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Kevin ten Haaf



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    MA18 - Modelling, Decision-Making and Population-Based Outcomes (ID 920)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 13:30 - 15:00, Room 201 F
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      MA18.06 - Patterns of Lung Cancer Care in the United States: Developments and Disparities (ID 11991)

      14:00 - 14:05  |  Author(s): Kevin ten Haaf

      • Abstract
      • Presentation
      • Slides

      Background

      The level of adherence to lung cancer treatment guidelines is unclear. The aims of this current study were to provide an overview of current patterns of lung cancer care in the United States and to identify possible disparities in receiving standard of care.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Using the National Cancer Database, we evaluated the first course therapy of 468,422 lung cancer cases diagnosed between 2010-2014. We used a series of multivariate logistic regression models to identify relationships between patient, tumor, and health care provider characteristics and receiving predefined stage-specific standards of care.

      4c3880bb027f159e801041b1021e88e8 Result

      Most common treatments were surgery only (15.2%), radiotherapy only (12.8%), chemotherapy only (13.5%), and radiotherapy and chemotherapy (26.2%). 22.1% of subjects received no treatment. Between 2010-2014, the use of Video-Assisted Thoracoscopic Surgery among surgically treated cases increased from 24.6% to 42.3%, while the rate of conversions to open surgery decreased from 18.3% to 10.4%. Among stage IA non-small cell lung cancer patients treated with thoracic radiotherapy, the use of Stereotactic Body Radiotherapy increased from 53.4% to 73.0%. Overall, only 63.3% of subjects received standard of care. Receiving surgery for early-stage non-small cell lung cancer was less likely with increasing age (for those 80 and over: odds ratio [OR], 0.08; 95% confidence interval [95%CI], 0.07-0.09), for non-Hispanic Blacks (OR, 0.59; 95%CI, 0.57-0.62), and for squamous cell histology (OR, 0.46; 95%CI, 0.45-0.47). These disparities were also present in other stages.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Particularly elderly lung cancer patients, non-Hispanic Blacks, and those with squamous cell histology are less likely to receive standard of care. These disparities may have consequences for lung cancer screening, as the effectiveness depends on adequate treatment of lung cancer.

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    MS29 - Selection into Screening Programs: Interplay of Risk Algorithms, Genetic Markers and Biomarkers (ID 807)

    • Event: WCLC 2018
    • Type: Mini Symposium
    • Track: Screening and Early Detection
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 13:30 - 15:00, Room 206 F
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      MS29.02 - Defining Screening Frequency & Duration Using Risk Prediction Algorithms and CT Image Findings (ID 11526)

      13:50 - 14:05  |  Presenting Author(s): Kevin ten Haaf

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    P2.11 - Screening and Early Detection (Not CME Accredited Session) (ID 960)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.11-04 - Treatment Capacity Required for Implementing Lung Cancer Screening in the United States (ID 13825)

      16:45 - 18:00  |  Author(s): Kevin ten Haaf

      • Abstract
      • Slides

      Background

      Implementing Low-Dose Computed Tomography screening for lung cancer will lead to an increased detection of early stages. The required resources to treat those cancers remains unknown.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We extended a well-established microsimulation model with data from the National Cancer Database to assess the number of lung cancer patients requiring surgery, radiotherapy, chemotherapy, and no therapy when implementing lung cancer screening in the United States in 2018. Three screening policies were assessed: the United States Preventive Task Force (USPSTF) recommendations; the Centers for Medicare & Medicaid Services (CMS) recommendations; and the most cost-effective policy from a study for Cancer Care Ontario (annual screening, ages 55-75, at least 40-pack year smoking history, currently smoking or quit within last 10 years). Base-case screening adherence was 50%. Sensitivity analyses assessed 20%, 35%, 65% and 80% adherence.

      4c3880bb027f159e801041b1021e88e8 Result

      Implementing the USPSTF recommendations with 50% screening adherence would require 35.3% more lung cancer surgeries in 2015-2040 compared to no screening. However, 2.1% less radiotherapy and 5.1% less chemotherapy treatments would be required. Furthermore, 6.2% fewer patients would receive no therapy. The required number of lung cancer surgeries would be 75,379 in 2018, 58,155 in 2023, 55,269 in 2028, and 45,007 in 2040. Compared to no screening, this is an increase of 92.7% in 2018, 44.3% in 2023, 36.8% in 2028, and 23.0% in 2040. Screening adherence strongly influenced results. By 2018, the required number of surgeries would range from 53,666 (with 20% adherence) to 96,953 (with 80% adherence). Results for the CMS and Ontario policies were similar to the USPSTF policy, although changes compared to no screening were smaller.

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      8eea62084ca7e541d918e823422bd82e Conclusion

      Implementing lung cancer screening in the United States requires a major increase in surgical capacity. The current workforce of thoracic surgeons in the United States may not be able to cope with this increased demand.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    PL02 - Presidential Symposium - Top 5 Abstracts (ID 850)

    • Event: WCLC 2018
    • Type: Plenary Session
    • Track: Advanced NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 08:15 - 09:45, Plenary Hall
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      PL02.05 - Effects of Volume CT Lung Cancer Screening: Mortality Results of the NELSON Randomised-Controlled Population Based Trial (ID 14722)

      08:45 - 08:55  |  Author(s): Kevin ten Haaf

      • Abstract
      • Presentation
      • Slides

      Abstract

      The NELSON-trial is a population-based RCT using nodule volume management for referral, initiated to show a 25% LC mortality reduction in males at 10-years of follow-up.

      606,409 persons, aged 50-74, in the Netherlands and Leuven were sent a general questionnaire about risk factors, leading to 150,920 responders. 30,959 responders were eligible and invited to participate, of which 15,822 gave informed consent and were randomized (1:1). CT-screening was offered to study arm participants at baseline and 1, 3 and 5.5 years after randomization, whereas no screening was offered to control arm participants. Participant’s records were linked to national registries with 100% coverage regarding cancer diagnosis (Netherlands Cancer Registry), date of death (Centre for Genealogy) and cause of death (Statistics Netherlands). Medical files for deceased lung cancer patients up to 2013 were reviewed by an expert panel (blinded to study arm); cause of death reported by Statistics Netherlands was used thereafter. Follow up to 31.12.2015 comprised a minimum duration of 10 years for 98.7% enrolled (unless deceased). A pre-determined 9-year analysis was also considered due to dilution effects by screening design given growth rate of LC.

      CT screening compliance was 94% on average, leading to a total of 29,736 scans. In 9.1% of the participants additional CT scans within 2 months were performed to estimate nodule Volume Doubling Time, leading to an overall referral rate of 2.1% for suspicious nodules. Detection rates across the rounds varied between 0.8-1.0%, and 69% of screen-detected LC were detected at stage IA or B. 261 lung cancers (52 interval cancers) were detected before the 4th round. In a subset of analyzed patients, surgical treatment was 3 times significantly more prevalent in study LC patients than in control arm patients (67.7% versus 24.5%, p<0,001). In total 934 participants have died in the control arm (NL), versus 904 in the study arm (NL). In the Dutch female enrolled participants, the rate-ratio of dying from lung cancer was 0.73 at 10-years, and 0.58 at 9-years FU.

      The minimum 10-year FU for NELSON has been realized, and full data on incidence, mortality and cause of death are equally available for both arms. A (non- significant) 41.8% lung cancer mortality reduction has been achieved in the small subset of 2,382 Dutch women. Post-hoc analysis shows a 51.4% (p=0.04) LC mortality reduction at 8 years of FU. Data for the full cohort will be presented on behalf of NELSON-investigators.

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