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An approach to establish behavioral determinants for predicting participation in cervical cancer screening of haitian women
OBJECTIVE: The rate of type I endometrial cancer (EC) in reproductive-age women continues to rise due to the national obesity epidemic. In addition, women with anovulatory cycles are at increased risk of EC. Fertility preservation in EC patients was not encouraged previously; now oncofertility consultation is recommended and patients may be given a time-limited period to try to conceive. We performed a costeffectiveness (C/E) analysis to examine reproductive options in premenopausal women with EC. DESIGN: Cost-effectiveness analysis. MATERIALS AND METHODS: A decision analysis model compared 4 strategies for achieving pregnancy in premenopausal women with stage I EC after successful regression of EC with progestin treatment. Strategies included: 1) unassisted pregnancy attempts (UAP) x 12 months; ovulation induction with either 2) clomiphene (CC) x 6 cycles or 3) gonadotropins (GND) x 3 cycles; and 4) in vitro fertilization (IVF) x 3 cycles. Effectiveness was defined as pregnancy rate at 12 months. Medication cost estimates were obtained from a national mail-order fertility pharmacy; procedural cost information was estimated from institutional charges. Pregnancy outcomes were derived from published data in anovulatory patients. The C/E ratio was defined as cost per pregnancy. Incremental cost-effectiveness ratios (ICER) were calculated and sensitivity analyses were performed on pertinent uncertainties. RESULTS: An estimated 1200 reproductive-aged women are diagnosed annually with stage I EC amenable to fertility preservation. If all pursued UAP, 468 pregnancies would result at a total cost of $216,000 and cost per pregnancy of $462. CC therapy would result in 612 pregnancies at a total cost of $3.6 million (M), cost per pregnancy of $5882, and an ICER of $23,500. GND would result in fewer pregnancies and greater cost than CC. IVF would result in 1,008 pregnancies at a total cost of $43.2M, cost per pregnancy of $42,857, and an ICER of $100,000 per each additional pregnancy. CONCLUSION: Several assisted reproduction options are available to young women with stage I EC. Our data demonstrate that CC is a cost-effective strategy while GND should not be pursued unless the patient fails CC. Although IVF is the most effective strategy, its costs are prohibitive and should not be considered first-line therapy. Consultation with a physician experienced in oncofertility is paramount to optimize delivery and timing of care.
P-44 Tuesday, October 21, 2014 CURRENT AND FUTURE TRENDS IN FERTILITY-PRESERVING SURGERY: A SURVEY OF THE SOCIETY OF GYNECOLOGIC ONCOLOGY (SGO) ON THE USE OF RADICAL TRACHELECTOMY FOR EARLY-STAGE CERVICAL CANCER. S. J. Churchill,a S. Armbruster,b K. M. Schmeler,b M. Frumovitz,b M. Greer,c J. Garcia,c G. Radworth,c P. T. Ramirez.b aDepartment of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA; bDepartment of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX; cDepartment of Institutional Research, The University of Texas MD Anderson Cancer Center, Houston, TX. OBJECTIVE: To survey gynecologic oncologists and fellows-intraining regarding the current and future role of radical trachelectomy (RT) for fertility preservation in patients with early-stage cervical cancer. DESIGN: Cross sectional survey. MATERIALS AND METHODS: From 06/2012 to 09/2012 surveys were mailed to all SGO member practitioners (N¼1,353) and gynecologic oncology fellows (N¼156). Practitioners were asked 37 questions and fellows were asked 19 questions to assess opinions on the current practice and training, and future role of radical trachelectomy in the treatment of early-stage cervical cancer. RESULTS: A total of 303 (22.4%) practitioners and 38 (24.4%) fellows completed the survey. Several important trends were noted. Approximately half (49.8%) of respondents reported that they perform RT. The most common reason provided for not performing the procedure was lack of training (53.4%). Of these, the majority (70%) performs one case annually however, the majority of practitioners (90%) and fellows (97%) propose that at least 25 annual cases should be performed to maintain expertise. While most practitioners (93%) support RT for fertility-preservation, 25% disclose that they routinely fail to initiate this discuority of practitioners (90%) and fellows
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(97%) propose that at least 2-5 annual cases should be performed to maintain expertise. Currently abdominal (40%) and robotic (47%) RT approaches are the most commonly performed. Most practitioners (75%) and fellows (64%) project that in the next 5 years there will be even less radical procedures to manage early stage cervical cancer; however, most (77%, 92%) still believe RT will continue to have a lasting role. CONCLUSION: RT has an important role in the management of patients with early-stage cervical cancer who wish to preserve future fertility. The most commonly used approach for RT is the robotic approach. Increased awareness is needed so that potential candidates for this procedure may benefit from this approach. Given that few SGO practitioners perform a low number of annual cases, consideration should be given to strong emphasis for referral to specialized centers. Supported by: This study was Supported through funding provided by the Innovative Surgery Fund in the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center, Houston, Texas. P-45 Tuesday, October 21, 2014 ABSTRACT WITHDRAWN
P-46 Tuesday, October 21, 2014 AN APPROACH TO ESTABLISH BEHAVIORAL DETERMINANTS FOR PREDICTING PARTICIPATION IN CERVICAL CANCER SCREENING OF HAITIAN WOMEN. S. R. Greenwald,a L. F. Conover.b aOB/Gyn & Reproductive Sciences, University of California San Francisco, San Francisco, CA; bOB/Gyn & Reproductive Sciences, Maine Medical Center, Portland, ME. OBJECTIVE: Disparities in health outcomes exist where there is limited utilization of primary and secondary prevention; cervical cancer is no exception. We sought to establish a stepwise approach for defining the behavioral determinants associated with predicting a woman’s intention to participate in a screening program in Haiti. DESIGN: We used the Theory of Planned Behavior (TPB) 1 to design a survey to investigate the behavioral determinants associated with predicting a woman’s intention to present for cervical cancer screening, the desired behavior, and ultimately craft a social marketing campaign encouraging participation. Assumed by this model is that intention is based on: (1) behavioral beliefs and attitudes towards the screening test, (2) subjective norms, (3) perceived control, and (4) actual control. MATERIALS AND METHODS: During a four-week period in 2013, the research team performed a cross-sectional study by administering 61 surveys to women in Milot, Haiti. Factor analysis was used to define each model component in predicting the behavior. We analyzed the likelihood that a woman would be screened using Wilcoxon Rank Sum test, Chi Square tests and factor analysis. A logistic regression model was created from the most significant factors to predict the odds of the behavior. RESULTS: Every participant had at least heard of cervical cancer, and 37.7% thought the disease was preventable. One third of women surveyed (34.4%) had ever had a screening test. Neither age nor years of education were significantly associated with ever having a screening test, but knowledge that sexual intercourse is a risk factor was. Factors significantly associated with performing the intended behavior were immediate personal awareness (p value 0.01), core social support (0.01) and perceived power (0.04). Sexual position was most commonly listed as a qualitative response for causes of cervical cancer. CONCLUSION: Exploring the extent to which the population has the intention to engage in the desired behavior enabled us to perform a meaningful factor analysis in which we could assess which components of the TPB model contributed to the outcome. We then targeted future interventions through a tailored social marketing campaign. This theory based approach to determining predictors of behavior may be replicated in methodology to craft targeted interventions in the field of gynecologic and reproductive health sciences. Supported by: Thank you to the Tufts University School of Medicine for travel support.
Vol. 102, No. 3, Supplement, September 2014
P-44 Tuesday, October 21, 2014 CURRENT AND FUTURE TRENDS IN FERTILITY-PRESERVING SURGERY: A SURVEY OF THE SOCIETY OF GYNECOLOGIC ONCOLOGY (SGO) ON THE USE OF RADICAL TRACHELECTOMY FOR EARLY-STAGE CERVICAL CANCER. S. J. Churchill,a S. Armbruster,b K. M. Schmeler,b M. Frumovitz,b M. Greer,c J. Garcia,c G. Radworth,c P. T. Ramirez.b aDepartment of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA; bDepartment of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX; cDepartment of Institutional Research, The University of Texas MD Anderson Cancer Center, Houston, TX. OBJECTIVE: To survey gynecologic oncologists and fellows-intraining regarding the current and future role of radical trachelectomy (RT) for fertility preservation in patients with early-stage cervical cancer. DESIGN: Cross sectional survey. MATERIALS AND METHODS: From 06/2012 to 09/2012 surveys were mailed to all SGO member practitioners (N¼1,353) and gynecologic oncology fellows (N¼156). Practitioners were asked 37 questions and fellows were asked 19 questions to assess opinions on the current practice and training, and future role of radical trachelectomy in the treatment of early-stage cervical cancer. RESULTS: A total of 303 (22.4%) practitioners and 38 (24.4%) fellows completed the survey. Several important trends were noted. Approximately half (49.8%) of respondents reported that they perform RT. The most common reason provided for not performing the procedure was lack of training (53.4%). Of these, the majority (70%) performs one case annually however, the majority of practitioners (90%) and fellows (97%) propose that at least 25 annual cases should be performed to maintain expertise. While most practitioners (93%) support RT for fertility-preservation, 25% disclose that they routinely fail to initiate this discuority of practitioners (90%) and fellows
e154
ASRM Abstracts
(97%) propose that at least 2-5 annual cases should be performed to maintain expertise. Currently abdominal (40%) and robotic (47%) RT approaches are the most commonly performed. Most practitioners (75%) and fellows (64%) project that in the next 5 years there will be even less radical procedures to manage early stage cervical cancer; however, most (77%, 92%) still believe RT will continue to have a lasting role. CONCLUSION: RT has an important role in the management of patients with early-stage cervical cancer who wish to preserve future fertility. The most commonly used approach for RT is the robotic approach. Increased awareness is needed so that potential candidates for this procedure may benefit from this approach. Given that few SGO practitioners perform a low number of annual cases, consideration should be given to strong emphasis for referral to specialized centers. Supported by: This study was Supported through funding provided by the Innovative Surgery Fund in the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center, Houston, Texas. P-45 Tuesday, October 21, 2014 ABSTRACT WITHDRAWN
P-46 Tuesday, October 21, 2014 AN APPROACH TO ESTABLISH BEHAVIORAL DETERMINANTS FOR PREDICTING PARTICIPATION IN CERVICAL CANCER SCREENING OF HAITIAN WOMEN. S. R. Greenwald,a L. F. Conover.b aOB/Gyn & Reproductive Sciences, University of California San Francisco, San Francisco, CA; bOB/Gyn & Reproductive Sciences, Maine Medical Center, Portland, ME. OBJECTIVE: Disparities in health outcomes exist where there is limited utilization of primary and secondary prevention; cervical cancer is no exception. We sought to establish a stepwise approach for defining the behavioral determinants associated with predicting a woman’s intention to participate in a screening program in Haiti. DESIGN: We used the Theory of Planned Behavior (TPB) 1 to design a survey to investigate the behavioral determinants associated with predicting a woman’s intention to present for cervical cancer screening, the desired behavior, and ultimately craft a social marketing campaign encouraging participation. Assumed by this model is that intention is based on: (1) behavioral beliefs and attitudes towards the screening test, (2) subjective norms, (3) perceived control, and (4) actual control. MATERIALS AND METHODS: During a four-week period in 2013, the research team performed a cross-sectional study by administering 61 surveys to women in Milot, Haiti. Factor analysis was used to define each model component in predicting the behavior. We analyzed the likelihood that a woman would be screened using Wilcoxon Rank Sum test, Chi Square tests and factor analysis. A logistic regression model was created from the most significant factors to predict the odds of the behavior. RESULTS: Every participant had at least heard of cervical cancer, and 37.7% thought the disease was preventable. One third of women surveyed (34.4%) had ever had a screening test. Neither age nor years of education were significantly associated with ever having a screening test, but knowledge that sexual intercourse is a risk factor was. Factors significantly associated with performing the intended behavior were immediate personal awareness (p value 0.01), core social support (0.01) and perceived power (0.04). Sexual position was most commonly listed as a qualitative response for causes of cervical cancer. CONCLUSION: Exploring the extent to which the population has the intention to engage in the desired behavior enabled us to perform a meaningful factor analysis in which we could assess which components of the TPB model contributed to the outcome. We then targeted future interventions through a tailored social marketing campaign. This theory based approach to determining predictors of behavior may be replicated in methodology to craft targeted interventions in the field of gynecologic and reproductive health sciences. Supported by: Thank you to the Tufts University School of Medicine for travel support.
Vol. 102, No. 3, Supplement, September 2014