Instructions for Webinar Participants

Transcription

1 Instructions for Webinar Participants Today s webinar is available in Listen-Only mode. Audio will only be available over your computer speakers. Participants can view and listen to the presentation through their computer or handheld device speakers. Check to make sure your computer speakers are turned on and turned up and that they are not muted. For assistance, info@vicnetwork.org

2 Welcome! An Interprofessional Approach to HPV and Oropharyngeal Cancer Prevention Education Will begin momentarily (11:00 am PT/ 2:00 pm ET) You will hear music until the start of the call. Please stand by

3 The Virtual Immunization Communication (VIC ) Network is a project of the National Public Health Information Coalition (NPHIC) and the California Immunization Coalition Funded through the Association of State and Territorial Health Officials (ASTHO) cooperative agreement with the Centers for Disease Control and Prevention, (CDC) 3

4 An Interprofessional Approach to HPV and Oropharyngeal Cancer Prevention Education Members of the Massachusetts Oral HPV Prevention Taskforce February 21, 2018

5 Describe action steps to build a partnership with dental providers on HPV education and the importance of HPV vaccination Identify the relationship between oral HPV infections and oropharyngeal cancers Discuss ways that dental professionals can include HPV education in patient visits, including an overview of helpful resources Determine the effectiveness of an HPV prevention campaign via interprofessional education and consider strategies for sustainability 5

6 Webinar Logistics Audio: All participant lines are muted. Webinar Recording: Webinar is being recorded and will be available online following the broadcast. Q & A Session: Type your question into the Questions panel. Selected questions will be read aloud for the presenters

7 Questions for Presenters? Submit questions through the Q&A window. If question is for a specific speaker, please indicate which one. Ask Questions Here

8 Rebecca Vanucci, MA Immunization Outreach Coordinator, Massachusetts Department of Public Health

9 Alessandro Villa, DDS, PhD, MPH Assistant Professor of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine Associate Surgeon, Division of Oral Medicine and Dentistry at Brigham and Women s Hospital and Dana Farber Cancer Center

10 Rosie Wagner, DDS Private Practice in Somerville, MA

11 Lisa Bennett Johnson, RDH, MS, MPH Research Registered Dental Hygienist, Oral Medicine and Dentistry Division, Brigham and Women s Hospital

12 HPV Dental Project Rebecca Vanucci Immunization Outreach Coordinator Massachusetts Department of Public Health No relationships to disclose 12

13 Why? How? 13

14 HPV Infection Most females and males will be infected with at least one type of mucosal HPV at some point in their lives Estimated 79 million Americans currently infected 14 million new infections/year in the US HPV infection is most common in people in their teens and early 20s Most people will never know that they have been infected Satterwhite et al. Sex Transm Dis

15 Cancers Caused by HPV per Year, U.S., Cancer site Number probably caused by any HPV type Male Female Both Sexes Percentage probably caused by any HPV type Anus 1,600 3,200 4,800 91% Cervix 0 10,600 10,600 91% Oropharynx 9,600 2,000 11,600 70% Penis % Rectum % Vagina % Vulva 0 2,500 2,500 69% TOTAL 12,100 19,400 31,500 Based on Viens et al. MMWR

16 HPV cancer rates rising ~31,500 a year HPV Vaccination can prevent ~28,000 of those cancers Oropharyngeal cancer now surpassed cervical cancer as most common Dental providers as advocates No screening for Oropharyngeal cancer 16

17 HPV Vaccine Recommendations Age Routine vaccination at age 11 or 12 years, but can start at age 9 Vaccination recommended through age 26 for females and through age 21 for males not previously vaccinated Vaccination recommended for men through age 26 who have sex with men (MSM) or are immunocompromised (including persons HIV-infected) Dosing 2 shots six to twelve months apart 3 shots if started after 15 th birthday or with an immunocompromising condition 17

18 When should the bike helmet go on? A B C 18

19 Advocacy Organizations MA Chapter of AAP Dept. of Public Health Comp. Cancer Dental Professionals Dept. of Public Health Immunization Program Oral HPV Prevention Taskforce Widow/Advocate 19

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21 Connect Dental world Cancer partners Meet Conference calls In-person Collaborate Presentations Projects 21

22 Overview of HPV and oropharyngeal cancers Alessandro Villa, DDS, PhD, MPH Division of Oral Medicine and Dentistry Dana-Farber/Brigham and Women s Cancer Center Department of Oral Medicine, Infection and Immunity Harvard School of Dental Medicine, Boston 22

23 No disclosures 23

24 Objectives Epidemiology of oral HPV infections Epidemiology of oropharyngeal cancers The association between HPV and oropharyngeal cancers 24

25 Head and neck cancer 25

26 Oropharyngeal cancers: risk factors Cigarette smoking (less with other tobacco) Alcohol (synergistic) Areca nut (India) Immunosuppression (pts with cancer, HIV) Family or personal history of cancer HPV 16 and 18 Age American Cancer Society 26

27 Oropharyngeal cancer 3,200 cases/year: women 13,200 cases/year: men >70% related to HPV MMWR 2016;65(26):

28 Incidence trends stratified by sex ( ) in the US *p<0.05 *p<0.05 Villa et al,. Unpublished from SEER 28

29 Oral HPV types Disease HPV Type OP cancer 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 69, 66, 68, 73 Squamous papilloma 6, 11 Verruca vulgaris 2, 4, 6, 40, 57 Condyloma acuminatum 6, 11, 42, 43, 44, 53, 54, 55, and others Focal epithelial hyperplasia 13, 32, 55 OPMD (?) 29

30 Prevalence of any oral HPV NCHS Data Brief Apr;(280):

31 Ann Intern Med Oct 17 Ann Intern Med Oct 17 Prevalence of high-risk oral HPV 4 Modified from NCHS Data Brief Apr;(280):

32 What is my risk of oral HPV? Ann Oncol Oct 1;28(10):

33 HIM study Int J Cancer Jun 15;136(12):

34 Does HPV-16 detection precede the incidence of OPC? 96,650 participants, cancer free at baseline, with available mouthwash samples; 2 prospective cohort studies Incident cases of HNSCC (n = 132) (f/u: 3.9 years) Oral HPV-16 detection was associated with incident HNSCC (OR, 7.1; 95% CI, ) + positive association for oropharyngeal SCC (OR, 22.4; 95% CI, ) HPV-16 detection precedes the incidence of OPC JAMA Oncol Jan 21 34

35 Concordance of oral and genital HPV 19.3% 13.7% 4.4% 3.9% 5.1% 3.2% 2.1% 1.1% Ann Oncol Oct 1;28(10):

36 Carcinogenesis Modified from Ann Oncol Oct 1;28(10):

37 Oral HPV tests? No screening tests or treatments for oral HPV Most HPV infections clear within 1 year spontaneously and do not require treatment Routine HPV testing of HNSCC (cancer specimen) of unknown primary are recommended (ISH and/or p16 IHC) HPV tumor status does not change current treatment or surveillance guidelines, except in the context of clinical trials Head Neck May;39(5):

38 Summary Persistent high-risk HPV infection (primarily HPV-16) is associated with oropharyngeal cancer Oral sex remains the major risk factor No screening tests are available/recommended for oral HPV 38

39 HPV, HPV-Related Oropharyngeal Cancers, and the Patient-Provider Relationship Rosie Wagner, DDS Founder, Smiles By Rosie Family Dentistry Co-Chair, Massachusetts Oral HPV Prevention Taskforce (413)

40 HPV, HPV-Related Oropharyngeal Cancers, and the Patient-Provider Relationship Dr. Wagner has no relevant financial relationships to disclose. Special thanks to: Dr. Alessandro Villa of Brigham and Women s Hospital Rebecca Vanucci, Massachusetts Department of Public Health Eileen Duffy-Lind at Team Maureen Members of the Oral HPV Prevention Taskforce Centers for Disease Control for contribution of You Are The Key slides 40

41 Why dental professionals? We can make a significant difference. Educating on HPV Explaining that HPV causes oropharyngeal cancers Educate patients on signs and symptoms of oropharyngeal cancers Referring patients to get vaccinated 41

42 Valuable Opportunity At least two exams per year Long-term patient relationship Treating children and their parents Community involvement 42

43 Initial Reluctance From Dental Professionals Immunizations not normally discussed in health history Limited knowledge on the topic Discomfort with discussing STIs Insufficient time during appointments Scope of practice concerns Daley et al. (2014) Prevention Of HPV-Related Oral Cancer: Assessing Dentists' Readiness. Public Health 128(3)

44 Addressing Provider Concerns Immunizations not normally discussed in health history Easy and important to include in comprehensive medical history Limited knowledge on the topic Important to become educated Discomfort with discussing STIs Transmission not an important aspect of discussions on HPV and it is quite common for it to clear on its own Insufficient time during appointments Does not add additional time to appointments Scope of practice concerns Within our scope of practice to understand risk factors, signs and symptoms of head and neck cancers, including HPV-related oropharyngeal cancers 44

45 Raising the Topic Medical history form Include immunizations Verbal medical histories are the best way. More thorough Extrapolation on any yes answers Begin the provider-patient relationship Clues about personality, medical literacy Source of referrals: Back to PCP, addiction and cessation resources, systemic health concerns 45

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48 Medical History Include a question on immunizations in general: Are you (or your child) current on all immunizations, including HPV? Would you like a link to or printout of the current CDC immunization schedule? 48

49 Opportunities Besides Medical History During exam A patient might bring it up after noting pamphlets or flyers at the office Initiated by assistants or hygienists 49

50 Explaining HPV What to say: HPV is a virus that can cause cancers in several parts of the body, including the throat. There is a vaccine that protects against many of the cancer-causing strains of HPV, and it is recommended for women aged 9-26 and for men aged

51 Important to Discuss Transmission? If that is your main barrier, drop it and focus on cancer prevention and encouraging vaccination. Many people already have HPV and it is transmitted by intimate skin-to-skin contact. Encouraging vaccinations for ages 9-12 (rather than older teenagers) might help separate it from a discussion about STIs. Remind parents and patients that all genders should be vaccinated. All of these patient discussions can occur without mentioning the phrase STI. 51

52 Explaining HPV Vaccine What to say: There is a vaccine that protects against this cancer-causing virus. It works really well and is the only vaccine that prevents cancer! To be most effective, your child should be vaccinated by age 13 The vaccine is very safe Most insurances cover the vaccine from ages

53 More on HPV Vaccine Remind patients that it is given in either 2 or 3 doses. Give patients physical referrals to go to their PCP, health clinic, pharmacist, or other immunization provider. Encourage parents and patients to keep you updated with their injection dates. 53

54 Explaining HPV Vaccine Referral What to say: Your child is now eligible for HPV vaccination, and I ll refer them to their pediatrician to start the immunization process. While you re there, please check in on their other vaccinations, like Tdap. ( Same day, same way ) Adults can also benefit from HPV vaccination. 54

55 Reasons parents won t initiate HPV vaccination for children Not sexually active Not recommended Safety concern/side effects Not needed or necessary Lack of knowledge MMWR 2014; 63(29); Percent 55

56 Addressing Patient Concerns Remember that people who don t arrive at conclusions from data might not respond well to data. (Don t be condescending or cite studies if it s inappropriate for the conversation). Vaccine concerns? Give general reassurance that you would get the vaccine for yourself, your patients, and your children. Thankfully, all studies that have actually looked at the vaccine itself, rather than stories or news articles, have not found any negative effects. Take the shame away from HPV. Remind patients that you are focused on preventing cancer, not judging them or their children for any viral status, behaviors or risk factors. 56

57 Common Questions 1. Should I (as a parent) get vaccinated as well? I don t want to get cancer! 2. I had no idea HPV caused throat cancer! 3. Is that what I ve been reading about in the news? 4. Can we get these vaccines here? 5. Isn t this something for teenager and young adults? My child isn t sexually active! 6. Yeah, I think I got this vaccine already? I m not sure? (Or I think my child got this ) 7. How do I know if I have cancer? 57

58 Thank you! Contact me any time at 58

59 Health Literacy Approaches: HPV and the Dental Team Lisa Bennett Johnson, RDH, MS, MPH 59

60 Lisa Bennett Johnson has no actual or potential conflict of interest in relation to this presentation 60

61 Overview Recap Role as Coordinator Talking points for the prevention specialists of the dental team Evidence-based resources Evaluation data and wrap up 61

62 HPV is a complex, emerging public health issue Human Papillomavirus (HPV) vaccines Recommended since 2006 Sub-optimally used particularly when compared to other routinely recommended adolescent vaccines. Walker TY, Elam-Evans LD, Singleton JA, et al. National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged Years - United States, MMWR Morb Mortal Wkly Rep. 2017;66(33):

63 HPV is a complex, emerging public health issue HPV vaccination is recommended at years of age for both females and males Catch-up vaccination is recommended through 26 years of age for females and 21 years for males Walker TY, Elam-Evans LD, Singleton JA, et al. National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged Years - United States, MMWR Morb Mortal Wkly Rep. 2017;66(33):

64 HPV is a complex, emerging public health issue Trailing behind other vaccines While most adolescents have received the first dose of HPV vaccine, only 43 percent of teens are up to date on all the recommended doses of HPV vaccine (CDC, na) Encourage parents to follow through with recommended number of doses 64

65 Massachusetts Oral HPV Prevention Taskforce Educational Outreach Coordinator Health Program Assessment and Evaluation Evaluation feedback coincides with current reports in the literature: RDH s report Low Self-Efficacy with HPV Education and Vaccine Referral Source: Thompson, E.L. et al. (2017) Health Literacy Approaches to Improving Communication between Dental Hygienists and Patients for HPV-Related Oral Cancer. The Journal of Dental Hygiene, 97:4. 65

66 Dental Hygienists = prevention specialists Primary Prevention Include HPV information and HPV vaccine recommendations within the education we already provided to our patients. 66

67 Education & Examination Consider opportunities for intervention to educate about HPV prevention during routine preventive care visits Highlight importance of HPV vaccination for males up to age 21 and for females up to age 26 Sharing this information with ALL patients will encourage and reinforce the importance of HPV vaccination for all young individuals 67

68 Steps toward self-efficacy RDH must be comfortable with topic for successful recommendation Educate yourself on the HPV infection and the protective benefits of vaccination Consider any level of discomfort regarding the topic vaccination, cancer, sex, other? As potential barriers to your professional communication Matter of fact approach don t preach and avoid getting into the weeds with details Include passive educational materials e.g. Videos in waiting room, pamphlets, etc. The Team Maureen Dental Toolkit is a user friendly resource 68

69 Are your recommendations Evidence-Based? Consider the following: Where do you find information about HPV and HPV related cancers? Scholarly journals, continuing education courses, dental hygiene education, websites, media? National Network of Libraries of Medicine (NNLM) resources Centers for Disease Control and Prevention website 69

70 Resources ADDITIONAL RESOURCES Additional resources on HPV and the Oral Cancer Connection can be found at: CDC's Oropharyngeal HPV Fact Sheet HPV and Men American Cancer Society Oropharyngeal Cancer page The Oral HPV Continuum Evaluating Health Information: A tutorial 70

71 Agenda Review HPV Cancer Prevention Education as a team Active role play to achieve self-efficacy Discuss and review progress regularly during staff meetings HPV Cancer Prevention Education Was this message a great idea that has been adopted by your practice, or did the idea fade away? 71

72 We want to hear from you! Assessment data is critical to measuring our success Visit Download free dental materials for HPV related cancer prevention education Share your with us! 72

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74 Questions and Answers

75 Frequently Asked Questions 1. Will I be able to get a copy of the slides after the webinar? Yes a copy will be posted on VICNetwork.org 2. Will I receive a copy of the webinar recording? Yes - a copy will be posted on the VICNetwork.org site and an announcement will be made via the #Preteen Vax Newsletter.

76 Final thoughts?

77 Evaluation 77

78 Connect with the VICNetwork Website 78

79 Thank you for your support and your participation! National Public Health Information Coalition California Immunization Coalition 79