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E. Bédard



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    MO27 - Patient Centred Care (ID 141)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Nurses
    • Presentations: 1
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      MO27.02 - Patient Centered Outcomes in the Management of Malignant Pleural Effusion (ID 1408)

      10:30 - 12:00  |  Author(s): E. Bédard

      • Abstract
      • Presentation
      • Slides

      Background
      Malignant pleural effusion (MPE) is common in individuals with advanced cancers and has an adverse impact on respiratory function and quality of life (QOL). Research evaluating treatment methods for MPE have focused on medical endpoints such as chest x-ray and there are no studies that have evaluated patient centered outcomes. Taking into consideration the short life expectancy in this patient population at the time of diagnosis, this study aims to determine the effect of any of the currently accepted treatment methods on QOL and hospital length of stay (LOS).

      Methods
      A prospective study of patients with a radiologically confirmed pleural effusion and an underlying malignancy evaluated patient centered outcomes using the London Chest Activity of Daily Living Scale (LCADL), Functional Assessment of Chronic Illness Therapy –Palliative (FACIT-PAL) and Functional Assessment of Chronic Illness Therapy Treatment Satisfaction (FACIT-TS-G). Cytological confirmation of MPE was obtained in the majority of patients. Treatment of MPE was determined by the attending physician. The study was approved by the institutional REB. Patients who were unable to read or speak English were excluded from the study. After providing informed consent, patients completed the questionnaires (LCADL, FACIT-PAL and FACIT-TS-G) prior to treatment, immediately post treatment and 2 and 6 weeks post treatment. Spearman correlation coefficients were calculated with 95% confidence intervals and p-values were utilized to assess linear relationships between QOL measurements. Mixed model regression analysis was used to estimate linear trends in LCADLS, FACIT-PAL, FACIT-TS Recommendation and FACIT-TS Satisfaction scores in the entire cohort and between treatment groups. Mean QOL scores at measurement time points were plotted in order to assess trends over time for both the entire cohort and for treatment groups.

      Results
      There were 105 study participants from 4 hospitals with a median age of 61 years (range 26-89 years). Lung cancer was the most common underlying malignancy, followed by breast and gastrointestinal cancers. MPE was treated by chest tube + pleurodesis (n=39), Tenckhoff catheter alone (n=27), VATS + Tenchkoff (n=20) and VATS + pleurodesis (n=17). In analyzing the entire cohort, there was an overall improvement in shortness of breath (p<0.0001), ability to perform activities of daily living (p=0.03) and quality of life (p<0.0001) for all treatments. There was no statistically significant difference between treatment groups. However, individuals treated with chest tube + pleurodesis had a decrease in treatment satisfaction, while individuals who were treated with VATS + Tenckhoff (p=0.03) or Tenckhoff alone (p=0.04) reported improvement in their treatment satisfaction. LOS was longer for individuals treated with chest tube + pleurodesis (median 10 days) and VATS pleuroscopy (median 6 days) when compared to VATS + Tenckhoff (median 3 days) & Tenckhoff catheter alone (median 2 days).

      Conclusion
      In the management of MPE, patient centered outcomes are most important. All treatment strategies evaluated in this study provided similar improvements in dyspnea, ability to perform activities of daily living and QOL. However, Tenchkoff catheter treatment strategies offer shorter LOS as well as improved treatment satisfaction which is important given the limited life expectancy of patients with MPE.

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    P3.17 - Poster Session 3 - Bronchoscopy, Endoscopy (ID 185)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track:
    • Presentations: 1
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      P3.17-009 - A Prospective Clinical Study of MicroRNA Expression Profiling of Bronchoalveolar Lavage Fluids and Sputum as a Means to Distinguish Early Stage Non-Small Cell Lung Cancer Cases From Cancer-Free Controls (ID 3403)

      09:30 - 16:30  |  Author(s): E. Bédard

      • Abstract

      Background
      MicroRNAs (miRNAs) post-transcriptionally regulate hundreds of gene targets involved in tumorigenesis and miRNA expression profiling is an emerging tool for the early detection of malignancy. We assessed the ability of microRNA (miRNA) expression profiling of bronchoalveolar lavage (BAL) fluids and sputum samples to distinguish early stage non-small cell lung cancer (NSCLC) cases from cancer-free controls.

      Methods
      The expression levels of 3 miRNAs (miR-21, miR-210, miR-372) were quantified in BAL fluids and sputum, normalized to an endongenous control (U6) relative to a MRC-5 reference sample, using RNA reverse transcription and Quantitative real-time Polymerase Chain Reaction (RT-qPCR). All sputum samples were collected by a single spontaneous expectoration while BAL fluids were obtained just prior to surgical resection. Unsupervised hierarchical cluster analysis was performed on the experimental-normalized miRNA expression profiles using within-group linkage and cosine correlation similarity.

      Results
      From April 2011 to January 2012, twenty-one eligible cases and 10 controls were entered into this study. The median age of cases was 70 years of which 17 were male and 4 were females. Thirteen cases had adenocarcinoma, five had squamous cell carcinoma, and 3 had large cell carcinoma. Twelve cases had stage I and 9 had stage II NSCLC. The median short axis diameter of the primary tumour amongst cases was 1.6 cm. With exception of one case, endobronchial lesions were not detected on inspection by flexible bronchoscopic examination prior to BAL fluid collection. The vast majority of cases were smokers (20/21). The median age of the control group was 58.5 and five were healthy without active medical conditions while five had COPD. Six controls had prior or current histories of smoking while 4 were never smokers. Cluster analysis of the miRNA expression profiles of BAL samples from 21 NSCLC cases and sputum samples from 10 cancer-free controls yielded a diagnostic sensitivity of 85.7% and specificity of 100%. Cluster analysis of sputum samples from the same 21 NSCLC cases and 10 cancer-free controls yielded a diagnostic sensitivity of 67.8% and specificity of 90%. A cosine similarity analysis of matched pairs of concordant and discordant BAL and Sputum samples was conducted and indicated that sampling error accounted for 6 of the 7 false negative results. This suggests that triplicate sputum sample collection could improve the overall sensitivity of this method for use as a safe, non-invasive screening test for NSCLC or as a pre-screening test to select patients for low-dose CT screening.

      Conclusion
      Hierarchical cluster analysis of 3 expressed miRNAs obtained from sputum and brochoalveolar lavage samples are highly specific and relatively sensitive methods for the timely diagnosis of early stage NSCLC. Larger, population-based studies are necessary for further validation of this promising approach in both the diagnostic and screening setting.