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C.R. Gilbert
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P1.05 - Early Stage NSCLC (ID 691)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.05-012 - Treatment Planning in Non-Small Cell Lung Cancer Shows Variable Utilization of Multidisciplinary Tumor Board (ID 10115)
09:30 - 16:00 | Author(s): C.R. Gilbert
- Abstract
Background:
With competing treatment options for early stage non-small cell lung cancer (NSCLC), and controversies over patient selection and management of later stage disease, multidisciplinary tumor board (MDTB) is a critical decision-making forum for management plans. Studies encompassing several cancer domains have shown the benefit of MDTBs on operative mortality, 5-year survival, and patient satisfaction. We aimed to determine the timing and utilization of MDTBs, relative to the initiation of treatment, for patients with NSCLC within a large community healthcare system.
Method:
We reviewed cI-III patients who underwent work-up for primary NSCLC during 6/2013-6/2015 in a hospital network of 7 institutions. This network offers mature multidisciplinary care with dedicated thoracic oncologic services collaborating for formal, weekly MDTBs. Only patients who underwent oncologic treatment were included, and were stratified based on initial treatment type: surgical versus chemotherapy (CHT) and/or radiation therapy (RT). Stage was defined as clinical stage established prior to MDTB, or treatment initiation.
Result:
We identified 203 patients; the figure depicts MDTB timing and utilization stratified by stage for each initial treatment type. Sixty seven percent (24/36) of cI patients did not have a MDTB prior to receiving stereotactic ablative radiotherapy (SABR). In addition, 33% (2/6) of the cIII patients did not receive a MDTB prior to surgical resection. Figure 1
Conclusion:
Variable utilization of MDTB was demonstrated for all clinical stages of NSCLC. In cI NSCLC where competing treatment options of surgery and SABR exist, less than half of the patients received multidisciplinary discussion. MDTB was also underutilized in cIII where treatment controversy exists. Although time constraints, referral patterns and provider bias challenge clinical practice, greater study and quality initiatives are necessary to ensure patients have access to MDTB discussion in the rapidly evolving landscape of NSCLC care.
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P1.10 - Nursing/Palliative Care/Ethics (ID 696)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Nursing/Palliative Care/Ethics
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.10-008 - Palliative Care and Hospice Resources are Underutilized in Patients with Advanced Non-Small Cell Lung Cancer (ID 8656)
09:30 - 16:00 | Author(s): C.R. Gilbert
- Abstract
Background:
The 2010 Temel et al. paper demonstrated a survival benefit from early implementation of palliative care (PC) in stage IV non-small cell lung cancer (NSCLC). Since this finding, medical systems have struggled with the adoption of clinical services for patients with advanced NSCLC, including PC and hospice resources for patients at the end of life. We aimed to document the utilization of PC and hospice resources in NSCLC patients within a large community healthcare system.
Method:
We reviewed a total of 406 stage cI-IV patients who were diagnosed and managed for primary NSCLC during 6/2013-6/2015, in a hospital network of 7 institutions with dedicated PC services. Patients were initially categorized according to the decision to undergo oncologic treatment (therapeutic or palliative) or to receive no oncologic treatment. Patients were further stratified into those who received PC consultation, those referred to hospice (without PC consultation), or those who received neither based on clinical stage.
Result:
We identified 182 stage cIV patients, of which 16% (30/182) received a PC consultation, 39% (71/182) were referred to hospice, and 45% (81/182) received neither. Of the stage cIV patients, those who received oncologic treatment were less likely to receive PC or hospice services (51%, 78/154) than patients without treatment (82%, 23/28); p=0.002 (figure). The figure also demonstrates services utilized by patients of all stages that were ineligible/refused oncologic treatment (48/406). Figure 1
Conclusion:
PC and hospice services were underutilized in patients with advanced disease, and in those likely to reap benefit from these resources. In addition, stage IV patients receiving oncologic treatment were less likely to receive PC or hospice services than patients undergoing no oncologic treatment. Quality improvement interventions and referral triggers targeting the implementation of PC and hospice services early in patient management are needed to meet patient’s global oncologic needs.
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P1.12 - Pulmonology/Endoscopy (ID 698)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Pulmonology/Endoscopy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.12-007 - Outcomes of Radiotherapy and Endoscopic Airway Stenting for Central Airway Obstruction in Non-Small Cell Lung Cancer (ID 9910)
09:30 - 16:00 | Author(s): C.R. Gilbert
- Abstract
Background:
Lung cancer is the leading cause of death from malignancy within the United States, exceeding that from breast, colon, and prostate combined. A common complication and challenge of advanced stage lung cancer is central airway obstruction (CAO). CAO can present with minimal symptoms, but often associated with hemoptysis, progressive dyspnea, and even respiratory failure. Interventions such airway stenting and radiation therapy are offered to palliate symptoms, potentially prevent future complications, and prolong survival. However, to date, very little data exists on the comparison of external beam radiotherapy (EBRT) to endoscopic airway stenting in patients with CAO related to non-small cell lung cancer (NSCLC).
Method:
Patients with NSCLC treated for CAO within the Division of Thoracic Surgery and Interventional Pulmonology from 2010-2013 were identified from diagnosis and billing codes. Patient demographics and interventions were obtained from chart review. Using the Kaplan-Meier method and log rank test, overall survival was calculated from the time to intervention; time from initial intervention to treatment failure (requiring second intervention) and/or death; ECOG status at presentation to death.
Result:
A total of 34 patients were identified that underwent palliative interventions, including initial treatment with stenting (21/34, 62%) and EBRT (13/34, 38%). No difference was identified in overall survival calculated by the Kaplan-Meier method, p=0.583. However, median overall survival tended to be longer for EBRT at 135 days (interquartile range, IQR: 83-263) compared to stenting at 44 days (IQR: 23-301), p=0.228. In addition, comparative Kaplan-Meier times to failure (second intervention/death) were significantly different, p=0.049; with a similar trend in median time to failure for EBRT at 135 days (IQR: 23-263) versus 27 days (IQR: 6-82) for stenting, p=0.063. Median survival by ECOG status was ECOG 1 – 263 days (IQR:197-463), ECOG 2 – 69 days (IQR:26-147), ECOG 3 – 107 days (IQR:51-209), ECOG 4 – 6 days (IQR:4-23), p=0.003; with sustained separation in Kaplan-Meier survival, p<0.001.
Conclusion:
NSCLC patients developing CAO represent a challenging population. Overall median survival times are poor, but appeared improved in patients receiving EBRT compared to those receiving airway stenting. From a physiologic standpoint, airway stenting often provides immediate relief of airway obstruction and respiratory embarrassment; however, our current results may question the role of airway stenting in NSCLC patients with CAO. Alternatively, additional outcomes such as quality of life and utilization of healthcare resources may also need to be explored to evaluate the full impact that EBRT and/or airway stenting may have on CAO.
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P2.13 - Radiology/Staging/Screening (ID 714)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.13-021 - Community Network Lung Cancer Screening Experience Underrepresents Medically Underserved and Geographically Remote Individuals (ID 10402)
09:30 - 16:00 | Author(s): C.R. Gilbert
- Abstract
Background:
The National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer mortality. However, it’s study centers may not have represented remote populations with low socioeconomic status and/or health care access. Previous reports on other cancers have demonstrated higher rates of screening in urban populations, with lower adoption in underserved and geographically remote communities. We aimed to quantify the proportion of screened individuals from medically underserved and geographically remote areas represented in our multi-state hospital network lung cancer screening programs (LCSPs).
Method:
We performed a multi-institution review using data from individuals enrolled in Pacific Northwest LCSPs, which form part of a multi-state hospital network. Individuals from programs spanning Washington State, Oregon, Montana, and Alaska from 2012-2016 were included. Definitions include: medically underserved area [MUA; healthcare resources deficient region], medically underserved population [MUP; area with economic/cultural/linguistic barriers to primary care services], health professional shortage area [HPSA; primary care physician shortage].
Result:
We identified a total of 2,379 screening participants. Of these, 22% (529) resided in a medically underserved area and 5% (108) were from a medically underserved population. Only 9% (216) resided in a HPSA, compared to the combined state data reporting a rate of 20% HPSA residents. Individuals lived a median of 6 miles from the screening site. Data stratified by state is shown in the figure, and demonstrates a high capture rate of individuals residing in MUAs in Montana. Figure 1
Conclusion:
All sites showed poor penetration into communities identified as MUPs and HPSAs. All sites also had poor penetration into MUAs; except for Montana, likely due to its overwhelming rural nature. However, the vast majority of screening participants lived in close proximity to screening centers. Therefore, novel approaches such as telemedicine and mobile screening clinics may be needed to reach underserved populations for LCS.
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P3.13 - Radiology/Staging/Screening (ID 729)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.13-029 - Imaging Guideline-Recommendations Prior to Treatment for Non-Small Cell Lung Cancer Demonstrates Variable Compliance (ID 10121)
09:30 - 16:00 | Author(s): C.R. Gilbert
- Abstract
Background:
Poor adherence to the recommended guidelines in diagnosing and staging patients with non-small cell lung cancer (NSCLC), with negative downstream effects has been previously shown. In addition, studies have demonstrated benefits of staging with PET, including a reduction in number of non-curative resections performed and a higher rate of identifying M1b disease. Staging with brain MRI has demonstrated a yield up to 10% for detecting metastasis in patients with negative clinical examinations. We aimed to assess the adherence to imaging guidelines for PET and brain MRI in the staging of NSCLC patients prior to treatment within our healthcare system.
Method:
We reviewed patients who underwent initial work-up for primary NSCLC during 6/2013–6/2015, in a hospital network of 7 institutions. Clinical stage II-IV patients were stratified by imaging performed prior to the initiation of treatment. Evidence-based clinical practice guidelines referenced include the American College of Chest Physicians (ACCP) 3[rd] edition and the National Comprehensive Cancer Network (NCCN) 7[th] version. Both ACCP and NCCN recommend a PET scan for suspected cIb-III; while ACCP recommends a brain MRI for suspected cIII-IV, and NCCN for suspected cIb-IV.
Result:
The figure demonstrates compliance rates for the 283 included patients. Of cII patients, 7% (2/30) did not receive a PET scan and 43% (13/30) did not receive a brain MRI; while, 11% (6/56) of cIII did not receive a PET scan and 20% (11/56) did not receive a brain MRI. Figure 1
Conclusion:
Variable compliance with imaging guidelines for the use of PET and brain MRI imaging for the staging of our NSCLC patients was seen. Lack of appropriate imaging for NSCLC staging may lead to inappropriate management decisions resulting from incomplete staging information. Quality initiatives are necessary to ensure guideline compliance.
