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A. Green



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    O06 - Cancer Control and Epidemiology I (ID 135)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Prevention & Epidemiology
    • Presentations: 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): A. Green

      • Abstract
      • Presentation
      • Slides

      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.

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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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      P2.24-042 - Role of comorbidity on survival after radio- and chemotherapy for non-surgically treated lung cancer (ID 2595)

      09:30 - 09:30  |  Author(s): A. Green

      • Abstract

      Background
      Comorbidity, such as diseases of the cardiovascular, pulmonary, and other systems may influence prognosis in lung cancer as well as complicate its treatment. The performance status of patients, which is a known prognostic marker, may also be influenced by comorbidity. Due to the close link between tobacco smoking and lung cancer, and because lung cancer is often diagnosed in advanced ages (median age at diagnosis is 70 years), comorbidity iwill be present in a substancial proportion of lung cancer patients.

      Methods
      Patients with any stage lung cancer who did not have surgical treatment were identified in the Danish Lung Cancer Registry (DLCR). DLCR collects data from clinical departments, the Danish Cancer Registry, Danish National Patient Registry (DNPR) and the Central Population Register. A total of 22,999 patients with lung cancer were identified. Due to missing variables, 19,561 patients were available for analysis. Comorbidity was sought in the DNPR which is a register of all in and out patient visits to hospitals in Denmark. By record linkage, all lung cancer patients who had previously been diagnosed with any of a number of comorbid conditions was recorded using the Charlsson comorbidity score CCS. First treatment was categorized as chemotherapy, chemo-radiotherapy, radiotherapy or no therapy. Data on CCS, performance status, age, sex, stage, pulmonary function (Fev1), histology and type of first treatment (if any) were included in univariable and multivariable Cox proportional hazard analyses.

      Results
      For patients receiving chemotherapy as first treatment for lung cancer, survival was increasing worsened by increasing comorbidity (HR=1,00,1.10, 1.17, 1,15 for CCS scores 0, 1, 2, 3+ respectively). After adjustment for potential confounders, risk estimates was reduced somewhat (HR: 1.00, 1.05, 1.11, 1.11 for CCS scores 0, 1, 2, 3+ respectively). For patients receiving radiotherapy as first therapy, a different pattern was seen with better survival for patients with comorbidity (HR=1.00, 0.99, 0.94, 0.87 for CCS scores 0, 1, 2, 3+ respectively). After adjustment, this effect disappeared and survival was unaffected by CCS. For patients receiving combined radio/chemo therapy there was no significant association between CCS and survival.Throughout the analysis, performance score remained a strong and highly significant risk factor for survival, and was robust in multivariate analysis (HRunivariate, all patients= 1.0, 1.40, 1.95, 3.23, 5.91 for ECOG performance score 0,1,2,3 and 4 respectively).

      Conclusion
      Comorbidity has a limited effect on survival and only for patients treated with chemotherapy. It is rather the performance of the patient at diagnosis than the medical history that prognosticates survival in this patient group.