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E. Jakobsen
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MO22 - Advanced Disease and Outcomes (ID 103)
- Event: WCLC 2013
- Type: Mini Oral Abstract Session
- Track: Surgery
- Presentations: 1
- Moderators:T. Yano, J. Roth
- Coordinates: 10/30/2013, 10:30 - 12:00, Parkside 110 A+B, Level 1
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MO22.03 - Postoperative Rehabilitation and Follow-up - a randomized study. (ID 2422)
10:40 - 10:45 | Author(s): E. Jakobsen
- Abstract
- Presentation
Background
The importance of postoperative follow-up and rehabilitation after lung cancer surgery remains a controversial topic. Previous studies have showed that follow-up programs did not influence survival but at that time there was little focus on the effects of rehabilitation. Introduction of new diagnostic procedures, improvements in treatment modalities and increasing awareness on quality of life after treatment has changed guidelines and recommendations for follow-up programs. There is little evidence for these recommendations which prompted us to conduct a randomized study to evaluate the effect of an intense follow-up program on survival and quality of life for patients undergoing surgery for lung cancer (NSCLC).Methods
Between January 2003 and April 2008 a total 197 NSCLC patients were included in the study after undergoing surgical resection (wedge, lobectomy or pneumonectomy) through a posterolateral thoracotomy. Adjuvant chemotherapy was offered to stage Ib - IIIa. Postoperatively patients were randomized to either active rehabilitation and follow-up (POREFU, N=103) or passive follow-up (Standard, N=94). Patients in the POREFU group had intensive follow-up in the form of annual clinical evaluation, chest X-ray, chest CT, bronchoscopy and EBUS (Endobronchial Ultrasound) for 5 years. In the POREFU group patients were also evaluated by a nurse and a physiotherapist after 6 weeks, 6 months and at annual controls. When indicated, interventions were established to correct patient symptoms. Patients in the standard treatment group were offered a chest X-ray one year after surgery and a clinical examination by their family doctors upon request. Quality of life in both groups was assessed after 6 weeks, 6 months, 12 months and 2, 3, 4 and 5 years evaluating EORTC QLQ-C30/LC13. All survivors were followed for 5 years.Results
Figure 1There was no significant difference in survival between the two groups (Kaplan Meier plot). There was a significant difference between the two groups in favour of active follow-up regarding Global health status as well as “Physical”, “Role” and “Emotional” functioning and POREFU patients had significant less pain and fatigue. There was no statistical significant improvement of other symptoms or functional issues.Conclusion
This randomized trial shows that a follow-up program with an additional focus on rehabilitation and intervention towards reported symptoms in patients operated for NSCLC significantly improves quality of life but has no effect on overall survival.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 - Cancer Control and Epidemiology I (ID 135)
- Event: WCLC 2013
- Type: Oral Abstract Session
- Track: Prevention & Epidemiology
- Presentations: 1
- 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
- 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.
