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X.S. Wang



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    OA 01 - The New Aspect of Radiation Therapy (ID 652)

    • Event: WCLC 2017
    • Type: Oral
    • Track: Radiotherapy
    • Presentations: 1
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      OA 01.07 - Tracking Major Symptom Burden from Chemotherapy Concurrent with 3D vs. IMRT vs. Proton Beam Radiotherapy for NSCLC (ID 9443)

      11:00 - 12:30  |  Author(s): X.S. Wang

      • Abstract
      • Presentation
      • Slides

      Background:
      During standard concurrent chemoradiotherapy (CRT), patients with NSCLC often report severe symptoms that should be routinely assessed and managed. According to the United States FDA specified standards, patient-reported outcome (PRO) instruments used in clinical trials should have good measurement properties of reliability, validity, and the ability to detect change. This quantitative study used a validated PRO symptom-assessment tool, the MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC), to compare a cluster of CRT-related symptoms in NSCLC patients receiving CRT, and to investigate the sensitivity of a composite score of these symptoms.

      Method:
      We enrolled patients with locally advanced NSCLC (n=118) who underwent intensity-modulated radiation therapy (IMRT, n=33), 3-dimensional conformal radiation therapy (3DCRT, n=22), or proton-beam therapy (PBT, n=63). Patients completed the MDASI-LC weekly for up to 12 weeks. Two criteria used for item selection to form a subscale for CRT-related symptoms: MDASI-LC items rated 4-10 in >25% of observations, and that increased significantly during therapy (by mixed-effect models). A CRT-symptom score (MDASI-LC-CRT) was generated by averaging scores from those symptoms. The MDASI-LC-CRT’s responsiveness to treatment was examined by within-person change over time and effect size (ES) statistics.

      Result:
      Six symptoms—pain, fatigue, drowsiness, lack of appetite, sore throat, coughing—were identified as the most-severe CRT-related symptoms during and after therapy. Before CRT, MDASI-LC-CRT scores did not differ by treatment (3DCRT 2.2±1.8, IMRT 1.6±1.5, PBT 1.8±1.7, p=0.329). At the end of CRT, MDASI-LC-CRT was highest for 3DCRT (4.85±2.40), followed by IMRT (3.18±1.85) and PBT (2.29±1.65). A large ES (1.24) was found for 3DCRT vs. PBT; medium ES were found for 3DCRT vs. IMRT (0.78) and IMRT vs. PBT (0.51). The ES for pre-CRT vs. post-CRT difference (1.8±1.7 vs. 3.0±2.1) was medium (0.63) for all patients, large for 3DCRT (1.25) and IMRT (0.93), and small for PBT (0.28). The MDASI-LC-CRT score increased significantly over treatment (estimated weekly increase=0.21, p<0.0001), peaking at week 7 (95%CL=6.2-7.8, p<.0001) and then decreasing to week 12 (est=0.18, p=0.001). Significantly larger weekly increase was reported by 3DCRT and IMRT patients, compared with PBT patients (all p<0.0001).

      Conclusion:
      The MDASI-LC-CRT is a sensitive indicator of dynamic change in major symptom burden during CRT. This subscale could be routinely used for symptom monitoring while patients are going through CRT and appropriate supportive measures could be instituted early. PBT was the best tolerated of the radiation modalities when given concurrently with chemotherapy with the least worsening of symptoms over the CRT period.

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    P2.01 - Advanced NSCLC (ID 618)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P2.01-036 - Symptom Trajectories During Chemotherapy Predict Overall Survival in Patients with Advanced Non-Small Cell Lung Cancer (ID 9393)

      09:00 - 16:00  |  Author(s): X.S. Wang

      • Abstract
      • Slides

      Background:
      Patient–reported symptoms have shown prognostic value for patients with advanced non-small-cell lung cancer (NSCLC). The value of persistently high levels of critical symptoms during chemotherapy for predicting survival is seldom addressed. We examined symptom trajectories during first 15 weeks of chemotherapy and their relations to 3-year overall survival (OS) in patients with advanced NSCLC.

      Method:
      Stage IIIB-IV NSCLC patients scheduled to receive either intravenous chemotherapy or the oral tyrosine kinase inhibitor erlotinib were enrolled in a multicenter longitudinal study. Patients rated 15 symptoms on the MD Anderson Symptom Inventory-Lung (MDASI-LC) before chemotherapy and weekly thereafter for 15 weeks, on 0-10 severity scales. Group-based trajectory analysis was used to categorize patients into groups according to the level and trajectory of symptom severity (either high or low) that patients experienced over time. The 3-year OS was compared between high/low groups via Kaplan-Meier analysis. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) were estimated by Cox regression modeling, with adjustment for demographic and clinical factors.

      Result:
      We analyzed data from 140 patients (90 died by end of study). High-severity trajectories of three symptoms (fatigue, shortness of breath (SOB), lack of appetite (LOA)) significantly predicted 3-year OS. Patients in the high-fatigue group (n=60) began with moderate fatigue (4.1±3.4) that increased significantly during weeks 1-4 of therapy (5.7±4.5 at week 4; estimated weekly change=0.33, p=0.0004) and remained at this level to week 15. Compared with patients in the low-fatigue group (mean=2.0±1.8, no significant change over time), high-fatigue patients had shorter OS (median=290 vs. 623 days, HR=2.3, 95%CI=1.4-3.8, p=0.001). The high-SOB group (n=62) maintained a moderate level of SOB (4.6±3.5) over 15 weeks and had lower 3-year OS rate than did patients in the low-SOB group (median=256 vs. 566 days; HR=2.7, 95%CI=1.6-4.4, p<0.0001). Compared with patients in the low-LOA group (n=66, mean=0.8±1.8, no change over time), high-LOA patients (n=74, mean=3.2±3.1, no change over time) had shorter OS (median=261 vs. 566 days, p=0.019). The prognostic value of LOA was insignificant after adjusting for other factors.

      Conclusion:
      Our results suggest that, through longitudinal patient-reported symptom profiling during chemotherapy, persistently high symptom burden can independently predict overall survival in patients with advanced NSCLC. Patients with persistently high symptoms should be targeted for alerts to providers about the need for symptom control during chemotherapy in routine care for advanced NSCLC. Such information could also be used as reference parameters for clinical trial/research design.

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