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I.A. Yang



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    C - Inaugural Cochrane Workshop (ID 78)

    • Event: WCLC 2013
    • Type: Other Sessions
    • Track: Other Topics
    • Presentations: 1
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      C.12 - Introduction to RevMan (ID 815)

      I.A. Yang

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    CALC - Chinese Alliance Against Lung Cancer Session (ID 79)

    • Event: WCLC 2013
    • Type: Other Sessions
    • Track: Other Topics
    • Presentations: 1
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      CALC.05 - COPD and Lung Cancer (ID 3869)

      I.A. Yang

      • Abstract
      • Slides

      Abstract
      Lung cancer and COPD frequently occur together in smokers, and COPD increases the risk of developing lung cancer in at-risk individuals. Exposure to cigarette smoke is clearly the most important causative factor. Other biological mechanisms for susceptibility to both lung cancer and COPD may involve inflammation, abnormal repair, oxidative stress, cellular proliferation, and epithelial-mesenchymal transition. In addition, genomic and epigenomic changes - such as single nucleotide polymorphisms, copy number variation, promoter hypermethylation and microRNAs - could alter biological pathways and enhance susceptibility to lung cancer and COPD. Approaches of studying genomics, epigenomics and gene-environment interaction will yield greater insight into the shared pathogenesis of lung cancer and COPD, leading to new diagnostic and therapeutic modalities. In addition to smoking cessation and preventing smoking initiation, understanding shared mechanisms in these smoking-related lung diseases is critical, in order to develop new methods of prevention, diagnosis and treatment of lung cancer and COPD.

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    P1.24 - Poster Session 1 - Clinical Care (ID 146)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P1.24-003 - A comparison of the Lung Cancer journey - Metropolitan and Non-Metropolitan (ID 674)

      I.A. Yang

      • Abstract

      Background
      Referrals and diagnostic pathways for people with symptoms of suspected lung cancer vary by where a person lives and ease of accessing services. Lung cancer diagnostic specialist and treatment services are mostly located in major cities, which can make access for people living in regional/rural and remote areas more difficult compared to major cities. Studies have shown that remoteness of residence is associated with an increase of lung cancer incidence and mortality. Hypothesis: The time required for the evaluation of suspected lung cancer is longer for people from regional/rural and remote areas compared to people living in metropolitan Queensland. The aim of the research study is to describe and compare the journey from referral to diagnosis for people with suspected lung cancer from regional/rural and remote areas referred to The Prince Charles Hospital , a tertiary referral center, compared to metropolitan residents.

      Methods
      A retrospective study of consecutive people with suspected lung cancer referred to The Prince Charles Hospital from December 2010 onwards will be reviewed. Data on patient demographics and referral patterns will be collected from medical records and relevant Queensland Health patient information systems. Information systems include Queensland Oncology Online, Queensland Oncology Analysis System (OASys), The Viewer, Hospital Based Corporate Information System (HBCIS), Practix, Outpatient Services Information Management (OSIM), Picture Archive and Communication System (PACS) and Auscare. The following times will be compared between regional/rural/remote (defined as >50km from TPCH) and metropolitan (<50km from TPCH) patients: (A) from receipt of referral to first specialist appointment (FSA), (B) FSA to first pathological (cytology or histology) diagnosis (FPD), (C) FPD to first multidisiciplinary team discussion (MDT) and (D) MDT to first definitive treatment (FDT). .

      Results
      Preliminary results show that there are clear differences in times to first specialist appointments, diagnosis and definitive treatment experienced by patients living in more regional and remote areas compared to patients from the metropolitan area. Patients from more regional and remote areas on average waited longer for their first specialist appointments e.g. Non Metro: N= 103 60% of patients seen within 30 days of a written referral and 28% were seen within 7 days. Metro: N= 60 78% patients seen within 30 days of a written referral and 50% were seen within 7 days There was also a pattern of admitting patients from remote areas to have all diagnostic workup and commence treatment as an inpatient. Admitting patients from remote areas for diagnostic workup appears to have decreased time to treatment for this cohort of patients although the cost effectivenss to the health service is unknown.

      Conclusion
      Lung cancer is a devastating disease and has a poor prognosis. Lung cancer diagnostic and treatment pathways should be developed for patients living in more regional and remote areas of Queensland to ensure times to diagnosis and treatment are optimised. Potentially this will decrease emotional and financial strain suffered by patients and their families as well as being cost effective to health services.

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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-001 - Lung cancer in rural and remote Aboriginal and Torres Strait Islander communities in Queensland (ID 212)

      I.A. Yang

      • Abstract

      Background
      The status of lung cancer in rural and remote Aboriginal and Torres Strait Islander ( from this point referred to as Indigenous) communities in Queensland is unclear. It is not known how much of a problem lung cancer is in these communities nor how much awareness exists regarding lung cancer risk factors and early symptoms. Several factors contribute to the uncertainty of lung cancer status in rural and remote communities. Factors include the quality of reporting Indigenous status and cancer registration, cultural influences affecting treatment decisions, access to health services and availability of culturally appropriate lung cancer information resources . Research on lung cancer in rural and remote Indigenous communities in Queensland is needed to improve lung cancer diagnostic and referral pathways and develop culturally appropriate and effective lung cancer information resources. Study Aims: 1. Describe the local and regional health care facilities for Indigenous people who may be referred for suspected lung cancer across the state of Queensland. 2. Interview Indigenous people and health workers in 3 population sample groups from six rural and remote Indigenous communities in Queensland to identify if there are variations in patient flow relative to predicted utilisation of local and regional health care facilities.

      Methods
      1. Using publically available information, identify relevant health care facilities including those with diagnostic bronchoscopy (with or without endobronchial ultrasound (EBUS) services across Queensland to predict expected referral pathways for suspected lung cancer. 2. Using quantitative and qualitative approaches to learn preferred referral pathways from 3 target population groups including patients referred for medical treatment with symptoms suspicious of lung cancer or confirmed lung cancer, Indigenous health workers, Indigenous community members aged 18 years and older. Frequency distributions in terms of the following will be analysed: demographics, current health status, social situation, access to health services, social and financial impact of treatment and information resources. Frequency distributions will be cross tabulated with age, education attainment, socio-economic characteristics, cultural influences, lung cancer awareness and knowledge. The responses to narrative questions will be analysed to identify main themes. These themes will be categorised by issues relating to lung cancer knowledge, cultural influences and beliefs, the patient experience and access to lung cancer medical and support services.

      Results
      We identified a spectrum of health care services across Queensland where patients may be referred for lung cancer management, ranging from public to private facilities. There are seventeen discrete Indigenous communities in Queensland. Compared to the nearest health care facility which offer diagnostic bronchosopy, 5 discrete Indigenous communities are situated > 200km away, 9 > 500km away and 2> 1000km away. Only one is situated 50km away.

      Conclusion
      The research findings will provide a clear understanding of the affect of lung cancer in rural and remote Indigenous communities in Queensland. Knowledge gained from research will enable better health service planning and help reduce any health disparities experienced by Indigenous people; particularly those who live in less advantaged areas compared to other Australians when facing a diagnosis of possible or confirmed lung cancer.

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    P3.01 - Poster Session 3 - Cancer Biology (ID 147)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P3.01-011 - Heterogeneity in tumour content and necrosis in primary lung cancers: Implications for molecular analysis (ID 3326)

      I.A. Yang

      • Abstract

      Background
      Lung adenocarcinoma (AC) and squamous cell carcinoma (SCC) tumours have a large variance in tumour cell content. This heterogeneity is a concern for genomic studies, as it is difficult to distinguish mutational differences between tumour and non-tumour if low percentage tumour is used for analysis. In addition to this, tumour samples are affected by the amount of necrosis present, as the overall number of viable cells is decreased. We assessed tumour and necrotic content in lung tumour specimens from AC and SCC patients and aimed to identify possible implications for the suitability of these samples in molecular characterisation studies using next generation sequencing technology.

      Methods
      Lung tissue specimens were collected during the period of 1990 to 2013 from patients at The Prince Charles Hospital who consented to donate their surgically resected lung tissues for research. Tissues were macroscopically dissected, snap frozen in liquid nitrogen and stored at -80°C. A tissue section was taken and stained with haematoxylin and eosin (H&E) for two pathologists to independently assess tumour cell and necrotic content. Tumour cell content (TC) in each specimen was scored as percentage of viable cells as seen on the H&E slide, where necrotic content (NC) was recorded as a percentage of the whole slide section. Statistics were calculated using SPSS v21 software. Tumour specimens screened for eligibility to The Cancer Genome Atlas sequencing project are presented here.

      Results
      Tumours from 62 AC and 104 SCC subjects were scored (specimen characteristics in Table 1). Scoring between the two pathologists was highly correlated, with a high intraclass reliability (0.94 and 0.96 for TC and NC respectively).

      Table 1: Clinical and Pathological Characteristics of Specimens
      AC SCC
      Number of Specimens 384 609
      Number of Males/Females 36/26 84/20
      Median Specimens per Subject 4 4
      Range of Specimens per Subject 1-25 1-27
      Median TC 35% 30%
      Range of TC 0-88% 0-90%
      Median NC 0% 6%
      Range of NC 0-90% 0-100%
      Median Age 62 yrs 68 yrs
      Range of Age 45-85 yrs 46-91 yrs
      Median Smoking Pack Years 40 56
      Range of Smoking Pack Years 0-115 0-158
      TC varied from 0-~90% for both subtypes. Comparing AC and SCC, the median TC was higher in AC than SCC (35% vs 30% respectively, p<0.05). NC varied from 0-~100%, but was generally low. The median NC was statistically significantly different between AC and SCC (0% and 6% respectively, p<0.001). TC was weakly correlated with NC (Spearman Rank r = 0.32, p<0.01). There were no clinically important correlations between smoking pack years, gender or age with TC and NC of specimens.

      Conclusion
      Lung AC and SCC specimens are heterogeneous in terms of TC and NC. Therefore, only a small proportion of resected lung cancer specimens meet the criteria required for massively parallel sequencing projects that require high quality tumour DNA and RNA (ie low NC) and relatively low stromal contamination (ie high TC).