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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)

  • 14339

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    P2.01-033 - Patients with Advanced NSCLC Requiring Inpatient Oncology Consultation (ID 504)

    09:30 - 09:30  |  Author(s): J. Gotfrit
    • Abstract
    • Slides

    Background:
    Most newly diagnosed advanced lung cancer patients have an initial medical oncology consult as an outpatient. However, occasionally the initial referral occurs as an inpatient. We explored the characteristics of advanced NSCLC patients whose first medical oncology consultation occurred while hospitalized.
    
    Methods:
    With ethics approval, we performed a retrospective analysis of all advanced NSCLC patients at our institution whose initial consult occurred while hospitalized, from 2007 to 2012. Demographics, treatment and survival data were collected. This was an exploratory analysis. Multivariate survival analysis was performed using Cox regression models.
    
    Results:
    In total, 223 patients were included (baseline characteristics in Table 1). Overall, only 24% received chemotherapy while 72% received some palliative radiotherapy. Median time from diagnosis to chemotherapy was 43 days. Reasons for not receiving chemotherapy included poor performance status (PS) (72%), patient choice (9%), clinical deterioration (6%) or co-morbidities (4%). Factors associated with receiving chemotherapy were good PS (OR 11.11 [95% CI 5.56-25.00], p<0.001), no constitutional symptoms (OR 2.86 [95% CI 1.41-5.88], p=0.004), no leukocytosis (OR 2.38 [95% CI 1.23-4.55], p=0.01), fewer co-morbidities (OR 1.54 [95% CI 1.27-1.89], p<0.001) and younger age (OR 1.09 [95% CI 1.05-1.12], p<0.001). Median OS was shorter in those not receiving chemotherapy (1.7 v 7.1 months, HR 2.76 [95% CI 1.72-4.41], p-value<0.001). Figure 1 shows Kaplan-Meier survival curves. In multivariate analysis, in addition to not receiving chemotherapy, factors associated with shorter OS were PS 3-4, (HR 1.55 [CI 1.03-2.33, p=0.04]), leukocytosis (HR 2.23 [95% CI 1.51-3.28], p-value <0.001) and thrombocytosis (HR 1.52 [1.06-2.18], p=0.02).
    
    Conclusion:
    Patients whose first consultation with medical oncologists occurs while hospitalized are an inherently sick population and only a minority receive chemotherapy. The lung cancer community must advocate for earlier diagnosis and referral, so more patients have access to treatment options before a terminal functional decline.

    Table 1: Baseline Characteristics

    Demographic (N=223)	%
    Age in years, median (range)	65 (23-89)
    Gender
    Male	48
    Female	52
    Charlson Comorbidity Index total score, median (range)	10 (6-18)
    Performance status
    0-2	24
    3-4	69
    Unknown	7
    Smoking status
    Current	49
    Ex	34
    Never	9
    Unknown	8
    Stage at diagnosis
    IIIB	10
    IV	89
    Unknown	1
    NSCLC subtype
    Adenocarcinoma	45
    Squamous cell	23
    Large cell	8
    Other	23
    Dominant presenting symptom
    Dyspnea	34
    Pain	23
    Constitutional symptoms	9
    Pneumonia	7
    Cough	5
    Hemoptysis	3
    Other	18
    Weight loss
    <5%	22
    >5%	52
    Unknown	25

    Figure 1
    
    
    
    

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