1. Evie Landry, Kimberly Luu, Jane Lea, Brian Westerberg
Outcomes of an Otolaryngology Screening Clinic in a High-Risk Underprivileged Community – Vancouver Downtown Eastside
Evie Landry, Kimberly Luu, Jane Lea, Brian Westerberg
Division of Otolaryngology - Head & Neck Surgery, University of British Columbia
Introduction
The objective of this study was to evaluate an otolaryngology outreach and screening initiative in one of Canada’s poorest communities, Vancouver’s Downtown Eastside (DTES). Specific aims included: (1) assessing the need for an outreach clinic and looking at patient acceptance; and (2) evaluating potential barriers to screening and subsequent follow-up.
Methods
The screening clinic was held every two months at various locations throughout the DTES on a walk in basis to anyone residing within the DTES.
Personal interviews were conducted by trained interviewers in order to collect data on demographic characteristics, known risk factors and medical history. Patients received a full head and neck examination by an Otolaryngology resident or attending. Biopsies were performed if indicated.
Descriptive statistics were performed on collected data.
Grant funding was obtained from the St. Paul’s Foundation.
Results
Discussion
99% of patients accepted screening.
Sample population was not representative of the comparative demographic population.
More females and aboriginal patients. Less elderly, Chinese and working patients.
High-risk population.
76 % unemployed and 96% earned less than $12,000/ year.
Majority of patients were active smokers and drinkers who had prolonged exposure >20 years.
Recreational drug use was reported in 79% with the most common substances being cocaine and marijuana. 75% reported using prescription drugs, pain-medications were most commonly used. 32% of our study population reported using Methadone or Suboxone.
33% of patients were Hepatitis C positive.
Challenging population many reasons;
No fixed address or telephone to arrange investigations and follow-up. Difficult to recruit patients, even those referred for suspected pathology.
Low acceptance of biopsy (29%).
Underreporting of precancerous/cancerous lesions.
Good evidence to suggest that screening programs amongst high-risk individuals reduces mortality.2
64% presented with specific otolaryngological complaints.
Significant disease burden identified with abnormal head and neck examination in 28%.
Conclusions
Our data supports the continued development of this initiative in order to develop a sustainable outreach strategy which encompasses screening, diagnostic work up, follow up and treatment on a regular basis in this high-risk population.
References
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C. E. Moore and F. Durden, Head and neck cancer screening in homeless communities: HEAL (Health Education, Assessment, and Leadership). Journal of the National Medical Association, vol. 102, no. 9, pp. 811–816, 2010.