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C. Dresler
Moderator of
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O06 - Cancer Control and Epidemiology I (ID 135)
- Event: WCLC 2013
- Type: Oral Abstract Session
- Track: Prevention & Epidemiology
- Presentations: 8
- Moderators:C. Dresler, C. Zhou
- Coordinates: 10/28/2013, 10:30 - 12:00, Bayside 104, Level 1
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O06.00 - Nationwide Quality Improvement in Lung Cancer Care: The Role of the Danish Lung Cancer Group and Registry. (ID 1014)
10:30 - 10:40 | Author(s): E. Jakobsen, A. Green, K. Oesterlind, T. Riis Rasmussen, M. Iachina, T. Palshof
- Abstract
- Presentation
Background
In order to improve prognosis and quality of lung cancer care the Danish Lung Cancer Group has developed a strategy consisting of national clinical guidelines and a clinical quality and research database. In 1998 the first edition of guidelines was published and a registry was opened for registrations in the year 2000. This abstract describes the methods used and the result obtained through the collaborative work and discusses how to improve the quality of lung cancer care through the development and monitoring of indicators.Methods
A wide range of indicators was established, validated and monitored. By registration of all lung cancer patients since the year 2000, more than 40.000 patients have been included in the database. Results are reported periodically and submitted to formal auditing on an annual basis.Results
Improvements in all outcome indicators are documented and statistical significant. Thus the one year overall survival has between 2003 and 2011increased from 36.6 % to 42.7 %; the 2 year survival from 19.8 % to 24.3 % and the 5 year survival from 9.8 % to 12.1 %. 5 year survival after surgery has increased from 39.5 % to 48.1 %. Improvements in waiting times, accordance between cTNM and pTNM and in resection rates are documented.No Indicator Threshold (%) 2003 (%) 2004 (%) 2005 (%) 2006 (%) 2007 (%) 2008 (%) 2009 (%) 2010 (%) 2011 (%) 2012 (%) Ia Patients surviving 1 year from date of diagnosis 42 36,6 37,4 37,3 37,2 39,3 38,2 38,3 40,2 42,7 Ib Patients surviving 2 years from date of diagnosis 22 19,8 20,5 20,7 20,9 22,9 21,8 23,0 24,3 Ic Patients surviving 5 years from date of diagnosis 12 9,8 9,6 10,4 10,5 12,1 IIa Patients surviving 30 days from date of operation 97 93,7 98,4 96,9 96,7 96,8 97,5 97,8 98,0 99,0 99,0 IIb Patients surviving 1 year from date of operation 75 73,8 76,4 79,7 80,7 83,8 82,2 86,1 85,9 88,6 IIc Patients surviving 2 years from date of operation 65 60,5 58,9 64,3 67,2 70,6 66,6 73,6 75,5 IId Patients surviving 5 years from date of operation 40 39,5 38,8 44,5 46,9 48,1 IIIc Rate of patients starting chemo within 42 days after referral 85 62,9 51,1 50,3 56,0 59,8 73,4 72,7 74,7 80,8 82,9 IV Rate of patients with accordance between cTNM and pTNM 85 68,2 70,2 77,0 72,7 79,8 77,6 80,1 83,3 86,4 91,3 V Rate of patients with NSCLC who had a resection 20 18,7 18,9 19,8 20,4 19,8 Conclusion
The Danish experience shows that a national quality management system including national guidelines, a database with a high degree of data quality, frequent reports, audit and commitment from all stakeholders can contribute to improve clinical practice, improve core results and reduce regional / geographic differences.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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O06.01 - Lung cancer risks, beliefs, and healthcare access among the underprivileged (ID 2113)
10:40 - 10:50 | Author(s): J. Morere, J. Viguier, C. Touboul, X. Pivot, J. Blay, Y. Coscas, C. Lhomel, F. Eisinger
- Abstract
- Presentation
Background
One goal of the current French National Cancer Plan is to reduce health inequities in cancer control. In this study, an underprivileged population was investigated to analyze exposure to lung cancer risk factors and health care access in order to highlight ways to improve lung cancer control in that population.Methods
Within the nationwide observational study EDIFICE 3, conducted by phone interviews among a representative sample of 1603 subjects aged between 40 and 75 years old, we used the “EPICES” validated questionnaire to examine the association of underserved status with lung cancer risk factors, beliefs, and health care access.Results
Based on the EPICES score, underserved subjects represented 33% of the sample. These subjects subjectively perceived a higher risk of cancer compared to subjects in the served population (21% vs. 14% respectively, p<0.01). Among people with cancer, underserved subjects have a higher rate of lung cancer (10% of cancers vs. 1%, p<0.05). They also have more cancer risk factors: a high BMI (26.0 vs. 24.8, p<0.01), are active smokers (38% vs. 23%, p<0.01) with a higher consumption of cigarettes (16.0 cigarettes/day vs. 10.1, p<0.01) and for a longer period (29.4 years vs. 26.3, p<0.01), and also practice less sport (42% vs. 77%, p<0.01). They have more comorbidities: on average (2.2 vs. 1.8, p<0.01), at least one (76% vs. 65%, p<0.01), hypertension (24% vs. 19%, p<0.05), cardiovascular disease (13% vs. 9%, p<0.05) and respiratory disease (13% vs. 7%, p<0.01). Access to healthcare is not an issue (consultations with a general practitioner are more frequent for the underserved group: 5.4 vs. 3.7 per year, p<0.01). They trust the national health system less (an average score from 1 to 10; 6.0 vs. 6.3, p <0.05). However, 85% of underserved subjects think that lung cancer can be efficiently screened vs. 78% of the served population (p<0.01).Conclusion
In order to reduce inequities in lung cancer control, the effort of upstream interventions should be focused on prevention, as healthcare access does not discriminate. Underserved subjects have a high level of trust in lung cancer screening but a riskier behavior in terms of smoking. This constitutes new targets for specific communication campaigns and Health authorities’ interventions.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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O06.02 - Statin Use and Reduced Lung Cancer-Related Mortality (ID 1535)
10:50 - 11:00 | Author(s): R.P. Young, R.J. Hopkins, G.D. Gamble
- Abstract
- Presentation
Background
Lung cancer results from the combined effects of smoking exposure and genetic predisposition. Recent studies have shown that susceptibility to chronic obstructive pulmonary disease (COPD) is also relevant to a predisposition to lung cancer. The latter may be mediated in part through exaggerated systemic inflammation secondary to smoking exposure and the innate response to smoking in genetically susceptible people. Recently a large population based study reported that statin therapy was associated with a reduction in mortality from cancer (Nielsen et al. Statin Use and Reduced Cancer-Related Mortality, NEJM 2012; 367: 1792-1802). The aim of this study was to examine the cancer specific effect of statins on mortality.Methods
Using the raw data from the Nielsen study, we calculated the estimated number of lives saved from statin therapy use according to type of cancer and then estimated the absolute numbers of lives saved.Results
When we examined the raw data showing hazard ratios according to statin use in each of the cancers described, we found that except for lymphoma, the mortality reductions were significant for smoking related cancers (lung, pharynx, oesophagus, urinary) and obesity-related cancers (colon, prostate, breast - see Figure 1). When we calculated the number of lives saved according to specific cancer type, we found that of all lives saved, 43% could be attributed to a reduction in lung cancer deaths (Table 1). Importantly, mortality for many of these cancers (lung, colon, breast and prostate) has been associated, in large prospective studies, to elevation of the C-reactive protein, a marker of systemic inflammation. Figure 1Figure 2Conclusion
We conclude that the reduction in cancer mortality attributed to statin therapy by Nielsen et al. is seen almost exclusively in cancers where smoking and/or systemic inflammation is thought to be of significant pathogenic importance. Significantly, the single largest reduction can be attributed to lung cancer where both smoking and systemic inflammation are strongly implicated. We suggest that a reduction in systemic inflammation by statins may be one mechanism underlying the reduction in mortality reported by Nielsen and colleagues.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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O06.03 - DISCUSSANT (ID 4002)
11:00 - 11:15 | Author(s): M.A. Steliga
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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O06.04 - The association between having a first-degree family history of cancer and smoking status (ID 1191)
11:15 - 11:25 | Author(s): H. Poghosyan, J.G. Joseph, J. Bell, M.E. Cooley
- Abstract
- Presentation
Background
Smokers with a family history of cancer are at higher risk for developing cancer. A diagnosis of cancer within the family may provide an opportunity for smokers to adopt health-promoting behavior. This study examined associations between having a first-degree family history of cancer and smoking status.Methods
Data from the 2009 California Health Interview Survey (CHIS) on 47,331 adults were used in this cross-sectional study. Sample weights were applied to account for the complex survey design with results generalizable to non-institutionalized adults in California (27.4 million). Smoking status was classified as current, former, or never-smoker. Family cancer history was defined as blood relatives that include biological father or mother, full brothers or sisters, or biological sons or daughters. Demographic characteristics included age, gender, race/ethnicity, marital status, poverty level, education level and health insurance coverage. General health status, physical activity, body weight status and binge drinking status were also included. CHIS defined binge drinking status as ≥5 alcoholic drinks for males or ≥4 alcoholic drinks for females in a single episode in the past year. Body weight status was defined by body mass index as underweight <18.5 kg/m2, normal = 18.5–24.9 kg/m2, overweight = 25.0–29.9 kg/m2, and obesity ≥30.0 kg/m2. Multinomial logistic regression was used to analyze the association between first-degree family history of cancer and smoking status.Results
In 2009, 13.6% (3.7 million) of the 27.4 million adults were current-smokers, 23.0% (6.3 million) former-smokers and 63.4% (17.4 million) never-smokers. Thirty-five percent (9.6 million) had a first-degree family history of cancer (Table 1). Among those with a first-degree family history of cancer, 13.5% (1.3million) were current-smokers, 29.7% (2.8 million) were former-smokers and 56.8% (5.4 million) were never-smokers. Adults with a first-degree family history of cancer were more likely to be former-smokers compared with adults without a first-degree family history of cancer (29.7% vs. 19.3%, p<.001). Controlling for demographic factors and other risk characteristics (binge drinking, obesity, physical activity), having a first-degree family history of cancer was significantly related to being a current-smoker (OR=1.16; 95% CI=1.01-1.34) and former-smoker (OR=1.17; 95% CI 1.05-1.30).Table 1: Characteristics of California Health Interview Survey participants, 2009
Characteristics Unweighted sample size Weighted percentages (95% CI) Smoking Status Current smokers 5,528 13.6 (12.8-14.4) Former Smokers 14,487 23.0 (22.1-23.8) Never smokers 27,317 63.4 (62.5-64.3) Family Cancer History Yes 22,286 35.0 (34.1-35.8) No 25,045 65.0 (64.1-65.8) Age 18-25 2,826 16.0 (15.6-16.4) 26-34 3,446 15.6 (15.0-16.0) 35-49 10,484 30.2 (29.7-30.5) 50+ 30,575 38.2 (38.1-38.2) Gender Male 19,280 49.0 (49.0-49.1) Female 28,051 51.0 (50.0-51.0) Race/Ethnicity Hispanic 8,281 32.5 (32.4-32.5) Non-Hispanic White 30,951 46.4(46.4-46.5) Non-Hispanic Black 1,839 5.6 (5.6-5.7) Non-Hispanic Asian 4,833 12.8 (12.8-13.0) Non-Hispanic Other 1,427 2.6 (2.5-2.6) Marital Status Married 27,079 61.3 (60.5-62.2) Not-married 20,252 38.6 (37.8-39.5) Federal Poverty Level (FPL) < 100% FPL 5,747 16.0 (15.3-16.8) 100-199 % FPL 7,950 18.0 (17.2-18.7) 200-299 % FPL 6,478 13.7 (13.0-14.5) ≥ 300% FPL 27,156 52.2 (51.3-53.1) Education Level < High-school 4,795 16.3 (16.1-16.4) High-school graduate 10,345 26.0 (25.8-26.0) Some college 12,858 23.7 (23.0-24.5) College or more 19,333 34.0 (33.3-34.7) Health Insurance Currently insured 42,186 82.0 (81.0-82.8) Not insured 5,145 18.0 (17.1-19.0) General Health Excellent/Very Good 24,554 52.0 (51.0-52.8) Good 13,588 29.8 (28.4-30.8) Fair/Poor 9,189 18.2 (17.4-19.0) Body Weight Status Underweight 1,051 2.2 (2.0-2.5) Normal 19,689 41.3 (40.4-42.3) Overweight 16,078 33.7 (32.8-34.5) Obese 10,513 22.7 (21.8-23.5) Physical Activity Sedentary 16,936 34.6 (33.6-35.7) Some activity 20,838 43.4 (42.3-44.5) Regular activity 9,557 21.8 (21.0-22.7) Binge drinking status Yes 11,049 31.4 (30.5-32.3) No 36,282 68.5 (67.6-69.4) Conclusion
In California, many adults with a first-degree family history of cancer still smoke which places them at higher risk for poor health outcomes. Smokers with a first-degree family history of cancer may be an important target population for smoking cessation interventions.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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O06.05 - Multidisciplinary smoking cessation model in a specialist oncology hospital - our 5 year experience (ID 2106)
11:25 - 11:35 | Author(s): M. Alexander, I. Plueckhahn, J.D. Mellor, S.W. Kirsa
- Abstract
- Presentation
Background
Australia established its first national quitline service in 1997 as part of the Australian National Tobacco Campaign (NTC). In 2005 our hospital, an Australian tertiary specialist cancer centre, commenced a multidisciplinary smoking cessation program which included the provision of counselling and behaviour techniques as well as free access to pharmacological smoking cessation agents. In 2007 the hospital went totally smoke free and in 2009 all new patient registrations included collection of information pertaining to smoking behaviours. Cancer patients are known to withhold and underreport details regarding current and previous smoking behaviours however there is limited data on the impact of non-disclosure on the ability to implement interventional smoking cessation programs in the oncology setting. Five years after initiation of an interventional smoking cessation program we present previously uncollected and unreported hospital wide smoking behaviour data (prevalence, magnitude and willingness to report) of cancer patients. We also evaluate our multidisciplinary smoking cessation model including recruitment and quit rates for cancer patients at a specialist oncology centre.Methods
For the two year period 2009-2011 self-reported smoking behaviors were obtained from hospital registration datasets. A retrospective single arm cohort study, including patients with a cancer diagnosis who accessed the smoking cessation program within the same two year period, was also conducted. Patients and family members are recruited to the program via a multidisciplinary referral system and have access to nurse led counselling and behaviour modification consultations as well as provision of free pharmacological smoking cessation aids. Evaluation of the program was undertaken through and audit of medical and pharmacy records for all patients who participated in the program (n=312) and by phone interviews with a subset of patients (n=30) and compared to data from a previously published study at our institution[1].Results
50% (n=10,401) of patients newly registered to the hospital identified as having ever smoked with 12% (n=2448) current smokers. Recruitment of self-identified active smokers into the smoking cessation program was low (7.3%). 43% (n=134) of patients enrolled into the program had not disclosed their smoking status at hospital registration. Magnitude of smoking was high; average pack-years of patients who have ever smoked was 22.6 and for current smokers was 27.8; 155 patients reported smoking magnitude as greater than 100 pack years. Provision of free pharmacotherapy equated to a net expenditure of AUD$22,042. Point prevalence smoking cessation rate among patients who participated in follow-up interviews (n=30) was similar to that previously reported following participation in our multidisciplinary smoking cessation program, 33% compared to 37%[1]. 66% of patients reported successful outcomes (cessation or reduction in consumption).Conclusion
Patient-reported smoking behaviours were grossly underreported impacting on the ability to actively enrol patients into established interventional cessation programs. Despite low recruitment rates and high magnitude of smoking, the multidisciplinary model was able to achieve successful outcomes at minimal cost in this vulnerable patient cohort. Improving disclosure practices may enable future targeted recruitment of patients by health-care professionals and increase the participation of smokers in proven healthcare interventions.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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O06.06 - Factors Associated with Smoking Cessation in Participants of The Pan Canadian Early Lung Cancer Study (ID 1469)
11:35 - 11:45 | Author(s): G.J. Korpanty, S. Lam, L. Eng, P. Selby, S. Su, W. Xu, A. McWilliams, S. Atkar-Khattra, J. Mayo, K. Evans, R. Finley, J. Yee, J.C. English, H. Roberts, M. Tsao, F.A. Shepherd, K. Soghrati, K. Yasufuku, S. Martel, F. Laberge, J.R. Goffin, M. Gingras, L. Stewart, S. Puksa, S. Tsai, D. Manos, M. Johnston, G. Nicholas, G. Goss, J. Seely, K. Amjadi, A. Tremblay, P. Burrowes, P. Maceachern, R. Bhatia, G. Liu, M. Tammemagi
- Abstract
- Presentation
Background
Lung cancer screening programs provide unique opportunities to facilitate smoking cessation in smokers who participate in these programs. However, the effects of screening on motivation to quit might be mediated or modified by other variables. Identifying the participants more likely to quit will allow rapid application of smoking cessation resources to these participants, while those least likely to quit can be afforded experimental interventions. The aim of our study was to assess the impact of lung cancer screening on smoking cessation in current smokers at the time of enrollment and to identify factors that were associated with quitting smoking in this screening population.Methods
Using data collected from the Pan-Canadian Study of Early Detection of Lung Cancer, both univariate and multivariable logistic regression analysis was used to identify predictors of smoking cessation among current smokers at enrolment. Smoking cessation was defined as quitting for at least a 6 month period, occurring anytime after enrolment.Results
We analyzed baseline and follow-up questionnaires of 2320 participants, of which 1419 were current smokers. Of these 1419 patients, 392 (27.8%) met the definition of smoking cessation during a median of two annual follow-up visits. In both univariate and multivariable (MV) analysis, greater smoking cessation was associated with four factors: (i) having a diagnosis of lung cancer at any time during the screening process, with a MV Odds ratio (OR) of quitting of 2.4 (95%CI: 1.1-5.0); (ii) lower and medium nicotine addiction as assessed by the Fagerström Nicotine Dependence Scale Score, with MV-ORs of 3.2 (95%CI: 2.2-4.6) and 1.4 (95%CI: 0.9-2.0), respectively; (iii) having higher education, with MV-OR: 1.4 (95%CI: 1.1-1.9); and (iv) having an earlier age of onset of regular alcohol intake, with MV-OR of 1.11 (95%CI: 1.02-1.21) per 5 year decrease in age. Smoking cessation was also associated with (i) previous attempts of quitting [UV-OR 1.8 (95%CI: 1.2-2.7)], willingness to quit smoking within the next month (at baseline screening) [UV-OR 2.2 (95%CI: 1.8-2.9)] or within the next 6 months after baseline screening [UV-OR 1.8 (95%CI: 1.3.-2.4)]. Second-hand smoking exposure, including exposure as a child, or as an adult at work, at home, privately with friends, or in public settings, or a cumulative index of these different exposures, was not associated with smoking cessation. Presence of potential index symptoms for lung disease, including shortness of breath, cough (both dry and productive), hoarseness, audible wheezing or even chest pain, was not associated with an increased chance of smoking cessation.Conclusion
The diagnosis of a new lung cancer had a major positive impact on screening participants quitting smoking, as were factors such as lower nicotine dependence, higher education, earlier starting alcohol drinking age, and willingness to quit. Whether a new lung cancer diagnosis triggered additional efforts by clinicians to help the person quit will be explored further. Individual lung symptoms and secondhand smoke exposure were not associated with smoking cessation. (Geoffrey Liu and Martin Tamemmagi are co-senior authors)Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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O06.07 - DISCUSSANT (ID 4003)
11:45 - 12:00 | Author(s): J.K. Cataldo
- Abstract
- Presentation
Abstract not provided
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Author of
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MS19 - New Health Technology for Lung Cancer; Assessment and Implementation (ID 36)
- Event: WCLC 2013
- Type: Mini Symposia
- Track: Radiation Oncology + Radiotherapy
- Presentations: 1
- Moderators:Y. Lievens, F.(. Kong
- Coordinates: 10/30/2013, 14:00 - 15:30, Parkside Ballroom B, Level 1
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MS19.2 - Cost Effectiveness of Prevention of Lung Cancer (Developed and Developing World) (ID 547)
14:25 - 14:45 | Author(s): C. Dresler
- Abstract
- Presentation
Abstract not provided
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P3.23 - Poster Session 3 - Tobacco Control, Prevention and Chemoprevention (ID 164)
- Event: WCLC 2013
- Type: Poster Session
- Track: Prevention & Epidemiology
- Presentations: 1
- Moderators:
- Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P3.23-004 - Thoracic oncology providers and addressing tobacco use in cancer patients: a report from an IASLC survey. (ID 2047)
09:30 - 09:30 | Author(s): C. Dresler
- Abstract
Background
Background: Tobacco use increases toxicity, recurrence, second primary cancers, and mortality in cancer patients. However, oncologists do not routinely provide assistance with tobacco cessation and little is known about potential barriers that could be addressed to improve cessation practices among oncologists.Methods
Methods: An online survey was sent to IASLC members querying demographics, tobacco assessment and cessation practices, perceptions of tobacco use by cancer patients, and barriers to tobacco cessation intervention. Results are reported and multivariate analyses were performed to identify likely barriers to tobacco assessment and cessation.Results
Results: A total of 1,507 IASLC members responded to the survey representing a 40.5% response rate. Most respondents reported that tobacco use affected cancer outcome (92%) and that tobacco cessation should be a standard part of cancer care (90%). However, whereas 90% indicated that they regularly asked about tobacco use, only about 40% regularly discussed medications or provided cessation assistance. A lower likelihood of assessing tobacco use was associated with the following demographic variables: a) location outside of the United States (USA), b) practice non-academic centers, c) fewer years of service as a medical provider, d) less time spent on clinical activities, or e) current smoking. Variables associated with a decreased likelihood of giving advice to stop smoking were a) location outside of the USA and b) less time spent in clinic. A lower likelihood of providing cessation assistance was associated with providers outside of the USA. After adjustment for demographic variables, variables associated with increased likelihood of assessing tobacco use were a) providers who felt cessation affected outcome and b) providers who reported more training on cessation is needed. An increased likelihood to advise patients to stop smoking was observed in respondents who reported that additional cessation training is needed whereas a lack of time was reported as a variable that decreased likelihood to provide patient advice. Variables associated with a decreased likelihood to provide tobacco cessation assistance included: a) lack of time, b) lack of training, c) lack of available resources, and d) perception that tobacco cessation was a waste of time. However, variables associated with an increased likelihood to discuss medications or provide cessation assistance included respondents who a) reported having had adequate training in tobacco cessation or b) who reported that additional training is needed for clinicians.Conclusion
Conclusions: Most IASLC member oncologists who responded to the survey asked about tobacco use, but few routinely provided tobacco cessation assistance to their patients. Cancer patients need increased access to tobacco cessation support. Differences in the measurements of perceived barriers suggest that efforts are needed to increase cessation resources and clinician education in order to improve tobacco cessation support for cancer patients.
