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Bian Liu



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    MA01 - Early Stage Lung Cancer: Questions and Controversies (ID 894)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 10:30 - 12:00, Room 202 BD
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      MA01.05 - Opioids and Sleep Medication Use After Surgery for Early Stage Lung Cancer: A SEER-Medicare Analysis (ID 12961)

      11:00 - 11:05  |  Author(s): Bian Liu

      • Abstract
      • Presentation
      • Slides

      Background

      More than 50% of patients undergoing surgery for early stage lung cancer experience persistent post-operative pain, which can prevent their returning to normal daily activities and cause disruptions in sleep. Whether Video-Assisted Thoracoscopic Surgery (VATS), a minimally invasive surgical technique, reduces long-term opioid and sleep medication use compared to traditional open surgery has not yet been established.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The Surveillance, Epidemiology and End Results data linked to Medicare data (SEER-Medicare) database was queried to identify patients with stage I primary non-small cell lung cancer (NSCLC) who had VATS or open resection between 2007 to 2013, and had no record of opioid medication in the 30 days before surgery. Long-term opioid and sleep medication use were defined as having fulfilled one or more prescriptions in the first 90 days after surgery as well another prescription in the 90-180 days post-surgery. Logistic regression was used to investigate the associations between surgical type and long-term opioid and sleep medication use. Models were adjusted for relevant clinical and socioeconomic covariates.

      4c3880bb027f159e801041b1021e88e8 Result

      There were 3,900 NSCLC patients included in this analysis; 1,987 (51.0%) VATS and 1,913 (49.0%) open surgery patients; 15.5% of patients had a record of opioid use and 9.7% of sleep medication use long-term postoperatively.

      In the adjusted model, patients were less likely to use opioids long-term if they had VATS (ORadj 0.69, 95% CI: 0.57-0.84), were older (ORadj 0.96, 95% CI: 0.94-0.98), diagnosed in a later year (ORadj 0.86, 95% CI: 0.82-0.90), and had higher income (ORadj 0.77, 95% CI: 0.60-0.99). Long-term opioid use was more likely in those with a higher comorbidity score (ORadj 1.10 , 95% CI: 1.05-1.16), large cell histology (ORadj 1.88, 95% CI: 1.17-3.00), using sleep medication before surgery (ORadj 1.72, 95% CI: 1.28-2.32) and with a previous psychiatric condition (ORadj 1.64, 95% CI: 1.28-2.09).

      After adjustment, only those with a previous psychiatric condition (ORadj 1.95, 95% CI: 1.40-2.71) and previous sleep medication use (ORadj 37.36, 95% CI: 27.92-50.00) were more likely to use sleep medications long-term; no significant difference were observed with type of surgery (ORadj 1.01, 95% CI: 0.76-1.33).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Patients who were not previous opioid users became long-term opioid users after surgery. VATS might offer NSCLC patients a better quality of life than open surgery, and therefore minimize the risk of longer-term opioid use.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.06 - Mesothelioma (Not CME Accredited Session) (ID 955)

    • 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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      P2.06-35 - Pleurectomy Decortication Versus Extrapleural Pneumonectomy in Malignant Pleural Mesothelioma: SPARCS Data (ID 13265)

      16:45 - 18:00  |  Author(s): Bian Liu

      • Abstract
      • Slides

      Background

      Malignant pleural mesothelioma (MPM) is a rare but grave cancer with poor survival. To date, the debate on the surgery of choice in patients with operable MPM is still ongoing. We evaluated surgery-related mortality and post-operative complications among patients treated with Extrapleural Pneumonectomy (EPP) vs Pleurectomy Decortication (P/D) in the New York Statewide Planning and Research Cooperative System (SPARCS) database.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      SPARCS is an all payer claim database for the State of New York. Data of inpatient stays (1995-2012) were used to extract 3826 unique patients with a diagnosis of MPM (ICD-9-CM: 163 identifying 233 patients treated with EPP (ICD-9-CM codes: 325, 3259) and 267 patients treated with P/D (ICD-9-CM codes: 345, 3451). We used propensity score methods using a logistic regression model matching patients on the following variables: age, race, the presence or absence of comorbidities, type of insurance and type of admission (using 1:1 matching with absolute difference in scores of 0.08).

      4c3880bb027f159e801041b1021e88e8 Result

      There was no difference in the proportion of males between EPP (76.2%) and P/D (80.9%). EPP patients were younger (mean age 60.8 vs 68.6 years), significantly more likely to be white (94.0% vs 85.2%), privately insured (56.6% vs 29.9%) and admitted for an elective procedure (97.9% vs 66.8%) than P/D patients. There were significantly more comorbidities in the EPP group (95.3% vs 85.9%). The in-hospital mortality in the matched patients groups comparing EPP and P/D was higher but not significant [ORadj: 2.82 (95% CI: 0.70-11.38)]. The odds of having postoperative complications was 1.22 (95% CI: 0.68-2.20) when comparing EPP and P/D. Supraventricular arrhythmia as postoperative complication was significantly more frequent after EPP compared to P/D (ORadj: 2.73; 95% CI: 1.14-6.50).

      8eea62084ca7e541d918e823422bd82e Conclusion

      The analysis showed a tendency towards higher odds of in-hospital mortality for EPP versus P/D however not statistically significant. While the odds of postoperative complications were not significantly different between EPP and P/D patients, the odds of supraventricular arrhythmia as postoperative complication were 2.7 times higher after EPP versus P/D. P/D, a less invasive surgical approach, may provide a better option when technically feasible for MPM patients.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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