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J.H. Pedersen



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    MO27 - Patient Centred Care (ID 141)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Nurses
    • Presentations: 1
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      MO27.01 - Operable lung cancer patients experiences of rehabilitation and supportive needs at diagnosis. A qualitative study (ID 1664)

      10:30 - 10:35  |  Author(s): J.H. Pedersen

      • Abstract
      • Presentation
      • Slides

      Background
      Lung cancer patients have complex problems and are considered as disadvantaged when compared with other cancer patients. The needs of lung cancer patients during the treatment trajectory still remain to be identified systematically. The present study is part of a Ph.D. study investigating ’Four critical moments’ in daily life during disease and treatment trajectory in operable lung cancer patients. The Ph.D. study is part of the Centre for Integrated Rehabilitation of Cancer Patients – CIRE. The present study aims to explore lived experiences at diagnosis of operable lung cancer patients in order to identify needs of supportive and rehabilitative care.

      Methods
      A sample of nineteen patients is included in the study. Inclusion criteria are a diagnosis of non small cell lung cancer referred for surgery at department of Thoracic surgery, Rigshospitalet and age above 18. Individual in-depths interviews with a phenomenological approach were conducted approximately seven days following diagnosis. The phenomenological approach is based on the French philosopher Paul Ricoeur. Focus in the interviews is the present and deals with themes of patients’ experiences with the diagnosis and daily life, bodily experiences, smoking and physical activity. Follow-up interviews are performed 14 weeks post surgery focusing on the patients return to daily life.

      Results
      Through the analysis of the narrative interviews, patients' lived experiences are described in themes such as onset of illness with no symptoms; resilience expressed as managing on their own, used to be strong and not complaining; psychological response expressed as feelings of unreality, trying to push it away and experiences of lack of concentration, lack of energy and excessive thoughts; existential thoughts, expressed as a confrontation with death, anxiety, loneliness, afraid of the unknown and an emotional rollercoaster ride; the continued daily life focusing on continuing with usual activities and patterns; disruptions in the social relations expressed as withdrawal from social situations or experiences of family and friends’ withdrawal from the ill person. Will not be a burden or receive compassion from family and friends and will not express their vulnerability to family and friends; physical activity as a daily activity but not used to exercise; smoking as stress reduction; supportive needs from a patient perspective such as conversations with healthcare professionals about the whole situation, early information about surgery and no need of further written information; confidence in the meeting with the health care system; uncertain but hopeful about the future.

      Conclusion
      It is important that health care professionals provide patients with opportunities to talk about their fears, concerns and experiences. Through listening to and understanding operable lung cancer patients, nurses can identify appropriate resources and help patients to access them. Results are expected to contribute to the development and initiation of further interventions for lung cancer patients early in the treatment trajectory.

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    O23 - Imaging and Screening (ID 125)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      O23.02 - Positron emission tomography (PET) in lung cancer screening<br /> - Final results after a 5 year screening programe. (ID 1021)

      16:25 - 16:35  |  Author(s): J.H. Pedersen

      • Abstract
      • Presentation
      • Slides

      Background
      PET is a useful tool in the diagnostic workup of lung cancer. However, its role in lung cancer screening with low dose Computed Tomography (CT), in which small sized nodules are detected, is still to be determined. We present final PET results from the 5 year (2005-2010) randomized Danish Lung Cancer Screening Trial (DLCST).

      Methods
      DLCST participants with indeterminate nodules mostly between 5 and 15 mm were referred for a 3-month rescan. Between the initial scan and the 3-month rescan, participants were also referred for a PET scan. Uptake on PET was categorized as most likely benign or malignant on a scale from I to IV). Receiver operating characteristic (ROC) analyses were used to determine the sensitivity and specificity of PET. Resected nodules and indolent nodules (i.e. stable for at least 2 years) were included, and the latter was categorized as benign. Nodules were only included once in the study, thus repeat PET scans were excluded.

      Results
      A total of 90 nodules were included, 50% men, mean age 67 years (58-79), prevalence of lung cancer was 38% (35/90). Mean follow-up time for benign non-resected nodules was approx. 2.8 years in screening. Clinical follow-up in central digital medical logs was done for all participants in 2013. The sensitivity and specificity of PET was 66% and 91%, respectively, with cut-off points for malignancy at PET>II (i.e. categorized as possibly or probably malignant at PET). The positive predictive value was 82% (23/28) and negative predictive value was 81% (50/62). 12 PET results were false negative, and of these 75% (9/12) were either ground glass nodules or partly solid nodules. Figure 1

      Conclusion
      PET is a valuable tool in lung cancer screening; our results show fair sensitivity and high specificity in a trial with long time follow-up of benign nodules. False negative PET results were found in non-solid nodules. We recommend PET as an integrated part of future lung cancer screening programs.

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    P1.19 - Poster Session 1 - Imaging (ID 179)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P1.19-006 - Predictors of nodule malignancy in the Danish Lung Cancer Screening Trial (DLCST) (ID 2172)

      09:30 - 09:30  |  Author(s): J.H. Pedersen

      • Abstract

      Background
      Pulmonary nodules are detected more frequently than ever in both clinical and screening settings. Timely and correct suspicion of malignancy is of great importance in the subsequent management of the nodules. We present data on pulmonary nodule growth and participants baseline characteristics to determine predictors of malignancy.

      Methods
      In DLCST, 4,104 current and former smokers, with a history of at least 20 pack years and age between 50-70 years, were randomized to either five annual multi-slice low-dose CT screenings or no screening. All participants had an annual visit to the screening clinic where lung function tests and questionnaires concerning health, lifestyle, smoking habits etc. were performed. The scans were read by two chest radiologists who recorded the location and size of any nodules. Nodules of diameters between 5-15 mm were considered indeterminate, and rescanned after three months. Participants with nodules larger than 15 mm were referred to diagnostic workup, as were those with growing nodules. Lung cancer was diagnosed by pathological evaluation. Using volumetric software solid and nonsolid/partsolid nodules were segmented and followed. Only visually correct segmented nodules that were present more than one year were included. Doubling times of mass, volume and diameter from the first to the last record of the nodule were calculated. We performed logistic regression analysis with malignancy as the outcome and baseline characteristics, nodule type and growth measurements as explanatory variables.

      Results
      975 nodules in 618 participants were included. 31 nodules (3%) were diagnosed as lung cancers. 10(33%) of the malignant nodules were nonsolid/partsolid. Fig. 1 shows histograms of growth measurements. Fig. 2 show the logistic regression analysis. In both cases FEV1 and Mass Doubling Times predicted malignancy significantly.Figure 1Figure 2

      Conclusion
      Growth rates measured by volumetric software and FEV1 are powerful predictors for malignancy when a pulmonary nodule is present in a low dose chest CT scan.

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    P1.20 - Poster Session 1 - Early Detection and Screening (ID 172)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P1.20-008 - Health Care costs in the Randomized Controlled Danish Lung Cancer CT Screening Trial. (ID 2741)

      09:30 - 09:30  |  Author(s): J.H. Pedersen

      • Abstract

      Background
      Low dose computerized tomography (CT) screening for lung cancer can reduce mortality but it is currently unclear whether CT screening is cost effective. Denmark is a small country (5.3 mio. inhabitants) with a uniform and a public health care system covering all inhabitants. The unique civil registration system allows a linking of all health care expenses to the individual person. The objective of this study is to evaluate the direct healthcare costs generated by a randomized lung cancer CT screening trial in Denmark.

      Methods
      Methods: A Registry study nested in the Danish lung cancer screening trial (DLCST), involving 4104 participants, current or former heavy smokers, aged 50–70 years. Participants were randomized to five annual low dose CT scans or usual care during 2004 – 2010. Total healthcare costs and utilization data for the primary and the secondary healthcare sector, were retrieved from public registries, covering the period from randomization until September 2011

      Results

      Table 1. Cumulative relative health care costs in the diagnostic groups compared with the control group in the DLCST, shown as the multiplicative factor the costs on average differ from the costs in the control group.
      Annual costs were significantly higher in the screening group compared with the control group (p<0.001), but when cost of CT-scans was excluded, there was no longer a significant difference (p=0.52). Analyses according to diagnostic groups showed that annual costs were 10.57 times higher for the true-positive and 1.67 times higher for the false-positive group compared with the control group (Table 1).

      Conclusion
      Lung cancer CT screening increases overall healthcare costs compared with no screening, equivalent to the costs of the CT-screening scans. Overall healthcare costs were higher for the true-positive and false-positive groups than for the control group, even when excluding CT-screening scan costs. This increase was outweighed by the larger true-negative group who had reduced, but not statistically significant, costs compared with the control group (Table 1 and Figure 1). .Figure 1