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J.H. Gooi
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P1.05 - Early Stage NSCLC (ID 691)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.05-022c - Screening for Psychosocial Distress in Lung Cancer: Defining the Unmet Gaps (ID 8412)
09:30 - 09:30 | Author(s): J.H. Gooi
- Abstract
Background:
Objective: The evaluation of supportive care needs in lung cancer patients may be enhanced by engaging systematic screening using a validated distress screening tool, the distress thermometer (DT). We aimed to identify the extent of use of the screening tool, levels of distress and psychosocial problems identified by the tool and to determine associations with distress and the impacts of distress screening on patient outcomes in an Australian university teaching hospital.
Method:
We recruited all new lung cancer diagnoses recruited via the Victorian Lung Cancer Registry at the Alfred Hospital, Melbourne, Australia, during the period 14 July 2011 to 24 September 2016. We evaluated the presence of documented supportive care screening using the distress thermometer and demographic, clinical, treatment and outcome measures.
Result:
Levels of screening were very low (15.2%) amongst this cohort and yet 49.2% respondents described high levels of distress (median DT 3.5; IQR 1-6). High levels of distress (DT≥4) were associated with higher levels of practical, family, emotional and physical problems. Patients reporting higher levels of distress experienced an accelerated rate of decline in physical component of quality of life and had increased risk of death.
Conclusion:
The identification of the supportive care needs for lung cancer patients may be augmented by the use of a systematic screening tool. This study identifies significant gap in supportive care screening, high levels of distress amongst screened subjects and poorer patient related outcomes for distressed patients. This study provides an important platform for institutional supportive care screening strategy planning.
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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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P2.13-026c - Impact of Lung Cancer Multidisciplinary Meeting Presentation on Quality of Life and Survival: A Victorian Retrospective Cohort Study (ID 8633)
09:30 - 09:30 | Author(s): J.H. Gooi
- Abstract
Background:
The creation of an effective management plan for non-small cell lung cancer (NSCLC) requires clinical and functional evaluation, a series of diagnostic and staging investigations and an evaluation of suitability for treatment. This process requires diverse multidisciplinary input and modern clinical guidelines therefore recommend presentation of all new lung cancer diagnoses to a multidisciplinary meeting (MDM) to facilitate evaluation and the development of an informed multidisciplinary management plan
Method:
We sought to evaluate the characteristics of patients presented to the lung cancer MDM and to evaluate the impact of MDM presentation on (i) management related outcomes including timeliness, supportive care screening, receipt of treatment and clinical trial participation, and (ii) patient related outcomes including survival and quality of life (QoL) in a metropolitan university teaching hospital.
Result:
In this cohort of cancer patients we found that just 59.6% of all new cancer diagnoses were presented to the lung cancer multidisciplinary meeting for clinical assessment and treatment planning despite the recommendation that all patients with lung cancer receive treatment in the context of a multidisciplinary setting. The likelihood of presentation was doubled for those with early clinical stage IA and halved for those with stage IV. Measures of quality of life (vitality and role emotion domain scores from the SF12v2) improved for those presented to the MDM between 3 and 12 months following presentation compared to those not presented. Advanced clinical stage was a strong predictor of mortality for all patients. MDM presentation conferred a significant crude protective effect on mortality for all patients (HR 0.63, 0.49-0.81; p<0.001) which was diminished when adjusted for confounding factors (0.79, 0.56-1.10;p=0.16), although this benefit was sustained for those with clinical stage IIIA (adjusted HR 0.31 0.12—0.79; p=0.01). The referral source for MDM presented patients were approximately one third from respiratory medicine, one third from lung cancer specialities and one third from medical and surgical specialty units with mortality risk increased for those referred by general medicine and surgical specialties.
Conclusion:
We found significant disparities in the utilisation of lung multidisciplinary meeting presentation which was associated with significant differences in uptake of active cancer therapy and ultimately survival. This study identifies significant benefit to those being presented to a lung cancer MDM and provides evidence to support multidisciplinary evaluation.
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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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P3.16-052 - Use of Decellularised Porcine Intestinal Submucosa Extracellular Matrix in Airway Reconstruction to Enable Lung-Sparing Oncological Surgery (ID 9639)
09:30 - 09:30 | Author(s): J.H. Gooi
- Abstract
Background:
Reconstruction of the airways following tracheal resection, tracheo-oesophageal complications and lung-sparing oncological surgery is challenging. Airway reconstruction materials ideally must possess balanced properties of rigidity, flexibility and have an intact surface of epithelium to maintain a functional airway. A novel approach is the use of bio-scaffolds which allow regeneration of respiratory epithelium and eliminate the need for immunosuppressive treatment. Initial experiences with decellularised porcine small intestine submucosa extracellular matrix (CorMatrix®) as a scaffold for vascular, cardiac and pericardial tissue repair and reconstruction has been encouraging. The properties of extracellular matrix are potentially suitable for airway reconstruction.
Method:
We initially used the bio-scaffold for repairing tracheal defects and tracheo-oesophageal fistulae (n=6). We then extended its use to reconstruct distal airways to facilitate lung-sparing oncologic resections of intermediate grade lung tumours (n=3). These patients would otherwise have required pneumonectomy (Case 1 and 2) or bi-lobectomy in a patient with borderline lung function (Case 3). We describe our experience using extracellular matrix for airway reconstruction in lung-sparing oncological surgery.
Result:
Three patients underwent complex sleeve resections with varying degrees of bronchial airway reconstruction using extracellular matrix. The lung tumours were: (1) muco-epidermoid tumour of the left upper lobe and left main bronchus; (2) typical carcinoid of the right main bronchus; (3) typical carcinoid of the intermediate bronchus and right middle lobe. All patients underwent frozen section pathology examination at the time of surgery and formal histology confirmed pT1N0 and R0 resection status. There were no perioperative complications. All patients underwent bronchoscopy prior to discharge and serial bronchoscopies were carried out 6 weeks, 3 months and at >1 year. All patients had complete integration of the scaffold by epithelialisation and the patch was not evident at 3 months. All segmental bronchi were widely patent. At 18 months there was no tumour recurrence.
Conclusion:
The use of decellularised porcine intestinal submucosa extracellular matrix (CorMatrix®) as a bio-scaffold is safe and shows remarkable epithelialisation and integrity. It is an option for airway reconstruction to facilitate lung-sparing surgery without compromising oncologic margins.
