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J. Gotfrit



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    P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P2.01-033 - Patients with Advanced NSCLC Requiring Inpatient Oncology Consultation (ID 504)

      09:30 - 09:30  |  Author(s): J. Gotfrit

      • Abstract
      • Slides

      Background:
      Most newly diagnosed advanced lung cancer patients have an initial medical oncology consult as an outpatient. However, occasionally the initial referral occurs as an inpatient. We explored the characteristics of advanced NSCLC patients whose first medical oncology consultation occurred while hospitalized.

      Methods:
      With ethics approval, we performed a retrospective analysis of all advanced NSCLC patients at our institution whose initial consult occurred while hospitalized, from 2007 to 2012. Demographics, treatment and survival data were collected. This was an exploratory analysis. Multivariate survival analysis was performed using Cox regression models.

      Results:
      In total, 223 patients were included (baseline characteristics in Table 1). Overall, only 24% received chemotherapy while 72% received some palliative radiotherapy. Median time from diagnosis to chemotherapy was 43 days. Reasons for not receiving chemotherapy included poor performance status (PS) (72%), patient choice (9%), clinical deterioration (6%) or co-morbidities (4%). Factors associated with receiving chemotherapy were good PS (OR 11.11 [95% CI 5.56-25.00], p<0.001), no constitutional symptoms (OR 2.86 [95% CI 1.41-5.88], p=0.004), no leukocytosis (OR 2.38 [95% CI 1.23-4.55], p=0.01), fewer co-morbidities (OR 1.54 [95% CI 1.27-1.89], p<0.001) and younger age (OR 1.09 [95% CI 1.05-1.12], p<0.001). Median OS was shorter in those not receiving chemotherapy (1.7 v 7.1 months, HR 2.76 [95% CI 1.72-4.41], p-value<0.001). Figure 1 shows Kaplan-Meier survival curves. In multivariate analysis, in addition to not receiving chemotherapy, factors associated with shorter OS were PS 3-4, (HR 1.55 [CI 1.03-2.33, p=0.04]), leukocytosis (HR 2.23 [95% CI 1.51-3.28], p-value <0.001) and thrombocytosis (HR 1.52 [1.06-2.18], p=0.02).

      Conclusion:
      Patients whose first consultation with medical oncologists occurs while hospitalized are an inherently sick population and only a minority receive chemotherapy. The lung cancer community must advocate for earlier diagnosis and referral, so more patients have access to treatment options before a terminal functional decline.

      Table 1: Baseline Characteristics
      Demographic (N=223) %
      Age in years, median (range) 65 (23-89)
      Gender
      Male 48
      Female 52
      Charlson Comorbidity Index total score, median (range) 10 (6-18)
      Performance status
      0-2 24
      3-4 69
      Unknown 7
      Smoking status
      Current 49
      Ex 34
      Never 9
      Unknown 8
      Stage at diagnosis
      IIIB 10
      IV 89
      Unknown 1
      NSCLC subtype
      Adenocarcinoma 45
      Squamous cell 23
      Large cell 8
      Other 23
      Dominant presenting symptom
      Dyspnea 34
      Pain 23
      Constitutional symptoms 9
      Pneumonia 7
      Cough 5
      Hemoptysis 3
      Other 18
      Weight loss
      <5% 22
      >5% 52
      Unknown 25
      Figure 1



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