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L. Backhus
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P1.08 - Poster Session with Presenters Present (ID 460)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.08-033 - Effect of EGFR Mutations on Survival in Patients following Surgical Resection of Lung Adenocarcinoma (ID 4938)
14:30 - 14:30 | Author(s): L. Backhus
- Abstract
Background:
While numerous trials have evaluated the effects of EGFR mutations on survival in patients undergoing treatment with tyrosine kinase inhibitors (TKIs), research on the influence of EGFR mutations in patients undergoing surgical resection as their primary intervention is limited and conflicting. We hypothesized that patients with resectable EGFR-mutant tumors have a better postoperative prognosis than those with wild-type (WT) tumors, as EGFR-mutant tumors often include an in-situ component that portends an improved prognosis. We further hypothesized that the two most common EGFR mutations may impact post-resection prognosis differentially.
Methods:
We carried out a single-center, retrospective study evaluating the influence of EGFR mutation status on progression-free (PFS) and overall survival (OS) after resection, adjusting for tumor stage and ethnicity. Kaplan-Meier plots and Cox proportional hazard models were used to generate crude and adjusted hazard ratios.
Results:
249 patients underwent lung adenocarcinoma resection and had mutational analysis and ≥1 year of follow-up at our institution between 2008-2015. These resections included 200 lobectomies, 12 segmentectomies, and 32 wedge resections. Ninety-three (37.3%) patients had EGFR-mutant tumors. Relative to WT tumors, EGFR-mutant tumors were more likely to exhibit well-differentiated (44.0% vs 29.0%, p=0.009) or lepidic (61.3% vs 36.5%, p <0.0001) histology, and trended towards presenting as pathologic stage IA/IB (p=0.082). EGFR mutation improved crude OS (HR 0.39, 95% CI 0.159-0.931, p=0.034), but this difference became nonsignificant when adjusted for tumor stage and ethnicity (OS HR 0.549, 95% CI 0.200-1.508, p=0.245). PFS did not differ between mutant and WT cohorts (adjusted HR 0.94, 95% CI 0.550-1.603, p=0.817). In comparing L858R and Exon 19, neither PFS (adjusted HR 0.91, 95% CI 0.350-2.379, p=0.851) nor OS (HR 0.88, HR 0.160-4.790, p=0.879) significantly differed. Lastly, sublobar resection did not interact with EGFR mutation presence to affect PFS (interaction p-value=0.735) or OS (interaction p-value=0.771).
Conclusion:
Patients with EGFR-mutant adenocarcinomas exhibit improved crude post-resection OS vs. those with WT tumors, but this difference disappears after adjustment for tumor stage and ethnicity. These findings appear attributable to EGFR-mutant tumors presenting at earlier stages. We hypothesize that this occurs because lepidic tumors spend a longer phase in stage I before developing a more aggressive phenotype. Our finding that EGFR mutation status does not interact with resection extent (sublobar vs. ≥ lobar) suggests that mutation status should not affect surgical planning prior to resection.
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P2.08 - Poster Session with Presenters Present (ID 491)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Patient Support and Advocacy Groups
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.08-004 - The Importance of Patient Recall within Cancer Survivorship Care for Improved Post-Treatment Surveillance in Lung Cancer Survivors (ID 3794)
14:30 - 14:30 | Author(s): L. Backhus
- Abstract
Background:
Despite widespread endorsement of survivorship cancer care plans, fewer than half of all National Cancer Institute Cancer Centers use them routinely. This may be due to inconsistent evidence linking survivorship care plans and improved cancer outcomes. We sought to examine the association between two specific survivorship care elements and patient reported quality of life and post-treatment cancer surveillance.
Methods:
We studied adults with Stage I or II non-small cell lung cancer having undergone surgical resection (2010-2013). The two survivorship care elements of interest were defined as cancer treatment summary and surveillance plan documentation assessed via chart abstraction. Patient recall of treatment summary was further assessed by patient interview. Patient reported quality of life was assessed via telephone interview using the Functional Assessment of Cancer Therapy-Lung (FACT-L) validated survey instrument. Surveillance imaging was defined as chest CT performed 6 months following resection per NCCN guidelines and was assessed via chart abstraction. Median scores from FACT-L and subscales were compared using non-parametric equality of medians test for univariate analysis and linear regression for multivariable analysis. Surveillance rates were compared using logistic regression. All data were analyzed in STATA 13.
Results:
A total of 24 patients were interviewed at a median of 9.4 months [Interquartile range 2.8 months] following treatment and 16 patients consented for chart abstraction. For survivorship care elements, 77% of patients had a documented treatment summary, however only 30% of patients recalled receiving a treatment summary when interviewed. A surveillance plan was documented for 50% of patients. For patient reported quality of life, FACT-L total and subscale scores did not differ based on chart documentation of surveillance plan, treatment summary or patient recall of treatment summary. A total of 37% of patients received a post-treatment surveillance CT by 6 months in accordance with guideline recommendations. Chart documentation of surveillance plan was not associated with a difference in receipt of surveillance imaging however, patient recall of treatment summary was associated with increased odds of receipt of surveillance CT (OR 21.25 [95%CI 2.36-191.59, p=0.006) which persisted following adjustment for covariates (OR 24.45 [1.10-543.27], p=0.043).
Conclusion:
There is a disconnect between documentation of survivorship care and patient recollection of receiving the intended information. This study suggests that efforts aimed at improving the transfer and retention of information might lead to greater adherence to guidelines and receipt of quality cancer care.
