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T. Christmas



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    P1.12 - Poster Session 1 - NSCLC Early Stage (ID 203)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 2
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      P1.12-010 - Lung cancer clinicians' preferences for adjuvant chemotherapy (ACT) in non-small-cell lung cancer (NSCLC): what makes it worthwhile? (ID 1498)

      09:30 - 09:30  |  Author(s): T. Christmas

      • Abstract

      Background
      Clinicians play an important role helping patients make decisions about ACT, but their views about trade-offs between the benefits and harms of ACT may differ from those of their patients. We sought to determine the minimum survival benefits that lung cancer clinicians judged sufficient to make ACT in NSCLC worthwhile, the factors associated with these judgements, and comparisons with the preferences of their patients.

      Methods
      82 lung cancer clinicians (medical oncologists & thoracic surgeons) completed a self-administered questionnaire. The time trade-off method was used to determine the minimum survival benefits judged sufficient to make ACT worthwhile in 4 hypothetical scenarios. Baseline survival times were 3 years and 5 years and baseline survival rates (at 5 years) were 50% and 65%. Patients’ preferences were those of 122 patients considering ACT for NSCLC elicited in a related study using similar methods. Differences between groups were assessed by 2-sample non-parametric tests. Determinants of preferences were assessed by univariable comparison after normal score transformation. Variance was assessed with the Ansari-Bradley rank test.

      Results
      Most clinicians were male (75%) with a median age of 43 years (range 28-65), had 5 or more years of professional experience (69%), were married (92%), and had dependent children (72%). More were medical oncologists (63%) than thoracic surgeons (31%). The median benefit judged sufficient (by 50% of clinicians) was an extra 9 months (IQR 6-12 months) beyond survival times of both 3 years and 5 years, and an extra 5% (IQR 5-10%) beyond 5-year survival rates of both 50% and 65%. Medical oncologists, compared with thoracic surgeons, judged smaller benefits sufficient to make ACT worthwhile (median benefit 8 months v 12 months, p=0.03). Clinicians’ preferences, compared with patients’ preferences, had the same median benefit (9 months survival time, 5% survival rate) but varied over a smaller range (IQR, 6-12 months v 1-12 months, p<0.001; 5%-10% v 0.1-10% p<0.001).

      Conclusion
      Lung cancer clinicians judged moderate survival benefits sufficient to make ACT in NSCLC worthwhile, but preferences differed according to specialty. Clinicians’ preferences were similar to patients’ preferences, but varied less. Lung cancer clinicians should be mindful of their own preferences and how they may influence discussions and decisions about ACT in NSCLC.

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      P1.12-011 - Patients' preferences for adjuvant chemotherapy (ACT) in early non-small cell lung cancer (NSCLC): What makes it worthwhile? (ID 1773)

      09:30 - 09:30  |  Author(s): T. Christmas

      • Abstract

      Background
      ACT for NSCLC improves overall survival, but the benefits are modest and must be weighed against the harms and inconvenience of the treatment. The aim of this study was to determine the survival benefits judged necessary to make ACT worthwhile for patients with resected early NSCLC, and the factors associated with their judgments.

      Methods
      122 patients considering ACT completed a self-administered questionnaire at baseline (before ACT, if they were having it) and 6 months later (after ACT, if they had it). The time trade-off method was used to determine the minimum survival benefits judged sufficient to make ACT worthwhile in 4 hypothetical scenarios. Baseline survival times were 3 and 5 years and baseline survival rates (at 5 years) were 50% and 65%. All tests were 2-sided and non-parametric. Determinants of preferences were assessed by (rank test) comparison of preferences in groups defined by each factor.

      Results
      Most patients were male (57%) with a median age of 63 years (range, 43-79 years), married (72%) and previous smokers (81%). The majority had had a lobectomy (84%), adenocarcinoma histology (60%), and half had stage II disease (50%). 106 patients decided to have ACT (87%), 16 declined ACT (13%); female sex and age over 65 years were associated with declining. ACT was most commonly 4 cycles (68%) of cisplatin/ vinorelbine (73%). At baseline, the median benefit judged sufficient (by 50% of patients) was 9 months (IQR 1-12 months) beyond life expectancies of 3 years and 5 years, and 5% (IQR 0.1-10%) beyond 5-year survival rates of 50% and 65%. Preferences varied across the entire range of possible benefits (from 0 days and 0% to an extra 15 years and 50%). At baseline, deciding to have ACT (p=0.01) was the only factor that predicted judging smaller benefits sufficient to make ACT worthwhile. At 6 months (n=91), the median benefits judged sufficient were the same as at baseline (9 months & 5%), but preferences varied over a greater range (IQR’s 0-18 months & 0-15%). At 6 months, deciding to have ACT (p=0.02) and better physical (p=0.02), emotional (p=0.004), and overall well-being (p=0.004) during adjuvant chemotherapy were associated with judging smaller benefits sufficient to make ACT worthwhile. Fatigue, nausea, sleeplessness and reduced appetite were the side effects of ACT that patients were most concerned about experiencing (at baseline) and were rated the most troublesome (at 6 months).

      Conclusion
      Most patients judged moderate survival benefits sufficient to make ACT worthwhile, but preferences varied widely and were not predicted by baseline characteristics. Preferences were stable over time. Patients with NSCLC judged larger benefits necessary for ACT than patients with breast and colon cancer in our previous studies. Clinicians should elicit the preferences of individual patients when discussing and making decisions about ACT.

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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-058 - Thoracic Multidisciplinary Meeting Discussion Outcomes at Auckland City Hospital: Concordance with Actual Patient Management for Lung Malignancies (ID 3423)

      09:30 - 09:30  |  Author(s): T. Christmas

      • Abstract

      Background
      Discussion of patients at multidisciplinary meetings (MDMs) is now considered the standard of care for management of thoracic malignancies. However, there is limited evidence regarding concordance of decisions made at MDMs with subsequent actual treatment. This study aimed to assess the concordance between MDM outcomes and subsequent treatment received by patients with thoracic malignancy at our centre, and to identify factors that contributed towards any deviation from the MDM management plan.

      Methods
      In this retrospective audit, patients discussed at 12 Auckland City Hospital MDMs between 1[st] May and 31st July 2012 were identified, using the MDM lists for each session and chairperson summaries of discussion and decisions. The electronic cases records of these patients were then reviewed for demographical data, information on the MDM outcome and to ascertain the eventual treatment received by these patients. Any discrepancies between MDM recommendations and eventual patient management were noted, and the reasons stated for this.

      Results
      There were 121 cases identified from 138 documented patient presentations; 17 patients were re-presented within the study period, and the presentation at which anti-cancer treatment was determined was analysed (if achieved). Of the 121 cases, 93 included a pathologically confirmed diagnosis (80 primary lung or pleural tumours, 13 other tumours or pulmonary metastases), and 28 did not, including 4 with suspected malignant pleural effusions. A decision for radical therapy was made for 22 cases at the MDM. 18 of these cases received treatment as determined at MDM: 13 of 15 surgical resection, 1 of 3 radical radiotherapy, 3 of 3 radical chemo-radiotherapy, and 1 was deemed not to need adjuvant chemotherapy. A decision for one or more palliative treatments was made for 72 cases. Of these, the MDM determined treatment was actually received in 41 (57% of cases): 5 of 7 palliative surgery cases (1 died pre-op, 1 patient declined), 18 of 28 chemotherapy as initial treatment, and 13 of 23 radiotherapy as initial treatment. In 14 cases with an MDM decision recorded recommending both palliative chemotherapy and radiotherapy, 5 received both modalities, 7 radiotherapy alone and 2 neither. Reasons for discordance between MDM decision and treatment included patient deterioration or poor performance status (n=14), patient choice (n=8), patient and doctor agreed choice (n=5) and did not attend/lost to follow up (n=4) In the remaining 27 cases, best supportive care was recommended in 7 and no definitive treatment decision was able to be made in 20.

      Conclusion
      This study demonstrated excellent concordance between decisions made for radical therapy at the MDM and actual treatment. Concordance was less for palliative therapies, and this is likely to reflect on the poorer performance status of these patients at presentation and the perceived benefit versus adverse effects of palliative measures to the patient and the clinician. Since this study, a standardised electronic MDM template has been introduced to ensure accurate and complete information is available.