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G. Darling
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P1.03 - Poster Session with Presenters Present (ID 455)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.03-059 - Organized High Risk Lung Cancer Screening in Ontario, Canada: A Multi-Centre Prospective Evaluation (ID 6086)
14:30 - 14:30 | Author(s): G. Darling
- Abstract
Background:
Guidelines published in Ontario Canada in 2013, recommend screening individuals at high risk of lung cancer with low-dose computed tomography through an organized program. Cancer Care Ontario, Ontario’s provincial cancer agency, is implementing a prospective evaluation of organized high risk lung cancer screening (HRLCS) in a 2-year, multi-centre pilot. The pilot evaluation aims to inform: · Recommendations to Ontario’s Ministry of Health and Long Term Care regarding the potential for a provincial program · Optimal program design and requirements for effective implementation
Methods:
The process to establish a robust evaluation plan for the HRLCS pilot included the development of a logic model, evaluation objectives and evaluation questions. Input from a multidisciplinary panel of experts, including clinicians, epidemiologists, and administrators guided the development of the evaluation plan. A modified Delphi technique facilitated panel input on the proposed evaluation questions, which were drafted based on the logic model and evaluation objectives, and aligned to the steps in the screening pathway. Panel members rated the importance of each evaluation question through an online survey using a 5-point Likert scale, and proposed changes or additional questions. A question was retained if >75% of panel members rated it as important or very important. A facilitated discussion post survey enabled a review of survey results to confirm consensus on the final set of evaluation questions.
Results:
The survey was completed by all panel members. Of 32 evaluation questions proposed, 31 were rated as important or very important by more than 75% of respondents. Endorsed questions addressed both screening processes and key outcomes, and included, for example: · Did recruitment strategies engage individuals representative of the eligible population? · Did the follow-up processes occur as intended? · Did screening identify early stage lung cancers? Panel discussion led to retention of the single question that did not meet the threshold, and the addition of one new question to the evaluation plan. Given consensus was achieved, a second round modified Delphi survey was not required.
Conclusion:
Using an expert panel and modified Delphi technique was an effective method to obtain consensus on the pilot evaluation questions. Endorsed evaluation questions will frame the development of measures and indicators to be assessed throughout the pilot. This comprehensive evaluation strategy will inform the design and implementation of a high quality organized HRLCS screening program.
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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: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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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): G. Darling
- 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.
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P1.05-068 - Elderly Patients with Resected Stage II Nonsmall Cell Lung Cancer Are Less Likely to Have a Consultation with a Medical Oncologist (ID 4814)
14:30 - 14:30 | Author(s): G. Darling
- 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.
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P1.07 - Poster Session with Presenters Present (ID 459)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: SCLC/Neuroendocrine Tumors
- Presentations: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.07-016 - Trends, Practice Patterns and Underuse of Surgery in the Treatment of Early Stage Small Cell Lung Cancer (ID 4070)
14:30 - 14:30 | Author(s): G. Darling
- Abstract
Background:
Current National Comprehensive Cancer Network guidelines recommend pathologic mediastinal staging and surgical resection for all patients with clinically node negative T1 and T2 small cell lung cancer (SCLC), but the extent to which surgery is used for early stage SCLC is unknown.Our obejctive was to assess trends and practice patterns in the use of surgery for SCLC.
Methods:
Clinical stage T1 or T2N0M0 SCLC cases were identified in the National Cancer Database (NCDB), 2004 – 2013. Demographics and clinical characteristics of patients undergoing resection were analyzed. Hierarchical logistic regression was used to identify individual and hospital-level predictors of receipt of surgical therapy. Trends in the rates of surgical resection for eligible patients were analyzed over the study period.
Results:
9,740 patients were identified with a diagnosis of clinical T1 or T2 N0M0 SCLC. Of these, 2,210 underwent surgery (22.7%), with 1,421 (64.3%) of these patients undergoing lobectomy, 739 (33.4%) sublobar resections and 50 (2.3%) pneumonectomies. After adjustment for clinical, demographic and facility characteristics, Medicaid patients were less likely to receive surgery (OR0.65 95% CI 0.48 – 0.89, p=0.006), as were those with T2 tumors (OR0.25 CI0.22 – 0.29, p<0.0001). Academic facilities were more likely to resect eligible patients (OR 1.90 CI1.45 – 2.49, p<0.0001). Between 2004 and 2013, rates of resection more than doubled from 9.1% to 21.7%. Overall, 68.7% of patients were not offered surgery despite having no identifiable contraindication. In patients not receiving surgery, only 7% underwent pathologic mediastinal staging.Figure 1
Conclusion:
Although rates of resection are increasing, surgery is rarely used nationally in the treatment of potentially eligible SCLC patients. About two thirds of potentially eligible patients fail to undergo potentially curative surgery. Further study is required to address the lack of concordance between guidelines and practice.
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P1.07-017 - Indications for Adjuvant Mediastinal Radiation in Surgically Resected Small Cell Lung Cancer (ID 4073)
14:30 - 14:30 | Author(s): G. Darling
- Abstract
Background:
Adjuvant mediastinal radiation (AMR) is an adjunctive therapy for patients with surgically resected small cell lung cancer (SCLC). However, little data guides its use. We sought to examine whether there was a survival benefit associated with AMR for resected SCLC patients and to define sub-populations who should be selected for AMR.
Methods:
Patients undergoing resection (lobectomy, pneumonectomy and sublobar resection) for SCLC were identified in the National Cancer Database, 2004 – 2013. Kaplan-Meier survival curves and Cox proportional hazards were used to evaluate the impact of receipt of AMR on survival. Hazard ratios were adjusted for patient comorbidity and demographic information, as well as tumor stage, grade, histology, margin status and receipt of adjuvant chemotherapy.
Results:
3,113 patients were identified. Those receiving AMR were younger, more likely to have greater pathologic T- and N- stage, more likely to undergo sublobar resection and have a positive margin. Kaplan-Meier curves showed better median survival for patients with N1-3 disease who received AMR. After adjustment, Cox models showed lower risk of death for N1, N2/3 and sublobar resection with AMR (HR0.79 CI0.65 – 0.96, p=0.02; HR 0.60 CI0.48 – 0.75, p<0.0001). In the overall cohort, AMR was not associated with better survival in node-negative patients. AMR was, however, associated with improved survival for patients receiving sublobar resection (HR0.72 CI0.58 – 0.92, p=0.006).Figure 1
Conclusion:
AMR has significant benefit for node-positive patients after resection for SCLC, especially those with pN2 or pN3. Patients undergoing sublobar resection may benefit from AMR.
