Author of

• 16751

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  P1.05 - Poster Session with Presenters Present (ID 457)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Early Stage NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 16818

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    P1.05-067 - Consultation with Medical Oncology Less Common in Elderly Patients with Resected Stage II Nonsmall Cell Lung Cancer (ID 4679)

    14:30 - 14:30  |  Author(s): A. Farrelly
    • Abstract

    Background:
    Adjuvant chemotherapy (AC) is guideline recommended standard of care for resected Stage II NSCLC patients in Ontario. Despite evidence of a significant survival benefit, uptake of AC has been lower than expected and has remained unchanged since 2008 at 50-55%. Factors that may preclude use of chemotherapy include comorbid medical conditions, socioeconomic and demographic factors and the opportunity for consultation with a medical oncologist (MO). This study evaluated: 1) patient opportunity for a consultation with a MO, and 2) differences between patients who had a consultation and those who did not.
    
    Methods:
    Stage II NSCLC adult patients diagnosed between 2010 and 2013 were identified using the Ontario Cancer Registry. Complete surgical resections and consultation with a MO were identified using multiple administrative databases. Receipt of guideline-recommended AC within 120 days after resection, and consultation with MO within 30 days prior and 90 days after resection were determined. Guideline-recommended AC includes platinum based regimens, including receipt outside a Regional Cancer Center (RCC). Alternative treatments were defined as non-platinum based chemotherapy or radiotherapy. Socioeconomic and demographic characteristics were compared between patients who received a consultation and those who did not. Characteristics associated with receiving a consultation were assessed using univariable analysis and multivariable logistic regression.
    
    Results:
    Of 778 Stage II resected NSCLC patients who survived at least 120 days, 40.9% (n=318, CI: 37.40–44.42) received guideline-recommended AC, 3.0% (n=23, CI: 1.70-4.40) received alternative treatment in an RCC, 11.2% (n=87, CI:8.95-13.50) received chemotherapy outside of an RCC hospital, and 45.0% (n=350, CI:41.45-48.56) of patients did not have systemic treatment after surgery. Overall, 72.9% (n=567) of patients had a consultation with a MO within 30 days prior or 90 days after resection. Of 350 patients who did not receive AC, 219 (62.6%) had a MO consultation. Median time from resection to consultation was 29 days, and did not differ between treatment groups (p=0.35). Age was a significant determinant for MO consultation. Adjusting for sex, patients aged 41-60yrs (OR 2.38, CI:1.25-4.56) and 61-70yrs (OR 2.46, CI:1.35-4.49) were significantly more likely to have a consultation versus patients >80 yrs. Other characteristics were not significantly associated with having a consultation.
    
    Conclusion:
    Although uptake of guideline-recommended AC is lower than expected (52.1%, CI:48.48-55.62), the majority of patients had an opportunity to discuss this treatment option with a MO. Patients over 80yrs were significantly less likely to have this consultation.