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Neal Navani



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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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      MA18.11 - Implementing a ComprehensiveĀ National Audit of Lung Cancer Surgery: The English Lung Cancer Clinical Outcomes Publication (LCCOP) Project (ID 12090)

      14:35 - 14:40  |  Author(s): Neal Navani

      • Abstract
      • Presentation
      • Slides

      Background

      We report the establishment of a national audit of outcomes after lung cancer resection (LCCOP) in the English National Health Service (NHS), a government healthcare system providing the great majority of lung cancer surgery. LCCOP is a compulsory audit commissioned by NHS England.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Unusually, for a surgical audit, data is initially obtained from the cancer registry, and matched to national Hospital Episode Data (HES), before local validation by clinical teams. After case mix adjustment, unit level survival rates at 30, 60 and 90 days, and length-of-stay data are published online and in an annual report. The first annual report was released in 2014.

      Survival is adjusted for age, sex, performance status, stage, laterality, FEV1 percentage, comorbidity and socioeconomic status

      4c3880bb027f159e801041b1021e88e8 Result

      The number of resections rose by 21% between 2015-2017 (4892 to 5936). Median annual activity per surgeon rose from 30 to 49 cases between 2014-2017, a 63% increase. In 2015 survival at 30, 90 and 365 days was 98.1%, 96.3% and 87.9% respectively. Median length of stay was 6 days (IQR 4-9).

      In 2015, 43.9% of lobectomies were completed by VATS, 4.3% were started VATS and completed by open surgery and 0.7% completed by robotics.

      Adjusted 90 day survival by surgical unit: 2017 report (2015 data)

      90 day 2017(15).png

      8eea62084ca7e541d918e823422bd82e Conclusion

      Using routinely collected NHS activity data for surgical audit is feasible, and reduces the data collection burden for hospital teams. Clinical validation remains important to correct discrepancies. Surgical activity has risen significantly. Increases in individual surgeon case volume may reflect increasing subspecialisation. Significant inter-provider variation remains, particularly in length of stay.

      More lung cancer surgery is being done in the English NHS. Surgeons are increasingly subspecialising, with higher case volumes. Local variation remains, particularly around length of stay. A mixed model of routinely collected data with local validation appears acceptable to clinical units.

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    MS09 - Tumour Board - Tissue Acquisition and Staging (ID 788)

    • Event: WCLC 2018
    • Type: Mini Symposium
    • Track: Interventional Diagnostics/Pulmonology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 15:15 - 16:45, Room 206 BD
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      MS09.01 - Cases Prepared by Drs. Edell/Murgu (ID 11436)

      15:15 - 16:35  |  Presenting Author(s): Neal Navani

      • 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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      P2.11-29 - Impact of an Information-Film to Promote Informed Decision-Making in Individuals Taking Part in a Lung Cancer Screening Demonstration Pilot (ID 12757)

      16:45 - 18:00  |  Author(s): Neal Navani

      • Abstract

      Background

      Lung cancer screening by Low Dose CT (LDCT) is underway in the United States, where a shared decision-making process is mandated for insurer funding. The potential harms of screening are complex and difficult to communicate. Participants do not always read written materials and audio-visual aids have been shown to improve informed decision-making in other areas of medicine. There are limited studies on the use of decision aids in lung cancer screening.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A five-minute information-film was made to explain the benefits and risks of lung cancer screening. Qualitative research informed the content and format to make it accessible for individuals of varying demographic and educational backgrounds. A sub-sample of participants (n=229) from a lung cancer screening pilot were randomised to watch the film and read a written information booklet (Group A) or read the booklet alone (Group B). Objective and subjective knowledge of the risks and benefits of screening were assessed before and after the intervention, and again after discussion with a heath care professional, when decisional conflict and satisfaction were also assessed.

      4c3880bb027f159e801041b1021e88e8 Result

      120 and 109 participants were randomised to groups A and B respectively. There was a statistically significant improvement in subjective and objective knowledge scores post-administration of the intervention in both groups (p<0.001). In a multivariate analysis adjusted for educational level and baseline knowledge score, post interventional scores were independently associated with film group (p=0.036). There were no group differences in decisional conflict or satisfaction, or in subsequent attendance for LDCT. Participantsā€™ views on the acceptability of the film are presented in table 1.

      Table 1: Feedback and acceptability of information filmscreen shot 2018-05-03 at 13.27.18.png

      8eea62084ca7e541d918e823422bd82e Conclusion

      The information-film was well-accepted and increased knowledge scores more than a written booklet alone, without raising decisional conflict or reducing attendance for LDCT.

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    P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)

    • 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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      P2.16-21 - Post-Treatment Survival Difference Between Lobectomy and Stereotactic Ablative Radiotherapy in Stage 1 Non-Small Cell Lung Cancer in England (ID 12349)

      16:45 - 18:00  |  Presenting Author(s): Neal Navani

      • Abstract
      • Slides

      Background

      Non-small cell lung cancer (NSCLC) accounts for almost 85% of all lung cancer cases diagnosed in England. Stage 1 lung cancer represents around 15-20% of all NSCLC cases, and while surgical resection (the current standard of care) offers the best chance to improve survival and is the standard of care in early lung cancer, not all patients undergo surgical treatment due to their advanced age and/or multiple comorbidities, while others may refuse surgery. Stereotactic ablative radiotherapy (SABR), a non-invasive external beam radiotherapy, has become an established treatment option for such patients. The aim was to compare survival at 90 days, 6 months, one year and overall for patients who received either lobectomy or SABR for NSCLC stage IA and IB.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We used data from the 2015 National Lung Cancer Audit (NLCA) database that were collected by Public Health England (PHE) and linked with Hospital Episode Statistics (HES) and the Radiotherapy Dataset (RTDS) to identify patients with NSCLC stage IA-IB and performance status 0-2 who underwent surgery or SABR treatment. We looked at survival risk difference at 90 days, 6 months, 1 year and 1 year between the two patient groups using propensity score derived using a logistic regression model with covariates that were predictive of treatment including age, sex, performance status and stage.

      4c3880bb027f159e801041b1021e88e8 Result

      We identified 2373 patients in our cohort, 476 of whom had SABR. The median difference between date of diagnosis and date of treatment for surgery patients was 17 days while for SABR patients it was 73 days. Increasing age and worsening performance status were associated with having SABR rather than surgery. Patients who had SABR had 1.4% better survival at 90-days; however, this survival benefit dropped at 6 months after treatment started and patients who had surgery had 14% better overall survival.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our analysis suggests that, while patients who underwent SABR have better short-term survival, patients who have surgery have better overall survival. However, the time to the start of treatment with SABR was 8 weeks longer than for surgery. Thus early survival may be underestimated for SABR although other (conflicting) factors may be at play including stage-shift (more in SABR group) and length time (potentially more indolent tumours in the SABR group).

      6f8b794f3246b0c1e1780bb4d4d5dc53

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