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S.K. Vinod
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MINI 28 - Psychological Impact of Lung Cancer and its Treatment (ID 150)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:A. Oton
- Coordinates: 9/09/2015, 16:45 - 18:15, 102+104+106
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MINI28.06 - Patterns of Palliative and Psychosocial Care in Stage IV NSCLC in South Western Sydney (ID 118)
17:15 - 17:20 | Author(s): S.K. Vinod
- Abstract
- Presentation
Background:
South West Sydney (SWS) is a region of greater ethnic diversity and poorer socioeconomic status than the Australian average. Over half of all patients with Non-Small Cell Lung Cancer (NSCLC) in SWS present with metastatic disease. The primary goals of management are palliation of symptoms and maintenance of quality of life. Patients need adequate access to specialist palliative care (PC) and psychosocial care (PSC) in order to achieve these goals. The aims of this study were to evaluate referrals to PC and PSC services in SWS residents with Stage IV NSCLC and identify factors associated with utilisation of these services.
Methods:
SWS residents diagnosed with Stage IV NSCLC between January 2006 and December 2012 were identified from the SWS Local Health District Clinical Cancer Registry. Supplementary information was sourced from oncology and hospital electronic medical records and palliative care databases. Modified Poisson regression was used to analyse significant factors associated with referrals to PC and PSC. Cox regression was used for multivariate survival analysis.
Results:
A total of 923 patients were identified. The median age was 69 years, 63% were male and 54% were born overseas. Active treatment was received by 65% of patients with 34% receiving chemotherapy and 65% receiving radiotherapy. Eighty-three percent of patients were referred to PC, with 67% occurring within 8 weeks of diagnosis. Eighty-two percent of patients were referred to PSC, with referrals to social workers being most frequent (76%) followed by specialist nursing (26%) and psychology/psychiatry (16%). On multivariate analysis, radiotherapy treatment, M1b disease and residential location were associated with PC referrals, and radiotherapy treatment, PC referral and residential location were associated with PSC referrals. Age, language spoken, country of birth, socioeconomic status, year of diagnosis and multidisciplinary team discussion were not significant factors in referral to either service. The median overall survival was 4.3 months and one year survival was 19%. On multivariate analysis, factors associated with improved survival were active treatment, chemotherapy and multidisciplinary team discussion.
Conclusion:
Rates of referral to PC and PSC services were high in this cohort suggesting good access to care. Greater referrals were particularly associated with patients undergoing radiotherapy. There were no sociodemographic barriers to referral. Some geographic differences were noted in referrals to both services. Further investigation into referral gaps will guide service delivery to improve quality of life and care for future patients.
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P1.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 212)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.03-018 - International Patterns of Radiotherapy Practice for Non-Small Cell Lung Cancer (ID 119)
09:30 - 09:30 | Author(s): S.K. Vinod
- Abstract
Background:
Radiotherapy is an important treatment modality for Non-Small Cell Lung Cancer (NSCLC). Models of radiotherapy utilization which evaluate the proportion on NSCLC patients who have an evidence-based indication for radiotherapy estimate a utilization of 46% -68% at diagnosis and 64%-75% during the overall course of the disease. The aim of this review was to document the actual use of radiotherapy for NSCLC patients and examine reasons for any discrepancies identified.
Methods:
A literature search was conducted using Medline and Pubmed databases to identify population-based studies, published in English, which reported the use of radiotherapy between 1990 and 2014. Reference lists of the identified studies were also scrutinised for further relevant publications.
Results:
Ten studies were identified from regions including North America, Europe, United Kingdom and Australasia. Actual radiotherapy utilization varied across these regions ranging from 20%-53%. In North America, actual utilization approached model estimates, but in the other regions actual utilization was lower than model estimates. The largest differences between actual and estimated radiotherapy utilization was seen in stage III NSCLC. Some of this discrepancy is attributable to the assumptions in the models which are based on broad factors such as stage and performance status. Characteristics of the underlying lung cancer population who often have comorbidities or compromised respiratory function also impact on the ability to deliver radiotherapy safely. Sociodemographic factors such as race and income have been found to affect access to radiotherapy in certain jurisdictions. The type of clinician or medical setting the patient presents to initially has also been found to influence radiotherapy use in NSCLC.
Conclusion:
Radiotherapy utilization for NSCLC is lower than that predicted by model estimates throughout much of the world. This is partly due to characteristics of the underlying lung cancer population which may preclude guideline-based treatment including radiotherapy. Physician characteristics and referral patterns can have a significant impact on the use of radiotherapy in NSCLC. Potential solutions to overcome this include restructuring models of care to ensure all lung cancer patients are managed within a multidisciplinary team including a radiation oncologist.
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P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.01-043 - Lung Cancer Radiotherapy - Current Patterns of Practice in Australia and New Zealand (ID 801)
09:30 - 09:30 | Author(s): S.K. Vinod
- Abstract
Background:
The RANZCR Faculty of Radiation Oncology Lung Interest Cooperative (FROLIC) surveyed patterns of lung cancer radiotherapy practice in Australasia for both non-small cell (NSCLC)and small cell lung (SCLC) cancer to evaluate current patterns of care and define gaps in optimal care requiring improvement.
Methods:
Radiation Oncologists were surveyed at all 62 departments in Australasia using a web-based survey targeting those treating lung cancer. Questions covered current radiotherapy practice as well as measures of quality
Results:
Of 62 responses received, 57 did treat lung cancer and were eligible for analysis. All Australian states and New Zealand were represented. Sixty-two percent of respondents worked at metropolitan centres, 58% were subspecialists in lung cancer and 60% participate in lung cancer trials. Ninety-four percent discuss lung cancer patients at a tumour board, 74% peer review contours for conventional fractionation and 50% for SABR. Fifty percent used a department protocol for contouring and/or prescription, 39%, an external protocol and 11% had no protocol. For radical conventional radiotherapy, 58% use 4DCT to assess tumour motion, 44% utilise breath hold or respiratory gating, 44% use PET Fusion, 35%, free-breathing CT and 23% PET-CT simulation. In palliative settings, free-breathing CT was most common (81%). For conventional treatment, 98% use 3DCRT, 34% IMRT and 18% VMAT. Image verification was primarily with cone beam CT (86%), KV imaging (72%) and MV imaging (30%). The commonest dose fractionation regime in NSCLC was 60Gy in 30 fractions used in 95% of node-positive and 82% of node-negative disease. 66Gy in 33 fractions and 50-55Gy in 20 had been used by 32% and 30%of respondents respectively. 30Gy/10 fractions was the most frequent palliative regime that had been used (by 76%), followed by 36Gy/12 (72%) . For limited stage SCLC, the majority (61%) treated with 45-50.4Gy in 25-28 fractions while 45Gy/30 twice daily had been used by 48%. In extensive stage SCLC, consolidation chest radiotherapy was used by 63% in complete response, 48% for partial response and 24% would not treat. 46% of departments provided SABR but only half treated central tumours. For peripheral tumours, 80% used 54Gy in 3 fractions and if close to chest wall, 70% used 48Gy in 4 fractions. In fit patients with synchronous solitary brain metastasis and controlled extra-thoracic disease, 37% of respondents would treat both chest and brain definitively, 43% would do so only if chest disease was equivalent to Stage I/II, and 9% would never treat radically. If three brain metastases were present, just 46% would treat definitively. In the setting of an isolated systemic metastasis only, 35% would treat definitively while 61% do not offer definitive treatment in the setting of systemic oligo-metastases.
Conclusion:
A significant proportion of radiation oncologists did not have access to 4DCT for simulation. The majority used 3D image verification and consistently prescribed evidence-based doses. Although protocols were widely used, a significant number did not participate in peer review of contours. The treatment of synchronous oligo-metastatic disease was variable, likely due to a lack of high quality evidence and should be an area of future research.
