Abstract PO-080: Reaching the “hard to reach” sexual and gender diverse communities for population-based research in cancer prevention

Purpose Despite about 5% of the US population identifying as Sexual and Gender Diverse (SGD), there is limited research on cancer prevention and control disparities in this population. In New Mexico (NM), population-level data from the Department of Health show differences in cervical and breast cancer screening uptake based on sexual orientation, but these data do not document disparities based on gender identity and for other types of cancer, prompting us to assess cancer prevention practices among NM SGD communities. SGD communities have consistently been considered “hard to reach” and much of the extant SGD studies have been conducted in large urban cities. We present findings on how to implement innovative, multi-pronged, and systematic recruitment strategies to engage SGD communities in NM, a state that is both largely rural and racially classified as “majority-minority” state. Methods Our recruitment efforts focused on four strategies: (1) Every Door Direct Mail program (by the United States Postal Services) was used to mail flyers across targeted (based on residential areas, income below $30,000, and between ages 30-71) mailing routes across NM. (2) These routes were also targeted for study-related ads via Google, Twitter, and Facebook. (3) Email outreach was conducted with SGD-friendly businesses, state cancer coalitions, and the University of New Mexico Comprehensive Cancer Center's Office of Community Outreach and Engagement. (4) Flyers were displayed at clinical and community settings across NM. All flyers, ads, and emails contained QR codes for a pre-survey that determined eligibility for participation in the main survey (i.e. 21-80 years old, NM resident, member of SGD community). Questions on the online survey, provided in both English and Spanish, inquired about the participant's demographics, body organs, physical health, vaccination history, healthcare access, and cancer screening practices. Results A total of 27,369 flyers were distributed and 436,177 impressions were made on social media, resulting in 5,080 surveys from eligible participants. Approximately 68% heard about the study from social media, 17% from email, 16% through friends or family, and 12% from flyers. All eligible participants were then emailed three times and, in a few cases, mailed a survey. This resulted in 3,115 completed surveys. Half of respondents were between 31-40 years, 38% were Black, Hispanic, or American Indian/Alaskan Native, and 48% had an annual household income below $50,000. Eighteen percent identified as lesbian, 30% gay, 28% bisexual, and 18% queer, while 48% were cisgender men, 32% cisgender women, and 13% transgender. Approximately 44% reported residing in rural areas and responses were received from 172 unique NM zip codes. Conclusion To reach state-wide SGD communities and engage them in population-based research, innovative and systematic efforts are needed. Social media and postal flyers may provide successful recruitment opportunities with potential to use these methods for future public health interventions for these populations.

Citation Format: Prajakta Adsul, Karen Quezada, Katie Myers, Talya Jaffe, Bernard Tawfik, Emily Wu, Molly McClain, Shiraz Mishra, Miria Kano. Reaching the “hard to reach” sexual and gender diverse communities for population-based research in cancer prevention [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-080.

Southwest Harvest for Health: An Adapted Mentored Vegetable Gardening Intervention for Cancer Survivors

Harvest for Health is a home-based vegetable gardening intervention that pairs cancer survivors with Master Gardeners from the Cooperative Extension System. Initially developed and tested in Alabama, the program was adapted for the different climate, growing conditions, and population in New Mexico. This paper chronicles the feasibility, acceptability, and preliminary efficacy of "Southwest Harvest for Health". During the nine-month single-arm trial, 30 cancer survivor-Master Gardener dyads worked together to establish and maintain three seasonal gardens. Primary outcomes were accrual, retention, and satisfaction. Secondary outcomes were vegetable and fruit (V and F) intake, physical activity, and quality of life. Recruitment was diverse and robust, with 30 survivors of various cancers, aged 50-83, roughly one-third minority, and two-thirds females enrolled in just 60 days. Despite challenges due to the COVID-19 pandemic, retention to the nine-month study was 100%, 93% reported "good-to-excellent" satisfaction, and 87% "would do it again." A median increase of 1.2 servings of V and F/day was documented. The adapted home-based vegetable gardening program was feasible, well-received, and resulted in increased V and F consumption among adult cancer survivors. Future studies are needed to evaluate the effectiveness of this program and to inform strategies to increase the successful implementation and further dissemination of this intervention.

Evaluating Nutrition Services in Outpatient Cancer Centers in New Mexico – A Pilot Study Protocol

Objectives

Nationally, 50% of all cancer patients experience malnutrition upon diagnosis or during the course of treatment. When registered dietitian nutritionists (RDNs) are involved in oncology treatment, outcomes improve, with a reduction in financial burden for the patient and health delivery system. Despite the high prevalence of outpatient treatment utilization (up to 90% of cancer patients), RDN understaffing is common in outpatient cancer treatment settings. The goal of this pilot project is to characterize and understand factors at the organizational level (e.g., policies and practices) and provider level (e.g., knowledge, attitudes, practices and needs) that affect implementation of nutrition standards of practice at outpatient oncology clinics in New Mexico (NM). Characterizing current nutrition resources in distinct regions across the state is crucial to the development of effective interventions to improve access to RDN nutrition care across NM.

Methods

We will conduct a comprehensive, 7-domain, nutrition-focused environmental scan of ∼15 treatment centers and surrounding areas. Data collected will include clinic catchment area information; patient and area census demographics; clinic screening and referral policies; clinic technical, financial, and personnel resources; and community nutrition resources. We will then conduct ∼50 semi-structured interviews of stakeholders, including administrators and medical and RDN providers, at ∼10 of these treatment facilities to contextualize the results of the environmental scan. Qualitative interviews will explore facilitators and barriers to provision of guideline concordant nutrition care. We will perform a case study analysis (both within-case and cross-case) of sites and examine the identified resources and gaps to care in each region and will note differences across settings (e.g., urban vs. rural centers).

Results

N/A.

Conclusions

This innovative, mixed-methods study will provide a context-driven inventory of nutrition processes, services, and resources at outpatient cancer treatment clinics in NM. These data will inform a tailored intervention to improve access to nutrition care for ambulatory oncology patients throughout NM.

Funding Sources

American Cancer Society Institutional Research Grant; NCI Cancer Center Support Grant.

Patient, provider, and nurse preferences regarding patient-reported outcomes (PRO) and side effect management during cancer treatment of minority, rural and economically disadvantaged patients

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Background: Side effects from treatment significantly impact quality of life and patients ability to continue cancer therapy. Patient Reported Outcomes (PRO) tools have been shown to significantly improve multiple key cancer endpoints including overall survival. However, preferences for PRO tool components, such as contact modality, is not well studied in minority, rural and low-income patient populations. As the only National Cancer Institute (NCI) Designated Cancer Center within a 500-mile radius, we care for the urban/rural, multiethnic communities we serve with tremendous cancer health and socioeconomic disparities. This study evaluated patient, provider and nurse perspectives with the goal of optimizing PRO tools for our unique population. Methods: A survey was developed to assess preferred PRO contact modality. Additional survey domains included side effect burden, quality of life, financial hardship and nutritional services accessed. The survey was offered to all patients receiving IV chemotherapy in the center infusion suite from June to August 2020 using the REDCap platform. Providers and nurses (P/N) were surveyed via email. Survey responses were analyzed using SAS 9.4 and compared via chi-square test where appropriate. Results: Ninety patient surveys were collected; 51.1% were minorities (44.4% Hispanic), 35.6% were rural and 40.0% had income < $30,000. All patients had access to a communication device but 12% did not have access to a cell phone of any kind. Device access included 68% smart phone, 20% cell phone, 22% landline, 53% computer, 39% tablet. Patients preferred a response to reported side effects within 0-3 hours (73%) while only 29% of 55 P/N surveyed shared this expectation (p < 0.0001). Almost half (48%) of patients felt side effect management was a moderate or significant issue with 58% experiencing nausea and/or vomiting, 41% diarrhea, 34% weight change, 33% pain, and 22% mucositis. While 72% of patients experienced nutritional related side effects and 95% of P/N preferred to answer nutritional issues by referring to a dietitian, only 9% of patients reported being referred. The majority of patients reported side effect quality of life implications (60.3%) or missed work / were unemployed (82%). Conclusions: In a minority, rural and low-income patient population, 88% of patients had access to a cell phone communication device, with smart phone access in the majority. Patients and P/N reported significantly different expectations regarding side effect management. Our data suggests an underutilization of nutritional referrals by P/N, despite a recognition of value. This study informs the implementation of a PRO tool to address side effects and develop nutritionist referral strategies in minority, rural and low-income patient populations.

Abstract D011: Assessing a toolkit and training community health workers to increase colorectal cancer screening rates among Hispanics in New Mexico

Rationale: Colorectal cancer (CRC) is the second leading cause of cancer mortality in the US and the fourth most frequently diagnosed cancer in New Mexico (NM). CRC is the fourth most common cause of death among Hispanics in NM. NM Hispanics are more likely than non-Hispanic whites to be diagnosed with later stage CRC (71% vs 50%). Due to NM’s diverse geography and culture, combined with a statewide shortage of medical professionals, community health workers (CHWs) serve as a critical link to health information in local communities. Funded by the National Cancer Institute’s Center to Reduce Cancer Health Disparities (CRCHD), the National Outreach Network (NON) Community Health Educator (CHE) program supports direct community outreach and adapts and tests educational initiatives. We describe one such initiative here. We used the RE-AIM framework to develop a CRC-focused training and toolkit for CHWs to apply in their work. The goal of this study is to assess the effectiveness and suitability of these materials. A sub-analysis explored barriers and facilitators to toolkit implementation and CRC screening interventions in predominantly monolingual Spanish-speaking communities. Approaches: We finalized the toolkit and training through a multi-year process that incorporated community and stakeholder input. The 3-hour in-person training focused on CRC risk, screening, and prevention, and included modules on anatomy, screening methods, and barriers to screening. A subset of CHWs completed semi-structured interviews at follow-up to provide insight into practical toolkit use. We used descriptive statistics to assess participant demographics. We used paired t-tests to assess mean changes in pre/ post-training survey data in knowledge and confidence. Results: We enrolled 79 CHWs (female: 89.9%, Hispanic: 94.9%) with median CHW experience 7 years (IQR: 3,15). 59.5% reported their patients prefer speaking Spanish, 29.1% prefer English, and 11.4% prefer both equally or another language. 30.4% of CHWs report their own preference for Spanish, 45.6% prefer English, 22.8% are equally comfortable with both, and 1.3% other language. Initial analyses show improvement for knowledge (mean 16.9%; 95%CI: 13.9, 19.9; p &lt;.001), and confidence on a 1-5 point scale where 5 is extreme confidence (mean 1.6 points; 95%CI: 1.3, 1.8; p &lt;.001). All participants agreed the training will help navigate barriers related to CRC screenings, while a majority said the trainings fit with their work (89.7%), they will use the knowledge and skills (97.4%), and the toolkit will make them a more effective team member (98.7%). Qualitative data additionally support known or suspected barriers to screening for monolingual Spanish speakers. Conclusion: While the training appears effective at increasing CRC knowledge, changes in confidence and beliefs are less clear. Educating CHWs and providing them with appropriate materials addresses some gaps to improve CRC screening rates; however, other barriers to screening among NM Hispanics remain.

Citation Format: Lila Baca, Karen Quezada, Miria Kano, Hailey Heinz, MA, Joesph Rodman, MA, Tawny W. Boyce, MS, MPH, Dolores D. Guest, PhD, RD. Assessing a toolkit and training community health workers to increase colorectal cancer screening rates among Hispanics in New Mexico [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 D011.