Virtual Library

Abstract:
The diagnostic and management strategies for stage IIIA-N2 non-small cell lung cancer (NSCLC), which represents locally advanced disease with involvement of ipsilateral mediastinal lymph nodes, remain controversial despite results from several randomized controlled trials [1-2]. There are various reasons for this ongoing debate. First, stage IIIA-N2 represents a very heterogeneous patient population ranging from incidental discovery of positive N2 nodes during lung resection, to single mediastinal nodal involvement and bulky N2 disease where individual lymph nodes are hard to identify. In this setting, the precise diagnostic algorithm remains controversial. Currently, patients with proven or suspected lung cancer are mainly staged by integrated positron emission tomography – computed tomography (PET-CT). However pathological proof of nodal involvement should be obtained by a minimally invasive or invasive technique due to a relatively high rate of false positive nodes, owing to mainly inflammation [3]. Secondly, the optimal restaging strategy after induction therapy is heavily debated. Thirdly, specific controversy relates to the role of surgery versus radiotherapy and the precise extent of resection after induction therapy. Randomized trials included different subsets of N2 disease making the interpretation of results quite difficult. As a result of the limitations of available data heated discussions have been taking place for several decades on the optimal treatment strategy for this subset of patients. When N2 disease is detected during thoracotomy, this is referred to as incidental, unsuspected, unforeseen or “surprise” N2 [4]. When found intraoperatively, a resection should be performed as long as it can be complete. Adjuvant chemotherapy prolongs survival and is currently recommended in this setting. However the role of radiotherapy remains controversial and is currently evaluated in the randomized LungART trial (NCT00410683) [5]. In quite a large subgroup of patients, N2 disease is suspected on PET-CT scanning and subsequently confirmed by minimally invasive or invasive staging techniques. Although the term “potentially resectable N2” is often utilized, no precise, internationally accepted definition is available. Most patients in this sub-group will be treated by concurrent chemo-radiotherapy alone or induction therapy followed by surgery or definitive radiotherapy. Whether induction chemo-radiotherapy yields better results than chemotherapy alone was studied in the recently published, randomised trial NCT00030771 of the Swiss Cancer League [6]. No significant differences were found. However, this study was not adequately powered to show non-inferiority between the two strategies. There are different restaging techniques to evaluate response after induction therapy. In contrast to imaging or functional studies, remediastinoscopy provides pathological evidence but is technically more difficult and less accurate than mediastinoscopy done prior to induction treatment [3]. An alternative approach consists of the use of minimally invasive staging procedures to obtain an initial proof of mediastinal nodal involvement. Mediastinoscopy is subsequently performed after induction therapy to evaluate response [3]. In patients with proven mediastinal downstaging after induction who can preferentially treated by lobectomy, surgical resection may be recommended. Whether radiotherapy yields similar results has not been established yet. One of the reasons is that in patients undergoing chemo-radiotherapy pathology to evaluate response is not available making comparison with surgery quite difficult. A recent meta-analysis tried to better clarify the outcome of surgery compared to radiotherapy after induction treatment in patients with N2 disease [7]. Six trials including a total of 868 patients were included. Main outcome was overall survival. The authors concluded that when bimodality treatment is applied, both surgery and radiotherapy options are valid with a pooled hazard ratio for mortality in the surgery group of 1.01 (p not significant). In contrast, in trimodality regimens results support surgical resection as part of multimodality management with a pooled hazard ratio for mortality in the surgery group of 0.87 indicating a 13% relative improvement in overall survival (p= 0.068). In the recently published ESPATUE trial, patients with resectable stage IIIA-N2 and selected stages IIIB NSCLC were included [2]. No significant differences were found between the control arm consisting of induction chemotherapy followed by definitive chemo-radiotherapy, and the experimental arm administering induction chemotherapy followed by chemo-radiotherapy with a dose of 45 Gy, followed by surgical resection. Both treatment options are considered acceptable strategies for these highly selected patients with a relatively good prognosis. North American (American College of Chest Physicians 2013) [8] and European guidelines (European Society of Medical Oncology 2015) [1] recommend that in NSCLC patients with N2 involvement the treatment plan should be made with the input of an experienced multidisciplinary team. The ESMO guidelines include induction chemotherapy followed by surgery, induction chemoradiotherapy followed by surgery, or concurrent definitive chemoradiotherapy as possible treatment strategies for potentially resectable stage IIIA-N2 However bulky N2 disease is mostly treated with chemo-radiotherapy as these patients do not qualify for surgical resection due to extensive extracapsular involvement [1]. Furthermore complete resection, which is a major prognostic factor, is mostly not achievable in this subset of N2 disease. The standard of care in patients with good performance status is concurrent chemoradiotherapy [1]. Of particular interest to thoracic surgeons is the relatively new concept of “salvage” surgery after full-dose chemo-radiotherapy in stage IIIA-N2 NSCLC [9, 10]. These patients present with recurrent or progressive locally advanced disease, in some cases complicated by an infected cavity, rendering surgical resection technically difficult. Furthermore, a systematic nodal dissection may be challenging, especially when bulky lymph nodes were initially present. In conclusion, although randomised controlled trials are available, no definite answer can be provided regarding the optimal strategy for staging, restaging and treatment of the different subsets of stage IIIA-N2 disease. Every patient with locally advanced NSCLC should be discussed within a multidisciplinary tumour board including radiation oncologists and thoracic surgeons who have a large experience with major lung resections. The best available diagnostic and treatment strategies should be discussed with the patient. Salvage surgery should be reserved for those centres having a large experience in thoracic surgery where a dedicated team is available as management of these patients requires multidisciplinary cooperation preoperatively, intraoperatively and postoperatively. References 1. Eberhardt WE, De Ruysscher D, Weder W, Le Péchoux C, De Leyn P, Hoffmann H et al. 2nd ESMO Consensus Conference in Lung Cancer: locally advanced stage III non-small-cell lung cancer. Ann Oncol 2015; 26:1573-88. 2. Eberhardt WE, Pöttgen C, Gauler TC, Friedel G, Veit S, Heinrich V et al. Phase III study of surgery versus definitive concurrent chemoradiotherapy boost in patients with resectable stage IIIA-N2 and selected IIIB non-small-cell lung cancer after induction chemotherapy and concurrent chemoradiotherapy (ESPATUE). J Clin Oncol 2015; 33:4194-201. 3. De Leyn P, Dooms C, Kuzdzal J, Lardinois D, Passlick B, Rami-Porta R et al. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg 2014; 45:787-98. 4. Van Schil P. Stage IIIA-N2 non-small-cell lung cancer: from “surprise” involvement to surgical nightmare. Eur J Cardiothorac Surg 2016; 49:1613-4. 5. Le Péchoux C, Dunant A, Faivre-Finn C, Thomas PA, Pourel N, Lerouge D et al. Postoperative radiotherapy for pathologic N2 non-small cell lung cancer treated with adjuvant chemotherapy: need for randomized evidence. J Clin Oncol 2015; 33:2930-1. 6. Pless M, Stupp R, Ris HB, Stahel RA, Weder W, Thierstein S et al. Induction chemo-radiotherapy in stage IIIA/N2 non-small cell lung cancer: a phase 3 randomised trial. Lancet 2015; 386(9998):1049-56. 7. McElnay PJ, Choong A, Jordan E, Song F, Lim E. Outcome of surgery versus radiotherapy after induction treatment in patients with N2 disease: systematic review and meta-analysis of randomised trials. Thorax 2015; 70:764-8. 8. Ramnath N, Dilling TJ, Harris LJ, Kim AW, Michaud GC, Balekian AA et al. Treatment of stage III non-small cell lung cancer: diagnosis and management of lung cancer, 3[rd] ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143 (5 Suppl): e314-30S. 9. Van Schil P. Salvage surgery after stereotactic radiotherapy: a new challenge for thoracic surgeons. J Thorac Oncol 2010; 5:1881-2. 10. Schreiner W, Dudek W, Sirbu H. Is salvage surgery for recurrent non-small-cell lung cancer after definitive non-operative therapy associated with reasonable survival? Interact Cardiovasc Thorac Surg 2015; 21: 682-4.

Abstract not provided

Abstract not provided

Abstract:
Figure 1Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors (EGFR-TKIs) are the standard therapy for patients with Non-Small-Cell Lung Cancer (NSCLC) harboring activating EGFR mutations. During the last 10 years several trials demonstrated that first and second generation EGFR-TKIs such as erlotinib, gefitinib or afatinib are superior to standard platinum-based chemotherapy in terms of efficacy and tolerability and quality of life. Development of EGFR-TKIs led to a dramatic change in mentality of physicians treating NSCLC. For many years NSCLC has been treated with chemotherapy and platinum-based doublets were offered to all patients irrespective of biological characteristics. Knowledge in the field of molecular biology were limited and even a small cytological sample was sufficient for defining the therapy. Tumor biopsy was recommended only at the time of initial diagnosis and changes in tumor biology as a consequence of therapy exposure were largely unknown. Discovery of EGFR mutations and the impressive activity observed with EGFR-TKIs in EGFR mutated patients led clinicians to understand the relevance of patient selection based on biomarker assessment and therefore the importance of tumor tissue analysis. Since EGFR-TKI approval, EGFR testing entered onto clinical practice and today several biomarkers are routinely tested in NSCLC patients for defining the best therapeutic strategy. In addition to EGFR, other biomarkers such as ALK or ROS1 rearrangements or PD-L1 expression are guiding physician for therapy choice and additional tests are expected to reach the clinic in the next future. As a consequence, tumor biopsy and tissue collection become relevant in clinical practice and also in trial design, since modern studies often claim for tumor tissue. In addition, identification of mechanisms responsible for acquired resistance led to repeat tumor biopsies. Unfortunately, in NSCLC, the amount of tissue obtained at the time of primary diagnosis is often not abundant and tumor re-biopsy if feasible in the minority of patients. Such limitations are leading to development of the so-called “liquid biopsy”, allowing physicians to obtain biomarker information in circulating tumor DNA. In addition, new technologies are implementing the possibility to test for multiple biological events using a single experiment, with a significant reduction in amount of tissue needed, reducing time and costs. Development of EGFR inhibitors also led to a different approach for treating lung cancer. For the first time physicians faced with oligo-progressing diseases, consisting in disease slowly progressing under EGFR-TKI therapy. Often the disease remains asymptomatic and it is still partially sensitive to the therapy. The possibility to control disease outcome by continuing the targeted agent led to the concept of “treatment beyond progression”, an approach that is preserving patient quality of life with also a favorable impact on duration of life. Finally, anti EGFR therapies also highlighted the new opportunity for treating brain metastases. Brain metastases (BM) are a frequent complication of NSCLC, with 25–40% of patients developing BM during the course of the disease, often within the first 2 years after the primary tumor diagnosis. A review of 1,127 NSCLC patients found that those with EGFR mutations were more likely to develop BM than those without such mutations. The frequency of BM was thus 31.4% for the mutation-positive patients but only 19.7% for the negative ones. Improvements in neurologic symptoms and performance status have been reported with whole-brain radiation therapy (WBRT) in combination with steroid therapy in these patients. However, due to their poor performance status, many patients with BM are not eligible for surgery or radiosurgery. Furthermore, the role of systemic chemotherapy for the treatment of BM is controversial due to the impenetrable nature of the blood brain barrier (BBB), with reported response rates to chemotherapy ranging from 15–30% (overall survival [OS] 6–8 months). Response rates of brain metastases to EGFR tyrosine kinase inhibitor (TKI) treatment (e.g. gefitinib, erlotinib, afatinib) in patients with NSCLC harboring EGFR mutations reach 60–80%, with a complete response rate as high as 40%. Median OS is 15–20 months, and progression-free survival in the brain reaches 6.6–11.7 months, demonstrating improved clinical outcome (Table I). Nevertheless, first and second generation EGFR-TKI may have limited BBB penetration. New EGFR-TKIs including the third-generation EGFR-TKI osimertinib and AZD3759, an oral reversible inhibitor of EGFR activating mutations, recently showed impressive activity in presence of BM. The possibility to obtain a long lasting brain disease control together with the positive impact on duration of life is also impacting on the strategy of BM treatment, with preference for therapies not or modestly impacting on cognitive functions, such as stereotaxic radiotherapy, and a lower usage of WBRT. Reference: 1. Porta R, et al. Eur Respir J 37: 624-631, 2011. 2. BPark SJ, et al. Lung Cancer 77: 556-560, 2012. 3. Li Z. J Clin Oncol 29 (Suppl): abstract e18065, 2011. 4. Kim JE, et al. Lung Cancer 65: 351-354, 2009. 5. Welsh JW, et al. J Clin Oncol 31: 895-902, 2013. 6. Iuchi T, et al. Lung Cancer 82: 282-287, 2013. 7. Hoffknecht P, et al.. J Thorac Oncol 10: 156-163, 2015.

Background:
The recent emergence of multiple new targeted therapies and immunotherapy drugs has significantly increased options in the systemic treatment of lung cancer (LC). While great news for patients, in the current environment of scarce health care resources, government agencies deliberating on public funding of cancer drugs struggle with ensuring sustainability of the public health system due to increasingly expensive drug costs. In Canada, the Pan-Canadian Oncology Drug Review (pCODR), a program of the Canadian Agency for Drugs and Technologies in Health (CADTH), provides recommendations that informs public funding decisions for cancer drugs. pCODR’s recommendations apply an evidence-based deliberative framework which considers the drugs clinical benefit, patient-based values, cost-effectiveness and adoption feasibility. As part of the pCODR review, patient input is integrated into the clinical and economic reports and recommendations. Patient groups, such as Lung Cancer Canada (LCC), can play a pivotal role by synthesizing the evidence gathered from patients and caregivers to inform the pCODR process.

Methods:
Both quantitative and qualitative techniques were used to gather data for LCC’s pCODR submissions. A national survey – the Faces of Lung Cancer (FOLC) - illustrated the perceptions and general unmet needs of those living with LC. Focus groups, one-on-one interviews and audits of patient discussion boards gathered the insights of patients and caregivers with experience on the drug under consideration. Patients were identified through LCC’s Medical Advisory Committee and their networks, clinical trial investigators, outreach to other patient groups and scans of LC patient/caregiver discussion boards.

Results:
Since 2014, LCC has made five pCODR submissions. 91 patients and 72 caregivers participated in the FOLC survey. The insights of an additional 62 patients and 38 caregivers with experience on the drugs under consideration were gathered qualitatively. LCC’s submissions describe the emotional, practical and logistical challenges of living with LC, and illustrate the “life impact” of the drug under consideration. - factors not traditionally included in clinical trial design.

Conclusion:
pCODR’s deliberative process, partnered with LCC’s methodology, may be an effective model to aid public funding discussions of new cancer drugs. pCODR and the reviewers have found patient group submissions valuable in providing lived-experience insight, at times changing perspectives. LCC’s contribution has been strongly reflected in the funding guidance reports. To supplement its process, pCODR recently launched a pilot project to include clinician input in the review process. The impact of the pilot will be assessed as data becomes available.

Background:
Shared decision making (SDM) between the patient and their physicians is recognized as a desirable goal. When one treatment option is not clearly superior to another, PDAs can help present risks and benefits in a simple, visual format. Of the 600 plus validated PDAs, less than 60 of these are designed for cancer treatment decisions, and only 10 deal with lung cancer diagnosis or treatment (www.ohri.ca/decisionaid). A survey of lung cancer patients or their significant others/caregivers collected information regarding decision making experiences, and the perceived usefulness of PDAs.

Methods:
A survey (via SurveyMonkey) was sent to lung cancer patients/caregivers/significant others who had signed up for email communication from the Bonnie Addario Lung Cancer Foundation (ALCF), Global Resource for Advancing Cancer Education (GRACE), or the University of Colorado. The survey collected information regarding demographics, categorization of the difficult problem, and the sources of problems encountered during decision making. A PDA regarding prophylactic cranial irradiation (PCI) for limited small cell cancer was made available, and opinions were sought regarding the usefulness of this format.

Results:
190 responses were obtained (123 patients, 67 other). This was predominantly a well-educated, white, North American population, with advanced disease, with more women than men (75% vs 25%). 115 (61%) of respondents had faced a difficult decision, women more so than men. Decisions regarding systemic therapy were the most commonly perceived difficult decision (58%) and/or tests that were done/not done (34%). Sources of difficulty were identified as insufficient information (44%), or conflicting information or recommendations from their physicians (34%). The amount of information available was categorized as insufficient, just right, too much or difficult to know in 14%, 22%, 2%, 50%. Men were more likely to indicate that they had sufficient information, 39% vs 14%, p< 0.05. Most patients desired SDM, with only 9% expressing the desire to make the decision alone. However, 26% perceived that they had done so. Fortunately, only 8% of respondents expressed regret regarding their decision. Of 90 respondents who viewed the PCI PDA, 61% felt that this type of decision aid would have been helpful. There were no gender differences regarding opinions towards the PDA, the desire for SDM, or the perception that it had occurred.

Conclusion:
Lung cancer patients desire shared decision making. Improvements in this process are perceived as needed, possibly with PDAs.

Background:
The disparities in lung cancer treatment and outcomes among minorities are well documented.1 Further, 80% of cancer patients are treated in the community hospital setting yet may not receive the same level of care as those treated at leading academic centers. The Bonnie J. Addario Lung Cancer Foundation (ALCF) Centers of Excellence (COE) program addresses this unmet need. The COE program is a patient-centric model for lung cancer that establishes a standard of care for community hospitals which often treat minority and underserved patient populations. The COE program, which currently includes 13 hospitals in regions of high unmet need, aims to improve the standard of care, patient experience and patient outcome by offering patients and caregivers the same type of multi-disciplinary and comprehensive care provided at leading academic centers. ALCF also provides lung cancer education and services to patients, caregivers and the community.

Methods:
The COE program tracks patient process data longitudinally for multiple quality-of-care metrics, including disease stage at diagnosis; molecular testing; tumor board review; time from diagnosis to treatment; treatment type; and clinical trial participation. Site data will also be monitored to provide a contextual picture of the program including total patients seen, demographics, insurance mix, rates and outcomes of molecular testing among other metrics. Data is analyzed across the COE community and against comparator groups to demonstrate impact of the COE program.

Results:
The COE program serves thousands of patients each year with a significant representation of minorities and underserved populations. Baptist Memorial Health Care System is an example of a COE that has demonstrated implementation of the COE model by providing multi-disciplinary care to a diverse population. Among those reporting race at Baptist, minorities represent more than 30% of lung cancer patients. Memorial Health Care System is another COE that is reaching and serving a diverse patient population. The patient mix at Memorial is : 64% whites; 18% Hispanics; and 18% African American. At Memorial, approximately 10% of the patient population is uninsured. Further, Memorial molecularly tests all stage III/IV patients. Compared with community hospitals in the National Cancer Database the patient mix is about 84% white, 2.5% Hispanic and 11% African American with 3% uninsured.

Conclusion:
The ALCF COE program is demonstrating that underserved lung cancer patient populations can be reached and receive standard of care treatment. The patient-focused COE approach effectively removes barriers to quality care.

Abstract not provided

Background:
Socioeconomic disparities in survival of patients with lung cancer have been identified in many countries. The aim of this study was to examine determinants of late diagnosis of lung cancer in France.

Methods:
All patients with a first diagnosis of lung cancer in 2011 in the National hospitals databases were included. Information on gender, age, presence of metastasis at diagnosis and any significant chronic comorbidities (hypertension, diabetes mellitus, renal insufficiency, and other chronic lung diseases) was retrieved. Based on municipality of residence, patients were classified by population density, social deprivation, access to general practitioners and pulmonologists.

Results:
We identified 41,015 patients newly diagnosed for lung cancer in French hospitals. Mean age at diagnosis was 66.4 (±11.9) years and 72% patients were men. 53% (N=21,613) patients were metastatic at the time of diagnosis. This rate was higher for patients in public compared to private hospitals (56.1% vs 42.9%, p<0.0001) and in community compared to university hospitals (60.2% vs 49.6%, p<0.0001). Multivariate analysis found that metastases at the time of diagnosis were significantly associated with a younger age (55 years or less, OR: 1.22 [95%CI:1.16–1.29]; p<0.0001), a low access to pulmonologists (OR: 1.13 [95%CI:1.04–1.23]; p=0.004), a rural or semi-rural dwelling (OR: 1.07 [95%CI:1.02–1.13]; p=0.004) and deprived areas (OR: 1.06 [95%CI:1.01–1.11]; p=0.01). Of the 8,413 patients (20%) who were initially admitted through emergency room (ER) 68.1% had metastatic tumors. Multivariate analysis showed significantly higher rate of admission through ER at diagnosis in patients from most deprived areas (OR: 1.44 [95%CI:1.37–1.52]; p0.0001), rural or semi-rural (OR: 1.25 [95%CI:1.19–1.32]; p<0.0001), with a low access to pulmonologists and general practitioners (OR: 1.24 [95%CI:1.17–1.30]; p<0.0001 and 1.15 [95%CI:1.08–1.23]; p<0.0001, respectively). Gender (male) and presence of comorbidities were also significant determinants of metastatic disease and admission through ER at diagnosis.

Conclusion:
A majority of French patients with lung cancer were initially metastatic at the time of diagnosis and 1 out of 5 were diagnosed following admission through ER. Residential socioeconomic indicators and access to general practitioners and pulmonologists were significantly associated with these indicators of poor outcome.

Background:
In this era of precision medicine, biomarker testing of cancer tissue is sometimes necessary to match the right patient to the right treatment. A patient might need multiple biopsies if there is recurrence of lung cancer, or to determine eligibility for a new drug or participation in a clinical trial. Anecdotal evidence suggests that physicians are unwilling to recommend additional biopsies because they assume that the patients are likely to refuse.

Methods:
To understand this patient-physician communications gap, we asked 340 lung cancer survivors through an online survey about their willingness to undergo additional biopsies. The survey was fielded through various social media platforms as well as through an independent research panel.

Results:
Three-quarters of the survivors surveyed indicated their willingness to have an additional biopsy, regardless of whether they reported any pain or complications from their initial biopsy. Specifically, among the survivors who were willing to undergo an additional biopsy: Almost all of the survivors (82%) would do so if it would help their health care team better match treatment to their specific cancer and personalize their care, versus just being told the test was to look for mutations. In other words, understanding the end benefit of having the test is an important piece of communication. Although almost 50% reported pain or complications from their initial biopsy, this group indicated equal willingness to have another biopsy as those without any issues. If the doctor were to recommend an additional biopsy or a biopsy after the start of treatment, nearly half would definitely undergo one. About two-thirds of the survivors felt that their doctor explained the reason for getting their initial biopsy really well.

Conclusion:
The study reinforces the importance of a patient-centric model in medicine–in which meaningful and timely information is provided to patients to enable them to be partners in their own care. The study has the following implications for different stakeholders: Patients: To ask their doctor about new treatments and discuss the need for additional biopsies if necessary. Understanding the end benefit of having the test is an important piece of communication. Patient Advocacy Organizations: To educate patients and physicians about having an open dialogue to help patients become equal partners in their treatment decision-making. Physicians: To discuss the benefits and the risks of an additional biopsy with their patients and how it may help decide course of treatment.

Background:
There are limited data on factors that contribute to the development of ROS1-fusion positive cancers. A group of ROS1+ patients approached the Bonnie J. Addario Lung Cancer Foundation (ALCF) for support of ROS1 research. As a first step in this unique, patient-driven effort, we designed a survey to understand epidemiologic/clinical factors that may contribute to the development and progression of ROS1 cancers. We aim to collect data with biospecimens and make these available through an open-access data-sharing platform to accelerate ROS1 research.

Methods:
With guidance from ROS1 patients, we designed a 204-question survey, obtained Stanford University IRB approval. The survey on the ALCF website from May 18, 2016, was widely publicized through conferences, patient support networks, social media and community-based outreach. The survey questions address demographic-, clinical-, diagnostic and treatment- factors, family and reproductive history, dietary, exercise, environmental exposure and hormone and substance use. We used Z-proportions test for statistical significance defined as p<0.05.

Results:
In 53 days, 95 global patients with ROS1-fusion+ cancer responded to the survey (median age at diagnosis 56 years). Respondents were 71% female (n=52/73), 79% never smokers (49/62). 71% respondents were otherwise healthy before diagnosis (n=46/65). The majority of respondents were diagnosed with lung cancer (n=68/72); and one each with gastric, ovarian, cervical and liver cancer. 76% reported metastatic disease (n=52/68) at diagnosis with the most common site of metastases as contralateral lung (65%) and bone (46%). 52% patients reported their ROS1 cancers were not detected at diagnosis (n=35/67); 80% didnot know their specific translocation (51/64). 71% patients received molecular testing on physicians’ orders (n=45/63), with 21% self-initiating molecular testing. Despite the availability of targeted treatments and clinical trials, most patients were prescribed chemotherapy in their first (62%), second (49%), third (60%) and further lines of therapy. 76% patients reported that crizotinib was the therapy that worked best, with 96% reporting significant improvement in symptoms and QoL. We found no significant correlations between oral contraceptive/hormone/anabolic steroid use, occupational exposure, geographic area of employment/residence, family history of cancer, and incidence of ROS1+ cancer.

Conclusion:
This is a unique patient and non-profit advocacy group-driven investigation that seeks to understand factors that may influence development and treatment of ROS1 cancers. The results highlight patient-centricity, the importance of upfront molecular testing and targeted therapies. We report patient-reported experiences with ROS1 testing and durable responses to targeted treatments e.g. crizotinib. As the study is ongoing, we will update results in December 2016.

Abstract not provided

Abstract:
Advances in lung cancer diagnosis and treatment are enabling many metastatic cancer patients to live months or years longer than ever before. Best practices in lung cancer detection, diagnosis, and treatment are changing so fast that keeping current with new developments is difficult for many healthcare providers-- more new drugs have been approved for lung cancer in the past five years than in the previous five decades. While testing for useful biomarkers such as EGFR, ALK and ROS1 is becoming more common, such tests are not yet standard procedure in many settings. Some patients who have limited tissue or who are interested in pursuing clinical trials might benefit from liquid biopsies or next generation sequencing (NGS) panels, but such tests might not available to them for a variety of reasons: the healthcare provider may be unfamiliar with the test or unconvinced of its merits, the facility may not have the technology or expertise to conduct the testing, or insurance may not cover the test. Even if the testing finds an actionable biomarker, patients may have difficulty obtaining novel therapies if those therapies are not approved or covered by insurance, or they may have trouble identifying and accessing appropriate clinical trials. Some biomarkers, such as PD-L1, are also less ‘definitive’ or standardized than others. This presentation discusses ways that patient access to molecular testing and novel therapies can not only improve lung cancer outcomes, but also help engage patients as partners in their own care and accelerate research through patient-driven data sharing.

Abstract:
A significant proportion of lung cancer patients are first diagnosed with their disease as part of an emergency presentation (EP) to acute medical services. EP includes patients attending the emergency department (ED), primary care referrals to acute services, and emergency admissions to secondary care. This route to diagnosis is more common in lung cancer than other malignancies[1]. Initial studies focused on the United Kingdom, where 40% of lung cancer patients were found to present in this fashion[1], but it occurs in all European countries, with rates up to 52%[2]. Lung cancer patients presenting via EP tend to be older, have lower socio-economic status and greater social deprivation, display worse overall health, and have a lower performance status[3]. They are more likely to present with advanced stage disease~,~ and are less likely to have surgery or other treatments with curative intent[2]. The emergency route to diagnosis is associated with poorer patient experience and is a significant additional burden on acute medical services[4]. Most importantly, EP lung cancer patients have poorer survival[1]: the risk of dying in the first month post-diagnosis is four times higher for EP compared to non-EP patients[2]. For the majority of lung cancer patients, there are opportunities for earlier diagnosis and prevention of EP[5]. Most have a relatively long history of symptoms, often more than 12 weeks, and three-quarters have been to their general practitioner (GP) with their symptoms, usually on several occasions. There is also a group of patients who delay consulting a doctor, and they are more likely to report barriers to presenting to healthcare services[5]. Novel methods of lung cancer diagnosis, focusing on symptom recognition, early involvement of primary care and prompt assessment in secondary care, have the potential to address this important problem. In the UK, the issue of late diagnosis and EP of cancer is increasingly recognised in cancer strategies. A number of innovative approaches have been brought together by the ACE (Accelerate, Coordinate and Evaluate) program, which aims to improve early diagnosis of cancer across a range of tumour types by learning from current best-practice and trialling new projects, many of which focus on lung cancer[6]. These are now informing health policy. Prominent independent reports have also addressed the EP of lung cancer, and have produced a series of recommendations[7]. At a national level, campaigns to raise public awareness of the signs and symptoms of lung cancer can help promote earlier presentation to primary care, whilst the adoption of lung cancer screening programmes has the potential to reduce the number of lung cancer patients diagnosed late. Lung cancer risk assessment and clinical decision support tools can assist the GP. System-based tools use patients’ current symptoms to provide an indication as to who should be referred for further investigations, whilst lung cancer risk prediction models identify high risk individuals without symptoms for CT screening. These require further testing and validation, but if proven successful, should be available in primary care practices. Improving communication between primary and secondary care is critical. Direct telephone or email access between GPs and secondary care consultants would speed discussion about high risk cases. Meanwhile GPs should be able to make direct referrals for CT scans for patients with suspected lung cancer without the need for specialist authorization. Other innovative schemes have pioneered open-access patient self-referral for chest radiographs. The ED is often used as a safe and quick access point to secondary care, even for those patients who do not require emergency medical care. Developing new outpatient pathways can prevent EP by providing GPs with access to rapid-access clinics for patients with, for example, clinical suspicion of cancer but who are too unwell to wait 2 weeks for an urgent outpatient appointment, or those in whom the likely tumour type is not clear[6]. The Danish pathway for patients with serious but non-specific symptoms and signs of cancer is one of the pioneers in this area[8]. To support the patient through their whole journey and expedite the diagnostic process, a clinical nurse specialist (CNS) should be available to all patients undergoing investigations for suspected lung cancer. Those who present via EP should be seen within 24 hours by a CNS who then acts as their key worker. The patient should be registered on a timed, multi-disciplinary pathway, so that diagnosis is efficient and the patient is afforded the same treatment opportunities as those presenting via elective routes. Although there is not one solution to the problem of EP in lung cancer, and different approaches are needed for different health systems, there are common themes by which survival can be improved by changing the system for this vulnerable patient group. References: 1. Elliss-Brookes L, McPhail S, Ives A, et al. Routes to diagnosis for cancer - determining the patient journey using multiple routine data sets. British journal of cancer 2012;107(8):1220-6. doi: 10.1038/bjc.2012.408 2. Newsom-Davis T, Berardi R, Cassidy N, et al. Emergency diagnosis of lung cancer: an international problem. American Society of Clinical Oncology Annual Meeting. Chicago, 2015. 3. Mitchell ED, Pickwell-Smith B, Macleod U. Risk factors for emergency presentation with lung and colorectal cancers: a systematic review. BMJ Open 2015;5(4):e006965. doi: 10.1136/bmjopen-2014-006965 4. NHS England. High quality care for all, now and for future generations: Transforming urgent and emergency care services in England - Urgent and Emergency Care Review End of Phase 1 Report: NHS England Leeds, 2013. 5. Forbes L, Sarafraz-Shekary N, Kaushal A, Ramirez A-J, Hughes C, Newsom-Davis T.[. ]What explains diagnosis of lung or bowel cancer as an emergency? 10th NCRI Annual Conference; 2014; Liverpool. 6. Cancer Research UK: ACE Programme: Cancer Research UK; 2016 [Available from: http://www.cancerresearchuk.org/health-professional/early-diagnosisactivities/ace-programme accessed May 2016. 7. Expert Lung Cancer Working Group. Tackling emergency presentation of lung cancer: An expert working group report and recommendations. London: British Lung Foundation, 2015. 8. Ingeman ML, Christensen MB, Bro F, et al. The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer-a cross-sectional study of patient characteristics and cancer probability. BMC Cancer 2015;15:421. doi: 10.1186/s12885-015-1424-5

Abstract:
WCLC Extended Abstract: Establishing a Paradigm for High Quality Lung Cancer Treatment David LeDuc Due to the complexities of diagnosing and treating lung cancer, and the high mortality rate of the disease, lung cancer specialty care is more important than ever. Proper and timely diagnosis and development of a patient-specific treatment plan can impact patient outcome and quality of life with vulnerable populations, such as those who are uninsured or who live in rural and remote places, often not having access to the quality of care and multi-disciplinary approach to treatment found at leading academic institutions. This dynamic results in vulnerable populations being diagnosed in later stages, with limited treatment options and poorer outcomes than those patients with access to quality multi-disciplinary care. The Addario Lung Cancer Foundation (ALCF) Community Hospital Centers of Excellence Program (COE) directly addresses this need by partnering with community hospitals, where 80% of cancer patients are treated, to deliver standard of care lung cancer screening, diagnosis and treatment. The COE program currently includes 13 hospitals and serves thousands of patients each year in regions of high unmet need. The program aims to improve the standard of care, patient experience and patient outcome by offering patients and caregivers the same type of multi-disciplinary and comprehensive care provided at leading academic centers. ALCF also provides lung cancer education and services to patients, caregivers and the community. The COE program helps to bridge the health-equity disparity and lung cancer information gap by establishing a standard of care (SOC) to improve health outcomes and quality of life through an approach that is personalized, multi-disciplinary/-institutional, considers the totality of each individual’s cancer, and is coordinated by an onsite Patient Navigator (PN) cognizant of the unique medical, economic, emotional, and cultural needs of their unique population. The COE approach embodies a support and engagement strategy that targets the patient, caregiver, family, healthcare team, and community. The goals of the program are to: Improve outcomes, survival and quality of life for patients. Implementation of SOC best practices enable a comprehensive and fully integrated multidisciplinary team (MDT) of doctors (oncologist, pulmonologist, radiologist, pathologist, immuno-oncologist, etc.) that personalizes treatment based on each patient’s specific disease state. SOC includes: tumor board review; timely biopsy; molecular testing; consideration for targeted and immunotherapies and access to clinical trials. Successful implementation of COE standards of care helps to improve patient outcome and quality of life. Provide on-site Patient/Nurse Navigator (PN/NN) to manage each patient’s cancer journey. Navigators build a trusted relationship with patients, families/caregivers, and physicians to better ensure patient retention, engagement, and utilization of comprehensive specialty care and support services. Patient oversight includes guidance on molecular testing to identify unique genetic profile of the individual’s cancer to determine the best first-line treatment and develop a treatment strategy. The PN also provides support by connecting patients to all ALCF programs and helps address non-clinical challenges. The PN oversees MDT coordination, data tracking, patient surveys, and other monitoring tools to measure patient satisfaction, outcomes, and program success. Educate and empower patients/families/caregivers. Education empowers patients/caregivers to self-advocate and communicate with their physician team to ensure access to the full breadth of treatment and care options including access to new diagnostic technologies and tests, clinical trials, symptom management & palliative care among other resources. Patients and providers have access to ALCF’s free support programs: Patient Education Handbook, “Navigating Cancer 360° of Hope” (in English, Spanish, Chinese and hard copy, downloadable, mobile App); Patient Web Portal; and monthly Living Room Education/Support & Speaker Series available 24/7 Video Library (with Spanish and Chinese subtitles to ensure access to diverse populations). The COE program also provides patient educational materials and outreach to help promote the program in the local community and drive awareness. Track program progress & metrics through database tools. A key element of the program is the ability to collect and analyze COE data and provide COEs with access to de-identified patient/population data and reports and insights that drives interventions and improved patient outcomes. Participating COE hospitals provide metrics that demonstrate adherence to the COE SOC and to patient care and outcome. Metrics include: survival rates; quality of life as defined by NCCN guidelines; time from diagnosis to treatment; patient referrals to ALCF education/support services; and patient-specific data such as percentages with: an early diagnosis; who complete molecular testing; are referred to clinical trials; and reviewed by tumor board. Insights derived from this data help demonstrate progress toward patient survival, and delineate outcomes by care facility, geography, treatment approach, and ethnic group. Data is used to benchmark against other COE sites as well as compared to national data/statistics. ALCF conducts an annual review, sharing all findings with ALCF partners and community hospital COE sites. The COE model has already demonstrated proof of concept and positive impact on patient care and outcomes. Several sites are already reporting servicing patients at levels above community hospitals reported in the National Cancer Database. The COE data collection and analytics tools will enable ALCF to demonstrate impact on the screening, diagnosis, treatment and survival of lung cancer patients. Further, as the COE program adheres to SOC and produces data, it is anticipated that more patients will be diagnosed at earlier stages when survival rates are highest; more patients will receive molecular and genetic testing steering them towards targeted and immunotherapies that improve outcome; and clinical trial participation rates will go up.

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WCLC abstract December 2016 Title: The role of the Lung Cancer Nurse Service within the Lung Foundation Australia (LFA) Introduction: The presence of a Lung Cancer Nurse within a dedicated Lung Foundation is rare, nationally and internationally. In response to the need to improve national lung cancer services, Lung Foundation Australia (LFA) successfully secured funding through the Cancer Australia grant initiative “Supporting people with cancer”. LFA directed these funds toward addressing challenges identified by Cancer Australia within the lung cancer community through the appointment of a Lung Cancer Nurse to provide support and information across all stages of a lung cancer patient’s experience – not only at diagnosis, but also as a consistent point of contact throughout an extremely stressful and uncertain time. The service is intended to be an extension of existing health services, supporting both patient and carer throughout their journey. The role of the LFA Lung cancer nurse has evolved with the launch of the National Lung Multidisciplinary Team (MDT) directory in June 2016. This directory, currently representing 64 Lung MDTs, provides a detailed understanding of the services each hospital can provide for a patient, from diagnostics through to various treatment modalities. These two key initiatives - the Lung Cancer Nurse Service and National Lung MDT Directory - service have become intertwined, supporting the needs of patients and, importantly, navigating them towards achieving the best level of care whilst ensuring the patient, their family and carers feel supported, informed and respected. The most significant aspect of the Lung Cancer Nurse Service is that of patient advocate, reflecting and representing the needs of patients nationally and, where appropriate, linking patients back into the health care system. Lung cancer specialist nurse roles are pivotal in representing patient needs within Lung MDT meetings as well as referring them into community support services. However, with the development of the National Lung MDT directory it has become evident there are significant variations among Lung MDT operations: including representation of the different professional disciplines involved in caring for patients with lung cancer; formal communication channels to primary care providers; and providing patients with access to a dedicated Lung Cancer Support Nurse. For example, data from the commencement of the Lung Cancer Nurse Service in July 2015 confirms that not every patient has access to a specialist Lung Cancer Nurse – currently the National Lung MDT directory has highlighted the existence of 30 dedicated Lung Cancer Nurses nationally, which currently equates to one specialised nurse per 400 patients diagnosed with lung cancer. Overall the National Lung MDT Directory and Lung Cancer Nurse Service have become a vital link in delivering efficient, up-to-date information for patients and carers seeking support and guidance. Ultimately the objective of the Lung Cancer Nurse Service is to continue to address the principles of best practice management in lung cancer ensuring: the patient and carer feel supported, informed and respected; all patients receive timely access to all components of their care regardless of location: and patients have access to all relevant treatment and supportive options and, importantly, have well-coordinated lung cancer care. This Service complements the support structures that are already in place, so clinicians can continue to strive to ensure the needs of lung cancer patients can be addressed and increase much-needed support and resources. The experience in establishing this new role within LFA, forming collaborations with national Lung Cancer MDTs and the measurable impact of the role on outcomes for lung cancer patients, will be presented in both qualitative and quantitative terms.

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*Seda Kansu Founder Member Pembe Hanım - *Beril Koparal, Vice President Pembe Hanım - * Cengiz MD Gemici Dr Lutfi Kirdar Kartal Training and Research Hospital Department of Oncology - * Hasan Fevzi Batirel MD Marmara University Medical FacultyDepartment of Thoracic Surgery - *Rıza Çetingöz MD.Professor in Medicine Turkish Lung Cancer Society President - *Ahmet Özet MD.Professor in Medicine Turkish Medical Oncology Society President References Pembe Hanım Cancer Patients Society Turkish Society of Medical Oncology Turkish Lung Cancer Society Dr Lutfi Kirdar Kartal Training and Research Hospital Department of Oncology Marmara University Medical FacultyDepartment of Thoracic Surgery The incidence of cancer in Turkey is 267 and 186 in a hundred thousand in men and women respectively. Lung cancer is the number one cause of cancer death in men in Turkey and its incidence is increasing in women in recent years as well. It is the fifth common cause cancer after breast, colon, thyroid and gynecologic malignancies in women in Turkey.The number of cancer cases directly related with smoking is expected to be 31.000. The incidence of lung cancer in men and women is 21.9 and 5.3 in a hundred thousand respectively. Namely there are 50.000 lung cancer patients in Turkey. And each year a new 30.000 patients are added to this number. Between 2009-2013,the incidence of lung cancer among men has decreased from 56 to 51 in a hundred thousand. However the number has increased from 16 to 18 in a hundred thousand among women. This decrease among men is the positive result of effective smoking cessation campaigns as the main cause of lung cancer in Turkey is smoking. The second reason is air pollution in workplaces. Lung cancer is diagnosed generally at late stages in Turkey as well as in the west, and more than 50% of the patients present with metastatic disease at diagnosis. Only minority, less than 20% present with localized disease and these cases are generally detected incidentally for other health reasons. Curative surgery can be offered to only 15% of the patients. There is no effective prevention other than smoking cessation and screening which is becoming more popular for certain risk groups in the west but it is not a proposed method actually in Turkey. Treatment decisions in high volume centers are taken by multidisciplinary way including radiologists, pathologists, nuclear medicine specialists, surgeons, medical and radiation oncologists. Surgery is the primary treatment modality in early stages of disease, and lung cancer surgeons are well experienced throughout the country being able perform all sort of surgical techniques including robotic one with high success. Cancer chemotherapy and radiotherapy are well developed in the country with the availability of recent FDA approved targeted drugs and immunotherapeutic agents as well. Certain centers in Turkey are also included in multinational studies involving new agents in treatment of this disease. Radiation oncology centers are equipped with high technology radiotherapy machines being able to perform image guided intensity modulated radiotherapies and stereotactic radiotherapies in treatment of lung cancer. For the last years prevention programs in Turkey has increased. Two main actions for this are smoking cessation and fight against air pollution. The effectiveness of early diagnosis programs in lung cancer has not been proved. There has been an initiation of screening programs by low dose BT in high-risk patients. The diagnosis and treatment of lung cancer is in line with global standards considering surgery, radiotherapy and chemotherapy. The global improvements in lung cancer is closely followed by oncologists and scientists in Turkey and rapidly integrated into clinical practice by means of prevention, diagnosis, treatment and follow-up. However the patient care in terminal stage should be improved. The set up of Turkish Cancer Institute has been initiated and targets for 2023 are the determination of molecular genetic targets for diagnosis and the treatment of lung cancer, the identification of cellular therapies and immunotherapy and other targeted therapy modalities. In Turkey it is not possible to talk about early diagnosis. But we can talk about early stage diagnosis. The rate of early stage lung cancer patients in Turkey is less than 1/5. Unfortunately population based screening programs for lung cancer has not been approved by Ministry of Health yet. With a screening program a tumor of 1 cm can be diagnosed. However a patient with symptoms being diagnosed has a tumor of 3 cm and the rate of cure between these patients is really different. 5 year survival for a patient with a tumor of 1 cm is 100% and a patient with a tumor of 3cm is 65-70%. Under screening programs for high- risk patients, the risk of death from lung cancer decreases 20%. On the patient organization side Pembe Hanım Association has made the first attempt in Turkey to raise awareness in the public for lung cancer. For four years a Project called “MegaLung” has reached many people talking about the prevention, diagnosis and treatment of lung cancer. This was the first and only project about lung cancer. “MegaLung” had its place in many organizations open to public to reach as many people as possible as lung cancer is a wide range cancer and it has a preventable cause namely smoking. At the moment with the collaboration of members of Pembe Hanım Association, mainly Seda Kansu and Turkish Lung Cancer Society, a patient organization for lung cancer called “Nefes (Breath)” is being set up with the aim of raising awareness among public and lung cancer patients about the all the issues related with lung cancer. * As Pembe Hanım Cancer Patients Society we would like to thank Turkish Society of Medical Oncology,Turkish Lung Cancer Society, Dr Lutfi Kirdar Kartal Training and Research Hospital Department of Oncology and Marmara University Medical FacultyDepartment of Thoracic Surgery for their valuable support. Seda Kansu IASLC Patient Advocates Committee Member References Pembe Hanım Cancer Patients Society Turkish Society of Medical Oncology Turkish Lung Cancer Society Dr Lutfi Kirdar Kartal Training and Research Hospital Department of Oncology Marmara University Medical FacultyDepartment of Thoracic Surgery

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In the United States of America (USA), the public is dangerously uninformed about lung cancer, our nation’s second leading cause of death behind heart disease[1]. Lung cancer accounts for more deaths than any other cancer[2]; more than breast, prostate and colon cancer combined! An estimated 220,000 new cases of lung cancer will be diagnosed the USA in 2016[3] resulting in 158,080 deaths or about 27% of all cancer deaths 2016[4]. Ready access to effective and comprehensive medical care at a reasonable cost is the key to our well-being. This is especially true for lung cancer. For lung cancer patients, access takes many forms, to include diagnosis, treatment and financial support for care and treatment. Regardless, for lung cancer patients, time is of the essence, making quick, effective and affordable access to care critical. This discussion will focus on four areas that affect access to care for lung cancer be it at the diagnostic stage or the treatment and care stage: (1) Stigma: At the outset, the negative bias against lung cancer may weigh against early access to treatment[5]. 68% of advanced cancer patients who have never received cancer care are lung cancer patients6. Cancer patients, healthcare professionals, caregivers and the general public are all equally likely to have a negative bias toward lung cancer[7]. (2) Timely diagnosis: The good news is that thanks to advances in technology, early detection screening using spiral CT has been shown to reduce lung cancer deaths by 16% to 20% ( in a defined population), compared to standard chest x-rays among adults[8]. Yet, only 16% of people will be diagnosed in the earliest stage, when the disease is most treatable[9 ]and at best, early diagnosis is usually the serendipitous result of some other unrelated procedure. Aside from the lack of public awareness that anyone with a set of lungs may be at risk for lung cancer, there remains no standard effective diagnostic tool for lung cancer. The development of affordable diagnostic tools using biomarkers in airway epithelial cells, sputum, blood, breath, and urine for early diagnosis and prediction of high risk individuals is critical. (3) Current and evolving treatment options: Once again, the good news is that treatment options for lung cancer patients are rapidly improving. In the last two years more treatments have been approved by the United States Food and Drug Administration (FDA) for the treatment of lung cancer than had been approved in the prior ten years. Most of the discoveries and associated clinical trials are happening at academic centers yet 80% of lung cancer patients are treated at their local community hospital. New and life savings treatments along with clinical trials are happening so quickly that it is sometimes challenging for these advancements to reach the treating physician thereby limiting ready access of these new treatments to the patient. (4) Cost of treatment and care: The Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA) or Obamacare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010. In April 2016, Gallup reported that the percentage of adults who were uninsured dropped from 18% in the third quarter of 2013 to 11% in the first quarter of 2016. Although individual insurance coverage has improved, the rapid pace of discovery and FDA approval of treatments, insurance payors and federal medical care assistance programs have not necessarily kept pace with these advancements in both testing and treatments by not providing insurance coverage, leaving lung cancer patients without the financial ability to pay for needed care. Various organizations such as ESMO, ASCO, ICER and others are attempting to compare drug prices to overall patient benefit through programed algorithms in order to assist payors and patients in treatment decision making. These are often long and laborious projects which may be out of date by the time the recommendations are published, and impede quick access to treatment and care Patients and patient advocates are in a strategically advantageous position to affect change in these four areas in order to provide greater access to care for all lung cancer patients. 1 http://www.medicalnewstoday.com/articles/282929.php#top_10_leading_causes_of_death_in_more_detail 2 http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf 3 American Cancer Society. Cancer Facts & Figures 2016. Atlanta: American Cancer Society; 2016. 4 http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf 5 LoConte NK, Else-Quest NM, Eickhoff J, Hyde J, Schiller JH. Assessment of Guilt and Shame in Patients With Non-Small-Cell Lung Cancer Compared With Patients With Breast and Prostate Cancer. Clinical Lung Cancer. 2008;9(3):171-8. 6 http://thelungcancerproject.org/#need-for-change 7 http://thelungcancerproject.org/#need-for-change 8 http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf 9 http://seer.cancer.gov/statfacts/html/lungb.html

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Patient Advocacy Track Access to Care: Malaysia Recently The Systemic Anti-Cancer Therapy (SACT) dataset collated by Public Health England reported the assessment of factors affecting 30-days mortality in national patient population. Although, the report was impressive, only 3% of lung cancer patient treated with curative intent died within 30 days of starting chemotherapy and 10% for palliative treatment. There was a vast disparity among some hospitals. This concluded that clinical decision making in can certainly impact on cancer mortality(Wallington et al., 2016). In the similar context, clinical decision making in Malaysia and the South East Asia (SEA) are hugely influenced by the affordability factor which can directly influence mortality rates. The clear evidence is seen in Globocan 2012 data. SEA despite having the lowest prevalence for all cancers combined has a highest mortality to incidences ratio when compare with countries which have universal health coverage with better access to innovative care. Figure 1 To understand why the clinical decision making in Malaysia or the SEA region is hugely influenced by the affordability factor we must first dive in the health-care systems in southeast Asia (SEA). There is an enormous social, economic and political diversity within and across the countries in SEA which is formed by its history, geography and position as a major trade route. All these have had contributed not only to the diverse population but also to the wide-ranging nature of its health systems which are at varying stages. This highly diverse health-care system, range from dominant tax-based financing to social insurance and high out-of-pocket payments across the regions. For example, The World Health Report 2006 estimated that the total private finance sources account for 41.8% of total health expenditure in Malaysia which is likely affect the equity of financing because private health payments might impose disproportionate financial burden on households (“WHO | The World Health Report 2006 - working together for health,” 2013). A subsequent analysis showed private health expenditure has dominant role in financing healthcare in five of the seven countries in the SEA, contributing more than 70% of the total spending on health in Laos and Cambodia. This urge for health-financing reform and there are multiple model which are considered by varies government. Among them are financial protections through payroll-financed social health insurance or tax-funded arrangements for formal employment. However, this approach still challenges the informal and the rest of the population with countries such as the Philippines and Vietnam(Tangcharoensathien et al., 2011) A reformed health-financing with universal coverage will not only decrease the Lung cancer mortality as seen in the developed countries but also hugely impact daily clinical practice and increase quality of services provided to the patients. Bibliography. Globocan. (2012). Fact Sheets by Cancer. Retrieved October 14, 2016, from http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx Tangcharoensathien, V., Patcharanarumol, W., Ir, P., Aljunid, S. M., Mukti, A. G., Akkhavong, K., … Wagstaff, A. (2011). Healthfinancing reforms in southeast Asia: challenges in achieving universal coverage. The Lancet, 377(9768), 863873. http://doi.org/10.1016/S01406736(10)618909 Wallington, M., Saxon, E. B., Bomb, M., Smittenaar, R., Wickenden, M., McPhail, S., … Dodwell, D. (2016). 30-day mortality after systemic anticancer treatment for breast and lung cancer in England: a population-based, observational study. The Lancet Oncology, 17(9), 1203–1216. http://doi.org/10.1016/S1470-2045(16)30383-7 WHO | The World Health Report 2006 - working together for health. (2013). WHO.

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2016 World Conference on Lung Cancer Presentation Title: Access to Care: Australia Lung Foundation’s Lung Cancer Patient Pathway In June 2016, Lung Foundation Australia launched an evidence-based, clear and concise guide, the “Lung Cancer Patient Pathway”, for patients with a confirmed lung cancer diagnosis. The guide is available as a printed resource and online resource supported by a micro-site on Lung Foundation Australia’s website and the Lung Cancer Network Australia website and has been distributed to the majority of dedicated lung cancer treatment centers around Australia. Project aims The main aim of producing the Lung Cancer Patient Pathway (LCPP) was to provide newly diagnosed patients with a “one stop” resource that outlines the clinical referral pathways and details the full range of treatment options and supportive care services available to them throughout their lung cancer journey. The LCPP also aims to improve patient health literacy and empower patients with access to evidence based information to support informed decision making and treatment choices, self- management and ultimately, to improve patient outcomes. Project Synergies The LCPP was launched in conjunction with the launch of the Lung Foundation’s Australian Lung Cancer Multi-Disciplinary Team Directory http://lungfoundation.com.au/mdt/. This national directory lists the current (64) dedicated lung cancer multidisciplinary (MDT) services around Australia. It is intended to facilitate referrals of patients to hospitals delivering MDT-based lung cancer management. The creation of this national directory has forged closer relationships between the Lung Foundation and dedicated lung cancer multidisciplinary (MDT) services and provided a mechanism to be able to reach patients at time of diagnosis. Lung Foundation has previously struggled to reach patients early in their cancer journey. Strengthening these relationships with Lung MDT services has led to a systematic distribution of Lung Foundation patient kits including the LCPP info-graph. The Cancer Nurses Society of Australia Winter Congress in May 2016 and Australian Lung Cancer Conference in August 2016 presented opportunities to distribute the printed LCPP in conference delegate bags and at trade exhibitions to more than 550 cancer clinicians and nurses. Sustainability The Lung Foundation will implement the following strategies to ensure the sustainability of this project: · Info-graph will be trialed in Lung Cancer MDTs around Australia · Info-graph will form part of the Lung Cancer Consultative Groups activities · A minimum review period of two years for info-graph and website content · Annual budget allocation for ongoing promotion and dissemination Conclusion The Lung Cancer Patient Pathway project has produced a patient centered resource to empower newly diagnosed patients with current, evidence based information so that they can make informed decisions on treatment options and supportive care services and access the right treatment and care at the right time. This project was managed by Glenda Colburn, Director, Lung Cancer National Program, Lung Foundation Australia. The Lung Cancer patient pathway was made possible via unrestricted education grants. Principal sponsor: Bristol-Myers Squibb Supporting Sponsors: AstraZenea, Boehringer Ingelheim, Cancer Australia, Pfizer, Maurice Blackburn Lawyers, MSD.

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The defining characteristic of the health system in Israel is its governance by the National Health Insurance Law (1995). This law ensures health coverage to every resident of Israel and defines the government's responsibility to provide health services to every person without discrimination. In other words, health insurance is mandatory, and all residents of Israel must be insured. Citizens pay a healthcare tax – 4.8% of income. Private Health Services Patients have the option of seeking private medical care from a physician of their choice, and at their own expense. There are four health funds, where each fund has branches throughout the country and provide its members with all mandated services. The Basket of Health Services, consists of a range of essential medical services, including treatments, medications, and equipment which each health fund is obligated to provide to its members. Its contents are defined by law, but are subject to periodic revision. Therefore, a treatment or medication that was covered at one point may be discontinued, or new items may be added. Every end of a year, new treatments and technologies are submitted to be included to the new health basket. First the physicians rate the proposed new treatments and technologies, then the top ones enter the basket debate, where eventually only some every year enter the health system. In the past years new treatments and technologies could be added until the sum of 300 million NIS, that equals, 80 million dollars. This year the basket fund was increased to 146 million dollars. The problem is that there are many new treatments and that the oncology rating is among all oncological diseases. Last year, four new lung cancer drugs were proposed to the health basket. The Israel Lung Cancer Foundation, advocated in the Israeli Kneset (house of parliament), attended meetings, raised awerness in digital and written media. Eventually 3 new lung cancer drugs were approved including OPDIVO, TAGRISSO and ALECTINIB. This end of year, KYTRUDA and OPDIVO for larger indications were submitted in addition to foundation 1 diagnosis test. This year, the foundation submitted to the health basket the lung cancer screening test, LDCT to be included for population at risk. Clinical studies take place in Israel, although as a very small country with only 8 million people, the number of clinical trials is not large. Companionate programs exist as well. Overall, Israel has a very good health system with good access to targeted therapy and immunotherapy. Drugs for mutations such as ALK and EGFR are approved including immunotherapy for NSCLC.

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Background: Cancer Patient’s Association of Slovenia (CPAS) is a non-governmental organisation, connecting the patients with all cancer types as well as their relatives and health professionals. The central programme that is being offered to patients by CPAS for more than three decades is an organized self-help »On the way to recovery«, that offers support in self-help groups on 20 locations and peer-to-peer counselling in two Info centres. The lung cancer patients are entering the programme alongside the other cancer patients. The peer-to-peer support programme has developed the system of regular supervisions, initial education, the study material aimed at volunteers and the network of self-help groups spread over the Slovenia. The research analysing peer-to-peer support showed clear benefits for the patients[1,2]. Since 2014, the Lung Cancer Support Division is organised in the framework of CPAS. Its main aim is the development of the programmes for lung cancer patients and their relatives. In Slovenia, with roughly 2 million inhabitants, there are some 1230 new lung cancer patients every year, and 1100 deaths due to lung cancer[3]. Patients with lung cancer are treated in four oncological centres (Institute of Oncology Ljubljana, University Clinic Golnik, University Medical Centres Ljubljana and Maribor). Among the burdens, all cancer patients are carrying, such as confronting its own vulnerability, mortality, coping with the hardships of treatment, psychic distress often combined with the fear of recurrence, lack of social support and changes in financial situation, some are disease specific. The burdens lung cancer patients are experiencing are connected with the poor prognosis, poorer quality of life and greater symptom management needs. These are due to physical troubles, social presentation of lung cancer as death sentence, sense of guilt and stigmatisation, but are also due to the need of information regarding new treatments available[4–6]. To be able to react on the specific lung cancer patient’s needs, we have within the Lung Cancer Support Division supplemented volunteer self-help programme »On the way to recovery« with the programme »How to live with lung cancer« [7]. How to live with lung cancer is a one-day programme, which is being implemented in various also smaller places and medical institutions throughout the Slovenia. It is aimed at lung cancer patients, their relatives and also health providers. The programme is carried out through recognized consultants working with lung cancer (surgeons, medical oncologists, radiation oncologists, physiotherapists, nurses and clinical psychologists from the medical institutions treating lung cancer). Methods: All participants in the programme were given a specific designed evaluation questionnaire. We present an evaluation from the program participants in the year 2016. We analysed the participants’ responses and the evaluation will be used in further program development. Results: The participants are being highly satisfied by the programme as whole and also with the individual sets of lectures. They are highly appraising the help our programme is providing in understanding the health situation, communication with the health professionals and in understanding coping processes. The programmes main goal is to inform participants on the lung cancer diagnostics, treatment and the rehabilitation possibilities. This information is given by the relevant professional. There is a special emphasis on the new and more efficient treatment possibilities. The programme presents in depth the ways and the means for the optimal coping with the disease and its treatment and also the advices for the living with the disease. We are widening the importance of comprehensive patient treatment, informing on psycho social considerations, possibilities on entering the CPAS programmes (and also related programmes that are offered locally), we are informing on benefits of early inclusion in the palliative care thus busting the myths regarding the palliative care. Except for presenting information, the programme’s goal is also the social support for lung cancer patients, as a large amount of the time is set by for the talk and the exchange of experiences among the participants. The inclusion of different professions into the comprehensive care of cancer patients due to the patients’ needs is being represented on the symbolic level with the joint presentation, where the presenters are alternating thus rounding up the “story” of treatment and rehabilitation. Incorporated in this programme is also a chance for the patients and their relatives to have an individual conversation with the medical professionals regarding their treatment and dilemmas. While the programme is being primarily aimed at the patients and their relatives, the local medical professionals are also invited. This beside the information point of view gives them also a chance to interact with the presenters and an opportunity to discuss with them their questions and dilemmas. Through this we are trying to ensure the equal availability of treatment and to approach the people with medical and psycho social support. Conclusions: With this programme we are following all three fields where the peer support programmes have been found to be beneficial to patient. Namely, their informational needs about the cancer and its treatment, management of emotional distress and finally the facilitation of empowerment [1,2]. REFERENCE: 1. Meyer A, Coroiu A, Korner A. One-to-one peer support in cancer care: a review of scholarship published between 2007 and 2014. Eur J Cancer Care (Engl). 2015;24(3):299-312. 2. Campbell HS, Phaneuf MR, Deane K. Cancer peer support programs-do they work? Patient Educ Couns. 2004;55(1):3-15. 3. Studio N. Rak v Sloveniji 2012 Cancer in Slovenia EPIDEMIOLOGIJA IN REGISTER RAKA EPIDEMIOLOGY AND CANCER REGISTRY. 2016. 4. Missel M, Pedersen JH, Hendriksen C, Tewes M, Adamsen L. Diagnosis as the First Critical Point in the Treatment Trajectory: An Exploration of Operable Lung Cancer Patients’ Lived Experiences. Cancer Nurs. 2015;38(6):E12-21. 5. Pujol J-L, Mérel J-P, Roth C. How preconceptions about lung cancer treatment interact with medical discourse for patients who accept chemotherapy? Psychooncology. July 2016. [Epub ahead of print] 6. Pozo CLP, Morgan MAA, Gray JE. Survivorship issues for patients with lung cancer. Cancer Control. 2014;21(1):40-50. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24357740. Accessed August 21, 2016. 7. Čufer T., Simonič A., Koren P., Crnjac A, Računica K., Rajer M., Kovač V, Škufca Smrdel A. C. VPM. KAKO ZIVETI Z RAKOM_za splet-film. 2015. Available at: https://drive.google.com/file/d/0ByMyk7OmgaDSVzR3ME1vZzltbVU/view. Accessed Sept 20, 2016

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Patient involvement in the evaluation of cancer medicines; the EMA experience The European Medicines Agency (EMA) is the authority which evaluates and monitors medicines across all EU Member States. Pharmaceutical companies wishing to market a new cancer medicine in Europe are obliged to apply for a licence through the EMA. With a remit to ensure that European citizens are provided with safe and effective medicines, the EMA realised early on that patients’ experience with their disease and its treatment is a fundamental parameter to include within the evaluation of medicines. The Agency’s engagement with these stakeholders has been a progressive journey whereby a steady increase in the numbers involved (76 in 2007 to 740 during 2015) has been coupled with a diversification of methodologies ensuring opportunities all along the medicines lifecycle. Learning from experience has also been paramount to ensure that the interaction is mutually beneficial and is carried out in the most optimal manner possible. Key milestones of EMA interaction with patients and consumers: Figure 1 The “framework of interaction” adopted by the EMA management board in 2005 provides the formal basis for involving patients and consumers in Agency activities and relies on five critical elements: A network of European patients and consumers organisations A forum of exchange: EMA Working Party with Patients and Consumers’ organisations A pool of patients acting as experts in their disease and its management Interaction with the EU Regulatory Network Capacity-building focusing on training and raising awareness about EU regulatory system Today patients and consumers are systematically involved in a wide range of EMA activities: Members of EMA Management Board and scientific committees Members of the EMA ‘Patients and Consumers Working Party’ Scientific advice procedures during medicines development; Discussions on benefit/risk evaluations; Review of information (e.g. package leaflet, safety communication); Topic groups and workshops The Agency works with a large network of organisations and individuals; organisations can register with the Agency and if they meet certain eligibility criteria they are then listed on the EMA website (EMA website). Individuals are also encouraged to register to be included in the EMA “individual experts’ stakeholder database” (registration form); they then receive targeted information and can be contacted for involvement in EMA activities. Patients usually participate in person or via written procedure and are involved as either representatives of their organisation or as individual experts, depending on the nature of the activity. There are opportunities for involvement all along the medicine’s evaluation lifecycle: Figure 2 EMA continually looks to further enhance its methods for gathering patient knowledge and preferences at each stage of the process and is investigating the use of additional tools to complement those already in-house. Surveys are regularly used to elicit feedback from both regulators and patients/consumers on their involvement, its added value to the process and identify areas for potential improvement. There are inevitably challenges to overcome, for example finding suitable patients (e.g. language barrier, availability), ensuring tailored support to facilitate and enhance participation, providing a clear definition of the patient role, addressing issues around confidentiality and representation and also how to measure the impact/value of the input. Evidence, including testimonies and concrete examples, has demonstrated that ultimately patient/consumer input: Brings the everyday aspects of living with a disease into the scientific discussions; Improves the quality of patient information and communication on medicines; Increases the dissemination of EMA outcomes. Today patients and consumers are a valued and integral part of the work at the EMA and their perspectives are considered an essential element for increasing transparency in the regulatory process and ensuring more meaningful decisions for all concerned.

Abstract:
Introduction Ireland has a proud record of leadership in the field of tobacco control. It was the first country in the world to introduce a Workplace Smoking Ban in 2013 and the first country in Europe to announce its intention to introduce plain packaging for cigarettes. In 2013 Ireland set a target date to achieve a tobacco free society with a targeted adult tobacco use prevalence of under 5%. Other countries to formally adopt a target for tobacco free societies include Finland 2040, New Zealand 2025, and Scotland 2034. Tobacco Free Ireland[1] is a new tobacco policy for Ireland coming more than a decade after the publication of the previous national policy Towards a Tobacco Free Society[2]. It is a timely successor because of the emerging non-communicable disease burden which is caused by risk factors that can be prevented. Tobacco is well known as a major contributor to ill-health and premature mortality. It is responsible for more than a third of all cancers. For the first time, we have a target date for Ireland to be tobacco free of 2025. The question is whether this target is in any way realistic. Discussion Tobacco Free Ireland addresses a range of tobacco control issues and initiatives and contains over 60 recommendations. A high level action plan, was drawn up in consultation with those who will lead out on the recommendations which outlines the responsibilities, actions necessary and timelines for the implementation of the recommendations. The recommendations to support Ireland becoming a tobacco free Society are categorised under:- • Protection of children and denormalisation of tobacco use • Legislative compliance and regulating the retail environment • Protect people from tobacco use • Offer help to quit tobacco use • Warn about the dangers of tobacco • Enforcement of bans on tobacco advertising, promotion and sponsorship • Raising taxation on tobacco products • National and International Partnerships For the first time in policy we see a commitment to substantially address supply side issues through introduction of levies such as an environmental waste levy and an industry profitability levy ring fencing income to address health promotion, cessation supports and illegal trade initiatives. The document fails to substantially address the inequality inherent in smoking patterns. In Ireland the bottom decile, at 35% prevalence, is more than twice as likely to smoke as the top decile at 16%. Specific deprived population targeted programmes such as the Irish Cancer Societies ‘We Can Quit’ programme, which challenges intergenerational smoking, have been successful and need to be funded and enhanced if a Tobacco Free Society is to be achieved. Conclusion Current adult smoking rates of 19.5%[3] suggest Ireland has some significant way to go towards achieving its target. Recent youth smoking rates of 13%[4 ]for 15-17 year olds and 8%[5] for 10-17 year olds suggests significant progress in reducing the uptake of smoking. Major investment is required to support increased quit attempts and increased success from quit attempts if the target of a Tobacco Free Ireland by 2025 is to be achieved. References 1. http://health.gov.ie/wp-content/uploads/2014/03/TobaccoFreeIreland.pdf 2. http://health.gov.ie/blog/publications/towards-a-tobacco-free-society-report-of-the-tobacco-free-policy-review-group 3. http://health.gov.ie/wp-content/uploads/2015/10/Healthy-Ireland-Survey-2015-Summary-of-Findings.pdf 4. http://health.gov.ie/blog/publications/irelands-report-on-the-european-schools-project-on-alcohol-other-drugs-in-ireland-espad/ 5. http://health.gov.ie/wp-content/uploads/2016/01/HBSC2014web3.pdf

Abstract:
Background: The Global Lung Cancer Coalition (GLCC) is a unique partnership, dedicated to improving disease outcomes for all lung cancer patients worldwide. Research is essential to drive improvements in cancer prevention, screening, diagnosis and treatment.[i] However, it is clear that lung cancer research is not being prioritised to a level that reflects its significant impact, with 1.8 million new cases globally every year.[ii] Poor lung cancer survival demonstrates that more can and should be done. The GLCC is calling for every country across the globe to examine and increase its investment in lung cancer research. Evidence of variations between countries in their approach to lung cancer research can be a powerful tool to advocate for increased investment and national policy that encourages a flourishing lung cancer research community. The GLCC commissioned the Institute of Cancer Policy at King’s College London to undertake a comprehensive examination of the state of global lung cancer research. The findings, published in the Journal of Thoracic Oncology, are intended to guide public policy and highlight where improvements can and should be made.[iii ]They have also been made available on the GLCC website with a range of campaigning materials for advocates to use in sharing insights and recommendations. Methodology: The GLCC commissioned the Institute of Cancer Policy at King’s College London to undertake a bibliometric review of global lung cancer research efforts. The team developed a complex validated mathematical algorithm to search articles and reviews in the Web of Science database for lung cancer research during 2004-13, looking to: · Identify the total number of papers in cancer research for each year in 24 leading countries, compared to that of other common cancers (breast and colorectal) · Isolate the number of papers referencing lung cancer or other relevant key words in their title The study identified the 24 countries globally with the most extensive research programmes in lung cancer. The authors’ research institutes were used to identify which country or countries had contributed to that paper. The study also analysed whether research outputs had changed over time as well as the focus of the research and how close the research is to patients. The methodology allows total number of papers, type, and research collaborations to be analysed over time. Results: The bibliometric review is a comprehensive and powerful resource allowing lung cancer patients, clinicians and policymakers to examine their national lung cancer research output and compare it with that of other countries. The 24 countries responsible for the majority of lung cancer research activity are: Australia, Austria, Belgium, Brazil, Canada, China (People’s Republic of), Denmark, France, Germany, Greece, India, Italy, Japan, Netherlands, Norway, Poland, Taiwan, Turkey, South Korea, Spain, Sweden, Switzerland, United Kingdom, and the USA (figure 1). Figure 1 Worldwide, the number of papers published on lung cancer has more than doubled from 2,157 papers in 2004 to 4,845 in 2013. However, there has only been a small increase in the proportion of global cancer research that is dedicated to lung cancer – from 4.4% in 2004 to 5.6% in 2013. By comparison (figure 2), both breast and colorectal cancer account for greater proportion of research activity, despite having a similar burden of disease. Figure 2 Colorectal cancer accounted for 6.2% of research activity in 2013 whereas breast cancer, at 10%, had nearly double the percentage of research activity compared to lung cancer. The figures can be used to make a persuasive case for increased investment in lung cancer research. To support this, the project team produced a campaigning toolkit, giving headline figures and statistics, tips for engagement and template briefings and press releases. Global and national-level briefing documents and infographics are also available on the GLCC’s website at: http://www.lungcancercoalition.org/en/state-global-lung-cancer-research. The GLCC is calling for every country across the globe to increase its investment in lung cancer research, to increase research efforts in aspects of care that are currently under-researched, and to collaborate with international partners to share findings and improve patient care. Conclusions: Feedback from GLCC members confirms that the bibliometric review is a valuable campaigning resource. The GLCC is keen for the review’s findings to be shared and for policymakers – nationally, regionally and globally – to consider how lung cancer research can be further supported. [i ]Yarden Y, Carols C, on behalf of the European Association for Cancer Research, Basic cancer research: why it is essential for the future of cancer therapy. European Journal of Cancer 2013, 49 issue 12. Accessed June 2015 [ii ]GLOBOCAN 2012, Lung Cancer, available here: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed June 2015 [iii ]Aggarwal A, Lewison G, Idir S, et al. The State of Lung Cancer Research: A Global Analysis; J Thorac Oncol. 2016 Jul;11(7):1040-50

Abstract:
Helpline: Adapting to changing needs and evolving science The Lung Cancer Alliance HelpLine launched over 21 years ago and until recently was the only lung cancer-specific toll-free line in the United States. The reasons people call—for information, understanding, referral, compassion and most of all, hope—remain the same over time. But to keep pace with dramatic advances in the ways lung cancer is detected, diagnosed and treated, the LCA HelpLine has adapted quickly to meet the changing needs of our community. For many survivors and their loved ones, understanding lung cancer and its treatment is a challenge. Those impacted by the disease tend to be older, poorer and less educated, groups which also prefer to get their initial cancer information from their treatment teams. With competing time demands, treatment teams may not have enough time to ensure information is understood or to be sensitive to providing it when the survivor can absorb, process and remember. Some are hesitant to admit they don’t understand all they have been told and are uncomfortable asking questions. Over the past 3.5 years, there have been nearly equal numbers of patients and caregivers calling the HelpLine. Roughly three-quarters of callers were women. In 2016, LCA began tracking more call statistics. Of those who told us the type of lung cancer, we see 83% NSLCC and 17% SCLC – quite representative of the lung cancer population. More than half (53%) were already in treatment. As the science has evolved and practice-changing discoveries are made, professional HelpLine staff provide up-to-date information, support and referrals to those in our community, no matter their place in the journey. The HelpLine provides the opportunity for in-depth conversations, problem solving and the development of questions to ask the team—it serves not as a substitute for conversations with treatment team but as support and complement to them. The LCA HelpLine also has grown with the internet. For some, the internet is a wealth of knowledge, psychosocial support and information. But sometimes even savvy users need help interpreting the information they have found. For others, the internet is a scary and overwhelming place, full of difficult statistics, conflicting recommendations and hard to understand concepts. Additionally, many in our community do not have access to the internet at all or lack broadband speeds that make it an effective tool. While the internet can be helpful, it does not take the place of contact with another caring person who can help. The HelpLine also gives us daily contact with lung cancer community and allows us to keep abreast of what lung cancer patients, their loved ones and those at risk need most. And as we listen, we adapt our services and programs to their needs. For example, we have recently started offering a new webinar series on the top symptoms and side effects reported by those in treatment and long-term survivors. Recently, the pace of scientific discovery and drug development in lung cancer has been accelerating rapidly. With six new drugs approved by the Food and Drug Administration in 2015 and countless new clinical trials launching to test not only new drugs but novel combinations of different classes of agents, patients and caregivers can be even more confused about the best treatment options for them. To address this changing environment, we have recently launched the LungMatch program to help patients find and understand personalized treatment options that they can discuss with their treatment team. LungMatch includes referrals to a concierge service for molecular testing if patients have not had it, a new, user-friendly online matching platform, and in-house personalized clinical trial navigation for interested callers on the HelpLine. The program is still in its infancy, but in the first month of tracking, we determined that 85% of callers asked had never been on clinical trials and only 50% reported molecular testing of the lung cancer. These early statistics indicate the widespread need in the lung cancer community. Through adapting to the changing needs of our community and helping them understand the evolving science, the HelpLine has been a lifeline for the lung cancer community in the United States for over 21 years.

Abstract not provided