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X. Zhi
Moderator of
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ED03 - Global Tobacco Control Policies: Advances & Challenges (ID 266)
- Event: WCLC 2016
- Type: Education Session
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 4
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ED03.01 - Tobacco Control in the Middle East (ID 6437)
14:30 - 14:50 | Author(s): F. Hawari
- Abstract
- Presentation
Abstract:
Despite many countries signing and ratifying the Framework Convention on Tobacco Control (FCTC), the prevalence of tobacco continues to be on the rise in the Middle East. For example, in countries like Jordan and Tunisia, tobacco prevalence among males is close to 5o% and in Jordan specifically it is estimated to increase to 88% over the next 5 years according to the World Health Organization (WHO). In 2008 it was estimated that five million people died due to tobacco related illnesses. This number is expected to increase to eight million in the year 2030 with individuals from low- and middle-income countries making up approximately 80% of these deaths. Tobacco is a risk factor for all major non-communicable diseases (NCDs) such as cardiovascular diseases, cancer, pulmonary diseases and diabetes mellitus. The developing countries and the Middle East in particular is bracing for at least a 25% increase in such diseases over the next few years. The world economic forum estimates that the cost for such chronic disabling diseases will exceed USD 15 trillion with cancer costs specifically reaching close to USD 3 trillion. The WHO outlined six strategies that, when implemented simultaneously, will result in significant reduction in tobacco prevalence and its related morbidity and mortality. Those strategies known as MPOWER (Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship, Raise taxes on tobacco) when implemented in a country like Jordan, for example, close to 180,000 deaths can be prevented over 5 years. Despite the documented benefits of these six strategies, compliance with implementing them across the Middle East remains low. Only few countries have pictorial warnings, exposure to second hand smoke (SHS) is high, tobacco prices remain low and smoking cessation services are scarce. As the population in the Middle East age and with the ongoing rise in tobacco prevalence and obesity, cancer is expected to be on top of the list of diseases causing death and disability in the region. For that reason, King Hussein Cancer Center (KHCC), one of the leading cancer centers in the region, took on the challenge of fighting tobacco across the region in collaboration with regional and international partners. KHCC became the regional host for Global Bridges (an international TDT healthcare alliance co-founded by the Mayo Clinic, the American Cancer Society, and the University of Arizona). The main mission of this collaboration is to address the implementation of article 14 of the FCTC agreement and design and implement effective programmes to promote the cessation of tobacco use and provide adequate treatment for tobacco dependence (TDT). This will also serve to address one of the six strategies recommended by the WHO; Offer help to quit tobacco use. Tobacco dependence in the region is severe. The high number of cigarettes smoked per capita and the significant exposure to SHS make people less capable of quitting on their own. Availing TDT across the region would respond to the high demand for such service (more than 65% of smokers are interested in quitting) and help curb the expected epidemic of NCDs. Long term, quitting tobacco generally reduces the risk of disease and premature death by 90% for those who quit before the age of 30 and by 50% for those who quit before the age of 50. In addition, TDT will optimize the management of certain NCDs such as cancer resulting in better treatment outcomes and long-term survivals. Over the past 5 years, KHCC developed partnership with countries across the Middle East and worked on training healthcare providers (HCPs) on how to treat tobacco dependence (figure 1). More than 2000 HCPS were trained to date (figure 2). Furthermore, 4 hubs designated for TDT training were established in Oman, Egypt, Tunisia and Morocco. In addition, an evidence-based TDT training curriculum specifically designed for the Middle East was developed and in the process of being made available in 3 languages; Arabic, English and French. In conclusion, tobacco dependence represents a major threat to the health and wellbeing of the people in the Middle East. Significant rise in NCDs including cancer is expected over the next few years. Many collaborative initiatives are underway to address this sever epidemic. Figure 1
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ED03.02 - The Australian Tobacco Control Strategy: Lessons Learned (ID 6438)
14:50 - 15:10 | Author(s): M. Daube
- Abstract
- Presentation
Abstract:
This presentation will outline the developments that have led the international tobacco industry to describe Australia as "the darkest market in the world". This will be presented in the context of international developments, with implications and recommendations for other countries, and researchers, clinicians, health professionals,health organisations and governments There will be discussion of the origins and early history of tobacco control in Australia; the components of comprehensive tobacco control programs; policy-relevant research; successes, failures and distractions; and the roles of key organisations and individuals. This will be followed by an outline of major developments, including the establishment of a consensus approach; national and local approaches; activity by key groups; progress across a range of key areas including public education, advocacy, tobacco advertising bans, taxation, health warnings, smoke-free, exposing tobacco industry activities, cessation supports; and other measures. There will be discussion of the Australian world-leading tobacco plain packaging legislation, which is now being replicated in many other countries, and the very encouraging resultant trends. The Australian experience and successes will be presented in a global context, with recognition that the tobacco industry will always oppose any measures that might reduce smoking and is constantly looking for new ways to resist action and promote its products. From this conclusions will be drawn and recommendations made for all concerned to reduce smoking, with consideration of next possible developments.
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ED03.03 - Tobacco Control and Lung Cancer in Africa (ID 6923)
15:10 - 15:30 | Author(s): L. Ayo-Yusuf
- Abstract
- Presentation
Abstract not provided
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ED03.04 - Trumping Big Tobacco (ID 6439)
15:30 - 15:45 | Author(s): B. King
- Abstract
- Presentation
Abstract:
Abstract for IASLC – Vienna conference ‘Trumping Big Tobacco’ Dr. Bronwyn King, CEO Tobacco Free Portfolios I never would have imagined my work as a doctor would take me to corporate boardrooms across the globe, from Melbourne to London, Paris, New York and more. But then I never would have imagined I would be invested in the tobacco industry either. In my early time as a doctor, I did a placement on the lung cancer ward of the Peter MacCallum Cancer Centre in Melbourne. Despite being able to offer the very best medicine available, the majority of my patients died, many of them in their 50’s and 60’s, some as young as 40. It was shocking to bear witness to the true impact of tobacco. Whilst the treatment and care of patients is paramount, we must deal with the source of the problem – tobacco and the companies that manufacturer it. Once I discovered that through my compulsory pension fund, I was invested in and actually owned a part of a several tobacco companies, I couldn’t just do nothing – I had to take action. In my quest to disentangle the Australian pension sector from tobacco I’ve become well informed about tobacco and the extent of the ‘tobacco epidemic’, as it is referred to by the World Health Organisation. The numbers astound me. Six million deaths per year are attributed to tobacco and we are on track for one billion tobacco related deaths this century. Many, including investors (both individual mums and dads as well as big financial institutions), aren’t actually aware of the extent of their tobacco exposure. Tobacco stocks are generally picked up in standard products. Often, tobacco companies have not been selected specifically for investment, but they are wrapped up within default investment products, so they still find a way into your portfolio. I founded Tobacco Free Portfolios to collaboratively engage with leaders of the finance sector to encourage tobacco free investment. Finance executives have been alarmed also, at the scale of the tobacco problem and have deeply considered the role they can play in addressing this pressing global issue. One by one, they have acted and are now proud to lead organisations that are tobacco free. There are now 35 tobacco free pension funds in Australia – just over 40% of all funds. Many more will soon follow. Each tobacco free announcement is met with resounding public support. Tobacco Free Portfolios recently took a global step and we were delighted to work with the global insurance giant AXA who announced a tobacco free decision in May 2016, divesting $1.8B Euro of tobacco assets. More organisations are soon to follow suit. That is the way of the future. Affiliations with the tobacco industry are no longer wanted. There are very few individuals or organisations that actively seek to be a part of the tobacco industry. The associations are often so deep and longstanding that it can seem overwhelming – but they must be addressed and they must be undone. Momentum for tobacco-free investment continues to grow steadily and I can confidently say that the conversation in Australian has largely moved from ‘should we go tobacco-free?’ to ‘how can we go tobacco-free?’ This is a pleasing development and a terrific case study, however, there is still much to do to accelerate action across the globe. The good news is that conversations I have in Vienna, Paris, Singapore, London and New York are received with exactly the same concern as the conversations I have in Melbourne, Sydney and Canberra. The devastating impact of tobacco is felt everywhere on Earth. Tobacco is everyone’s problem, not just the doctors that provide the care and treatment. We should all feel obliged to do something about it and all those with investments, including those through compulsory pension schemes have a role to play. It’s up to us to keep tobacco control on the agenda and in public dialogue. A tobacco free future that will allow our children and the generations to come to enjoy long and healthy lives should be our shared hope. If you are interested in supporting this work, please come along to the Tobacco Free Portfolios workshop on the morning of Wednesday 7[th] December. Further details available at www.tobaccofreeportfolios.org
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Author of
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ED12 - Regional Tobacco Control Policies: Advances & Challenges (ID 281)
- Event: WCLC 2016
- Type: Education Session
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 1
- Moderators:Z. Zain, F. Mihaltan
- Coordinates: 12/07/2016, 11:00 - 12:30, Hall C7
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ED12.04 - Tobacco Control Policies in China (ID 6492)
11:45 - 12:00 | Author(s): X. Zhi
- Abstract
- Presentation
Abstract not provided
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MA11 - Novel Approaches in SCLC and Neuroendocrine Tumors (ID 391)
- Event: WCLC 2016
- Type: Mini Oral Session
- Track: SCLC/Neuroendocrine Tumors
- Presentations: 1
- Moderators:P. Lara, A. Mohn-Staudner
- Coordinates: 12/06/2016, 14:20 - 15:50, Strauss 3
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MA11.09 - Progastrin-Releasing Peptide (ProGRP) to Rule out Progressive Disease in Patients with Small Cell Lung Carcinoma (SCLC) (ID 4002)
15:20 - 15:26 | Author(s): X. Zhi
- Abstract
- Presentation
Background:
For patients with SCLC, response to chemotherapy is monitored by computed tomography (CT) scans, which can be costly and inconvenient. A previous study showed that baseline levels (>100 pg/ml) of the tumor marker, ProGRP, were positively correlated with advanced SCLC, and a decline in ProGRP levels during treatment was associated with response.[1] However, the best approach to fully exploit ProGRP for monitoring treatment response is still unknown. The objective of this study was to determine if progression could be ruled out solely by combining the changes in ProGRP levels over two chemotherapy cycles.
Methods:
Patients with SCLC receiving first-line platinum-based doublet chemotherapy or a single-agent cytotoxic in any subsequent treatment line were included from six centers in Europe and China. Samples were collected prospectively and ProGRP levels were measured in serum or plasma samples using a fully automated ProGRP assay at baseline and after chemotherapy cycles 1 and 2. Only patients with blood samples taken at these time points and with elevated baseline ProGRP >100 pg/ml were eligible for this analysis. A logistic regression model was calculated to incorporate changes after the first cycle (i.e. from baseline to the end of cycle 1) and in between cycles (i.e. end of cycle 1 to the end of cycle 2). Progression was ascertained with CT scans. A non-progressor was defined as a patient with complete response, partial response, or stable disease, according to the RECIST v1.1 or WHO criteria. Progressors were patients with progressive disease only.
Results:
Overall, 123 patients (n=108 non-progressors, n=15 progressors) satisfied the eligibility criteria. Median age was 62.0 years (range 36.0–83.0), 56% were male, and 78% reported to be current or past smokers. In this population, a decline in ProGRP from both baseline to cycle 1 and from cycle 1 to cycle 2 was associated with non-progression (AUC 91.5%; 95% CI: 85.3−97.8; sensitivity 100%; specificity 71%). All patients who experienced a >25% relative decline in ProGRP levels after the first chemotherapy cycle, followed by any further decrease (>0%) after the second cycle, were found to be non-progressors.
Conclusion:
By measuring the change in ProGRP levels at baseline and after each of the two subsequent chemotherapy cycles, we were able to identify patients with non-progressive disease. This might reduce the need for interim CT scans. References 1. Muley, et al. Journal of Thoracic Oncology 2015; 10(9) Supplement 2:MINI27.13
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