Author of

• 11001

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11036

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    P1.24-035 - Times to presentation and treatment : A prospective comparision of rural and urban lung cancer patients in North Queensland (ID 2500)

    09:30 - 09:30  |  Author(s): S. Varma
    • Abstract

    Background
    Disparities in cancer survival among rural and urban population is known. Time delay from symptom to presentation for medical attention and treatment in rural lung cancer population is partly responsible for lower survival rates in this population. Identification of specific barriers can help form strategies to improve survival. There are no prospective studies evaluating referral pathways and identifying barriers in lung cancer presentation in rural areas . This study's aim was to analyse time delays in management pathways of rural lung cancer patients and explore the influence of various demographic factors on these times.

    Methods
    Lung cancer patients presenting to Townsville Cancer Centre, Cairns Base Hospital and Mackay Base Hospital were prospectively recruited over a 36 month period from 2009 to 2012. As per ASGC (Australian Standard Geographical Classification) guidelines of remoteness patients were classified as regional or remote. Fisher’s test was used to identify differences between these two cohorts. Times along referral pathway were divided into symptoms to first presentation, symptoms to diagnosis, symptoms to specialist visit, specialist to treatment and symptoms to treatment. The influence of clinical and socio-demographic factors like gender, ethnic status, education level, income, remoteness of location and stage of disease on these times were analysed using Kruskal-Wallis and Mann-Whitney tests for statistical significance.

    Results
    A total of 252 lung cancer patients were eligible for recruitment. Of these 180 (71.4%) were classified as urban and rest remote. In remote compared to urban patients there were more males (73.6% vs 60%, p=0.046) and more Caucasians (96.2% vs 90%,p=0.068). Also level of secondary or higher education was significantly more in urban compared to remote cohort (88.5% vs62.7%). Tumour demographics like histology and stage were balanced between the two cohorts. Median time from symptoms to first presentation was significantly affected by ethnicity (indigenous vs non indigenous 92 vs 57 days, p=0.05), older age (<51yr vs >51yr 14 vs 45 days, p= 0.026) and lower level of education (primary/secondary vs tertiary/TAFE 61 vs 23 days, p=0.023). Median time between symptoms to specialist consultation were significantly higher for lower level of education ( primary / secondary vs tertiary/TAFE 140 vs 55 days, p=0.05) and remoteness of location (remote vs urban 113 vs 89 days, p=0.05). Specialist to treatment time was delayed by stage (III vs IV 34 vs 18 days, p=0.021). On multivariate analysis time between symptoms to first presentation was influenced by level of education (primary/secondary vs tertiary/TAFE, p=0.006). For rural compared to urban patients, time between first consultation to specialist visit (p=0.022) and time between symptoms to first treatment (p=0.015) were significantly longer.

    Conclusion
    The demographic profile of lung cancer patients from remote areas is quite smilar to their regional counterparts. In the five time zones from presentation to treatment, median time from symptoms to first presentation was the most susceptible. In the referral pathways, indigenous ethnicity, level of education, remoteness and stage of disease affected time delays but no impact was found for socio-economic status. On multivariate analysis level of education and remoteness of location emerged as significant barriers to presentation.

• 12853

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  P3.24 - Poster Session 3 - Supportive Care (ID 160)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12898

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    P3.24-046 - Feasibility and safety of chemotherapy administration using Teleoncology for rural lung cancer patients in North Queensland. (ID 3009)

    09:30 - 09:30  |  Author(s): S. Varma
    • Abstract

    Background
    Chemotherapy is the standard treatment for most (stage II and beyond) lung cancer patients and treatment duration can be long ranging from months to years. Rural lung cancer patients often have to travel long distances for such specialist treatment. Geographical isolation and remoteness is implicated as one of the factors leading to inferior outcomes in these patients. Since 2007 Townsville cancer centre has been providing chemotherapy services to Mount Isa at a distance of 1000 km via Teleoncology ( using video conferencing). This model has previously been shown to be effective, safe, cost saving and sustainable. This study evaluates the feasibility and safety of chemotherapy for lung cancer patients treated via Teleoncology.

    Methods
    All patients with a diagnosis of lung cancer from Townsville Teleoncology data resource (comprising all patients treated with chemotherapy at Mount Isa Base hospital using videoconferencing from Townsville cancer centre) between April 2007 and March 2012 were eligible. Patient and tumour characteristics were studied and feasibility was evaluated using number and type of cycles, dose intensity and completion rates for chemotherapy administration. Toxicity was graded as per common terminology criteria for adverse events (CTCAE) v 4.0.

    Results
    Out of total 170 patients treated using Teleoncology, 33 (22%) had lung cancer. Of these 3 (9%) were small cell (SCLC) and remaining non small cell lung carcinomas. A total of 287 chemotherapy cycles (148 in first line, 97 in second line and 42 in third line) were administered under distant supervision. Of these, 8 cycles were neoadjuvant, 15 cycles in adjuvant and 254 cycles in palliative setting. One patient of SCLC had emergency chemotherapy initiated via Teleoncology. Carboplatin(C) and Gemcitabine(G) was the commonest regimen (72 cycles 25%) followed by Pemetrexate (66 cycles 23%) and C and Paclitaxel (56 cycles 19%). Other types of regimen administered were Cisplatin (Cis) and G, C and Etoposide (Eto), Cis and Vinorelbine (Vnb), and single agent Docetaxel, Gem, Vnb, Eto, C and Erlotinib. Commonest toxicities were fatigue, neuropathy, thrombocytopenia and anaemia. Grade 3-4 toxicity requiring dose reduction was 4% in first line, 32% in second line and 58% in third line setting. Accounting for dose reductions based on toxicity, anticipated chemotherapy dose intensity could be maintained in 261 cycles (91%). There were 7 episodes of inpatient admission at Mount Isa (3 febrile neutropenia and 2 each pulmonary embolism and recurrent pleural effusion), all supervised via Teleoncology from Townsville. 29 of these 33 patients had all of their chemotherapy treatment at Mount Isa without travelling to Townsville. Only 3 patients needed to travel to Townsville during palliative treatment, two for brain radiotherapy and one for VATS pleurodesis.

    Conclusion
    Teleoncology is a novel model of care for rural lung cancer patients. Using this model, standard chemotherapy for lung cancer can be safely administered with expected dose intensity. The feasibility and safety results from this study are comparable to published literature in lung cancer. Use of teleoncology has the potential to overcome the barrier of travel time associated with long distances and possibly improve outcome for rural lung cancer patients.