent samples from both adults and children. Analysis of the identified bacteria showed significant proportional changes for 12 of 23 common oral microbiome genera in association with azinphos-methyl detection and farmworker occupation. The most common significantly altered genera had reductions in the abundance of Streptococcus, suggesting an anti-microbial effect of the pesticide. Principal component analysis of the microbiome identified two primary clusters, with association of principal component 1 to azinphos-methyl blood detection and farmworker occupational status of the household. The children's buccal microbiota composition clustered with their household adult in ∼95% of the households. Household adult farmworker occupation and household pesticide exposure is associated with significant alterations in their children's oral microbiome composition. This suggests that parental occupational exposure and pesticide take-home exposure pathways elicit alteration of their children's microbiomes.

Effects of visual span on Chinese reading performance in normal peripheral vision

The current study examined the relationships among temporal processing speed, spatial visual span and Chinese character reading speed in normal central and peripheral vision. Maximum reading speed (MRS) and critical print size (CPS) of 26 native Chinese readers (13 young and 13 older adults) were determined at three visual field locations: central vision, 10° left and 10° below fixation using a rapid serial visual presentation (RSVP) task. Temporal processing speed was measured using trigrams of randomly selected Chinese characters presented at a range of exposure durations, while spatial visual span was measured using trigrams presented at different spatial positions. It was found that shorter temporal processing speed and larger spatial visual span were associated with faster MRS at the central and inferior visual field locations, but not at the left of fixation location. As expected, reading and visual span metrics were better in central vision compared to both peripheral locations. In addition, reading, temporal processing, and spatial visual span metrics were better in the young than older subjects (except for similar temporal processing speed at two peripheral locations). The results for central and inferior presentation locations support the hypothesis that temporal processing speed and spatial visual span were associated with Chinese character reading speed. Surprisingly, no correlation was observed for the 10° left of the fixation location, suggesting that the factors affecting reading speed might differ for inferior and lateral peripheral viewing locations.

Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery

BACKGROUND

Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort.

METHODS

Participants were adults (40 years of age or older) who underwent inpatient non-cardiac surgery. The 12-item WHODAS and EQ-5DTM-3L questionnaires were administered preoperatively (in person) and 1 year postoperatively (by telephone). Responsiveness was characterized using standardized response means (SRMs) and correlation coefficients between change scores. Construct validity was evaluated using correlation coefficients between 1-year scores and comparisons of WHODAS scores across clinically relevant subgroups.

RESULTS

The analysis included 546 patients. There was moderate correlation between changes in WHODAS and various EQ-5DTM subscales. The strongest correlation was between changes in WHODAS and changes in the functional domains of the EQ-5D-3L-for example, mobility (Spearman's rho 0.40, 95 per cent confidence interval [c.i.] 0.32 to 0.48) and usual activities (rho 0.45, 95 per cent c.i. 0.30 to 0.52). When compared across quartiles of EQ-5D index change, median WHODAS scores followed expected patterns of change. In subgroups with expected functional status changes, the WHODAS SRMs ranged from 'small' to 'large' in the expected directions of change. At 1 year, the WHODAS demonstrated convergence with the EQ-5D-3L functional domains, and good discrimination between patients with expected differences in functional status.

CONCLUSION

The WHODAS questionnaire has construct validity and responsiveness as a measure of functional status at 1 year after major surgery.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Disparities in post-operative surveillance testing for metastatic recurrence among colorectal cancer survivors

PURPOSE

Among colorectal cancer (CRC) survivors, treatment for metastatic recurrence is most effective when malignancies are detected early through surveillance with carcinoembryonic antigen (CEA) level test and computer tomography (CT) imaging. However, utilization of these tests is low, and many survivors fail to meet the recommended guidelines. This population-based study assesses individual- and neighborhood-level factors associated with receipt of CEA and CT surveillance testing.

METHODS

We used the Surveillance, Epidemiology and End Results (SEER)-Medicare data to identify Medicare beneficiaries diagnosed with CRC stages II-III between 2010 and 2013. We conducted multivariate logistic regression to estimate the effect of individual and neighborhood factors on receipt of CEA and CT tests within 18 months post-surgery.

RESULTS

Overall, 78% and 58% of CRC survivors received CEA and CT testing, respectively. We found significant within racial/ethnic differences in receipt of these surveillance tests. Medicare-Medicaid dual coverage was associated with 39% lower odds of receipt of CEA tests among non-Hispanic Whites, and Blacks with dual coverage had almost two times the odds of receiving CEA tests compared to Blacks without dual coverage.

CONCLUSIONS

Although this study did not find significant differences in receipt of initial CEA and CT surveillance testing across racial/ethnic groups, the assessment of the factors that measure access to care suggests differences in access to these procedures within racial/ethnic groups.

IMPLICATIONS FOR CANCER SURVIVORS

Our findings have implications for developing targeted interventions focused on promoting surveillance for the early detection of metastatic recurrence among colorectal cancer survivors and improve their health outcomes.

AB1209 MECHANISTIC FACTORS CONTRIBUTING TO PAIN AND FATIGUE IN FIBROMYALGIA AND ME/CFS: AUTONOMIC AND INFLAMMATORY INSIGHTS FROM AN EXPERIMENTAL MEDICINE STUDY

Background

Fibromyalgia and ME/CFS are multifaceted conditions with overlapping symptoms(1); the pathoaetiological mechanisms are complex and debated(2), however there is a strong association with features of hereditary disorders of connective tissue (hypermobility) and autonomic and inflammatory abnormalities (1,2).

Objectives

To determine potential autonomic and inflammatory mechanisms of pain and fatigue in fibromyalgia and ME/CFS

Methods

After excluding participants with WCC higher than 10 (suggesting acute infection) baseline markers of inflammation (CRP and ESR) were available for 60 patients with confirmed diagnoses of Fibromyalgia and/ or ME/CFS and 23 matched controls. Participants then underwent full research diagnostic evaluation including a hypermobility assessment(1) and autonomic challenge (60 degree head up tilt, ISRCTN78820481). Subjective pain and fatigue were assessed before and after challenge (VAS). Linear regression models were used to explore predictors, with adjustment for confounders as appropriate. Mediation analyses (looking for mechanistic effects) were conducted according to the method of Hayes (3) and mediation considered significant if bootstrapped confidence intervals of the estimated indirect effect did not cross zero. In these mediation analyses predictor variable was group membership (patient or control), outcome variable was change in 1)pain and 2)fatigue induced by challenge and mediatiors 1)no of connective tissue features in hypermobility diagnostic criteria endorsed by participant; 2)baseline inflammatory markers.

Results

ESR and CRP were significantly higher in patients rather than controls, even after correcting for BMI, age and sex (B=5.15, t=2.05, p=0.044; B=1.77, t=2.15, p=0.044 respectively). Adjusted ESR and CRP correlated with both subjective fatigue (B=0.44, t=2.09, p=0.04; B=1.63, t=2.60, p=0.011) and pain severity (B=0.13, t=2.51, p=0.014; B=0.45, t=3.01, p=0.004) at baseline. Autonomic challenge amplified pain (B=14.20, t=2.87, p=0.005) and fatigue (B=31.48, t=5.95, p=<0.001) in patients to a significantly greater degree than controls, controlling for baseline levels. Baseline ESR and CRP also predicted challenge-induced increase in fatigue (B=0.78, t=370, p=<0.001; B=1.91, t=3.36, p=<0.001) and ESR challenge-induced increases in pain (B=0.46, t=2.35, p=0.021).

Mediation analysis demonstrated that number of connective tissue features expressed in hypermobility criteria mediated the degree to which subjective pain was increased by the autonomic challenge (Bootstraped 95% CI of indirect effect do not cross zero, 0.1572 – 6.8171). ESR mediated the degree to which subjective fatigue was increased by the autonomic challenge (Bootstraped 95% CI of indirect effect do not cross zero,0.7541 – 7.3888).

Conclusion

To our knowledge this is the first study to directly explore autonomic and inflammatory mechanisms of pain and fatigue in a combined population of Fibromyalgia and ME/CFS. This study this adds to the evidence-base of baseline inflammatory abnormalities in fibromyalgia and ME/CFS. It highlights their potential role in predicting symptom severity and their potential mechanistic role in autonomic induced pain and fatigue, suggesting future treatment strategies.

References

[1]Eccles JA, Thompson B, Themelis K, Amato ML, Stocks R, Pound A, et al. Beyond bones: The relevance of variants of connective tissue (hypermobility) to fibromyalgia, ME/CFS and controversies surrounding diagnostic classification: an observational study. Clin Med (Lond). 2021;21(1):53-8.

[2]Eccles JA, Davies KA. The challenges of chronic pain and fatigue. Clin Med (Lond). 2021;21(1):19-27.

[3]Hayes AF. Partial, conditional, and moderated moderated mediation: Quantification, inference, and interpretation. Commun Monogr. 2018;85(1):4-40.

Disclosure of Interests

Jessica Eccles: None declared, Charlotte Thompson: None declared, Beth Thompson: None declared, Marisa Amato: None declared, Kristy Themelis: None declared, Hugo Critchley: None declared, Neil Harrison Grant/research support from: speakers bureau, Kevin Davies: None declared

Teaching Strategies During the COVID-19 Pandemic: Tailoring Virtual Learning for Public Health and Cancer Health Disparities Education

The COVID-19 pandemic has dramatically impacted higher education institutions in the United States (US). Given the dangers of close social interaction in spreading COVID-19, colleges and universities closed their campuses to minimize and often restrict face-to-face instruction of any kind, including supplemental skill development training and experiential learning. In exchange, higher education institutions implemented online learning strategies to continue education for students, including in-person experiential field experiences. This paper describes the adaptation of an in-person experiential field experience into an eight-day virtual workshop as a result of COVID-19 restrictions along with results from participant surveys evaluating pre-and post-test changes in knowledge and their overall assessment of the virtual workshop. This workshop, the Public Health and Cancer Research Workshop (PHCRW), was tailored for students from health-related graduate programs with the primary goal of introducing students to the causes and impacts of cancer disparities in the US/Mexico border region and research related to mitigating those disparities. The course facilitators added a professional development curriculum necessary for student success and the pursuit of advanced degrees such as academic/job interviewing skills and scientific and grant writing. The objectives were for students to (1) understand introductory and intermediate curriculum on public health, cancer, and cancer research; (2) examine the interrelationships among factors impacting public health problems; (3) describe the components of the research process; (4) describe various components of scientific writing; and (5) demonstrate professional strategies associated with school admission and employment. Students completed pre-and post- self-assessments that indicated gains in knowledge about cancer topics, particularly cancer prevention strategies (M_pre = 3.43; M_post = 4.43), social determinants associated with cancer (M_pre = 3.29; M_post = 4.43), and cancer rates by characteristics (M_pre = 3.43; M_post = 4.43). Additionally, students overwhelmingly stated that they appreciated the opportunity to supplement their educational experience in a virtual format. Though the virtual format proved challenging in some respects, students expressed high satisfaction with the workshop. In addition to achieving the goals, the workshop successfully increased students' skills, knowledge, and self-confidence. Despite the last-minute adaptation of the PHCRW, students' satisfaction indicated that this program was an overall success.

Complex cognitive algorithms preserved by selective social learning in experimental populations

Many human abilities rely on cognitive algorithms discovered by previous generations. Cultural accumulation of innovative algorithms is hard to explain because complex concepts are difficult to pass on. We found that selective social learning preserved rare discoveries of exceptional algorithms in a large experimental simulation of cultural evolution. Participants (N = 3450) faced a difficult sequential decision problem (sorting an unknown sequence of numbers) and transmitted solutions across 12 generations in 20 populations. Several known sorting algorithms were discovered. Complex algorithms persisted when participants could choose who to learn from but frequently became extinct in populations lacking this selection process, converging on highly transmissible lower-performance algorithms. These results provide experimental evidence for hypothesized links between sociality and cognitive function in humans.

Human psychophysical discrimination of spatially dependant Pancharatnam-Berry phases in optical spin-orbit states

We tested the ability of human observers to discriminate distinct profiles of spatially dependant geometric phases when directly viewing stationary structured light beams. Participants viewed polarization coupled orbital angular momentum (OAM) states, or "spin-orbit" states, in which the OAM was induced through Pancharatnam-Berry phases. The coupling between polarization and OAM in these beams manifests as spatially dependant polarization. Regions of uniform polarization are perceived as specifically oriented Haidinger's brushes, and study participants discriminated between two spin-orbit states based on the rotational symmetry in the spatial orientations of these brushes. Participants used self-generated eye movements to prevent adaptation to the visual stimuli. After initial training, the participants were able to correctly discriminate between two spin-orbit states, differentiated by OAM [Formula: see text], with an average success probability of [Formula: see text] ([Formula: see text], [Formula: see text]). These results support our previous observation that human observers can directly perceive spin-orbit states, and extend this finding to non-rotating beams, OAM modes induced via Pancharatnam-Berry phases, and the discrimination of states that are differentiated by OAM.

A decision support tool for the detection of pancreatic cancer in general practice: A modified Delphi consensus

BACKGROUND/OBJECTIVES

Diagnosis of pancreatic cancer is often delayed, contributing to patient and family distress and leading to worse survival. We aimed to develop a decision support tool to support primary care providers to identify patients that should undergo investigations for pancreatic cancer, and to recommend initial diagnostic pathways.

METHODS

A modified Delphi process, including a series of three surveys, was undertaken to ascertain clinical expert opinion on which combinations of signs, symptoms and risk factors should be included in a tool for the early identification of pancreatic cancer. A group of clinical specialists finalised the development of the tool during a focus group meeting.

RESULTS

The tool presents individual or combinations of signs, symptoms, and risk factors in three tiers which direct the urgency of investigation. Tier 1 includes 5 clinical presentation and risk factors clusters that indicate the need for urgent investigation of the pancreas. A further five clusters are included as Tier 2 aiming to elimate other causes and reduce the time to investigating the pancreas. Tier 3 includes a list of non-specific signs, symptoms and risk factors that indicate the need to consider pancreatic cancer as a potential diagnosis, but without specific recommendations for investigation.

CONCLUSIONS

Prospective validation studies are now required prior to implementation in the primary care setting. Implementation into primary care practice and as an educational resource may facilitate rapid diagnosis and improve outcomes such as distress and survival.

Factors influencing aspirations for practice ownership by veterinary professional students at the University of Sydney

Understanding the factors that influence the aspirations of future veterinary practitioners is critical to assist succession planning. The aim of this study was to discover factors that currently influence veterinary students' desire to own a veterinary practice in the future, including whether these aspirations were influenced by a student's experience throughout their years of veterinary studies. The study surveyed University of Sydney students enrolled in the postgraduate Doctor of Veterinary Medicine (DVM) degree in 2020. A response rate of 29% was obtained (142/508). Of those 142 respondents, 50 (35%) indicated that they wished to own a practice in the future, 40 (28%) indicated that they did not wish to own a practice in the future and 52 (37%) were unsure. The results demonstrate that practice ownership is currently only influenced by factors that are external to a student's experience at university, given that there was no significant difference between practice ownership aspirations between DVM years. After excluding those who were unsure, veterinary students whose parents or guardians own, or have owned, a business are three times more likely (OR = 3.19; 95% CI = 1.35-7.73; P < 0.01) to aspire to practice ownership than those students whose parents have not. Asian students showed significantly less interest in practice ownership than Caucasian students (OR = 0.41; 95% CI = 0.16-0.99, P < 0.05). Further qualitative research is required to better understand these findings so that tailored advice can be provided to students and veterinary schools to positively support graduating veterinary professionals towards future practice ownership.

COVID-19 infection in ethnic minorities: A systematic review of age and gender distribution

Background

Currently, there have been 135,646,617 cases of COVID-19 infection and 2,930,732 deaths in the world. Compared with the White populations, members of the ethnic minorities living in Europe and North America are disproportionately diagnosed, hospitalized and dying from COVID-19. The reasons for this relatively increased risk of infection and adverse outcome are poorly understood. The aim of this review is to summarise current epidemiological evidence on age and gender distribution in ethnic minority patients hospitalized with COVID-19 infection.

Methods

Multiple electronic databases were searched. Data from studies, published in any language, reporting the risk factors, incidence and outcomes of COVID-19 infection in hospitalized White and ethnic minorities patients were extracted, reviewed and compiled.

Results

36 studies reporting data on age and 26 on gender were included in the review. Ethnic minority patients hospitalized with COVID-19 were relatively younger than White patients. Within the different minority groups, a greater proportion of Black patients were female, whereas a greater proportion of Asian patients were male.

Conclusions

This review confirms findings from individual studies that with regard to age, the ethnic minority patients hospitalized with COVID-19 infection are relatively younger than the White patients. There is also a disparity with regard to gender within the different minority groups.

Key messages

There is a disparity with regard to age and gender between the different ethnic groups affected with COVID-19 infection in Europe and North America. Potential factors for disparities are genetics, vitamin D deficiency, BCG vaccine, comorbidities, occupation, social gradient, housing, PPE access and understanding/compliance to protection measures.

The interdisciplinary and psychosocial gap in cancer survivorship: A longitudinal study in a Latin American Cancer Center

BACKGROUND AND OBJECTIVES

There is lack of information on the quality of care provided to the rapidly increasing population of cancer survivors in Latin America. Our study attempts to address this gap and to identify areas needed to be improved.

METHODS

A random sample of 210 breast and colorectal cancer survivors were selected from a hospital-based registry in Chile. Cancer registry information, electronic chart review, and personal interviews were used to assess medical and nonmedical care over a 5-year period. Survivorship care practices were compared to a standardized reference based on the US Institute of Medicine domains and the American Cancer Association guidelines.

RESULTS

Over 80% of breast and colorectal cancer survivors received appropriate medical care, ongoing testing surveillance and risk factors assessment. Only a third of survivors were assessed for psychosocial disorders and 25% of them received interdisciplinary care. Overall, 66.1% of breast and 58.6% of colorectal cancer survivors reached the expected quality level of cancer survivorship care according to the reference standard (p < .001).

CONCLUSION

Medical care practices reached a high standard in a leading cancer center in Latin America. However, a much stronger psychosocial assessment and interdisciplinary care is needed to improve survivorship cancer quality care.

Understanding a Diverse Cancer Center Catchment Area: A Qualitative Needs Assessment Built on a Theoretical Framework

INTRODUCTION

Quantitative approaches to the cancer incidence and mortality of a geographic region may lack understanding of the human context in the region thereby affecting how relevant cancer prevention and control activities can best be targeted to a cancer center's catchment area.

OBJECTIVES

The objective of this study was to obtain and analyze qualitative data that described the barriers and facilitators in a cancer center's catchment area. A further objective was to use the assessment to plan a comprehensive approach to cancer prevention and control activities in the region.

METHODS

Extensive qualitative data were gathered from 32 key informants in the 13 county catchment area. We used the Warnecke Model for Analysis of Population Health and Health Disparities to analyze the qualitative data. We coded factors affecting cancer prevention and control using a directed content analysis approach guided by the Warnecke Model.

RESULTS

Four outcome types included fundamental barriers such as political environment and discrimination, gaps in resources, and lack of coordinated activities. Social and physical barriers included distrust, diverse language and cultures, and geographic distance. Individual barriers included lack of system negotiation, health literacy, and poverty. Biological barriers were disparate disease rates in specific groups.

CONCLUSION

The analysis and assessment led to the creation of a catchment area wide coalition that used the results to formulate a comprehensive strategic plan to address the barriers in the region.

OP0078 HIGH MEDIAN NERVE LESION SECONDARY TO SEVERE GIANT CELL ARTERITIS (GCA)

Background:

Giant cell arteritis (GCA) is a systemic vasculitis affecting large to medium-sized vessels. Cranial nerve lesions are frequently documented secondary to GCA, however peripheral nerves are rarely involved.

Objectives:

We present an unusual case of a GCA-associated isolated high median nerve palsy.

Methods:

Case report.

Results:

A 76 year old white British female presented in Spain with three weeks of frontotemporal headaches, mandibular claudication, photopsia and constitutional symptoms, followed by acute-onset right hand paresis and dysaesthesia. Acute-phase reactants were elevated. COVID-19 PCR was negative. Shortly after admission she developed acute bilateral anterior ischaemic optic neuropathy and tongue necrosis with autoamputation. Temporal artery ultrasound and biopsy confirmed GCA. PET-CT showed no evidence of a diffuse large-vessel vasculitis. She was repatriated to the UK for ongoing inpatient care. Upper limb neurophysiology two months later demonstrated an isolated right high median nerve lesion, with reduced median motor responses and absent sensory responses with denervation in extensor carpi radialis. Imaging excluded a central lesion. The timing of her symptoms suggested the lesion was secondary to GCA. Treatment was with tocilizumab, methotrexate and tapering corticosteroids, alongside PEG feeding and careful multi-disciplinary rehabilitation.

Conclusion:

We suggest there are two important learning points from this complex case. Firstly, peripheral nerve lesions can occur in GCA, although they are rare. A literature search identified a modest number of case reports of brachial plexus or lower cervical nerve lesions1,2. Neurologic manifestations in GCA are attributed to vasculitis of the vasa nervorum, or extension of inflammation from arteries to contiguous nerves1,2. The restriction of clinical involvement to the median nerve alone would appear to favour the former mechanism. Functional recovery of neurological deficits is typically partial at best.

Secondly, this case highlights the difficulty faced by clinicians in recognising GCA and the importance of urgent treatment with glucocorticoids. The patient developed GCA during the ongoing COVID-19 pandemic when Spain was the second-worst affected European country (5% seroprevalence; 95% CI 4.7-5.4)3. The partial overlap in symptoms between GCA and COVID-19 (e.g. headache, pyrexia, malaise, elevated acute-phase reactants) can cause diagnostic confusion and treatment delay4. GCA should be considered in the differential diagnosis of older patients with suspected COVID-19, or the non-specifically unwell elderly patient.

References:

[1]Blaise S, et al. Horton’s disease revealed by brachial C5 plexopathy [French]. Rev Med Interne. 2005;26(7):578-82.

[2]Merianos P, et al. Giant cell arteritis of the median nerve simulating carpal tunnel syndrome. Hand. 1983;15(3): 249-251.

[3]Pollán M, et al. Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study. Lancet. 2020; 396(10250): 535-544.

[4]Monti S, Delvino P, et al. Impact of delayed diagnoses at the time of COVID-19: increased rate of preventable bilateral blindness in giant cell arteritis. Ann Rheum Dis. 2020;79:1658-1659.

Table 1.Area/movementResultAbductor pollicis brevisGrade 2 weaknessOpponens pollicisGrade 4 weaknessPronator teres/quadratusGrade 4 weaknessFlexor pollicis longusGrade 1-2 weaknessFlexor digitorum profundus (digit 2 and 3)Grade 1-2 weaknessFinger abductionPreservedFinger extensionPreservedOther commentsDysaesthesia in distribution of median nerve

Disclosure of Interests:

Kundan Iqbal: None declared, James Miller Speakers bureau: Dr Miller has participated in pharmaceutical-sponsored symposiums previously but not in last five years., Consultant of: Dr Miller has participated in pharmaceutical-sponsored consultancy previously but not in last five years., Ming Lai: None declared, Mia Charnley: None declared, Muhammad Meraj: None declared, Ben Thompson Speakers bureau: Dr Thompson has participated in educational talks for Roche, Novartis, Lilly and UCB., Consultant of: Dr Thompson has participated in advisory boards for Roche, Novartis, Lilly, Gilead, Abbvie and UCB.

Implementation of an integrated framework for a breast cancer screening and navigation program for women from underresourced communities

BACKGROUND

Trends in breast cancer mortality in the United States are decreasing, but racial disparities persist. Using an implementation science framework to inform evidence-based breast cancer screening and navigation within federally qualified health centers (FQHCs) with community stakeholders can mitigate barriers to screening.

METHODS

Using an integrated theoretical framework of the Practical, Robust Implementation and Sustainability Model and the Social Ecological Model, the University of Illinois Cancer Center and Mile Square Health Centers (MSHC) FQHC developed a breast cancer screening and navigation program, known as the Mile Square Accessible Mammogram Outreach and Engagement (Mi-MAMO) program, to tackle breast cancer disparities in Chicago among underresourced communities. To increase access to screening, patient navigators conducted community outreach activities. Partnerships were forged with community-based organizations, health care systems, and insurers. Outcomes were monitored with standardized performance measures.

RESULTS

Between January and December 2017, 103 women received a screening mammogram at MSHC. To increase screening rates, Mi-MAMO was started in August 2017. Between January and December 2018, the number of women who received a screening mammogram increased to 567. From August 2017 to December 2018, 779 women received navigation to screening and/or diagnostic services through the Mi-MAMO program. The majority of women were uninsured (63.9%), and 95.5% were racial/ethnic minorities. Twenty-four percent (n = 185) completed diagnostic services, and 10 women received positive breast cancer diagnoses (mean age, 49.7 years); all successfully navigated to treatment. The Mi-MAMO program is ongoing.

CONCLUSIONS

Deploying an integrated framework for patient navigation programs can increase breast cancer screening utilization and awareness among underresourced populations at higher risk for breast cancer.

Eat Healthy, Be Active Community Workshops implemented with rural Hispanic women

Background

In the U.S., obesity disproportionately affects some racial/ethnic groups more than others; 42.5% of Hispanic adults are obese, compared to 32.6% of non-Hispanic whites (NHW). Research also shows that Mexican American women are 40% more likely to be overweight, as compared to NHW women. With high obesity rates among Hispanics, improving healthier lifestyle practices is an important step for reducing health disparities. The Eat Healthy, Be Active (EHBA) community workshops were developed to assist individuals in translating national nutrition and physical activity recommendations into action. Promotora-led EHBA workshops could be used to promote obesity-related health behavior lifestyle changes among Hispanics.

Methods

Hispanic women from rural communities in Washington state were recruited to participate in a six-week Promotora-led workshop series. This pilot study used a pre- and post-test study design to examine differences in healthy lifestyle knowledge and practices.

Results

A total of 49 Hispanic women participated in the workshops, of whom 45% were obese. Six-weeks after implementation of EHBA, women had improvements in healthy lifestyle practices, including an increase in nutrition label literacy, decrease in consumption of food eaten in restaurants, and an increase in the number of times a woman performed physical activity long enough to make them sweat.

Conclusion

The findings from this pilot study indicate that delivering EHBA workshops through promotoras is a feasible culturally relevant approach to promoting healthier lifestyle practices among Hispanic women. Further, focusing on females, who do the food shopping and preparation in their homes, may help increase awareness among whole families.

Transdisciplinary research outcomes based on the Transdisciplinary Research on Energetics and Cancer II initiative experience

Intractable public health problems are influenced by interacting multi-level factors. Dynamic research approaches in which teams of scientists collaborate beyond traditional disciplinary, institutional, and geographic boundaries have emerged as promising strategies to address pressing public health priorities. However, little prior work has identified, defined, and characterized the outcomes of transdisciplinary (TD) research undertaken to address public health problems. Through a mixed methods approach, we identify, define, and characterize TD outcomes and their relevance to improving population health using the Transdisciplinary Research on Energetics and Cancer (TREC) II initiative as a case example. In Phase I, TREC II leadership (n = 10) identified nine initial TD outcomes. In Phase II (web-based survey; n = 23) and Phase III (interviews; n = 26; and focus groups, n = 23) TREC members defined and characterized each outcome. The resulting nine outcomes are described. The nine complementary TD outcomes can be used as a framework to evaluate progress toward impact on complex public health problems. Strategic investment in infrastructure that supports team development and collaboration, such as a coordination center, cross-center working groups, annual funded developmental projects, and face-to-face meetings, may foster achievement of these outcomes. This exploratory work provides a basis for the future investigation and development of quantitative measurement tools to assess the achievement of TD outcomes that are relevant to solving multifactorial public health problems.

The Health Disparities Field Experience: College students and community health workers in the field

CONTEXT

Immersing students studying health promotion and disease prevention into community settings facing health disparities is an essential supplement to their academic experience. As part of many public health professions, these students will likely need to understand the values and beliefs of different cultures so that decisions of appropriate health promotion and treatment can be made equitably. This paper evaluates an education immersion program that was part of a National Cancer Institute funded collaboration supporting the recruitment and training of university students in cancer research. The primary aim of the Health Disparities Field Experience (HDFE) was to facilitate an experience for students pursuing a health-related degree to understand the conceptual issues in border/rural health and the cultural contexts related to health disparities among medically and financially indigent populations in the region.

SUBJECTS AND METHODS

This study was conducted using qualitative research methods using a variation of the content analysis approach using open codes to categorize the data. Six students were selected to participate in the HDFE (five graduate students and one undergraduate) and all six of the participants completed pre- and post-test surveys.

RESULTS

From the analysis of the data, posttest qualitative responses indicated that three participants saw racism as a primary cause of cancer-related disparities, a change from their pretest responses. When asked about the personal impact of the HDFE, respondents mentioned the importance of the experiential component.

CONCLUSIONS

Participants learned about health disparities from the HDFE and expressed high satisfaction with this approach to education.

Financial Hardship and Health Related Quality of Life Among Older Latinos With Chronic Diseases

BACKGROUND

Financial hardship influences health-related quality of life (HRQoL) of older adults. However, little is known about the relationship between financial hardship and HRQoL among vulnerable populations.

OBJECTIVE

We examined the associations between financial hardship and HRQoL among older Latinos living with chronic disease, including cancer.

METHODS

This cross-sectional study included 68 Latinos (age range 50-87) with one or more chronic health conditions who participated in a pilot randomized clinical trial. Participants responded to 11 financial hardship questions. We used factor analysis to explore constructs of financial hardship. HRQoL was assessed using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G). Multiple linear regression examined the associations between financial hardship and HRQoL subscales (physical, social/family, emotional, functional well-being).

RESULTS

The factor analysis revealed 3 constructs of financial hardship: medical cost concerns, financial hardship treatment adherence, and financial worry. A 1-point increase in the factor score for financial hardship treatment adherence was associated with a 2.1-point (SE = 0.771) decrease in physical well-being and with a 1.71-point (SE = 0.761) decrease in functional well-being. A 1-point increase in the financial stress factor score was associated with a 2.0-point (SE = 0.833) decrease in social/family well-being, and with a 2.1-point (SE = 0.822) decrease in functional well-being.

CONCLUSION

In this study of older Latinos with chronic diseases, financial hardship was associated with worse HRQoL across several domains. Healthcare providers should refer older Latinos living with chronic disease to appropriate support providers, such as care coordinators, social workers, or patient navigators, who can assist them with obtaining financial assistance and other resources.

Inequitable access to surveillance colonoscopy among Medicare beneficiaries with surgically resected colorectal cancer

BACKGROUND

After colorectal cancer (CRC) surgery, surveillance with colonoscopy is an important step for the early detection of local recurrence. Unfortunately, surveillance colonoscopy is underused, especially among racial/ethnic minorities. This study assesses the association between patient and neighborhood factors and receipt of surveillance colonoscopy.

METHODS

This retrospective, population-based cohort study used Surveillance, Epidemiology, and End Results-Medicare linked data (2009-2014). Beneficiaries with surgically resected stage II or III CRC between the ages of 66 and 85 years were identified, and multivariable logistic regression was used to assess the effect of factors on receipt of colonoscopy.

RESULTS

Overall, 57.5% of the patients received initial surveillance colonoscopy. After adjustments for all factors, Blacks and Hispanics had lower odds of receiving colonoscopy than non-Hispanic Whites (NHWs; 29.6% for Blacks; P = .002; 12.9% for Hispanics; P > .05). NHWs with Medicaid coverage had 35% lower odds of surveillance colonoscopy than NHWs without Medicaid coverage. Minority patients with Medicaid were more likely to receive colonoscopy than their racial/ethnic counterparts without Medicaid coverage (P > .05). Hispanics residing in neighborhoods with incomes of ≥$90,000 had significantly lower odds of surveillance colonoscopy than Hispanics residing in neighborhoods with incomes of $0 to $30,000.

CONCLUSIONS

Receipt of initial surveillance colonoscopy remains low, and there are acute disparities between Black and NHW patients. The association between factors that assess a patient's ability to access colonoscopy and actual receipt of colonoscopy suggests inequitable access to surveillance colonoscopy within and across racial/ethnic groups.

Determinants of Guideline-Discordant Breast Cancer Care

BACKGROUND

Evidence-based breast cancer treatment guidelines recommend the most appropriate course of therapy based on tumor characteristics and extent of disease. Evaluating the multilevel factors associated with guideline discordance is critical to identifying strategies to eliminate breast cancer survival disparities.

METHODS

We identified females diagnosed with a first primary, stage I-III breast cancer between the ages of 20-69 years of age from the population-based Seattle-Puget Sound Surveillance, Epidemiology, and End Results registry. Participants completed a survey about social support, utilization of patient support services, hypothesized barriers to care, and initiation of breast cancer treatment. We used logistic regression to estimate odds ratios and 95% confidence intervals (CI).

RESULTS

Among 1,390 participants, 10% reported guideline-discordant care. In analyses adjusted for patient-level sociodemographic factors, individuals who did not have someone to go with them to appointments or drive them home (OR 1.96; 95% CI, 1.09-3.59) and those who had problems talking to their doctors or their staff (OR 2.03; 95% CI, 1.13-3.64) were more likely to be guideline discordant than those with social support or without such problems, respectively. Use of patient support services was associated with a 43% lower odds of guideline discordance (OR 0.57; 95% CI, 0.36-0.88).

CONCLUSIONS

Although guideline discordance in this cohort of early-stage breast cancer survivors diagnosed <70 years of age was low, instrumental social support, patient support services, and communication with doctors and their staff emerged as potential multilevel intervention targets for improving breast cancer care delivery.

IMPACT

This study supports extending the reach of interventions designed to improve guideline concordance.

Abstract C006: Sociodemographic predictors of adherence to postoperative surveillance colonoscopy among patients diagnosed with nonmetastatic colorectal cancer

Background: Despite progress in colorectal cancer (CRC) screening and treatment over the past two decades, striking disparities in CRC survival persist among racial/ethnic minorities, with Blacks experiencing a 10% lower 5-year overall survival compared to Whites (American Cancer Society, 2017). One potential reason for the disparity in survival may be due to lower rates of appropriate surveillance care among racial/ethnic minorities. Among CRC patients, postoperative surveillance (PS) received at recommended intervals within 5-years following surgery improves overall survival up to 33% (Rodríguez-Moranta, 2006). Unfortunately, minority CRC survivors are approximately 30% less likely to receive PS compared to non-Hispanic Whites (NHW) (Carpentier, 2013). There are likely multiple underlying factors contributing to disparities in the timely receipt of recommended PS procedures such as colonoscopy, a PS procedure with adherence proportions as low as 18% among CRC patients. The differences in CRC patients who adhere or do not adhere to PS procedures are understudied.

Purpose: Based on Andersen's (1978, 1995, 2007) Behavioral Model of Health Services Use, this study will assess the association between individual- and contextual-level factors and adherence to PS colonoscopy among Medicare beneficiaries from different racial/ethnic groups.

Methods: This is a retrospective population-based cohort study using the SEER-Medicare linked database (2009-2014). Medicare beneficiaries diagnosed with CRC as their first cancer and who received surgical resection for CRC stage II and III, and who are between the ages of 66 and 85, are included in this sample. Chi-squared test will be used to assess significant differences in the distribution of patient characteristics across race/ethnicity, and analysis of variance (ANOVA) is used to assess differences for age as a continuous variable. Descriptive statistics will be presented for all demographic and socioeconomic variables to describe the characteristics of the sample population, stratified by racial/ethnic group. A hierarchical generalized linear model will be used to assess adherence to PS colonoscopy as a nonlinear function of explanatory variables defined at the individual- and contextual-levels. The adjusted odds with 95% confidence intervals of adherence to PS colonoscopy also will be presented by racial/ethnic group.

Conclusions: Appropriate surveillance following a CRC diagnosis is critical for improving CRC outcomes. Characteristics that are unique to racial/ethnic minorities may contribute to lower rates of adherence to PS colonoscopy, leading to poor survival outcomes. Findings from the proposed research may help guide future public health and clinical interventions focused on improving the timely receipt of PS procedures among older adults.

Citation Format: Janeth Sanchez, Veena Shankaran, Joseph Unger, Margaret Madeleine, Beti Thompson. Sociodemographic predictors of adherence to postoperative surveillance colonoscopy among patients diagnosed with nonmetastatic colorectal cancer [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C006.

Abstract A031: The influence of diet and physical activity in the relationship between context, obesity, and obesity-related cancer disparities: A systematic review

Purpose: Latino- and African-Americans suffer disproportionately from obesity- and obesity-related cancers relative to non-Latino Whites (NLWs). A large body of work has focused on addressing these disparities through individual-level obesity-related behaviors (diet, physical activity [PA]). Simultaneously, a growing body of work has highlighted the role of contextual factors on disparities in obesity and obesity-related cancers, including neighborhood and cultural factors. Multilevel frameworks suggest that one way in which contextual factors impact obesity and obesity-related cancers among Latino- and African-Americans is through diet and PA. Yet, little work has evaluated empirical evidence testing this multilevel hypothesis. Such data are warranted to understand if individual-level interventions are sufficient or if direct intervention at the contextual-level is warranted to reduce disparities in obesity and obesity-related cancers.

Objective: To conduct a systematic review and evaluate research that examined the influence of contextual level factors on obesity and breast and colorectal cancer via diet and physical activity.

Method: Between June and July 2015, authors conducted a systematic review via electronic literature searches using PubMed and Web of Knowledge databases. Studies were included if they reported a measure of a) cultural and/or neighborhood factors, b) obesity and obesity-related cancers, c) physical activity and diet, targeted African- and Latino-American populations, and conducted a test of mediation effects of diet and/or PA.

Results: Of the 229 titles identified, 177 abstracts and 7 full text articles were reviewed. Of the 7 articles reviewed, 5 specifically tested diet and PA as pathways in the relationship between contextual factors and obesity. All studies focused on PA-related behaviors as mechanisms, and one included diet. Studies varied in terms of measurement of diet and PA. Among the studies that investigated neighborhood-level factors, only one study found evidence of PA as a mediator. This study found that infrastructure for walking was indirectly related to obesity via accelerometer-measured PA. Two studies examining cultural factors linked acculturation and obesity via PA—specifically if measured as sedentary behavior as well as leisure-time, transportation-related, and work-related PA.

Conclusion: The evidence remains limited in terms of whether individual-level behaviors underlie the effects of contextual factors on obesity- and obesity-related cancers among Latino- and African-Americans. Indeed, little to no research examines these relationships in terms of two more commonly studied obesity-related cancers, and little work has assessed diet as the mechanism by which contextual factors influence obesity. To understand which interventions are optimal for addressing these multifaceted disparities, further research is needed to clarify if and how context influence health behaviors.

Citation Format: Catherine M. Pichardo, Beti Thompson, Yamile Molina. The influence of diet and physical activity in the relationship between context, obesity, and obesity-related cancer disparities: A systematic review [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A031.

Abstract A058: Patient and neighborhood factors associated with receipt of surveillance colonoscopy among Medicare beneficiaries with surgically resected colorectal cancer

Background: After colorectal cancer (CRC) surgery, surveillance with colonoscopy is an important step for the early detection of local recurrence. Unfortunately, surveillance colonoscopy is underutilized and only about 55% of CRC patients receive a colonoscopy as recommended. Lower rates are observed among racial/ethnic minorities. Identifying the factors that contribute to disparities in receipt of surveillance colonoscopy can assist researchers in developing targeted interventions to promote surveillance colonoscopy for the early detection of recurrence. Purpose: This study assesses the association between patient- and neighborhood-level factors and receipt of surveillance colonoscopy. Methods: This retrospective population-based cohort study uses the National Cancer Institutes’ Surveillance, Epidemiology and End Results (SEER) – Medicare linked data collected from 2009 to 2014. We identified beneficiaries with surgically resected CRC stages II and III between the ages of 66 and 85. We used multivariate logistic regression to assess the effect of factors on receipt of colonoscopy. Results: A total of 6,602 patients were identified. Overall, 57.5% of patients received a colonoscopy within 18-months after surgery. After adjusting for patient- and neighborhood-level factors, Blacks had 29.6% lower odds of receiving a colonoscopy compared to non-Hispanic Whites (NHWs) (p=.002). Hispanics had 12.9% lower odds of receiving a colonoscopy compared to NHWs, however, this association was not significant (p&gt;.05). Among NHWs, older age, male gender, and single status were significantly associated with lower odds of receipt of colonoscopy. Clinical factors, such as higher stage, no comorbidities and receipt of chemotherapy, were significantly associated with higher odds of receipt of colonoscopy, but only among NHWs. The odds of receipt of surveillance colonoscopy was 35% lower among NHWs patients with Medicaid coverage compared to NHWs without coverage. Although not significant, Black and Hispanic patients with Medicaid coverage were more likely to receive a colonoscopy compared to their racial/ethnic counterparts without coverage. Hispanics residing in neighborhoods with median household incomes of $90K+ had significantly lower odds of receipt of colonoscopy compared to Hispanics residing in neighborhoods with incomes of $0-$30K. Conclusion: Receipt of initial surveillance colonoscopy remains low and disparities exist between Blacks and NHW patients. The association between factors that assess a patient’s ability to access colonoscopy and actual receipt of colonoscopy suggest inequitable access to surveillance colonoscopy within and across racial/ethnic groups.

Citation Format: Janeth I Sanchez, Veena Shankaran, Joseph Unger, Beti Thompson. Patient and neighborhood factors associated with receipt of surveillance colonoscopy among Medicare beneficiaries with surgically resected colorectal cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A058.

Abstract C110: Implementation of an integrated framework for a breast cancer screening and navigation program for under-resourced women

Background As detection and treatment for breast cancer in the United States have improved, racial and ethnic disparities persist. Utilizing an implementation science framework to inform an evidence-based breast cancer screening and navigation program within Federally Qualified Health Centers (FQHCs) with community stakeholders can mitigate multiple barriers to breast cancer screening. Methods Utilizing an integrated theoretical framework of the Practical, Robust Implementation and Sustainability Model (PRISM) and the social ecological model (SEM), the University of Illinois Cancer Center, University of Illinois Hospital & Health Sciences System (UI Health) including Mile Square Health Centers (MSHC) FQHC, and the Chicago Department of Public Health (CDPH) developed a breast cancer screening and navigation program to tackle breast cancer disparities in Chicago among under-resourced women, known as the Mi-MAMO program. To increase access to screening services, patient navigators conducted community outreach and engagement activities. Program partnerships were forged with community-based organizations, healthcare systems and insurers. Program outcomes were monitored using standardized performance measures. Results Between January-December 2017, 103 women received a screening mammogram at MSHC. To increase screening rates, the Mi-MAMO program was started in August 2017. Between January-December 2018, the number of women who received a screening mammogram at MSHC increased to 1051. From August 2017 (start of program) to December 2018, 779 women received navigation to screening and/or diagnostic services through the Mi-MAMO program. The majority of women were uninsured (63.9%) and 95.5% were racial/ethnic minorities. Twenty-four percent (n=185) of women completed diagnostic services and ten women received positive breast cancer diagnoses (mean age 49.7 years). All diagnosed women were successfully navigated to treatment. The Mi-MAMO program is on-going. Conclusion Deploying an integrated framework that merges an implementation science and multi-level behavioral health framework for patient navigation programs has the potential to increase breast cancer screening utilization and awareness among under-resourced populations who may be at higher risk for breast cancer.

Citation Format: Vida A Henderson, Katherine Tossas-Milligan, Erica Martinez, Barbara Williams, Paola Torres, Nasima Mannan, Lauren Green, Beti Thompson, Robert Winn, Karriem S Watson. Implementation of an integrated framework for a breast cancer screening and navigation program for under-resourced women [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C110.

SAT0272 THE VALUE OF CLINICAL AND LABORATORY FEATURES TO PREDICT EXTENT OF LARGE VESSEL VASCULITIS ON PET CT

Background:

Giant cell arteritis (GCA) is an idiopathic vasculitis affecting large and medium-sized vessels. The pattern of arterial involvement is heterogeneous with two overlapping categories recognised: classical cranial GCA and extra-cranial GCA (or large vessel vasculitis – LVV) that predominantly affects the aorta and its proximal branches. Although LVV is present in around 80% of patients with cranial GCA, and around one third will develop large vessel complications, there are no guidelines for which patients should be screened for it (1). We sought to investigate whether clinical and laboratory features were a useful guide to the severity of LVV on FDG PET-CT.

Objectives:

To retrospectively analyse whether baseline patient characteristics are able to predict the extent of large vessel vasculitis on PET-CT.

Methods:

Clinical data for 65 patients referred for a PET-CT scan by Rheumatology at the Freeman Hospital, Newcastle between January 2015 and May 2018 were retrospectively analysed. The most recent full blood count and inflammatory markers prior to the scan were used. Scans were reviewed by a consultant radiologist and trainee. The arterial network was split in to ten potentially involved territories (aortic arch, thoracic aorta, abdominal aorta, iliac vessels, axillary, brachiocephalic, subclavian, carotid, vertebral and femoral arteries. Both the value of highest standardised uptake value (SUV max) and the territory affected was recorded for each positive scan.

Results:

In the period analysed 65 PET-CT scans were requested, mostly (77%) as baseline investigations for symptoms with LVV in the differential diagnosis. Of these 22 (34%) were positive for LVV and in that group the majority of patients (64%) were female. In those with a negative scan, 47.5% were on concurrent steroid treatment compared to 9% with a positive scan. Regression analysis suggested that the number of systemic features (weight loss, pyrexia, polymyalgia) was weakly correlated with the number of affected territories (p=0.04). In contrast there was no correlation between laboratory tests ((CRP (p=0.91), ESR (p=0.46), Hb (p=0.44), platelets (p=0.74)) and the number of territories affected. The aortic arch (47%) was most commonly the territory with the highest degree of FDG uptake (SUV max) followed by the abdominal aorta (21%) and thoracic (10%) and femoral arteries (10%). There was no correlation between SUV max and laboratory tests ((CRP (p=0.55), ESR (p=0.89), Hb (p=0.82), platelets (p=0.17)) or the number of systemic features (p=0.7). There was no significant difference in the number of territories affected between those on steroid treatment at the time of the scan and steroid-naïve patients, albeit the number of positive scans in those on steroid treatment was low (n=5).

Conclusion:

These results suggest that clinical and laboratory features are a poor guide to predicting the maximal severity and extent of disease on FDG PET-CT.

References:

[1]Koster MJ, Matteson EL, Warrington KJ. Large-vessel giant cell arteritis: diagnosis, monitoring and management. Rheumatology (Oxford). 2018;57(suppl_2):ii32-ii42.

Disclosure of Interests:

None declared

Abstract A056: Supporting the next generation of researchers: The effects of a U54 Partnership

Background: The REACH Education Core of the U54 Partnership between New Mexico State University (NMSU) and Fred Hutch is reaching under-represented (UR) students through summer internships in the laboratories of U54-funded investigators on both campuses.

Objective: The objective of this study is to provide information on successful educational outcomes of under-represented students.

Methods: The Partnership generated an extensive participate tracking database. Outcomes included undergraduate graduation, entry into advanced degree programs, awards, and publications. Using the tracking database, we identified the number of students who achieved these outcomes. In addition, we evaluated student attitudes, efficacy, and participation in collaborative research activities.

Results: We facilitated research internships for 83 undergraduates (83% UR) and 23 graduate students (74% UR). Of the undergraduates, 96% completed their BS degree and 86% are on track to complete a graduate degree. Of the graduates, 96% have completed their graduate degree. Since the inception of the partnership in 2002, 72 (56%) of the total Partnership publications have students as coauthors. A total of 133 student participants are now employed in cancer-related research. A total of 697 students have been exposed to the Partnership's cancer and health objectives.

Conclusions: The Partnership has had a high impact in preparing future scientists who will contribute to the diversification of the biomedical research workforce. The educational components of this Partnership have had exceptional successes.

Implications: This study demonstrates that institutions of higher learning can implement research experiences to maintain, strengthen, and evaluate effective programs for current and future under-represented scientists.

Citation Format: Marilyn Drennan, Helena Loest, Beti Thompson, Graciela Unguez. Supporting the next generation of researchers: The effects of a U54 Partnership [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A056.

Abstract C004: Collecting evidence to drive research that addresses community cancer needs in Western Washington

Background: The Fred Hutch/University of Washington Cancer Consortium (Consortium) is a National Cancer Institute-designated comprehensive cancer center located in the Seattle metro area. The Consortium comprises four partnering institutions (Fred Hutchinson Cancer Research Center, University of Washington, Seattle Children's Hospital, and Seattle Cancer Care Alliance [SCCA]) that together address the full spectrum of cancer research and interventions to reduce the burden of cancer among catchment area (CA) residents. The Consortium's CA is thirteen counties in western Washington (WA). In an effort to understand and document ongoing research conducted to address the cancer burden, risk factors, incidence, mortality, and inequities in the CA, we initiated a comprehensive needs assessment.

Methods: We conducted a quantitative and qualitative needs assessment from September 2017 to June 2018. Quantitative assessment included secondary data analyses from multiple sources (Seattle-Puget Sound Surveillance, Epidemiology and End Results cancer registry, Behavioral Risk Factor Surveillance Survey data, and WA State Department of Health data). Qualitative assessment included semistructured interviews (n=32) conducted in person and over the telephone with key informants representing county health departments, clinic/health systems, SCCA network sites, and community-based organizations. Interviews included questions about barriers and facilitators to cancer screening, referrals, services, access to care, and cancer inequities.

Results: The quantitative data analysis identified the top five cancer incidence sites in the CA as breast, prostate, lung, hematologic malignancies and colorectal; the top five mortality sites in the CA are lung, prostate, breast, hematologic malignancies and colorectal. Comparisons of incidence and mortality for the region revealed several inequities: 1) American Indians and Alaska Natives (AIAN) had the most numerous and severe inequities for incidence and mortality of the top cancers; 2) non-Hispanic Blacks had the most severe mortality for prostate cancer; and 3) outlying rural counties had higher incidence and mortality rates than urban areas. Through the qualitative data analysis, we identified seven major themes that influenced cancer prevention and control, including geography, social determinants of health, financial issues, issues around provider trust and communication, issues with agency partnerships/collaboration, and race/ethnicity. Qualitative interviews suggested opportunities for the Consortium to address barriers that underlie several major cancer inequities in the CA.

Conclusion: The Consortium will use the needs assessment as a baseline measure to evaluate future research that addresses the cancer burden in the CA. The Consortium now has information to take an informed approach to engage key stakeholders to collaborate and holistically improve cancer research and outcomes for all CA residents.

Citation Format: Katherine J. Briant, Beti Thompson, David R. Doody, Clara Reyes, Stephen M. Schwartz, Peggy A. Hannon, Jason A. Mendoza. Collecting evidence to drive research that addresses community cancer needs in Western Washington [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C004.

Psychosocial Adjustment to Age-related Macular Degeneration

This article reports on a study of the psychosocial adjustment to age-related macular degeneration of 30 elderly persons by comparing the responses of subjects with this condition to those from age- and sex-matched controls on four psychosocial scales: life satisfaction, daily hassles, social support, and self-esteem. The subjects with the condition reported significantly poorer life satisfaction and greater stress, perhaps as a result of poor social support.

Characterizing the Neurodevelopmental Pesticide Exposome in a Children's Agricultural Cohort

The exposome provides a conceptual model for identifying and characterizing lifetime environmental exposures and resultant health effects. In this study, we applied key exposome concepts to look specifically at the neurodevelopmental pesticide exposome, which focuses on exposures to pesticides that have the potential to cause an adverse neurodevelopmental impact. Using household dust samples from a children's agricultural cohort located in the Yakima Valley of Washington state, we identified 87 individual pesticides using liquid chromatography-tandem mass spectrometry. A total of 47 of these have evidence of neurotoxicity included in the Environmental Protection Agency (EPA) (re)registration materials. We used a mixed effects model to model trends in pesticide exposure. Over the two study years (2005 and 2011), we demonstrate a significant decrease in the neurodevelopmental pesticide exposome across the cohort, but particularly among farmworker households. Additional analysis with a non-parametric binomial analysis that weighted the levels of potentially neurotoxic pesticides detected in household dust by their reference doses revealed that the decrease in potentially neurotoxic pesticides was largely a result of decreases in some of the most potent neurotoxicants. Overall, this study provides evidence that the neurodevelopmental pesticide exposome framework is a useful tool in assessing the effectiveness of specific interventions in reducing exposure as well as setting priorities for future targeted actions.

Abstract P6-05-03: Exogenous steroid hormone exposure and the biology of lobular breast cancer

Introduction. Invasive lobular carcinoma (ILC) accounts for 10-15% of breast cancer diagnoses and is characterized by a high rate of estrogen and progesterone receptor (ER and PR) expression, low rate of HER2 amplification, and a defining lack of e-cadherin expression. Multiple population-based, observational studies have shown that the risk of ILC is significantly elevated with the intake of combined estrogen/progestin (E+P) hormone replacement therapy (HRT) but not with estrogen-alone (E alone) HRT. In addition, recent studies have revealed that ILCs might respond differently to hormone therapies than IDCs. We sought to understand the influence of exogenous hormone exposure in the form of HRT on biological pathways in ILCs compared to the more common histologic subtype, ER+ invasive ductal carcinoma (IDC).

Specimens and Methods. We assessed 297 ER+/HER2- FFPE breast carcinomas, 165 IDCs and 132 ILCs, previously collected from an epidemiological study of HRT use and breast cancer in post-menopausal women. These tumors were characterized for histopathological features and protein marker expression by immunohistochemistry along with the extensive clinical and demographic data, including HRT use, collected in the parent study. Using the Nanostring nCounter assay, we measured expression of ~1000 genes representing canonical cancer-promoting pathways and steroid hormone-associated pathways to determine the relationship between HRT use and pathway alterations in ER+ breast cancer subtypes.

Results. From the histopathological assessment, we observed that ILCs had lower overall lymphocyte response than IDCs (p=0.005), but HRT use shifted the lymphocyte response higher than what was observed in ILCs from never/former HRT users (p=0.002). In the gene expression analysis, we found that IDCs and ILCs have distinct expression profiles after adjusting for HRT use, including genes in cell cycle, steroid hormone-response pathways, and cytokine/cytokine receptor interactions, with increased signaling seen in the IL6/12-like family. When comparing gene expression between the HRT-use groups, adjusting for histology, we observed that E+P and E alone are both associated with down-regulation of cell cycle and DNA repair genes compared to the never/former use group. When we focused on expression patterns specific to progestin exposure, (i.e., E+P versus all others), we found decreased expression of genes related to DNA replication initiation and G1/S transition and WNT4. Unsupervised hierarchical clustering revealed additional subgroups within each histologic subtype including a group of low-grade, low-proliferating IDCs enriched for E+P exposure, which clusters with the majority of the ILCs. While many gene expression changes with HRT use are shared across the tumors, we observed alterations that are specific to either ILCs or IDCs, suggesting different steroid hormone-responsive pathways between the subtypes.

Conclusions. Our study demonstrates there are potentially specific pathways differentially activated between ILCs and IDCs dependent on the type of hormone exposure. Further, while our study is focused on tumor molecular pathways modulated in response to HRT use, steroid hormone exposure can come from multiple sources, and we propose that the results from this study can provide insight into hormonally-driven breast cancers that develop with excess estrogen and/or progesterone exposure. This could have implications in clinical management of ILCs and IDCs that arise in HRT users.

Citation Format: Jamie Guenthoer, Isaac C Jenkins, Beti Thompson, Mei-Tzu C Tang, Nancy E Davidson, Ryan L Ashley, Christopher I Li, Li Hsu, Peggy L Porter. Exogenous steroid hormone exposure and the biology of lobular breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-05-03.

Long-term tracking demonstrates effectiveness of a partnership-led training program to advance the careers of biomedical researchers from underrepresented groups

The demographic profile of the biomedical workforce in the U.S. does not reflect the population at large, raising concerns that there will be insufficient trained researchers in the future, and the scope of research interests will not be sufficiently broad. To diversify and expand the pool of researchers trained to conduct research on cancer and cancer health disparities, a series of training activities to recruit and train primarily Hispanic students at both the undergraduate and graduate level were developed. The strengths of both a Hispanic Serving Institution and an NIH-designated Comprehensive Cancer Center were leveraged to develop appropriate research training and professional development activities. The career progression of the participants and degree completion rates was tracked, along with persistent interest in biomedical research in general and cancer and cancer health disparities research in particular for these underrepresented individuals. Finally, this report demonstrates that these training activities increased general knowledge about cancer among participants.

Perspectives of Community Advisory Board Members in a Community-Academic Partnership

BACKGROUND

Community-academic partnerships are increasingly used to engage community members and researchers in research activities; however, little is known about the motivations and perceptions of community members to participate in such projects.

OBJECTIVES

The overall goal was to elicit Community Advisory Board (CAB) members' motivations and perceptions of involvement in a community-academic partnership about cancer prevention.

METHODS

An external evaluator conducted 15 one-on-one semi-structured interviews with CAB members of the project. Coders conducted a conventional content analysis to derive themes from the interview data.

RESULTS

Emergent themes were grouped into four categories: CAB members' 1) motivation to participate in the project, 2) perceptions that they had insider information, 3) views of roles and responsibilities in project planning and implementation, and 4) challenges and suggestions to improve the community-academic relationship.

CONCLUSIONS

This study found substantial evidence that CAB members perceived they were working to involve the Hispanic community in health promotion.

Community Empowerment Partners (CEPs): A Breast Health Education Program for African-American Women

Peer educators have been shown to provide effective interventions in breast cancer screening. Few studies have compared the effects of peer education on breast cancer knowledge among peer educators and the community members who are subsequently reached through the peer education. Further, little is known as to whether those who received the education then go on to educate others in the community. The purpose of this study is to address those gaps. Using a pre- and post-test study design, we trained peer educators, provided the educators with resources to train community members, and assessed changes in knowledge. We sought to train ten educators and recommended each train ten community members in breast cancer knowledge and screening strategies. A total of 14 peer educators were trained, who subsequently trained a total of 121 community members, of whom 94 were African American women. Peer educators and community members, showed comparable increases in knowledge. Community members who were educated also increased intention to discuss breast cancer and breast cancer screening with their family, friends, and acquaintances. Our study suggests that it is feasible to train peer educators to increase knowledge among community members to the same level that they themselves experience when trained. Further, community members are interested in sharing information learned related to how much they learn from peer educators.

Overcoming Barriers to Sustaining Health Equity Interventions: Insights from the National Institutes of Health Centers for Population Health and Health Disparities

We conducted qualitative semi-structured telephone interviews with the directors of the 10 National Institutes of Health Centers for Population Health and Health Disparities (NIH/CPHHD) to identify factors that were associated with the sustainability of 19 interventions developed to address cancer disparities and 17 interventions developed to address cardiovascular disease disparities in the United States. Interview transcripts were analyzed using the constant comparative method of analysis to identify key themes and synthesize findings. Directors at NIH/CPHHD reported that barriers to sustainability included uncertainty about future funding and insufficient resources to build and maintain diverse stakeholder partnerships. Strategies that helped to overcome these barriers included developing and engaging community partnerships with health care systems; early pursuit of multiple funding sources; and investments in infrastructure to address the social determinants of health. Sustainability planning should be incorporated during the early stages of intervention development to facilitate maintenance of successful programs that address health disparities.

A framework for coordination center responsibilities and performance in a multi-site, transdisciplinary public health research initiative

Funding bodies in the USA and abroad are increasingly investing in transdisciplinary research, i.e. research conducted by investigators from different disciplines who work to create novel theoretical, methodological, and translational innovations to address a common problem. Transdisciplinary research presents additional logistical and administrative burdens, yet few models of successful coordination have been proposed or substantiated, nor have performance outcomes or indicators been established for transdisciplinary coordination. This work uses the NIH-funded Transdisciplinary Research on Energetics and Cancer (TREC) Centers Initiative as a case study to put forward a working framework of transdisciplinary research coordination center (CC) responsibilities and performance indicators. We developed the framework using a sequential mixed methods study design. TREC CC functions and performance indicators were identified through key-informant interviews with CC personnel and then refined through a survey of TREC research center and funding agency investigators and staff. The framework included 23 TREC CC responsibilities that comprised five functional areas: leadership and administration, data and bioinformatics, developmental projects, education and training, and integration and self-evaluation, 10 performance outcomes and 26 corresponding performance indicators for transdisciplinary CCs. Findings revealed high levels of agreement about CC responsibilities and performance metrics across CC members and constituents. The success of multi-site, transdisciplinary research depends on effective research coordination. The functions identified in this study help clarify essential responsibilities of transdisciplinary research CCs and indicators of success of those transdisciplinary CCs. Our framework adds new dimensions to the notion of identifying and assessing CC activities that may foster transdisciplinarity.

Efficacy of Motivational Interviewing to Enhance Advance Directive Completion in Latinos With Chronic Illness: A Randomized Controlled Trial

BACKGROUND

End-of-life (EOL) care for Latinos with chronic illness is a critically important problem. Latinos with chronic illness suffer worse health outcomes and poorer quality of care due to various issues occurring in care delivery systems. Latinos are less likely than non-Hispanic whites to prepare an advance directive (AD) for health-care decision-making that impacts treatment decisions for when EOL is near. Advance care planning (ACP) interventions tailored specifically for Latinos have rarely been implemented.

OBJECTIVE

The primary aim examines whether a motivational interviewing (MI) intervention increased rates of AD documentation among older Latinos. The secondary aim was to examine whether MI improved communication with providers and family members.

METHODS

We pilot tested a randomized controlled trial with older Latinos >50 years with one or more chronic illnesses, including cancer. Participants were randomly assigned to usual care (UC) receiving ACP education alone versus treatment (TX), which received ACP education, plus MI counseling including interactive decisional support, emotional support, and barrier navigation.

RESULTS

Results of logistic regression indicate TX group participants were significantly more likely to document an AD than UC, however were less ready to talk with health-care providers or family members. Those reporting navigational barriers for talking about dying is difficult showed a significant negative relationship for AD completion even with significant intervention effects.

CONCLUSION

When using MI to motivate individuals toward ACP EOL conversations other factors are important to consider. Further research is needed, especially among Latinos to understand best practices for ACP education and counseling for EOL care.

Role of Family Obligation Stress on Ugandan Women's Participation in Preventive Breast Health

BACKGROUND

The purpose of this study is to determine the role of family obligation stress on Ugandan women's participation in preventive breast health through the receipt of breast cancer education and health check-ups.

MATERIALS AND METHODS

A validated survey was conducted on a community sample of Ugandan women, providing a multi-item scale to assess preventive breast-health-seeking behaviors and measure family obligation stress (FO; range 6-18). Univariate and multivariate linear regression was used to assess associations between sociodemographic factors and FO. Univariate and multivariate linear regression (used in conjunction with the robust sandwich estimator for standard errors) and probability differences (PDs) were used to evaluate associations between preventive breast-health-seeking behaviors, sociodemographic factors, and FO.

RESULTS

A total of 401 Ugandan women ages 25-74 participated in the survey. Most had three or more children in the home (60%) and were employed full time (69%). Higher FO was associated with increasing number of children and/or adults in the household (p < .05), full-time employment (p < .001), and being single (p = .003). Women with higher FO were less likely to participate in breast cancer education (PD = -0.02 per 1-point increase, p = .008) and preventive health check-ups (PD = -0.02, p = .018), associations that persisted on multivariate analysis controlling for sociodemographic factors.

CONCLUSION

Ugandan women with high FO are less likely to participate in preventive breast cancer detection efforts including breast cancer education and preventive health check-ups. Special efforts should be made to reach women with elevated FO, because it may be a risk factor for late-stage presentation among women who develop breast cancer.

IMPLICATIONS FOR PRACTICE

High family obligation stress (FO) significantly reduces women's participation in preventive health check-ups and breast cancer education. These findings support research in U.S. Latinas showing high FO negatively affects women's health, suggesting that FO is an important factor in women's health-seeking behavior in other cultures. Addressing family obligation stress by including family members involved in decision-making is essential for improving breast cancer outcomes in low- and middle-income countries, such as Uganda.

Evaluation of the relationship between residential orchard density and dimethyl organophosphate pesticide residues in house dust

Reducing residential pesticide exposure requires identification of exposure pathways. Compared to the agriculture worker 'take-home' and residential use pathways, evidence of the 'drift' pathway to pesticide exposure has been inconsistent. Questionnaire data from individuals (n = 99) and dust samples (n = 418) from households across three growing seasons in 2011 were from the For Healthy Kids! study. Summed dimethyl organophosphate pesticide (OP) (Azinphos-Methyl, Phosmet, and Malathion) concentrations were quantified from house dust samples. Spatially-weighted orchard densities surrounding households were calculated based on various distances from homes. Regression models tested associations between orchard density, residential pesticide use, agriculture worker residents, and summed dimethyl OP house dust concentrations. Estimated relationships between orchard density and dimethyl OP in house dust were mixed: a 5% increase in orchard density resulted in 0.3 and 0.5% decreases in dimethyl OP house dust concentrations when considering land-cover 750 m or 1250 m away from households, respectively, but null associations with land-cover 60 m or 200 m away. Dimethyl OP house dust concentrations were 400% higher within homes where at least two residents were agriculture workers. Despite inconclusive evidence for the drift pathway due to potential for bias, relationships between number of agriculture workers and dimethyl OP house dust concentration underscores the take-home pathway.