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D. Debieuvre
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ORAL 27 - Care (ID 123)
- Event: WCLC 2015
- Type: Oral Session
- Track: Advocacy
- Presentations: 1
- Moderators:M.N. Mountain, J. Freeman-Daily
- Coordinates: 9/08/2015, 10:45 - 12:15, 708+710+712
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ORAL27.06 - Disparities in Lung Cancer Incidence and Management Care in France: A Nationwide Cohort Study (the TERRITOIRE Study) (ID 1177)
11:39 - 11:50 | Author(s): D. Debieuvre
- Abstract
- Presentation
Background:
Reducing health inequalities in oncology is a major public health priority in France, particularly in terms of social and geographic exclusion and equity of access to health care services. However, no specific registry currently exists for patients with lung cancer allowing description and comparison of local situations. Our aim was to use available National medico-administrative databases to constitute a nationwide population-based cohort study to analyze disparities among French areas (the TERRITOIRE study).
Methods:
We included all patients who had a first diagnosis of lung cancer between January 1rst and December 31th 2011 in the National hospitals databases (PMSI, Programme de Médicalisation des Systèmes d'Information). Patients’ data were linked to create a retrospective cohort study with a two-year follow-up period. The 22 administrative regions were considered in this analysis. In addition of demographic characteristics, metastatic status, comorbidities and treatment procedures, we assigned each patient to socioeconomic deprivation and urbanization scores based on their postcode of residence.
Results:
We identified 41,715 patients newly diagnosed for lung cancer. Mean age at diagnosis was 66.4(±11.9) years and most of patients were men (71.8%). Patients from socioeconomic deprived areas represented 27.5% of the whole lung cancer population, ranging from 9.6% to 55.2% according to the region. Incidences of lung cancer were 35.1 per 100,000 in women and 95.3 per 100,000 in men. Age-standardized incidences showed important disparities between French regions ranging from 27.5 to 55.0 and from 82.4 to 118.2 per 100,000 in women and men, respectively. Higher incidences were found in the northern and eastern regions for men and in the southern and eastern regions for women. Although patients living in rural areas were the larger group (34.5%), Age-standardized incidence significantly increased with urbanization: from 61.8 per 100.000 in rural areas to 73.9 per 100.000 in urban areas. A majority of patients was diagnosed at a metastatic stage (52.7%) and regional disparities were important ranging from 45.0% to 58.1%. This rate also appeared higher in patients diagnosed in public hospitals compared to private ones (56.1% vs 42.9%, p<0.0001) and in local hospitals compared to university ones (60.2% vs 49.6%, p<0.0001). Adjusted comparisons showed significantly higher incidences of stage IV patients at the time of diagnosis in five regions for men and two regions for women. A majority of patients (N=23,842; 57.2%) died in the hospital during the 2-year follow-up, including 15,642 patients (71.2%) having metastasis at the time diagnosis.
Conclusion:
We have demonstrated that a comprehensive population-based cohort using medico-administrative data is a suitable approach to illustrate disparities in lung cancer incidence, management care and outcomes in France. Data from this study should help local clinical teams and health stakeholders to better understand inequality issues in their areas.
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P1.07 - Poster Session/ Small Cell Lung Cancer (ID 221)
- Event: WCLC 2015
- Type: Poster
- Track: Small Cell Lung Cancer
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.07-013 - Real-Life 2-Year Therapeutic Strategies in the Management of 525 Small-Cell Lung Cancers: The ESCAP Study Preliminary Results (ID 1657)
09:30 - 09:30 | Author(s): D. Debieuvre
- Abstract
Background:
In the last years, new drugs and strategies have emerged in the management of lung cancer (LC). The French College of General Hospital Respiratory Physicians therefore promoted a prospective multicenter epidemiological study: the ESCAP study. This study was aimed to describe the therapeutic strategies implemented during the first 2-year after diagnosis in patients with LC followed in French General Hospital chest departments. We report below descriptive results for small-cell lung cancer (SCLC).
Methods:
For each patient with a LC diagnosed in 2010, a standardized form was completed at diagnosis and following each change in treatment strategy up to at least 2 years after diagnosis.
Results:
53 centers participated in the ESCAP study, and included 3,943 LC patients. Of these, 525 patients had a SCLC. Characteristics of SCLC patients at diagnosis were: mean age +/- standard deviation (SD), 65.6 +/- 10.8 years; male, 77%; never-smokers, 4.8%. The mean follow-up in SCLC patients was 10.5 months (SD: 8.8) and median number of strategies was 2 (Interquartile range: 1-3). Main strategy characteristics are summarized in the following table.
As regards first strategy, cisplatin (46%) and carboplatin (42%) were the most frequent used drugs associated with etoposide. As regards second strategy, the most frequently used drugs were topotecan (22%), etoposide (21%), or carboplatin (20%). Few patients received targeted therapy (< 1% in strategies 1 and 2).First strategy (N=525) Second strategy (N=309) Third strategy (N=153) Duration (months): mean+/-SD 5.4 +/- 4.5 3.6 +/- 3.5 2.7 +/- 2.4 Curative surgery 2% 1% - Radiotherapy 10% 47% 20% Radiochemotherapy 15% - - Chemotherapy 75% 55% 61% Exclusive supportive care 8% 14% 27% Patients died during the strategy 195 (37%) 134 (43%) 90 (59%) Patients with a new strategy 309 (59%) 153 (50%) 54 (35%)
Conclusion:
The ESCAP study describes the 2-year management of SCLC on real-life settings in France. Its preliminary results showed that 3 or 4 strategies were not uncommon in the management of SCLC patients.
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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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P2.01-048 - Real-Life 2-Year Therapeutic Strategies in the Management of Metastatic Non-Small-Cell Lung Cancers: The ESCAP Study (ID 1515)
09:30 - 09:30 | Author(s): D. Debieuvre
- Abstract
Background:
In the last years, new drugs and strategies have emerged in the management of lung cancer (LC). The French College of General Hospital Respiratory Physicians therefore promoted a prospective multicenter epidemiological study: the ESCAP study. This study was aimed to describe the therapeutic strategies implemented during the first 2-year after diagnosis in patients with LC followed in French General Hospital chest departments. We report below descriptive results for metastatic non-small-cell lung cancer (mNSCLC).
Methods:
For each patient with a LC diagnosed in 2010, a standardized form was completed at diagnosis and following each change in treatment strategy up to at least 2 years after diagnosis.
Results:
53 centers participated in the ESCAP study and included 3,943 patients. Among them, 3,418 patients had a NSCLC. NSCLC was metastatic in 2,003 patients. In patients with mNSCLC, the first therapeutic strategy was chemotherapy alone (56%) followed by palliative chemotherapy plus incidental radiotherapy (35%); 4% of patients died without any implemented therapeutic strategy (see figure). 29% of patients with chemotherapy alone as first strategy died without undergoing any other strategy and 70% had a second strategy (72% chemotherapy alone). 35% of patients with radiochemotherapy died without undergoing any other strategy and 64% had a 2[nd] strategy (73% chemotherapy alone). Figure 1 The most frequent chemotherapy during the first strategy was platinum salts doublet with pemetrexed (39%), followed by platinum salts doublet with paclitaxel (15%). Chemotherapy during the second strategy was second line chemotherapy (67%) or maintenance therapy (25%). EGFR-TKi (34%) and docetaxel (26%) alone were the most frequently prescribed drugs for second line chemotherapy, and pemetrexed (44%) and EGFR-TKi (26%) alone for maintenance therapy.
Conclusion:
The ESCAP study describes the 2-year management of metastatic NSCLC on real-life settings in France. Its preliminary results are consistent with the guidelines of the French National Cancer Institute.
