Background
Vaccines are effective in preventing Coronavirus Disease 2019 (COVID-19). Vaccine hesitancy defined as delay of acceptance or refusal of the vaccine is a major barrier to effective implementation.
Methods
Participants were recruited statewide through an English and Spanish social media marketing campaign conducted by a local news station during a one-month period as vaccines were becoming available in Rhode Island (from December 21, 2020 to January 22, 2021). Participants completed an online survey about COVID-19 vaccines and vaccine hesitancy with constructs and items adopted from the Health Belief Model.
Results
A total of 2,007 individuals completed the survey. Eight percent (n = 161) reported vaccine hesitancy. The sample had a median age of 58 years (interquartile range [IQR]: 45, 67), were majority female (78%), White (96%), Non-Hispanic (94%), employed (58%), and reported an annual individual income of $50,000 (59%). COVID-19 vaccine hesitancy was associated with attitudes and behaviors related to COVID-19. A one unit increase in concern about COVID-19 was associated with a 69% (Adjusted Odds Ratio: 0.31, 95% CI: 0.26–0.37) decrease in vaccine hesitancy. A one-level increase in the likelihood of getting influenza vaccine was associated with a 55% (AOR: 0.45 95% CI: 0.41–0.50) decrease in vaccine hesitancy.
Conclusions
COVID-19 vaccine hesitancy was relatively low in a state-wide survey in Rhode Island. Future research is needed to better understand and tailor messaging related to vaccine hesitancy.
225 Background: Existing data on patient satisfaction after radiotherapy (RT) is scarce. The specific aim of this analysis is to describe the clinical experience for cancer patients (pts) completing a course of RT at OHSU’s Knight Cancer Institute. Methods: The records of 200 OHSU pts that completed a 5-item “Was It Worth It (WIWI)?” questionnaire highlighting pt satisfaction were reviewed. These data were collected upon the completion of treatment and, if available, first follow-up (f/u). Univariate analysis & logistic regression modeling were performed on pt demographic and treatment characteristics to ascertain predictors of satisfaction. Results: 200 pts (M = 174; F = 26) completed the questionnaire on their last day of treatment and 60 upon their first f/u. The median elapsed days of treatment was 34. The median days from end of RT to f/u were 46 (range: 17-302). More pts were treated for curative intent (73%) than palliative (27%). 71% and 90% stated RT was ‘worth it’ at end of treatment and at first f/u, respectively. Upon therapy completion, 52% were ‘uncertain’ if quality of life (QOL) improved. However, at first f/u, 58% reported improved QOL. Temporal differences in treatment time favored morning treatment time over evening being ‘worthwhile’ (77% vs 61%; p = 0.015). This difference remained significant on multivariate analysis (p = 0.02). Longer elapsed days conferred higher likelihood of treatment being ‘worthwhile’ compared to ‘uncertain’ (30 days vs 24 days; p = 0.023), also significant on multivariate analysis (p = 0.029). Treatment time and elapsed days were not predictive of improved QOL. Age, gender, race, marital status, employment, treatment intent or modalities, treatment delays, distance travelled, insurance type, anatomic site of treatment, and cancer stage, did not predict pt satisfaction. Conclusions: RT as being ‘worthwhile’ was associated with morning treatment times and total duration of treatment as measured by total elapsed days. Among variables analyzed, there were no significant predictors of improved QOL. The majority of patients are satisfied with RT but there is room for improvement with those treated in afternoon or in shorter durations.
Materials/Methods: PICOS/PRISMA methods were used to identify English-language studies on PubMed (from 1985 to 2018), including patients with T1-2N0 SCCs/BCCs, 10 months follow-up, treated with CE, MMS, EBRT, or BT. Primary endpoint was cosmesis categorized as "good," "fair," or "poor." Secondary endpoints were 1-year and 5-year LR separated by histology. Fixed and random-effects meta-analyses were performed using standard methods. Meta-regression and Wald-type tests with Bonferroni correction were used to evaluate primary and secondary outcomes with respect to treatment modality. We report statistically significant findings. Results: Of studies meeting inclusion criteria, 24 used CE, 13 used MMS, 19 used EBRT, and 7 used BT, with a combined 21,371 patients. Summary effect size of "good" cosmesis for BT [97.6% (95% CI: 91.3-100%)] was superior to EBRT [74.6% (95% CI: 63.0-84.6%)] pZ0.0025. Good cosmesis was 96% in the only MMS study that reported cosmesis. Summary effect size of "fair" cosmesis for BT [0.9% (95% CI: 0-5.6%)] was superior to both EBRT [18.2% (95% CI: 7.8-31.7%)] pZ0.0139 and CE [17.4% (95% CI: 8.6-28.4%)] pZ0.0159. Poor cosmesis summary effect sizes were similar for all modalities. For BCC 1-year LR, MMS [0% (95% CI 0-0.1%)] was superior to EBRT [2.0% (95% CI: 0.8-3.7%)] pZ0.0016. All other modalities had similar LR for both BCC and SCC at 1 year. At 5 years, LR of BCC treated with MMS [1.0% (95% CI: 0.2-2.5%)] and CE [1.6% (95% CI: 1.6-3.0%)] were superior to EBRT [6.8% (95% CI: 5.0-8.9%)], with both pvalues <0.0001. For SCC at 5 years, again, LR of MMS [2.1% (95% CI: 1.0-3.4%)] was superior to EBRT [7.9% (95% CI: 4.8-11.7%)] pZ0.0012. A meta-regression comparison of primary and secondary endpoints is presented in the table below. Conclusion: For early cutaneous BCCs and SCCs, BT and MMS have improved cosmesis over EBRT and CE. Surgical modalities result in improved LR rates than EBRT. It is unclear if this is due to treatment superiority or selection and reporting bias.
403 Background: To report toxicities and outcomes for stereotactic body radiotherapy (SBRT) and accelerated hypofractionated radiotherapy (AHRT) in patients with Child-Pugh (CP) A/B/C and Albumin-Bilirubin (ALBI) score 1/2/3 hepatocellular carcinoma (HCC). Methods: We retrospectively reviewed 151 patients with HCC treated with SBRT (50 Gy in 5 fractions) or AHRT (45 Gy in 18 fractions) between 2007 and 2015. Primary endpoint was incidence of grade 3 or higher toxicities within 6 months of radiotherapy (RT). Patients were censored for toxicity upon local progression, further liver-directed therapy, or if they exhibited grade 3 or higher toxicities prior to RT, unless RT elevated the grading or a new toxicity class was observed. Secondary endpoints of overall survival and local control were calculated. Results: Median follow-up was 11 months (1 – 90 months). Most received SBRT (72%), while 28% received AHRT due to size criteria ( > 5 cm) or proximity to a critical organ-at-risk. Grade 3 or higher hyperbilirubinemia and hypoalbuminemia was greater in the CP-B8/B9/C patients (42% and 22%) or ALBI-3 patients (45% and 31%) compared to patients with CP-A/B7 (11% and 4%, p < 0.001) or ALBI-1/2 (14% and 4%, p < 0.001). For all other toxicity classes, no difference between liver functionality groups was seen. Eleven grade 4 and no grade 5 toxicities were observed. For all pts, 1- and 2-year treated-lesion local control (LC) rates were greater for SBRT as compared to AHRT (2-year LC 95% vs. 66%, p < 0.0001). When excluding patients with planning treatment volumes > 115 cc (equivalent to a 6 cm sphere), SBRT still yielded superior outcomes. Conclusions: Other than higher rates of grade 3+ hypoalbuminemia and hyperbilirubinemia, highly conformal RT appears to be a potentially safe and effective treatment option for HCC patients with advanced liver dysfunction. Compared to AHRT, SBRT is associated with superior local control.
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