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T. Gudbjartsson
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P1.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 233)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.04-073 - The Role of the Stress-Response to a Lung Cancer Diagnosis in Disease Progression (ID 2661)
09:30 - 09:30 | Author(s): T. Gudbjartsson
- Abstract
Background:
Receiving a cancer diagnosis, particularly of lung cancer, has been shown to increase psychological and biological stress responses and the immediate risks of extreme adverse health outcomes, such as suicide and cardiovascular deaths. Data are scarce on the potential influence of this diagnosis on tumor progression. Prior studies lend suggestive evidence for an association of psychobiological stress-responses on lung cancer progression. The aim of this study is to improve understanding of determinants of the stress-response to a lung cancer diagnosis and explore potential role of this response in disease progression and survival.
Methods:
We have initiated a nationwide prospective cohort study of Icelandic lung cancer patients with a comprehensive questionnaire and biomarker measures of stress, as well as detailed documentation of clinical parameters and disease course. Eligible are all individuals diagnosed with lung cancer at Landspitali University Hospital in Iceland. The aim is to recruit 300 patients over a three year period between 2015 and 2017. Patients with clinical or radigraphic changes suggestive of lung cancer are referred to our hospital. They go through a diagnostic work-up, leading to a definite lung cancer diagnosis and staging during a 24 hour diagnostic course or within few days thereafter. Assessment of psychological stress and relevant biomarkers are integrated with clinical assessments at two time points, i.e. during the diagnostic work-up and at follow-up visit 1-3 weeks later (before treatment). The study participation involves questionnaire assessment of symptoms of anxiety, depression, posttraumatic stress, sleep disturbances and quality of life. Biomarker repositories include overnight urine collection, diurnal saliva and hair sampling for analysis of cortisol and catecholamines along with ECG to determine heart rate variability. Bronchoscopic and core needle biopsies as well as surgical tumor samples will be used for assessment of apoptosis, proliferation, microvascular density and adrenoreceptors expression. Radiographic progression will be assessed at baseline and every 6 months from diagnosis along with complete documentation of clinical parameters, disease course and survival.
Results:
In 4 weeks we have recruited 8 patients (80% acceptance rate). We will characterize determinants of a severe psychological-, neuro-endocrine- and cardiovascular stress-response to a cancer diagnosis, as well as the potential relevance of these responses on tumor characteristics, radiographic progression and disease-specific survival. We expect to present preliminary results from approximately 30 patients at the conference.
Conclusion:
Significance: This research program is the first comprehensive attempt to evaluate determinants of psychobiological-induced responses to a lung cancer diagnosis and their potential impact on cancer progression. The findings might guide intervention strategies to improve quality of life, reduce morbidity and prolong survival in lung cancer patients.
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P1.06 - Poster Session/ Screening and Early Detection (ID 218)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.06-015 - A Population Based Study on Pulmonary Carcinoids in Iceland: Epidemiology, Diagnosis and Survival Over Sixty Years (ID 2158)
09:30 - 09:30 | Author(s): T. Gudbjartsson
- Abstract
Background:
Pulmonary carcinoids are usually localized to the lungs but can also metastasize to mediastinal lymph nodes or to other organs. We studied the incidence and patient outcome in a well-defined population over a 60 year period.
Methods:
A nationwide study, including all pulmonary carcinoids diagnosed in Iceland from 1955 to 2014. Histologic specimens were re-evaluated and information retrieved from medical records. The tumors were staged according to the TNM staging system (6[th] edition). Survival was estimated using the Kaplan-Meier method, with end of follow-up on January 1[st] 2015. Mean follow-up was 186 months.
Results:
93 patients (62 females, average age of 52 years) were diagnosed during the 60 year period. Incidence increased from 0,2/100.000/year between 1955-1964 to 0,7 2005-2014. A total of 26 out of 85 patients (31%) were asymptomatic upon diagnosis and the rate of incidental detection increased from 17% in the first 30 years to 33% in the later 30 years. The most common symptoms were cough (56%), pneumonia (28%) and chest pain (11%). Mean tumor diameter was 2,7 cm (range: 0,3-6,3), 71 (84%) patients were diagnosed with typical carcinoid tumors and 14(16%) with atypical carcinoid tumors. Out of 77(91%) patients who had surgery, 65(84%) underwent a lobectomy. One patient died within 30 days of surgery. Most patients(n=67, 79%) were on stage I upon diagnosis and 4(5%) on stage II. Another 4 patients were on stage III with mediastinal lymph node metastases, all with typical histology. Out of six patients(7%) with distal metastases (stage IV), two had typical histology. Five patients(6%) had died from pulmonary carcinoids upon follow-up, but total 5-year survival was 92% for all patients and 87% for patients with typical carcinoids.
Conclusion:
The incidence of pulmonary carcinoids in Iceland has tripled over the last 6 decades, mostly due to steep increase in incidental detection on chest imaging. Most patients (>84%) are diagnosed with a localized disease, where long-term outcome is excellent.
