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Gail Elizabeth Darling
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MA20 - Implementation of Lung Cancer Screening (ID 923)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 15:15 - 16:45, Room 206 F
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MA20.06 - Lung Cancer Screening Pilot for People at High Risk: Early Results on Cancer Detection and Staging (ID 13890)
15:50 - 15:55 | Author(s): Gail Elizabeth Darling
- Abstract
- Presentation
Background
In June 2017, Cancer Care Ontario initiated organized lung cancer screening for people at high risk of developing lung cancer, using annual low-dose computed tomography (LDCT), at three pilot sites in Ontario. A key indicator of pilot success is detection of lung cancers at early stages. Ontario Cancer Registry (OCR) is used to track lung cancer diagnosis, stage and histology.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patient abstracts were created using Registry Plus CDC abstracting software for pilot participants and patient-level data were collected from hospital data submissions, hospital electronic medical records via remote access, OCR pathology database (eMaRC) and OCR clinical source records (Resolink). Confirmed lung cancer cases were reviewed by a team of cancer staging analysts to achieve consensus on stage group using AJCC TNM 8th edition. A post-staging review was conducted for all staged cases to ensure accuracy and completeness.
4c3880bb027f159e801041b1021e88e8 Result
As of February 2018, 1086 participants received a baseline LDCT scan. 37% (n=404) of participants had Lung-RADS™ scores of 1; 45% (n=487) had Lung-RADS™ scores of 2; 10% (n=112) had Lung-RADS™ scores of 3; and 8% (n=83) had Lung-RADS™ scores of 4A, 4B or 4X, which triggered additional follow-up or diagnostic workup. 18 lung cancers were confirmed and 11 were fully staged.
Of the 11 staged cases: 45% (n=5) was stage I; 9% (n=1) stage II; 9% (n=1) stage III; and 36% (n=4) stage IV. This represents a statistically significant increase in the proportion of early stage lung cancers (stage I and II) compared to historical proportions (p<0.05). 73% (n=8) were adenocarcinoma. The median risk score (i.e., PLCOm2012 risk prediction model probability of developing lung cancer in 6 years) was 8.1%, considerably higher than the median risk score of the overall pilot cohort (2.9%). 82% (n=9) had baseline Lung-RADS™ scores of 4X and 18% (n=2) had 4B. The average age at diagnosis was 67. 45% (n=5) were male; 55% (n=6) were current smokers; and 55% (n=6) had high school education or less. In addition, the screening pilot facilitated the successful transition by the OCR from AJCC TNM 7th to TNM 8th edition in lung cancer staging. Results will be updated in the conference presentation.
8eea62084ca7e541d918e823422bd82e Conclusion
Early pilot results demonstrate success in detecting early stage lung cancers and a statistically significant stage shift to earlier cancer stages. We anticipate a greater proportion of early stage lung cancers on annual recall LDCT scans. The OCR efficiently enabled capturing important incidence, staging and histological pilot data.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MA22 - New Therapeutics, Pathology, and Brain Metastases for Small Cell and Neuroendocrine Tumour (ID 925)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 15:15 - 16:45, Room 206 BD
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MA22.06 - Preinvasive Multifocal Neuroendocrine Lesions with Primary Typical Carcinoid Lung Tumors: A Negative Prognostic Factor? (ID 12432)
15:50 - 15:55 | Author(s): Gail Elizabeth Darling
- Abstract
- Presentation
Background
Impact on survival in patients with surgically resected multifocal neuroendocrine lesions (MNET), such as diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) or tumorlets, along with primary typical lung carcinoid (TC) is unclear. Aim of this study is to analyze whether synchronous preinvasive multifocal neuroendocrine lesions of the lung with primary TC tumors (MTNET+TC) may represent a negative prognostic factor.
a9ded1e5ce5d75814730bb4caaf49419 Method
A retrospective study, prospectively collected, for TC from two institutional databases was evaluated with a lifelong follow-up from surgery. Patients who did not receive surgery, underwent bronchial resection or lung transplant were excluded. Pathology specimens were all reclassified according the 2015 WHO and the eight AJCC Staging system. Kaplan-Meier(KM) method and Log-rank test reports significance between TC and were MTNET+TC were used. Hence a 1:1 propensity score matching analyses was done by adjusting the imbalance and comparing the overall survival and progression free rate between matched groups with a Cox proportional hazards regression model. A p value of 0.05 or less was considered significant.
4c3880bb027f159e801041b1021e88e8 Result
From January 1983 to December 2013 a total of 234 patients was outlined from the databases (TABLE). A total of 41 patients (17.5%) with MNET+TC were identified. Overall KM progression free survival achieved at 5 and 10 years respectively MNET+TC 93.2% and 83.8% compare to TC 98.4% and 96.1% (p =0.00039). Thirty-six MNET+TC were matched pairs vs. TC alone. Univariate Cox proportional hazards model for matched patients MNET+TC compared to TC was 2.78 (95% CI=0.84-9.3, p=0.095). Difference in progression free rate between matched groups was p<0.001.
8eea62084ca7e541d918e823422bd82e Conclusion
Synchronous multifocal neuroendocrine preinvasive lesions (MNET) with primary typical carcinoid (TC) lung tumors can be a negative prognostic factor. Careful search of MNET should be always performed in clinical and pathological staging of a suspected primary TC. The increased risk of progression of MNET+TC warrants an accurate and lifelong follow-up.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MA23 - Early Stage Lung Cancer: Present and Future (ID 926)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 10:30 - 12:00, Room 105
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MA23.07 - Defining the Role of Adjuvant Therapy for Early Stage Large Cell Neuroendocrine Lung Cancer (ID 12814)
11:10 - 11:15 | Author(s): Gail Elizabeth Darling
- Abstract
- Presentation
Background
Large cell neuroendocrine lung cancer (LC-NEC) is a rare, high-grade neuroendocrine tumor. Patterns of adjuvant treatment after surgical resection have not been well defined.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients with a pathologic diagnosis of LC-NEC were identified in the National Cancer Database 2004-2014. Patient demographics, tumor and treatment characteristics were examined. Survival differences in patients receiving chemotherapy were evaluated using Kaplan-Meier curves, and multivariate hierarchical Cox models were constructed to evaluate the impact of patient, histologic, tumor, treatment and hospital characteristics on overall survival (OS). A conditional landmark of 90-day postoperative survival was used to address immortal time bias and propensity-matching was used to address imbalance in covariates between groups.
4c3880bb027f159e801041b1021e88e8 Result
1,793 patients were identified with pathologically stage I LC-NEC, of which 482 (26.9%) received adjuvant chemotherapy. Use of adjuvant chemotherapy remained similar across the study period. Patients receiving adjuvant chemo were younger, less comorbid and more likely to have T2 tumors. Significantly longer survival was observed with the receipt of adjuvant chemotherapy (5-year OS 59.2% vs. 45.3%), which persisted after adjustment in multivariable Cox models (HR 0.69, 95%CI0.58 – 0.82, p<0.0001). Adjuvant chemotherapy was associated with longer survival in patients with tumors 2-3cm (60.4% vs. 41.8%; HR 0.64, 95%CI 0.46-0.89, p<0.0001), and T2 tumors (59.8% vs. 42.1%; HR 0.63, 95%CI 0.50-0.81, p<0.0001), but no differences were observed for LC-NEC patients with tumor size <2cm. Adjuvant chest radiotherapy was not associated with improved survival. T-stage specific propensity-matching confirmed these findings, however the association between survival and adjuvant chemotherapy for patients with tumors 2-3cm was no longer significant.
8eea62084ca7e541d918e823422bd82e Conclusion
In this national study of LC-NEC, adjuvant chemotherapy was associated with significantly longer survival in Stage I tumors greater than 2cm. Adjuvant radiation was not associated with survival. A randomized trial of stage T2-4N0 LCNEC is needed to clarify the role of adjuvant chemotherapy in this population.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MS16 - Implementation of Lung Cancer Screening (ID 795)
- Event: WCLC 2018
- Type: Mini Symposium
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 13:30 - 15:00, Room 206 F
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MS16.03 - Recruitment Strategies for the Lung Cancer Screening (ID 11470)
14:00 - 14:15 | Presenting Author(s): Gail Elizabeth Darling
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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OA09 - Prevention and Cessation (ID 909)
- Event: WCLC 2018
- Type: Oral Abstract Session
- Track: Prevention and Tobacco Control
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 15:15 - 16:45, Room 205 BD
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OA09.02 - Acceptance of Smoking Cessation Services in Cancer Care Ontario’s Lung Cancer Screening Pilot for People at High Risk (ID 13032)
15:25 - 15:35 | Author(s): Gail Elizabeth Darling
- Abstract
- Presentation
Background
Participation in lung cancer screening can be a teachable moment for smoking cessation. Current smokers who attend for lung screening may also be motivated to quit. In June 2017, Cancer Care Ontario launched organized lung cancer screening at 3 pilot sites in Ontario with smoking cessation embedded in the screening pathway. Participants are recruited through primary care providers and public-facing messaging.
a9ded1e5ce5d75814730bb4caaf49419 Method
Smoking cessation services (SCS) are offered to all current smokers (anyone who smoked a cigarette in the past 30 days) interacting with the pilot. Individuals found ineligible for screening are offered a direct referral to the Canadian Cancer Society’s Smokers’ Helpline. Screen-eligible individuals are scheduled for smoking cessation counselling during their baseline low-dose computed tomography (CT) appointment, using an opt-out approach. Hospital-based SCS are provided by trained counsellors and consist of 10 minutes (minimum) of behavioural counselling, a recommendation or prescription for pharmacotherapy, and arrangements for proactive follow-up. The proportions of current smokers who accept referral to SCS and who attend hospital-based smoking cessation counselling are being monitored throughout the pilot. A participant satisfaction survey is completed after the screening appointment (if applicable). Data on quit rates, quit attempts, heaviness of smoking and relapse among screening participants is being captured.
4c3880bb027f159e801041b1021e88e8 Result
Between June and October 2017, 50% of the 1241 individuals who underwent risk assessment to determine eligibility for screening were current smokers. Of the 808 individuals eligible for screening, 63% were current smokers: 52% were male, (age 55-64, 61%; 65-74, 39%), 55% had a high school education or less. 27% of ineligible individuals were current smokers. 83% of all current smokers (regardless of screen-eligibility) accepted a referral to SCS. Of screen-eligible current smokers, 89% accepted hospital-based cessation counselling; 88% of those who had a baseline low-dose CT in the reporting period attended a hospital-based counselling session. 93% of survey respondents (response rate 56%) reported being satisfied with the smoking cessation counselling they received.
8eea62084ca7e541d918e823422bd82e Conclusion
Acceptance of SCS by current smokers in Cancer Care Ontario’s lung cancer screening pilot is very high. A large majority of screened current smokers have attended a hospital-based counselling session, and satisfaction with this service was high. These findings suggest that an opt-out approach is acceptable to individuals motivated to attend a lung screening program. The final pilot evaluation in spring 2020 will evaluate the success of the smoking cessation initiative by assessing quit attempts, quit rates and relapse among screening participants.
6f8b794f3246b0c1e1780bb4d4d5dc53Information from this presentation has been removed upon request of the author.
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P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.01-76 - The Impact of Concordance with a Lung Cancer Diagnosis Pathway Guideline on Treatment Access in Patients with Stage IV Lung Cancer (ID 12628)
16:45 - 18:00 | Author(s): Gail Elizabeth Darling
- Abstract
Background
Lung cancer is the leading cause of cancer mortality with the majority of cases diagnosed at an advanced stage. Timely access to treatment is dependent on efficient and appropriate patient assessment and early referral for diagnostic workup. This study aims to assess the impact of referral concordance with a new Lung Cancer Diagnostic Pathway Guideline (LCDPG) on access to treatment in patients with stage IV lung cancer.
a9ded1e5ce5d75814730bb4caaf49419 Method
This is a retrospective cohort study of patients with clinical stage IV lung cancer referred to the Diagnostic Assessment Program (DAP) at a Canadian tertiary cancer centre between November 1, 2015 and May 31, 2017. Patient referrals were defined as concordant or discordant based on Cancer Care Ontario LCDPG. The primary outcome; time to treatment from initial healthcare presentation; was compared between the concordant and discordant referrals.
4c3880bb027f159e801041b1021e88e8 Result
Two hundred patients were referred for clinical stage IV lung cancer during the study period. Of these referrals, 151 (75.5%) were assessed and referred in concordance with LCDP guidelines. Guideline concordant referrals were associated with reduced time to treatment from first healthcare presentation compared with guideline discordant referrals (55.3 vs 108.8 days, p<0.001). Time to diagnostic procedure (32.2 vs 86.7 days, p<0.001) and decision to treat (38.5 vs 93.8 days, p<0.001) was also reduced with guideline concordance. The most common reason for discordant assessment and referral was delayed or inadequate investigation of symptoms in a high risk patient (32.7% of discordant referrals).
The mean time from referral to diagnostic procedure (19.4 [SD 16.0] days), decision to treat (23.3 [SD 17.1] days), and treatment initiation (39.7 [SD 26.3] days) did not significantly differ between concordant and discordant groups. Time from referral to decision to treat was within 28 days in 71.5% of patients. The mean number of hospital visits from referral to treatment was 4.9 (SD 3.5). Diagnosis was achieved with a single diagnostic test in the majority of patients (91%). The most common method of diagnosis was EBUS-TBNA (33.5%). The most common treatment modalities initiated were radiation (60.5%) followed by chemotherapy (43%) and targeted therapy (21.5%).
8eea62084ca7e541d918e823422bd82e Conclusion
Guideline concordant assessment and referral of patients with stage IV lung cancer results in reduced time to diagnosis and treatment. The utilization of a LCDPG for lung cancer provides a streamlined and efficient framework to facilitate early diagnosis and treatment. Future research and education should focus on improving factors leading to a delay in DAP referral.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.11 - Screening and Early Detection (Not CME Accredited Session) (ID 977)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.11-21 - The Development of a Robust Radiology Quality Assurance (QA) Program in a Provincial High-Risk Lung Cancer Screening Pilot (HRLCSP) (ID 13811)
12:00 - 13:30 | Author(s): Gail Elizabeth Darling
- Abstract
Background
Lung cancer is the leading cause of cancer death in Ontario, with an estimated 7100 patient deaths occurring in 2016 (Canadian Cancer Society, 2016). Based on results from the National Institute of Health’s National Lung Screening Trial, Cancer Care Ontario (CCO) implemented the HRLCSP in 2017 to determine feasibility of provincial scale roll-out of an organized lung cancer screening program. An integral component of the HRLCSP is to ensure low-dose computed tomography (LDCT) scans would be performed, interpreted and reported in a standardized, and high-quality manner.
a9ded1e5ce5d75814730bb4caaf49419 Method
The HRLCSP project team coordinated with CCO’s Cancer Imaging Program (CIP) to gain insight into cancer imaging practices and protocols, and recruited clinical expertise through a Radiology QA Clinical Lead (RQACL). In collaboration with pilot site radiologists, a comprehensive QA program was developed to encompass all aspects of radiology including facility, educational, and reporting standards, in addition to defining quality improvement criteria.
4c3880bb027f159e801041b1021e88e8 Result
To ensure pilot centres were able to deliver high-quality LDCTs, the RQACL, site participants and clinical experts collaborated to define and implement quality parameters. Equipment standards were defined in The Radiology QA Program Manual, and agreement from pilot sites was confirmed. Collaboration with reading radiologists led to tailored educational workshops designed to ensure consistency in the reporting of lung nodules based on the Lung-RADS™ scoring criteria, adapted from the American College of Radiology. Scan interpretation considerations, scoring criteria, and reporting templates were implemented. Annual assessments have ensured compliance across pilot sites. A working group aiming to determine an algorithm to examine incidental findings is being created. LDCT scan Double Read minimums and Peer Review adjudication processes were developed to ensure expert opinion availability with radiologist discrepancies to ensure high quality scan interpretation.
8eea62084ca7e541d918e823422bd82e Conclusion
The design of the HRLCSP offered opportunities for implementing high quality standards around the LDCT scans. Implementation of a robust quality assurance program can ensure that the radiology component is delivered in a high-quality manner. Radiologist training programs, centre minimum requirements, and standardized reporting can ensure standards remain high. Lessons learned through the development of this comprehensive radiology QA program in the HRLCSP will allow for adoption of high-quality radiology standards on a larger provincial scale.
6f8b794f3246b0c1e1780bb4d4d5dc53
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PR01 - Press Conference (ID 872)
- Event: WCLC 2018
- Type: Press Conference
- Track:
- Presentations: 2
- Moderators:
- Coordinates: 9/23/2018, 16:00 - 17:30, Room 202 BD
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Preview of the WCLC/Key Themes/Practice-Changing Abstracts (ID 14871)
16:05 - 16:13 | Presenting Author(s): Gail Elizabeth Darling
- Abstract
Abstract not provided
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Welcome (ID 13396)
16:00 - 16:05 | Presenting Author(s): Gail Elizabeth Darling
- Abstract
Abstract not provided
