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R. Flores



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    P1.01 - Poster Session with Presenters Present (ID 453)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Epidemiology/Tobacco Control and Cessation/Prevention
    • Presentations: 2
    • Now Available
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      P1.01-029 - Personal and Hospital Factors Associated with Limited Surgical Resection, In-Hospital Mortality and Complications in New York State (Now Available) (ID 5359)

      R. Flores

      • Abstract
      • Slides

      Background:
      Lung cancer represents 13.4% of all newly diagnosed US cancers and 27.1% of all cancer deaths. Early stage lung cancer is generally treated with surgical resection. Many patient- and hospital-level factors influence the selection of appropriate surgical procedures and their outcome. We identified patient- and hospital-level characteristics influencing the type of lung cancer surgical approach utilized in New York State and assessed in-hospital complications and mortality.

      Methods:
      Patients were selected from the Statewide Planning and Research Cooperative System, SPARCS (1995-2012) based on ICD-9-CM codes of diagnosis (162 and 165) and procedures (32.0-32.9). Surgery was categorized into: limited resection (LR: 32.2-32.3), lobectomy (L: 32.4), and pneumonectomy (P: 32.5-32.6). Statistical analyses were performed in SAS v9.4 and ArcMap v10.3.1.

      Results:
      There were 36,460 patients (age 60-75 years); 56% underwent L, 37% LR, and 7% P. LR patients were more likely to be older (OR~adj~ 1.01, 95%CI [1.01-1.02]), female (OR~adj~ 1.10 [1.06-1.15]), Black (OR~adj~ 1.24 [1.15-1.34]), with comorbidities (OR~adj~ 1.10 [1.04-1.16]) than L patients. Opposite trends were observed among P patients, except for race. Over time, the odds of P decreased, while those of LR significantly increased (OR~adj~ 1.22 [1.16-1.29] for years 2007-2012 vs 1995-2000). Teaching hospitals were less likely to perform LR over L (OR~adj~ 0.82 [0.75-0.88]), while the opposite was true for hospitals with larger surgery volumes (OR~adj~ 1.07[1.03-1.11]). In-hospital complications were significantly less after LR than L (OR~adj~ 0.66 [0.62-0.69]), while in-hospital mortality was similar (OR~adj~ 0.93 [0.84-1.03]). In-hospital mortality was directly associated with age, length of stay, urgent/emergency admission, and inversely associated with female gender, private insurance, and surgery volumes. Figure 1



      Conclusion:
      There is a growing trend towards LR, which is still more likely to be performed in older patients with co-morbidities. In-hospital outcomes were affected by patients’ clinical and personal characteristics, and were better after LR than L or P.

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      P1.01-045 - Patient to Hospital Distance in Access to Care and Lung Cancer Surgical Treatment (Now Available) (ID 4464)

      R. Flores

      • Abstract
      • Slides

      Background:
      Lung cancer represents 13.4% of all newly diagnosed US cancers and 27.1% of all cancer deaths. Health disparties exist in accessing proper care and receving surgical treatment. We examined the role of Patient to Hospital distance (P-H) in access to care.

      Methods:
      Patients were selected from the New York State Statewide Planning and Research Cooperative System (1995-2012) based on ICD-9-CM diagnosis (162 and 165) and procedures (32.0-32.9). Surgery was categorized into: limited resection (LR: 32.2-32.3), lobectomy (L: 32.4), and pneumonectomy (P: 32.5-32.6). Distance calculations (ArcMap 10.3.1) and linear regressions (SAS v9.4) were performed to determine the factors influencing P-H.

      Results:
      There were 36,460 patients (age 60-75 years); 56% underwent L, 37% LR, and 7% P; 95% of patients underwent surgery at a hospital < 70 kilometres (km) from their home (mean±SD 20.49±30.24 km; median 11.10 km). P-H was shorter in LR (19.10±27.71 km) than L (21.00±30.96 km) and P (23.87±36.56 km; p < 0.001). At multivariable analysis, P-H was positively associated with teaching hospitals (β: 3.33, p < 0.001), admitted during 1995-2000 (β: 1.08, p < 0.001) and 2001-2006 (β: 1.23, p < 0.001), and P (β: 1.57, p < 0.001), and inversely associated with female gender (β: -0.49, p = 0.016), age at admission (β: -0.17, p < 0.001), black race (β: -8.22, p < 0.001), Medicaid (β: -3.37, p < 0.001), private insurance (β: -0.79, p = 0.004), rural hospitals (β: -2.80, p < 0.001), LR (β -0.81, p < 0.001), and mortality (β -1.05, p = 0.081). Similar associations were found in the L subgroup; among LR patients there was no statistically signficant association between P-H and female gender. Figure 1



      Conclusion:
      Significant differences exist in P-H and patient/hospital characteristics, which may affect type of surgery and outcome. P-H should be incorporated to improve health disparities in accessing surgical care.

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    P1.05 - Poster Session with Presenters Present (ID 457)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 1
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      P1.05-073 - Evaluation of Stage 1 Sub-Solid Lung Nodules Using PET Imaging (ID 4287)

      R. Flores

      • Abstract

      Background:
      Positron emission tomography (PET) scans are valuable in the evaluation of lung nodules. Subsolid (SS:<80% solid) lung nodules, however, often have low levels of metabolic activity and rare metastases. The purpose is to assess PET in the evaluation of SS nodules.

      Methods:
      Between 2009-2015, 892 patients had a chest computed tomography (CT) with a SS finding and PET within 6 months, with pathology specimen, at our institution. 50 patients had clinical stage IA/B lung cancer and were retrospectively analyzed. CT analysis further classified these subsolid lesions as nonsolid(NS) and part-solid(PS).

      Results:
      26 patients had NS nodules and 24 PS. Mean maximal tumor dimension was not statistically significantly different between the groups (mean±SD; NS- 16.8±6.9; PS- 16.9±6.2). PET positive nodules (SUV>2.5) were larger in maximal tumor dimension than PET negative on CT though the difference was not statistically significant (mean±SD; PET Neg, n=42- 16.1±5.7; PET-pos, n=8- 20.9±8.8). Among the 39 patients in which lymph node pathology was obtained, sensitivity and specificity of PET in identifying N1 disease was 0% and 92.9%; and 0% and 100% for N2 disease. Recurrence and overall survival were 0% and 100%, with median follow-up of 34 months. Figure 1



      Conclusion:
      The use of PET for the evaluation of SS nodules in stage I lung cancer may have limited value in detecting metastases and affecting current clinical decision making for these patients.

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    P3.03 - Poster Session with Presenters Present (ID 473)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
    • Presentations: 1
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      P3.03-031 - Definitive Radiation Therapy is Associated with Improved Survival in Non-Metastatic Malignant Pleural Mesothelioma (ID 4458)

      R. Flores

      • Abstract

      Background:
      To analyze rates of definitive radiation therapy (RT) utilization for malignant pleural mesothelioma (MPM) and evaluate the association between RT and overall survival (OS).

      Methods:
      The National Cancer Data Base (NCDB) was queried to identify patients with non-metastatic MPM diagnosed between 2004 and 2013. Definitive RT was defined as receipt of 40-65 Gy of external beam radiation therapy to the chest wall, lungs, or pleura. Multivariate logistic regression was performed to identify predictors of RT receipt. OS was estimated using the Kaplan-Meier method. Cox proportional hazards models were used to identify predictors of mortality. Propensity score matching was performed to verify the effect of definitive RT on OS.

      Results:
      Among 14,090 MPM patients, 3.6% received RT. Younger age, lower co-morbidity score, private insurance, surgical resection, and receipt of chemotherapy were associated with increased RT utilization. Patients who received RT had higher crude 2 and 5-year OS rates (33.9% and 12.6%, respectively) compared to patients who did not (19.5% and 5.3%, respectively; p<0.001). On multivariable analysis and propensity matched analysis, definitive RT was associated with improved survival (adjusted hazard ratio [adj HR] 0.78, 95% CI 0.70-0.87) and (adj HR 0.77, 95% CI 0.67-0.89), respectively. Compared to no therapy, surgery and RT (adj HR 0.41, 95% CI 0.31-0.54) and trimodality therapy (adj HR 0.47, 95% CI 0.40-0.55) were associated with the best survival.

      Comparison of Overall Survival According to Definitive RT
      2-yr rate 95% CI 5-yr rate 95% CI p Adjusted HR 95% CI
      No RT 19.5% 18.8-20.3 5.3% 4.9-5.8 <0.001 1.00 Ref
      RT 33.9% 29.4-38.4 12.6% 9.4-16.3 <0.001 0.78 0.70-0.87


      Conclusion:
      The rate of definitive RT utilization for non-metastatic MPM has remained low over the past decade. Patients who received RT had improved OS, suggesting a role for increased utilization, particularly with the advancement in RT techniques. Combined modality therapy was associated with a greater improvement in survival than any single modality treatment.

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    P3.07 - Poster Session with Presenters Present (ID 493)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Regional Aspects/Health Policy/Public Health
    • Presentations: 1
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      P3.07-015 - Patterns and Risk Factors of Patient Flows across Different Geographic Health Service Units for Lung Cancer Surgery (ID 5052)

      R. Flores

      • Abstract

      Background:
      To date lobectomy patient flows across different geographic units and time periods has not been quantified; little is known about associations between hospital- and patient-level factors and travel choices for surgery and the subsequent outcomes. We explored these issues as well as the robustness of the aforementioned associations with changing geographic health service units.

      Methods:
      The New York Statewide Planning and Research Cooperative System database (2007-2012) was used to select lung cancer patients who underwent lobectomy by Video-Assisted Thoracic Surgery (VATS) or open thoracotomy techniques. Hierarchical logistic regressions were used to examine factors associated with surgeries occurred within or outside of patients’ geographic units: Health Service Regions (HSRs), Health Referral Regions (HRRs), and Health Service Areas (HSAs), respectively.

      Results:
      A total of 9,655 lobectomies (43% of which were VATS) from 8 HSRs, 21 HRRs, and 145 HSAs were identified. At the state-level, 17%, 22%, and 56% of the lobectomies occurred outside of patients’ HSRs, HRRs, and HSAs, respectively; the percentages varied spatially but the spatial patterns remained stable from 2007 to 2012. Travel-out patients were more likely to be males or with private insurance, and less likely to be non-Hispanics Blacks, Hispanics, or with Medicaid insurance. Travel-out lobectomies were more likely to be performed by VATS, in urban setting, teaching hospitals, with higher lung surgery volume, and higher numbers of surgeons. In-hospital mortality of travel-out lobectomies was not significantly different from that of the stay-in. These associations were consistent among models using different health service geographic units.

      Conclusion:
      Lung cancer patients tended to travel farther to be treated with VATS in urban/teaching hospitals with high surgery and surgeon volumes. Other independent determinants of the travel choice included sex, insurance type, and race/ethnicity. Patients’ choices and preferences should be taken into account when planning specialized health care delivery services.Figure 1



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    WS04 - Mesothelioma Workshop (Ticketed Session) (ID 416)

    • Event: WCLC 2016
    • Type: Workshop
    • Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 12/04/2016, 08:00 AM - 11:00 AM, Stolz 2
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      WS04.01 - Debate - Extrapleural Pneumonectomies Should be Performed for Pleural Mesothelioma (Now Available) (ID 6981)

      R. Flores

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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