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Richard J Gralla



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    MS21 - Giants in Thoracic Oncology (ID 869)

    • Event: WCLC 2018
    • Type: Mini Symposium
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 15:15 - 17:00, Room 105
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      MS21.05 - Quality of Life - Are we Paying Enough Attention? (ID 13378)

      15:55 - 16:05  |  Presenting Author(s): Richard J Gralla

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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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
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.01-39 - Can Benefit or Futility in Treating Advanced Nsclc Be Determined Early Using the LCSS 3-Item Global Index (3-IGI) PRO? (ID 12299)

      16:45 - 18:00  |  Presenting Author(s): Richard J Gralla

      • Abstract
      • Slides

      Background

      Background: Early assessment of the effect of treatment for advanced NSCLC can prevent unnecessary exposure to toxic and costly therapy while aiding in decision making to continue or change treatment. In a prior analysis in patients with mesothelioma (Symanowski JCO 2014), a 20% decline from baseline after 2 cycles of chemotherapy in the 3-Item Global Index of the LCSS identified patients unlikely to benefit. The 3-IGI (which evaluates: 1) global distress, 2) patient rated activities, and 3) quality of life, all in single VAS scales) takes less than 2 minutes to assess.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Methods: 164 patients with NSCLC receiving chemotherapy or checkpoint inhibitors were prospectively evaluated with the LCSS at baseline and every 3 weeks using electronic media. Patients were also randomized 1:1 so that their physicians knew the results of the LCSS immediately in half of the patients.

      4c3880bb027f159e801041b1021e88e8 Result

      Results: Patients: Stage IV 92%; first line 73%; female 43%; median PS 1; mean age 63. The LCSS was completed after 2 cycles of treatment and prior to planning for the next cycle (generally 6 weeks after baseline; representing 91% of the 148 patients living). Patients with a 20% decline in the 3-IGI compared with baseline had a median survival of 7.6 months, contrasted to 15.8 months for those without this degree of 3-IGI decline (p = 0.01); 1 year survivals = 26% versus 62%. Even with the marked PRO decline after 2 treatment cycles, patients in the 20% decline group received a median of 2.3 more cycles of the same chemotherapy (median cost = $10,712 per patient). In the 50% of patients for which their physicians knew the ongoing LCSS results, fewer chemotherapy and imaging studies were performed, but the differences were not significant (p = 0.8).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Conclusions: Assessing change from baseline with the 3-IGI of the LCSS identifies after only 2 cycles of treatment those patients who have poor response and survival outcomes if continued on the same therapy. This PRO assessment is rapid, easy, and inexpensive. Physicians need to consider the impact of decline on decision options given that even when physicians were aware of the worsening PRO they often did not act on the findings. Patient responses to this validated PRO questionnaire provide valuable information that is not otherwise attainable. Responding to 3-IGI changes can result in better decisions concerning continuing or changing treatment, lessening toxicity, and savings in cost of unhelpful treatment.

      Supported by: NIH/NCI R01 CA157409

      6f8b794f3246b0c1e1780bb4d4d5dc53

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