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M.K. Doherty



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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-008 - The Impact of Brain Metastases and Their Treatment on Health Utility Scores in Molecular Subsets of Lung Cancer Patients (ID 4348)

      14:30 - 14:30  |  Author(s): M.K. Doherty

      • Abstract

      Background:
      New therapies, particularly in advanced patients with EGFR-mutated and ALK-rearranged tumors, result in prolonged survival. Brain metastases and/or their treatment, may have a negative impact on health-related quality of life. Technological assessment of the cost-effectiveness of various treatments for brain metastases will benefit from measurements of health-related qualify of life and health utility scores (HUS). This study evaluated the impact of brain metastases on HUS across multiple health states defined on the basis on disease stability, brain-specific therapies, and molecularly-defined subsets of NSCLC.

      Methods:
      A longitudinal cohort study at Princess Margaret Cancer Centre evaluated 1571 EQ5D-3L-derived HUS in 476 Stage IV lung cancer outpatients, from Dec, 2014 through May, 2016: EGFR+ (n=183), ALK+ (n=38), wild-type (WT) non-squamous (n=171), squamous (n=29), and small cell lung cancer (SCLC) (n=30). Patients were stratified according to presence or absence of brain metastases at the time of assessment; mean HUS (± standard error of the mean, SEM) by presence of brain metastases and various health states and disease subtypes were reported. For patients with repeated measures, only the earliest time point was analyzed.

      Results:
      172 patients had brain metastases, median age 62, (range 32-86) years and 304 patients did not have brain metastases, median age 66 (29-96) years. Overall HUS was related to disease subtype but not presence of brain metastases: EGFR/ALK+ patients with (0.78±0.02) or without brain metastases (0.79±0.01) versus WT/SCC/SCLC with (0.74±0.02) and without brain metastases (0.73±0.01) (p=0.01 by subtype; p>0.10 by presence of brain metastases). However, symptomatic CNS disease (0.69±0.04) had lower HUS (versus asymptomatic disease (0.77±0.02)) (p=0.03). Patients achieving intracranial stability or response to treatment had significantly higher HUS (0.81±0.05) than patients with progressive CNS metastases (0.72±0.02) (p=0.03). Extra-cranial control also correlated with higher HUS (0.81±0.02 versus 0.69±0.03, p<0.0001). When local treatment for brain metastases was delivered within 6 months, HUS was lower (0.71±0.02 versus 0.82±0.02, p=0.0005). CNS disease treated only with systemic therapy or on no active therapy had mean HUS of 0.81±0.03, while patients treated only with stereotactic radiosurgery (SRS) had values of 0.80±0.04; there was a trend for lower HUS with whole brain radiation (WBRT) only (0.72±0.03) or WBRT+SRS (0.74±0.03) (p=0.11).

      Conclusion:
      Brain metastasis stability has significant impact on HUS in lung cancer patients. Treatment modalities of brain metastases may also impact HUS. Data collection is ongoing; updated HUS data including longitudinal assessments and multivariable analyses will be presented.

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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
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      P2.08-001 - Giving a Voice to Patients and Caregivers through the Lung Cancer Canada ‘Faces of Lung Cancer’ Survey (ID 4340)

      14:30 - 14:30  |  Author(s): M.K. Doherty

      • Abstract

      Background:
      Lung cancer (LC) is a major cause of cancer death, morbidity and loss of function. Caregivers of LC patients provide emotional, physical, and financial support, but their contribution is under-reported. The Lung Cancer Canada (LCC) Faces of Lung Cancer Survey aimed to study the impact of LC diagnosis and treatment on patients and caregivers.

      Methods:
      This 15-minute online survey for patients and caregivers was conducted in August 2015. Participants were recruited from a database of patients and caregivers, who previously consented to survey participation; targeted emails, social media postings and other patient groups were also utilized. The questionnaire covered demographics, emotional issues and stigma, symptom burden, quality of life, treatment experiences, and unmet needs. Anonymously collected results were collated by LCC.

      Results:
      Overall, 91 patients and 72 caregivers completed 163 interviews. Of surveyed patients, 57% had no active cancer. Fatigue, depression, and respiratory complaints were the most challenging symptoms for patients. Fear/uncertainty was reported as the hardest thing about LC by 40% of patients and 17% of caregivers. Most caregivers were partners (54%) or parents (38%). 60% were the primary caregiver, and 79% were former caregivers: 68% of their care receivers had died. Most caregivers coped well (79%), but stressors included care-receiver’s declining health, their own emotions, and balancing responsibilities. Caregivers reported more negative feelings than patients: anxious/stressed 61%v42%, depressed/hopeless 32%v11%, cared for 13%v38%, confident/encouraged 11%v25%. Caregivers felt less support than patients from their healthcare team (75%v92%) and family/friends (65%v87%). Treatment satisfaction was lower among caregivers: only 58% felt very/somewhat satisfied (v 82% patients). 60% of patients and 68% of caregivers reported a negative stigma attached to LC. 35% of respondents felt there was less empathy toward LC than other cancers, and 38% of caregivers felt they had to advocate harder for LC than other cancers. Notably, some caregivers (8%) and patients (5%) reported a lack of compassion from medical professionals after a LC diagnosis. 37% of patients and 50% of caregivers reported a negative household financial impact from LC diagnosis.

      Conclusion:
      This report on the experiences of lung cancer patients and their caregivers highlights their reactions to the illness, and the associated prejudice and stigma. Lung Cancer Canada is working to improve patient access to supportive services, to decrease caregiver burden through support initiatives such as peer-to-peer support programs, to educate patients and caregivers on LC and their treatment options, and to advocate for LC patients in the face of established stigma.