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Bonnie Leung



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    MA14 - Survivorship, Socioeconomic and End-of-Life Considerations (ID 915)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/25/2018, 10:30 - 12:00, Room 205 BD
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      MA14.05 - Social Isolation Increases Psychological Distress in Patients With NSCLC (ID 11959)

      11:00 - 11:05  |  Author(s): Bonnie Leung

      • Abstract
      • Presentation
      • Slides

      Background

      The Psychosocial Screen for Cancer (PSSCAN-R) questionnaire is a validated screening tool used to identify the psychosocial needs of patients with cancer. The questionnaire assesses patients’ perceived social supports and identifies patients at risk for developing psychological distress. The study goal was to examine patients with NSCLC who reported risk factors for social isolation and their risk for developing psychological distress.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      All patients with NSCLC referred to BC Cancer from 2011-2015 who completed a prospective PSSCAN-R questionnaire at the time of first visit were included in the study. Perceived social support questions include: if patients live alone, lost a life partner recently, have no help with IADLs, have no regular contact with friends and family or have no emotional support from others. Demographics were collected retrospectively. Chi-squared test and logistical regression were used to compare patient groups based on age, gender and perceived social support factors.

      4c3880bb027f159e801041b1021e88e8 Result

      The study cohort was comprised of 4428 patients who completed the PSSCAN-R questionnaire. Female 50%, patients ≥65 years 69%, live alone 29%, lost life partner 13%, no help with IADLs 9%, no regular contact 3% and no emotional support 5%.table1.png

      8eea62084ca7e541d918e823422bd82e Conclusion

      Female patients and patients younger than 65 are more at risk for developing moderate to severe anxiety and depression. Lack of perceived social support also contributes to the risk of developing psychological distress. In addition to developing gender and age-based resources for patients addressing their psychosocial needs, greater efforts in assessing patients’ perceived social supports and allocating community and institutional resources to isolated patients should also become an important part of the patients’ comprehensive and holistic care.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      MA14.07 - The Impact of Socioeconomic Status and Geographic Location on Palliative Chemotherapy Uptake in Patients with Metastatic NSCLC  (ID 13098)

      11:10 - 11:15  |  Author(s): Bonnie Leung

      • Abstract
      • Presentation
      • Slides

      Background

      Socioeconomic status (SES) and geographic factors may impact patient treatment choices. Canada has a publically funded health care system and in BC, there are 35 community oncology network sites that delivery treatment in patients’ local communities. We studied the impact between SES and geographic location upon delivery of chemotherapy/survival in metastatic NSCLC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      All patients with metastatic NSCLC referred to BC Cancer centres from 2011-2015, who completed a prospective Canadian Problem Checklist questionnaire at the time of their first visit and for which chemotherapy data was available were included in the study. The CPC assesses patient distress in 6 domains including practical aspects of cancer care. The Postal Code Conversion File Plus uses data from Statistics Canada 2011 census to determine population size and income quintiles. Baseline characteristics and chemotherapy treatments were collected retrospectively. Univariate analysis using the Chi-squared test and Fisher’s exact test were used for analysis.

      4c3880bb027f159e801041b1021e88e8 Result

      1113 patients were included with median age of 69 years, 54% female and 77% were former/current smoker and 47% received palliative chemotherapy. Uptake of chemotherapy did not differ between lowest + mid-lowest 44%, middle 51% /mid-highest + highest 49% income quintiles (p=0.18). Chemotherapy use was also similar between patients reporting financial concerns 50% versus none 47% (p=0.51). Uptake of chemotherapy was lower in patients who lived in rural communities population<10 37% (P 0.00), 10K-1.5M 41%, >1.5 million 53% (p<0.001). Chemotherapy use was lower for patients with concerns about getting to appointments (39% vs 49%, p=0.008) or accommodations (33% vs 48%, p=0.012).

      8eea62084ca7e541d918e823422bd82e Conclusion

      This dataset provide evidence that patients from rural communities were less likely to receive palliative chemotherapy treatment for metastatic NSCLC in BC despite the availability of multiple local community oncology services. SES did not appear to impact the proportion of patients treated, congruent with a government funded health care system. An in depth assessment of distances to local cancer services and treatment delivery is warranted to investigate these differences and their effect on mortality.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)

    • 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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      P2.17-23 - Optimal Therapy of Stage III NSCLC: The Role of Surgery in the Era of Immunotherapy (ID 12537)

      16:45 - 18:00  |  Author(s): Bonnie Leung

      • Abstract
      • Slides

      Background

      Curative intent treatment of stage III NSCLC may include surgery, radiotherapy, chemotherapy, or combination therapy. Management is influenced by both patient and disease characteristics. N2 disease is optimally treated with concurrent chemoradiotherapy (CRT) and the role of surgery after CRT remains a subject of debate. The recent PACIFIC study of adjuvant durvalumab after CRT in stage III showed unprecedented improvements in relapse free survival, which further calls into question the role of surgery. We sought to perform a real-world analysis of curative therapies in stage III NSCLC, and explore the impact of known prognostic factors on outcome.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A retrospective review was completed of all patients referred to BC Cancer from 2005-2012 with stage III NSCLC treated with curative intent including surgery, radiotherapy, chemoradiotherapy, and combined surgery and radiation +/- chemotherapy (S+RT+/-C). Information was collected on known prognostic factors. The primary outcome measure was overall survival.

      4c3880bb027f159e801041b1021e88e8 Result

      688 patients were included in the study. Baseline characteristics: female 47%, median age 65, ECOG 0-1 65%, weight loss <5% 74%, stage IIIA/IIIB 73%/27%. Treatment: 82 (12%) surgery, 127 (18%) radiotherapy, 423 (62%) chemoradiotherapy, and 56 (8%) combined S+RT+/-C. Median overall survival: surgery 28.6m, chemoradiotherapy 27.6m, radiotherapy alone 18.0m, and S+RT+/-C 55.9m. In a multivariate model incorporating age, sex, weight loss, ECOG, and stage, the survival difference disappeared between the surgery, chemoradiotherapy, and radiotherapy cohorts and persisted in the S+RT+/-C cohort.

      Table 1: Univariate and multivariate analysis of the impact of prognostic factors and treatment cohort on survival
      Variable UVA MVA
      HR p-value HR 95% CI p-value
      Treatment

      Surgery

      Radiotherapy

      Chemoradiotherapy

      S+RT+/-C

      Ref

      1.669

      0.993

      0.475

      0.001

      0.625

      0.001

      Ref

      1.241

      0.912

      0.523

      0.873-1.764

      0.675-1.234

      0.330-0.830

      0.229

      0.552

      0.006

      Age 1.018 <0.001 1.009 0.999-1.020 0.076
      Sex

      Female

      Male

      Ref

      1.211

      0.028

      Ref

      1.111

      0.923-1.338

      0.264

      Stage

      IIIA

      IIIB

      Ref

      1.239

      0.025

      Ref

      1.121

      0.910-1.381

      0.283

      ECOG

      0-1

      >=2

      Ref

      2.128

      <0.001

      Ref

      1.844

      1.468-2.265

      <0.001

      Weight loss

      <5%

      5-10%

      >10%

      Ref

      1.382

      1.557

      0.010

      0.001

      Ref

      1.232

      1.268

      0.959-1.582

      0.958-1.678

      0.102

      0.097

      8eea62084ca7e541d918e823422bd82e Conclusion

      In stage III NSCLC, the performance of surgery, chemoradiotherapy and radiotherapy alone are comparable after controlling for known prognostic factors. Combined S+RT+/-C appears to provide a significant benefit above other modalities in highly selected patients. The role of surgery post-CRT remains controversial, as immunotherapy demonstrates greater promise for improving outcomes for the diverse group of stage III NSCLC.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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