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R. Stirling



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    P1.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 206)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P1.01-040 - Determining Completeness of Case Ascertainment to the Victorian Lung Cancer Registry: A Quantitative Case Finding Audit (ID 388)

      09:30 - 17:00  |  Author(s): R. Stirling

      • Abstract

      Background:
      The Victorian Lung Cancer Registry (VLCR) pilot project aims to recruit all lung cancer cases diagnosed across participating Victorian sites. Case ascertainment derives from institutional ICD-10 coding. A quantitative, case finding audit was employed to evaluate the case ascertainment methodology and assess capture completeness at a Victorian public and private metropolitan hospital.

      Methods:
      Lists of lung cancer patients recorded for the period 01/07/2011 and 30/06/2012 were requested from institutional departments including; Radiotherapy, Palliative Care, Day Procedure Unit, Oncology Lung Multidisciplinary Team Meeting (MDM), Cardiothoracic Surgery (CTS), Pathology and the Victorian Cancer Registry (VCR). Comparisons were made between VLCR administrative capture versus clinical capture achieved by the use of clinical databases compared with mandated VCR capture.

      Results:
      The VLCR registered 125 new cases in Site A and 100 in Site B. A total of 10 (7.5%) patients in Site A and 13 (11%) patients in Site B had not been recruited by the registry. Investigations indicated that the underreporting of these cases was attributed to: Use of the ICD10 R91 Code (when lung cancer is suspected but not confirmed) Non coded patients (e.g. day admissions, direct admission to palliative care or MDM)

      Conclusion:
      The completeness of capture of incident cancers occurring in a population and included in a registry database is a vital attribute of a cancer registry. Current capture is approximately 90% and inclusion of the R code and an attempt to capture un-coded patients will ensure registry incidence rates are close to their true value.

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    P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P2.01-067 - Quality in Lung Cancer Care: The Victorian Lung Cancer Registry Pilot Initial Report (ID 1296)

      09:30 - 17:00  |  Author(s): R. Stirling

      • Abstract

      Background:
      The Victorian Lung Cancer Registry is a clinical quality registry designed with the aim of improving the quality of care delivered to Victorians with lung cancer by collecting and assessing management, treatment and outcome data on all new cases of lung cancer.

      Methods:
      The establishment of the Victorian Lung Cancer Registry Pilot Project commenced with the appointment of a Steering Committee to provide project governance. Review of current literature and evidence-based national and international clinical practice guidelines was undertaken by an expert working group. Included data items were epidemiologically sound, reproducible and valid. The data set enables the capture of identified quality indicators designed to describe the structural quality, process quality and indicators of outcome in lung cancer management. Case ascertainment is derived from institutional ICD-10 coding and participant consent occurs via an “opt-off” system. Follow up and outcome measures are collected at baseline, 6 and 12 months after diagnosis capturing survival, treatment and quality of life. Institutional recruitment was designed to sample from metropolitan public, metropolitan private and regional hospitals.

      Results:
      Data was collected on 690 patients from 1 July 2012 to 31 June 2013 from 8 Victorian Hospitals (3 public and 3 private metropolitan and 2 regional). Evidence of distress screening was available for 27% of subjects. Diagnosis was confirmed < 28 days from referral in 66% of cases across institutions. A statement of ECOG status was available in 45% of cases and clinical TNM staging in 49% prior to treatment. A record of multidisciplinary team meeting presentation was available in 59% of cases. First treatment was initiated < 42 days from diagnosis in 76% of cases. Curative surgery was provided for 28% of subjects, curative chemotherapy <5% and curative radiotherapy < 5%.

      Conclusion:
      The evaluation of registry outcomes at governance, administrative and clinical levels may identify targets for quality and service improvement and further define safety measures. The comparison of performance outcomes across institutions and sectors may drive competitive recruitment to improve measures on a longitudinal basis.

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    P3.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 208)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P3.01-029 - Factors Impacting Delay in Timely Care for Patients Diagnosed with Lung Cancer in Victoria (ID 511)

      09:30 - 17:00  |  Author(s): R. Stirling

      • Abstract

      Background:
      Delay in patient management timelines in lung cancer may exceed recommended timeframes, potentially adversely impacting quality of life, curative resection rates, disease progression and survival. The aim of this study was to evaluate the contribution of health service variables to delay between referral (T0), diagnosis (T1) and treatment (T2) for lung cancer patients.

      Methods:
      Demographic, clinical and health service data from the Victorian Lung Cancer Registry (VLCR) was analysed to identify variables predictive of extended critical time intervals. Explanatory variables were included in multivariate models. Sub-group analysis of the magnitude of delay of each interval was also performed.

      Results:
      Among 1417 subjects, median T0-T1 interval was 15 days (IQR 5-38), T1-T2 was 12 days (IQR 0-34) and diagnosis to palliative care 19 days (IQR 5-48). Significant T0-T1 delay was associated with country of birth, whether English is the first language, treatment first received and health status at diagnosis (ECOG score). Significant T1-T2 delay was associated with country of birth, the type of hospital where treatment was provided, presence of major comorbidities and initial treatment type. Factors associated with T2-T3 delay included age at diagnosis, the type of hospital where treatment was provided, health status at diagnosis and initial treatment type. Multivariate analysis demonstrated that type of hospital, stage of disease at diagnosis, ethnicity and type of initial treatment were all associated with significant delay at various stages of the patient journey to initial treatment (T0, T1 and T2).

      Conclusion:
      Understanding factors associated with delay in patients with lung cancer receiving effective management is crucial to developing interventions to address gaps. This research has identified priority areas for action in Victoria