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D. Debieuvre
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OA16 - Improving the Quality of Lung Cancer Care - Patients Perspective (ID 399)
- Event: WCLC 2016
- Type: Oral Session
- Track: Patient Support and Advocacy Groups
- Presentations: 1
- Moderators:G. Kreye, D. Tan
- Coordinates: 12/06/2016, 16:00 - 17:30, Schubert 6
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OA16.05 - Socioeconomic Determinants of Late Diagnosis of Lung Cancer in France: A Nationwide Study (the TERRITOIRE Study) (ID 4840)
16:00 - 17:30 | Author(s): D. Debieuvre
- Abstract
- Presentation
Background:
Socioeconomic disparities in survival of patients with lung cancer have been identified in many countries. The aim of this study was to examine determinants of late diagnosis of lung cancer in France.
Methods:
All patients with a first diagnosis of lung cancer in 2011 in the National hospitals databases were included. Information on gender, age, presence of metastasis at diagnosis and any significant chronic comorbidities (hypertension, diabetes mellitus, renal insufficiency, and other chronic lung diseases) was retrieved. Based on municipality of residence, patients were classified by population density, social deprivation, access to general practitioners and pulmonologists.
Results:
We identified 41,015 patients newly diagnosed for lung cancer in French hospitals. Mean age at diagnosis was 66.4 (±11.9) years and 72% patients were men. 53% (N=21,613) patients were metastatic at the time of diagnosis. This rate was higher for patients in public compared to private hospitals (56.1% vs 42.9%, p<0.0001) and in community compared to university hospitals (60.2% vs 49.6%, p<0.0001). Multivariate analysis found that metastases at the time of diagnosis were significantly associated with a younger age (55 years or less, OR: 1.22 [95%CI:1.16–1.29]; p<0.0001), a low access to pulmonologists (OR: 1.13 [95%CI:1.04–1.23]; p=0.004), a rural or semi-rural dwelling (OR: 1.07 [95%CI:1.02–1.13]; p=0.004) and deprived areas (OR: 1.06 [95%CI:1.01–1.11]; p=0.01). Of the 8,413 patients (20%) who were initially admitted through emergency room (ER) 68.1% had metastatic tumors. Multivariate analysis showed significantly higher rate of admission through ER at diagnosis in patients from most deprived areas (OR: 1.44 [95%CI:1.37–1.52]; p0.0001), rural or semi-rural (OR: 1.25 [95%CI:1.19–1.32]; p<0.0001), with a low access to pulmonologists and general practitioners (OR: 1.24 [95%CI:1.17–1.30]; p<0.0001 and 1.15 [95%CI:1.08–1.23]; p<0.0001, respectively). Gender (male) and presence of comorbidities were also significant determinants of metastatic disease and admission through ER at diagnosis.
Conclusion:
A majority of French patients with lung cancer were initially metastatic at the time of diagnosis and 1 out of 5 were diagnosed following admission through ER. Residential socioeconomic indicators and access to general practitioners and pulmonologists were significantly associated with these indicators of poor outcome.
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P1.01 - Poster Session with Presenters Present (ID 453)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.01-038 - Prognosis Value of Body Mass Index (BMI) and Weight Loss at Diagnosis in Primary Lung Cancer: Results of KBP-2010-CPHG Study (ID 4373)
14:30 - 15:45 | Author(s): D. Debieuvre
- Abstract
Background:
We studied the relationship between 1-year mortality and weight at diagnostic in 6,965 adult patients followed for primary lung cancer in 104 general hospitals.
Methods:
Patients were classified into 5 groups: Group 1, underweight with recent weight loss; Group 2, underweight without recent weight loss; Group 3, normal weight; Group 4, overweight; Group 5, obese. Kaplan-Meier method (1-year mortality) and Cox multivariate analysis (independent risk-factors) were used.
Results:
Respectively, 11%, 4%, 45%, 29%, and 12% of patients belonged to Groups 1, 2, 3, 4, and 5. One-year survival was lower in Group 1 (27% [24%-30%]) and higher in Group 4 (50% [48%-52%]) or 5 (53% [50%-57%]) than in Group 2 (47% [41%-53%]) or 3 (43% [42%-45%]) (Fig. 1). As compared with normal weight, overweight was an independent protective factor. Independent protective/risk factors are presented in Table 1. Interaction analyses showed that overweight was a significant independent protective factor for stage IIIA and IIIB cancer (HR=0.77 [0.6-0.99], p=0.038; HR=0.75 [0.59-0.97], p=0.029, respectively). Figure 1Variable HR 95%CI P BMI (group) 3 1 1 1.06 0.96-1.17 0.26 2 1.03 0.85-1.23 0.789 4 0.92 0.85-0.99 0.036 5 0.9 0.81-1.01 0.061 Age (years) <=40 1 41-50 1.07 0.74-1.54 0.714 51-60 1.02 0.72-1.46 0.899 61-70 1.05 0.74-1.49 0.796 71-80 1.11 0.78-1.59 0.553 >80 1.54 1.07-2.22 0.02 Sex Men 1 Women 0.81 0.74-0.88 <0.001 Smoking Never-smoker 1 Former-smoker 1.19 1.06-1.35 0.004 Current-smoker 1.27 1.13-1.44 <0.001 PS PS0 1 PS1 1.58 1.45-1.73 <0.001 PS2 2.66 2.4-2.95 <0.001 PS3 5.6 4.95-6.34 <0.001 PS4 10.61 8.62-13.05 <0.001 Stage <=IIB 1 IIIA 1.89 1.61-2.21 <0.001 IIIB 3 2.56-3.52 <0.001 IV 4.71 4.13-5.38 <0.001
Conclusion:
In 2010, in France, in real life conditions, 1-year survival was low in lung cancer patients with low BMI at diagnosis and recent weight loss. Overweight appeared to be a protective factor in particular for stage IIIA and IIIB cancers.
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P1.01-039 - Does Distance between Chest and Surgery Departments Impact Outcome in Lung Cancer Patients? Results of KBP-2010-CPHG Study (ID 4585)
14:30 - 15:45 | Author(s): D. Debieuvre
- Abstract
Background:
We studied the impact of the distance between chest and thoracic surgery departments on the outcome of patients followed, for primary lung cancer diagnosed in 2010, in the chest department of 104 French general hospitals participating in KBP-2010-CPHG study.
Methods:
6,083 patients with non-small-cell lung cancer (NSCLC) participated in this study. Univariate and multivariate analyses were performed to identify independent factors for surgery and 1-year mortality. Distance from the usual thoracic surgery department in 2010 was collected for each chest department and included in the model as a 4-class variable: 0 km (same hospital), 1-34 km, 35-79 km, and ≥80 km.
Results:
Overall, 23% of hospitals had a thoracic surgery department; otherwise, mean distance between the hospital and the surgical center was 65 km. 1,157 patients (19%) were operated on; vital status was known for 5,876 patients (97%). Distance was not an independent factor for surgery and for mortality. Independent factors for surgery and mortality are presented in Tables 1 and 2. Table 1- Surgery (multivariate analysis: adjusted odd-ratios)
Table 2- Mortality (multivariate analysis: adjusted hazard-ratios)OR 95% CI p Distance (km) 0 1 1-34 0.97 [0.74-1.27] 0.833 35-79 0.88 [0.66-1.18] 0.399 >=80 1.02 [0.78-1.32] 0.91 Age (year) Continuous 0.95 [0.94-0.96] <0.001 Stages IV 1 I 248.18 [172.48-357.11] <0.001 II 155.78 [107.70-225.32] <0.001 IIIA 34.23 [24.80-47.25] <0.001 IIIB 2.33 [1.40-3.89] 0.001 Histology Adenocarcinoma 1 Squamous-cell carcinoma 0.77 [0.61-0.96] 0.023 PS PS0 1 PS1 0.58 [0.47-0.71] <0.001 PS2 0.12 [0.08-0.17] <0.001 PS3 0.08 [0.04-0.16] <0.001 PS4 0.07 [0.02-0.32] <0.001 HR 95% CI p Distance (km) 0 1 1-34 1.02 [0.94-1.11] 0.661 35-79 1.00 [0.91-1.10] 0.985 >=80 1.01 [0.93-1.09] 0.887 Age (year) Continuous 1.01 [1.01-1.01] <0.001 Sex Men 1 Women 0.86 [0.80-0.94] <0.001 Stages IV 1 I 0.15 [0.13-0.18] <0.001 II 0.29 [0.25-0.34] <0.001 IIIA 0.41 [0.37-0.46] <0.001 IIIB 0.65 [0.58-0.72] <0.001 PS PS0 1 PS1 1.58 [1.45-1.73] <0.001 PS2 2.79 [2.52-3.09] <0.001 PS3 5.75 [5.11-6.48] <0.001 PS4 10.2 [8.52-12.20] <0.001 Smoking Never-smoker 1 Former-smoker 1.18 [1.05-1.33] 0.005 Current-smoker 1.33 [1.18-1.49] <0.001
Conclusion:
In 2010, the absence of an on-site thoracic surgery department did not impair outcome in NSCLC patients managed in the chest departments of French general hospitals.
