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R.B. Hubbard
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MINI 19 - Surgical Topics in Localized NSCLC (ID 138)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:D. Jablons, B. Stiles
- Coordinates: 9/08/2015, 16:45 - 18:15, 605+607
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MINI19.08 - Validation of a Surgical Predictive Score for 90 Day Mortality in Lung Cancer and Comparison with Thoracoscore (ID 2754)
17:25 - 17:30 | Author(s): R.B. Hubbard
- Abstract
- Presentation
Background:
Current British Thoracic Society (BTS) guidelines advocate the use of a global risk prediction score such as Thoracoscore to estimate the risk of death prior to radical surgical management in those with non-small cell lung cancer (NSCLC). A recent publication by Powell et al(1) used the National Lung Cancer Audit (NLCA) linked to Hospital Episode Statistics (HES) to produce a score to predict 90 day mortality. The aim of this study is to validate this score, henceforth called the NLCA score, and compare its performance with Thoracoscore.
Methods:
We identified data on all patients in the NLCA who received curative surgery for NSCLC between 2010 and 2012. We calculated the proportion that died in hospital and within 90 days of surgery. Each person was given a score based on the coefficients and constants in the NLCA score and Thoracoscore. The discriminatory power of both scores was assessed by a receiver operating characteristic (ROC) and an area under the curve (AUC) calculation.
Results:
We identified 2858 patients for whom we had complete data to form our validation cohort. The 90 day mortality was 5%. We generated ROC curves to assess the discrimination of the NLCA score in predicting 90 day mortality and to test the ability of Thoracoscore to predict in-hospital mortality. Area under the ROC curve was 0.68 and 0.60 respectively. We performed a post hoc analysis using data from the NLCA on all 15554 patients who underwent curative surgery for NSCLC between 2004 and 2012 to derive summary tables for 90 day mortality, stratified by procedure type, age and performance status (table 1).
Conclusion:
These results suggest that although the NLCA score performs slightly better than Thoracoscore neither performs well enough to be advocated for routine use to risk stratify patients prior to lung cancer surgery. It may be that the addition of physiological parameters to demographic and procedural data or use of physiological measurements alone would better predict mortality; however this would form the basis of a further project. In the interim we advocate the use of our summary tables that serve to provide clinicians and patients the real-life range of mortality according to performance status and age for both lobectomy and pneumonectomy. 1. Powell HA, Tata LJ, Baldwin DR, Stanley RA, Khakwani A, Hubbard RB. Early mortality after surgical resection for lung cancer: an analysis of the English National Lung cancer audit. Thorax. 2013;68(9):826-34. Figure 1
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ORAL 43 - Enhancing Physical Wellbeing in Lung Cancer (ID 168)
- Event: WCLC 2015
- Type: Oral Session
- Track: Nursing and Allied Professionals
- Presentations: 1
- Moderators:G. Bates, M. Hesdorffer
- Coordinates: 9/09/2015, 18:30 - 20:00, 102+104+106
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ORAL43.02 - Which Patients Are Assessed by a Lung Cancer Nurse Specialist: A UK National Lung Cancer Audit Study (ID 1258)
18:41 - 18:52 | Author(s): R.B. Hubbard
- Abstract
- Presentation
Background:
Lung cancer nurse specialists (LCNS) are an integral part of the multidisciplinary team, supporting, managing and coordinating of care for people with lung cancer. In the UK the National Institute of Health and Care Excellence (NICE) recommends that all patients have access to a LCNS in a trust, but recent National Lung Cancer Audit (NLCA) reports show that LCNS access varies across England. The aim of this study was to examine how access to a LCNS varies by patient and National Health Service (NHS) trust characteristics.
Methods:
We used data on all lung cancer patients in the NLCA first presenting to 150 English NHS trusts between January 1[st] 2007 and December 31[st] 2011. NHS trusts are health care organisations typically 1-3 hospitals collectively covering regional catchment populations. The NLCA collects key clinical information, including LCNS assessment on all individuals with a diagnosis of lung cancer presenting to NHS trusts. Data from 146/150 trusts were successfully linked with the National Cancer Action Team (NCAT) census of the LCNS workforce (number, salary grades) for 2011. Multinomial logistic regression was used to calculate the likelihood of being assessed by a LCNS by patients clinical and LCNS workforce at each trust.
Results:
Across 146 NHS trusts there were128,124 patients and 321 LCNSs. LCNS assessment records showed80,113 (62%) patients were assessed, 7,544 (6%) were not assessed, and 40,467 (32%) had missing information on assessment. Missing assessment information was random and not biased to certain types of patients or trust and data completeness increased over the years. Patients (>75 years old), those with poor performance status (i.e. PS 4) and those with comorbidities were less likely to be assessed (adjusted relative risk ratios (RRR) (95% confidence interval) 0.84 (0.75 – 0.93), 0.34 (0.24 – 0.47) & 0.71 (0.63 – 0.79) respectively). There was no difference in assessment rates by socioeconomic groups. Patients who received anti-cancer treatment (surgery, chemotherapy with radiotherapy or chemotherapy alone) were over twice likely to have been assessed by a LCNS compared with those who did not receive treatment 2.09 (1.75 – 2.50), 3.96 (3.11 – 5.04) & 3.45(2.71 – 4.38). Annual LCNS patient caseload did not appear to impact access, but there was an association between assessment and a higher salary grade of the LCNS workforce in a trust (RRR 1.59 (0.86 – 2.92) for trusts with LCNS salary band 7 & 8).
Conclusion:
We found variations in access to LCNSs by both patient and trust a feature, which indicates an unmet need for people with lung cancer in England. To meet the needs of all people with lung cancer and the clear targets set out by NICE, we need to expand the current LCNS workforce and ensure that we retain experienced nurses as LCNS are an integral part of the lung cancer team and provide help to people with lung cancer.
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P1.11 - Poster Session/ Palliative and Supportive Care (ID 229)
- Event: WCLC 2015
- Type: Poster
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.11-013 - Place and Cause of Death in Patients with Lung Cancer in the United Kingdom (ID 2735)
09:30 - 09:30 | Author(s): R.B. Hubbard
- Abstract
Background:
Many patients with cancer die in an acute hospital bed, which has been frequently identified as the least preferred location, with psychological and financial implications. This study aims to look at place and cause of death in patients with lung cancer to identify which factors are associated with dying in an acute hospital bed versus at home.
Methods:
We used data from the National Lung Cancer Audit (NLCA) linked to Hospital Episode Statistics (HES) and Office of National Statistics (ONS) records to determine cause and place of death in those with lung cancer overall. England was divided into 28 cancer Networks at the time these data were collected so we used these to assess geographical variation in place of death. We used multivariate logistic regression to compare demographic, co-morbid and tumour-related factors between those who died in an acute hospital versus those who died at home.
Results:
Of 143627 patients identified 40% (57678) died in an acute hospital, 29% (41957) died at home and 17% (24108) died in a hospice. Individual factors strongly associated with death in an acute hospital bed compared to home were male sex, increasing age, poor performance status, social deprivation and diagnosis via an emergency route (table 1). There was marked variation between cancer Networks in place of death. The proportion of patients dying in an acute hospital ranged from 28% to 48%, with variation most notable in provision of hospice care (9% versus 33%). Cause of death in the majority was lung cancer (86%), with other malignancies, chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD) comprising 9% collectively.
Conclusion:
A substantial proportion of patients with lung cancer die in acute hospital beds and this is more likely with increasing age, male sex, social deprivation and in those with poor performance status. There is marked variation between Networks, suggesting a need to improve end-of-life planning in those at greatest risk, and to review the allocation of resources to provide more hospice beds, enhanced community support and ensure equal access. Figure 1
