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J. Vardy
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MO09 - Mesothelioma I (ID 120)
- Event: WCLC 2013
- Type: Mini Oral Abstract Session
- Track:
- Presentations: 1
- Moderators:K. Suzuki, S.G. Armato III
- Coordinates: 10/28/2013, 16:15 - 17:45, Bayside 204 A+B, Level 2
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MO09.07 - Disease and Patient Characteristics related to Survival in a large population-based cohort of patients with Malignant Pleural Mesothelioma (MPM) (ID 3184)
16:15 - 17:45 | Author(s): J. Vardy
- Abstract
- Presentation
Background
Despite advances in therapy, the prognosis of MPM remains poor (median overall survival (OS) of 9-12 months). Nevertheless, as described in surgical series, a small proportion of patients survive far longer. Previously identified prognostic factors in patients undergoing extra-pleural pneumonectomy (EPP) include histological subtype, gender and neutrophil-lymphocyte ratio (NLR). Similar factors including stage and performance status have also been shown to be prognostic in chemotherapy studies. We aim to assess in the general MPM patient population, what factors predict for better prognosis independent of the treatment path chosen.Methods
We reviewed records of patients registered (2002 -2009) with the NSW Dust Diseases Board; a government compensation body for NSW workers with occupational asbestos exposure. We evaluated a priori prognostic factors including age, gender, histological subtype, staging on CT imaging and NLR using Kaplan Meier and Cox regression analysis, and by treatment interventions, smoking and asbestos exposure history. Exploratory subgroup analyses compared these factors in long-term (>20 months) survivors versus the remainder of the study population.Results
We identified 913 patients: 90% male; median age 71.9 years; histological subtype (epithelioid 54%; biphasic 11%; sarcomatoid 16.3%; unknown 19%); stage on CT imaging (Tx-I-II 49%; III-IV 51%). 51% of patients received chemotherapy and 6% underwent EPP (of which 67% received chemotherapy. Median age of first occupational asbestos exposure was 18 years, cumulative duration of exposure, 24 years and latency from exposure to diagnosis, 50 years. Median OS was 10.0 months, 15.0 months (range(1-120) in patients receiving chemotherapy and/or EPP and 5.8 months (range 0-125) in patients receiving neither. On univariate analysis, younger age (<70 vs. >70yrs at diagnosis; 13.1 vs. 8.5 months; p<0.001); female gender (12.0 vs. 9.8months; p<0.001); epithelioid subtype (11.8 vs. 7.2 months ;p>0.001); and NLR <5 (12.9 vs. 7.5months; p<0.001) were associated with prolonged OS. Patients who underwent chemotherapy (13.6 vs. 7.2 months; p<0.001) and EPP (17.9 vs. 9.6 months; p<0.001) also had an improved survival. Smoking history (current/ex vs. never) and cumulative asbestos exposure did not affect survival. A trend to improved survival was noted with early stage disease (11.2 vs. 9.1 months; p=0.284) and younger age at first exposure (<18 vs. >18 years of age; 10.9 vs. 9.4 months; p=0.091). On multivariate analysis, age, gender, histological subtype, NLR, EPP and chemotherapy administration remained significant. 24% of patients demonstrated survival over 20 months. Of those, 14% underwent EPP, and 63% received chemotherapy. On multivariate analysis, epithelioid histology (p<0.001), chemotherapy use(p=0.002), undergoing EPP(p=0.01) and NLR<5(p=0.007) were independently associated with survival over 20 months.Conclusion
In this large, population based cohort of MPM patients, we have validated age, gender, histological subtype and NLR as significant prognostic factors. Patients undergoing interventions such as EPP or chemotherapy demonstrated more favourable survival, however it is important to note that 86% of long survivors did not receive radical surgery, and 37% did not receive chemotherapy. As such, we hypothesise that apart from active treatment and inherent selection criteria, there are additional factors, such as favourable tumour biology, that seem to positively influence survival of MPM patients.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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MO27 - Patient Centred Care (ID 141)
- Event: WCLC 2013
- Type: Mini Oral Abstract Session
- Track: Nurses
- Presentations: 1
- Moderators:C. Broderick, J. McPhelim
- Coordinates: 10/30/2013, 10:30 - 12:00, Bayside 104, Level 1
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MO27.05 - DISCUSSANT (ID 4012)
10:30 - 12:00 | Author(s): J. Vardy
- 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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P1.14 - Poster Session 1 - Mesothelioma (ID 194)
- Event: WCLC 2013
- Type: Poster Session
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P1.14-010 - Estimation of an optimal chemotherapy utilisation rate for malignant pleural mesothelioma: An evidence-based benchmark for patient care (ID 2535)
09:30 - 16:30 | Author(s): J. Vardy
- Abstract
Background
Chemotherapy has been shown to provide a survival benefit in malignant pleural mesothelioma (MPM). There are wide ranging chemotherapy utilisation rates internationally (18 – 61%). This study aims to determine the optimal proportion of patients with MPM that should receive chemotherapy at least once during the course of their illness, based on the best available evidence, so that it can be determined whether chemotherapy is under-utilised in MPM.Methods
An optimal chemotherapy utilisation tree was constructed using indications for chemotherapy identified from evidence-based treatment guidelines. Epidemiological data on the proportion of patient and tumour-related attributes for which chemotherapy was indicated (resectability of the tumour, degree of comorbidities and patient performance status) were obtained and merged with the treatment indications to calculate an optimal chemotherapy utilisation rate, using the decision analysis software (TreeAge Pro 2007). Sensitivity analyses were performed to assess the impact of major variations in the epidemiological data on the overall utilisation rate. This optimal rate was compared with reported actual rates of chemotherapy utilisation in the literature.Results
Chemotherapy is recommended at least once in 65% of all MPM patients. Sensitivity analyses indicate an optimal utilisation rate ranging from 50 to 65% for at least once during the course of their illness. The optimal utilisation rate is consistently higher than the reported actual chemotherapy utilisation rates in United Kingdom (18%), Netherlands (36%), United States (37%), and Australia (54%).Conclusion
An evidence-based model provided an optimal chemotherapy utilisation rate for patients with MPM of 65%. It can serve as a feasible measure of the quality of cancer care. Chemotherapy appears to be under-utilised in the management of MPM in a number of high-income countries.
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P2.10 - Poster Session 2 - Chemotherapy (ID 207)
- Event: WCLC 2013
- Type: Poster Session
- Track: Medical Oncology
- Presentations: 1
- Moderators:
- Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P2.10-030 - Eastern Cooperative Oncology Group (ECOG) score: Agreement between non-small-cell lung cancer (NSCLC) patients and their oncologists and clinical implications (ID 1792)
09:30 - 16:30 | Author(s): J. Vardy
- Abstract
Background
Oncologists use ECOG score to assess patients’ performance status (PS) and guide treatment decisions, but patients and doctors do not necessarily agree on their score. We compared ECOG scores assessed by NSCLC patients and their oncologists to determine if this has implications on treatment and survival prediction.Methods
NSCLC patients who underwent chemotherapy in prospective inter-ethnic difference and nutrition studies at Concord Hospital were included. Patients self-assessed their ECOG score as part of the Patient-Generated Subjective Global Assessment questionnaire prior to chemotherapy. Kappa was used to assess agreement of ECOG score between patients and oncologists. Survival was calculated from date of chemotherapy, using Kaplan Meier method.Results
79 patients (median age 63 years, 86% Stages IIIB/IV, median survival of 15.5 months) were included. ECOG scores differed in 34 (43%) cases (Table).The interrater reliability between patients and their oncologists was Kappa = 0.35 (p <0.001). Figure 1 If patient ECOG scores were used, 11 patients (14%) would be deemed unfit for chemotherapy (ECOG≥3) and 21 patients (27%) would be excluded from clinical trials (ECOG≥2). ECOG status (0 versus >0) irrespective of assessor was predictive of overall survival (18.7 vs. 12.1 months with p=0.023 and 17.4 vs. 11.1 months with p=0.017 for patient and oncologist-assessed ECOG respectively). In patients whose ECOG score was assessed to be 0 by their oncologist (n=39), a worse survival was associated with a poorer patient assessed PS (median survival 16.7 vs. 18.2 months for patient assessed ECOG >0 vs. ECOG=0 respectively; p=0.31).Conclusion
Both physician and patient-assessed ECOG scores are predictive of overall survival. In this study, there was only fair agreement in ECOG assessed by NSCLC patients and their oncologists, with patient scores usually poorer. A number of patients would have excluded themselves from therapeutic interventions including clinical trials based on their ECOG PS rating. Patient-assessed ECOG scores of > 0 may be associated with worse survival despite their oncologist’s more optimistic scoring, a finding which may be incorporated to benefit clinical decision-making.
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P3.14 - Poster Session 3 - Mesothelioma (ID 197)
- Event: WCLC 2013
- Type: Poster Session
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P3.14-013 - Longitudinal Observation of Health Related Quality of Life following Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma (ID 3159)
09:30 - 16:30 | Author(s): J. Vardy
- Abstract
Background
The aim of this study was to describe the longitudinal picture of Health Related Quality of Life (HQOL) in people with Malignant Pleural Mesothelioma (MPM) post Extrapleural Pneumonectomy (EPP).Methods
Participants receiving EPP from 2011- 2013 were assessed pre-operatively, pre and post adjuvant radiotherapy (Rt), and at 8, 12 and 24 months following surgery. Here we report Global HQOL and HQOL Domain Scores of the EORTC QLQ-C30, and Fatigue Scores from FACT-F. Least squares means were obtained from a mixed models analysis with time as a fixed effect, the pre-op assessment as a covariate and a random subject effect.Results
Twelve men with a mean age of 65 years (range 48-78) completed pre-op and at least one post op assessment. Table 1 and Figure 1 report the mean HQOL domain scores, global HQOL and fatigue at baseline as well as the least squares mean and 95% confidence intervals at each follow up assessment. Table 1. Health related quality of life over time Figure 1 Figure 2 Figure 1: Health related quality of life over time These results suggest that people who elect to have EPP have baseline levels of HQOL comparable to the general population. As expected, HQOL declines after surgery and during adjuvant radiotherapy. Emotional functioning changes least, while physical and social functioning closely mirror each other. Role functioning is the domain most affected and remains low out to 24 months. Global HQOL is relatively stable over time, with an apparent increase at 24 months. Fatigue is worst at the conclusion of radiotherapy and gradually improves.Conclusion
People electing to have EPP report a sudden decline in HQOL, with the nadir around the end of adjuvant radiotherapy. This gradually improves over time, returning to slightly below baseline in many domains.
