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Maria Teresa Ruiz Tsukazan
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P1.06 - Epidemiology/Primary Prevention/Tobacco Control and Cessation (ID 692)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.06-020 - Unequal Access to Health Care System Have a Higher Impact in Upgrading Staging for 8th TNM Ed (ID 10239)
09:30 - 09:30 | Presenting Author(s): Maria Teresa Ruiz Tsukazan
- Abstract
Background:
Lung cancer is the leading worldwide cancer related death. Recently, 8[th]edTNM lung cancer was published, changing prognosis. Brazil provides free public healthcare system(SUS); however, we believe access is unequal. 25% of population has private healthcare insurance(SHS). Our objective was to evaluate the impact of the new staging and overall survival comparing patients from SUS and SHS.
Method:
Restrospective analysis of primary lung cancer patients resected between 2011 and 2016. Pathological was classificated according to 8[th]ed TNM. Proportional odds model was used to compare staging and healthcare system,Kaplan-Meier and Log-Rank test for survival analysis.
Result:
267 patients underwent surgery for lung cancer. 52.6%(139)were females, 64.5yo(SD=10.06), adenocarcinoma(60.7%) and 61%(163)from SUS. The upgrade in staging for the current system(8[th]) was significantly higher for SUS(graphic 1)(OD1.55– 95%CI1.00-2.39). Overall median survival was 61months regardless staging, with SHS better survival(p=0.080),graphic 2.Figure 1Figure 2
Conclusion:
Lung cancer new staging is more precise predicting prognosis. An upstaging was expected with new TNM classification. However, a patient from SUS has a 55% higher chance than private care patients of being upstaged not only in T descriptor but also in final staging TNM. Also, SUS had a lower survival tendency. We need to review and address our unequal healthcare system in order better assist our patients.
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P1.16 - Surgery (ID 702)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.16-028 - Is Video-Assisted Thoracic Surgery a Safer Procedure for Lung Cancer Patients? (ID 10442)
09:30 - 09:30 | Presenting Author(s): Maria Teresa Ruiz Tsukazan
- Abstract
Background:
Video-assisted anatomical lung resections(VATS) have been increasingly performed worldwide for lung cancer with excellent results. Nonetheless, no comparative analysis has been done in Latin America where we find a different mix of cases when compared to the US or Europe. The purpose of this study was to compare the outcomes of VATS versus open thoracotomy (OT) for anatomical lung resection in patients from the Brazilian Society of Thoracic Surgery (BSTS) database.
Method:
This study was a propensity score analysis of 728 lung cancer patients who underwent anatomic lung resections (358 thoracotomies and 370 VATS) registered in the BSTS database from its inception in August 2015 until May 2017. Pneumonectomies were excluded for analisis purposis A propensity-score model was built using the following baseline characteristics: age at surgery, gender, BMI, comorbidities, type of resection, staging. The main outcomes were mortality, complications and major cardiopulmonary complications.
Result:
Overall in hospital mortality was significant higher in OT(3.6%) in comparison to VATS(0.8%) (OD=4.75, 95%CI=1.28-17.62). Major cardiopulmonary complications were more frequent in patients who underwent OT (17.3%) in comparison to VATS (13%) (OR=1.32; 95%CI:0.85-2.05), but not significant. When analyzing all complications, both technics were similar (OD=1.08, 95%CI0.77-1.51). Figure 1
Conclusion:
In Brazil, minimally invasive surgery (VATS) for anatomic lung resections is associated with a significantly lower rate of mortality when compared to conventional thoracotomy.
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P2.13 - Radiology/Staging/Screening (ID 714)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.13-022 - Lung Nodule Survey: One Pathology, Perspectives from Thoracic Surgeon, Pulmonologist and Radiology Point of View (ID 10408)
09:30 - 09:30 | Presenting Author(s): Maria Teresa Ruiz Tsukazan
- Abstract
Background:
Screening program for lung cancer are leading for more incidental lung nodules diagnosis.This study aimed to address the lung nodule management from different specialty perspective working in different settings. This is the first survey uniting national societies in Brazil and in Latin America.
Method:
A web-based survey was developed by thoracic surgeons, pulmonologists and radiologists to evaluate lung nodule perception and management. This survey was sent to their respective national societies members and answers collected between August and December 2016. That included multiple choice questions regarding age, specialty, lung nodule management, accessibility to exams and interventional procedures characterizing public (SUS) and supplementary(SHS) working settings.
Result:
A total of 461 questionnaires were answered. More than half of participants live in cities with over one million population. Specialties were reasonable equilibrated with 43.5% radiologists, 33.5% thoracic surgeons, 20.3% pulmonologist and 2.6% others. Most of the respondents work in both public and private sector (72.7%). SHS has a similar reality compared to well developed nations regarding exams accessibility and interventions. SUS setting has a significant difference according to the participants. CT is only easily available in 31.9% of cases, PET-CT is easily available in 24.4%(graphic1), bronchoscopy is unavailable and almost unavailable for 33.1%, IR biopsy is unavailable in 38.2% and video-assisted thoracic surgery (VATS) biopsy is easily available in 42.8%. When there is a probability of malignancy of 50% or higher, 46.5% of participants would be comfortable recommending surgical biopsy. When the probability higher than 10%, only 36.9% would be comfortable following up radiologically. Figure 1
Conclusion:
Brazil has a very different setting for SUS and SHS patients regarding exams availability and management options. That might explain why participants have a higher tendency to choose interventional diagnosis and explains why current guidelines may not be applicable to developing countries reality.
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P3.16 - Surgery (ID 732)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.16-034 - Impact of Travel Distance to Treatment Institution on Survival from Stage I to III Lung Cancer (ID 10350)
09:30 - 09:30 | Author(s): Maria Teresa Ruiz Tsukazan
- Abstract
Background:
Over the last decade, attention and emphasis on regionalization of care for tertiary hospitals have increased in order to improve outcomes, especially in complex surgical procedures such as resection of lung cancer. On the other hand, the growing centralization of cancer services increases patient displacement and may delay access to specialized services and treatment. Impact of travel distance on patients’ outcome from lung cancer is poorly described. The objective of this study is to evaluate whether distance to treatment institution has an impact on survival from patients with lung cancer.
Method:
This is an observational, retrospective study, which included patients with stage I-III lung cancer that performed curative resection at Hospital São Lucas da PUCRS, Brazil. Data was collected from medical charts including demographic, clinical-pathological features and survival. Survival was estimated using the Kaplan-Meier method and log-rank test was used to perform multivariate analysis for prognostic factors. Chi-squared test was used to compare variables between groups.
Result:
Between January 2011 and December 2015, 234 patients with stage I-III lung cancer performed curative resection at Hospital São Lucas da PUCRS. The median age was 65 years (24-85 years) and 50.85% were male. 147 (62.82%) patients were from public health insurance and 87 (37.18%) had private coverage. The distribution of clinical stage ( AJCC 8th ed) was : 116 (49.57%) stage I, 71 (30.34%) stage II and 47 (20.09%) stage III. The median distance to institution was 19.7 (2-1086 km). Patients with public health insurance traveled higher distance than those with private coverage (p= 0.0004). The 3-year overall survival was 86.13% for stage I, 77.74% for stage II and 48.95% for stage III. The distance to institution had no impact in overall survival (p=0.85 for stage I, p= 0.63 for stage II and p= 0.46 for stage III).
Conclusion:
Our study shows that the distance between residence and treatment institution was not found to influence survival of the patients with lung cancer treated by surgery. Importantly, patients with public health insurance, which are in general poorer, have to travel longer distances for curative treatment.
