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Cancer Screening Behavior in a Native American Population
Proceedings of the 47th Annual ASTRO Meeting
always located in the muscle posterior to the vertebral body, which is generally less of a concern compared with cord dose coverage. Conclusions: We report a novel technique utilizing the supine setup, pseudo-IMRT treatment, and setup film verification to deliver CSI to pediatric patients. This method is both cost-effective on multiple levels of treatment planning, yet provides significantly superior dose uniformity in the treatment volume as well as reliable QA for setup parameters.
2365
Cancer Screening Behavior in a Native American Population
D.G. Petereit,1,2 D. Rogers,1 P. Helbig,1 R. Koscik,3 K. Molloy,1 R. LeBeau,1 M. Reiner,1 C. Spotted Tail,1 P. Conroy1 Radiation oncology, Rapid City Regional Cancer Center, Rapid City, SD, 2Radiation oncology, University of Wisconsin, Madison, WI, 3Biostatistics, University of Wisconsin, Madison, WI
1
Purpose/Objective: Native Americans in the Northern Plains region experience cancer mortality rates significantly higher than those of the general US population. Native Americans in our region present with more advanced stages of cancer (stage III/IV) compared to the white population (50% vs 37%). As part of an NCI-funded Cancer Disparities Research Partnership, a community survey was designed to identify barriers to early cancer diagnosis and treatment. It was hypothesized that cancer screening rates for prostate, breast and cervical cancer would positively correlate to: 1) increased level of education; 2) greater knowledge about cancer; 3) positive perception of the chances of surviving cancer; and 4) younger age groups (i.e. those in which individuals experienced more exposure to cancer screening). Materials/Methods: A 1-hour survey was administered on 3 reservations and to the local urban Native American community. Individuals were recruited using a stratified sampling design in which location, gender, and age group sample size goals were set based on the distribution of the population summarized in the US Census 2000. Individuals were recruited at public events such as health fairs, in private settings, and over the radio. Statistical analyses of the hypotheses were based on the subset of patients who were eligible for breast, cervical or prostate screening, and included chi-square and t-tests based on a significance level of 0.05. Results: Preliminary results of the survey based on 289 participants (⬎25% of the target sample size) were analyzed; 198 (69%) were eligible for breast, cervical, or prostate cancer screening. Of these, 52% reported having obtained cancer screening at least once in their life. Knowledge about cancer (as measured by 5 questions on the survey) differed significantly between those who did and did not report having received cancer screening. Specifically, the mean number of questions answered correctly for those who reported having received a cancer screening was 4.03 vs. 3.45 among those who reported never having received a cancer screening (t-test p⬍0.01). There was no significant relationship between a more positive perception of the chances of surviving cancer and reporting having received cancer screening (chi-square p⫽0.258). In addition, most survey participants indicated a fairly positive set of beliefs (mean rating ⫽ 3.25 on a 0 – 4 point scale). There was no significant relationship between the participants’ age group and having received cancer screening. There was, however, a significant relationship between gender and screening behavior: eligible men (n⫽30 ) were far less likely to obtain prostate screening than eligible women (n⫽168 ) were to obtain breast or cervical screening (30% vs 56%, p-value⫽ 0.009). Conclusions: Preliminary results indicate that about half of adult Native Americans surveyed in our region, who were eligible for screening, report having received cancer screening at least once. Factors associated with having obtained screening were greater knowledge of cancer and being female. These results suggest that an educational program on cancer and the importance of early detection and treatment, aimed at both men and women, could be effective in reducing cancer disparities in this population.
2366
Comparison of Quality of Life Outcomes in Prostate Cancer Patients Receiving either Brachytherapy Alone, with Hormonal Therapy or in Combination with External Beam Irradiation
N.N. Stone,1,2 R.G. Stock2,1 Urology, Mount Sinai School of Medicine, New York, NY, 2Radiation Oncology, Mount Sinai School of Medicine, New York, NY 1
Purpose/Objective: Morbidity associated with prostate brachytherapy is thought to be increased with the addition of hormonal therapy (HT) or external beam irradiation (EBRT). However, no long-term studies have adequately addressed this issue. We report on the urinary and rectal morbidity and erectile function (EF) in a large cohort of patients treated by implant, implant plus HT and implant with HT and EBRT. Materials/Methods: 771 men with T1-T3 prostate cancer followed a minimum of 3 years (median- 6, range 3–14) were treated by I-125 (440 –57.1%), Pd-103 (133-17.3%) or Pd-103 combined with EBRT (198-25.6%). 401 (52%) had 3–9 months of neoadjuvant/concurrent HT. Quality of life (QOL) data was prospectively collected and included IPSS with QOL records and incontinence designated by urinary pad requirement and erectile function (EF) by questionnaire. Radiation doses were determined by post-implant CT and were reported as a percent of prescription. For those receiving implant and EBRT the % of normal prescription for each was summed. Associations were tested by chi square and linear regression. Means were tested by student t and one way Anova. Results: Patient age ranged from 42– 86 years (median 67). Median PSA was 7.4 ng/ml (mean 11.9, range 0.8 –300); 62.2% had stage T1c-T2a and 72.2% had Gleason score 2– 6. 51 (6.6%) had a TURP prior to and 21 (2.7%) post-implantation. Mean initial IPSS increased from 6.95 to 7.96 (p⬍0.0001), while mean QOL score increased from 1.53 to 1.68 (p⬍0.0001). The median pre and post IPSS and QOL difference was 0. Patients with higher initial IPSS and QOL scores were more likely to experience a lower post-implant scores (p⬍0.0001). Neither implant type nor radiation dose influenced IPSS or QOL results. 62 (7.9%) developed urinary retention post-implant. Retention was more common in Pd-103 implants (13.5%, p⫽0.008), dose ⬍ 117% (10.6%, p⫽0.007) and IPSS ⬎ 7 (12.4%, p⫽0.001). Regression analysis revealed only IPSS as significant
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always located in the muscle posterior to the vertebral body, which is generally less of a concern compared with cord dose coverage. Conclusions: We report a novel technique utilizing the supine setup, pseudo-IMRT treatment, and setup film verification to deliver CSI to pediatric patients. This method is both cost-effective on multiple levels of treatment planning, yet provides significantly superior dose uniformity in the treatment volume as well as reliable QA for setup parameters.
2365
Cancer Screening Behavior in a Native American Population
D.G. Petereit,1,2 D. Rogers,1 P. Helbig,1 R. Koscik,3 K. Molloy,1 R. LeBeau,1 M. Reiner,1 C. Spotted Tail,1 P. Conroy1 Radiation oncology, Rapid City Regional Cancer Center, Rapid City, SD, 2Radiation oncology, University of Wisconsin, Madison, WI, 3Biostatistics, University of Wisconsin, Madison, WI
1
Purpose/Objective: Native Americans in the Northern Plains region experience cancer mortality rates significantly higher than those of the general US population. Native Americans in our region present with more advanced stages of cancer (stage III/IV) compared to the white population (50% vs 37%). As part of an NCI-funded Cancer Disparities Research Partnership, a community survey was designed to identify barriers to early cancer diagnosis and treatment. It was hypothesized that cancer screening rates for prostate, breast and cervical cancer would positively correlate to: 1) increased level of education; 2) greater knowledge about cancer; 3) positive perception of the chances of surviving cancer; and 4) younger age groups (i.e. those in which individuals experienced more exposure to cancer screening). Materials/Methods: A 1-hour survey was administered on 3 reservations and to the local urban Native American community. Individuals were recruited using a stratified sampling design in which location, gender, and age group sample size goals were set based on the distribution of the population summarized in the US Census 2000. Individuals were recruited at public events such as health fairs, in private settings, and over the radio. Statistical analyses of the hypotheses were based on the subset of patients who were eligible for breast, cervical or prostate screening, and included chi-square and t-tests based on a significance level of 0.05. Results: Preliminary results of the survey based on 289 participants (⬎25% of the target sample size) were analyzed; 198 (69%) were eligible for breast, cervical, or prostate cancer screening. Of these, 52% reported having obtained cancer screening at least once in their life. Knowledge about cancer (as measured by 5 questions on the survey) differed significantly between those who did and did not report having received cancer screening. Specifically, the mean number of questions answered correctly for those who reported having received a cancer screening was 4.03 vs. 3.45 among those who reported never having received a cancer screening (t-test p⬍0.01). There was no significant relationship between a more positive perception of the chances of surviving cancer and reporting having received cancer screening (chi-square p⫽0.258). In addition, most survey participants indicated a fairly positive set of beliefs (mean rating ⫽ 3.25 on a 0 – 4 point scale). There was no significant relationship between the participants’ age group and having received cancer screening. There was, however, a significant relationship between gender and screening behavior: eligible men (n⫽30 ) were far less likely to obtain prostate screening than eligible women (n⫽168 ) were to obtain breast or cervical screening (30% vs 56%, p-value⫽ 0.009). Conclusions: Preliminary results indicate that about half of adult Native Americans surveyed in our region, who were eligible for screening, report having received cancer screening at least once. Factors associated with having obtained screening were greater knowledge of cancer and being female. These results suggest that an educational program on cancer and the importance of early detection and treatment, aimed at both men and women, could be effective in reducing cancer disparities in this population.
2366
Comparison of Quality of Life Outcomes in Prostate Cancer Patients Receiving either Brachytherapy Alone, with Hormonal Therapy or in Combination with External Beam Irradiation
N.N. Stone,1,2 R.G. Stock2,1 Urology, Mount Sinai School of Medicine, New York, NY, 2Radiation Oncology, Mount Sinai School of Medicine, New York, NY 1
Purpose/Objective: Morbidity associated with prostate brachytherapy is thought to be increased with the addition of hormonal therapy (HT) or external beam irradiation (EBRT). However, no long-term studies have adequately addressed this issue. We report on the urinary and rectal morbidity and erectile function (EF) in a large cohort of patients treated by implant, implant plus HT and implant with HT and EBRT. Materials/Methods: 771 men with T1-T3 prostate cancer followed a minimum of 3 years (median- 6, range 3–14) were treated by I-125 (440 –57.1%), Pd-103 (133-17.3%) or Pd-103 combined with EBRT (198-25.6%). 401 (52%) had 3–9 months of neoadjuvant/concurrent HT. Quality of life (QOL) data was prospectively collected and included IPSS with QOL records and incontinence designated by urinary pad requirement and erectile function (EF) by questionnaire. Radiation doses were determined by post-implant CT and were reported as a percent of prescription. For those receiving implant and EBRT the % of normal prescription for each was summed. Associations were tested by chi square and linear regression. Means were tested by student t and one way Anova. Results: Patient age ranged from 42– 86 years (median 67). Median PSA was 7.4 ng/ml (mean 11.9, range 0.8 –300); 62.2% had stage T1c-T2a and 72.2% had Gleason score 2– 6. 51 (6.6%) had a TURP prior to and 21 (2.7%) post-implantation. Mean initial IPSS increased from 6.95 to 7.96 (p⬍0.0001), while mean QOL score increased from 1.53 to 1.68 (p⬍0.0001). The median pre and post IPSS and QOL difference was 0. Patients with higher initial IPSS and QOL scores were more likely to experience a lower post-implant scores (p⬍0.0001). Neither implant type nor radiation dose influenced IPSS or QOL results. 62 (7.9%) developed urinary retention post-implant. Retention was more common in Pd-103 implants (13.5%, p⫽0.008), dose ⬍ 117% (10.6%, p⫽0.007) and IPSS ⬎ 7 (12.4%, p⫽0.001). Regression analysis revealed only IPSS as significant
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