Download Vancouver Downtown Eastside

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, painmedications 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
1. Poh CF. Oral cancer screening in a high-risk underserved community –
vancouver downtown eastside. J Health Care Poor Underserved 2007;18:76778.
2. Brocklehurst P. Screening programmes for the early detection and prevention
of oral cancer. Cochrane Database Syst Rev 2013;11:CD004150.
3. 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.
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