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Laura Donahoe



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    MS27 - Therapeutic Implications of Staging Issues (ID 805)

    • Event: WCLC 2018
    • Type: Mini Symposium
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/26/2018, 10:30 - 12:00, Room 201 BD
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      MS27.04 - Therapeutic Implications of AJCC 8th Edition T1 Subsets (Now Available) (ID 11518)

      11:15 - 11:30  |  Presenting Author(s): Laura Donahoe

      • Abstract
      • Presentation
      • Slides

      Abstract

      In January 2018, the American Joint Committee on Cancer (AJCC)/International Union for Cancer Control (UICC) introduced the 8thedition of the tumor, node, and metastasis (TNM) staging system for lung cancer. In the 7thedition, T1a tumors were defined as <2cm and T1b tumors were defined as 2-3cm. In preparation for the 8thedition, an analysis was done of the International Association for the Study of Lung Cancer (IASLC) database and statistically significant differences in survival based on tumor size in increments of 1cm were found (1). Thus, the 8thEdition T-stage was divided into three subgroups: T1a, tumor 1cm or less; T1b, tumor more than 1cm but not larger than 2cm; T1c, tumor more than 2cm but not larger than 3cm. Currently, the standard of care for early stage lung cancer is surgical resection by lobectomy, based on the results of the 1995 Lung Cancer Study Group trial showing improved survival compared with sublobar resection (2). With improvements in imaging technology and clinical staging, the question of whether sublobar resection, in the form of wedge resection or segmentectomy, can provide an oncologically equivalent treatment remains to be answered (3). In a comparison of survival between lobectomy and sublobar resection, it was found that the survival benefit from lobectomy was only present for patients before 1997 and not for the newer cohorts (4). This suggests that early stage lung cancer patients of the present era are different from the era by which our current standards of care were established. Similarly, in comparing outcomes after lobectomy with sublobar resection using the T-stage from the AJCC/UICC 7thedition, there was no difference in survival based on the type of resection for T1a and T1b ground glass-predominant nodule groups, although there was a higher rate of lymph node metastases in the T1b group (5). Additionally, Okada et al found that there was no difference in survival between lobectomy or segmentectomy for T1a tumors based on the AJCC/UICC 7thedition classification (6). Thus, even when using the prior classification of T-stage, there is evidence to suggest that these early tumors should be managed differently than larger, more advanced non-metastatic tumors. With the introduction of the AJCC/UIC 8thedition of the staging system, further studies will be able to better delineate the question of whether sublobar resection is appropriate for early stage lung cancer and whether a specific size cutoff within the T1 stage can guide the extent of resection.

      1. Rami-Porta R, Bolejack V, Crowley J, Ball D, Kim J, Lyons G, et al. The IASLC Lung Cancer Staging Project: Proposals for the Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2015;10(7):990-1003.

      2. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60(3):615-22; discussion 22-3.

      3. Van Schil PE. Non-small cell lung cancer: the new T1 categories. F1000Res. 2017;6:174.

      4. Yendamuri S, Sharma R, Demmy M, Groman A, Hennon M, Dexter E, et al. Temporal trends in outcomes following sublobar and lobar resections for small (≤ 2 cm) non-small cell lung cancers--a Surveillance Epidemiology End Results database analysis. J Surg Res. 2013;183(1):27-32.

      5. Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage IA lung adenocarcinoma: wedge resection or segmentectomy. Chest. 2014;145(1):66-71.

      6. Okada M, Mimae T, Tsutani Y, Nakayama H, Okumura S, Yoshimura M, et al. Segmentectomy versus lobectomy for clinical stage IA lung adenocarcinoma. Ann Cardiothorac Surg. 2014;3(2):153-9.

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    P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.01-76 - The Impact of Concordance with a Lung Cancer Diagnosis Pathway Guideline on Treatment Access in Patients with Stage IV Lung Cancer (Now Available) (ID 12628)

      16:45 - 18:00  |  Author(s): Laura Donahoe

      • Abstract
      • Slides

      Background

      Lung cancer is the leading cause of cancer mortality with the majority of cases diagnosed at an advanced stage. Timely access to treatment is dependent on efficient and appropriate patient assessment and early referral for diagnostic workup. This study aims to assess the impact of referral concordance with a new Lung Cancer Diagnostic Pathway Guideline (LCDPG) on access to treatment in patients with stage IV lung cancer.

      Method

      This is a retrospective cohort study of patients with clinical stage IV lung cancer referred to the Diagnostic Assessment Program (DAP) at a Canadian tertiary cancer centre between November 1, 2015 and May 31, 2017. Patient referrals were defined as concordant or discordant based on Cancer Care Ontario LCDPG. The primary outcome; time to treatment from initial healthcare presentation; was compared between the concordant and discordant referrals.

      Result

      Two hundred patients were referred for clinical stage IV lung cancer during the study period. Of these referrals, 151 (75.5%) were assessed and referred in concordance with LCDP guidelines. Guideline concordant referrals were associated with reduced time to treatment from first healthcare presentation compared with guideline discordant referrals (55.3 vs 108.8 days, p<0.001). Time to diagnostic procedure (32.2 vs 86.7 days, p<0.001) and decision to treat (38.5 vs 93.8 days, p<0.001) was also reduced with guideline concordance. The most common reason for discordant assessment and referral was delayed or inadequate investigation of symptoms in a high risk patient (32.7% of discordant referrals).

      The mean time from referral to diagnostic procedure (19.4 [SD 16.0] days), decision to treat (23.3 [SD 17.1] days), and treatment initiation (39.7 [SD 26.3] days) did not significantly differ between concordant and discordant groups. Time from referral to decision to treat was within 28 days in 71.5% of patients. The mean number of hospital visits from referral to treatment was 4.9 (SD 3.5). Diagnosis was achieved with a single diagnostic test in the majority of patients (91%). The most common method of diagnosis was EBUS-TBNA (33.5%). The most common treatment modalities initiated were radiation (60.5%) followed by chemotherapy (43%) and targeted therapy (21.5%).

      Conclusion

      Guideline concordant assessment and referral of patients with stage IV lung cancer results in reduced time to diagnosis and treatment. The utilization of a LCDPG for lung cancer provides a streamlined and efficient framework to facilitate early diagnosis and treatment. Future research and education should focus on improving factors leading to a delay in DAP referral.

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    WS03 - Endoscopic Diagnosis and Staging of Lung Cancer – Interventional Pulmonology Hands-On Workshop (Ticketed Session) (ID 986)

    • Event: WCLC 2018
    • Type: Workshop
    • Track: Interventional Diagnostics/Pulmonology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/23/2018, 08:00 - 11:30, Room 205 BD
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      WS03.05 - Navigational Bronchoscopy (Now Available) (ID 14661)

      09:10 - 09:30  |  Presenting Author(s): Laura Donahoe

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.