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K.M. Tong
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O15 - NSCLC - Chemotherapy II (ID 109)
- Event: WCLC 2013
- Type: Oral Abstract Session
- Track: Medical Oncology
- Presentations: 1
- Moderators:G. Richardson, J.V. Heymach
- Coordinates: 10/29/2013, 10:30 - 12:00, Bayside Auditorium A, Level 1
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O15.01 - Evaluation of a "watch and wait" approach for patients with newly diagnosed advanced non-small cell lung cancer in a diverse community population (ID 2384)
10:30 - 10:40 | Author(s): K.M. Tong
- Abstract
- Presentation
Background
The current treatment paradigm for metastatic non-small cell lung cancer (NSCLC) includes systemic therapy, radiotherapy or both. A “watch and wait” approach (WW) is commonly used in clinical practice. Whether this approach would have any effect on survival outcomes has not previously been evaluated.Methods
The British Columbia Cancer Agency (BCCA) provides comprehensive cancer care to a population of 4.5 million across 944735 sq kms. A retrospective review was conducted of all referred patients diagnosed with stage IIIb/IV NSCLC from January to December 2009 in BC who saw a medical oncologist (MO). Patient characteristics, treatment recommendations, and outcomes were abstracted. WW-treated is defined as initial observation with chemotherapy > 8 weeks from MO consult. WW-missed are patients who were on a WW strategy that did not receive chemo. Kaplan-Meier survival analysis was compared using log rank test. Cox proportional hazards modeling was used to evaluate prognostic factors and control for potential confounders.Results
710 patients were seen by a MO. Median age 66 years (29-90), ECOG 0-1 51%, male 52%, non squamous/squamous/NOS 40%/19%/41%, rural/urban 19%/81%. 327 received upfront chemo, 171 WW and 209 deemed chemo ineligible due to poor ECOG, and comorbidities. Of the 171 patients on a WW approach 44% missed an opportunity for chemotherapy (Figure 1). Reasons for WW-missed included poor ECOG (50%), death (47%), asymptomatic (1%), and illness (1%). Median OS was highest in the WW-treated 16.5 months (CI 12.7-20.3), followed by 13.9 months (CI 12.0-15.8) in the upfront chemo and lowest in the WW-missed 5.9 months (CI 4.4-7.4), p<0.0001. On multivariate analysis, factors predicting a poorer OS included ECOG >2, squamous histology, and a shorter the time from diagnosis to referral and referral to MO consult. When controlled for confounding factors (age, sex, ECOG) OS was similar between the upfront chemo and WW-treated (HR 1.16, CI 0.849-1.58, p=0.353), while those who were in the WW-missed had a significantly lower OS (HR 5.54, CI 3.00-10.24, P<0.0001). Figure 1Conclusion
Our study demonstrates that a “watch and wait” strategy is potentially detrimental to patients because a significant proportion never receives chemotherapy. A decline in ECOG status accounts for 50% of the “missed” chemotherapy. Frequent follow up should be employed for patients who are on a WW approach to ensure the window of opportunity for chemotherapy is not lost.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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P3.10 - Poster Session 3 - Chemotherapy (ID 210)
- Event: WCLC 2013
- Type: Poster Session
- Track: Medical Oncology
- Presentations: 1
- Moderators:
- Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P3.10-048 - Referral patterns in advanced non small lung cancer: Impact on delivery of treatment and survival in British Columbia (ID 2931)
09:30 - 09:30 | Author(s): K.M. Tong
- Abstract
Background
Chemotherapy improves overall survival in advanced non-small cell lung cancer (NSCLC). We sought to evaluate clinical effectiveness of chemotherapy in the general population by looking at referral patterns, and outcomes.Methods
The British Columbia (BC) Cancer Agency is a publicly funded system that serves a population of over 4.5 million. All referred cases of stage IIIb/IV non-small cell lung cancer were identified using the BC Outcomes and Surveillance Integrated System and retrospectively reviewed. Patient demographics, tumour characteristics and treatments were extracted. Overall survival (OS) was estimated using the method of Kaplan-Meier. Cox Proportional Hazards (CPH) modeling was used to control for possible confounders. Multiple logistic regression (MLR) was used to compare characteristics between patients who were referred and not referred to a medical oncologist (MO).Results
1384 patients were diagnosed with Stage IIIb/IV NSCLC between January 1 to December 31, 2009. Median age 70 years (29-96), male 53%, ECOG 0-1 38%, rural/urban 17%/83%, non-squamous/squamous/NOS 34%/21%/46%. 710 (51%) patients were assessed by a MO and of these, 382 (54%) received chemotherapy. 1225 (89%) were assessed by a radiation oncologist (RO), and 1025 (84%) received radiation. MLR showed that patients referred to MO were more likely to be younger, from an urban area, and have a better ECOG. Median OS for the entire cohort was 9.6 months (CI 8.5-10.7). There was a statistically significant improvement in OS in patients who received chemotherapy at 14.2 months (CI 12.5-15.9) in comparison to 7.6 months (CI 6.6-8.6) who did not receive chemotherapy (p<0.0001). This remained statistically significant in the CPH model, controlling for ECOG, sex, age, histology (HR 0.80, CI 0.65-0.92). In comparison, OS was 8.6 months (CI 7.4-9.8) for patients who received only radiotherapy, and 5 months (CI 3.1-6.8) for those treated with best supportive care.Conclusion
Only half of the referred patients were assessed by a medical oncologist and only 54% of them received chemotherapy. This is despite the awareness that chemotherapy significantly improves OS. Strategies to improve upon this 51% referral rate should be evaluated, such that patients do not miss out on life-prolonging therapy.
