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R. Milroy



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    OA14 - Nurses in Care for Lung Cancer and in Research (ID 398)

    • Event: WCLC 2016
    • Type: Oral Session
    • Track: Nurses
    • Presentations: 1
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      OA14.07 - The Relationship between Lung Cancer Stigma and Patient Reported Outcomes (ID 6379)

      16:00 - 17:30  |  Author(s): R. Milroy

      • Abstract
      • Presentation
      • Slides

      Background:
      Patients with lung cancer (LC) report lower quality of life (QoL) and higher levels of psychological distress compared to other cancer populations (Hewitt et al, 2013). Lung cancer stigma (LCS) may in part explain these findings. Evidence from studies in the Unites States has shown associations between LCS and lower QoL, higher symptom burden and higher levels of anxiety and depression (Cataldo et al, 2013). Whether these associations exist in people diagnosed with LC in the United Kingdom is unknown. Therefore this study explored the prevalence of LCS and its relationship with patient outcomes as well as QoL in a Scottish population.

      Methods:
      This study was a cross-sectional study. Patients (n=201) diagnosed with LC were recruited by health care professionals at follow-up clinics at four hospitals in Scotland. Participants completed questionnaires to collect demographic data and assess perceived LCS, QoL, symptom severity and level of depression. Clinical data was collected by casenote review. Bivariate correlations were performed to investigate the relationships between stigma, demographics, and patient outcomes. Multiple regression further explored the individual contributions of LCS on symptom burden and quality of life.

      Results:
      Participants had a mean age of 69 years (range 41-89 years), 46.8% were males, 92.0% were ever smokers, 17.9% current smokers. The mean LCS score was 53.1 (SD=14.1, range 31-124,). There were significant correlations between higher LCS and age (r= -0.28, p<0.001), being a current smoker (r= 0.17, p<0.05), deprivation index (r=0.15, p<0.05) depression (r=0.40, p<0.001), symptom burden (r=2.60, p<0.001), and QoL (r= - 0.52, p<0.001). Multiple regression revealed an overall model that explained 30.6% of the total variance of stigma (F=14.82, p<0.001). Perceived stigma also accounted for significant unique variance in QoL (4.3%, p<0.001) and depression (3.6%, p<0.001) above and beyond that accounted for by relevant variables. No contribution of stigma on symptom burden was found.

      Conclusion:
      Stigma was correlated with depression, and QoL. Therefore, it is expected that depression and stigma share some of the explanation of variance of QoL. Nevertheless, stigma was found to have a unique contribution on QoL, and on depression. With this in mind, management of patients with LC could determine the patients’ experience of stigma to tailor treatment plans to improve QoL and psychosocial outcomes. Being younger was correlated with higher LCS. This might reflect changed attitudes toward smoking due to changed marketing strategies in the 1960s.

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    P2.06 - Poster Session with Presenters Present (ID 467)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Scientific Co-Operation/Research Groups (Clinical Trials in Progress should be submitted in this category)
    • Presentations: 1
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      P2.06-038 - An RCT of the Detection of Autoantibodies to Tumour Antigens in Lung Cancer Using the EarlyCDT-Lung Test in Scotland (ECLS) in 12 208 Study Subjects (ID 4546)

      14:30 - 15:45  |  Author(s): R. Milroy

      • Abstract

      Background:
      The majority (around 80%) of cases of lung cancer are detected at a late stage when prognosis is poor. The EarlyCDT®-Lung Test detects autoantibodies to abnormal cell surface proteins in the earliest stages of the disease with a specificity of 93% which may allow tumour detection at an earlier stage thus altering prognosis. The primary research question is: Does using the EarlyCDT®-Lung Test to identify those at high risk of lung cancer, followed by computed tomography (CT) scanning, reduce the incidence of patients with late-stage lung cancer (III & IV) or unclassified presentation (U) at diagnosis, compared to standard practice? We have completed recruitment with 12 208 study subjects randomised by June 2016.

      Methods:
      A randomised controlled trial in general practices serving areas of Scotland representing the most socially disadvantaged quintile based on Scottish Index of Multiple Deprivation. Adults aged 50 to 75 at high risk for lung cancer (>20 pack years) and healthy enough to undergo potentially curative therapy (Performance Status 0-2) are eligible to participate. The intervention is the EarlyCDT®-Lung Test, followed by X-ray and CT in those with a positive result. The comparator is standard clinical practice in the UK. The primary outcome is the difference, after 24 months, between the rates of patients with stage III, IV or unclassified lung cancer at diagnosis. The secondary outcomes include: all-cause mortality; disease specific mortality; a range of morbidity outcomes; cost-effectiveness and measures examining the psychological and behavioural consequences of screening. Participants with a positive test result but for whom the CT scan does not lead to a lung cancer diagnosis have been offered 6 monthly thoracic CTs for 24 months. An initial chest X-ray was used to determine the speed and the need for contrast in the first screening CT. Participants who were found to have lung cancer are being followed-up to assess both time to diagnosis and stage of disease at diagnosis.

      Results:
      575/ 6 120 (9.8%) of the test group had a positive test with 207 found to have lung nodules > 8mm. 16 lung cancers have been detected, 12(75%) of which are early stage and 11 abnormalities are undergoing further investigation. At this stage of the trial we have no outcome data for the comparison group.

      Conclusion:
      The study will determine the EarlyCDT-Lung test’s clinical and cost effectiveness. It will also assess potential morbidity arising from the test and potential harms and benefits of EarlyCDT-Lung test screening.