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A.K. Ganti



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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
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      P1.07-046 - Uptake of Recommended Treatment in Small Cell Lung Cancer: Trend over the Last 15 Years and Risk Factors (ID 6326)

      14:30 - 14:30  |  Author(s): A.K. Ganti

      • Abstract

      Background:
      Despite the dismal outcomes of small-cell lung cancer (SCLC), the fact that SCLC patients are generally responsive to treatment emphasizes the importance of adherence to recommended treatment. This study analyzed the trend in treatment provision in SCLC over the last 15 years and its associated factors.

      Methods:
      A total of 207,375 adult patients diagnosed with SCLC between 1998 and 2012 in the United States were identified from the National Cancer Data Base. In this study, recommended treatment was defined as surgery and/or chemoradiation for the limited stage (LS-SCLC), regardless of sequence; and chemotherapy for the extensive stage (ES-SCLC). We excluded patients who did not receive treatment due to a contraindication. Logistic regression was used to analyze the risk of not receiving recommended treatment, adjusted for socio-demographics, facility type, and clinical factors. Kaplan-Meier estimator was used to estimate patients’ survival.

      Results:
      Between 1998 and 2012, the proportion of patients receiving recommended treatment increased among LS-SCLC patients (63% to 73.4%), but was unchanged in ES-SCLC (75.7% to 76.6%). Nevertheless, a significant proportion of patients did not receive recommended treatments. Older age, low income, use of non-private insurance or no insurance, higher comorbidity score, and diagnosis and/or treatment at a community cancer program were independent predictors of inadequate treatment for both LS-SCLC and ES-SCLC, while Black race was a predictor only in LS-SCLC. For instance, compared to patients with private insurance, the odd ratios of uninsured patients not receiving recommended treatment or no treatment was 1.7 (95% CI 1.543-1.932) in LS-SCLC and 1.9 (95% CI 1.751-2.060) in ES-SCLC patients. Both LS-SCLC and ES-SCLC patients aged 65-74 years had 1.5 (95% CI for LS-SCLC: 1.402-1.587; 95% CI for ES-SCLC: 1.454-1.613) times higher odds of not receiving recommended treatment or no treatment, compared to younger patients. In both groups, patients who received recommended treatment had better survival than those who did not receive recommended treatment or any treatment (median survival time of 18.4 vs. 6 months in LS-SCLC; 8.3 vs. 1.2 months in ES-SCLC).

      Conclusion:
      This study demonstrated an increase in the uptake of recommended treatment in LS-SCLC, but relatively no change in ES-SCLC. Reasons for not receiving recommended treatment warrant further investigation. The survival benefit among patients with recommended treatment highlights the need to alleviate any system-based barriers that may impact more patients receiving recommended treatment.

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      P1.07-047 - Refusal of Chemoradiotherapy and Chemotherapy among SCLC Patients: Analysis of US National Facility-Based Data (ID 5360)

      14:30 - 14:30  |  Author(s): A.K. Ganti

      • Abstract

      Background:
      Less than 7% of small cell lung cancer (SCLC) patients survive five years after diagnosis. Although receipt of recommended treatment is a key to survival, factors associated with treatment refusal have not been well studied in SCLC. Our study examined factors associated with treatment refusal by SCLC patients and effect of refusal on survival.

      Methods:
      We analyzed data of 114,004 SCLC patients diagnosed between 2003 and 2012 from the National Cancer Data Base. Analyses were conducted separately for refusal of chemoradiotherapy among limited stage (LS) and refusal of chemotherapy among extensive stage (ES) patients. We used multivariable logistic regression to investigate factors associated with treatment refusal and calculated median survival using Kaplan-Meier method.

      Results:
      There was a female preponderance among LS (56%), whereas 52% of ES patients were male (p <.001). Majority of the LS patients received chemoradiotherapy (67%), and ES patients received chemotherapy only (44%) as their first-course treatment. Refusal of chemoradiotherapy among LS patients was 2%, and refusal of chemotherapy among ES patients was 5%. On multivariable analysis, patient diagnosed at age >70 years were more likely to refuse treatment compared to those age 50-70 years; the adjusted odds ratio (AOR) was 3.39 (95% CI: 2.68-4.28) for refusal of chemoradiotherapy among LS patients and 2.54 (95% CI: 2.28-2.84) for refusal of chemotherapy among ES patients. Females were more likely to refuse recommended treatment than males, the AOR was 1.34 (95% CI: 1.09-1.65) for refusal of chemoradiotherapy and 1.29 (95% CI: 1.17-1.42) for refusal of chemotherapy. Compared to those with private insurance, uninsured patients were more likely to refuse chemoradiotherapy (AOR= 2.70, 95% CI: 1.49-4.91) and chemotherapy (AOR=2.26, 95% CI: 1.76-2.91). Patients with comorbid conditions were more likely to refuse recommended treatment compared to those without comorbidity; the AOR was 1.66 (95% CI: 1.33-2.07) for refusal of chemoradiotherapy and 1.37 (95% CI: 1.23-1.53) for refusal of chemotherapy. Median survival of LS patients who received and refused chemoradiotherapy was 18 and 3 months respectively (p <.001). Among ES patients, median survival was 8 months for those who received chemotherapy and 1 month for those who refused (p <.001).

      Conclusion:
      Although treatment refusal was uncommon, older age at diagnosis, female, uninsured status, and comorbid conditions were associated with higher treatment refusal. These factors should be specially addressed in patient-provider communication and patient-education. Interventions targeting these issues will increase acceptance of recommended treatment and ultimately will improve patient outcomes.

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    P2.03b - Poster Session with Presenters Present (ID 465)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P2.03b-048 - Access to Biomarker Testing in Patients with Advanced Non-Small Cell Lung Cancer (ID 4461)

      14:30 - 14:30  |  Author(s): A.K. Ganti

      • Abstract

      Background:
      Access to biomarker testing is critical for selecting appropriate treatment for patients with advanced non-small cell lung cancer (aNSCLC). This study assessed rates and patterns of biomarker testing among patients with aNSCLC.

      Methods:
      Patients aged ≥65 years diagnosed with aNSCLC between 2007-2011 were identified in the SEER-Medicare database and were followed for ≥4 months post-diagnosis (n = 9,651). Patients’ first biopsy within ±8 weeks of diagnosis was defined as the index date. Biomarker tests included procedure codes for gene analyses to test for EGFR, ALK, and other mutations. IHC tests, which are mostly used for diagnosis, were excluded. The use of biomarker tests was assessed from the index date until the end of data availability (12/31/2013) or end of Medicare Parts A, B and D eligibility. Analyses were replicated in the subgroup with cancer stages IIIB-T4 or IV and adenocarcinoma, adenosquamous or unknown type of NSCLC histology (n = 6,193).

      Results:
      Of 9,651 patients observed for a median of 11 months, 18% had a biomarker test during the follow-up. The use of biomarker testing increased from 5% in 2007 to 35% in 2011, and was higher among patients who saw a cancer specialist as compared to those who did not see a cancer specialist. When comparing the patients with and without a biomarker test diagnosed in 2011 (i.e., the most recent year in the data) in the full study sample, a higher proportion of patients without a biomarker test were males (51 vs 43%), non-Hispanic Blacks (13 vs 5%), resided in areas with higher poverty (27 vs 15%) and lower education levels (26 vs 17%), and had larger tumors at diagnosis (median 41 vs 38 mm; p <.05 for all). In addition, a lower proportion of them were married (44 vs. 52%), resided in big metropolitan areas (51 vs 57%), had stage IV cancer (64 vs 69%), and adenocarcinoma histology at diagnosis (43 vs. 77%; p <.05 for all). Among tested, >40% of the patients had their first biomarker test >8 weeks after biopsy. Results were similar in the subgroup, but the rate of biomarker testing was slightly higher and with slightly shorter delays.

      Conclusion:
      Among patients with aNSCLC diagnosed in 2007-2011 a substantial proportion did not undergo biomarker testing or had their biomarker test delayed by >8 weeks post-biopsy. Significant differences exist in demographic and cancer characteristics between patients with and without a biomarker test.